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Clinton K Murray

Publications and source records attributed to Clinton K Murray.

At least 19 recordsLinked to original sources
PubMed2006

An approach to prevention of infectious diseases during military deployments.

The US military conducts missions that range from major ground combat operations to disaster and humanitarian relief efforts. A primary goal of military medical professionals is disease prevention, which can be made more difficult in the context of short preparation times and prolonged deployment duration. The military uses a 6-component approach to deployment medicine, emphasizing preparation, education, personal protective measures, vaccines, chemoprophylaxis, and surveillance in an attempt to prevent infectious diseases. Many of the components of military deployment medicine are applicable to civilian disaster relief and humanitarian missions.

Antibiotic Prophylaxis↗
PubMed2006

Effect of timing and duration of azithromycin therapy of leptospirosis in a hamster model.

OBJECTIVES: Azithromycin is not associated with significant adverse effects or restricted usage in certain populations unlike standard antileptospirosis agents. In this study, the utility of short courses of azithromycin in treating or preventing leptospirosis was investigated in a lethal hamster model. METHODS: All hamsters were infected intraperitoneally with 10(5) leptospires. In experiment one, animals received 5 mg/kg of doxycycline or 10 mg/kg of azithromycin via intraperitoneal injection beginning on the second day after infection and continuing once daily for 1, 2, 3 or 5 days. In experiment two, animals received 1 or 2 day courses of azithromycin initiated 2 or 4 days following infection, or 4 days prior to infection. RESULTS: All untreated control animals died between the sixth and ninth day following infection. In experiment one, survival rates in the doxycycline groups were 0, 50, 80 and 100% for those animals treated for 1, 2, 3 and 5 days, respectively. Except for the 1 day treatment group (which had an 80% survival), there was 100% survival in all azithromycin-treated groups. In experiment two, all animals treated after infection survived until study completion. No animals survived with 1 day of therapy started 4 days prior to infection while only 20% survived if they received 2 days. CONCLUSIONS: These results suggest short-course therapy with azithromycin, even started well after infection, is efficacious in preventing mortality from acute leptospirosis.

Animals↗
PubMed2006

Impact of Acinetobacter infection on the mortality of burn patients.

BACKGROUND: Acinetobacter calcoaceticus-baumannii complex (Acb) is recognized as an important cause of nosocomial infections. Although Acb can be associated with multidrug resistance, its impact on mortality in burn patients has not been fully elucidated. STUDY DESIGN: In a retrospective cohort study assessing medical records and microbiology laboratory data at a US military tertiary care burn center, we evaluated all patients admitted to the burn center between January 2003 and November 2005. Data collected included age, severity of burn, comorbidities, length of stay, and survival to hospital discharge. In addition, microbiology data were reviewed to determine which patients were infected with Acb during this time frame. These data were then used to compare patients infected with Acb to patients not infected. Multivariate analysis using logistic regression was performed to determine which patient characteristics were associated with increased mortality. RESULTS: There were 802 patients included in the study. Fifty-nine patients met the case definition for infection. An additional 52 patients were found to be colonized with Acb. Patients with Acb infection had more severe burns and comorbidities, and had longer lengths of stay compared with patients without Acb or those with Acb colonization. Mortality in infected patients was higher compared with those without infection (relative risk = 2.86, p = 0.001). On multivariate analysis, infection with Acb was not statistically associated with mortality. CONCLUSIONS: Multidrug-resistant Acb is a common cause of nosocomial infection in the burn patient population. Despite this, it does not independently affect mortality.

Acinetobacter Infections↗
PubMed2006

Acinetobacter skin colonization of US Army Soldiers.

OBJECTIVE: To evaluate whether skin colonization with Acinetobacter calcoaceticus-baumannii complex exists in a population of healthy, nondeployed US Army soldiers and, if present, how it might relate to the infections seen in current war casualties. DESIGN: We sampled various skin sites of soldiers to test for the presence of A. calcoaceticus-baumannii complex and to establish the prevalence of colonization. We then used ribotyping and antimicrobial susceptibility profiles to compare the isolates we recovered with A. calcoaceticus-baumannii complex isolates from injured soldiers. SETTING: Fort Sam Houston, Texas. PARTICIPANTS: A population of healthy, nondeployed US Army soldiers in training. RESULTS: A total of 17% of healthy soldiers were found to harbor A. calcoaceticus-baumannii complex. However, the strains differed from those recovered from injured soldiers. CONCLUSIONS: Skin carriage of A. calcoaceticus-baumannii complex exists among soldiers before deployment. However, the difference in the strains isolated from healthy soldiers, compared with the strains from injured soldiers, makes it difficult to identify skin colonization as the source of infection.

