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Biomedical subjects

F L Sapico

Publications and source records attributed to F L Sapico.

47 records · Page 3Linked to original sources
PubMedDate not supplied

Spontaneous bacterial peritonitis.

Forty-three patients with spontaneous bacterial peritonitis (SBP) between 1973 and 1978 were identified. Criteria for SBP included a positive ascites culture and polymorphonuclear cell concentration greater than 250 cells per mm3. Chronic liver disease was documented by varices in 91%, severe histologic fibrosis or cirrhosis in 94%, splenomegaly in 91%, and past hospitalization for liver disease in 57% of the patients. SBP was detected within 7 days of admission in 17 patients (40%) and within 35 days in 38 patients. Single organisms were isolated from 38 patients and multiple organisms from 5 patients. Twenty-six of 43 patients survived the episode of SBP, but only 13 survived the hospitalization. Analysis of the survival curve from the onset of SBP revealed a rapid death rate and a slow death rate set of patients. Rapid death (less than or equal to 7 days from SBP onset) correlated with a lack of prior hospitalization for liver disease (p less than 0.001), hepatomegaly (p less than 0.001), increased serum bilirubin (p less than 0.005), serum creatinine (p less than 0.05), and peripheral white blood cell concentrations (p less than 0.05). Survival during hospitalization was associated with prior hospitalization with liver disease (p less than 0.001) and chills during the episode of SBP (p less than 0.001). The 43 patients were divided into Group 1 patients on the basis of a serum bilirubin greater than 8 mg% and/or serum creatinine greater than 2.1 mg%; Group 2 patients had lower values. Survival was greater in Group 2 patients with advanced, relatively quiescent liver disease compared to Group 1 patients for both the episode of SBP (91 vs. 29%; p less than 0.001) and for hospitalization (50 vs. 9%; p less than 0.05). Death in Group 2 patients was related to inadequate antibiotic therapy (p less than 0.05), nonhepatic factors, and new onset of renal failure. Although SBP in the setting of severe acute liver injury has a dismal prognosis, SBP with minimal acute liver injury has a relatively good prognosis for hospital survival even with advanced chronic liver disease. Long-term survival is also possible since 4 of 9 patients with prolonged follow-up have survived 3 years.

Anti-Bacterial Agents↗
PubMedDate not supplied

Cefpirome, alone and in combination with gentamicin for enterococcal pyelonephritis in the rodent model.

The in vitro and in vivo activity of cefpirome (CF) against Enterococcus faecalis GK strain was examined. The ratio of minimal inhibitory to bactericidal concentration (MIC/MBC) values in microgram/ml were (a) ampicillin 0.8/1.5; (b) gentamicin 2/25; (c) vancomycin, 0.8/50; and (d) CF, 8/32. A time-kill study using 10(7) organisms per milliliter showed a drop of 3 logs10 at 4 hr in the tube containing cefpirome (10 micrograms/ml) as well as the tube containing cefpirome (5 micrograms/ml) plus gentamicin (GM) (2 micrograms/ml), as compared to the control and the tube containing GM at 4 micrograms/ml. At 8 and 24 hr, however, regrowth to control levels occurred. Of this enterococcal strain consisting of 10(8) organisms, 1 ml was then injected intravenously by tail vein into 150 male Wistar rats weighing 120 g each. Eleven days after injection, 10 rats were killed and the remaining ones were randomized into four treatment groups: (a) untreated control; (b) BM, 0.9 mg; (c) CF, 10 mg; and (d) CF + GM. The rats received the injections intramuscularly twice daily. At least 10 rats from each group were killed for quantitative kidney cultures at 1, 2, and 4 weeks after start of therapy. At the end of 4 weeks of therapy, the results were significantly better in the combination group compared to the other three groups.

Ampicillin↗
PubMedDate not supplied

Infections in the diabetic patient: the role of immune dysfunction and pathogen virulence factors.

It is a common belief that certain infections occur more frequently in patients with diabetes mellitus than in nondiabetics. In some infections, poor diabetic control is strongly linked. Diabetics comprise 50%-70% of all patients who undergo nontraumatic foot or leg amputations, the overwhelming majority of which are necessitated by infection and necrosis of soft tissue and/or bone. Imputed host defense abnormalities include defective immune responses (e.g., white blood cell function, granuloma formation), peripheral neuropathies, impaired distal arterial supply, and problems in "control" of the diabetic state eventuating in catabolic metabolism. Increased bacterial translocation as a source of the causative bacteria is another potential entry site. Possible virulence factors of the invading organisms include polymicrobial synergism, glycocalyx formation, and inoculum size. Attention to the principles of preventive education, vascular evaluation, diabetes management, and adequate debridement maximize healing potential.

Communicable Diseases↗
PubMedDate not supplied

Low mortality among patients with spinal cord injury and bacteremia.

We reviewed 103 episodes of bacteremia in 93 patients with spinal cord injury who had bacteremia during initial hospitalization (39 patients) or readmission (54 patients) during 1978-1988. Eighteen episodes (18%) were due to polymicrobial infections. Urinary tract infections (47%), infected pressure areas (19%), and pneumonia (9%) were the most frequent primary infections and sources of the bacteremia. The bacteria most frequently associated with urinary tract infections were enterococci (26%), Escherichia coli (26%), Pseudomonas species (20%), and Klebsiella pneumoniae (12%). Bacteria most frequently isolated from patients with infected pressure areas were anaerobes and Staphylococcus aureus. Bacteremia was the cause of death for 8 patients (9%). The urinary tract was identified only once as the source of gram-negative bacteremia in an immunocompetent patient who died. The reason for the low mortality in patients with spinal cord injury is unclear.

