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Biomedical subjects

D S Gilmore

Publications and source records attributed to D S Gilmore.

At least 19 recordsLinked to original sources
PubMed1997

Wound infections following spinal fusion with posterior segmental spinal instrumentation.

Twenty-three of 238 patients (9.7%) developed wound infections following segmental spinal instrumentation. When the infected group and a matched control group were compared, the infected group had a significantly higher number of patients with cerebral palsy and myelodysplasia (nonambulatory), patients with wound hematomas, patients with fusions that extended into the sacral region, and patients who were incontinent of urine. A high incidence of infections with gram-negative aerobic bacilli correlated with the extension of the surgery into the sacral region and bowel and/or bladder incontinence. Prophylactic antibiotics with broader coverage for gram-negative bacilli may be warranted for these procedures. Postoperative wound infections were managed by surgical drainage and debridement as well as antibiotics. Removal of the hardware was not necessary to control the infection in these patients who underwent segmental spinal instrumentation.

Adolescent↗
PubMed1995

A peaceful coexistence? State MR/DD agency trends in integrated employment and facility-based services.

National survey data reported by state MR/DD agencies for integrated and segregated employment and facility-based nonwork services provided during FYs 1988 and 1990 were examined. The percentage and total number of individuals in integrated employment grew significantly across the 2 years. However, there were no significant changes in the percentage or number served in facility-based settings. State MR/DD agencies continue to fund a dual service system, with the vast percentage of total resources allocated to segregated programs. Policy and funding incentives need to be developed to stimulate conversion of segregated services to integrated employment.

Adult↗
PubMed1993

Increased frequency of large R-plasmids in Klebsiella pneumoniae colonizing patients with spinal cord injury.

From 1978 to 1988 strains of gentamicin-susceptible (Gms) and gentamicin-resistant (Gmr) Klebsiella pneumoniae were saved from annual surveillance cultures of the perineal region of patients with spinal cord injury (SCI). Of 38 strains selected for further study (24 Gms and 14 Gmr), there were 23 different serotypes (two nontypable). Fourteen Gms as well as 14 Gmr strains displayed no common plasmid patterns, but all contained a large plasmid of 168-208 kb. Among the 14 Gmr strains, nine had large conjugative plasmids of approximately the same size (166-193 kb), which conferred to a susceptible Escherichia coli host an identical resistance pattern: ampicillin, chloramphenicol, gentamicin, piperacillin, trimethoprim-sulfamethoxazole, tetracycline, and tobramycin. Of the nine transconjugants, eight contained a single plasmid. One transconjugant contained a 168- and 80-kb plasmid. Restriction endonuclease digestion patterns of the R-plasmids revealed minimal similarity. We conclude that, during a 10-year period, different large R-plasmids have spread among multiple serotypes of K. pneumoniae in spinal cord injury (SCI) patients in one rehabilitation hospital. We hypothesize that other genes located on large, R-, and non-R-plasmids may confer an additional advantage for colonization by K. pneumoniae in SCI patients.

Conjugation, Genetic↗
PubMed1992

Effect of external urinary collection system on colonization and urinary tract infections with Pseudomonas and Klebsiella in men with spinal cord injury.

Urinary tract infection of men with spinal cord injuries has been associated with a high incidence of colonization of the patients with gram-negative bacilli. We have examined the factors influencing colonization of 119 patients with Pseudomonas and Klebsiella and studied methods of reducing this colonization. The urethra, perineum, rectum, and drainage bag of all patients were cultured on selective media at two week intervals until discharge. The use of the external urinary collection system (EUCS) was discontinued in a group of patients at night, in an attempt to reduce colonization. Pseudomonas and Klebsiella were isolated from one or more body sites in 65 percent and 69 percent of total culture days. The urethra, perineum, rectum, and drainage bags were reservoirs of Pseudomonas and Klebsiella in men with spinal cord injuries, even in the absence of urinary tract infections. The EUCS proved to be an important factor influencing colonization. Pseudomonas and Klebsiella colonization was higher in patients using the EUCS. Removal of the EUCS at night reduced urethral colonization with Pseudomonas, but did not significantly reduce urethral colonization with Klebsiella. The prevalence of bacteriuria with Pseudomonas and Klebsiella was not significantly influenced by the use of the EUCS.

