The emergence of multi-antibiotic-resistant strains of Salmonella typhi in northern Natal-KwaZulu.
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Drug Resistance, Microbial↗
Biomedical subjects
A Bhamjee
Publications and source records attributed to A Bhamjee.
An outbreak of multiresistant Salmonella typhi in South Africa.
Typhoid fever caused by Salmonella typhi remains endemic to many parts of South Africa, including Natal and KwaZulu, Northern Transvaal and the Transkei. Until recently, the majority of S. typhi isolates from South Africa have remained susceptible to ampicillin/amoxycillin and chloramphenicol, and only three cases of typhoid due to multi-antibiotic resistant strains of S. typhi have been documented. Ampicillin/amoxycillin and chloramphenicol are, therefore, still recommended as first line therapy for patients with typhoid fever in this country. We describe a cluster of six cases of typhoid caused by S. typhi that was resistant to ampicillin, chloramphenicol and trimethoprim-sulphamethoxazole. All these patients presented over a 3-month period; the patients were from three adjacent districts in the Northern Natal area of South Africa. The high rate of intestinal perforation (two of six) was a direct consequence of inappropriate antibiotic treatment. Failure of surgical intervention, renal impairment as well as delay in starting appropriate antibiotic treatment were factors contributing to the high mortality (three of six). The good clinical outcome in the remaining three patients probably resulted from treatment with appropriate antibiotics; however, mild disease in two of these patients may have been a contributing factor. All isolates showed high minimal inhibitory concentrations (MIC) of greater than or equal to 256 micrograms/ml to ampicillin, chloramphenicol and trimethoprim-sulphamethoxazole. The isolates were all highly sensitive to the third generation cephalosporins (MIC less than or equal to 0.06 micrograms/ml) and quinolones (MIC less than or equal to 0.03 micrograms/ml). Conjugation studies suggest a genetic transfer of resistance, probably plasmid mediated. The presence of beta-lactamase and chloramphenicol acetyl transferase enzymes in all six isolates tested would account for the resistance to ampicillin and chloramphenicol respectively. The transfer of such plasmids to erstwhile sensitive strains could conceivably occur in this typhoid-endemic area, where sanitary conditions are poor and living conditions crowded, thus further exacerbating the problem. It is recommended that in areas where such multiresistant strains are encountered, the third generation cephalosporins or quinolones be used as empiric therapy for typhoid fever.
Adult↗
Evaluation of a new hydrocolloid occlusive dressing for central catheters used in total parenteral nutrition.
Catheter-related sepsis still remains one of the most frequent and serious complication of total parenteral nutrition. Strategies for preventing contamination of central venous lines have focused on decreasing the number of micro-organisms around the exit site and inhibiting their entry into the catheter wound. This prospective study compares a new occlusive hydrocolloid dressing (Visiband; Convatec Squibb) with that of a polyurethane film dressing for nutritional catheters. Dressings were changed either on day 3 or day 5 after application. Swab smears of the catheter exit site at each dressing change were stained by Gram's method before inoculation onto a blood agar plate, a chocolate agar plate and a MacConkey agar plate. Significantly less colonisation occurred under the former dressing at day 3 and day 5 dressing changes. In addition, the polyurethane film dressing was associated with a significant increase in skin colonisation (P = 0.04) and the number of positive Gram-stain microbes if left unchanged for 5 days (P = 0.0018). Staphylococcus aureus catheter-related sepsis occurred in 1 patient on day 18 in the polyurethane film dressing group. In addition, Candida albicans colonisation was confined to patients with the polyurethane film dressing. While the type of dressing applied to the catheter exit site may influence the incidence of catheter colonisation and infection, it must be emphasised that strict adherence to aseptic technique during catheter insertion and manipulation of the dressing is vital in the prevention of catheter-related sepsis during total parenteral nutrition.
Adult↗
Fatal neonatal meningitis and ventriculitis caused by multiresistant Achromobacter xylosoxidans. A case report.
Meningitis and ventriculitis in a 6-day-old neonate caused by a Gram-negative glucose-non-fermenting organism, Achromobacter xylosoxidans, was resistant to most antibiotics except ceftazidime and imipenem. The organism became resistant after 28 days treatment with ceftazidime. When the infant was 7 weeks old, imipenem became available but, in spite of 3 days of intravenous treatment, the organism was still recovered from ventricular cerebrospinal fluid and the child died. This would appear to be only the second report of neonatal meningitis caused by this organism.
Alcaligenes↗
The value of adjuvant systemic antibiotic therapy in localised wound infections among hospital patients: a comparative study.
In a prospective randomised double-blind controlled trial that involved 73 patients with non-invasive wound infections receiving local wound treatment, the effect of adjuvant systemic antibiotic therapy was compared with that of a placebo. On inspection, more wounds were assessed as clinically clean after administration of an antibiotic than after the placebo was given although this difference was not statistically significant. Microbiological evaluation, however, showed a significantly higher cure of sepsis and elimination of individual organisms (P less than 0.05) after antibiotic therapy. Furthermore, eradication of antibiotic-susceptible organisms was significantly greater than that of resistant organisms (P less than 0.005), indicating adequate penetration of antibiotic into the septic wound exudate. The results suggest that appropriate adjuvant systemic antibiotic therapy in the management of infected wounds promotes bacterial clearance and this may enhance healing of wounds.
