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Biomedical subjects

D J Flournoy

Publications and source records attributed to D J Flournoy.

At least 19 recordsLinked to original sources
PubMed1992

A pseudo-outbreak of Methylobacterium mesophilica isolated from patients undergoing bronchoscopy.

An unusual, slow growing, pink-pigmented gram-negative bacillus was isolated from bronchoscopy specimens of seven patients over a three-month period. The organism was identified as Methylobacter mesophilica. None of the patients were believed to be infected with Methylobacter mesophilica. The results of environmental cultures showed that the organism was present in tap water from the bronchoscopy room.

Adult↗
PubMed1992

Prevalence of Lyme disease infection in Oklahoma.

Even though Lyme disease probably existed in Oklahoma prior to 1975 when the disease was first reported in Connecticut and even though ecological conditions favor a high prevalence, an unexpectedly low rate was evidenced in both a serological survey and the number of cases reported to the Oklahoma State Department of Health. Lyme disease does not appear to pose a significant public health threat in Oklahoma at the present time; however, the the presence of all the necessary factors for transmission and the rapidly increasing number of cases reported in nearby areas merits continued surveillance in this state. The need for consistent case definition is discussed.

Enzyme-Linked Immunosorbent Assay↗
PubMed1992

Lethal Staphylococcus aureus-induced shock in primates: prevention of death with anti-TNF antibody.

A successful experimental treatment for gram-positive sepsis to our knowledge has not been achieved. The objectives of this study were to develop a nonhuman primate model of lethal gram-positive sepsis employing the micro-organism Staphylococcus aureus and to determine the efficacy of treatment using monoclonal antibody (MAb) to tumor necrosis factor alpha (TNF). The antibody was administered intravenously, 15 mg/kg, 30 minutes after the beginning of a 2-hour infusion of S. aureus, 4 x 10(10) colony forming units/kilogram. The baboons infused with S. aureus demonstrated the release of the cytokines TNF and interleukin-6 (IL-6), but endotoxin was not observed in the plasma at any time. Treatment with antibody to TNF abolished the rise in serum TNF levels and reduced the increased levels of IL-6. Treatment with MAb to TNF prevented multiple organ failure and achieved permanent (> 7 day) survival of all baboons.

Animals↗
PubMed1992

A descriptive analysis of urine cultures: pure versus mixed isolates.

Out of 5,670 urine cultures performed in 1989, 1,448 positive cultures with unique results were analyzed. Of these 1,448, 67% were pure cultures, and 50% had at least one isolate with a colony count greater than 100,000 colony forming units/ml. Pseudomonas aeruginosa, Enterococcus faecalis, Proteus mirabilis, Klebsiella pneumoniae, Staphylococcus aureus, and diphtheroids were more likely (p < 0.01) to occur in mixed than pure culture, while Escherichia coli was more likely to occur in pure than mixed culture. The most common organism combinations were diphtheroids-coagulase negative Staphylococcus (30 cultures), E. faecalis-coagulase negative Staphylococcus (28), E. faecalis-P. aeruginosa (13), K. pneumoniae-P. aeruginosa (9), and E. coli-P. aeruginosa (9).

Bacteria↗
PubMed1991

A comparison of bacterial resistance to antimicrobials in Riyadh, Medina, and Oklahoma City.

Many bacteria are known to develop resistance to anti-microbial agents following their clinical use. The resistance pattern varies from one geographic location to another depending upon the patient population and local history of antibiotic use. The bacterial resistance to commonly used antimicrobial agents in Oklahoma City was found to be different from two cities in Saudi Arabia, especially amongst Gram-negative bacilli. A total of 13,575 fresh clinical isolates from the Veterans Administration Medical Center (VAMC), Oklahoma City, Oklahoma; the King Faisal Specialist Hospital and Research Centre (KFSH), Riyadh; and the King Fahad Hospital (KFH), Medina, Saudi Arabia; were used. There were 6,270 isolates of Enterobacteriaceae, 2,799 pseudomonads and Acinetobacter, and 4,506 Gram positive strains of staphylococcus bacteria. Gram-negative bacteria from KFH were considerably more resistant to ampicillin, gentamicin, and trimethoprim-sulfamethoxazole than at KFSH and VAMC. On the other hand, Staphylococcus aureus isolated from VAMC exhibited a significantly higher degree of resistance to oxacillin and trimethoprim-sulfamethoxazole than those at KFSH and KFH.

