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Biomedical subjects

J A Jacobson

Publications and source records attributed to J A Jacobson.

At least 91 records · Page 5Linked to original sources
PubMed1983

Fever, chills, and hypotension following cardiac catheterization with single- and multiple-use disposable catheters.

Recognition of pyrogen reactions in patients studied with multiple-use cardiac catheters led to recommendations regarding their cleaning and ultimately to the expensive practice of discarding catheters after a single use. Primarily because of cost considerations, our laboratory continued to clean and reuse catheters through 1981. This afforded an opportunity to assess the endemic rate of adverse reactions associated with this practice. We prospectively evaluated 341 patients who were studied with single-use or multiple-use catheters. The overall incidence of adverse reactions was: hypotension 27%, fever 3%, chills 3%, and all three 0.6%. There were no statistically significant increases in these reactions associated with the reuse of catheters. Bacterial infection did not appear responsible for these reactions, and it is possible that they were due to angiographic dye. We conclude that careful cleaning and reuse of catheters does not create an obvious increase in the risk of infection, and it appears to play a minor role, if any, in the development of other adverse reactions.

Adolescent↗
PubMed1983

Evaluation of daily meatal care with poly-antibiotic ointment in prevention of urinary catheter-associated bacteriuria.

Meatal care with a poly-antibiotic ointment twice daily was evaluated in a prospective, randomized, controlled study of patients with temporary indwelling urethral catheters. Bacteriuria was acquired in 14 of 214 patients treated (6.5 per cent), compared to 16 of 214 patients not given treatment (7.5 per cent). The rate of bacteriuria was slightly lower in the treated than in the untreated group by each of 4 different statistical methods. In a subset of female patients at high risk a significant reduction in the rate of bacteriuria in treated patients was found by 1 method of analysis. These results contrast to previous studies in our hospital in which meatal care, using either nonantiseptic soap and water or an iodophor solution and ointment, was found to predispose to bacteriuria in high risk female patients. The benefit, if any, of meatal care with poly-antibiotic ointment appears to be small.

Administration, Topical↗
PubMed1983

Comparison of cefadroxil and cephalexin in the treatment of community-acquired pneumonia.

Thirty-four patients with community-acquired acute pneumonias were treated in a prospective, randomized trial with either cefadroxil, 500 mg twice daily, or cephalexin, 250 mg four times daily. In both groups of patients, the presence of chronic illnesses predisposing to pneumonia was common. Streptococcus pneumoniae was isolated from 65% of the initial sputum specimens, and most illnesses were of mild to moderate severity. All 19 cases treated with cefadroxil and all 15 cases treated with cephalexin were clinically cured, and adverse reactions to the medications were minimal. The success of these regimens suggests that outpatient use of oral cephalosporin therapy may be an appropriate treatment of patients with mild or moderate community-acquired pneumonia.

Adult↗
PubMed1982

The effect of menses and use of catamenial products on cervical carriage of Staphylococcus aureus.

Cervical specimens for culturing for Staphylococcus aureus were obtained during menstruation and at midcycle from 40 users of tampons and twelve users of pads. Nine women (two users of pads and seven users of tampons) were colonized by S. aureus. Colonization rates of the cervix were similar for users of tampons and users of pads (18% and 17%, respectively). S. aureus was isolated more frequently during menstruation (17%) than at midcycle (5.8%). Six women had positive menstrual cultures without a positive midcycle culture, whereas no women had positive midcycle cultures and negative menstrual cultures. These observations indicate a significant (p less than 0.05) association of menses with staphylococcal colonization of the cervix.

Adolescent↗
PubMed1982

Comparison of ceforanide and cephalothin prophylaxis for vaginal hysterectomies.

We compared the safety and efficacy of a six-dose regimen of cephalothin with a two-dose regimen of ceforanide for the prevention of infection after elective vaginal hysterectomy. A total of 150 patients were randomly assigned to either regimen. The overall incidence of documented pelvic infection was 5.3% and did not differ significantly between the prophylaxis groups when stratified by type of surgery. No serious adverse reactions were encountered in either group, but phlebitis was significantly more common in patients receiving cephalothin. We conclude that a two-dose regimen of ceforanide given intramuscularly is as effective as, and possibly better tolerated than, a six-dose regimen of cephalothin.

Cefamandole↗
PubMed1982

Bacterial flora of the vagina during the menstrual cycle: findings in users of tampons, napkins, and sea sponges.

