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Biomedical subjects

A I Hartstein

Publications and source records attributed to A I Hartstein.

15 recordsLinked to original sources
PubMed1992

Recurrent Staphylococcus aureus bacteremia.

Sequential blood isolates from eight patients with 10 episodes of recurrent Staphylococcus aureus bacteremia were typed by restriction endonuclease analysis of plasmid DNA (REAP DNA fingerprinting) and immunoblotting. There were six early recurrences (within 2 months of stopping antimicrobial therapy) and four late recurrences. All early recurrences isolates were identical to initial isolates. These recurrences were defined as possible relapses. Three of four late recurrence isolates were different from the preceding isolates recovered from four patients. This was considered indicative of new infections. There was complete concordance between REAP DNA fingerprinting and immunoblot typing results. However, four isolates lacked plasmid DNA and could be typed only by immunoblotting. All initial isolates from different patients were different types by immunoblotting and by REAP DNA fingerprinting (except for those lacking plasmid DNA). The bacterial traits detected by these methods appear to be stable in vivo for up to 3 months. Relapsing infections were associated with the presence of intravascular foreign bodies and vancomycin therapy of the preceding episodes.

Bacteremia↗
PubMed1990

Plasmid DNA fingerprinting of Acinetobacter calcoaceticus subspecies anitratus from intubated and mechanically ventilated patients.

Forty-three intubated and mechanically ventilated patients in five intensive care units (ICUs) of one hospital developed respiratory colonization or infection with Acinetobacter calcoaceticus subspecies anitratus over a 16-month interval. Neither the frequency nor rate of A anitratus isolation exceeded the hospital endemic norms. Single isolates from 34 of the patients were subtyped by plasmid DNA analysis, two biotyping systems and antimicrobial susceptibility to 24 drugs. Plasmid DNA fingerprints were distinct in 18 isolates (they differed from each other and all others), similar in two and identical or similar in ten. The latter group of isolates were recovered from patients in four ICUs. Reproducibility of biotyping was poor. Neither biotyping nor antimicrobial susceptibility were successful in identifying sameness among the group isolates nor differences among other isolates. We conclude that plasmid DNA fingerprinting should be used to assess the possibility of multiple patient transmissions of the same A anitratus strain in the absence of an obvious outbreak.

Acinetobacter↗
PubMed1989

Restriction enzyme analysis of plasmid DNA and bacteriophage typing of paired Staphylococcus aureus blood culture isolates.

We compared restriction enzyme analysis of plasmid (REAP) DNA profiling with bacteriophage typing for determination of similarities and differences among 50 pairs of Staphylococcus aureus blood isolates from patients with multiple positive blood cultures. Isolates from 17 pairs did not have detectable plasmids. Isolates from 33 pairs had plasmids classified into 17 distinct REAP DNA profiles. Paired isolates from 31 of these episodes were identical to one another. By phage typing, 35 pairs had strong lytic reactions to a phage(s), 9 pairs lacked strong reactions, and 6 pairs consisted of a strongly reactive isolate and an isolate with no strong reaction to a phage. When consolidated into 11 general phage groups, pairs from 44 of the 50 episodes were in the same general group. REAP DNA profiles were highly reproducible (99%), whereas phage typing was not. REAP DNA profiling is superior to phage typing as a technique for determining similarities and differences among S. aureus blood isolates.

Bacteriophage Typing↗
PubMed1988

Multiple intensive care unit outbreak of Acinetobacter calcoaceticus subspecies anitratus respiratory infection and colonization associated with contaminated, reusable ventilator circuits and resuscitation bags.

