Biomedical subjects
Publications and source records attributed to G Verschraegen.
The microbiologist states that 50% of acute sinusitis are caused by pneumococcus and H. influenzae. On the other hand, in chronic sinusitis, the main pathogens are anaerobes and aerobic gram negative rods and alpha streptococcus. The reason for this is not alone clearly defined by microbiology.
Gardnerella vaginalis is usually associated with nonspecific bacterial vaginitis. This paper presents a CAPD patiënt with peritonitis due to G. vaginalis. The infection route remained speculative. Treatment with gentamicin was not successful while the clinical signs of peritonitis disappeared within 24 hours after starting cefazolin.
The diagnosis of male adnexitis is difficult and the influence of this condition on fertility is still a matter of debate. With the intention to define diagnostic criteria a comprehensive study of biochemical and morphological features of semen, plus culture for microorganisms, was performed in patients who were assessed for infertility during a four year period. The following parameters were considered of diagnostic value: a) history of urogenital infection and/or abnormal rectal palpation. b) significant alterations in the expressed prostatic fluid and/or urinary sediment after prostatic massage. c) 1. Uniform growth of more than 10(3) pathogenic bacteria, or more than 10(4) non-pathogenic bacteria per ml, in culture of diluted seminal plasma. c) 2. Presence of more than 10(6) (peroxidase positive) leucocytes per ml of ejaculate. c) 3. Signs of disturbed secretory function of the prostate or seminal vesicles. The diagnosis of infection is accepted if either of the following combinations if found: a + b, a + c (1 or 2 or 3), b + c (1 or 2 or 3), c1 + c2, c1 + c3, c2 + c3.
Bacterial respiratory infections, especially with Haemophilus influenzae and Streptococcus pneumoniae, are frequently associated with an increase of airways obstruction in patients with bronchial asthma. The possible involvement of immediate hypersensitivity in this phenomenon was studied. IgE antibodies to Haemophilus influenzae (HI) and Streptococcus pneumoniae (SPn) were investigated in the serum of 190 adult patients with bronchial asthma. The IgE antibodies were measured using a solid phase radioimmunoassay method. Living bacteria were used as solid phase. A correction of the non-specific binding of IgE was necessary. IgE antibodies to one or both bacteria were present in 55 of the 190 patients (29%). Eighteen patients were sensitive to HI, 33 to SPn and four to both bacteria. Significantly more IgE antibodies to bacteria were found in patients with demonstrable IgE antibodies to various inhalant allergens. However, the IgE antibodies to one or both bacteria were also present in 22% of patients with no other demonstrable IgE mediated hypersensitivity. The total serum IgE level in patients with IgE antibodies to bacteria was not significantly higher than in patients without hypersensitivity to these bacteria. From these data we concluded that immediate hypersensitivity to bacteria may play a role in the infectious exacerbations of bronchial asthma.
After the review of the morphology, the identification and the pathogenic properties of H. influenzae, its occurrence in the different ENT infections is discussed. H. influenzae is found in chronic tonsillitis in 64% of the cases, in the deeper tissue of the tonsils, while its occurrence in the throat swabs is rare. In acute otitis media H. Influenzae is present in 10 to 150% of the cases, while in rhinitis and sinusitis its increasing occurrence until 1974 is noted (28% of all sinusitis cases showed H. Influenzae in that year); since 1974 its occurrence is somewhat decreasing: 18% in 1976. Susceptibility testing for antibiotics with the disc-method is unreliable; we have to use the tube or plate-dilution methods. The increasing occurrence of ampicilline resistant strains of H. influenzae is discussed.
