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Biomedical subjects

B A Lipsky

Publications and source records attributed to B A Lipsky.

At least 55 records · Page 3Linked to original sources
PubMed1990

Ofloxacin treatment of Chlamydia pneumoniae (strain TWAR) lower respiratory tract infections.

PURPOSE: Limited data suggest that tetracycline or erythromycin is the antibiotic of choice for treating Chlamydia pneumoniae infection, but they are not always effective or well tolerated. Because the fluoroquinolone ofloxacin is effective for Chlamydia trachomatis infections, we investigated its role in treating C. pneumoniae infections. PATIENTS AND METHODS: Eighty-seven patients were enrolled in a randomized trial of antibiotic therapy for acute lower respiratory tract infections. The patients were randomly assigned to oral treatment with either ofloxacin (400 mg twice a day) or erythromycin (400 mg four times a day) for 10 days. Frozen acute and convalescent serologic specimens were tested for TWAR antibody by microimmunofluorescence. Susceptibility testing of C. pneumoniae to ofloxacin was also performed. RESULTS: Four patients who received ofloxacin were retrospectively identified as having C. pneumoniae pneumonia (two) or bronchitis (two). Within 2 weeks of starting ofloxacin therapy, all were cured or markedly improved. The minimum inhibitory concentrations of ofloxacin for three previously isolated clinical strains of C. pneumoniae were determined to be 1.0 to 2.0 micrograms/mL, well within the achievable serum levels (3 to 5 micrograms/mL) with ofloxacin therapy. CONCLUSION: Ofloxacin may be an effective alternative antibiotic treatment for C. pneumoniae respiratory infections.

Aged↗
PubMed1990

Coryneform bacteria in infectious diseases: clinical and laboratory aspects.

Coryneform isolates from clinical specimens frequently cannot be identified by either reference laboratories or research laboratories. Many of these organisms are skin flora that belong to a large number of taxonomic groups, only 40% of which are in the genus Corynebacterium. This review provides an update on clinical presentations, microbiological features, and pathogenic mechanisms of infections with nondiphtheria Corynebacterium species and other pleomorphic gram-positive rods. The early literature is also reviewed for a few coryneforms, especially those whose roles as pathogens are controversial. Recognition of newly emerging opportunistic coryneforms is dependent on sound identification schemes which cannot be developed until cell wall analyses and nucleic acid studies have defined the taxonomic groups and all of the reference strains within each taxon have been shown by molecular methods to be authentic members. Only then can reliable batteries of biochemical tests be selected for distinguishing each taxon.

Actinomycetales↗
PubMed1990

Outpatient management of uncomplicated lower-extremity infections in diabetic patients.

Most diabetic foot infections are believed to be caused by both aerobic and anaerobic bacteria and to require hospitalization and parenteral antimicrobial therapy. We prospectively evaluated diabetic patients with non-limb-threatening lower-extremity infections not yet treated with antibiotics. The patients were randomized to outpatient treatment with oral clindamycin hydrochloride or cephalexin for 2 weeks and evaluated every 3 to 7 days. In 56 assessable patients, curettage yielded a mean of 2.1 microorganisms. Aerobic gram-positive cocci were isolated in 50 cases (89%), and were the sole pathogen in 21 (42%) of these. Aerobic gram-negative bacilli and anaerobes were isolated in 20 (36%) and 7 (13%) cases, respectively, and almost always in polymicrobial infections. Fifty-one infections (91%) were eradicated, 42 (75%) after 2 weeks of treatment; only 5 (9%) were initially treatment failures, and 3 (5%) were subsequently cured with further outpatient oral antibiotic treatment. After a mean follow-up of 15 months, no further treatment was required in 43 (84%) of the cured patients. Previously untreated lower-extremity infections in diabetic patients are usually caused by aerobic gram-positive cocci, and generally respond well to outpatient management with oral antibiotic therapy.

Ambulatory Care↗
PubMed1990

The diabetic foot. Soft tissue and bone infection.

Diabetic patients, as a consequence of various neurologic, vascular, and metabolic perturbations, are at high risk for developing infections of the soft tissue and bones of the feet. The microbial etiology of soft tissue in infections is best determined by cultures of a tissue curetting or aspiration, rather than a swab. Aerobic gram-positive cocci are the major pathogens in diabetic foot infections; these may be the sole isolate(s) in acute uncomplicated infections, but they are usually accompanied by aerobic gram-negative bacilli or anaerobes in chronic or previously treated infections. Carefully selected patients with mild infections can be treated as outpatients with oral antibiotics, but others require hospitalization and broad-spectrum parenteral antibiotics. Bone infections are frequently diagnosed on the basis of roentgenographs and nuclear medicine scans, but these methods are often inaccurate, and bone cultures should be obtained whenever possible.

Cellulitis↗
PubMed1990

Foot ulceration and infections in elderly diabetics.

