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Biomedical subjects

D C Speller

Publications and source records attributed to D C Speller.

At least 19 recordsLinked to original sources
PubMed1992

A controlled trial of selective decontamination of the digestive tract in intensive care and its effect on nosocomial infection.

Nosocomial infection is a major problem in intensive therapy units (ITUs) and a significant cause of mortality. Selective decontamination of the digestive tract (SDD) has been advocated as a means to reduce ITU morbidity and mortality. Ninety-one patients in a general ITU underwent SDD, consisting of topical polymyxin E, tobramycin and amphotericin B administered throughout the unit stay together with parenteral ceftazidime for the first three days, and were compared with 84 historical and 92 contemporaneous control patients who were treated conventionally. Twenty-seven historical and 32 contemporaneous control patients developed unit-acquired infections, in comparison with only three patients in the SDD group (P less than 0.01). Mortality in the SDD group (36%) was not significantly different from that in the other two groups (historical control 40%, contemporaneous control 43%). Screening specimens revealed a significantly higher rate of colonization with resistant Acinetobacter spp. in the contemporaneous control than in the other two groups of patients; infection caused by resistant bacteria did not occur. SDD did not lead to a significant reduction in the use of systemically-administered antibiotics when compared with either control group. SDD may be used selectively in an ITU without ill effects on those patients not receiving SDD; nevertheless, microbiological monitoring is needed to detect emergence of resistant bacteria in the unit.

Adolescent↗
PubMed1991

An outbreak of aspergillosis in a general ITU.

Over a 5-month period, six patients in a general intensive therapy unit became colonized by Aspergillus species including Aspergillus fumigatus, and invasive infection occurred in at least two of them. Broncho-alveolar lavage was unhelpful in discriminating between infection and colonization. The source of infection was presumed to be disturbance of an accumulation of spores in fibrous insulation material above the perforated metal ceiling. Patients in such units without clearly identifiable defects of defence against infection may be at risk from aspergillosis. The risk can be reduced by improved hospital design, satisfactory ventilation and thorough regular cleaning of environmental surfaces.

Adult↗
PubMed1990

Acquired immune deficiency syndrome: recommendations of a Working Party of the Hospital Infection Society.

Unified procedures to control those infections that are transmitted by inoculation of blood are recommended. These should be applied to patients with acquired immune-deficiency syndrome (AIDS), AIDS-related complex, persistent generalized lymphadenopathy or hepatitis B, those with serological evidence of infection by human immunodeficiency virus or hepatitis B virus, and those in medical and social categories with a higher than average prevalence of such infections. When the identification of these categories of patient would be particularly difficult, the precautions should be applied to all patients, in situations of high risk for inoculation incidents. Rational infection-control measures, based on the known mode of spread, permit efficient management of infected patients, with satisfactory protection of staff and other patients.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Acute epididymo-orchitis caused by Pseudomonas aeruginosa and treated with ciprofloxacin.

Acute epididymo-orchitis caused by Pseudomonas aeruginosa is relatively unusual but difficult to treat, especially in the elderly. We report three cases involving P. aeruginosa all of which concerned patients with preexisting genito-urinary disease. The properties of ciprofloxacin make it suitable for the treatment of this condition. Its use was followed by clinical cure in all three patients and eradication of P. aeruginosa in two of them.

Administration, Oral↗
PubMed1989

Roxithromycin as a possible agent for prophylaxis of endocarditis: a study in normal volunteers.

A single dose of roxithromycin, 300 mg, was taken by six healthy male volunteers on three occasions at consecutive weekly intervals. It was well tolerated. On the first two occasions, roxithromycin was assayed in serum samples taken at intervals up to 8 h after the administration. The mean peak concentration at 1 h was 3.0 mg/l (range 0.3-7.3). The serum samples from the volunteers showed variable bactericidal activity against a strain of Streptococcus sanguis isolated from a case of bacterial endocarditis. Roxithromycin was not detected in saliva or gingival fluid. Smooth surface plaque samples taken at intervals were investigated for the emergence of streptococci resistant to roxithromycin at 2 and 8 mg/l. Initially two volunteers had small number of roxithromycin-resistant streptococci. At the end of the study all six volunteers had resistant streptococci detectable in their plaque samples and these accounted for 100% of the streptococci in two volunteers. The most resistant isolates (in several cases with MIC greater than 64 mg/l) were Str. sanguis or Str. mitior; individual volunteers tended to yield the same strain on consecutive samplings.

