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Biomedical subjects

G L Saunders

Publications and source records attributed to G L Saunders.

11 recordsLinked to original sources
PubMed2006

Resistance in clinical isolates of Enterococcusfaecalis encountered at the University Hospital of the West Indies, Jamaica.

Enterococcus faecalis isolates were examined by an automated identification and susceptibility system. Almost all of the 97 isolates were ampicillin susceptible (n = 86) and tetracycline resistant (n = 89). All were nitrofurantoin susceptible. About a third of isolates showed high level resistance to the aminoglycosides streptomicin and gentamicin and this was usually associated with ciprofloxacin resistance (n = 34). Seven isolates were vancomycin resistant, including one that was ampicillin resistant. Most forms of resistance described elsewhere were found

Ampicillin↗
PubMed2004

An unusual presentation of group B streptococcal sepsis.

This paper describes the devastating outcome of a neonate who presented with severe late onset group B beta-haemolytic streptococcal (GBS) disease. There were extensive infarcts of the brain and gangrene of the toes. The purpose of this report is to alert healthcare workers of the unusual presentation and that fatal late onset group B beta-haemolytic streptococcal disease may occur despite early and effective management.

Cellulitis↗
PubMed1999

Molecular and antibiogram relationships of Acinetobacter isolates from two contrasting hospitals in the United Kingdom and South Africa.

The aim of this study was to compare the molecular relationships and antibiograms of nosocomial isolates of Acinetobacter spp. from two acute-care hospitals in Nottingham, UK, and Soweto, South Africa, with different hospital infection control problems and procedures. In contrast to Nottingham, where randomly amplified polymorphic DNA fingerprinting demonstrated that a single multiresistant strain of Acinetobacter baumannii has predominated in the hospital intensive care unit over an 11-year period, the Soweto isolates formed a heterogeneous group of unrelated molecular clusters of different antibiograms, with numerous different strains of Acinetobacter baumannii, Acinetobacter sp. 3 and Acinetobacter sp. 13TU apparently being endemic throughout the Soweto hospital. The contrasting results illustrate the need to maintain exemplary infection control procedures in hospitals where high standards have been achieved and warn of what might result if such measures are diminished.

Acinetobacter↗
PubMed1997

Streptococcus pneumoniae blood culture isolates from patients with and without human immunodeficiency virus infection: alterations in penicillin susceptibilities and in serogroups or serotypes.

We performed a 3-year retrospective study of Streptococcus pneumoniae blood culture isolates recovered at Baragwanath Hospital, Soweto, South Africa, from 1993 to 1995. The study group comprised 457 patients, including 98 children, of known human immunodeficiency virus (HIV) serostatus. Of these patients, 70 (30 [8.4%] of 359 adults and 40 [40.8%] of the 98 children) were infected with penicillin-resistant S. pneumoniae strains (minimal inhibitory concentration, > or = 0.12 microg/mL); 56 of these strains were intermediately resistant to penicillin. HIV-positive patients had significantly more penicillin-resistant isolates than did HIV-negative patients (43 [29.7%] of 145 HIV-positive patients vs. 27 [8.6%] of 312 HIV-negative patients; P < .001); this difference was found for both adults (19% vs. 4.3%; P < .001) and children (53.3% vs. 30.2%; P < .0343). Multiple resistance occurred more frequently in HIV-positive children (P = .02). HIV-positive adults had a statistically significant increase in the percentage of serogroups and serotype usually found in children and commonly associated with antimicrobial resistance, i.e., serotype 14 and serogroups 6, 19, and 23 (48% vs. 28.6%; P < .001). The increased prevalence of serogroups or serotypes usually found in children was also found among penicillin-susceptible strains. These data suggest that HIV-infected adults may again become susceptible to the serogroups or serotypes found in children.

AIDS-Related Opportunistic Infections↗
PubMed1994

Microbiological surveillance during selective decontamination of the digestive tract (SDD)

The use of selective decontamination of the digestive tract (SDD) as prophylaxis against nosocomial respiratory tract infection remains controversial, largely because of concerns that, in the long term, it may promote the emergence of antibiotic-resistant strains. This report describes the results of surveillance cultures and susceptibility testing undertaken during the course of a 2-year, double-blind study of the efficacy of SDD which was conducted in a respiratory intensive care unit (ICU). Surveillance specimens from the alimentary tract and trachea were obtained from each patient on admission and then twice weekly until 48 h after discharge from the unit. Specimens were cultured semiquantitatively and organisms from morphologically distinct colonies were identified by standard methods; the susceptibilities of these isolates were determined by the disc diffusion method. Five thousand, nine hundred and sixty surveillance samples from 239 patients were processed in this way. Compared with the placebo group, SDD caused a significant reduction in the incidence of colonization of the alimentary tract with aerobic Gram-negative bacilli (AGNB), and Candida spp. were almost totally eliminated. The incidence of colonization with enterococci increased in both groups, while the incidence of both colonization of the alimentary tract with strains of coagulase-negative staphylococci and methicillin-resistant Staphylococcus aureus and infection caused by these organisms increased in the SDD group. Acinetobacter spp. were the most common bacteria associated with unit-acquired colonization and lower respiratory tract infection in both groups. The acquisition of strains of Pseudomonas aeruginosa and cefotaxime- and/or tobramycin-resistant Enterobacteriaceae was significantly greater in the placebo group than in the SDD group, although tobramycin-resistant strains of Proteus, Morganella and Providencia spp. were isolated from three of 114 patients receiving SDD. The use of SDD did not lead to an overall increase in antibiotic resistance amongst the AGNB usually associated with ICU-acquired infection. However, colonization with strains which were either resistant to one or more of the antibiotic components of the regimen or which were not inhibited by the regimen was observed and may subsequently lead to infection.

