Interpretation of data regarding the protection afforded by serum, IgG, or IgM antibodies after immunization with the rough mutant R595 of Salmonella minnesota.
Explore the source record for details and available documents.
Antibodies, Bacterial↗
Biomedical subjects
J D Baumgartner
Publications and source records attributed to J D Baumgartner.
[Clinical spectrum of a common and insidious pathogen: Streptococcus milleri].
We studied the clinical significance of S. milleri isolated in our hospital in 68 patients during a 18-month period. In 51 patients (median age: 43 years, no underlying diseases in 29 patients), the isolates were associated with significant infections. They were beta-hemolytic in 32 cases and non-hemolytic in 19. The primary infection sites were the head and neck area (21 cases), the lungs (5 cases of pneumonia), the gastrointestinal tract (12 cases), the urogenital tract (3 cases), the soft tissues (6 cases), and the heart (2 endocarditis). Two septicemias were of unknown origin. Head and neck infections and pneumonia were most often associated with beta-hemolytic strains, and bacteremia, gastrointestinal and urogenital tract infections with alpha-hemolytic strains. S. milleri was found in pure culture in 24 cases. Polymicrobial associated flora (27 cases) was more frequent in the abdominal infections (87%) than in supra-diaphragmatic infections (42%). Severe complications were observed in 12 head and neck infections (57%) (cerebral abscesses 3, lethal mediastinitis 2, osteitis 1, meningitis 1, other suppurative lesions 5). When abscesses were present (27 cases), surgery was required in all cases. Despite the high frequency and severity of local complications, the clinical outcome was usually favorable. However, deaths directly related to S. milleri infections occurred in 2 cases of mediastinitis complicating the course of apparently harmless primary infections. Owing to the possible occurrence of life-threatening complications, S. milleri infections require early identification, treatment and surgery when indicated.
Female↗
[Use of antibiotics for the prevention of bacterial pneumonia in surgical intensive care units].
Bacterial pneumonia is responsible for high mortality in surgical intensive care patients which is partly attributable to a high incidence of gram-negative bacillary pneumonia. In these patients alterations to epithelial cell surfaces promote colonization of the oropharynx by gram-negative bacilli. The alterations are directly related to the severity of the patients' underlying disease and not to the hospital environment. Prospective studies on prophylactic administration of antibiotics to decrease the incidence of nosocomial pneumonia are reviewed. In these studies antibiotic have been administered either locally in the respiratory tract or systemically by the i.v. route. In both cases a moderate decrease in the incidence of pneumonia was observed, but selection of resistant bacteria occurred. Pneumonia appearing despite antibiotic prophylaxis was difficult to treat and had a high mortality. Therefore, local or intravenous antibiotic administration for routine prophylaxis of pneumonia seems to do more harm than good in patients from intensive care units.
Administration, Topical↗
[Indications for passive immunotherapy in infectious diseases].
The most important indications for passive immunotherapy in the field of infectious diseases are reviewed. Intramuscular immunoglobulins are useful in prophylaxis and treatment of diseases due to bacterial exotoxins and in prophylaxis of some viral infections. However, their efficacy against bacterial infections has not been demonstrated. Intravenous immunoglobulins have theoretical advantages in these infections. The few clinical studies performed in neonates and in patients of surgical intensive care units have suggested modest benefits. However, these studies did not allow to decide whether intravenous immunoglobulins have a role in these situations. Another approach still under investigation is to administer polyclonal antibodies directed against the central part of the endotoxin, the structure of which is well preserved among gram-negative bacteria. These antibodies have improved the survival of patients with gram-negative bacteremia or septic shock. When given prophylactically, they have reduced the incidence of gram-negative shock and related mortality in patients from surgical intensive care units. Further studies are in progress to determine the class and the precise specificity of these protective antibodies.
Bacterial Infections↗
Demonstration of cross-reactive antibodies to smooth gram-negative bacteria in antiserum to Escherichia coli J5.
We investigated the discrepancy between the broad cross-protection against gram-negative infections afforded by antiserum to Escherichia coli J5 and its apparently narrow cross-reactivity in vitro. Rabbits immunized with J5 bacteria produced antibodies to both the J5 lipopolysaccharide (LPS; titer by ELISA, 1:60,000) and LPS from the Re mutant of Salmonella minnesota (i.e., to the ketodeoxyoctonate [KDO] and lipid A determinants; titer, 1:3,200). In highly diluted antiserum, titers of antibody to J5 LPS were reduced by 28%-41% after adsorption with seven strains of smooth gram-negative bacteria and by only 4% after adsorption with the Re mutant. Smooth gram-negative bacteria adsorbed virtually all antibody to Re LPS. Therefore, rabbit antiserum to J5 contains type-specific antibodies to core determinants distal to KDO that can obscure highly cross-reactive antibodies to lipid A-KDO in vitro. Cross-reactive antibodies are demonstrable by adsorption with whole bacteria at limiting concentrations of antibody.
Adsorption↗
Anti-endotoxin immunotherapy in septic shock.
Explore the source record for details and available documents.
