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Biomedical subjects

H M Just

Publications and source records attributed to H M Just.

At least 19 recordsLinked to original sources
PubMed2000

How to survey nosocomial infections.

Many surveillance methods for nosocomial infections (NIs) have been put forward in the literature, and all have their advantages and disadvantages. Different surveillance methods are useful, depending on whether the objective of surveillance is only to increase sensitivity to infection control problems and to identify areas with possible infection control problems; to confirm a possible infection control problem through comparison with other units or departments; or to use surveillance data for identifying the sources of infections. Furthermore, time effectiveness is a major point in selecting the most appropriate method, particularly the method for case identification. In units or departments with a high level of NI, even highly time-consuming surveillance methods may be ultimately time-effective; in units or departments with a lower level of NI, the time-effectiveness depends on the time necessary for case identification. Close liaison with staff in the units is a sine qua non for the success of all surveillance activities.

Cross Infection↗
PubMed1998

Controlled clinical laboratory comparison of two supplemented aerobic and anaerobic media used in automated blood culture systems to detect bloodstream infections.

A 20-ml blood sample was collected from adult patients with suspected bloodstream infections and distributed equally into the four volume-controlled bottles of a blood culture set consisting of aerobic and anaerobic BACTEC Plus/F bottles and aerobic and anaerobic BacT/Alert FAN bottles. All bottles were incubated in their respective instruments for a standard 5-day protocol or until the instruments signalled positivity. Samples in all bottles with negative results by these instruments were terminally subcultured. A total of 8,390 blood culture sets were obtained during the study period, of which 4,402 (52.5%) met the study criteria. Of these, 946 (21.5%) were positive either by instrument signal or by additional terminal subculture of all negative bottles and yielded growth of microorganisms. Five hundred eighty-nine (13.4%) blood culture sets were considered to have recovered 663 clinically significant organisms. When both the BACTEC and the BacT/Alert systems were used, 465 positive sets were detected; BACTEC alone detected 52 positive sets and BacT/Alert alone detected 72 (P = 0.09). No differences were found between the two systems in microbial recovery rate from blood cultures obtained from patients on antibiotic therapy. Significantly more members of the family Enterobacteriaceae (P < 0.01) were detected from patients without antimicrobial therapy by BacT/Alert than by BACTEC. The false-negative rates were 0.20% for BACTEC and 0.32% for BacT/Alert. A significantly higher false-positive rate was found for BACTEC (P < 0.0001). Both systems were comparable for the time to detection of microorganisms. However, gram-positive bacteria were detected faster by BACTEC and Enterobacteriaceae were detected faster on average by BacT/Alert. We concluded that both systems are comparable in their abilities to recover aerobic and anaerobic organisms from blood cultures and a terminal subculture might not be necessary for either of the two systems. The increased positivity rate when using an anaerobic bottle in a two-bottle blood culture set is due to the additional blood volume rather than to the use of an anaerobic medium.

Adult↗
PubMed1997

Multicenter clinical comparison of resin-containing bottles with standard aerobic and anaerobic bottles for culture of microorganisms from blood.

In a study comparing the Bactec 9240 (Plus Aerobic/F and Anaerobic/F bottles, containing resins; Becton Dickinson, USA) and the Vital (standard aerobic and anaerobic bottles, with no additives; bioMérieux, France) blood culture systems, 6456 sets of four bottles of 9660 blood cultures submitted were evaluated. There were 531 clinically significant isolates from 795 positive blood cultures. Of the 531 positive blood cultures, 355 were positive in both systems, 141 with the Bactec 9240 alone, and 30 with the Vital alone (p < 0.001); five were not detected by either system. The average time to detection of positive cultures for the matched sets was 10.65 h and 18.41 h by the Bactec 9240 system and the Vital system, respectively. The false-positive rate per bottle was 0.65% in the Bactec 9240 and 0.71% in the Vital. The rate of false-negative pairs (i.e., major errors) was very low (0.12% for the Bactec 9240, 0.19% for the Vital) and not significantly different between the two systems. The striking differences in recovery of microorganisms may be due to the presence of resins in the Bactec medium. However, the observed superiority of the Bactec 9240, even for patients not receiving antibiotics, suggests that resins adsorb other inhibitors present in patients' blood.

Adult↗
PubMed1997

[Importance of mycoses in intra-abdominal infections].

