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Biomedical subjects

A M Stamm

Publications and source records attributed to A M Stamm.

At least 19 recordsLinked to original sources
PubMed1993

Higher overall nosocomial infection rate because of increased attack rate of methicillin-resistant Staphylococcus aureus.

BACKGROUND: Methicillin-resistant Staphylococcus aureus has become a frequent cause of hospital-acquired infectious disease. However, the impact of methicillin-resistant S. aureus on the overall nosocomial infection rate has not been clearly defined. METHODS: The University of Alabama at Birmingham Hospital is a tertiary care facility and participant in the National Nosocomial Infections Surveillance system. Prospective, hospital-wide surveillance for nosocomial infections was conducted for 8 months per year during 1986 through 1991. RESULTS: The total nosocomial infection rate increased from 4.5% in 1987 to 5.9% in 1990. This was temporally associated with a rise in the attack rate of methicillin-resistant S. aureus from 0% to 0.4%. The remainder of the increase was caused by other gram-positive microorganisms, including methicillin-sensitive S. aureus. We identified methicillin-resistant S. aureus most commonly in the surgical intensive care unit and as a cause of lower respiratory tract infections. In contrast, methicillin-sensitive S. aureus was most frequently found in the neurologic intensive care unit and as the etiologic agent of surgical wound infections. CONCLUSIONS: Methicillin-resistant S. aureus has become a common nosocomial pathogen. There has been no decrease in the attack rate of methicillin-sensitive S. aureus or other gram-positive cocci. The total nosocomial infection rate has increased as a result equally of the emergence of methicillin-resistant S. aureus and of the renewed activity of other gram-positive pathogens. Methicillin-resistant S. aureus has added to the overall burden of nosocomial infectious disease.

Alabama↗
PubMed1987

Treatment of cryptococcal meningitis with combination amphotericin B and flucytosine for four as compared with six weeks.

One hundred ninety-four patients with cryptococcal meningitis were enrolled in a multicenter, prospective, randomized clinical trial to compare the efficacy and toxicity of four as compared with six weeks of combination amphotericin B and flucytosine therapy. Among 91 patients who met preestablished criteria for randomization, cure or improvement was noted in 75 percent of those treated for four weeks and in 85 percent of those treated for six weeks. The estimated relapse rate for the four-week regimen was higher--27 as compared with 16 percent--whereas the incidence of toxic effects for the two regimens was similar--44 as compared with 43 percent. Among 23 transplant recipients, 4 of 5 treated for four weeks relapsed, leading to the decision to treat the rest of the group for six weeks. Only 3 of the 18 treated for six weeks relapsed. In a third group of 80 patients, the protocol was not followed during the initial four weeks, and these patients were not randomized. Thirty-eight died or relapsed. Multifactorial analysis of pretreatment factors for all 194 patients identified three significant predictors (P less than 0.05) of a favorable response: headache as a symptom, normal mental status, and a cerebrospinal fluid white-cell count above 20 per cubic millimeter. These and other findings in this study are consistent with the view that the four-week regimen should be reserved for patients who have meningitis without neurologic complications, underlying disease, or immunosuppressive therapy; a pretreatment cerebrospinal fluid white-cell count above 20 per cubic millimeter and a serum cryptococcal antigen titer below 1:32; and at four weeks of therapy, a negative cerebrospinal fluid India ink preparation and serum and cerebrospinal fluid cryptococcal-antigen titers below 1:8. Patients who do not meet these criteria should receive at least six weeks of therapy.

Adolescent↗
PubMed1987

Cryptococcosis associated with low-dose methotrexate for arthritis.

One patient with psoriatic arthritis and a second with rheumatoid arthritis were each treated with low-dose methotrexate (10 to 15 mg per week, orally) for more than a year before pulmonary cryptococcosis developed. These are the first case reports of opportunistic fungal disease during this treatment. Low-dose methotrexate may be more immunosuppressive than has been appreciated. Patients demonstrating pneumonitis while receiving this therapy should be carefully evaluated to rule out an infectious cause.

Arthritis↗
PubMed1987

Toxicity of amphotericin B plus flucytosine in 194 patients with cryptococcal meningitis.