The recent association of menstruation, tampon use, and staphylococcal infection with toxic shock syndrome led us to study the association of menstruation and catamenial product use with changes in vaginal flora. Cultures of the cervical os were obtained in midcycle and during menstruation from 12 women who used napkins and 40 women who used tampons. Staphylococcus aureus was found during midcycle and menstruation in three women, during menstruation alone in six, and during midcycle alone in none, indicating a significant association of S. aureus with menstruation (p = 0.04). No difference was found in the rate of S. aureus colonization during menstruation in tampon users (18%) and napkin users (17%). In a similar study, cultures were taken for S. aureus and other aerobic bacteria from 58 tampon users and 25 users of sea sponges. Staphylococcal colonization was found to be increased during menstruation in both groups. Among the cultures done during menstruation, those from users of sea sponges were found to have significantly higher colonization rates with S. aureus, Escherichia coli and other Enterobacteriaceae. The association of sea sponges with a high rate of S. aureus colonization suggests that they are not an alternative to tampons for women seeking to decrease the risk of toxic shock syndrome.

Adult↗
PubMed1982

Sterility and use patterns of multiple-dose vials.

The viability of microorganisms in multiple-dose vials (MDVs) and the use and in-use contamination rate of MDVs were investigated. Serial tenfold dilutions of stationary cultures of Escherichia coli and Pseudomonas aeruginosa were injected into 30-ml MDVs containing bacteriostatic agents, and samples were removed at 1, 16, 24, and 48 hours, and at seven days to test for viable organisms. All opened MDVs were removed from each patient-care area and the pharmacy in a hospital and tested for microbial contamination using an aliquot-sampling method. One nursing unit was visited each day, in random order, until all opened MDVs from all units and the pharmacy were collected. The day following collection, all newly opened MDVs at each unit were marked inconspicuously and tallied. On the first, sixth, and thirteenth day after marking, all marked MDVs remaining on the unit were tallied. Bacteria were isolated from deliberately contaminated MDVs when inoculated with 1-100 colony-forming units/ml or greater when the sample was tested within one hour after contamination. Only one product was positive in 16 hours, and none was positive beyond that time. A total of 928 opened MDVs was collected from 31 nursing units and the pharmacy; none was positive for microbial contamination, indicating that the contamination rate was probably less than 4 per 1000. Lidocaine, insulin, diluents, and heparin constituted 57% of collected vials. The length of time that opened vials remained on a unit and the number of opened vials per unit varied considerably between units. The cost, feasibility, and effectiveness of control policies regarding use of MDVs should be weighed objectively against potential benefits.

Drug Contamination↗
PubMed1981

Prevention of catheter-associated urinary tract infections. Efficacy of daily meatal care regimens.

To evaluate the efficacy of daily cleansing of the urethral meatus-catheter junction in preventing bacteriuria during closed urinary drainage, randomized, controlled trials of two widely recommended regimens for meatal care were completed. In 32 (16.0 percent) of 200 patients given twice daily applications of a povidone-iodine solution and ointment bacteriuria was acquired, as compared with 24 (12.4 percent) of 194 patients not given this treatment. In 28 (12.2 percent) of 229 patients given once daily meatal cleansing with a nonantiseptic solution of green soap and water bacteriuria was acquired, as compared with 18 (8.1 percent) of 23 patients not given special meatal care. There was no evidence in either trial of a beneficial effect of meatal care. Moreover, each of four different statistical methods indicated that the rates of bacteriuria were higher in the treated groups than in the untreated groups. In subsets of female patients at high risk in both studies significantly higher rates of bacteriuria were noted in the treated groups than in the untreated groups. Current methods of meatal care appear to be hazardous, as well as expensive, and cannot be recommended as measures to control infection.

Administration, Topical↗
PubMed1981

Risk factors for staphylococcal toxic-shock syndrome.