Anti-Bacterial Agents↗
PubMed1991

A comparison of human and animal mouth flora.

Human bite injuries are often believed to be more serious than animal bite injuries. One reason for this distinction might be a species difference in the microbial mouth flora. In order to compare this possibility, we cultured the mouths of humans, dogs, and cats. Human oral flora contained the smallest number of bacteria followed by dog and cat oral flora, respectively. Veillonella parvula was cultured from all humans and was also found in dog and cat mouths, but less frequently. V parvula is not usually considered a virulent organism but occasionally may become a pathogen and should not be overlooked especially following human bite injury.

Animals↗
PubMed1991

Descriptive analysis of diagnosis-related groups in patients from a Veterans Administration Medical Center.

Discharge diagnoses from October 1, 1987 to September 30, 1988 were analyzed to quantitate infection. Four hundred forty-nine (4.8%) of 9,290 discharges (excluding 1-day stays) were infections. Pneumonia, caused by all etiological agents, was responsible for 2.4% of the principal diagnoses. These data help define the role of infection in hospitalized veterans and further supports earlier findings that respiratory tract infections are the most common of all infections in our veterans.

Cross Infection↗
PubMed1991

Flow characteristics of enteral feeding with psyllium hydrophilic mucilloid added.

One therapy for managing diarrhea in patients in intensive care units who are receiving enteral nutrition is administration of psyllium hydrophilic mucilloid (PHM). This laboratory study was conducted to determine whether the addition of PHM (Metamucil) to enteral feeding formula (Entrition) adversely affected the flow characteristics of the feeding formula through a small-bore feeding tube. Descriptive data were obtained from 72 trials of feeding formula with varied infusion rates, formula osmolality and temperature, and PHM concentrations. Two thirds (n = 48) of the trials were successful (PHM did not clog the tubing and obstruct flow). The remaining one third of the trials (n = 24) were unsuccessful. Successful formula infusion was influenced by formula temperature and osmolality but not by infusion rate, PHM concentration, or flow interruption. If formula with PHM was followed by formula without PHM, the infusion was successful regardless of infusion rate or formula osmolality. Thus, the data from this laboratory study indicate that when therapeutic doses of PHM are prescribed, it is feasible for PHM to be mixed in room-temperature feeding formula and infused without clogging the feeding tube.

Administration, Oral↗
PubMed1991

The relationship of immunity and nutrition to the acquisition of methicillin-resistant Staphylococcus aureus.

Selected nutritional and immunological indices of 118 patients with methicillin-resistant Staphylococcus aureus (MRSA) were reviewed retrospectively. Those patients with nosocomial infections had significantly (P less than .05) lower levels of serum albumin, total protein, absolute lymphocyte, and percentage of lymphocytes (on differential) than all others (ie, community-acquired infections and colonizations and nosocomial colonizations). Therefore, these parameters might be important indicators of subsequent MRSA infestation in certain patient populations.

Aged↗
PubMed1991

Enterococcus: an old pathogen with new tricks.

Recent clinical enterococcal isolates from the Oklahoma City Department of Veterans Affairs Medical Center were screened for high-level aminoglycoside resistance, vancomycin resistance, beta-lactamase production, and hemolysin production. Twenty-nine of 53 (55%) enterococcal isolates had high-level resistance to gentamicin, kanamycin, or streptomycin; 27 of these isolates were from the blood and 16 (59%) showed high-level gentamicin resistance. Twenty-one percent of 259 enterococcal isolates from blood, urine, stool, and other sources were hemolytic. Of thirteen blood isolates tested for both high-level gentamicin resistance and hemolysin production, 6 (46%) showed both characteristics. Vancomycin-resistant or beta-lactamase-producing isolates were not found. Nineteen of 21 charts from patients with premortem enterococcal blood isolates were reviewed, and no correlation was found between appropriate antibiotic treatment for high-level gentamicin-resistant or susceptible enterococcal bacteremia and outcome. Enterococci with multiple high-level aminoglycoside resistance, but not vancomycin resistance or beta-lactamase production, are common at this referral medical center. Clinical microbiology laboratories in Oklahoma should routinely screen enterococcal isolates causing potentially serious infections (eg, from blood or cerebral spinal fluid) for high-level aminoglycoside resistance.