Adolescent↗
Wound infection after major lower-limb amputation--the role of antibiotic prophylaxis.
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Adult↗
The antibacterial action of honey. An in vitro study.
The reported antibacterial effect of pure honey was evaluated by an in vitro study testing the growth of various Gram-positive and Gram-negative bacteria in media containing varying concentrations of honey. It was found that most pathogenic bacteria failed to grow in honey at a concentration of 40% and above. The possible mechanisms of this effect are briefly outlined.
Bacteria↗
Concomitant and secondary bacterial infection of the pus in hepatic amoebiasis.
In a series of 48 consecutive patients with clinically diagnosed uncomplicated amoebic liver abscess (ALA), the pus obtained by closed drainage of the abscess was bacteriologically sterile. Secondary bacterial infection of the ALA as a direct result of the aspiration procedure occurred in only 1 patient, the causative organism being Escherichia coli. Entamoeba histolytica was identified in a total of 39 cases (81%) by means of direct microscopy of the pus as well as culture methods.
Amebiasis↗
The emergence of penicillinase-producing strains of Neisseria gonorrhoeae in Durban.
Gonorrhoea was diagnosed in 179 (87%) of 206 Black males who presented with urethritis at a sexually transmitted disease clinic at the King Edward VIII Hospital, Durban. Penicillinase-producing strains of Neisseria gonorrhoeae were detected in 7 (5%) of 140 gonococcal isolates, and a further 13 strains were relatively resistant to penicillin. Microscopic examination of Gram-stained smears provided a rapid presumptive diagnosis of gonorrhoea in 162 cases. The modified Thayer-Martin medium proved marginally superior to chocolate agar for the isolation of N. gonorrhoeae from urethral exudates. The causation and laboratory diagnosis of urethritis in males and the antibiotic susceptibility pattern of the gonococcal isolates are discussed.
Adult↗
Vibrio cholerae bacteraemia in a newborn infant. A case report.
A 6-day-old Black male infant presented with diarrhoea and biochemical evidence of severe electrolyte imbalance. Despite treatment with intravenous fluids and antibiotics, he died within 24 hours of admission. Enterotoxigenic Vibrio cholerae, biotype E1 Tor, serotype Inaba, was isolated from the blood. The significance of this finding is discussed.
Humans↗
Salmonella typhi meningitis. A case report.
A case of purulent Salmonella typhi meningitis in a 5-month-old child is discussed. The patient was treated successfully with amoxycillin, and there were no neurological sequelae. S. typhi should be included in the differential diagnosis of Gram-negative bacillary meningitis, especially in children from areas in which typhoid is endemic.
Amoxicillin↗
Acquisition of resistance by Salmonella typhi in vivo.
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Adolescent↗
Gentamicin extraction from an anuric patient by combined haemodialysis and charcoal haemoperfusion.
A 39-year-old woman who developed acute renal failure following intra-abdominal sepsis was treated with gentamicin. Her serum concentrations reached potentially toxic levels. Combined haemoperfusion and haemodialysis removed approximately 70% of the given drug and the patient made a complete recovery.
Adult↗
Secondary spread of H. influenzae.
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Adolescent↗
Pharmacokinetics of Bay k 4999, a new broad-spectrum penicillin.
The pharmacokinetics of the broad-spectrum penicillin Bay k 4999 were studied in six healthy male volunteers. A 2-g dose was given by the intravenous route. The tissue penetration of the antibiotic was studied by both dermabrasion and blister techniques. A total of 26.4% of the drug was recovered in the urine in 24 h, 79% of this being excreted in the first 2 h. The elimination half-life in serum was 1.3 h. The dermabrasion levels of Bay k 4999 were generally similar to those in serum, but after 1 h the blister fluid levels of antibiotic were greater than those in serum. Different drug levels obtained by blister and dermabrasion techniques may be due to the different composition of the two fluids.
Adult↗
Streptococcus pneumoniae resistant to penicillin and chloramphenicol.
Three cases of meningitis and two of septicaemia were caused by pneumococci resistant to the penicillins/cephalosporins and chloramphenicol. No beta-lactamase was demonstrated in any of the organisms. All three patients with meningitis died, but the patients with septicaemia recovered after being given appropriate antibiotic therapy.
Anti-Bacterial Agents↗
A comparative study of ovarian tumours in black and Indian patients.
An analysis of 426 primary ovarian tumours in Black and Indian patients in Natal shows a disparity in the incidence of cystomas and teratomas in the two groups. Cystomas comprise 29% of all ovarian tumours in Blacks compared with 67% in Indians. Germ cell tumours, however, predominate in Blacks, comprising 52%, as opposed to 19% in Indians. The Indian distribution is similar to that of American and European groups.
Adolescent↗