Foot lesions occur commonly among patients with diabetes, particularly the elderly and those with sensory neuropathy. Because of serious or recurrent infections and impaired healing processes, initially trivial lesions may progress to chronic nonhealing wounds, gangrene, or untreatable infections that can lead to limb amputation. Strategies to prevent amputation depend on understanding the multifactorial nature of diabetic foot disease; providing effective ongoing preventive care, including patient education; and prompt and aggressive treatment of foot lesions when they occur. The approach to treatment of infections depends on many factors, including the severity of the soft tissue infection, whether or not underlying bone or joints are involved, the types of infecting organisms, the patient's social situation, and his other medical problems. Proper diagnostic studies followed by appropriate antimicrobial therapy and local wound care can usually lead to resolution of these potentially serious infections.

Age Factors↗
PubMed1989

Urinary tract infections in men. Epidemiology, pathophysiology, diagnosis, and treatment.

PURPOSE: To review the epidemiology, pathophysiology, diagnosis, and treatment of urinary tract infections in men, especially insofar as they differ from those in women. DATA IDENTIFICATION: Studies published between 1954 and 1988 were identified using MEDLINE (1981-1988) and Index Medicus (1981-1988), and through extensive manual searching of textbooks, symposia, monographs, and bibliographies of identified articles. STUDY SELECTION: More than 200 studies were reviewed; those studies most pertinent to the topics reviewed were cited. Unpublished data from the author's studies were also cited. DATA EXTRACTION: Study quality and descriptive information about prevalence, evaluations, interventions, and outcomes were assessed. Quantitative synthesis was not done. RESULTS OF DATA ANALYSIS: Most men with urinary tract infection have a functional or anatomic abnormality of the genitourinary tract. Prostatic hypertrophy and genitourinary instrumentation are the major predispositions to infection in men. Signs and symptoms of bacteriuria in men are similar to those in women. Diagnosis rests on a properly collected specimen yielding 10(3) or more colony-forming units/mL of a single or predominant species. Eschericia coli is the most frequent uropathogen, but other gram-negative and gram-positive species cause up to one half of cases. Treatment of men with single-dose therapy is inadequate; men with recurrent infections require at least 6 weeks of appropriate treatment. Asymptomatic bacteriuria is common in elderly men, but does not usually necessitate treatment. Although genitourinary abnormalities are frequent in bacteriuric male patients, a diagnostic evaluation is probably indicated only in young boys and in men with recurrent or complicated infections. CONCLUSIONS: Several important aspects of the epidemiology, pathophysiology, diagnosis, and treatment of urinary tract infections differ in male populations from those in the much better studied female populations. Knowledge of recently available data will help clinicians develop a rational approach to caring for bacteriuric men.

Adolescent↗
PubMed1989

NIDDM and prevalence of nasal Staphylococcus aureus colonization. San Luis Valley Diabetes Study.

Previous studies of hospitalized and ambulatory patients have found a higher prevalence of Staphylococcus aureus nasal colonization in diabetic than nondiabetic subjects. We examined this association in a geographically based study among 551 residents of the San Luis Valley of Colorado and found no statistically significant increase in the relative risk of nasal S. aureus colonization in 188 non-insulin-dependent diabetic (NIDDM) versus 363 nondiabetic subjects (relative risk 1.3, 95% confidence limits 0.9-1.8). Adjustment for confounding by age, sex, ethnicity, county of residence, and frequency of hospitalizations or physician visits in the previous year did not affect the results. Among the diabetic subjects, S. aureus colonization was not associated with type of treatment for diabetes, level of glucose control, clinical duration of diabetes, or frequency of hospitalizations or physician visits in the previous year. In this population-based study, diabetes mellitus did not increase S. aureus nasal colonization, suggesting that factors other than diabetes mellitus may have caused the higher colonization rate found in previous clinic-based studies.

Colorado↗
PubMed1987

Diagnosis of bacteriuria in men: specimen collection and culture interpretation.

Bacteriologic criteria for diagnosing urinary tract infections in men have not been well defined. For determination of the bacterial colony count in voided specimens that most accurately reflects bladder bacteriuria, culture results were compared for voided urine and bladder urine (obtained by suprapubic aspiration and urethral catheterization) from men with various genitourinary problems. Bladder bacteriuria was found in 36 (47.3%) of 76 sets of specimens from 66 individuals. Culture results of bladder specimens showed excellent agreement with those of clean-catch midstream-void and uncleansed first-void specimens (weighted kappa = 0.924 and 0.906, respectively). The criterion for clean-catch midstream-void specimens that best differentiated sterile from infected bladder urine was growth of greater than or equal to 10(3) cfu of one predominant species/ml; this definition had a sensitivity of 0.97 and a specificity of 0.97. Uncleansed first-void specimens were equally sensitive (0.97) but less specific (0.91-0.92) in detection of bacteriuria. Pyuria (greater than or equal to leukocytes/mm3) and irritative genitourinary symptoms showed modest correlations with bladder bacteriuria.

