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E Lautenbach

Publications and source records attributed to E Lautenbach.

At least 19 recordsLinked to original sources
PubMed1999

Enterococcal bacteremia: risk factors for vancomycin resistance and predictors of mortality.

OBJECTIVE: To identify risk factors for vancomycin resistance and mortality in enterococcal bacteremia. DESIGN: Historical cohort study. SETTING: A large academic medical center with a high prevalence of vancomycin-resistant enterococci (VRE). PATIENTS: Two hundred sixty patients with enterococcal bacteremia, of whom 72 (28%) had VRE. RESULTS: Independent risk factors for infection with VRE were the mean number of antibiotic days (P<.001), renal insufficiency (P<.001), mean days of vancomycin use (P = .005), and neutropenia (P = .013). A trend toward a significant association between metronidazole use and VRE also was noted (P = .068). Mortality was attributable to the bacteremia in 96 patients (37%). Severity of illness (P<.001) and age (P = .020) were independent risk factors for mortality. Vancomycin resistance was not, however, an independent predictor of mortality. CONCLUSION: These results suggest that restrictions on antibiotic use, particularly in patients with renal insufficiency and neutropenia, may help to combat the rising incidence of VRE. Although patients with VRE bacteremia demonstrated higher mortality rates than patients with infection due to susceptible isolates, vancomycin resistance was not an independent predictor of mortality in these patients and likely serves more as a marker of underlying severity of illness.

Adolescent↗
PubMed1998

Risk factors for early postoperative recurrence of Crohn's disease.

BACKGROUND & AIMS: Despite many advances in our understanding of Crohn's disease, the course of the disease in any given patient remains unpredictable. There is little agreement as to which factors increase a patient's risk of early postoperative recurrence. We have attempted to identify predictors of early recurrence after surgical resection, specifically whether the indication for initial surgery (perforating or nonperforating) or the duration of preoperative disease may be associated with early recurrence. METHODS: We studied 88 patients who had undergone at least two resections for Crohn's disease. Multivariable survival analysis was performed to elucidate predictors of early postoperative recurrence. RESULTS: A perforating indication for initial surgery (P < 0.001) and a longer preoperative disease duration (P = 0.004) were found to be the only independent predictors of earlier postoperative recurrence after initial surgery. A longer preoperative disease duration also showed a borderline significant association with a shorter interval from second to third surgery (P = 0.075). Finally, the indication for initial surgery was predictive of the indication at a subsequent surgery for recurrence (P = 0.001). CONCLUSIONS: A perforating indication for initial resection and a longer duration of disease before initial surgery predicted an earlier postoperative recurrence. The latter association was borderline. This suggests that prognostic groups based on these factors may help to stratify patients with regard to risk of early recurrence.

Adolescent↗
PubMed1998

The role of chloramphenicol in the treatment of bloodstream infection due to vancomycin-resistant Enterococcus.

The incidence of bacteremia due to vancomycin-resistant Enterococcus (VRE) has increased markedly in recent years. We investigated the role of chloramphenicol in its treatment. All cases of VRE bacteremia occurring at our facility during a 45-month period were analyzed. The response to chloramphenicol, its effect on mortality, and the incidence of adverse effects were assessed. Fifty-one patients (65.4%) received chloramphenicol. Among patients in whom a response could be assessed, 22 (61.1%) of 36 demonstrated a clinical response, while 34 (79.1%) of 43 showed a microbiological response. Forty-two patients (53.8%) died as a result of the bacteremia. Although the mortality rate was lower for patients treated with chloramphenicol, the difference was not significant (odds ratio = 0.72; 95% confidence interval, 0.28-1.85; P = .49), nor was there an association between earlier initiation of therapy and reduced mortality (P = .45). In cases with central line-related bacteremia, there was no difference in mortality among patients treated with chloramphenicol, line removal, or both (P = .36). Although 16 patients (31.4%) had adverse effects, none could be definitely attributed to chloramphenicol. Although chloramphenicol was well-tolerated, no significant effect of its use on mortality could be demonstrated.

Adolescent↗
PubMed1997

Human immunodeficiency virus infection and Crohn's disease: the role of the CD4 cell in inflammatory bowel disease.

