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Biomedical subjects

D W Burdon

Publications and source records attributed to D W Burdon.

At least 19 recordsLinked to original sources
PubMed1991

Effects of chlorhexidine-coated intrauterine device on the bacteriology of the uterine cavity.

Twenty-nine women, aged 31-53 years, scheduled for an abdominal hysterectomy, participated in this study. The patients were divided into three groups. The first received a Multiload MLCu250 intrauterine device (IUD); the second group received a chlorhexidine acetate medicated Multiload MLCu250 IUD; the third group acted as a control group receiving no IUD. Bacteriological cultures of the vagina and ectocervix were taken prior to insertion of the IUD. At hysterectomy, some 18 hours later, specimens were taken from the cervical canal, uterine cavity, and the device itself, for culture of anaerobic and aerobic organisms using a standardized previously validated technique. In three of the nine control patients, organisms were cultured from the uterine cavity. There were no differences between the bacteriological results of the two groups with medicated and non-medicated devices, with regard to the cultures from the cervical canal, uterine cavity or the devices themselves. Nor was there any difference between the control and the IUD group.

Adult↗
PubMed1990

Short-term chemoprophylaxis with ceftizoxime vs. five-day aminoglycoside with metronidazole in 'contaminated' lower gastrointestinal surgery.

In a prospective, open, randomized controlled trial, 173 patients requiring surgery for potentially "contaminated" lower gastrointestinal surgery were allocated to receive either two doses of ceftizoxime (2 gm) with one dose of metronidazole (1.5 gm) or gentamicin 3 mg/kg/day for five days with one dose of metronidazole (1.5 gm). Eighty-nine patients received ceftizoxime and 84 patients received gentamicin. The groups were comparable with respect to diagnosis, procedure, type of anastomosis, and wound closure. The incidence of withdrawal due to failure to respond to the study drug (11.5 percent) was equivalent in the two groups. There was no difference in the overall incidence of postsurgical infection between the ceftizoxime and metronidazole group (22.2 percent) and the gentamicin and metronidazole group (25.7 percent). The incidence of wound infection (ceftizoxime and metronidazole, 6.9 percent; gentamicin and metronidazole, 10 percent) and deep sepsis (ceftizoxime and metronidazole, 15.3 percent; gentamicin and metronidazole, 15.7 percent) was similar.

Aminoglycosides↗
PubMed1990

Studies of a novel agent possessing resistance to moist heat and disinfectants: parallels with Creutzfeldt-Jakob agent.

The resistance to sterilization and disinfection of a novel replicating agent (IFDO) with similarities to Creutzfeldt-Jakob agent (CJA) was investigated. Moist heat at 121 degrees C for 30 min did not kill the agent. Increasing the temperature to 140 degrees C, and the length of the autoclave cycle to 120 min also failed to guarantee sterilization, although some samples were sterilized after these treatments. Dry heat at 160 degrees C for 1 h sterilized 24 of 25 samples. Overnight disinfection with 10% Stericol or 1.2% chlorhexidine left few detectable survivors. Samples pretreated with these disinfectants and then autoclaved at 134 degrees C for 20 min were sterilized. Disinfection with hypochlorite (500 ppm available chlorine) was very effective if organic matter derived from spent culture medium was removed. We have adopted overnight Stericol disinfection, followed by autoclaving at 134 degrees C for 1 h for sterilization of glassware contaminated by IFDO. The agent may provide a valid model for sterilization of items contaminated with CJA and, if so, our data suggest that current disinfection guidelines for CJA by autoclaving at 134 degrees C for 1 h are inadequate.

Creutzfeldt-Jakob Syndrome↗
PubMed1979

Comparison between systemic and oral antimicrobial prophylaxis in colorectal surgery.

In a prospective randomised trial in which 93 patients undergoing elective colorectal operations were given a short prophylactic course of metronidazole and kanamycin orally or systemically, postoperative sepsis occurred in only 3 (6.5%) of those given antimicrobials systemically, compared with 17 (36%) of those given oral prophylaxis (P less than 0.01). 15 of the 17 infections in patients who received antimicrobials orally were due to kanamycin-resistant bacteria present in the colon at operation. Bacterial overgrowth of Staphylococcus aureus was recorded in 6 of the patients who received oral therapy. Antibiotic-associated pseudomembranous colitis occurred in 7 patients, 6 of whom had received prophylaxis orally. These results indicate that oral administration of prophylactic antimicrobials in colon surgery should be avoided because of the risks of bacterial resistance, superinfection, and antibiotic-associated pseudomembranous colitis. Systemic per-operative antimicrobial prophylaxis is safer and more effective.

Administration, Oral↗
PubMed1979

Antibiotic-associated colitis--a review of 66 cases.

We have reviewed 66 cases of antibiotic-associated colitis since March 1975, which have been associated with a 27 per cent mortality. We believe antibiotics may predispose patients to this condition which is caused by a toxin produced by Clostridium difficile. Although the disease is rare, it is more common than previously reported. The presentation, methods of diagnosis and treatment are discussed.