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Two different studies were performed in order to determine the role of aerobic and anaerobic bacteria in sinusitis. Aerobes: A retrospective study of 331 cases of all types of sinusitis (from 1963 till 1975) showed an increasing occurrence of Haemophilus influenzae during the last three years. Only in the acute sinusitis is Streptococcus pneumoniae more frequently found than Haemophilus influenzae, which exhibits the highest occurrence in chronic and undeterminable cases. We found cultures with pathogenic aerobes in 64% of the acute and 56% of the chronic cases of sinusitis. Anaerobes: A prospective study of 100 sinus secretions from 66 patients with paranasal sinusitis showed the great importance of anaerobes; they were present in 33% of samples, pure anaerobic cultures in 12% and mixed aerobic-anaerobic in 21%. Peptostreptococcus sp. showed the highest occurrence (15%). Anaerobic sinusitis is more frequent in unilateral cases. The presence of anaerobes is not dependent on the patient's age or the duration of the sinusitis. In 76% the anaerobes disappeared after the initial antral irrigation.
Two successive Acinetobacter outbreaks in a neonatal intensive care unit were studied with arbitrarily primed polymerase chain reaction (AP-PCR), cell envelope protein electrophoresis (protein fingerprinting) and antibiotic susceptibility testing. AP-PCR fingerprinting and protein fingerprinting yielded identical clustering of the isolates studied. Susceptibility test results were useful for rapid recognition of the outbreaks, but clustering of several isolates was different from the clustering obtained with AP-PCR fingerprinting and protein fingerprinting. Typing results indicated that the two outbreaks, which occurred at a three-month interval, were each caused by a single strain, and that both strains differed from the strains prevailing in the hospital. The strain of one outbreak was identified as A. junii, a species commonly not involved in outbreaks. A. baumannii isolates collected from different departments of this hospital during a period of four years clustered into only five different types. Moreover, strains from different departments of a second hospital belonged to the type prevailing in the first hospital, although there were no apparent connections between the two institutions. This may indicate that only a limited number of strains of the A. calcoaceticus-baumannii complex are involved in nosocomial outbreaks.
The aim of the study was to evaluate cefepime, a "fourth generation" cephalosporin, for its in vitro activity in comparison with 5 other broad spectrum antibiotics against clinical isolates from ICU and haematology patients. The strains were isolated from blood (8%), lower respiratory tract (41%), upper respiratory tract (14%), urine (20%) and other sites (17%). They were divided into: 28 non-inducible Enterobacteriaceae, 35 inducible Enterobacteriaceae, 20 non-fermenters, 10 S. aureus and 10 Streptococcus spp. The MIC-values were determined by E-test. Overall, the rank order of susceptibility was cefepime (93%), imipenem (90%), piperacillin-tazobactam (81%), ciprofloxacin (79%), ceftriaxone (75%) and ceftazidime (74%). Only cefepime was able to inhibit all inducible Enterobacteriaceae. Against Pseudomonas aeruginosa, cefepime had the same activity as ceftazidime. With the exception of ceftazidime (65%), all beta lactams demonstrated good activity against Gram positive cocci. The excellent activity against most Gram negative and Gram positive pathogens suggests that cefepime may be useful in the treatment of serious infections in the described patient population.
An open, comparative, randomized study was performed in two medical intensive care units to compare the efficacy of the combination of aztreonam and either cloxacillin or oxacillin [(cl)oxacillin] with that of the combination of tobramycin and a cephalosporin. Of the 92 patients who were included in the study, 76 were evaluable. All patients suffered from severe, mostly pulmonary, infections and received ventilatory support. The aztreonam combination yielded an 80% rate of clinical cure; mortality was 15%. Use of the aminoglycoside combination resulted in a 51% rate of clinical cure; mortality was 23%. The difference in cure rate between the two combinations was statistically significant. Adverse effects were negligible in patients who received the aztreonam combination, and superinfection was seen in only 2%. Of the patients who received the aminoglycoside combination, 20% developed a superinfection and 11% developed a new renal insufficiency. Therefore, the combination of aztreonam and (cl)oxacillin is a valuable alternative to the combination of an aminoglycoside and a cephalosporin.