Although there is a 20% yeast colonization in the gastrointestinal tract of the population, fungal infections appear only rarely in secondary peritonitis. The risk of severe mycosis increases after a major operation and when a patient is taking broad-spectrum antibiotics, is on total parenteral nutrition, is catheterized, and/or is immune-suppressed. In the past years the incidence of nosocomial fungal infections (usually Candida spp.) has risen significantly. Five percent of CAPD-related peritonitis is caused by fungi. In enteral anastomosis breakdown, invasive mycosis occurs more often, with an accompanying lethality of up to 80%. In severe pancreatitis, up to 5% of peripancreatic necrosis is infected with fungi. The clinical course of severe mycosis, like the septic syndrome, is associated with fungemia in up to 50% of cases. As most of the facultative pathogenic fungi are part of the physiological flora, it is difficult to interpret mycological cultures. In order to diagnose invasive fungal infections, histopathological techniques and serologic tests for antigens and antibodies are available. Three antifungal agents (amphotericin B, flucytosine, fluconazole) are available for intravenous administration. Amphotericin B is given at doses of up to 1 mg/kg per day, in liposomal galenism up to 3 mg/kg per day. Combining amphotericin B with flucytosine (150-200 mg/kg per day) a synergistic effect is reached. Fluconazole at a dosage of 200-800 mg per day represents an alternative with similar antifungal activity and lower side effects.

Antifungal Agents↗
PubMed1990

An epidemiological study assessing the relative importance of airborne and direct contact transmission of microorganisms in a medical intensive care unit.

A prospective epidemiological survey was carried out over a period of seven weeks in a medical intensive care unit. Bacteria from patients, staff and air were monitored and the transmission of isolated microorganisms was followed. Handwashing samples revealed pathogenic bacteria in 30.8% of physicians (average number of colony forming units: 71,300 per hand) and 16.6% of nurses (39,800 cfu per hand). Air cultures yielded pathogens in 15% of sampling periods and nine of 53 patients were found to be colonized with Gram-negative bacteria, Staphylococcus aureus or Candida spp. The spectrum of bacteria recovered from patients and air was generally different, whereas strains recovered from patients and their attendants' hands were indistinguishable on multiple occasions. The results of this study confirm that direct contact is the principal pathway of microbial transmission, whereas little evidence for a significant role of airborne transmission is shown. The call for more extensive air-filtering and ventilation systems in medical intensive care units is not supported by the results shown in this communication.

Air Microbiology↗
PubMed1989

Influence of architectural design on nosocomial infections in intensive care units--a prospective 2-year analysis.

Nosocomial infection rates in an old intensive care ward constructed in 1924 were compared with those in a new one constructed in 1986. The nosocomial infection rate in the old unit was 34.2% and that in the new unit 31.9%, with an average of 33%. The most frequent infections were: pneumonia, urinary tract infection, septicaemia and wound infection. After transfer of the intensive care unit (ICU) the incidence and profile of nosocomial infections remained the same. These findings suggest that the influence of architectural design has little impact on the incidence of nosocomial infections.

Cohort Studies↗
PubMed1987

[Effect of Pseudomonas immunoglobulin on the antibacterial activity of human phagocytes].

The in vitro influence of a pseudomonas immunoglobulin in active and inactivated serum on the bactericidal activity and phagocytosis of human polymorphonuclear leukocytes was evaluated against Pseudomonas aeruginosa. No lysis of the bacteria could be found in either serum, however, the bactericidal activity of the leukocytes was significantly enhanced in active serum (p less than or equal to 0.05), whereas no effect was measurable in inactivated serum. Phagocytosis could be increased in concentrations of 10% immunoglobulin, (equivalent to 5 mg IgG/ml); however, a concentration of 15% showed a lower phagocytosis index which was comparable to that in the 5% preparation. This immunoglobulin proved to be able to support the bacterial phagocytosis and killing of P. aeruginosa by human polymorphonuclear leukocytes in vitro.

Humans↗
PubMed1987

Proven and unproven methods in hospital infection control in intensive care units.

Most common nosocomial infections in Intensive Care Units are: respiratory tract infections, urinary tract infections, bacteremias, and wound infections. Proven methods in hospital infection control are: hand washing, discipline of all personnel, appropriate nursing techniques, specially trained hygiene staff, isolation, appropriate number of nursing personnel per patient, appropriate use of antibiotics, few and brief usage of foreign bodies such as intravenous lines. Useless and unproven methods in hospital infection control are: environmental cultures, routine cultures of personnel, routine air sampling, fogging and spraying of disinfectants, UV lights, plastic shoe covers, routine floor disinfection, disinfection or sticky mats, change of humidifiers and tubings every eight hours, and systematic antibiotic prophylaxis against pneumonia.

Critical Care↗
PubMed1986

[Effect of adjuvant immunoglobulin therapy on infections in patients in an surgical intensive care unit. Results of a randomized controlled study].

