PubMed Health⌕ Search

Biomedical subjects

H D Isenberg

Publications and source records attributed to H D Isenberg.

At least 19 recordsLinked to original sources
PubMed1992

Ingestion of yogurt containing Lactobacillus acidophilus as prophylaxis for candidal vaginitis.

OBJECTIVE: To assess whether daily ingestion of yogurt containing Lactobacillus acidophilus prevents vulvovaginal candidal infections. DESIGN: Crossover trial for at least 1 year during which patients were examined for candidal infections and colonizations while receiving either a yogurt-free or a yogurt-containing diet. Patients served as their own controls. SETTING: Ambulatory infectious disease center in a teaching hospital providing tertiary care. PATIENTS: Thirty-three women with recurrent candidal vaginitis were eligible after recruitment from community practices and clinics and through advertising. Twelve patients were eliminated for protocol violations. Of the remaining 21 patients, 8 who were assigned to the yogurt arm initially refused to enter the control phase 6 months later. Thus, 13 patients completed the protocol. INTERVENTIONS: Women ate yogurt for 6 months of the study period. MEASUREMENTS: Colonization of lactobacilli and candida in the vagina and rectum; candidal infections of the vagina. MAIN RESULTS: Thirty-three eligible patients were studied. A threefold decrease in infections was seen when patients consumed yogurt containing Lactobacillus acidophilus. The mean (+/- SD) number of infections per 6 months was 2.54 +/- 1.66 in the control arm and 0.38 +/- 0.51 per 6 months in the yogurt arm (P = 0.001). Candidal colonization decreased from a mean of 3.23 +/- 2.17 per 6 months in the control arm to 0.84 +/- 0.90 per 6 months in the yogurt arm (P = 0.001). CONCLUSION: Daily ingestion of 8 ounces of yogurt containing Lactobacillus acidophilus decreased both candidal colonization and infection.

Adult↗
PubMed1992

Vancomycin-resistant Enterococcus faecium in hospitalized children.

OBJECTIVE: Determine the epidemiology and risk factors for colonization with vancomycin-resistant Enterococcus faecium. DESIGN: Survey; case-control study. SETTING: Children's hospital. PATIENTS: Pediatric oncology patients. INTERVENTION: Contact isolation, restriction of vancomycin prescribing. RESULTS: There was a high prevalence of colonization with vancomycin-resistant enterococci among pediatric oncology patients. The length of hospitalization and the administration of vancomycin and other intravenous antibiotics was associated with colonization. Prevention of colonization was associated with restriction of vancomycin use and contact isolation. CONCLUSIONS: Vancomycin use may predispose to colonization with vancomycin-resistant E faecium. Vancomycin-resistant E faecium may be nosocomially spread. Contact isolation and restriction of vancomycin use may prevent spread of vancomycin-resistant E faecium.

Bacterial Typing Techniques↗
PubMed1992

Clinical significance of Staphylococcus warneri bacteremia.

Twenty-seven episodes of bacteremia caused by Staphylococcus warneri were identified at Long Island Jewish Medical Center in New York between 1984 and 1989. Fourteen of these were thought to represent true bacteremias and 13 to represent contaminants. Of the 14 true bacteremias, 5 were in pediatric and 9 were in adult patients. Eight of 14 patients (57%) had catheter-related bacteremia and 5 of 14 had bacteremia of unknown source. There was one case of fulminant native valve S. warneri endocarditis. All cases of catheter-related bacteremia, except one, were nosocomially acquired, and 75% of these patients had an underlying immunosuppressive condition. Only 40% of patients with bacteremias of unknown source were immunocompromised, and S. warneri appeared to be noninvasive in this group. Interestingly, all five of the pediatric isolates were oxacillin susceptible, although four of five were resistant to penicillin, despite the fact these patients were hospitalized an average of 29 days. In contrast, seven of nine adult isolates were resistant to both oxacillin and penicillin. The only case of native valve S. warneri endocarditis occurred in a patient who had no known underlying valvular heart disease, but had an underlying immunosuppressive condition. Identification to species level of coagulase-negative staphylococci may lead to appreciation of the importance of bacteria such as S. warneri as human pathogens.

Adolescent↗
PubMed1992

Abscess and empyema caused by Legionella micdadei.

Legionella micdadei is the second most common species implicated in the occurrence of Legionella pneumonia (D. J. Bremer, Semin. Respir. Infect. 4:190-205, 1987). Although there has been a reported lung abscess caused by dual infection (L. micdadei and L. pneumophila), there are no known cases of L. micdadei as the only causative organism. We report a case of a patient with a lung abscess from which L. micdadei was the sole organism isolated.

