Biomedical subjects
Publications and source records attributed to B S Azadian.
Campylobacter sputorum biovar sputorum is a rarely isolated organism, particularly from human clinical specimens. Its pathogenic potential is unknown. We present here what we believe to be the first report of this organism being isolated from a clinically significant source, an axillary abscess. To our knowledge, this organism has not been reported previously as one of clinical relevance in the U.K.
To determine appropriate doses of ciprofloxacin and vancomycin for septic patients with acute renal failure (ARF) treated by continuous arteriovenous and venovenous haemodialysis, (CAVHD/CVVHD), we performed pharmacokinetic studies in patients receiving these antibiotics. All patients were treated by CAVHD/CVVHD using Hospal AN69S 0.43 m2 filters and Fresenius 1.5% peritoneal dialysis fluid at dialysate flow rates (Qd) of 1 and 2 l/h. Patients received ciprofloxacin 200 mg i.v. 12-hourly (n = 6) or 8-hourly (n = 5); vancomycin 1 g i.v. was administered to 10 patients approximately every 48 h to maintain therapeutic plasma levels. For ciprofloxacin, volume of distribution (Vdarea) was 136.5 +/- 9.81, terminal elimination half-life (t1/2) 6.4 +/- 0.8 h, and total body clearance (TBC) 264.3 +/- 22.9 ml/min (mean +/- SEM). Mean sieving coefficient (S/C) was 0.76 +/- 0.05 and filter clearances at Qd 1 and 2 l/h were 16.2 +/- 1.9 and 19.9 +/- 1.1 ml/min respectively. For vancomycin, Vdarea was 60.7 +/- 5.11, t1/2 24.7 +/- 2.6 h and TBC 31.0 +/- 4.6 ml/min. Mean S/C was 0.66 +/- 0.08 and filter clearances at Qd 1 and 2 l/h 12.1 +/- 2.0 and 16.6 +/- 2.0 ml/min. These data suggest that patients with ARF treated by CAVHD/CVVHD should be given ciprofloxacin 200 mg i.v. 8-12-hourly and vancomycin every 48 h.
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Curettage of skin lesions was not followed by bacteraemia in 22 patients. The risk of bacterial endocarditis after curettage and other minor skin surgery is small but should not be overlooked in those with a prosthetic heart valve, a history of other cardiac surgery, a previous episode of infective endocarditis, drug addiction, diabetes, alcoholism, immunosuppression, or renal failure--especially where the skin lesion might be infected.
A marked increase in the prevalence of bacteraemia due to Escherichia coli of serogroup O15 was noted during November and December 1986 at Charing Cross Hospital. This multiresistant strain had been reported by several hospitals in south London. All isolates of E. coli from patients with bacteraemia between October 1986 and the end of September 1988 were assessed for the presence of the O15 antigen and for the unusual pattern of resistance to six antimicrobial agents. As a guide to faecal carriage, isolates from urine were similarly assessed during seven 4-week periods between January 1987 and June 1988. Of the 123 E. coli isolates from blood, 25 (20%) were serogroup O15 and 20 of these expressed the same pattern of multiresistance; 17 of these multiresistant isolates occurred in the 4-month period 1 Nov. 1986-28 Feb. 1987. During the remaining 19 months of the study only eight isolates were serogroup O15 of which only three were multiresistant. In the first 4-week period that urine isolates were studied 21 Jan. 1987-17 Feb. 1987, 26 (13.2%) of the 195 isolates were serogroup O15 of which 20 were multiresistant. The proportion of serogroup O15 isolates fell gradually until, in June 1988, the last period studied, only 8 (4.2%) of the 189 isolates were serogroup O15, of which only one was multiresistant. In a preliminary study of plasmids in six serogroup O15 isolates from blood, three multiresistant isolates and one that was sensitive to chloramphenicol appeared to carry a similar plasmid of c. 100 Mda.(ABSTRACT TRUNCATED AT 250 WORDS)
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A patient presented with a posterior uveitis. An inferior plaque of retinal exudation was seen. Full investigation failed to establish a cause until six weeks later, when cryptococcal meningitis developed. The patient was immunocompetent. Exudation in relation to retinal vessels is unusual in idiopathic posterior uveitis, and cryptococcosis should be considered in the differential. Diagnosis is by lumbar puncture or vitreous aspiration.
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One hundred and twelve penicillinase producing Neisseria gonorrhoeae (PPNG) isolates and the same number of non-PPNG isolates were obtained from patients attending the genitourinary department of this hospital. Susceptibilities to six beta lactam antibiotics--ceftriaxone, cefotaxime, cefuroxime, ceftazidime, amoxycillin, and temocillin--to the combined formulation of amoxycillin and clavulanic acid, Augmentin, and to the aminocyclitol, spectinomycin, were compared by assessing their minimum inhibitory concentrations (MICs). Results showed that all the cephalosporins used in this study had good in vitro activity against both PPNG and non-PPNG strains, and ceftriaxone had the lowest MICs. Temocillin and Augmentin also showed good activity against both types of strain. Spectinomycin resistance was shown in about 4% of the PPNG isolates but was not found in any non-PPNG strains.
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We studied 220 patients (138 men and 82 women) with uncomplicated gonorrhoea who were entered into a randomised double blind trial and treated with either Augmentin (amoxycillin 3 g and potassium clavulanate 125 mg) or amoxycillin 3 g, with probenecid 1 g by mouth in all cases. Seven (6.5%) of 108 patients treated with Augmentin were still culture positive after treatment, compared with 15 (13.4%) of 112 of those treated with amoxycillin. Penicillinase (beta lactamase) producing strains of Neisseria gonorrhoeae (PPNG) were found in 23 (10.5%) patients, of whom 10 were treated with Augmentin and 13 with amoxycillin. Treatment failed in all 13 patients who received amoxycillin. Augmentin was shown to be an effective treatment for gonorrhoea caused by PPNG strains.
An extremely rare case of primary extragenital granuloma inguinale affecting the axillae is reported. Clinical, histological, and electron microscopical features of the disease are described, and the rarity, absence of genital lesions, and consequent difficulty in diagnosis are emphasised.