Colony Count, Microbial↗
PubMed1990

Ceftazidime in treatment of urinary tract infection in patients with spinal cord injury: comparison with moxalactam.

Ceftazidime was compared with moxalactam in the treatment of urinary tract infections in patients with spinal cord injury. Patients received ceftazidime or moxalactam, 500 mg twice daily for five days. Urine specimens were collected by urethral catheter. Adequate follow-up was obtained in 26 patients treated with ceftazidime and 13 patients treated with moxalactam. The infecting bacteria were not cultured in significant numbers from the urine of any patients after two to four days of antibiotics, except for 1 patient who had Pseudomonas aeruginosa persisting in the urine while receiving ceftazidime. At five to nine days after completing antibiotic therapy, the cure rate was 42 percent for ceftazidime and 15 percent for moxalactam. The rate of reinfection was significantly lower in the ceftazidime group than the moxalactam group.

Adult↗
PubMed1989

Pseudomonas urinary tract infection in patients with spinal cord injury.

Serum antibodies to P. aeruginosa were measured in 28 patients with spinal cord injury before and after the development of bacteriuria during their hospital rehabilitation. Serum IgG, IgA and IgM were measured against the infecting strain of P. aeruginosa isolated from the urine of each patient. After bacteriuria was detected, a significant increase (fourfold or greater) in IgG and/or IgA antibodies was found in nine patients (33%). This increase was significantly associated with leucocytosis. These observations indicate that bacteriuria with P. aeruginosa in patients with spinal cord injury is associated with a serum antibody response in a significant number of patients, indicating tissue invasion by this microorganism.

Antibodies, Bacterial↗
PubMed1989

Long-term colonization of spinal cord injury patients with Klebsiella pneumoniae.

The duration of colonization of the human perineum, bowel, and urethra with Klebsiella pneumoniae was studied in 10 male patients with spinal cord injury while they were undergoing rehabilitation in the hospital. Colonization defined as persistence of klebsiellae of the same serotype occurred on 13 occasions in five of the patients for up to 55 days. Colonization was less marked with Klebsiella than with Pseudomonas spp. The presence of quadriplegia correlated with Klebsiella colonization and also with the presence of positive Klebsiella cultures from the urethra and perineum. Seven episodes of significant bacteriuria occurred with or after the finding of positive cultures from body sites.

Adult↗
PubMed1989

Enterococci highly resistant to penicillin and ampicillin: an emerging clinical problem?

Sixteen clinical isolates of ampicillin-resistant enterococci (ARE) were recovered from the microbiology laboratory of a 450-bed rehabilitation medical center from January 1981 to September 1987. These isolates were detected when a disk diffusion test using 10 micrograms of ampicillin on a blood agar plate revealed no zones of inhibition. Tube macrodilution tests yielded an MIC of greater than or equal to 16 micrograms of ampicillin per ml. None of the isolates were penicillinase producers by the chromogenic cephalosporin disk test. Ten isolates were Enterococcus faecium, four isolates were E. raffinosus, one isolate was E. gallinarum, and one isolate was not identified (lost). There were 6 male and 10 female patients. The sources of isolates were urine (n = 7), wound (n = 5), ascitic fluid (n = 2), blood (n = 2), peritoneal catheter tip (n = 1), Bartholin's cyst abscess (n = 1), rectal swab (n = 2), and pancreatic abscess (n = 1). The organism was isolated from multiple sites in 4 patients, was a pure culture isolate in 5 patients, and was part of a polymicrobial flora in 11 patients. Six patients were diabetic, and four had liver cirrhosis. All but four patients had received at least one antibiotic within 3 weeks of ARE isolation. The MICs (micrograms per milliliter) for 50 and 90% of isolates tested, respectively, were as follows: ampicillin, 64 and 64; penicillin, 128 and greater than 128; vancomycin, 1 and 2; gentamicin, 4 and 16; ciprofloxacin, 1.6 and 3.2; imipenem, 128 and greater than 128; and daptomycin (LY146032), 1.6 and 6.4. ARE may be an emerging pathogen in the hospitalized patient population.