In a multicenter open study, intraperitoneal aztreonam was used together with vancomycin, cloxacillin, or flucloxacillin for initial empiric treatment of peritonitis associated with continuous ambulatory peritoneal dialysis (CAPD). Monotherapy with aztreonam was continued in 34 episodes of gram-negative peritonitis in 28 patients. The microorganisms isolated included Escherichia coli, Acinetobacter species, Pseudomonas species, and Klebsiella species. In three episodes, two organisms were cultured. Microbiologic assessment revealed cure in 27 episodes, cure with relapse in two, cure with superinfection in one, and treatment failure in four (with resistance to aztreonam in three). As assessed by clinical criteria, 27 episodes were cured, five failed to respond, and two responded partially. No adverse reactions to aztreonam were observed. Comparison of these 34 episodes with 35 episodes in historical controls (treated mainly with aminoglycosides and/or trimethoprim-sulfamethoxazole) showed significantly higher rates of cure (84% vs. 51%) and of survival (97% vs. 86%) as well as lower rates of catheter removal (65% vs. 87%) with aztreonam. Thus aztreonam is a safe and efficient agent for the treatment of peritonitis caused by gram-negative organisms in patients undergoing CAPD.
Ralstonia pickettii bacteraemia from the atrial part of a ventriculo-atrial shunt was diagnosed as the cause of recurring febrile episodes with systemic toxicity in a 38-year old female. A prior neurosurgical resection of intracerebral cavernoma was complicated by postoperative recurrent meningitis with this non-fermenting gram-negative rod, due to an intra-operative contamination of a in situ shunt, from which only the intracerebral part of the ventriculo-atriostomy had been removed, following the episodes of meningitis. Ralstonia pickettii is a rare isolate and is seldom identified as a human pathogen. It formerly belonged to the genera Pseudomonas and Burkholderia. There are some casuistic reports of nosocomial bacteraemias, associated with the use of contaminated IV products or aerosols. There was an important diagnostic delay due to (1) insufficient communication between the different medical doctors in several hospitals, in different episodes of the clinical follow-up and (2) a misinterpretation of a positive blood culture with R. pickettii, which was interpreted as contamination. This misinterpretation and insufficient data transfer caused a considerable delay in the diagnostic process.
This prospective study represents an attempt to find a link between subclinical intra-amniotic infection and preterm singleton labor in 27 asymptomatic patients with intact membranes. Liquor amnii was obtained by transabdominal amniocentesis and cultured for anaerobic and aerobic bacteria and mycoplasmas. None of these cultures was positive. The value of gas-liquid chromatographic determination of volatile and non-volatile acids in liquor amnii could not be determined because amniotic infections did not occur in the population under study.
OBJECTIVE: Despite many improvements in connectology, peritonitis continues to be a major burden in peritoneal dialysis. Because of the high variety in causative organisms and of the differences in their sensitivity patterns, surveillance of the epidemiology of peritonitis and the appropriate adaptation of the therapy are necessary. This study was performed to evaluate the influence of the nature of causative bacteria on the effectiveness of empirical treatment protocols. Based on this information, a new empiric treatment protocol was proposed. SETTING: Peritoneal dialysis program of a university hospital. DESIGN: All episodes of peritonitis at the University Hospital Gent between 1 January 1994 and 31 December 1996 were analyzed retrospectively. Results of microbiological cultures, microscopic evaluation of dialysate, and clinical course were noted. RESULTS: During 1240 patient-months at risk, 50 episodes of peritonitis with identifiable responsible bacteria were observed. Gram-positive organisms were cultured in 34 episodes, and gram-negative organisms were found in 16 episodes. No responsible organism could be identified in 25 additional cases. Resistance to methicillin was registered in 33% of the cultures with staphylococci. There was no resistance to vancomycin. A new empirical treatment protocol was proposed, using a single dose of vancomycin and gentamicin intraperitoneally the first day, followed by oral treatment with ciprofloxacin. With this protocol, a 96% coverage rate is obtained, as opposed to a 78% coverage by using the Ad Hoc Advisory Committee protocol (p < 0.01). CONCLUSION: Individual centers should continue to monitor the epidemiology of peritoneal dialysis-related peritonitis and the epidemiology of the causative organisms and their sensitivity patterns in order to adapt general guidelines into a center-tailored empirical treatment protocol.