Adolescent↗
PubMedDate not supplied

Vertebral osteomyelitis in intravenous drug abusers: report of three cases and review of the literature.

Three cases of vertebral osteomyelitis in intravenous drug abusers are described, and 64 cases in the literature are reviewed. The patients were almost exclusively heroin users from the United States, were predominantly male, and were frequently of black or Hispanic ethnic background. Symptoms were present for less than threemonths in 81% of patients. On admission to the hospital, fever was seen in 42%, transient neurologic deficits in 15%, elevated erythrocyte sedimentation rate in 91%, and leukocytosis in 35%. Twenty-two percent of patients with initially normal X rays had spinal abnormalities detected by tomography and technetium bone scan. A strikingly high incidence (27%) of cervical spine involvement was found. Gram-negative aerobic bacilli accounted for 82% of infections, and Pseudomonas species comprised 66% of the total. Ninety-two percent of the patients responded to parenteral antibiotic therapy administered for four weeks or longer. Patients experiencing relapses responded to a second course of therapy. The prognosis for intravenous drug abusers with vertebral osteomyelitis appeared to be good with appropriate therapy, and no deaths or permanent neurologic sequelae were seen.

Adult↗
PubMedDate not supplied

The infected foot of the diabetic patient: quantitative microbiology and analysis of clinical features.

The quantitative deep-tissue microbiology of the infected feet of 32 patients with diabetes mellitus was studied, and the clinical features of the patients were analyzed. Techniques of specimen collection designed to avoid contamination from surface flora were used to study amputated lower limbs. Cultures of deep tissue from six patients yielded only aerobes, and for one patient, only anaerobes. Cultures for 25 patients yielded a mixture of aerobes and anaerobes. A mean of 4.81 species (2.84 aerobes and 1.97 anaerobes) were isolated from each patient. The density of growth of anaerobes, however, was significantly higher than that of aerobes. Culture specimens obtained by curettage of the base of the ulcer correlated better with results of deep-tissue culture than did those obtained by needle aspiration or swab of the ulcers. The most frequently isolated organisms were Bacteroides species, anaerobic streptococci, group D streptococci, Clostridium species, and Proteus species. The presence of anaerobes was associated with a higher frequency of fever and foul-smelling lesions and with the presence of a foot ulcer. Prior antibiotic therapy did not appear to influence the nature of the microorganisms isolated. The polymicrobial nature of this disease should be considered when antimicrobial therapy is indicated.

Aged↗
PubMedDate not supplied

Methicillin-resistant Staphylococcus aureus bacteriuria.

Methicillin-resistant Staphylococcus aureus (MRSA) bacteriuria was detected in 11 of 41 patients colonized or infected with MRSA. The patients with bacteriuria generally were older than 40 years of age, five were diabetic, seven had prior indwelling uretheral catheters, two had undergone other urologic manipulations, and only one was clinically symptomatic. Eight patients received variable combinations of antibiotic therapy prior to the diagnosis of MRSA bacteriuria, and seven were still on antibiotic therapy at the time the bacteriuria was detected. Bacteriuria lasted four days to 14 weeks, and was eradicated promptly with cephalosporin therapy in five six patients. Bacteriuria in the untreated patients cleared spontaneously in one month. A single MRSA serotype (83A) predominated. The MRSA isolates were resistant in vitro to most antibiotics except vancomycin. Resistant colonies were observed within cephalothin disc zones of inhibition at 30C (resistance was confirmed by microtube-dilution sensitivity testing). MRSA disc sensitivity testing for cephalothin may be unreliable when performed at 35C.

Adult↗
PubMedDate not supplied

Bacteremia in diabetic patients with infected lower extremities.

Eleven cases of bacteremia in diabetic patients with infected lower extremities at Rancho Los Amigos Hospital (RLAH) were observed over a 34-mo period. The yearly incidence was 0.6% of admissions to the Ortho-Diabetes service. Aerobic bacteria were recovered in six cases and anaerobic bacteria in five. Bacteroides fragilis was isolated four times, Staphylococcus aureus three times, and nonfragilis Bacteroides sp., Escherichia coli, group B streptococcus, and viridans streptococcus were each seen once. Ten of the 11 patients were febrile at the time of bacteremia. Clinical, laboratory, radiologic, and ultrasonographic parameters were comparable in patients with aerobic and anaerobic bacteremia, and between bacteremic patients and nonbacteremic controls. Fever, however, was significantly more frequent in bacteremic patients. Foul-smelling lesions were seen in two of the five patients with anaerobic bacteremia, and in none of the patients with aerobic bacteremia. Postoperative B. fragilis bacteremia was observed to be transient and resolved without definitive therapy in one patient. Appropriate antibiotic therapy in 10 patients together with surgical intervention in eight cases resulted in resolution of the infection in the remaining patients.

Bacteria, Aerobic↗