Adolescent↗
PubMed1988

The effects of antiperspirant on the perineal skin flora of patients with spinal cord injury.

The relationship of pH and moisture to Pseudomonas aeruginosa and Klebsiella pneumoniae colonization of the perineal skin was studied in male patients with spinal cord injury. The increased pH of the perineal skin was significantly associated with the presence of P. aeruginosa but not other bacterial species. No correlation between colonization and moisture or pH and moisture was found. An antiperspirant produced a significant reduction in the number of total aerobic bacteria, total gram-negative bacilli, P. aeruginosa and K. pneumoniae over a 24-h period. Long-term use of the antiperspirant for 10 days did not alter the persistence of P. aeruginosa of the same serotypes on the perineum.

Adolescent↗
PubMed1987

Colonization of patients with spinal cord injury with Pseudomonas aeruginosa and Klebsiella pneumoniae at different institutions.

Colonization of patients with Pseudomonas aeruginosa and Klebsiella pneumoniae was studied in patients with spinal cord injury at two institutions in Los Angeles County. The method of care of patients was similar at both institutions. A high prevalence of perineal colonization with P. aeruginosa and K. pneumoniae and similar serotypes of Pseudomonas were seen at both institutions. This colonization probably reflects the type of bladder management in patients with spinal cord injury. It would be of interest to examine other facilities to determine if colonization is influenced by techniques or local factors.

Adult↗
PubMed1987

Klebsiella pneumoniae colonization in patients with spinal cord injury.

Klebsiella pneumoniae colonization of 53 patients with spinal cord injury was studied. Cultures of multiple body sites from patients, the environment, food, and hospital personnel were obtained. K. pneumonaie was cultured from one or more body sites in 46% of male patients. Significant bacteriuria was found in 10% of male patients. Positive cultures of the urethra and perineum for K. pneumoniae were significantly associated with the use of the external condom catheter (p less than 0.05, Fisher's exact test). K. pneumoniae colonization increased with length of stay in the hospital. Serotype 64, the predominant serotype found, was isolated only from patients who had been in the hospital for at least 4 wk and primarily in those patients using the external condom catheter. Urinary drainage bags were frequently colonized with K. pneumoniae at a time when the patients did not have significant bacteriuria. Colonized male patients were found to be the primary reservoir of K. pneumoniae and may serve as the major source for cross-contamination.

Female↗
PubMed1986

Cefsulodin in treatment of Pseudomonas urinary tract infection in patients with spinal cord injury. Comparison with aminoglycosides.

Male patients with spinal cord injury and urinary tract infection with Pseudomonas aeruginosa were treated with cefsulodin (1.0 or 1.5 Gm) every six hours or an aminoglycoside (amikacin 5 mg/Kg or tobramycin 1 mg/Kg) every eight hours for seven days. The study was discontinued after treating 6 patients with aminoglycosides because of the poor results with these antibiotics. At five to nine days after completing treatment P. aeruginosa was eliminated from the urine of 12 to 15 patients (80%) treated with cefsulodin and 3 of 6 patients (50%) treated with an aminoglycoside. When examined at four to six weeks 5 of 15 (33%) of the cefsulodin group had persistent infection or relapse, while 5 of 6 (83%) infections treated with an aminoglycoside either persisted or relapsed. Cefsulodin was discontinued in 1 patient, known to be allergic to penicillin, because of hypersensitivity resulting in periorbital edema and rash. No other serious side effects were noted with cefsulodin or the aminoglycosides. These results indicate that cefsulodin is an effective antibiotic in the treatment of urinary tract infection with P. aeruginosa in patients with neurogenic bladder resulting from spinal cord injury and confirmed previous observations of a poor response of Pseudomonas urinary tract infection to aminoglycosides in this group of patients.

