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Biomedical subjects

G K Harding

Publications and source records attributed to G K Harding.

100 records · Page 6Linked to original sources
PubMed1975

A comparison of trimethorprim-sulfamethoxazole with sulfamethoxazole alone in infections localized to the kidneys.

Ninety patients with urinary tract infections were treated in a randomized double-blind study with either a combination of trimethoprim and sulfamethoxazole (TMP-SMX) or sulfamethoxazole alone (SMX). Thirty of 42 patients treated with TMP-SMX were cured by the time of follow-up compared with 26 of 48 treated with SMX alone. Of the 29 patients infected with SMX-resistent organisms, the combination TMP-SMX cured 12 of 17, whereas SMX alone cured 2 of 12. Of the 61 patients infected with SMX-sensitive organisms, TMP-SMX cured 18 of 25; SMX alone cured 24 of 36. In 50 women the infection was found localized to The upper urinary tract by the use of the Fairley bladder washout technique. TMPsmx cured 16 or 24 of these patients with proved upper tract infections and SMX alone cured 11 of 26. Although none of these differences were significant, TMP-SMX appears to be an effective drug combination for the therapy of proved upper tract infection and is also effective in eradicating sulfonamide-resistant organisms.

Administration, Oral↗
PubMedDate not supplied

Screening pregnant women for group B streptococcal colonization.

The recovery rates of group B streptococcus (GBS) from anorectal swabs (RS) and vaginal swabs (VS) that were enriched were compared to the routine method to determine the optimal procedure. Separate RS and VS were collected from women attending antenatal clinics. RS and VS were placed in 2 ml enrichment and selective broth. Swabs were inoculated onto colistin/nalidixic acid agar (CNA) upon arrival in the laboratory and onto 5% sheep blood agar (SBA) and CNA after 24 h enrichment. The routine method consisted of a VS sent in transport medium and inoculated in the laboratory onto SBA (no enrichment). The overall GBS colonization rate was 24% (64/264). Of the 64 GBS carriers, 77% were colonized in the vagina and 89% were colonized in the anorectum. The anorectum was the only site of colonization in 24% of the women, whereas the vagina was the only site of colonization in 11% of cases. Enrichment increased the detection of GBS from both RS (55 versus 42; P < 0.025) and from VS (49 versus 27; P < 0.001). Of the 64 cases, enriched RS detected 86%, enriched VS detected 77% and the standard VS detected only 41%. Enriched RS and enriched VS collectively detected 99% of cases. SBA was better than CNA for subculture of the enrichment broth because of a higher recovery rate (98-100% versus 80-82%; P < 0.01) and the fact that the hemolysis on SBA made it easier to differentiate GBS from enterococci. The data confirm that optimal screening of pregnant women for GBS should include a combined RS/VS swab placed in enrichment broth that is then subcultured onto SBA after 24 h incubation.

Culture Media↗
PubMedDate not supplied

Asymptomatic bacteriuria in patients with diabetes mellitus.

This review analyzes several aspects of asymptomatic bacteriuria in patients with diabetes mellitus, including prevalence, bacteriology, coexistent risk factors, localization, natural history, and treatment. The prevalence of asymptomatic bacteriuria is threefold higher among diabetic women than among nondiabetic women. However, rates among diabetic and nondiabetic men are similar. Studies consistently document that the prevalence of asymptomatic bacteriuria is not influenced by the type or duration of diabetes or by the quality of diabetic control. The microorganisms causing asymptomatic bacteriuria in persons with diabetes mellitus are similar to those causing bacteriuria in nondiabetic individuals. More than half of diabetic patients with asymptomatic bacteriuria have upper urinary tract involvement. The long-term consequences of asymptomatic bacteriuria in patients with diabetes mellitus are poorly documented. Clinical trials describing the treatment of asymptomatic bacteriuria in this population suggest that a 2-week course of therapy is equivalent to a 6-week course for the initial eradication of bacteriuria and that, following treatment, reinfection rather than relapse usually occurs. Important questions remaining include whether asymptomatic bacteriuria should be treated in this population and what the optimal antimicrobial regimen is.

Bacteriuria↗
PubMedDate not supplied

Long-term antimicrobial prophylaxis for recurrent urinary tract infection in women.

Thirteen women and two preadolescent girls who suffered recurrences after six months of prophylaxis with trimethoprim (TMP; 40 mg) and sulfamethoxazole (SMZ; 200 mg) taken thrice weekly at bedtime were enrolled in a 24-month study of prophylaxis with the same region. During 29.1 cumulative patient-years of prophylaxis, two infections due to Escherichia coli and one each due to Staphylococcus epidermidis and Streptococcus faecalis occurred (0.14 infection/patient-year). MICs for these isolates were less than or equal to 2 micrograms of TMP/ml and greater than 512 micrograms of SMZ/ml. During prophylaxis, 106 of 116 cultures from the periurethral area and 66 of 97 cultures from the anal and canal yielded no aerobic gram-negative bacilli. In three patients, the periurethral area was colonized with aerobic gram-negative bacilli with MICs of greater than or equal to 2 micrograms of TMP/ml. Thirteen patients were followed after the discontinuation of prophylaxis. Eight suffered recurrences, seven with organisms susceptible to TMP. After one year the remaining five had experienced no recurrences. It is concluded that long-term prophylaxis with 40 mg of TMP and 200 mg of SMZ thrice weekly is an effective, well-tolerated regimen that can maintain an infection-free state in women with histories of frequent urinary reinfections.