Anti-Bacterial Agents↗
PubMed1989

Impaired sweating in the diabetic neuropathic foot and its influence on skin flora.

Three groups each of 10 subjects, were defined by clinical and neurophysiological studies: diabetic with neuropathy (Group A), diabetic without neuropathy (Group B) and normal control (Group C). Sweating on the foot was quantified and the bacterial flora on the dorsum of the foot and deltoid area were examined. There were no significant differences in type of density of bacterial species found on either foot or deltoid regions between any of the three groups. Diabetics free of clinical infection have a similar skin microbial flora to non-diabetics even when sweating is seriously impaired. It is therefore unlikely that a change in the resident microbial flora is involved in the propensity of diabetic neuropathic patients to foot ulceration and infection.

Actinomycetales↗
PubMed1979

Antibodies to Candida species after operations on the large intestine: observations on the association with oral and faecal yeast colonization.

The occurrence of agglutinating and precipitating antibodies to Candida species was determined in 50 patients undergoing operations on the large intestine. The number of patients with oral or faecal yeast colonization and the amount of faecal colonization increased during the period after operation. No patient developed overt fungal infection but 15 patients developed precipitins to mannan antigens and 9 patients developed percipitins to cytoplasmic antigens during this period. The association between the formation of precipitins and the extent of faecal colonization is discussed.

Adult↗
PubMed1979

Therapy of fungal infections of the central nervous system.

Fungal infections of the central nervous system present a considerable challenge to available chemotherapy and other forms of treatment. The particular difficulties are discussed here, after an account of the fungi involved and their sensitivity to antifungal agents. Cryptococcal, coccidioidal and candidal infections are considered in more detail.

Antifungal Agents↗
PubMed1979

Antifungal agents.

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Antifungal Agents↗
PubMed1978

A hospital epidemic caused by gentamicin-resistant Klebsiella aerogenes.

In the 15 months, February 1976 to April 1977, more than 241 patients became colonized with a strain of Klebsiella aerogenes, capsular serotype K2, resistant to most antibiotics. Urinary tract infection was the most common clinical manifestation but bacteraemia and, occasionally, infections of other sites were encountered. The main reservoir of the epidemic klebsiella was the gut, urine and skin of colonized patients. Gut carriage among staff was very uncommon. The most susceptible patients were elderly males, with debilitating illnesses and urinary tract abnormalities, especially if they were catheterized or receiving antibiotics. Likely vehicles for spread were the hands of staff, and contaminated bedpans and urinals. Control measures were directed at these factors. At the end of April 1977 no new cases had occurred for 3 months in the ward in which the outbreak began, and which had been the main focus of infection, and only 5 patients in the affected hospitals were known to be colonized by the epidemic klebsiella.

Cross Infection↗
PubMed1978

Isolation of Staphylococcus aureus from sputum in cystic fibrosis.

The success in the isolation of Staphylococcus aureus of different methods of sputum processing was investigated in 60 specimens collected from 14 patients with cystic fibrosis during a seven-month period. Fifty specimens (83%) from 11 patients yielded Staph. aureus by one or more methods. Direct plating of purulent portions of sputum on to media designed for general use in respiratory infections gave unsatisfactory results (35% yield of Staph. aureus). Some increase in isolations was obtained with preliminary liquefaction of sputum; but the best results were given by the addition of a medium selective for staphylococci (mannitol salt agar, BBL) or by initial sonication of sputum (each 83% yield). Seven of the 11 strains of Staph. aureus were thymidine-dependent and otherwise atypical in laboratory characteristics; these were isolated from patients who had received co-trimoxazole.

Adolescent↗