Acinetobacter baumannii↗
PubMed2006

Viability of Leptospira in BacT/ALERT MB media.

Recovery of Leptospira in the clinical setting is typically low as specialized culture media is needed. Previous data demonstrated that blood culture media commonly available to most clinical laboratories do not adequately sustain viable Leptospira. We hypothesized that mycobacterial blood culture medium, which is often readily available to most clinical laboratories, might be able to support the growth of Leptospira. Leptospires and fresh human blood were inoculated into BacT/ALERT (bioMérieux, Durham NC) mycobacterial (MB) and enriched mycobacterial bottles. Standard aerobic (FA) and anaerobic (SN) bottles were also inoculated as a control group. Inoculated bottles were then evaluated for their ability to support Leptospira growth using dark-field microscopy, subculture, and an automated growth detection system. Viable leptospires were detected in MB bottles up to day 14. FA and SN were performed in accordance with prior data. We conclude that MB and enriched MB bottles of the BacT/ALERT blood culture system can support viable leptospires.

Blood↗
PubMed2006

Presumptive identification of Candida species other than C. albicans, C. krusei, and C. tropicalis with the chromogenic medium CHROMagar Candida.

BACKGROUND: CHROMagar Candida (CaC) is increasingly being reported as a medium used to differentiate Candida albicans from non-albicans Candida (NAC) species. Rapid identification of NAC can assist the clinician in selecting appropriate antifungal therapy. CaC is a differential chromogenic medium designed to identify C. albicans, C. krusei, and C. tropicalis based on colony color and morphology. Some reports have proposed that CaC can also reliably identify C. dubliniensis and C. glabrata. METHODS: We evaluated the usefulness of CaC in the identification of C. dubliniensis, C. famata, C. firmetaria, C. glabrata, C. guilliermondii, C. inconspicua, C. kefyr, C. lipolytica, C. lusitaniae, C. norvegensis, C. parapsilosis, and C. rugosa. RESULTS: Most NAC produced colonies that were shades of pink, lavender, or ivory. Several isolates of C. firmetaria and all C. inconspicua produced colonies difficult to differentiate from C. krusei. Most C. rugosa isolates produced unique colonies with morphology like C. krusei except in a light blue-green color. C. glabrata isolates produced small dark violet colonies that could be differentiated from the pink and lavender colors produced by other species. All seventeen isolates of C. dubliniensis produced green colonies similar to those produced by C. albicans. CONCLUSION: C. glabrata and C. rugosa appear distinguishable from other species using CaC. Some NAC, including C. firmetaria and C. inconspicua, could be confused with C. krusei using this medium.

Agar↗
PubMed2006

Antimicrobial therapy of leptospirosis.

PURPOSE OF REVIEW: Leptospirosis is an important but often overlooked zoonotic disease that can cause significant morbidity and mortality. The optimal antimicrobial treatment for this disease has not been established. This review summarizes the most recent literature pertaining to the use of antimicrobial agents in the treatment of leptospirosis. RECENT FINDINGS: Leptospira are highly susceptible to a wide variety of antimicrobials in vitro. Despite this, it is not clear what the best choice of antimicrobial agents is for human disease. Based on the best available literature, the current choices of treatment for leptospirosis include penicillin, doxycycline, cefotaxime, ceftriaxone and azithromycin. Penicillin has long been considered the treatment of choice. Doxycycline is a reasonable alternative, but concerns exist regarding its use in all patients. Recent trials have demonstrated that cefotaxime and ceftriaxone are also acceptable agents. For a variety of reasons, these may be the preferred agents at this time. Azithromycin appears promising for the treatment of less severe disease. Another option for treating leptospirosis is the fluoroquinolone antimicrobials, although adequate human trials are lacking to fully support their use. SUMMARY: Leptospirosis is an important cause of morbidity and mortality worldwide. Despite this, the optimal treatment is not fully defined.

Anti-Bacterial Agents↗
PubMed2006

Efficacy of macrolides and telithromycin against leptospirosis in a hamster model.