PURPOSE: Acinetobacter calcoaceticus subspecies anitratus (A. anitratus) can cause nosocomially and community acquired pneumonia. Source identification of the organism is often difficult. An outbreak of respiratory infection and colonization with A. anitratus affecting 93 ventilated patients in all six of a hospital's intensive care units (ICUs) over 10 months is described. PATIENTS AND METHODS: In April 1984, the infection control staff started to review positive culture results from all patients in all ICUs. At this point, information on significant isolates was recorded by patient, site, date, genus and species, and antimicrobial susceptibility. During the month of August 1984, an increased number of A. anitratus isolates from sputum began to be detected. Information was expanded to include the date of hospital admission, ICU admission, intubation, and extubation; the dates and types of all surgical procedures; the results and dates of all prior sputum cultures; and the use of nebulized bronchodilator medications. Monthly numbers of cases were compared for four months prior to the outbreak, during the outbreak, and for seven months after the outbreak. Plasmid DNA from isolates was prepared, electrophoresed, and visualized. Isolates were designated according to the molecular weights of visualized plasmids. RESULTS: Barrier precautions and improved staff handwashing did not diminish the frequency of new cases. When pasteurized, reusable ventilator circuits and resuscitation bags were cultured for the possibility of low-level contamination, 18 percent were positive for A. anitratus. Terminal ethylene oxide sterilization of these devices was associated with prompt control of the outbreak. Plasmid DNA analysis of isolates from patients involved in the outbreak, contaminated devices, and the hands of personnel responsible for device disinfection revealed two predominant plasmid profiles. After outbreak control, isolates with these profiles were found much less frequently in patient specimens. CONCLUSION: Contaminated, reusable ventilator support equipment may be a leading cause for the extent of A. anitratus in the sputum of intubated patients. This problem is potentially correctable by the use of terminal etyhlene oxide sterilization of reusable ventilator circuits and resuscitation bags.

Acinetobacter↗
PubMed1988

Plasmid DNA analysis of Staphylococcus epidermidis isolated from blood and colonization cultures in very low birth weight neonates.

We prospectively studied the course of colonization and sepsis with Staphylococcus epidermidis among 29 very low birth weight neonates undergoing prolonged umbilical catheterization. S. epidermidis bacteremia occurred in 7 patients. In 6 bacteremia was preceded by positive colonization cultures. Isolates obtained from nares, base of umbilicus, umbilical catheter entry sites, catheter tips and blood were examined for plasmid DNA profiles. In 4 patients the plasmid profiles of the catheter entry site isolates were identical with those of the blood isolates. In the other 3 bacteremic patients plasmid profiles of the catheter entry site and blood isolates were different. No correlation was observed in the plasmid DNA patterns of isolates obtained from catheter tip cultures as compared to the corresponding blood cultures. The blood isolates from bacteremic patients had different plasmid profiles.

Catheterization↗
PubMed1988

Pharmacokinetics of fluconazole in cerebrospinal fluid and serum in human coccidioidal meningitis.

The pharmacokinetics of fluconazole, a new oral azole, were evaluated in cerebrospinal fluid and sera of eight patients with coccidioidal meningitis. At a dose of 50 mg/day, peak concentrations of 2.5 to 3.5 and 2.0 to 2.3 micrograms/ml occurred at 2 to 6 and 4 to 8 h in serum and cerebrospinal fluid, respectively. At 100 mg/day, peak concentrations of 4.5 to 8.0 and 3.4 to 6.2 micrograms/ml occurred at 2 to 4 and 4 to 12 h, respectively. The mean ratios of the concentration in cerebrospinal fluid to that in serum were 73.8% at 50 mg/day and 88.7% at 100 mg/day. Results suggested that there was a prolonged half-life in both cerebrospinal fluid and serum and that it was slightly longer in the former. Minimal toxicity was noted in 34 patient months of therapy (12 months on 50 mg daily; 22 months on 100 mg daily). After a mean of 4.5 months of therapy, five patients responded to therapy and three were unevaluable. The penetration of fluconazole into cerebrospinal fluid was substantial, toxicity was minimal, and early clinical experience was encouraging. Fluconazole holds promise as the sole or adjunctive therapy for fungal meningitis.

Adult↗
PubMed1987

Effects of antacids and dialysate dwell times on multiple-dose pharmacokinetics of oral ciprofloxacin in patients on continuous ambulatory peritoneal dialysis.

Six stable patients on continuous ambulatory peritoneal dialysis were evaluated for the appearance of ciprofloxacin in their peritoneal dialysate following oral ingestion of 750 mg of the drug every 12 h for four doses. Three subjects participated in this study twice, once while taking and once while abstaining from phosphate-binding aluminum antacids. Subjects tolerated the medication without evidence of toxicity. Food may have delayed or decreased the absorption of ciprofloxacin, whereas antacids definitely decreased the absorption of the drug. Peak concentrations in serum noted in the absence of antacids ranged from 2.9 to 6.4 micrograms/ml, and peak concentrations in dialysate in the absence of antacids ranged from 1.8 to 4.5 micrograms/ml. Peak ciprofloxacin concentrations in serum achieved in subjects taking antacids were 14 to 50% of those achieved in subjects without antacids. The peak concentrations in dialysate achieved in subjects on antacids were 8 to 33% of those observed in subjects off antacids. The clearance of ciprofloxacin by continuous ambulatory peritoneal dialysis represented 2% of the total body (systemic) clearance. Simultaneous ratios of concentration in dialysate to concentration in serum (D/S) were determined at various durations of dialysate dwelling within the peritoneum. A progressive rise of the D/S ratio was noted as dwell time increased. At 4 h D/S was 0.57 +/- 0.07 (mean +/- standard error of the mean; n = 9), and at 8 h it was 0.75 +/- 0.04 (n = 26). Long-dwell exchanges may be necessary to achieve reasonable concentrations of orally ingested ciprofloxacin in dialysate.

