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Biomedical subjects

A L Baltch

Publications and source records attributed to A L Baltch.

At least 91 records · Page 5Linked to original sources
PubMed1981

Secondary syphilitic uveitis.

A patient with secondary syphilis had positive serum and cerebrospinal fluid findings. Fluorescent-antibody darkfield testing demonstrated spirochetes (Treponema pallidum) in the aqueous. There were clinical signs of secondary syphilis, including palmar skin lesions and frontal balding, and bilateral nasal altitudinal visual field loss. The discrete, waxy, yellow-white retinal lesions became increasingly pigmented and later migrated anteriorly into the vitreous chamber. The patient was treated with large amounts of penicillin (total dosage, 440 million units) and probenecid. Visual acuity improved to R.E. : 6/9 (20/30) and L.E.: 6/12 (20/40) and the inflammatory reaction disappeared. A second aqueous tap eight weeks after therapy ended showed no spirochetes by fluorescent-antibody testing.

Aqueous Humor↗
PubMed1981

The prevalence survey as an infection surveillance method in an acute and long-term care institution.

A point prevalence survey of infections was done in 22 patients areas at the Albany VA Medical Center between September 17 and 28, 1979. The study was designed by a consultant epidemiologist, two infectious disease physicians, a biostatistician, two infection control nurses, a microbiologist, and a clinical pharmacist. A 16-page worksheet was designed for rapid and complete data collection, with computer codes and programming cross references incorporated. A total of 572 patients were seen and evaluated for signs and symptoms of infection; cultures were taken if indicated, and charts were reviewed. Urine cultures were obtained in 95% of patients. Data available for analysis will allow for a description of the characteristics of the patient population, identification of the most prevalent sites of infection and causative organisms, an analysis of antimicrobial agent use, and a description of the risk factors and their interactions that may influence the acquisition of infection.

Cross Infection↗
PubMed1981

Antibody response to pneumococcal vaccine in patients with multiple myeloma.

Patients with multiple myeloma and Waldenström's macroglobulinemia respond poorly to antigenic stimuli and may not be protected by pneumococcal vaccine. Thirty-seven patients and 10 controls received 14-valent pneumococcal capsular polysaccharide vaccine. The patients had lower (P less than 0.01) titers of antibody to 11 of the 12 antigens assayed before vaccination and to 10 of 12 antigens (P less than 0.01) after vaccination than did controls, but the ratios of antibody titers before vaccination to those after vaccination were remarkably similar. A poorer antibody response was observed in patients receiving multiagent chemotherapy than in those receiving chemotherapy with alkylating agents (P less than 0.01 for six of the antigens). That these patients did respond to the vaccine (although titers of antibody after vaccination were significantly lower than those in controls) suggests that patients with multiple myeloma or macroglobulinemia may benefit from pneumococcal vaccine.

Aged↗
PubMed1981

Susceptibility of Pseudomonas aeruginosa to serum bactericidal activity. A comparison of three methods with clinical correlations.

Twenty-nine blood culture isolates of Pseudomonas aeruginosa were tested by three established methods to determine the effect of in vitro conditions on the survival of this organism in human serum. Clinical correlations were made to determine the relationship of serum resistance as defined by each method to clinical outcome. Major differences of bacterial survival in the presence of pooled normal human serum and in classification of isolates (sensitive, intermediate, resistant) were observed among the three methods. Isolates grown in broth for preparation of inocula demonstrated significantly greater sensitivity to serum bactericidal activity than those grown on agar. The use of organisms in early logarithmic growth phase or increased concentrations of serum augmented the serum sensitivity of these isolates. No correlation was observed between serum bactericidal activity and antibiotic susceptibility, pyocine type, patient mortality, or underlying disease. All strains of serotype 6 or 11 (immunotype 1 or 2) were serum-sensitive by one of the three methods. This study indicates that by testing isolates of P. aeruginosa under a variety of in vitro conditions, it is possible to identify a few isolates that are highly sensitive or resistant to serum under all conditions. The survival of the majority of strains of P. aeruginosa in human serum is highly dependent on in vitro conditions. Conclusions regarding the role of serum bactericidal activity in host defense must be drawn cautiously when based solely on in vitro tests.

