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Biomedical subjects

G Orange

Publications and source records attributed to G Orange.

8 recordsLinked to original sources
PubMed1996

Impact of an infection consultation service for bacteraemia on clinical management and use of resources.

Since 1993, the infection consultation service for bacteraemia has seen 310 patients in the Medical and Surgical Directorates at Ninewells Hospital and Kings Cross Hospital. A random sample of 100 was audited. Case-notes were incomplete for five patients, leaving 95 fully-audited patients. Clinical outcome measures were death from infection, and readmission within 2 weeks of discharge. Initial treatment was inconsistent with antibiotic policy in 46 patients (48%). Antibiotic treatment was changed in 37 (80%) of these patients: increased in intensity in 19 (41%) and decreased in 18 (39%). Changes were also made in 30 (61%) of the 49 patients whose initial treatment was consistent with sepsis policy-increased in seven (14%) and decreased in 23 (47%). Median daily antibiotic costs were lowered in patients whose initial treatment was consistent with sepsis policy (pounds 10.10 vs. pounds 7.28, p = 0.0274). However, in the other patients, savings were balanced by increases (p = 0.7696). Consultation required one consultant session per week (3.5 h) and the audit required an additional 16 consultant sessions. Seven patients died, but only one death was directly related to infection. Six patients were readmitted to hospital within 2 weeks, in three due to recurrence of infection. Changes to treatment were recommended in the majority of patients, regardless of whether initial treatment complied with the sepsis policy. The service primarily redistributed resources rather than reducing costs. A fully audited service requires considerable consultant time, but we believe such time is well spent.

Anti-Bacterial Agents↗
PubMed1996

Genetic heterogeneity of M type 3 group A streptococci causing severe infections in Tayside, Scotland.

To explain the worldwide increase in the frequency of severe infections by group A streptococci, molecular techniques are increasingly being employed to evaluate the genetic relationships of strains. We used restriction endonuclease analysis, pulsed-field gel electrophoresis (PFGE), the PCR, ribotyping, and DNA sequence analysis in a study of 13 group A streptococci isolated from a cluster of cases of serious infections over a 3-month period in Tayside, Scotland. Eight of the strains were M type 3; molecular characterization identified two subclones. The first, displaying PFGE profile 4, has been observed in Northern Scotland and has been circulating in New Zealand for over a decade. The second subclone has been documented only in the United Kingdom; it was first seen in 1993 in Scotland. Sequence analysis of emm-3 genes further differentiated the PFGE 4 subclone. DNA sequence analysis of virulence factors supports the suggestion that they may have recently been acquired by horizontal gene transfer.

Bacterial Typing Techniques↗
PubMed1995

Prospective audit of costs and outcome of aminoglycoside treatment and of therapy for gram-negative bacteraemia.

The aims of this study were to audit the monitoring of aminoglycoside treatment to develop a method for measurement of the cost and outcome of treatment, and to assess the accuracy of a previously published sepsis score to predict cost and outcome. Measurements of costs and outcomes were also made for all patients (n = 85) with Gram-negative bacteraemia. Of these, 40 received an aminoglycoside and an additional 215 patients received aminoglycosides for other indications (total aminoglycoside patients 255; total patients 300). There were no interpretable assays for 82 (32%) of the aminoglycoside patients and only 33/173 (19%) patients assayed had first peak serum concentrations within the recommended range of 8-10 mg/L. Median costs of aminoglycoside treatment were 599 pounds in neutropenic patients, 471 pounds in ICU patients and 185 pounds in other patients. In the bacteraemic patients, median costs of aminoglycoside regimens (278 pounds) were higher than for non-aminoglycoside regimens (97 pounds). Death in hospital was twice as common in bacteraemic patients (20% versus 10%) and there was a stepwise increase in rate of mortality with sepsis scores. Treatment costs were markedly higher in patients who failed to respond to initial treatment, the mean difference in cost was 418 pounds per patient (95% CI 89 pounds - 747). Sepsis scores only explained 2.6% of the variance in treatment costs, and 22 patients with zero sepsis scores received prolonged courses of i.v. antibiotic treatment at an average cost of 209 pounds per patient. In conclusion, aminoglycoside regimens rarely conformed to accepted standards of care and treatment failure was associated with markedly increased treatment costs. Three readily measurable indicators of adverse outcome were identified (death in hospital, change of i.v. treatment and readmission within 2 weeks of discharge) and all were related to initial severity of illness as measured by sepsis score. The sepsis score may prove useful for assessment of individual risk but would benefit from further analysis to validate and possibly reduce the number of items in the score.