Administration, Oral↗
PubMed1987

Antimicrobic susceptibility and plasmid profile analysis as identity tests for multiple blood isolates of coagulase-negative staphylococci.

We compared a disk diffusion antimicrobic susceptibility panel with plasmid DNA profiles as tests for identity of 106 isolates of coagulase-negative staphylococci cultured from the blood of 45 patients on multiple occasions. The antimicrobic panel included penicillin, oxacillin, clindamycin, trimethoprim-sulfamethoxazole, chloramphenicol, tetracycline, tobramycin, kanamycin, and gentamicin. Nineteen patterns of antimicrobic susceptibility were found. The most common pattern was present in 25% of the isolates, and at least one isolate from 31% of the patients had this pattern. Forty-seven distinct plasmid DNA profiles were found. The most common plasmid profile was present in 8.5% of the isolates, and at least one isolate from 15% of the patients had this profile. Twenty-eight patients had multiple isolates that were identical by plasmid profile analysis. Twenty-seven (96%) of these patients had isolates that were also identical by antimicrobic susceptibility. Nineteen patients had multiple isolates that were different by plasmid profile analysis. In 18 (95%) of these patients, the isolates were also different by antimicrobic susceptibility. Although plasmid DNA profile analysis is a more discriminating tool, these data confirm that a selected disk diffusion antimicrobic susceptibility panel may be used to screen multiple blood isolates of coagulase-negative staphylococci for identity or differences.

Anti-Bacterial Agents↗
PubMed1987

Oral ciprofloxacin in refractory gram-negative bacillary infections.

The 13 patients included in this series: had chronic Gram-negative bacillary infections that were refractory to prior antibiotic therapy; were unable or unwilling to receive intravenous antibiotics; and had altered host defenses or environmental factors that contributed to persistent infection. Five patients had chronic polymicrobic Gram-negative osteomyelitis, three had urinary tract infections caused by Pseudomonas aeruginosa, two had Pseudomonas skin infections and three had respiratory tract infections with Gram-negative bacilli. The overall bacteriological cure rate for Gram-negative bacilli was four of five osteomyelitis, all three urinary tract infections, both skin infections and one out of three respiratory infections. Secondary infections occurred in two patients with bone infections, one with prostatitis and one with deep seated cellulitis and myonecrosis. Two patients with end-stage lung disease had emergence of resistant strains during therapy. Ciprofloxacin was well tolerated and effective in most of the ambulatory patients with refractory Gram-negative bacillary infection. It appears to be especially promising for Pseudomonas infections of the bone, urinary tract and soft tissue.

Adult↗
PubMed1986

Analysis of the causative pathogens in uncomplicated CAPD-associated peritonitis: duration of therapy, relapses, and prognosis.

We analyzed the frequency with which certain bacteria caused uncomplicated peritonitis in an adult continuous ambulatory peritoneal dialysis (CAPD) program that continued patients on this modality of therapy despite frequent infections. All infections were treated with a commonly employed 10- to 14-day course of narrow spectrum intraperitoneal antibiotics. Although the distribution of bacterial pathogens was similar to previous reports (coagulase-negative staphylococci, 43%; Staphylococcus aureus, 13%), we observed no episodes of fungal peritonitis. Twenty percent of our infections were associated with either "no specimens obtained" or "no growth," a finding similar to the CAPD registry. When the data were available, two thirds of all infections were caused by the same pathogen (genus and species) as in the most immediately preceding infection. Twenty-two of 96 episodes of uncomplicated peritonitis occurred within three weeks of a preceding infection. In all 11 cases where organisms were isolated from both paired episodes, the infecting agent was the same as in the preceding infection and was a staphylococcus. This high rate of apparent relapse and the absence of fungal infections may relate to our treatment protocol and possible explanations are discussed. Lastly, the occurrence of coagulase-negative staphylococcal peritonitis is a harbinger of future episodes of peritonitis caused by a variety of organisms.

