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Biomedical subjects

E R Brenner

Publications and source records attributed to E R Brenner.

13 recordsLinked to original sources
PubMed1998

Risk factors for congenital syphilis in infants of women with syphilis in South Carolina.

OBJECTIVES: This study examined risk factors for congenital syphilis in South Carolina. METHODS: Case infants with presumptive and confirmed congenital syphilis were compared with control infants born to women with reactive serologies during pregnancy, allowing investigation of risk factors for congenital rather than acquired transmission of syphilis. Data were collected from congenital syphilis report forms and birth certificates for 186 case infants and 487 controls born from 1991 to 1993. Odds ratios were calculated for maternal risk factors. RESULTS: Significant statistical trends were found for timing of first prenatal visit and number of visits. Other significant factors included rural residence (odds ratio [OR] = 2.0, 95% confidence interval [CI] = 1.4, 2.9) and previous pregnancy loss (OR = 0.3, 95% CI = 0.2, 0.6). CONCLUSIONS: Prevention of congenital syphilis may be less effective among pregnant women with syphilis in South Carolina who have fewer prenatal care visits. Health care providers need further education on maternal/child syphilis management and techniques for motivating and educating patients.

Abortion, Spontaneous↗
PubMed1995

Measles control in institutional settings.

This paper reports on the utility of screening pediatric psychiatric admissions for the presence of antibodies to measles to determine the need for administration of MMR Vaccine to 314 children admitted over an 11-month period. Four fifths (80.6 percent) of the children had positive antibody tests when screened. No sex difference in antibody prevalence was noted but Caucasians were more likely (18.2 percent) than African American (6.2 percent) to have negative antibody tests. No relationship was noted between psychiatric diagnosis and antibody test results. A substantial proportion of adolescents have negative or equivocal measles antibody tests and interpretation of such results may be difficult. Antibody testing is cost-effective in institutional settings and, in the future, may become so in selected ambulatory settings.

Adolescent↗
PubMed1994

Changing patterns of mycobacterial disease at a teaching community hospital.

OBJECTIVES: To evaluate trends in the occurrence and diagnosis of mycobacterial disease. DESIGN: Prospective surveillance study using a central tuberculosis registry at a 611-bed teaching community hospital. RESULTS: Data pertaining to 715 patients were entered into the registry between 1976 and 1991 on the basis of positive smears or cultures for acid-fast bacilli (AFB). Over time, the ratio of isolates of Mycobacterium tuberculosis to isolates of nontuberculous mycobacteria reversed (from 3.2 to 1 between 1976 and 1981 to 1 to 1.6 between 1986 and 1991). The sensitivity of the sputum AFB smear for diagnosis of pulmonary tuberculosis increased (from 0.73 to 0.96), but the positive predictive value of the sputum AFB smear declined (from 0.72 to 0.59). The acquired immunodeficiency syndrome epidemic accounted for these changes only to a small extent. CONCLUSIONS: The increasing occurrence of non-tuberculous mycobacterial disease and the declining positive predictive value of the sputum AFB smear at this hospital imply that respiratory isolation and antituberculous therapy will be used inappropriately for many patients. The development and use of newer tests for early isolation and specific identification of M tuberculosis should be accelerated.

Hospitals, Community↗
PubMed1994

Utility of the hospital tuberculosis registry.

Emerging guidelines suggest that the management of tuberculosis and suspected tuberculosis in the hospital will become an increasingly costly enterprise. The local hospital registry can be a focal point for determining the extent to which such measures are necessary at individual institutions, that existing infection control recommendations are being carried out, and that patients released from the hospital are not lost to follow-up. Consideration might be given to inclusion of all patients begun on antituberculous therapy, regardless of the results of acid-fast bacilli cultures, in view of renewed concern about patient compliance.

Contact Tracing↗
PubMed1994

Immunization of 6 and 9 month old infants with AIK-C, Edmonston-Zagreb, Leningrad-16 and Schwarz strains of measles vaccine.

BACKGROUND: Measles kills more than 1 million infants per year and is particularly lethal in infants < 1 year old in developing countries. Recent reports have suggested that measles vaccines of different strains and titre differ in their immunogenicity in young infants. We sought to identify strains and titres of measles vaccines which would be effective in 6 and 9 month old infants. METHODS: We conducted a randomized trial of AIK-C, Edmonston-Zagreb (EZ), Leningrad-16 and Schwarz strains of measles vaccine at different titres in 1202 6 month old and 1250 9 month old infants. Antibody levels were measured by haemagglutination inhibition assay. Seroconversion was defined as a change from seronegative to seropositive or a fourfold rise in titre above the expected level after antibody decay (assumed antibody half-life = 6 weeks). Chi-square tests were used to compare seroconversion rates and rates of adverse reactions among the groups. Comparison of geometric mean titres (GMT) was done by the Student's t-test. RESULTS: No severe or unusual adverse reactions occurred during the 6 weeks after vaccination. All strains induced high seroconversion rates in 9 month old infants. In 6 month olds, medium- and standard-titre AIK-C induced the highest rates of seroconversion. Antibody titres at 6 weeks after vaccination were highest in recipients of Schwartz vaccine and lowest for EZ vaccine recipients. CONCLUSIONS: Standard-titre AIK-C may be more effective than other measles vaccine strains for early measles immunization and should be evaluated further for efficacy, long-term immunogenicity, and long-term safety.

Antibodies, Viral↗
PubMed1986

Endemic bacteremia in Columbia, South Carolina.