Animals↗
Prevention of gram-negative shock and death in surgical patients by antibody to endotoxin core glycolipid.
The prophylactic effect of antibody to endotoxin core glycolipid was studied in surgical patients at high risk of gram-negative infection. At randomisation (on admission to intensive care unit), every 5 days thereafter, and at onset of septic shock, patients received plasma taken from donors before (control) or after immunisation with Escherichia coli J5, a mutant with only core determinants in its endotoxin. Gram-negative shock occurred in 15 of 136 controls and 6 of 126 J5 antibody recipients and related deaths in 9 of 136 and 2 of 126, respectively. J5 antibody was most effective in abdominal surgery patients, in whom shock occurred in 13 of 83 controls and 2 of 71 antibody recipients. Although antibody prophylaxis did not lower the infection rate, it prevented the serious consequences of gram-negative infections and thus improved the overall prognosis.
Bacterial Infections↗
Tolerance study of ceftriaxone compared with amoxicillin in patients with pneumonia.
The safety of ceftriaxone was compared with that of amoxicillin in a randomized study of 91 patients with community-acquired pneumonia. The origin of infection was similar in the two groups. It was proven or probable Streptococcus pneumoniae in 50 percent of the patients and remained uncertain in 40 percent. Ninety percent of the patients who received ceftriaxone were clinically cured compared with 69 percent of those given amoxicillin (p less than 0.05). However, this difference was not apparent among the patients with proven or probable pneumococcal pneumonia. No severe clinical side effects were observed. Cutaneous reactions were more prevalent in the amoxicillin group, whereas mild diarrhea and mucosal candidiasis were more frequent in the ceftriaxone group. Reversible neutropenia was observed in two patients treated with ceftriaxone and none of those treated with amoxicillin.
Adult↗
An extreme form of the hyperdynamic syndrome in septic shock.
We classified 41 patients in septic shock on the basis of cardiac index (CI) after volume expansion with plasma protein solution, in order to obtain adequate filling pressures. Five had decreased CI (less than 3.5 1/min per m2), 31 had moderately increased CI (3.5 - 7.0 1/min per m2) and 5 had extreme hyperdynamic shock with CI superior to 7.0 1/min per m2. Among the patients with increased CI, those with extreme hyperdynamic state (EHS) had lower total systemic and pulmonary arteriolar resistances (370 vs 658 and 52 vs 119 dynes X s X cm-5, respectively) and a higher stroke index (67 vs 46 ml/m2), in spite of similar right atrial pressures. In this latter group, blood lactate was higher (6.5 vs 2.1 mmol/l), acidosis was more severe and coagulation disorders more pronounced; all five patients maintained an extremely high CI until death, which supervened after a brief episode of sinus bradycardia. A similar clinical course was rarely observed in the remaining moderately hyperdynamic group, in which mortality rate was significantly lower (35%). Three of five patients with EHS (compared to 2 of 31 in the moderately hyperdynamic group) had liver cirrhosis, the fourth died of fulminant meningococcemia and the fifth had prolonged polymicrobial bacteremia before adequate treatment was begun. Thus, underlying liver disease or particularly severe and uncontrolled infection seems to predispose to EHS. It is concluded that septic shock with extremely high cardiac output and excessively low peripheral resistances represents a distinct subset with more severe metabolic and coagulation disorders, an unusual hemodynamic evolution and a particularly poor prognosis.
Adult↗
Pharmacokinetic and microbial susceptibility studies of ceftriaxone.
The in vitro activity of ceftriaxone, a new parenteral cephalosporin, was tested against 450 strains isolated from blood cultures and compared with that of various other antibiotics. The compound was comparable to cefotaxime for all species tested. It was more potent than cefoperazone, cefamandole and ticarcillin in inhibiting Enterobacteriaceae (Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, indole-positive Proteus spp. and Serratia marcescens). The MIC95 of ceftriaxone for these strains was 0.5 microgram/ml. The drug was less active against Staphylococcus aureus than cefamandole, cloxacillin and vancomycin, but most isolates were inhibited by 4 micrograms/ml. Against Pseudomonas aeruginosa, ceftriaxone was comparable in activity to ticarcillin (MIC95 = 64 micrograms/ml), and inferior to cefoperazone, ceftazidime and cefsulodine. Levels of ceftriaxone in serum and various body fluids were determined by bio-assays. Due to its very long half-life (8 h), ceftriaxone serum levels 24 h after i.v. or i.m. injection of 1 and 2 g were still above the MIC95 of all strains tested except Pseudomonas aeruginosa. Levels in bile, synovial and cerebro-spinal fluids were high.
Anti-Bacterial Agents↗
Comparative study of imipenem in severe infections.