Adult↗
PubMed1986

Category 1, 2, 3 and 4: a procedure-oriented isolation system.

A procedure-oriented isolation system, Category 1,2, 3, and 4, was introduced at a 547-bed, acute and rehabilitative medical center. The system consisted of four categories of isolation which followed a numerical sequence that represented the necessary attire needed to complete the procedure. After 1 year of use, personnel compared the procedure-oriented system with the previously-used system (Strict, Respiratory, Wound and Skin, Enteric, and Limited Barrier). Personnel found the procedure-oriented system easier to understand (84%) and follow (83%). Seventy-six percent felt their isolation techniques had improved with the new system. A reduction in the cross-infection rate with methicillin-resistant Staphylococcus aureus did coincide with the use of the new isolation system, however, no causal relationship was established. The Category 1, 2, 3, and 4 isolation system was well received by personnel and was found to be an effective alternative to the previous, more complicated system used in this setting. Further evaluation of this system in other settings would seem warranted.

California↗
PubMed1984

Effect of antiseptic agents on skin flora of the perineum of men with spinal cord injury.

Male patients with spinal cord injury are frequently colonized with P. aeruginosa and K. pneumoniae on the perineum. Regular bathing with bar soap has not influenced this colonization. We have attempted to remove these bacteria using antiseptic agents. The number of P. aeruginosa, K. pneumoniae and total aerobic bacteria on the perineum and the penile shaft was determined before and after cleaning with bar soap, chlorhexidine, povidone-iodine and pHresh. Povidone-iodine and chlorhexidine had no advantage over bar soap or pHresh in the removal of P. aeruginosa or K. pneumoniae from the perineum of patients with spinal cord injury.

Adolescent↗
PubMed1983

pH and water content of Pseudomonas aeruginosa- and Klebsiella pneumoniae-Colonized Perineal Skin of Men with spinal cord injuries.

Men with spinal cord injuries have a high incidence of Pseudomonas aeruginosa colonization of the perineum. Studies were carried out to determine whether colonization with Pseudomonas aeruginosa or Klebsiella pneumoniae is associated with changes in the pH or surface moisture of the perineal skin. Increased skin moisture correlated with a higher pH (P less than 0.01). In patients using the external urinary collection system, the pH was significantly higher on the perineum of patients colonized with P. aeruginosa or K. pneumoniae than on the perineum of patients not colonized with these bacteria. There was no correlation between moisture and colonization.

Humans↗
PubMed1982

Pseudomonas aeruginosa colonization in patients with spinal cord injuries.

The prevalence of Pseudomonas aeruginosa colonization of patients with spinal cord injury was studied annually from 1976 to 1980. The urethra, perineum, rectum, drainage bag, and urine of patients on the spinal cord injury service were cultured. A total of 224 men and 32 women were studied. Most patients were managed with an external urinary collection system or padding, with or without intermittent catheterization. P. aeruginosa was cultured from one or more body sites (urethra, perineum, or rectum) in 65% of men and 18% of women. Drainage bags on the beds were frequently colonized with P. aeruginosa (73%). Significant bacteriuria with P. aeruginosa was present in 19% of the men and 13% of the women. P. aeruginosa colonization of body sites in men was closely associated with the use of an external urinary collection system. Significantly greater urethral and perineal colonization was found in men using an external urinary collection system. P. aeruginosa serotype 11 was the predominant serotype for the first 3 years, and the number of patients colonized with serotype 11 increased with length of hospital stay. The prevalence of serotype 11 significantly decreased in the last 2 years. The antibiotic susceptibility of the strains of P. aeruginosa isolated from these patients did not change in the 5 years, except that there was increasing susceptibility to carbenicillin in later years. This increasing susceptibility to carbenicillin was a reflection of a decreased prevalence of serotype 11 in these patients, since serotype 11 was more resistant than other serotypes to carbenicillin.

Adolescent↗