Empyema↗
PubMed1991

Evaluation of the Roche Septi-Chek AFB system for recovery of mycobacteria.

The Septi-Chek AFB system for the recovery of mycobacteria from clinical specimens was compared with a conventional approach using Lowenstein-Jensen and Middlebrook 7H11 agars. A total of 1,532 clinical specimens were analyzed; 132 yielded mycobacteria. Mycobacterium tuberculosis and Mycobacterium avium complexes were the predominant isolates. With the conventional combination of Lowenstein-Jensen and 7H11 agars, 75.8% of the isolates were recovered; the Septi-Chek AFB allowed recovery of 100% of the isolates. Septi-Chek AFB required less time for the detection of mycobacteria than did the conventional media.

Agar↗
PubMed1991

Restriction fragment analysis of a Candida tropicalis outbreak of sternal wound infections.

An apparent single-source outbreak of Candida tropicalis sternal wound infections in eight patients was investigated by utilizing DNA restriction fragment analysis (RFA) with HindIII and BstNI. All eight outbreak isolates appeared to be identical and were easily differentiated from control isolates by DNA RFA. Compared with an arbitrarily selected reference outbreak isolate, greater than or equal to 95% of the bands in the restriction digests identified by a computerized image analysis system from each of the outbreak isolates were identical versus 13 to 53% of the bands in any of the nine control isolates. Outbreak strains were significantly more likely to match the reference outbreak isolate than were controls (P less than 0.0001). The RFA was greatly facilitated by the use of computerized image analysis and confirmed the epidemiologic link between a scrub nurse and the infected patients.

Candida↗
PubMed1991

Candida zeylanoides: another opportunistic yeast.

A patient with a long history of scleroderma and gastrointestinal malabsorption requiring total parenteral nutrition was admitted with Candida zeylanoides fungemia. The yeast responded to therapy, but on two subsequent admissions for episodes of fever the blood cultures yielded the same yeast. The identity of the Candida species was established biochemically by both the API (Analytab) and Vitek system approaches. C. zeylanoides ATCC 20356 and ATCC 7351 served as controls for these analyses and for antifungal susceptibility studies and restriction endonuclease analyses of chromosomal DNA. These investigations indicated that representative isolates of the yeasts from the three episodes were identical and differed in several respects from the ATCC strains, which did not share many of the characteristics bands with the DNA restriction fragment analysis. C. zeylanoides variants capable of tolerating 35 degrees C can complicate the recovery of patients, especially individuals compromised by their underlying disease.

Amphotericin B↗
PubMed1991

Collaborative feasibility study of a biphasic system (Roche Septi-Chek AFB) for rapid detection and isolation of mycobacteria.

A study to delineate the feasibility of a biphasic-culture approach for detection and isolation of mycobacteria from clinical specimens except blood was conducted in four medical centers. The biphasic system (Septi-Chek AFB, Roche Diagnostic Systems, Nutley, N.J.) was compared with conventional mycobacterial isolation media and the BACTEC system. Septi-Chek AFB showed the highest degree of mycobacterial recovery. In addition, Septi-Chek AFB consistently shortened the time required for recovery of mycobacteria from clinical specimens and supported the growth of small inoculum numbers of stock cultures of 14 mycobacterial species. The study indicates the feasibility and potential advantages of the biphasic approach for detection and isolation of mycobacteria.

Bacteriological Techniques↗
PubMed1989

Single-source outbreak of Candida tropicalis complicating coronary bypass surgery.

Candida tropicalis was isolated from the sternal wounds of eight coronary bypass patients from 18 to 89 days postoperatively; infections were limited to soft tissue in five patients but involved the sternum in three patients. Analysis of surgery records implicated one individual as the potential source of the yeast; this was confirmed by microbiological studies of fingertips and nasopharynx cultures of all personnel in contact with these patients. Only the suspect nurse, then acting as a scrub nurse and not as a circulator, infected the eight patients. Her removal from the cardiac team terminated the cluster outbreak.

Candida↗
PubMed1988

Central catheter infections: single- versus triple-lumen catheters. Influence of guide wires on infection rates when used for replacement of catheters.