Human studies support the use of beta-lactams and tetracyclines in the treatment of leptospirosis. Additional agents from these and other classes of antimicrobials also have in vitro activity against Leptospira species, though corroborating in vivo data are limited or lacking. We evaluated the therapeutic efficacy of azithromycin, clarithromycin, and telithromycin in a lethal hamster model of leptospirosis using Leptospira interrogans serogroup Canicola serovar Portlandvere. A range of dosages for each antimicrobial was given to the infected animals on days 2 through 7 (5 days) of the 21-day survival model. All untreated control animals survived less than 10 days from infection. Ninety to 100% of doxycycline controls, treated for 5 days with 5 mg/kg of body weight of drug, survived to 21 days. Treatment with azithromycin (daily dose: 6.25, 12.5, 25, 50, 100, or 200 mg/kg) resulted in 100% survival at all evaluated doses. Animals receiving 20 mg/kg or more of clarithromycin (daily dose: 1, 5, 10, 15, 20, 40, 60, or 100 mg/kg) had improved survival. Ninety-eight percent of animals treated with telithromycin (daily dose: 1, 5, 10, 15, 20, or 40 mg/kg) survived. We conclude that all agents tested have demonstrated in vivo efficacy in treating acute leptospirosis. These results provide support for further evaluation of macrolide and ketolide antimicrobial agents in human trials.

Animals↗
PubMed2006

Development of a deployment course for graduating military internal medicine residents.

Graduates of military internal medicine residency programs are required to have the necessary knowledge and skills to function as internists, military physicians, and military medical leaders. The global war on terrorism has increased the role internists are playing in combat theaters as they fill multiple different military medical positions including battalion, brigade, and division surgeons as well as physicians in echelon I, II, and III medical facilities. Along with general internists, internal medicine subspecialists, pediatricians, and family physicians also fill these roles. Although internal medicine training provides a broad-based knowledge to care for adults, it does not provide significant training in combat casualty care, detainee health care, or environmental health. To overcome many of these perceived shortfalls, we developed the 3-day deployment course for graduating internal medicine residents outlined in this article. Through a combination of didactic and hands-on training, militarily relevant medical knowledge and skills necessary to function at echelon I and II levels of care were provided. Residents uniformly accepted the course with measurable increase in their fund of knowledge at the completion of the course.

Adult↗
PubMed2006

Bacteria recovered from patients admitted to a deployed U.S. military hospital in Baghdad, Iraq.

The predominant bacteria and antimicrobial susceptibilities were surveyed from a deployed, military, tertiary care facility in Baghdad, Iraq, serving U.S. troops, coalition forces, and Iraqis, from August 2003 through July 2004. We included cultures of blood, wounds, sputum, and urine, for a total of 908 cultures; 176 of these were obtained from U.S. troops. The bacteria most commonly isolated from U.S. troops were coagulase-negative staphylococci, accounting for 34% of isolates, Staphylococcus aureus (26%), and streptococcal species (11%). The 732 cultures obtained from the predominantly Iraqi population were Klebsiella pneumoniae (13%), Acinetobacter baumannii (11%), and Pseudomonas aeruginosa (10%); coagulase-negative staphylococci represented 21% of these isolates. These differences in prevalence were all statistically significant, when compared in chi2 analyses (p < 0.05). Antimicrobial susceptibility testing demonstrated broad resistance among the Gram-negative and Gram-positive bacteria.

Acinetobacter baumannii↗
PubMed2006

Bacteriology of war wounds at the time of injury.

Bacterial contamination of war wounds occurs either at the time of injury or during the course of therapy. Characterization of the bacteria recovered at the time of initial trauma could influence the selection of empiric antimicrobial agents used to prevent infection. In the spring of 2004, U.S. military casualties who presented to the 31st Combat Support Hospital in Baghdad, Iraq, with acute traumatic injuries resulting in open wounds underwent aerobic culture of their wounds to identify the bacteria colonizing the wounds. Forty-nine casualties with 61 separate wounds were evaluated. Wounds were located predominantly in the upper and lower extremities and were primarily from improvised explosive devices or mortars. Thirty wounds (49%) had bacteria recovered on culture, with 40 bacteria identified. Eighteen casualties (20 wounds) had undergone field medical therapy (irrigation and/or antimicrobial treatment); six of these had nine bacterial isolates on culture. Of the 41 wounds from 31 patients who had received no previous therapy, 24 grew 31 bacteria. Gram-positive bacteria (93%), mostly skin-commensal bacteria, were the predominant organisms identified. Only three Gram-negative bacteria were detected, none of which were characterized as broadly resistant to antimicrobial agents. The only resistant bacteria recovered were two isolates of methicillin-resistant Staphylococcus aureus (MRSA). Our assessment of war wound bacterioly soon after injury reveals a predominance of Gram-positive organisms of low virulence and pathogenicity. The presence of MRSA in wounds likely reflects the increasing incidence of community-acquired MRSA bacteria. These data suggest that the use of broad-spectrum antibiotics with efficacy against more resistant, Gram-negative bacteria, such as Pseudomonas aeruginosa and Acinetobacter spp., is unnecessary in early wound management.

Anti-Bacterial Agents↗
PubMed2006

Prevalence of glucose-6-phosphate dehydrogenase deficiency in U.S. Army personnel.

