Biomedical subjects
Publications and source records attributed to J A Carton.
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OBJECTIVES: To compare the incidence, mortality, clinical characteristics and outcome between bacteraemias in diabetic and non-diabetic patients. METHODS: A prospective study of all adult patients with bacteraemia admitted to a large Spanish teaching hospital during six consecutive years (1984-1990); 152 were diabetics and 1488 non-diabetics. RESULTS: Rates per 1000 admissions when bacteraemic diabetic patients were compared with non-diabetics (p < 0.001) were respectively as follows: incidence 26.8/15.5, acquisition in the community 18.4/6.2, urinary tract source 8.7/2.2, and E. coli aetiology 8.9/3.4. Diabetes mellitus type II was found in 138 episodes. Glycosylated haemoglobin levels were 13 +/- 3%. Bacteraemia developed in association with hyperosmolar status in 14.5% of patients and with ketoacidosis in 5%. Patients in the diabetic group developed septic shock in 22% of the episodes, acute renal failure in 40%, superinfections in 22% and had an inappropriate empirical antibiotic treatment in 6%, vs 15.6%, 20%, 11% and 25% respectively of the non-diabetic bacteraemic patients (p < 0.05 for all comparisons). Overall mortality and bacteraemia-related mortality were similar in both groups. Multivariate analysis showed that the association with fatal diseases, shock and renal insufficiency negatively influenced the outcome of diabetic patients, while the nephro-urologic source and an appropriate therapy were accompanied by a better prognosis. CONCLUSIONS: A higher incidence of bacteraemia, mainly of urinary source, community-acquired, and due to E. coli was found in the diabetic patients compared to non-diabetics. The common use of rapidly effective drugs for this predominant bacteraemia conditioned similar outcome and prognosis factors in both populations, in spite of the higher incidence of septic shock and acute renal failure in the diabetic population.
OBJECTIVES: We prospectively investigated 274 consecutive Staphylococcus aureus septicaemias in adult patients between January 1983 and December 1989 to evaluate outcome in hospital acquired and community acquired episodes. METHODS: Epidemiologic, clinical, laboratory and therapeutic parameters were analyzed with univariate and multivariate statistical tests. RESULTS AND CONCLUSIONS: Ninety episodes of Staphylococcus aureus bacteraemia were acquired in the community and 184 in hospital. Diabetes mellitus and renal failure were accompanied by a clear increase in bacteraemia related death in the community-acquired category. Correct antibiotic therapy showed a better response in the community-acquired group. Bacteraemia related death was 22.6% for episodes acquired in the hospital and 18.8% for those originating in the community.
We have evaluated 283 consecutive hospital acquired urinary tract infections (HAUTI) in a University hospital (incidence 5.6% of admissions). In females, spontaneous, symptomatic and younger patient infections predominated, while in males HAUTI were mostly asymptomatic, after catheterization and in elderly patients. Chronic nonfatal diseases--particularly neurologic disease and diabetes--, old age, previous antibiotic use, the postoperative period, and cancer were the major general predisposing factors, mostly because they involved urological procedures. There was an urethral catheter in 78% of cases, with questionable indication or maintenance in 37%. In 65% of cases there were clinical data attributable to HAUTI; however, on strict criteria only 5% of pyelonephritis and 24% of cystitis were detected. Mortality rate was 0.4%. Etiology was E. coli in 29%, Proteus in 13%, Enterobacter in 12%, enterococcus in 11.5%, Serratia in 7%, Pseudomonas in 6.5%, and Klebsiella in 6.5%. There were differences regarding endogenous and hospital flora on the basis of sex, hospital situation, catheterization, mobility, and previous duration of hospitalization. The microbial resistance pattern was high in the hospital flora. The major therapeutical problem was the high number of unnecessary treatments representing the automatic medical response to the finding of a positive urine culture.
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A prospective study of an epidemic outbreak of acute lead poisoning characterized by unusual clinical and analytic manifestations was carried out. Its source was traced to lead-contaminated flour. Thirty-two adult patients presented with classic clinical symptoms of saturnism; however, 13 severely poisoned patients simultaneously manifested unusual clinical features such as hemolytic anemia and multiorgan dysfunction. We compared the diagnostic value of the different toxicity markers in 68 of 136 adults exposed to lead. Porphyrin precursors, urine levels of lead, and results from an edetic acid-provocative test gave poor diagnostic information and low correlation values with lead levels in blood. However, erythrocyte delta-aminolevulinic acid dehydratase activity showed a closer correlation with lead levels in blood, although we observed a frequent overlap of results in severe cases. The test for levels of lead in blood was the most reliable, suitable, and simplest test performed, and gave the best correlation with the external dose of lead, the clinical situation, and the toxicologic effects described by 12 different analytic data.
Imipenem was successfully used to treat a case of subdural empyema complicated by multiple cerebral abscesses, in which surgery and therapy with other antibiotics had previously failed. Imipenem concentrations in serum, cerebrospinal fluid and the cerebral abscess were much higher than the MICs for the infecting organisms, qualifying this antibiotic as an effective option in therapy of suppurative intracranial infections.
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Explore the source record for details and available documents.
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We report a rare case of a male patient without known immunodeficiency consecutively diagnosed with visceral leishmaniasis, brain abscess and cavitating pneumonia in the 3rd decade of life. Chronic granulomatous disease (CGD) was diagnosed by a nitroblue tetrazolium test. A p47-phox mutation of the NADPH oxidase of the leukocytes was suspected by immunoblotting and confirmed by DNA analysis. The patient was homozygous for this mutation while his mother and sister were heterozygous asymptomatic carriers. After the CGD diagnosis the patient started a chronic prophylactic regimen with subcutaneous interferon-gamma (0.05 mg/m2 of body surface/three times a week), and oral trimethoprim-sulfamethoxazole and itraconazole (both at 5 mg/kg/day) with no subsequent infections after 12 months of follow-up.