Bacteria↗
PubMed1986

Emphysematous pyelonephritis caused by Candida albicans.

We report a case of emphysematous pyelonephritis that was proved by histological examination and culture to be caused by Candida albicans. The fungal infection caused ureteral obstruction. Nephrectomy alone resulted in complete recovery.

Candidiasis↗
PubMed1986

Risk factors for acquiring pneumococcal infections.

To identify risk factors for developing pneumococcal infections, we carried out a case-controlled study on a retrospectively constituted cohort of 3074 clinic patients in a presumed high-risk population. Culture-proved pneumococcal infections were identified in 63 men over a period of 5.5 years, yielding an estimated incidence of 6.3 cases per 1000 person-years. By comparing these patients with 130 uninfected control patients, the relative risk of pneumococcal infections related to various exposures was calculated by logistic regression analysis. Statistically significant independent risk factors (and their relative risks) were as follows: dementia (5.82), seizure disorders (4.38), current cigarette smoking (4.00), congestive heart failure (3.83), cerebrovascular disease (3.82), institutionalization (3.13), and chronic obstructive pulmonary disease (2.38). Risk was increased with age and previous hospitalizations, and, to a nonsignificant degree, by hotel residence (3.93), lung cancer (2.24), previous smoking (2.14), corticosteroid use (1.81), and alcoholism (1.35); but not by diabetes mellitus (0.99), nonlung malignancies (0.93), nonwhite race (0.89), or ischemic heart disease (0.58).

Aged↗
PubMed1985

Comparison of the automicrobic system, acridine orange-stained smears, and gram-stained smears in detecting bacteriuria.

We compared the accuracy of the Gram-stained smear, the acridine orange-stained smear, and the AutoMicrobic system (AMS; Vitek Systems, Inc., Hazelwood, Mo.) in screening for bacteriuria, as detected by conventional cultures. For 1,024 clinical specimens, results with the acridine orange-stained smear and the Gram-stained smear were very similar. When read for the presence of one or more microorganisms or leukocytes per 20 oil immersion fields, both smears were highly sensitive (92.1 and 93.3%, respectively) and moderately specific (70.0 and 61.7%, respectively). Sensitivity was greater for specimens yielding greater than or equal to 10(5) CFU/ml (96.1 and 98.9%, respectively) than for those with 10(3) to 10(4) CFU/ml (81.4 and 78.0%, respectively). Preliminary classification based upon the tinctorial and morphological characteristics of the Gram-stained smear was compatible with culture results in nearly all cases. The accuracy of the Gram-stained smears was not influenced by special cleaning of the microscopic slides, or the level of expertise of the microscopist. For 715 specimens, the sensitivity of the AMS in detecting bacteriuria (91.5%) was very similar to that of the stained smears (92.1 and 95.7%, respectively), but the specificity was significantly higher (83.2% versus 42.6 and 70.0%). Detection of microorganisms by the AMS took an average of 6.3 +/- 3.0 h. These data suggest that the Gram-stained smear is easily interpreted, very sensitive, acceptably specific, and still the optimal rapid method for screening for bacteriuria in most clinical microbiology laboratories.

Acridine Orange↗
PubMed1984

Is the clean-catch midstream void procedure necessary for obtaining urine culture specimens from men?

To determine whether the results of voided urine cultures in men are affected by meatal cleansing, midstream sampling, or circumcision status, 308 paired (initial and midstream) specimens were collected from 254 urology clinic patients. Half of the patients cleansed their urethral meatus with povidone-iodine prior to voiding. The circumcision status of all patients was noted. The rates of true bacteriuria (growth of 10(4) or greater colony-forming units/ml urine with a single predominant species) and contamination (growth of 10(3) or greater colony-forming units/ml urine with two or more colonial types) were compared in the various collection technique subgroups. Neither the bacteriuria nor contamination rates were significantly different (p greater than 0.05) in circumcised and uncircumcised patients, or in those who cleansed their meatus and those who did not. Contamination, but not bacteriuria, rates were higher in initial as compared with midstream specimens. These data suggest that the clean-catch midstream void procedure is unnecessary for obtaining routine voided urine culture specimens from men.

Bacteriuria↗
PubMed1984

Influenza vaccination and warfarin anticoagulation.

Because influenza vaccine can markedly depress hepatic cytochrome P450 activity and may have caused an extreme prolongation of the prothrombin time in one patient receiving warfarin, we studied the effect of influenza vaccine on anticoagulation in 21 male outpatients receiving chronic warfarin therapy. Prothrombin times measured three to five times in the month after vaccination were in the therapeutic range as often as those measured before vaccination. Mean changes in prothrombin times measured after vaccination were not significantly different from those on the day of vaccination or in the 3 months before vaccination. The size of this study assured an 80% chance that any deviation from the observed mean prothrombin times would not exceed 2.1 s. No patient had any bleeding or thromboembolic problems. Thus, influenza vaccination of patients anticoagulated with warfarin appears to be safe.

Aged↗