Adolescent↗
PubMed1981

Pseudomonas aeruginosa: quantitation of maximum phagocytic and bactericidal capabilities of normal human granulocytes.

The maximum phagocytic and bactericidal capabilities of normal human PMNs against a seroresistant strain of Pseudomonas aeruginosa were evaluated by morphological observation, uptake of radiolabeled bacteria, and quantitative killing methods. The number of bacteria killed per PMN increased from 3 to 23 as the bacteria-to-PMN ratio was increased from 3:1 to 100:1. Conversely, the percent of bacteria killed decreased from 94% to 3%. In monolayers, an increase in the inoculum from 10(5) to 10(8) cfu/ml was associated with greater phagocytosis and a sixfold increase in PMNs containing greater than or equal to 5 bacteria/PMN. With the use of 75Se-labeled P. aeruginosa, optimal phagocytosis was observed with 10 to 20 bacteria/PMN in 20% NPS. Maximum uptake of 70% occurred in 40 min. No difference was observed in the uptakes of live or heat-killed bacteria. The maximum number of bacteria ingested per PMN was 32 +/- 5 at the highest ratio tested (100:1). The use of altered opsonic sources indicated the need for the classical complement pathway for optimal phagocytosis. Thus study describes the requirements and necessary standardization parameters that were found to be essential for a highly reproducible method for measuring phagocytosis and killing of P. aeruginosa by normal human PMNs. This method could be employed for clinical assessment of partial opsonic or PMN dysfunction in the study of the interaction of PMNs and P. aeruginosa.

Blood Physiological Phenomena↗
PubMed1979

Pseudomonas aeruginosa bacteremia: relationship of bacterial enzyme production and pyocine types with clinical prognosis in 100 patients.

Strains of Pseudomonas aeruginosa were studied from 100 patients with bacteremia. In vitro quantitation of extracellular enzymes (lecithinase, protease, and elastase) and pyocine typing of these isolates were performed. No significant difference was found in the quantity of the enzymes produced or in the pyocine types by isolates obtained from patients dying from bacteremia or surviving this serious infection. Quantitation of the extracellular enzymes and pyocine types of blood isolates were contrasted with similar data obtained from sputum, urine, and skin isolates. One third of all strains produced minimal or no extracellular enzymes regardless of their source. However, the highest enzyme-producing strains were observed in the blood isolates. Although a greater variability of pyocine types was found in blood culture isolates, there was no significant difference between the pyocine types found in blood, urine, sputum, or skin isolates. The lack of correlation between the in vitro quantity of lecithinase, protease, and elastase produced by P. aeruginosa strains isolated from bacteremic patients and the prognosis of these patients supports the possible local rather than systemic significance of these extracellular enzymes in the pathogenesis of P. aeruginosa bacteremia.

Extracellular Space↗
PubMed1979

Pseudomonas aeruginosa bacteremia: susceptibility of 100 blood culture isolates to seven antimicrobial agents and its clinical significance.

The susceptibility of 100 blood culture isolates of Pseudomonas aeruginosa observed during 4 1/2 years was tested for tobramycin, netilimicin, gentamicin, amikacin, pirbenicillin, ticarcillin and carbenicillin, singly and in combination. For aminoglycosides, the agar MICs were twofold to threefold greater than tube dilution MICs but for the penicillins they were similar. For aminoglycosides and ticarcillin, the MBCs were twofold greater than the tube dilution MICs. The MBCs were not achieved at concentrations as high as 512 micrograms/ml for 40% of the isolates for pirbenicillin and for 10% for carbenicillin. Tobramycin and pirbenicillin had the lowest MICs for the aminoglycosides and penicillins, respectively. Synergism was tested and observed between tobramycin + ticarcillin and amikacin + ticarcillin. No overall increase in resistance to gentamicin or carbenicillin was seen from 1974 to 1977. However, patients given repeated courses of gentamicin had more resistant strains. Following the administration of 1.5 mg/kg/dose of gentamicin, peak serum concentrations failed to achieve the MIC for the microorganism in 22% of the patients. The MIC was achieved in all patients receiving the same dose of tobramycin. The overall fatality rate was 67% with one third of the patients dying within 36 hr. There was no relationship of patient fatality rate and MIC for the microorganism. Although in the rapidly fatal group of all patients receiving inappropriate therapy died, the fatality rates of appropriately or inappropriately treated patients in the ultimately fatal and nonfatal groups were similar. Underlying host disease was the major determining factor in patient survival.