A multicenter prospective randomized trial of four versus six weeks of amphotericin B, 0.3 mg/kg per day, plus flucytosine, 150 mg/kg per day, was performed with 194 patients with cryptococcal meningitis. One or more toxic drug reactions developed in 103 patients: azotemia (51), renal tubular acidosis (two), leukopenia (30), thrombocytopenia (22), diarrhea (26), nausea/vomiting (10), and hepatitis (13). The four- and six-week regimens were complicated by toxicity in 44 percent and 43 percent of cases, respectively. Toxicity appeared during the first two weeks of therapy in 56 percent and during the first four weeks in 87 percent. Azotemia did not occur more frequently in renal transplant recipients or diabetic patients. Cytopenias did not appear more often in patients with hematologic malignancies or those receiving immunosuppressive therapies. Toxic reactions that contributed to death developed in five patients (two with azotemia, one with pancytopenia, one with hepatitis, one with ileus). Amphotericin B-induced azotemia was not a significant risk factor for the subsequent development of bone marrow, gastrointestinal, or hepatic toxicity attributable to flucytosine. Flucytosine toxicity was associated with peak serum flucytosine levels of 100 micrograms/ml or more during two or more weeks of therapy (p = 0.005). Peak 5-fluorouracil levels were not predictive of toxicity. An initial dose of flucytosine is recommended based on the creatinine clearance: 150 mg/kg per day at a creatinine clearance above 50 ml/minute, 75 mg/kg per day at a creatinine clearance of 26 to 50 ml/minute, and 37 mg/kg per day at a creatinine clearance of 13 to 25 ml/minute. The serum creatinine level should be monitored twice weekly and the creatinine clearance weekly during therapy in order to anticipate changes in serum flucytosine concentration. In addition, it is recommended that the serum flucytosine level be determined two hours after an oral dose once a week, and that the dose be adjusted to maintain a level of 50 to 100 micrograms/ml.

Adolescent↗
PubMed1984

Failure of colchicine in the treatment of Mollaret's meningitis.

A 32-year-old man was hospitalized 23 times in 11 years because of attacks of Mollaret's meningitis. Colchicine (0.6 mg twice daily) was administered for 15 months but failed to decrease the severity or the frequency of attacks. The prophylactic efficacy of drugs in Mollaret's meningitis is difficult to assess because episodes are unpredictable and remissions occur spontaneously. There remains no established therapy for Mollaret's meningitis.

Adult↗
PubMed1983

Activity of rifampin against viridans streptococci.

Optimal antimicrobial therapy for viridans streptococcal endocarditis remains controversial. Rifampin was bactericidal at less than 0.2 micrograms/ml for ten strains of viridans streptococci isolated from patients with endocarditis. Administration of rifampin to one endocarditis patient already receiving penicillin and gentamicin increased the serum bactericidal activity fourfold. Rifampin has been effective in combination therapy for serious staphylococcal and enterococcal infections. The combination of penicillin and rifampin may be an effective, less toxic alternative to penicillin and streptomycin for the treatment of viridans streptococcal endocarditis.

Drug Synergism↗
PubMed1983

Treatment of systemic mycoses with ketoconazole: emphasis on toxicity and clinical response in 52 patients. National Institute of Allergy and Infectious Diseases collaborative antifungal study.

The pharmacology, in vitro mycologic activity, toxicity, and efficacy of ketoconazole were studied in a Phase-II evaluation by the National Institutes of Health and National Institute of Allergy and Infectious Disease Mycoses Study Group. This report emphasizes the toxicity and clinical response data in 52 patients with the following systemic mycoses: blastomycosis in 16 patients; nonmeningeal coccidioidomycosis in 13; histoplasmosis in 8; nonmeningeal cryptococcosis in 7; sporotrichosis in 7; and both blastomycosis and nonmeningeal coccidioidomycosis in 1. Maximum daily doses of ketoconazole were 100 mg in 1 patient; 200 mg in 23; 400 mg in 12; and 600 mg in 16. In 52% of the patients, duration of therapy ranged from less than 1 to 6 months, whereas in 35%, duration ranged from 7 to 12 months, and in 13%, from 12 to 22 months. In 35 patients (67%), evidence of toxicity was not seen. Nausea, anorexia, or vomiting occurred in 21%. Cure or marked improvement was shown in 27 patients (52%), whereas failure of the primary course was seen in 14 (27%) and relapse after ketoconazole was discontinued in 11 (21%). Although this evaluation did not provide clear-cut clinical response data, our results indicate that ketoconazole, in the dosage regimens used, was more effective in patients with histoplasmosis and nonmeningeal cryptococcosis than in patients with blastomycosis and nonmeningeal coccidioidomycosis, and least effective in patients with sporotrichosis.