Adolescent↗
PubMed1993

Biocidal effects and residual glutaraldehyde in cellulosic and synthetic polymers.

The amount of leachable glutaraldehyde from medical grade Cuprophan 150PM (cellulose based) and AN69S (a copolymer of acrylonitrile and sodium methallyl sulphonate) membranes, and polyproprene plates following 72 hr immersion in 2% alkaline glutaraldehyde was determined. After rinsing the materials for 30 minutes in distilled water at 37 degrees C, the mean concentration of leachable glutaraldehyde from Cuprophan 150 PM (8. 60 +/- 0.55 micrograms/g) was significantly greater than that from AN69S membrane (6.50 +/- 0.60 micrograms/g), (p < 0.01). The mean leachable glutaraldehyde from plates was 0.30 +/- 0.15 microgram/g. There was a significant decrease in the mean leachable glutaraldehyde from AN69S (5.35 +/- 0.25 micrograms/g) after second immersion (p < 0.05). The concentration of leachable glutaraldehyde in the plates and Cuprophan 150PM remained relatively unchanged. Absence of growth following infusion of 2% alkaline glutaraldehyde into blood contaminated miniature dialyzers containing high microbial loads of selected bioindicator organisms (S. aureus, P. aeruginosa, B. subtilis (Var globigii) spores, M. gordonae, A. niger spores and attenuated polio virus) demonstrated its effectiveness under environmental conditions that were conducive to high resistance. These findings indicate that 2% alkaline glutaraldehyde is readily washed from the three polymer materials that were studied and its accumulation following repeated exposure was not evident. Its application in pre-sterilization treatment of heavily contaminated invasive polymer based devices seemed feasible.

Acrylic Resins↗
PubMed1985

Clostridium difficile-associated colitis in uremic patients.

Five uremic patients managed in a renal unit developed Clostridium difficile-associated colitis. Four cases occurred in a cluster at about the same time. All patients had previously received or were on antibiotic therapy at the onset of diarrhea and one patient was also on oral steroid therapy. Cefotaxime, a third generation cephalosporin was involved in all five cases. All patients had severe diseases with explosive diarrhea and systemic toxicity. The diagnosis was confirmed in all cases by culture of C. difficile and demonstration of high titers of C. difficile cytotoxin in the stool. Histology from rectal biopsy in one patient showed classical pseudomembranous colitis. Response to treatment with vancomycin was generally good though one patient had two relapses. Uremic patients have impaired immune response and intestinal motility and are predisposed to C. difficile infection. Cross-infection can occur and the isolation of affected patients seems prudent.

Adult↗
PubMed1984

Diphtheroid peritonitis associated with continuous ambulatory peritoneal dialysis.

Five patients on continuous ambulatory peritoneal dialysis (CAPD) developed peritonitis caused by diphtheroid bacteria. Peritoneal catheter exit site inflammation and/or discharge preceded all cases and relapses were common. Antimicrobial therapy alone failed to eradicate the bacteria and peritoneal catheter removal was required before peritonitis resolved. Laboratory culture of the diphtheroid bacteria was difficult and prolonged incubation was often necessary. Diphtheroid bacteria are important opportunistic pathogens in immunocompromised patients and should be carefully sought for in all cases of culture-negative CAPD-associated peritonitis.

Adult↗