A prospective study was conducted over six months to determine if triple-lumen catheters were associated with a higher rate of infection than single-lumen catheters. A total of 502 central intravascular catheters were prospectively collected from 362 consecutive patients in the adult intensive care units. Semiquantitative and broth cultures were performed on distal and proximal catheter segments, with peripheral blood culture specimens drawn in febrile patients. The overall infection rate for the 502 catheters was 11.8 percent or 2.2 infections per 100 days at risk. The infection rates were: single-lumen lines, 8 percent; triple-lumen lines, 32 percent; and triple-lumen pulmonary artery catheters, 12 percent. When corrected for time at risk, the triple-lumen lines and the triple-lumen pulmonary artery catheters had the same rate of infection, which was three times greater than that of the single-lumen catheters. After correction for confounding variables such as the presence of diabetes mellitus, the use of hyperalimentation, the degree of illness, dialysis, or ultrafiltration, and the use of a guide wire to place a replacement line over a pre-existing one, the risk of infection remained significantly higher for triple-lumen than for single-lumen catheters. The use of a guide wire to place a new line over an old one also was associated with a trend towards an increased risk of infection.

Adult↗
PubMed1988

Evaluation of three disinfectants after in-use stress.

Solutions of 2.0% and 3.4% glutaraldehyde, and of 0.5% phenate with 0.18% glutaraldehyde were stressed with a microbial and organic soil load for the periods advocated by the respective manufacturers. The disinfecting efficacy of the stressed solutions was challenged with Staphylococcus aureus, Pseudomonas aeruginosa, Bacillus subtilis, Mycobacterium bovis (BCG), a water Mycobacterium sp. and Candida albicans. The three disinfectants were active against the fast-growing bacteria in appropriate dilutions; lesser dilutions of the glutaraldehyde solutions killed the mycobacteria and the yeast, while stressed phenate with glutaraldehyde did not. One hour exposure of the stressed disinfectants failed to kill the spore preparations while reducing the number of survivors.

Aldehydes↗
PubMed1988

Antimicrobial susceptibility testing: a critical evaluation.

Antibiotic susceptibility test results must be interpreted cautiously. There are important differences between the laboratory and natural environments. There are also important differences between disc and dilution tests, and between laboratories. Laboratory tests can demonstrate antagonism and synergy. Because beta-lactamases can be induced, beta-lactam susceptibility may have to be monitored during therapy. Increases in the incidence of drug resistance are particularly important in nosocomial infections.

Anti-Bacterial Agents↗
PubMed1988

Pathogenicity and virulence: another view.

The concepts of pathogenicity and virulence have governed our perception of microbial harmfulness since the time of Pasteur and Koch. These concepts resulted in the recognition and identification of numerous etiological agents and provided natural and synthetic agents effective in therapy and prevention of diseases. However, Koch's postulates--the premier product of this view--place the onus of harmfulness solely on the microbial world. Our recent experiences with polymicrobic and nosocomial infections, legionellosis, and acquired immunodeficiency syndrome point to the host as the major determinant of disease. The principles of parasitism, enunciated by Theobold Smith, approximate more accurately the disturbances of the host-parasite equilibrium we designate as infection. Many complex attributes of microbial anatomy and physiology have been obscured by our dependency on the pure-culture technique. For example, bacterial attachment organelles and the production of exopolysaccharides enable microorganisms to interact with mammalian glycocalyces and specific receptors. In addition, selection, through the use of therapeutic agents, aids in the progression of environmental organisms to members of the intimate human biosphere, with the potential to complicate the recovery of patients. These factors emphasize further the pivotal significance of host reactions in infections. Parasitism, in its negative aspects, explains the emergence of "new" infections that involve harm to more than host organs and cells: we may encounter subtler infections that reveal parasitic and host cell nucleic acid interactions in a form of genomic parasitism.

Animals↗
PubMed1988

Nosocomial urinary tract infection with a slowly growing, fastidious Escherichia coli.

Escherichia coli recovered from a nosocomially acquired urinary tract infection required 48 h of incubation on blood agar and did not grow on other routine clinical laboratory media. This bacterium dissociated readily into three colony types, all of which were confirmed as E. coli by DNA hybridization studies. Preliminary studies indicate a prolonged lag phase that could not be corrected by the addition of a variety of peptones and yeast extracts. Better growth was achieved by the addition of 10% horse serum.

Aged↗
PubMed1988

Comparison of three enzyme-linked immunosorbent assays and a direct fluorescent-antibody test for detection of respiratory syncytial virus antigen.

We prospectively evaluated three enzyme immunoassays (EIAs) and a direct fluorescent-antibody (DFA) test for respiratory syncytial virus detection. Of 90 specimens, 79% gave the same results in all four tests (30 positive and 41 negative) and 97% were in agreement in three of the four assays. The agreement between the direct fluorescent-antibody test and each enzyme immunoassay was greater than or equal to 86%.

Antigens, Viral↗