Between 1977 and 1981, there were 4.9 episodes of community-acquired bacteremia and 5.1 episodes of hospital-acquired bacteremia per 1,000 patients in the four major hospitals of one metropolitan area. Case fatality rates were 30.1 per cent based on deaths due to all causes and 14.7 per cent based on deaths attributed specifically to bacteremia. Patients who experienced bacteremia had a 12-fold excess in mortality compared with other patients. Bacteremia occurred more frequently and was associated with greater case fatality rates at university-affiliated teaching hospitals compared with nonteaching community hospitals. At the nonteaching community hospitals, the odds of mortality for patients with bacteremia were lower even after adjustment for age, sex, severity of underlying medical problems, and severity of infection. Patients on private services at a teaching municipal hospital experienced greater odds of mortality compared with private patients at two nonteaching community hospitals. These latter observations may reflect, at least in part, limitations in the standard parameters used for determining severity of underlying medical problems and severity of infection.

Adolescent↗
PubMed1985

Epidemiology of a tuberculosis outbreak in a South Carolina junior high school.

A 13-year-old, female, seventh-grade student (the index patient) was found to have smear-positive, cavitary, pulmonary tuberculosis. Epidemiologic and contact investigation, involving skin testing over 900 people, revealed a 40 per cent tuberculin reactor rate for persons in the junior high school she attended compared to a 2 per cent rate for control schools. Repeat skin testing of initial non-reactors identified an additional 3 per cent of infected school children. School teachers showed a seven-fold increase in the prevalence of positive skin-test reactions following the outbreak. Tuberculin-reactor rates for seventh graders were substantially higher than for eighth graders. The more classes shared with the index patient, the higher the probability of being a reactor. Among students who shared no classes with the index patient, the highest rates of tuberculin reactions were found for those who had entered a classroom immediately after the index patient had left it. Evidence of transmission on the school bus and in the church choir was also suggested. Six secondary cases (three pulmonary) resulted from the outbreak. Identical phage types from the index and secondary patients suggest who had left school during the term proved useful in determining when transmission began. The index case was found to be a missed contact of a previously identified case of tuberculosis. Since household contacts are at high risk for developing active disease, there is a need for meticulous and complete investigation and preventive therapy for all such persons, especially children.

Adolescent↗
PubMed1984

Staphylococcal bacteremia: current patterns in nonuniversity hospitals.

We studied 390 consecutive episodes of Staphylococcus aureus bacteremia in the four nonuniversity hospitals of one metropolitan area between 1977 and 1981. Overall mortality was 31%, with 52% of deaths being attributed to the infection. The 4.9% incidence of recognized endocarditis was lower than that previously reported. Although 41% of deaths occurred by the end of the third day after positive blood cultures had been obtained, choice of antimicrobial therapy bore no apparent relationship to eventual clinical outcome.

Adolescent↗
PubMedDate not supplied

Nosocomial bacteremia in perspective: a community-wide study.

Prospective surveillance of 1,527 episodes of bacteremia in the four major hospitals serving a community of 300,000 revealed striking differences among the hospitals. The rate of community-acquired bacteremia ranged from 1.9 to 6.8 per 1000 discharges; the rate of nosocomial bacteremia ranged from 0.9 to 9.8 per 1000 discharges. Death rates attributed to nosocomial bacteremias varied among the hospitals by as much as 40-fold. Nosocomial bacteremias were less frequent at two community non-teaching hospitals than at two teaching hospitals. Although fewer blood cultures were obtained at the nonteaching hospitals, the ratio of blood cultures obtained to deaths attributed to bacteremic infection was highest at these hospitals, suggesting that physicians recognized the importance of obtaining blood cultures in critically ill patients. The potential usefulness of bacteremia surveillance is reviewed. It is suggested that hospitals serving a single community might constitute an appropriate unit for such surveillance.

Cross Infection↗
PubMedDate not supplied

Analysis of 1,186 episodes of gram-negative bacteremia in non-university hospitals: the effects of antimicrobial therapy.

Over the five-year period 1977-1981, we studied 1,186 episodes of bacteremia due to Enterobacteriaceae and Pseudomonadaceae in the four non-university hospitals of a single metropolitan area. Overall patient mortality was 36.3%, and mortality attributed specifically to infection was 19.0%. The importance of severity of underlying disease, site of infection, microorganism, and age--previously determined to be prognostic factors in studies conducted at tertiary-care centers--was confirmed. Appropriate initial antimicrobial therapy (defined as the administration of an effective agent in adequate dose and by a suitable route of administration on the first calendar day on which blood cultures were positive) did not improve survival compared with the use of an ineffective antimicrobial agent or no therapy at all. However, appropriate antimicrobial therapy subsequent to the first calendar day on which blood cultures were positive clearly affected survival. These findings confirm previous conclusions regarding the frequency and severity of gram-negative bacteremia and the overall impact of antimicrobial therapy on this condition. These studies also suggest the possibility that the definition of optimal initial therapy in some groups of patients should be reconsidered.

Adolescent↗
PubMedDate not supplied

Symptomatic response to therapy of men with gonococcal urethritis: do all need posttreatment cultures?

Because the large majority of men with gonorrhea respond to antimicrobial therapy with the rapid disappearance of signs and symptoms, it was hypothesized that a symptomatic response to therapy would predict successful treatment. The records of 4897 men with gonorrhea, of whom 183 (3.7%) were treatment failures on days 3-7 after treatment were studied, and the clinical response to therapy with microbiologic outcome was correlated. Before therapy, 4662 men (95.2%) had dysuria and/or urethral discharge. Of the 582 men who remained symptomatic, 103 (17.7%) had a positive culture after treatment, as compared with only 78 (1.9%) of 4080 men who became asymptomatic (P less than .01). The conclusion was that men who are initially symptomatic and become asymptomatic after therapy have a small chance (one of 50) of being infected at the posttreatment visit. However, because of its very large size, this group contributed almost one-half of all treatment failures (78 of 183; 42.6%).

Amoxicillin↗