A randomized controlled clinical trial was conducted on the effects of immunoglobulin in therapy for infections in 104 intensive care patients. At the first sign of infection, one group of 50 patients received an i.v. preparation of immunoglobulin (4 X 100 ml) combined with antibiotics. The other 54 control patients received antibiotics alone. The most common infections in these patients were pneumonia, septicemia, peritonitis and wound sepsis. Infections were significantly seldom the cause of death, especially in patients with high-risk surgery who had been treated with immunoglobulin (p less than or equal to 0.05). Likewise ventilation time in the high-risk surgery group averaged only 5.5 days for those receiving immunoglobulin as opposed to 12.7 days in controls (p less than or equal to 0.01). Whereas the control group, in particular patients with pneumonia, remained in intensive care an average of 21.5 days, those receiving immunoglobulin stayed only 14.8 days (p less than or equal to 0.01). In general, patients treated with immunoglobulin recovered more rapidly from infections than did controls (p less than or equal to 0.01).

Adult↗
PubMed1986

Effect of 5-fluorouracil, mitoxantrone, methotrexate, and vincristine on the antibacterial activity of ceftriaxone, ceftazidime, cefotiam, piperacillin, and netilmicin.

Using the checkerboard agar dilution technique, antibacterial activity and in vitro interactions of 4 antineoplastic agents and 5 antimicrobial drugs were examined against 56 strains of 7 bacterial species. 5-fluorouracil was found to inhibit all strains of Staphylococcus aureus and of Staphylococcus epidermidis at a concentration of 0.8 micrograms/ml or less. 84% of all gram-negative strains were inhibited synergistically when 5-fluorouracil was combined with beta-lactam antibiotics. Methotrexate and cefotiam were antagonistic in 42% of all combinations, especially when tested against Escherichia coli and Klebsiella pneumoniae.

Anti-Bacterial Agents↗
PubMed1985

In vitro combination-effect of temocillin with ticarcillin and aminoglycosides on gram-negative and gram-positive bacteria.

The in vitro efficacy of temocillin in combination with ticarcillin and with gentamicin, tobramycin, amikacin and netilmicin against 80 Gram-negative and 20 Gram-positive bacterial strains was compared by use of the checkerboard agar dilution technique. No synergistic or additive effect was seen on the Gram-positive strains. Great variations occurred between the different bacterial species, and the temocillin-ticarcillin combination had only little effect against the Pseudomonas strains tested. On average, only 12% of all strains tested were inhibited synergistically by temocillin-gentamicin combinations, and only 7 to 10% by combinations of temocillin with the other aminoglycosides. However, 25% of Gram-negative strains were inhibited synergistically and 40% of Gram-negative strains were inhibited additively by the combination of temocillin-gentamicin.

Aminoglycosides↗
PubMed1985

[Comparative antibacterial activity of piperacillin against Pseudomonas aeruginosa, Escherichia coli and Streptococcus faecalis in cultures and human serum].

The in vitro activity of piperacillin at 1/4, 1 and 4 X MHK against 5 strains each of Pseudomonas aeruginosa, Escherichia coli and Streptococcus faecalis was compared in Mueller-Hinton-bouillon and human serum. Serum without piperacillin was bacteriostatic against P. aeruginosa for 8 hrs., against E. coli for 24 hrs. Subinhibitory piperacillin concentrations were bacteriostatic against E. coli, but had no effect against P. aeruginosa and S. faecalis. Bactericidal activity against E. coli was achieved at 1 X MHK against P. aeruginosa and S. faecalis at 4 X MHK. Except for P. aeruginosa in concentrations of 1/4 and 1 X MHK the piperacillin activity in bouillon and serum was almost identical.

Animals↗
PubMed1984

Netilmicin versus tobramycin in multi-centre studies.

In two prospective, randomized studies conducted in West Germany and involving 80 patients, netilmicin-ticarcillin was compared to tobramycin-ticarcillin in the treatment of serious systemic infections. Both regimens were essentially identical with respect to the clinical and bacteriological results they produced. The netilmicin group developed significantly less nephrotoxicity than the tobramycin group (0% versus 15%, P = 0.03). Ototoxicity also occurred less frequently in the netilmicin-treated patients (3% versus 10%, P = 0.4). In a large collaborative study involving 15 centres, 254 patients were enrolled. Clinical and bacteriological responses were excellent, with netilmicin and tobramycin equally effective, but the incidences of nephrotoxicity and ototoxicity were lower in patients treated with netilmicin than those receiving tobramycin.

Acute Kidney Injury↗