Anti-Bacterial Agents↗
PubMed1991

The relationship of septicemia-related diagnoses and positive blood cultures.

In order to determine the relationship of blood culture results and septicemia-related diagnoses, laboratory and patient chart records were evaluated on 25 intensive care unit patients who were hospitalized in 1989. Overall, there were 14 in whom the DRG and blood culture results were both positive, 4 with positive DRGs and negative blood cultures, and 7 with negative DRGs and positive blood cultures. These findings suggest that neither positive blood culture results nor diagnosis codes are entirely accurate indicators of the overall incidence of septicemia, and that the two indicators were not closely associated in our hospital.

Bacteremia↗
PubMed1990

Screening media for detection of methicillin-resistant Staphylococcus aureus from non-sterile body sites.

Four hundred and forty clinical isolates were tested on Baird-Parker and Vogel-Johnson agars with 6 micrograms/ml of oxacillin, to determine their growth characteristics on these potential screening media for methicillin-resistant Staphylococcus aureus (MRSA). While both media performed well individually, a combination biplate with each medium may be the most useful in screening patients for MRSA from normally non-sterile sites.

Adult↗
PubMed1990

In vitro antimicrobial susceptibilities of 349 methicillin-resistant Staphylococcus aureus isolates from veterans.

Three hundred and forty-nine methicillin resistant Staphylococcus aureus (MRSA) isolates from veterans were tested (by disc agar diffusion) for their in vitro activity against 18 antimicrobial agents. At least 90% of the isolates were susceptible to bacitracin, nitrofurantoin, hydrogen peroxide, novobiocin, netilmicin and vancomycin. We feel that the aminoglycoside, netilmicin, might provide an alternative agent (to intravenously administered vancomycin) for treating multiply-antimicrobial resistant MRSA. In addition, hydrogen peroxide exhibited very good activity against the test isolates and may have some use as a topical agent for reduction of MRSA on skin and some mucous membranes. This study suggests that further evaluation of netilmicin and hydrogen peroxide (topical only) might be useful.

Anti-Bacterial Agents↗
PubMed1990

Contamination of enteral feedings and diarrhea in patients in intensive care units.

To investigate the effect of contamination of enteral feeding solutions on the incidence of diarrhea in critically ill patients, 36 adult intensive and coronary care unit patients received enteral feeding by an aseptic or a routine protocol. Cultures of formula were obtained on the first 4 days of enteral feeding. A significantly greater incidence of contamination was found for the routine protocol group than for the aseptic protocol group (p less than 0.05); however, differences in incidence of diarrhea between subjects who did and did not receive contaminated formula were not significant. Subjects who had diarrhea also had significantly lower (p less than 0.05) serum albumin and transferrin levels. The effects of severity of illness, osmolality, and rate of formula administration on incidence of diarrhea were investigated, and these were not found to be significant factors. Implications for nursing practice and further research are generated.

Adult↗
PubMed1990

Incidence of Legionella pneumophila infections among Oklahoma pulmonary disease patients.

Prior studies by the authors suggested high levels of Legionella pneumophila in the recreational and water supply reservoirs in central Oklahoma. This high exposure potential was supported by a relatively high prevalence of seropositive, asymptomatic infections among healthy blood donors in the area. In contrast, the present 9-month laboratory-based study confirmed only one clinical Legionella infection among 117 unidentified pulmonary disease patients admitted to the Oklahoma City Veterans Administration Medical Center. Comparison with the reports of others and with reported legionellosis in Oklahoma indicates that differences in cohort definition and variations in utilization and interpretation of clinical analyses leads to wide variations in the reported incidence of legionellosis.

Humans↗