Anti-Bacterial Agents↗
PubMed1977

Bacteremia after upper gastrointestinal endoscopy.

During 24 months, 200 upper gastrointestinal endoscopies were performed on 193 patients. Blood cultures were obtained before and five and 30 minutes after the procedure using thiol (50 ml) and trypticase soy broth (100 ml) media. The mean endoscopic time was 34 minutes. Sixteen patients developed bacteremia (8%). Twelve groups of microorganisms were detected in positive blood cultures: Streptococcus (5 species), Lactobacillus sp, Veillonella alcalescens, Staphylococcus aureus, Staph epidermidis, Propioni-bacterium acnes, Corynebacterium acnes, and Bacillus subtilis. Seven patients had positive blood cultures at five and 30 minutes, eight at five minutes, and one at 30 minutes only. There was no clear correlation of bacteremia with the age or previous history of the patient, biopsy, active bleeding, endoscopic time, or findings. A follow-up study of all patients for six months to two years indicated no complications related to endoscopy and/or bacteremia.

Adult↗
PubMedDate not supplied

Concentration of cefaclor in human prostatic tissue.

Concentration of cefaclor, a new oral cephalosporin, was measured in prostatic tissue of ten patients undergoing suprapubic prostatectomy. The average prostatic tissue concentrations were 0.51 +/- 0.22 microgram and 0.74 +/- 0.67 microgram per gram of tissue following the oral administration of 250-milligram and 500-milligram doses, respectively. The prostate/plasma ratios of cefaclor were approximately 0.7 indicating no evidence of accumulation of the drug in prostatic tissue. Levels of cefaclor achieved in human prostatic disease are equal to or less than the minimum inhibitory concentration of strains of known facultative bacterial pathogens associated with prostatitis.

Aged↗
PubMedDate not supplied

Bacteremia following dental extractions in patients with and without penicillin prophylaxis.

This study describes the type, rate and magnitude of bacteremia in 128 patients undergoing dental extractions with and without penicillin prophylaxis. The most prolonged and highest rates of bacteremia occurred in patients undergoing extractions and alveoplasty while under general anesthesia following nasotracheal intubation. The most common aerobes in patients receiving no penicillin were streptococci. Bacteroides sp. were detected most often in patients receiving penicillin prophylaxis. The overall bacteremia, streptococcal and polymicrobial bacteremia rates were lowest for the patients receiving penicillin. Only two of 66 patients given penicillin prophylaxis had recoverable streptococci in blood cultures. Our study indicates that both intravenous and oral penicillin G prophylaxis for dental extractions decreased bacteremia rates significantly, including the recovery of streptococci.

Alveoloplasty↗
PubMedDate not supplied

Inhibitory and bactericidal effects of telithromycin (HMR 3647, RU 56647) and five comparative antibiotics, used singly and in combination, against vancomycin-resistant and vancomycin-susceptible enterococci.

The inhibitory and bactericidal effects of telithromycin (HMR 3647, RU 66647) were compared with those of gentamicin, ampicillin, erythromycin, azithromycin and vancomycin against 74 strains of enterococci (34 Enterococcus faecalis and 40 Enterococcus faecium) by agar dilution, broth dilution, time kill assays and postantibiotic effect (PAE). The telithromycin MIC(90) for vancomycin-sensitive (VSE) E. faecalis strains tested using the agar dilution method was 8 microg/ml. For a different group of VSE E. faecalis strains tested using the broth dilution method it was 0.06 microg/ml The telithromycin MIC(90)s for vancomycin-resistant (VRE) and VSE E. faecium strains, determined using the agar dilution method, were 4 and 8 microg/ml, respectively, while for a different set of VRE and VSE E. faecium strains tested using the broth macrodilution method, they were 32 and 16 microg/ml, respectively. Telithromycin MBC(90)s for E. faecalis were 4-6 tubes higher and for E. faecium 3-5 tubes higher, respectively, than the MIC(90)s. In time kill assays, telithromycin had bactericidal activity against only 1 of 7 E. faecium strains; for all other E. faecium and E. faecalis strains, only inhibitory activity was demonstrated. Neither synergy nor drug interference was observed when telithromycin was used in combination with ampicillin, vancomycin or gentamicin. At 10 times the MIC, the PAE of telithromycin against E. faecalis was 2.8 h, while for E. faecium it was 1.6 h. Telithromycin should be evaluated for therapy of enterococcal infections, including those caused by VRE organisms. However, because of the strain-to-strain variability in susceptibility to telithromycin, MIC determinations are important, especially for erythromycin-resistant strains.

