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Biomedical subjects

C Henning

Publications and source records attributed to C Henning.

At least 19 recordsLinked to original sources

Antibiotic resistance in Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes in respiratory tract infections in outpatients.

Sensitivity patterns of Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes were studied prospectively in an outpatient population seeking medical advice for respiratory tract infections (RTI) in the Southern parts of Stockholm. In total, 3,214 nasopharyngeal and 1,907 throat swabs were cultured during January-February 1996. 32% of the patients had received antibiotics during the previous year. Reduced penicillin sensitivity in S. pneumoniae was rare (1.3%) and only seen in patients treated with antibiotics during the previous 4 months. Beta-lactamase production in H. influenzae was found in 13.4% of patients who had been treated with antibiotics during the last 4 months and in 7.9% of the others. No resistance (< 1%) to erythromycin was seen in S. pyogenes. In this population-based surveillance, the levels of resistance in common respiratory tract pathogens were thus low and correlated to previous antibiotic treatment. Strict indications for antibiotic treatment in uncomplicated RTI are advocated to maintain a low resistance rate. Penicillin is still the drug of choice in patients without frequent recurrences of RTI in a setting similar to the one studied.

Adolescent↗

Is penicillin the appropriate treatment for recurrent tonsillopharyngitis? Results from a comparative randomized blind study of cefuroxime axetil and phenoxymethylpenicillin in children. The Swedish Study Group.

The efficacy of cefuroxime axetil compared with phenoxymethylpenicillin (PcV) was studied in group A beta-haemolytic streptococci (GAS) culture-proven tonsillitis in children aged 3-12 years with a history of at least 1 episode of tonsillopharyngitis requiring antibiotic therapy during the previous 3 months. This was a comparative, randomized, investigator-blind, multicentre study. A total of 236 children received either cefuroxime axetil suspension or PcV syrup. Inclusion criteria were a positive, rapid, group A strep test verified by bacteriological culture and clinical signs and symptoms of tonsillopharyngitis. Cefuroxime axetil treatment gave a significantly higher bacteriological eradication rate and clinical cure rate than PcV. At day 2-5 post treatment the eradication rates were 99/114 (87%) for cefuroxime axetil vs 61/109 (56%) for PcV (p < 0.001). The clinical cure rates were 98/114 (86%) and 73/109 (67%) respectively (p < 0.01). Up to 21-28 days post-treatment, 9/114 (8%) cefuroxime axetil patients and 37/109 (34%) PcV patients were treatment failures or had recurrence/reinfection of GAS tonsillopharyngitis (p < 0.001). More than 90% of the patients who experienced bacteriological treatment failure at either the first or second follow-up had the same serotype isolated pre- and post-treatment. During the study period, 21/114 (18%) patients in the cefuroxime axetil group and 50/109 (46%) patients in the PcV group received additional antibiotics (p < 0.001). No serious adverse events were noted and the mild adverse events were equally distributed among the patients in the 2 study groups: 15% for cefuroxime axetil and 14% for PcV.

Cefuroxime↗

Theoretical aspects of detection of bacteraemia as a function of the volume of blood cultured.

UNLABELLED: Clinically significant bacteraemia in adults is characterized by low numbers of circulating bacteria. Assuming a Poisson or a binomial distribution we have calculated the probability of detecting bacteria as a function of the concentration in blood, estimated the concentration of bacteria in blood from a given test result, and calculated the blood volume required to detect bacterial growth with a probability of 95% at a given mean number of colony-forming units (cfu) per sample unit. These theoretical assumptions have been used on an empirical population of patients with proven bacteraemia. RESULTS: 18% of Staphylococcus aureus bacteraemias and 29% of Escherichia coli bacteraemias have circulating bacteria with an estimated spread of less than 0.04 cfu/ml. With a 95% probability of detection of a bacteraemia, a concentration in blood corresponding to 3 cfu/sampling unit is necessary. In our empirical material, where 30 ml was cultured, the probability of detection of E. coli bacteraemias would have decreased by 11% if 20 ml had been cultured, and 27% if only 10 ml had been cultured. The corresponding figures for S. aureus were 6% and 15%, respectively. For low grade E. coli bacteraemias (< 0.04 cfu/ml) the decrease would have been 33% and 67%, respectively.

Bacteremia↗

Isolation of Francisella tularensis biovar palaearctica from human blood.

Francisella tularensis septicemia has previously been reported in the USA, where Francisella tularensis biovar tularensis (type A) occurs endemically. The present report describes two cases of septicemia caused by the Euro-Asian Francisella tularensis biovar palaearctica (type B). The patients lived in an endemic region of Sweden and presented with high fever and pneumonia. Both patients recovered. The ability of Francisella tularensis biovar palaearctica to cause bacteremia has consequences for laboratory safety.

Aged↗

In-vitro activity of the new penems FCE 22101 and FCE 24362 alone or in combination with aminoglycosides against streptococci isolated from patients with endocarditis.