Anti-Bacterial Agents↗
PubMed1994

Selective decontamination of the digestive tract in multiple trauma patients--is there a role? Results of a prospective, double-blind, randomized trial.

OBJECTIVE: To evaluate the efficacy of the technique of selective decontamination of the digestive tract in preventing the development of secondary infection and its influence on morbidity and mortality rates in multiple trauma patients with chest injuries requiring intermittent positive-pressure ventilation. DESIGN: Prospective, double-blind, randomized study. SETTING: A multidisciplinary respiratory intensive care unit (ICU) in a 1,500-bed teaching hospital. PATIENTS: Seventy-two patients (mean Injury Severity Score of 29.5) who were intubated for > 48 hrs and remained in the ICU for > 5 days. INTERVENTIONS: Patients were randomized on admission to receive selective decontamination therapy or placebo. All patients received intravenous cefotaxime for 72 hrs and the treatment group received oral and enteral selective decontamination with amphotericin B, polymyxin E, and tobramycin (n = 39), while the placebo group received a placebo containing oral paste and enteral solution (n = 33). MEASUREMENTS: Secondary infection was determined clinically and microbiologically and surveillance cultures were monitored for gastrointestinal colonization. RESULTS: The patient groups were fully comparable for age, severity of illness, and compromising factors. There was no difference in the number of patients infected (11 treatment group vs. 11 placebo), infections (17 vs. 16) and deaths (5 vs. 3); the duration of ICU (15.5 vs. 14.2 days) and hospital stays (26.3 vs. 25.5) were also similar. Microbiological surveillance cultures confirmed effective elimination of aerobic Gram-negative bacilli, and infections in the treatment group were largely due to Staphylococcus aureus and Staphylococcus epidermidis. CONCLUSION: We have been unable to show any benefit from the use of selective decontamination of the digestive tract in the prevention of secondary infections in multiple trauma patients.

Adult↗
PubMed1994

Invasive candidiasis in the ICU--pathogenesis and management strategy.

How should new and old antifungals be used in the management of invasive candidiasis in ICU patients? A pathogenesis-based management strategy for invasive candidiasis is outlined. Colonisation of the catheterised bladder by Candida species should be eliminated to prevent invasion from the urinary tract. Invasion from the peritoneum (in the patient with a perforated bowel) should be treated promptly to prevent local vascular invasion. Empirical therapy is recommended for treatment of suspected disseminated candidiasis, 'pulmonary' candidiasis and vascular-access candidiasis. Dose and duration of therapy are decided according to clinically determined patient/disease categories and modified according to information from laboratory results. Short-term low-dose regimens are suitable for peritoneal candidiasis that is recognised early, and for vascular-access candidiasis, provided the source-catheter can be removed.

Antifungal Agents↗
PubMed1992

Double-blind study of selective decontamination of the digestive tract in intensive care.

Selective decontamination of the digestive tract (SDD), by means of non-absorbable antibiotics, to prevent infection in intensive-care units (ICUs) remains controversial; there is evidence that the regimen reduces the incidence of secondary infection, but no convincing reduction in morbidity or mortality has been shown and the costs and effect on microbial resistance patterns need further study. In a double-blind, placebo-controlled trial, we have tried to find out whether SDD should be used routinely in all ICU patients at high risk of secondary infection. All patients admitted to the ICU who were thought likely to stay in the unit for at least 5 days and to need intubation for longer than 48 h were enrolled and randomly allocated to groups receiving placebo or SDD (amphotericin, colistin, and tobramycin applied to the oropharynx and enterally); all patients received intravenous cefotaxime for 72 h. Of 322 patients randomised, 83 were withdrawn (80 ICU stay or duration of intubation too short, 3 protocol violations). 239 medical, trauma, and surgical patients completed the trial period (114 SDD, 125 placebo). There were no differences between SDD and placebo groups in incidence of infection (30 [26%] vs 43 [34%] patients; p = 0.22), duration of ICU stay (mean 16.2 [14.3] vs 16.8 [12.3] days), hospital stay (29.9 [SD 25.0] vs 31.9 [22.2] days), or mortality (21 [18%] vs 21 [17%]). SDD substantially increased the costs of intensive care. Mechanisms other than bacterial colonisation of the gut may bring about substantial numbers of secondary infections in ICUs. Routine use of SDD in multidisciplinary ICUs cannot be recommended.

Administration, Oral↗