Anti-Bacterial Agents↗
PubMedDate not supplied

Comparison of in vitro inhibitory and bactericidal activities of daptomycin (LY 146032) and four reference antibiotics, singly and in combination, against gentamicin-susceptible and high-level-gentamicin-resistant enterococci.

The in vitro inhibitory and bactericidal activities of daptomycin and reference antibiotics were determined by serial macrobroth dilution for 23 gentamicin-susceptible (MIC: < 2,000 mg/l) and 21 high-level-gentamicin-resistant (HLGR) Enterococcus faecalis, Enterococcus faecium, and Enterococcus avium isolates. The activities of daptomycin, vancomycin, and teicoplanin were independent of the gentamicin susceptibility profile and species tested. For all the isolates, the inhibitory activity of daptomycin (MIC90: 2 mg/l) was comparable to vancomycin (MIC90: 2 mg/l), but less than that of teicoplanin (MIC90: 0.5 mg/l). Daptomycin demonstrated excellent bactericidal activity against all enterococci tested (MBC90: 8 mg/l). In contrast, all microorganisms were tolerant to vancomycin and teicoplanin. Ampicillin and ciprofloxacin MICs and MBCs were dependent on enterococcal gentamicin resistance profile and species, with MICs and MBCs that ranged between 1 and > 64 mg/l. By time-kill curves, the combination of daptomycin plus ampicillin demonstrated synergistic bactericidal activity against gentamicin-susceptible and HLGR E. faecalis. Daptomycin, singly and in combination, may be useful in treating enterococcal infections, including those caused by HLGR microorganisms.

Ampicillin↗
PubMedDate not supplied

In vitro activity of cefdinir (FK482) and ten other antibiotics against gram-positive and gram-negative bacteria isolated from adult and pediatric patients.

The in vitro activity of cefdinir, an oral aminothiazolyl hydroxyimino cephalosporin was compared with that of cefixime, cefpodoxime, cefaclor, cephalexin, ciprofloxacin, ofloxacin, oxacillin, ampicillin, vancomycin and trimethoprim-sulfamethoxazole against 279 gram-positive and gram-negative recent clinical isolates from adult and pediatric patients. Cefdinir was the most active drug among the cephalosporins against oxacillin-sensitive Staphylococcus aureus and coagulase-negative staphylococci, Streptococcus pneumoniae, S. pyogenes, Escherichia coli and Moraxella catarrhalis (MIC90 0.015-2 mg/l). Cefixime was the most active agent against Hemophilus influenzae, Klebsiella pneumoniae, K. oxytoca, Proteus mirabilis and P. vulgaris (MIC90 < 0.015-0.125 mg/l). The activity of cefpodoxime was better than that of cefixime against S. pneumoniae and oxacillin-sensitive staphylococci (MIC90 0.25-8 vs. 0.5-32 mg/l), similar to cefixime against S. pyogenes (MIC90 0.06 mg/l) and not as good as cefixime against H. influenzae, M. catarrhalis, Klebsiella spp. and Proteus spp. (MIC90 < 0.015-0.25 vs. 0.125-0.5 mg/l). The activity of cefdinir was greater than that of the other cephalosporins against Enterococcus faecalis (MIC90 16-32 vs. > 64 mg/l). None of the cephalosporins were active against methicillin-resistant, coagulase-positive or -negative staphylococci or Pseudomonas aeruginosa (MIC90 > 64 mg/l). Overall, the susceptibilities of adult and pediatric isolates were similar. Kinetic kill curves demonstrated rapid and similar killing at 6 h by cefdinir, cefixime, cefpodoxime and ofloxacin. At 24 h at 1 x MIC, the least regrowth was observed with cefdinir and cefpodoxime; at 2 x MIC, suppression of growth was similar with all four drugs.

Adult↗