Adult↗
PubMedDate not supplied

Prospective, randomized, comparative trials in the therapy for intraabdominal and female genital tract infections.

The results of four prospective, randomized comparative trials, in which the authors' two university teaching hospitals participated, that compared selected antimicrobial regimens with the combination of clindamycin and an aminoglycoside in the therapy for intraabdominal and female genital tract infections are reviewed. In the first trial, the rates of cure for patients with intraabdominal infections were 33 (79%) of 42 treated with clindamycin and gentamicin, 43 (81%) of 53 treated with chloramphenicol and gentamicin, and 35 (90%) of 39 treated with ticarcillin and gentamicin. The rates of cure for females with genital tract infections were 16 (94%) of 17, 11 (100%) of 11, and 12 (92%) of 13 treated with the three respective combinations. The rates of cure in the second study were 22 (88%) of 25 treated with metronidazole and gentamicin and 23 (88%) of 26 treated with clindamycin and gentamicin. In the third study, the rates of cure were 23 (82%) of 28 treated with cefoxitin and tobramycin as compared with 24 (89%) of 27 treated with clindamycin and tobramycin. In the fourth study, 21 (87%) of 24 patients treated with ceftizoxime alone are cured as compared with 13 (87%) of 15 treated with clindamycin and tobramycin. These prospective, randomized trials suggest that chloramphenicol and gentamicin, ticarcillin and gentamicin, metronidazole and gentamicin, cefoxitin and tobramycin, or ceftizoxime alone are as effective as clindamycin and gentamicin or tobramycin in therapy for mixed aerobic/anaerobic infections.

Abscess↗
PubMedDate not supplied

Prospective randomized comparison of imipenem/cilastatin and cefotaxime for treatment of lung, soft tissue, and renal infections.

Thirty-one moderately or severely ill hospitalized patients with proved (25 patients) or suspected (six) bacterial infections were randomly allocated to receive imipenem/cilastatin (16) or cefotaxime (15). The median age, sex, duration of therapy, underlying disease, and types of infection were similar in both groups. Nineteen patients with pneumonia, eight with soft tissue infection, and four with acute pyelonephritis were included. The pathogens isolated included Escherichia coli (six), Streptococcus pneumoniae (five), Streptococcus pyogenes (five), Haemophilus species (four), Proteus species (three), Staphylococcus aureus (three), and Serratia marcescens (two). In the imipenem/cilastatin group, 13 patients were cured of their infections and three showed improvement. In the cefotaxime group, nine were cured, three showed improvement, and three showed no improvement. Nine patients treated with imipenem/cilastatin developed phlebitis, as compared with eight treated with cefotaxime. One patient treated with cefotaxime developed diarrhea. During therapy, potential pathogens were isolated from four patients in the imipenem/cilastatin group (Candida species [two] and Pseudomonas maltophilia [two]), as compared with eight in the cefotaxime group (enterococci [two], Pseudomonas aeruginosa [two], Candida species [two], Acinetobacter anitratus [one], and Pseudomonas fluorescens [one]). There were no recognized superinfections.

Adult↗
PubMedDate not supplied

Preservation of colonization resistance parameters during empiric therapy with aztreonam in the febrile neutropenic patient.

The role of the anaerobic intestinal flora in maintaining colonization resistance was examined in a study of empiric therapy in febrile neutropenic patients who received aztreonam plus tobramycin, aztreonam plus cloxacillin, or moxalactam plus tobramycin, regimens with differential effects on the anaerobic intestinal flora. Surveillance cultures showed that all regimens eradicated fecal carriage of enteric gram-negative bacilli but that fecal acquisition of fungi occurred in 4 (27%) of 15 aztreonam/tobramycin, 6 (43%) of 14 aztreonam/cloxacillin, and 13 (81%) of 16 moxalactam/tobramycin recipients. Fungi were acquired at 11 (22%) of 49 sites in aztreonam/tobramycin, 15 (31%) of 48 sites in aztreonam/cloxacillin, and 28 (54%) of 52 sites in moxalactam/tobramycin recipients. Aztreonam/tobramycin reduced fecal anaerobe counts by less than 1 log10; aztreonam/cloxacillin, by a mean of 2.5 log10; and moxalactam/tobramycin, by 5.1 log10 colony-forming units (cfu)/g of feces by day 10 +/- 3 of therapy. Elimination of the anaerobes was reflected by a reduction in concentrations of short-chain fatty acids (SCFAs) in fecal supernatants. Fecal specimens containing greater than or equal to 10(6) cfu of Bacteroides fragilis group organisms/g (dry weight) contained significantly higher concentrations of succinic, propionic, and isobutyric acids. Flat SCFA chromatograms were observed in 90% of fecal samples from which no anaerobes were recovered. Preservation of the anaerobic flora appears critical in the prevention of fungal acquisition in neutropenic patients.

Adolescent↗