Adult↗
PubMed1978

Prophylactic antibiotics and the insertion of permanent transvenous cardiac pacemakers.

Prophylactic antibiotics are prescribed frequently for patients requiring permanent transvenous cardiac pacemakers, despite a paucity of data indicating effectiveness. A 10 year retrospective analysis was performed of 298 pacemaker insertion procedures involving 204 patients. On the basis of prestudy criteria relating to timing and dosage of antibiotics, the use of prophylactic antibiotics was judged as adequate or inadequate. There were no postoperative infections in the 108 battery pack replacement procedures despite no or inadequate use of antibiotics in 49 procedures. There were nine infections in the 190 battery pack plus pacing wire procedures for an infection rate of 5 percent. There was no significant difference in infection rate between the group given prophylactic antibiotics and the group given no or inadequate prophylactic antibiotics. Of the 190 battery pack plus pacing wire procedures, no infections occurred in the 50 procedures in which surgical drains were not used (p less than 0.003). In the 140 procedures in which drains were used, there was no correlation between wound infection and absent or inadequate coverage with prophylactic antibiotics. Two severe bacteremic Staphylococcus aureus infections occurred in two patients not given prophylactic antibiotics. The other seven infections were clinically indolent. These results suggest the following: (1) There is no need for prophylactic antibiotics in battery pack replacement procedures; (2) prophylactic antibiotics may decrease the severity of infection in battery pack plus pacing wire procedures; (3) surgical drains should be avoided in battery pack plus pacing wire procedures. A prospective controlled study is necessary to confirm these results.

Aged↗
PubMed1977

Comparison of pharmacological and antimicrobial properties of cefadroxil and cephalexin.

Pharmacological and antimicrobial properties of cefadroxil, a new cephalosporin antibiotic, were compared with cephalexin. Absorption and excretion were studied in 20 healthy men. Peak concentrations of the drugs in serum were similar after ingestion of single 500-mg tablets. The concentration of cefadroxil in serum was more sustained than that of cephalexin. Levels of cefadroxil in serum after a dose of 1,000 mg were approximately twice those after a 500-mg dose through 6 h. Each drug administered in a dose of 500 mg every 6 h for 24 h resulted in concentrations in serum that were similar to a single dose without accumulation. Ninety-three percent of the cefadroxil and 85% of the cephalexin were excreted in urine after ingestions of single 500-mg tablets. The urine concentration of cefadroxil was more sustained than cephalexin. Minimal inhibitory and minimal bactericidal concentrations for clinical isolates were comparable with each drug. Cefadroxil compares favorably with cephalexin in this study. Sustained levels of cefadroxil in serum and urine suggest that this drug may be given at less frequent intervals than cephalexin.

Adult↗
PubMedDate not supplied

Reproducibility of Staphylococcus epidermidis plasmid profiles.

The plasmid profiles of six isolates of Staphylococcus epidermidis were repetitively evaluated over an 8-month period. Each isolate was subcultured and stored at three different temperatures (-70 degrees C, -20 degrees C, and room temperature) and plasmid DNA was prepared from each subculture at 0, 1, 4, and 8 months by two different methods of plasmid extraction [using mixed alkyltrimethylammonium bromide (ATAB) or Brij 58 and deoxycholate (modified Parisi)]. Plasmid DNA bands were lost from two isolates when subcultures were kept at room temperature. This plasmid loss was confirmed by repetitive extractions and electrophoresis, as well as by restriction endonuclease analysis of the ATAB preparations. Profiles were otherwise highly related to one another, with occasional exceptions being extra or missing plasmid DNA bands of high molecular size. The latter findings were not reproducible. Plasmid DNA extracted by the modified Parisi method was not reliably digested with restriction endonuclease enzymes. We conclude that the plasmid profiles of Staphylococcus epidermidis isolates are highly reproducible as long as isolates are stored at less than or equal to -20 degrees C. Minor discrepancies in the number of plasmid DNA bands of large molecular size may occur. These are resolvable by repetitive testing or restriction endonuclease analysis of ATAB-extracted plasmid DNA preparations.

Cold Temperature↗