The U.S. Army recently mandated that soldiers undergo glucose-6-phosphate dehydrogenase (G6PD) testing before deployment to malarious regions. We retrospectively characterize the presence and degree of G6PD deficiency in U.S. military personnel by sex, self-reported ethnicity, and World Health Organization deficiency classification through test results obtained October 1, 2004 through January 17, 2005. Data were available for 63,302 (54,874 males and 8,428 females) subjects; 2.5% of males and 1.6% of females were deficient, with most having only moderate enzyme deficiency. African American males (12.2%) and females (4.1%), along with Asian males (4.3%), had the highest rates of G6PD deficiency. Most males were found to have class III variants while most females were class IV variants. The most severely deficient were Asian males (class II). These results suggest that universal screening for G6PD deficiency is clinically warranted, and particularly essential for those male service members who self-report ethnicity as African American, Asian, or Hispanic.

Adult↗
PubMed2006

Causes of fever in adults on the Thai-Myanmar border.

A hospital-based study was conducted along the Thai-Myanmar border to provide greater knowledge of the causes of febrile illness and to determine what zoonotic and vector-borne emerging infectious diseases might be present. A total of 613 adults were enrolled from June 1999 to March 2002. Cases were classified based on clinical findings and laboratory results. An etiologic diagnosis was made for 48% of subjects. Malaria was the most common diagnosis, accounting for 25% of subjects, with two-thirds Plasmodium falciparum. Serologic evidence for leptospirosis was found in 17% of subjects. Other etiologic diagnoses included rickettsial infections, dengue fever, and typhoid. The most frequent clinical diagnoses were nonspecific febrile illness, respiratory infections, and gastroenteritis. Clinical associations were generally not predictive of etiologic diagnosis. Apparent dual diagnoses were common, particularly for malaria and leptospirosis. Findings have been used to modify treatment of unspecified febrile illness in the area.

Adult↗
PubMed2006

Retrospective serosurvey of leptospirosis among patients with acute febrile illness and hepatitis in Egypt.

The epidemiologic status of leptospirosis in Egypt has not been well defined because of difficulties in disease diagnosis. A retrospective study was conducted to detect leptospiral antibodies among undiagnosed acute febrile illness (AFI) and hepatitis cases. Approximately 16% of both AFI (141/886) and acute hepatitis (63/392) cases showed seroreactivity to Leptospira IgM by ELISA and microscopic agglutination test (MAT). Canicola, Djasiman, Grippotyphosa, Pyrogenes, Icterohemorrhagiae, and Pomona were the most commonly reactive serovars among patients with AFI. Djasiman, Grippotyphosa and Icterohemorrhagiae were the most reactive among patients with acute hepatitis. This study represents the first systematic report of Leptospira associated with patients with AFI and hepatitis in Egypt. Physicians need to have increased awareness about the importance of leptospirosis in the differential diagnosis of AFI and acute hepatitis in Egypt. In addition, laboratory capacity should be developed at fever hospitals to diagnose leptospirosis.

Adolescent↗
PubMed2005

Treatment of multidrug resistant Acinetobacter.

PURPOSE OF REVIEW: Acinetobacter baumannii-calcoaceticus complex has become a serious nosocomial pathogen due to its persistence in the hospital environment and its broad antimicrobial resistance patterns. This review summarizes the most recent literature pertaining to the clinical management of infections with this bacteria emphasizing in-vitro antimicrobial resistance patterns and antimicrobial efficacy in animals and humans. RECENT FINDINGS: Although this pathogen can be associated with an elevated crude mortality, it only contributes to this mortality in a subset of high-risk patients. Determining in-vitro activity of antimicrobial agents can be problematic due to conflicting results sometimes obtained through different testing methods. There is no simple answer as to the most appropriate antimicrobial therapy secondary to lack of adequate studies. Imipenem/cilastatin, amikacin, ampicillin/sulbactam, colistin, rifampin, and tetracyclines are typically active against these bacteria. It is also not clear if combination therapy is more effective than monotherapy. In cases in which A. baumannii-calcoaceticus complex bacteria are resistant to all available agents, we have prolonged infusion times, increased drug dose, and altered route of instillation, such as nebulized therapy for pulmonary infections with mixed results. A primary goal of A. baumannii-calcoaceticus complex management should be to prevent initial colonization and subsequent infection by adequate infection control. SUMMARY: The A. baumannii-calcoaceticus complex continues to play a significant role in our healthcare systems. Prompt and adequate therapy with agents having in-vitro activity is required once it is established that the bacteria represents infection and not colonization. Aggressive infection control policies should be enforced when this pathogen is identified.

Acinetobacter Infections↗