Crohn's disease is believed to have an immunologic basis. The importance of the CD4 cell in particular has been supported by several reports of patients whose symptoms of Crohn's disease resolved after a decline in CD4 count associated with human immunodeficiency virus (HIV) infection. A patient with known Crohn's disease, however, who was later infected with HIV, was reported to continue to have symptomatic Crohn's disease despite an eventual decrease in CD4 count to 84/mm3. We report the new onset of Crohn's disease in an HIV-infected patient with a CD4 count of 100/mm3. This report is the first to document the new onset of Crohn's disease in a patient with HIV and a CD4 count in the range commonly associated with various opportunistic infections and neoplasms. In addition, it is the first to confirm the recent finding that Crohn's disease may be active despite the profound immune deficiency associated with advanced HIV infection. Thus this report further challenges the significance of the CD4 cell in the pathogenesis of Crohn's disease.

Adult↗
PubMed1996

Incidence of adenomas after curative resection for colorectal cancer.

OBJECTIVE: The benefits of periodic colonoscopic surveillance after curative resection for colon cancer are controversial. We investigated the incidence, size, and time interval to the detection of recurrent adenomatous polyps in patients who have undergone resection of a colorectal cancer. METHODS: In this retrospective study, the records of 351 patients who underwent curative resection for colorectal carcinoma between 1967 and 1991 were reviewed. Sixty-one patients were excluded because of incomplete data. RESULTS: Eighty-seven patients (30%) were found to have had at least one adenoma. Twelve patients had more than five adenomas. The median time to diagnosis was 24 months. Forty-six patients of the 87 (52.9%) had polyp recurrences within 2 yr after cancer resection. CONCLUSION: This group of patients is at increased risk for the development of adenomatous polyps. Surveillance colonoscopy and polypectomy may reduce the incidence of metachronous colon cancer.

Adenomatous Polyps↗
PubMed1995

Retroperitoneal leiomyosarcoma and gastroparesis: a new association and review of tumor-associated intestinal pseudo-obstruction.

Intestinal pseudo-obstruction has been associated with several types of underlying neoplasms and has been hypothesized to result from a paraneoplastic process in patients with small cell lung carcinoma and bronchial carcinoid. This article documents the first reported association of gastroparesis and a retroperitoneal leiomyosarcoma. A paraneoplastic process is the proposed basis of this relationship, inasmuch as these syndromes have been noted in other tumors of mesodermal origin. The resolution of intestinal dysmotility after tumor resection, as described here, has only rarely been reported.

Female↗
PubMed1994

Benefits of colonoscopic surveillance after curative resection of colorectal cancer.

OBJECTIVE: The authors determined the usefulness of routine colonoscopy after colorectal cancer surgery. SUMMARY BACKGROUND DATA: Some studies suggest benefit to colonoscopy in the routine follow-up of patients with colorectal cancer who are resected for cure, whereas other studies show no benefit. METHODS: Chart review was conducted for 290 patients who underwent curative resection for colorectal cancer between 1967 and 1991 at a colorectal surgeon's practice. Colonoscopy was performed every 6 months during the first year, then every 1 to 2 years, or when intercurrent symptoms appeared. RESULTS: Overall, 31 patients (10.7%) developed recurrent disease, which increased as a function of stage (C2 > B2 > A), with a median time to diagnosis of 20 months. Of these 31 recurrences, 14 (45.2%) were solely local (of whom 12 were asymptomatic); 17 (54.8%) involved distant disease. Nine locally recurrent patients were able to undergo curative resection. Of 19 symptomatic patients, only 3 (15.8%) were amenable to curative resection. Six patients (2.1%) developed a metachronous second primary colorectal cancer, of whom four (66.7%) were asymptomatic, and five (83.3%) were able to undergo curative resection. Overall, because of surveillance colonoscopies, 13 asymptomatic patients (4.5%) had curative resection for localized recurrent disease or a metachronous second primary cancer. CONCLUSIONS: Colonoscopy is a useful modality in the early detection of recurrent and metachronous disease after colorectal cancer, increasing the potential for curative resection and improved survival.

Aged↗