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David Holland

Publications and source records attributed to David Holland.

7 recordsLinked to original sources
PubMed2006

Antimicrobial susceptibility of anaerobic bacteria in New Zealand: 1999-2003.

OBJECTIVES: Routine susceptibility testing of all anaerobic organisms is not advocated, but it is useful for laboratories to test periodically for anaerobic organisms and provide local susceptibility data to guide therapy. This study reports the national trend of antibiotic susceptibility of clinically significant anaerobes in New Zealand. METHODS: Clinical isolates were tested using standardized methods against a range of antibiotics commonly used to treat anaerobic infections. Susceptibility was determined using NCCLS criteria. The change in susceptibility trends between this study and earlier studies was measured by comparing the geometric mean of the MIC. RESULTS: A total of 364 anaerobes were tested. Penicillin had poor activity against Bacteroides spp., Prevotella spp., Eubacterium spp., Clostridium tertium and Veillonella spp. In general, Fusobacterium spp., Bacteroides ureolyticus, Propionibacterium spp., Clostridium perfringens and anaerobic streptococci isolates, with the exception of Peptostreptococcus anaerobius, were penicillin susceptible. Amoxicillin/clavulanate showed good activity against most anaerobes, but resistance was seen with Bacteroides fragilis group and P. anaerobius isolates. Cefoxitin was more active than cefotetan, particularly against non-B. fragilis species, Eubacterium spp. and P. anaerobius. Meropenem and imipenem showed good activity against all anaerobes, with only 2 and 4% of Bacteroides spp., respectively, showing resistance. With the exception of Propionibacterium acnes isolates, which are predictably resistant, metronidazole was active against all anaerobes tested. There has been little change in susceptibility since 1997. CONCLUSIONS: Metronidazole, cefoxitin, piperacillin/tazobactam and amoxicillin/clavulanate remain good empirical choices when anaerobes are expected in our setting. No clinically relevant changes in susceptibility over time were found.

Anti-Bacterial Agents↗
PubMed2005

Nebulised gentamicin-suitable for childhood bronchiectasis.

UNLABELLED: Nebulised antibiotic therapy is an established, safe and effective therapy for cystic fibrosis with chronic pseudomonas infection resulting in improved pulmonary function and reduced hospitalisation. Despite similar respiratory disease, this therapy has not been evaluated in children with non cystic fibrosis bronchiectasis. This study evaluates the suitability of a gentamicin solution and nebuliser combination for use in this population. MATERIALS AND METHODS: Four millilitres of gentamicin (80 mg) in saline delivered by a PARI LC plus nebuliser and PARI Turboboy N compressor was used. The pH, osmolarity, chloride concentration and aerosol particle size was determined. Ten children with non cystic fibrosis bronchiectasis received nebulised antibiotic and had peak gentamicin concentrations measured in sputum and serum. Pulmonary function was measured pre and post nebulisation. RESULTS: The solution had an osmolarity of 199 mOsm/l, pH of 4.1, chloride concentration of 75 mmol/l and the aerosol a mass median aerodynamic diameter of 3.3 microm. Nebulisation was well tolerated, with no significant change in FEV1. Peak serum levels were at the threshold of detectability (0.3 mg/l). Sputum concentrations had a mean of 624 mg/g and lower 95th confidence interval 25 times the minimum inhibitory concentration for the predominant infecting organism, Haemophilus influenzae. CONCLUSION: Nebulisation of 80 mg of gentamicin in saline achieved bactericidal concentrations in sputum, was well tolerated and had negligible systemic absorption making it a suitable choice for this population.

Adolescent↗
PubMed2005

Intracranial tuberculomas developing while on therapy for pulmonary tuberculosis.

We describe the case of a south Asian man who developed symptomatic intracranial tuberculomas while on therapy for pulmonary tuberculosis. The development or progression of intracranial tuberculomas during the course of appropriate antituberculous therapy has been recognised previously. We review the epidemiology, pathophysiology, diagnosis, and treatment of this paradoxical phenomenon. Although the aetiology of this reaction is unknown, it may be related to an enhanced immune response during the course of therapy. Routine brain imaging for all patients diagnosed with tuberculosis is not recommended; however, in patients presenting with new neurological findings, neuroimaging is clearly warranted. Stereotactic brain biopsy should be done whenever the diagnosis of an intracranial tuberculoma is in doubt. When intracranial tuberculomas become symptomatic, antituberculous therapy generally does not need to be changed. Corticosteroids are indicated in all symptomatic cases.