Adolescent↗
PubMed1979

Influence of neomycin and metronidazole on colonic microflora of volunteers.

The influence on colonic microflora of neomycin and metronidazole alone, or in combination, was studied in volunteers taking a normal diet. Bacterial counts on daily faecal samples revealed that metronidazole had no influence on anaerobic faecal bacteria. Neomycin on the other hand, was effective against sensitive aerobes. However, the combination of neomycin and metronidazole profoundly reduced both aerobic and bacteria. Assay of faecal antibiotic concentrations showed that neomycin achieved high intraluminal levels while metronidazole was undetectable or present at low concentrations.

Bacteroides fragilis↗
PubMed1978

Randomised controlled trial of vancomycin for pseudomembranous colitis and postoperative diarrhoea.

The efficacy of vancomycin in pseudomembranous colitis was assessed in a prospective randomised controlled trial. Forty-four patients with postoperative diarrhoea were allocated to five days' treatment with either 125 mg vancomycin six-hourly or a placebo. Sixteen patients had high titres of the neutralised faecal toxin characteristic of pseudomembranous colitis; nine received vancomycin and seven placebo. At the end of treatment faecal toxins were present in one patient given vancomycin compared with five of the controls. Vancomycin caused the disappearance of Clostridum difficile from the stool in all except one patient, whereas toxicogenic strains of Cl difficile persisted in all but one of the controls. Histological evidence of psuedomembranous colitis had disappeared by the end of treatment in six out of seven patients given vancomycin compared with only one out of seven patients given vancomycin compared with only one out of five patients given placebo. In patients with faecal toxins bowel habit had returned to normal in seven of the vancomycin group compared with only one of the controls, but there was no significant difference in clinical response among patients without faecaal toxins. The results suggest that vancomycin eliminates toxin-producing Cl difficile from the colon and is associated with rapid clinical and histological improvement in patients with pseudomembranous colitis.

Bacterial Toxins↗
PubMed1978

Diarrhoea and pseudomembranous colitis after gastrointestinal operations. A prospective study.

241 patients who had gastrointestinal operations were studied prospectively. Postoperative diarrhoea occurred in 58 patients (24%) and was significantly more common after exposure to antibiotics. 9 patients (4%) had high titres of a neutralisable faecal toxin characteristic of pseudomembranous colitis. Toxigenic Clostridium difficile strains were isolated from the stools of all patients with neutralisable faecal toxin. If pseudomembranous colitis is defined as the presence of neutralisable faecal toxin, then the diagnosis is often missed by sigmoidoscopy and rectal biopsy.

Anti-Bacterial Agents↗
PubMed1978

Prediction of wound sepsis following gastric operations.

Gastric aspirates were obtained from 12 healthy volunteers, 49 patients with duodenal ulcer, 14 with gastric ulcer and 35 with gastric carcinoma. The mean total viable bacterial counts in these groups were as follows: volunteers 0, duodenal ulcer 3.8 X 10(1), gastric ulcer 6.95 X 10(4), carcinoma 1.9 X 10(7) organisms/ml. The incidence of wound sepsis in patients without antibiotic cover was; duodenal ulcer 17 per cent, gastric ulcer 38 per cent, carcinoma 56 per cent. Regardless of the underlying pathology, patients with counts greater than 5 X 10(6) organisms/ml in the gastric aspirate had a 93 per cent incidence of wound sepsis, compared with 16 per cent in patients with counts of less than 5 X 10(6) organisms/ml (P less than 0.001). In the group with high counts all except one of the wound infections were caused by organisms present in the stomach at the time of operation. There was a good correlation in the bacteriology of apirates obtained during preoperative endoscopy compared with operative nasogastric samples (n = 31) both for viable counts (r = 0.93) and for the counts of individual organisms. Therefore, preoperative endoscopy can be used to identify patients who are at risk of developing wound sepsis after gastric surgery.

Duodenal Ulcer↗
PubMed1978

Influence of bowel preparation and antimicrobials on colonic microflora.

The influence of three types of preoperative mechanical bowel preparation on colonic microflora has been studied in 88 patients undergoing elective bowel resection and compared with 21 controls. Neither conventional bowel preparation (CBP) using oral magnesium sulphate, enemas and rectal washouts nor whole bowel irrigation (WBI) via a nasogastric tube influenced the type or number of organisms in the colon at the time of operation. The administration of an elemental diet (ED) was associated with only a small reduction the numbers of Escherichia coli (P less than 0.02). The addition of oral neomycin and metronidazole for 48 h before operation to all three methods of bowel preparation was associated with a highly significant reduction in the counts per ml of E. coli (P less than 0.001) and Bacteroides fragilis (P less than 0.001) in the colon. There was no correlation between the diameter of the lesion being resected with the numbers of bacteria in the colon even when oral neomycin and metronidazole were added to the bowel preparation.

Adult↗