Biomedical subjects
D MacCulloch
Publications and source records attributed to D MacCulloch.
Education may help reduce Yersinia sepsis from blood transfusion.
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Direct antigen test for group A streptococcal pharyngitis.
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Investigation of nosocomial prosthetic valve endocarditis due to antibiotic-resistant Staphylococcus epidermidis.
A reservoir of antibiotic-resistant Staphylococcus epidermidis strains in our cardiac surgery unit appeared to be the source of organisms responsible for three cases of early prosthetic valve endocarditis. Staphylococcus epidermidis isolates recovered from the skin of 13 patients before and after surgery were compared. All were typed by plasmid profile, antimicrobial susceptibility and slime production. The three strains from early prosthetic valve endocarditis resembled the antibiotic-resistant nosocomial strains recovered from the skin of eight patients following surgery and the environment of the operating theatres. These strains expressed resistance to oxacillin, gentamicin, kanamycin and tobramycin and most produced slime, whereas those isolated from the skin of patients at the time of admission were predominantly susceptible to antibiotics and few produced slime.
Water associated infections.
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Adaptation of methicillin-resistant Staphylococcus aureus during antibiotic therapy.
Colonization of a patient by methicillin-resistant Staphylococcus aureus (MRSA) of a single phage-type for over four years is described. During this period we observed the appearance and disappearance of resistance to erythromycin, clindamycin, gentamicin, kanamycin, tobramycin, neomycin and mupirocin. We also saw stepwise increases in methicillin resistance and reversible changes in physical appearance and the colonizer pathogen role. Correlation of clinical observations, details of antibiotic therapy and laboratory studies demonstrated that adaptation of MRSA during antibiotic therapy favoured MRSA establishment and predominance.
Antibacterial activity of mupirocin (Bactroban)
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Cephalosporin susceptibility of methicillin-resistant, coagulase-negative staphylococci.
Coagulase-negative staphylococci were tested for susceptibility to methicillin, cephradine, ceftriaxone, cephalothin, and cefamandole by standard broth microdilution. Most of the 26 methicillin-resistant isolates were susceptible to cephalothin and cefamandole, but very few were susceptible to ceftriaxone, and none was susceptible to cephradine. The proportion of bacterial cells that grew in the presence of 128 micrograms of methicillin per ml was calculated for each methicillin-resistant isolate. Those with every cell or 1 in 10 cells resistant to 128 micrograms of methicillin per ml included the isolates that were most resistant to the cephalosporins and highly resistant to methicillin. Those with 1 cell resistant in 10(5) or 10(6) cells were the isolates most susceptible to the cephalosporins, and their methicillin MICs were lower. When cells resistant to 128 micrograms of methicillin per ml were used as inocula for broth microdilution tests, resistance to cephradine remained the same, but resistance to ceftriaxone, cephalothin, and cefamandole increased significantly. Cefamandole was the only cephalosporin which retained antibacterial activity against some methicillin-resistant isolates (12 of 26). Cephradine, ceftriaxone, cephalothin, and cefamandole resistance appeared to be expressed by the same cells that expressed methicillin resistance. In this way, cross resistance was demonstrated between methicillin and the cephalosporins.
Comparison of a beta-lactamase induction test with a test that detects low-frequency resistance to cefotaxime.
A paper strip test that detects cefotaxime-resistant variants of gram-negative bacilli was described and compared with a beta-lactamase induction test. Both tests demonstrated a potential for resistance that is not indicated by standard agar dilution and agar diffusion tests.
Culture negative infective endocarditis.
Twenty cases of culture negative infective endocarditis admitted to the Cardiology Department of Green Lane Hospital from 1959 to 1980 out of a total of 265 cases (7.5%), were analysed retrospectively. Cases were included only when adequate proof of endocarditis was available at surgery or postmortem. Indiscriminate use of antibiotics before taking blood cultures was the most common association with failure to obtain positive cultures, seen in 16 of the 20 patients described. Failure to obtain positive cultures in four cases was attributed to inadequate bacteriologic techniques before 1967. Where no antibiotics were given prior to collecting blood cultures and bacteriologic techniques were adequate, proven culture negative endocarditis was virtually unknown. When antibiotics have been given, repeated blood cultures are recommended following withdrawal of antibiotic for at least four days.
Bacterial endocarditis due to Kingella kingae.
A case of infective bacterial endocarditis due to Kingella kingae in a 26 year old male involving a prosthetic mitral valve is described. Microbiological features of this organism are outlined, and the treatment of this endocarditis is discussed with reference to the four previously reported cases.
Disinfection of human heart valve allografts with antibiotics in low concentration.
Antibiotic disinfection of allograft heart valves is now an established procedure. A new low-concentration, broad-spectrum mixture of antibiotics was formulated and used successfully to disinfect 58 of 60 human aortic and pulmonary valves after 48 h exposure at 4 degrees C. The antibiotics included were cefoxitin 240 mcg/ml, lincomycin 120 mcg/ml, polymyxin B 100 mcg/ml, vancomycin 50 mcg/ml and amphotericin B 25 mcg/ml. Microorganisms isolated from experimental tissue and from clinical valves before treatment were tested for sensitivity to these antibiotics and were found to be sensitive to one or more. One isolate of Pseudomonas spp. showed decreased sensitivity to polymyxin B, and was found to have a minimum bactericidal concentration of 70 mcg/ml. Results indicated this antibiotic mixture had superior antibacterial efficiency to that in routine clinical use for the past 13 yr.
Antibiotics and streptococcal infections.
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In-vitro activity of cefoxitin against recent clinical bacterial isolates.
The susceptibility of 635 clinical isolates of bacteria to cefoxitin was determined. Isolates from the urinary tract showed 97% sensitivity, isolates from infected wounds showed 93% sensitivity and 82% of blood culture isolates were sensitive. Streptococcus faecalis isolates showed only 50% sensitivity and pseudomonas organisms were predominantly resistant. Bacteria isolated from unprepared heart valves submitted for use as homografts showed only 71% sensitivity due to the large proportion of Streptococcus and Pseudomonas species isolated.
Urinary tract infections.
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Endocarditis due to Citrobacter diversus developing resistance to cephalothin.
A 43-year-old man was admitted with acute bacterial endocarditis. Citrobacter diversus susceptible to cephalothin was isolated from blood cultures. Citrobacter diversus was later isolated from the aortic valve cusps at surgery, but this isolate was resistant to cephalothin. Laboratory testing showed that the Citrobacter diversus recovered from blood cultures was capable of producing mutants highly resistant to cephalothin.
Letter: Drug-induced red cell aplasia.
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