Adult↗
PubMed2005

Canadian randomized trial of hemoglobin maintenance to prevent or delay left ventricular mass growth in patients with CKD.

BACKGROUND: This randomized clinical trial is designed to assess whether the prevention and/or correction of anemia, by immediate versus delayed treatment with erythropoietin alfa in patients with chronic kidney disease, would delay left ventricular (LV) growth. Study design and sample size calculations were based on previously published Canadian data. METHODS: One hundred seventy-two patients were randomly assigned. The treatment group received therapy with erythropoietin alfa subcutaneously to maintain or achieve hemoglobin (Hgb) level targets of 12.0 to 14.0 g/dL (120 to 140 g/L). The control/delayed treatment group had Hgb levels of 9.0 +/- 0.5 g/dL (90 +/- 5 g/L) before therapy was started: target level was 9.0 to 10.5 g/dL (90 to 105 g/L). Optimal blood pressure and parathyroid hormone, calcium, and phosphate level targets were prescribed; all patients were iron replete. The primary end point is LV growth at 24 months. RESULTS: One hundred fifty-two patients were eligible for the intention-to-treat analysis: mean age was 57 years, 30% were women, 38% had diabetes, and median glomerular filtration rate was 29 mL/min (0.48 mL/s; range, 12 to 55 mL/min [0.20 to 0.92 mL/s]). Blood pressure and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use were similar in the control/delayed treatment and treatment groups at baseline. Erythropoietin therapy was administered to 77 of 78 patients in the treatment group, with a median final dose of 2,000 IU/wk. Sixteen patients in the control/delayed treatment group were administered erythropoietin at a median final dose of 3,000 IU/wk. There was no statistically significant difference between groups for the primary outcome of mean change in LV mass index (LVMI) from baseline to 24 months, which was 5.21 +/- 30.3 g/m2 in the control/delayed treatment group versus 0.37 +/- 25.0 g/m2 in the treatment group. Absolute mean difference between groups was 4.85 g/m2 (95% confidence interval, -4.0 to 13.7; P = 0.28). Mean Hgb level was greater in the treatment group throughout the study and at study end was 12.75 g/dL (127.5 g/L in treatment group versus 11.46 g/dL [114.6 g/L] in control/delayed treatment group; P = 0.0001). LV growth occurred in 20.1% in the treatment group versus 31% in the control/delayed treatment group (P = 0.136). In patients with a stable Hgb level, mean LVMI did not change (-0.25 +/- 26.7 g/m2), but it increased in those with decreasing Hgb levels (19.3 +/- 28.2 g/m2; P = 0.002). CONCLUSION: This trial describes disparity between observational and randomized controlled trial data: observed and randomly assigned Hgb level and LVMI are not linked; thus, there is strong evidence that the association between Hgb level and LVMI likely is not causal. Large randomized controlled trials with unselected patients, using morbidity and mortality as outcomes, are needed.

Adult↗
PubMed2002

Corynebacterium species isolated from patients with mastitis.

Corynebacteria were isolated from breast tissue, pus, or deep wound swabs of 24 women; the most common species isolated was the newly described Corynebacterium kroppenstedtii, followed by Corynebacterium amycolatum and Corynebacterium tuberculostearicum. Gram-positive bacilli were seen in samples sent for culture or in histological specimens for 12 women, and 9 of the 12 women from whom adequate histological specimens were obtained had conditions that met the criteria for granulomatous lobular mastitis, a chronic inflammatory disease of unknown etiology.

Adult↗
PubMed2002

Vancomycin-resistant enterococcal colonisation of hospitalised patients in Auckland.

AIM: To assess the prevalence of vancomycin-resistant enterococcal colonisation of hospitalised patients in five selected Auckland hospitals. METHODS: Faeces specimens submitted to the Microbiology Laboratories at Auckland and Middlemore Hospitals for Clostridium difficile toxin assay were screened for the presence of vancomycin-resistant enterococci (VRE). RESULTS: VRE were cultured from two of 686 patients, giving a colonisation rate of 0.3% in those patients who had a faeces sample submitted for C. difficile toxin assay (95% CI 0 to 0.7%). Both isolates were Enterococcus faecalis; susceptible to ampicillin, resistant to vancomycin and of the vanA genotype. CONCLUSIONS: This is the first screening study in New Zealand that has identified patients with VRE colonisation. While VRE are still rarely isolated in this country, rates of colonisation and infection may be increasing. Hospitals need to be aware of the likely emergence of VRE and be prepared to implement strategies to limit their spread.

Adolescent↗