Adolescent↗
PubMed1983

Failure of sulfonamides and trimethoprim in the treatment of nocardiosis.

An immunocompromised patient with Nocardia brasiliensis pneumonia and empyema acquired disseminated disease due to Nocardia asteroides and died. The treatment of choice for pulmonary or disseminated nocardiosis is 6 to 12 g/day of sulfisoxazole (or adjusted dosage to achieve a serum level of 100 to 150 mg/L) continued for six to 18 months. Combination therapy may be beneficial in selected patients; if trimethoprim therapy is used with sulfonamides, higher than usual doses of trimethoprim may be required to achieve optimal antinocardial activity. When the condition of a patient with nocardiosis falls to improve on sulfonamide therapy, patient compliance should be questioned, serum sulfonamide levels should be measured, cultures and susceptibility studies should be repeated, and a search for sequestered pus should be made.

Adult↗
PubMed1982

Salmonella bredeney mastitis during pregnancy.

A young woman developed mastitis due to Salmonella bredeney during the 25th week of her first pregnancy and recovered with ampicillin therapy. Unusual microorganisms occasionally cause breast disease. Material for Gram stain, cultures, and susceptibility studies should be obtained before treatment in all cases.

Adult↗
PubMed1976

Effect of aerosolized isoproterenol on resting myogenic tone in normals.

The effects of aerosolized isoproterenol on expiratory (exp) and inspiratory (insp) conductance (Gaw), maximal exp and insp flow (VEmax and VImax), and static elastic recoil pressure (Pst) were measured in 12 normals. Both exp and insp Gaw increased throughout the vital capacity (37% at 50% VC; P less than 0.01). VEmax increased only at 50% VC (9%; P less than 0.01). VImax and Pst did not change. Accordingly, a dichotomy existed between the Gaw and Vmax changes during both exp and insp. We do not attribute this dichotomy to loss of driving pressure or to volume-time-dependent behavior of airway tone. We interpret the increased exp and insp Gaw to indicate isoproterenol deposition within and bronchodilatation of larger central airways (trachea, main stem, lobar, segmental). Since insp Gaw increased and VImax did not, we conclude that the caliber of these central airways is not the exclusive deteminant of VImax, that the caliber of some more distal airways (subsegmental and beyond) did not change, and that these airways are important determinants of VImax. We conclude that non-uniform distribution of isoproterenol could account for the Gaw-Vmax dichotomy during inspiration, and that such non-uniform distribution coupled with resultant increased compliance and compressibility of the downstream segment could account for the Faw-Vmax dichotomy during expiration.

Adult↗
PubMedDate not supplied

Listerial myocarditis in cardiac transplantation.

Clinical signs of heart failure developed in two cardiac transplant recipients and were interpreted initially as graft rejection. Morphologic examination of explanted hearts revealed myocarditis with abscess formation and necrosis consistent with a bacterial process; Listeria monocytogenes was isolated from myocardial tissue in the first case and from blood in both. The first patient also developed signs of meningoencephalitis, but the second had no signs of infection outside the heart. Antimicrobial therapy and retransplantation were successful in eradicating listeriosis. The differential diagnosis of heart failure in cardiac transplant recipients includes infectious myocarditis due to L. monocytogenes.

Adult↗
PubMedDate not supplied

Group C streptococcal pneumonia: report of a fatal case and review of the literature.

A previously healthy 22-year-old man acquired tonsillitis due to Streptococcus equisimilis, a group C Streptococcus. He rapidly developed pneumonia, empyema, septicemia, and metastatic arthritis, and despite appropriate therapy with antibiotics and drainage of abscesses, he experienced progressive respiratory insufficiency and died. The four species of group C streptococci are described in terms of their biochemical properties, the infections they cause in animals, and their tendency to produce disease in humans. Pharyngeal carriage of these organisms is not rare, and outbreaks of pharyngitis and tonsillitis occur. Group C streptococcal pneumonia, like group A pneumonia, is often a severe disease with a prolonged febrile course and frequently is complicated by empyema. Appropriate management includes isolation of the patient, penicillin G therapy, drainage, and respiratory support.

Adult↗