Fifty-two cases of toxic-shock syndrome that occurred in January 1, 1976 through August 31, 1980, were reported to the Utah State Health Department between February 1 and August 31, 1980. The annual attack rate for Utah based on a six-month surveillance period was 14.4 per 100,000 women ages 12-49 years. All cases were in women who had onset of illness within two days of menses. Potential risk factors were investigated with a case-control study utilizing 29 women hospitalized with toxic-shock syndrome and 91 neighborhood female controls. Nine of the 29 (31%) women reported recurrences of similar illness. Use of tampons (p = 0.012) and use of a single brand of tampon-Rely-during the month of illness (p less than 0.005, RR =6.11) were associated with a significantly increased risk of acquiring toxic-shock syndrome. More controls were sexually active than women who had toxic-shock syndrome (p less than 0.05, RR - 0.277). This epidemiologic investigation of toxic-shock syndrome in menstrual-age women has identified tampons generally and a single brand specifically as significant risk factors in acquiring toxic-shock syndrome.

Adolescent↗
PubMed1981

Cellulitis: treatment with cefoxitin compared with multiple antibiotic therapy.

Cefoxitin, a parenteral cephamycin beta-lactam antibiotic was prospectively evaluated as a single drug alternative in 31 children with cellulitis and the results of therapy were compared retrospectively with those from prevailing multiple antibiotic therapy for cellulitis in 56 children. Periorbital and lower extremity cellulitis accounted for more than 60% of the cases in both study groups. The most common bacterial agents included Haemophilus influenzae, Staphylococcus aureus, and group A beta-hemolytic Streptococcus. In as many as 50% of the cases, no etiologic agent could be found. In addition to blood cultures, cellulitis leading edge aspirate cultures were helpful in establishing the etiologic diagnosis. Of 52 patients sampled in the combined studies, 21% had positive aspirate cultures in the presence of negative blood cultures. The outcome and mean duration of hospital stay were similar in both groups. No severe adverse reactions were encountered. The mean number of antibiotics used in the retrospective study was three (range 1 to 7) whereas cefoxitin alone was used in the prospective study. All organisms isolated in the prospective study were susceptible to cefoxitin. Single antibiotic therapy with cefoxitin appears to be as safe and as effective in the treatment of cellulitis in children as multiple antibiotic therapy.

Anti-Bacterial Agents↗
PubMed1981

Changing patterns of hospital infections and antibiotic use. Prevalence surveys in a community hospital.

The results of a physician-performed prevalence survey of infections and antibiotic use at the Salt Lake City LDS Hospital in 1979 were compared with those from a previous survey in 1971. The overall prevalences and types of infections found in the two surveys were similar. Although Gram-negative bacilli accounted for 60% or more of all bacterial isolates from hospital-acquired infections in both surveys, Gram-negative bacilli other than Escherichia coli were more prevalent in the 1979 survey. An anticipated increase in numbers of critically ill patients resulting from our hospital's evolution as a regional tertiary care center was reflected by more patients with multiple sites of infection, with vascular or urinary catheters, and who were receiving multiple antibiotics. Use of antimicrobial agents increased from 23% to 37% of all surveyed patients and was attributed mainly to wide use of cephalosporins for prophylaxis in surgical patients.

Anti-Bacterial Agents↗
PubMed1979

Clinical and bacteriological evaluation of cefoxitin therapy in children.

Cefoxitin, a parenteral cephamycin beta-lactam antibiotic, was evaluated for safety and efficacy in children with bacterial infections other than meningitis. Twentysix patients between 3 months and 7 years of age were treated with 80 to 160 mg/kg per day. The most common diagnoses were cellulitis (13 patients), pneumonia (5 patients), and bone and joint infection (4 patients). Nine patients were bacteremic. The most frequently recovered pathogens were Staphylococcus aureus (six patients), Haemophilus influenzae (four patients), and Streptococcus pneumoniae (three patients). All organisms were susceptible to cefoxitin. All 26 children were considered improved or cured. No severe adverse reactions were encountered. Phlebitis (4%), eosinophilia (12%), and elevated liver function tests (4%) were associated with therapy. Cefoxitin appears to be a safe, effective, and well-tolerated antibiotic when used in children with susceptible bacterial infections other than meningitis.

Bacterial Infections↗
PubMed1979

Evaluation of cefaclor and amoxycillin in the treatment of acute otitis media.

Twenty-eight patients with acute otitis media were treated in a random double blind manner with either amoxycillin or cefaclor. The predominant organisms isolated were H. influenzae and S. pneumoniae. All patients responded satisfactorily except one, treated with cefaclor, whose compliance with the regimen was very doubtful. One instance of mild elevation of SGOT and one case of mild erythematous rash occurred in each treatment group. In this limited study, cefaclor appeared comparable to amoxycillin in the treatment of acute otitis media.

Acute Disease↗