Seven strains of viridans streptococci isolated from patients with endocarditis were inhibited in vitro by 0.06-2 mg/l and 0.016-0.5 mg/l of the penems FCE 22101 and FCE 24362 respectively. The MBCs were the same or two-fold higher than the respective MIC with three exceptions. One strain of Streptococcus faecalis was only inhibited (8 mg/ml respectively 0.5 mg/l; MBC greater than 32 mg/l) and one strain of Str. faecium was resistant (MIC greater than or equal to 16 mg/l). When combined with gentamicin or netilmicin a bactericidal and synergistic killing was observed within 1-8 h in all strains except Str. faecium. Synergy could also be confirmed in all cases by following bacterial growth kinetics after elimination of antibiotics, by calculating the difference between the times required for bacteria exposed to antibiotic and unexposed bacteria to increase in numbers (PAE).

Anti-Bacterial Agents↗

Factors influencing the biological inactivation of high protein bound beta-lactam antibiotics in vitro.

Unpredictable inactivation of antimicrobial agents may cause erratic results in pharmacokinetic studies. In this study we followed the inactivation of the high protein bound beta-lactams flucloxacillin, dicloxacillin and ceftriaxone in vitro. The antibiotics were added to pools of human and rabbit sera, ultrafiltrates of these pools, rabbit interstitial fluid, phosphate buffered saline (PBS), rabbit albumin in PBS and sodium dodecyl sulphate (SDS) treated preparations of human sera. Ceftriaxone was relatively stable but different serum pools varied significantly in their flucloxacillin and dicloxacillin inactivating capacity. The dominating inactivation took place within five minutes after the addition of antibiotics to serum. The inactivating factor was heat stable at 56 degrees C, 0.5 h, of relatively high molecular weight, and not related to albumin. The inactivating capacity could be diminished by SDS-treatment of serum suggesting a lipoprotein nature.

Animals↗

Susceptibility to beta-lactam antibiotics and gentamicin of gram-negative bacilli isolated from hospitalized patients: a Swedish multicenter study.

A total of 952 blood and 1543 urine isolates of gram-negative bacilli from hospitalized patients in 1986-1987 were consecutively collected by 10 Swedish laboratories and tested for susceptibility to 8 beta-lactam antibiotics and to gentamicin. The isolates were mostly Escherichia coli (58% and 44%, respectively) and Klebsiella sp. (17% and 18%). Resistance to ampicillin in blood and urine isolates was found in 35% and 45%, respectively, to piperacillin in 5% and 6%, to cephalothin in 26% and 34%, to cefuroxime in 12% and 22%, to cefotaxime in 3% and 5%, to ceftazidime in 1% and 1%, to imipenem in 0.5% and 0.1%, to aztreonam in 3% and 2%, and to gentamicin in 0.8% and 0%. Resistance of clinically important gram-negative bacilli to new beta-lactam antibiotics and to gentamicin is infrequent in Sweden.

Ampicillin↗

Density of the microflora in hand eczema before and after topical treatment with a potent corticosteroid.

Twenty patients with hand eczema were studied with the use of quantitative bacteriologic cultures before and after successful topical treatment with a potent corticosteroid. One sample was taken from the most pronounced eczematous lesion, a second from skin affected with only erythema, and a third from clinically normal skin. Before quantitative bacteriologic analysis, the different species were combined into three main groups: Staphylococcus aureus, other aerobes, and anaerobes. Before treatment, S. aureus colonized the most pronounced eczematous lesion in eighteen of twenty patients and exceeded 10(5) cfu/cm2 in fifteen of twenty patients. The geometric mean count of S. aureus before treatment was significantly higher in eczema (10(4.8) cfu/cm2) than in erythema (10(3.4) cfu/cm2) and significantly higher in erythema than in normal skin (10(1.7) cfu/cm2). The density of other aerobes and anaerobes was similar in the three sampling sites. After treatment, the mean count of S. aureus was significantly reduced at all three sampling sites, and the densities became equal. Treatment did not affect the mean count of other aerobes or anaerobes.

Administration, Topical↗

In vitro aminoglycoside resistance of gram-negative bacilli and staphylococci isolated from blood in Sweden 1980-1984.

The in vitro susceptibility to gentamicin, tobramycin, amikacin and netilmicin in septicaemia isolates was followed during 1980-1984 in 6-8 Swedish laboratories. The bacterial distribution was similar over the years and was dominated by Escherichia coli and staphylococci. Resistance to gentamicin was found in 2.3-3.6%, to tobramycin in 1.4-3.4%, to amikacin and netilmicin in 0.5-0.9%. Production of aminoglycoside modifying enzymes was observed among resistant strains.

Amikacin↗

Cefadroxil once daily for three or seven days versus amoxycillin for seven days in uncomplicated urinary tract infections in women.

The cure rate of acute uncomplicated urinary tract infection in general practice using 3 different treatment regimens, was studied in a randomized, multicenter trial. Patients were assigned to receive either cefadroxil 1 g once daily for 3 or 7 days or amoxycillin 375 mg t.i.d. for 7 days. 310 patients entered the study, of whom 230 could be evaluated according to the protocol. Two thirds of the cases were due to infections with Escherichia coli and about one fourth to Staphylococcus saprophyticus. No statistically significant differences in cure rates between the 3 regimens could be demonstrated neither at 1 week nor at 5 weeks of follow-up. The frequency of adverse reactions was low and similar in each treatment group.

Amoxicillin↗