Forty patients with severe bacterial infections due to micro-organisms known or presumed to be sensitive to both study antibiotics, were randomized to receive either imipenem with cilastatin, 500 mg/500 mg iv tid (20 patients), or cefotaxime, 2 g iv tid (20 patients). The types of infections observed were equally distributed between the 2 groups, and consisted of 18 complicated urinary tract infections, 9 pneumonia, 7 bone and soft tissue infections, 4 septicaemia of unknown origin and 2 intravenous-catheter-related septicaemia. In the imipenem group, 12 patients were bacteraemic, compared to 10 in the cefotaxime group. The micro-organisms observed were evenly distributed with Escherichia coli (22 cases) and Klebsiella pneumoniae (6 cases) being the most frequent. Sixteen patients were cured in the imipenem group and 15 in the cefotaxime group, while 2 and 2 improved, 2 and 1 relapsed and 0 and 2 did not respond to the therapy, respectively. In the imipenem group, no clinical side effects were observed while 5 patients had mild reactions in the cefotaxime group (2 fever, 1 skin rash, 1 oral candidiasis and 1 diarrhoea). Imipenem thus appeared as effective and well tolerated as cefotaxime in the treatment of severely infected patients.
Adolescent↗
Comparative imipenem treatment of Staphylococcus aureus endocarditis in the rat.
The efficacy of imipenem alone or in association with gentamicin against Staphylococcus aureus experimental endocarditis was compared to the efficacy of cloxacillin alone or in association with gentamicin. Parenteral treatment was started 24 h after intravenous bacterial challenge of rats with catheter-induced aortic valve vegetations. The cloxacillin MIC and MBC for Staph. aureus were 0.125 and 32 mg/l and the imipenem MIC and MBC 0.008 and 8 mg/l, respectively. In-vitro killing curves showed a synergistic effect between cloxacillin and gentamicin, and an additive effect between imipenem and gentamicin. Only large doses of cloxacillin (400 mg/kg tid) (producing serum levels above those obtained after intravenous injection of 2 g in man) achieved results comparable to those of imipenem 80 mg/kg tid (producing serum levels similar to those obtained after an intravenous dose of 750 mg in man) in reducing the bacterial numbers in vegetations after 3 and 5 days of treatment. There was a significantly greater reduction of bacterial numbers in vegetations after treatment with the association of cloxacillin and gentamicin than with cloxacillin alone. In contrast, the addition of gentamicin to imipenem did not improve significantly the results of treatment with imipenem alone, but imipenem alone was as good as the combination cloxacillin and gentamicin after 5 days of treatment. We conclude that imipenem is a highly bactericidal drug in this animal model, worth considering for clinical trials in the treatment of Staph. aureus infections.
Animals↗
Single daily dose treatment of severe refractory infections with ceftriaxone. Cost savings and possible parenteral outpatient treatment.
Ceftriaxone sodium, a new cephalosporin with a very broad spectrum of action and a very long serum half-life, was administered to 127 patients in the treatment of 133 severe infections at our institution in Lausanne, Switzerland. Eighty infections had previously been treated unsuccessfully with other antimicrobials to which the pathogens were most often resistant. Sixty-five episodes were treated with two daily injections until there was an improvement in the patient's clinical condition, while 67 infections were treated from the start by a single daily injection. The results in the two groups were similar. One hundred fifteen infections (86%) were cured or improved, ten (8%) did not respond to therapy or recurred, and eight (6%) were not evaluable. The treatment was well tolerated, even by the 18 patients who received the drug for more than four weeks. The administration of a single daily dose instead of four doses as with standard antibiotic regimens produced a saving of Sfr 84,000 (+42,000) in the 127 patients. The single daily dose also made it possible to treat 25 of the 127 severely ill patients as outpatients, with a saving of Sfr 388,500 (+195,000) with respect to the hospital costs that would have been incurred for the same time period.
Adolescent↗
[Strategy in the choice of antibiotics in treating an acute infection caused by undetermined bacteria].
Explore the source record for details and available documents.
Adult↗
Severe cytomegalovirus infection in multiply transfused, splenectomized, trauma patients.
During a 2-year period 5 previously healthy young men who had undergone splenectomy and received multiple transfusions for trauma had severe cytomegalovirus (CMV) infection. Their illness was characterised by a long period of high fever, severe interstitial pneumonitis with dyspnoea and hypoxaemia, and an unusually high lymphocytosis (12 000-26 000 cells/microliter) with numerous atypical forms. The presumptive diagnosis was based on the patients' seroconversion and viral excretion, on the clinical and haematological findings which were typical of severe CMV infection, and on the absence of other infective organisms. In 1 case widespread CMV pneumonitis was confirmed at necropsy. These observations raise the possibility that splenectomy increases the severity and modifies the pattern of CMV infection, since during the same period no other case of severe CMV infection was observed among a large number of patients who had received multiple transfusions but had not undergone splenectomy.
Abdominal Injuries↗
[Prognostic factors of survival and tumor recurrence following surgery and radiotherapy for breast cancer with positive axillary nodes. La Chaux-de-Fonds, 1968-1975].
Survival and treatment failure are analyzed in a homogeneous group of 70 pre- or post-menopausal patients with operable breast cancer and histologically involved axillary nodes. From March 1968 to December 1975, all patients underwent simple or radical mastectomy, followed by radiotherapy in 67. The period of observation varied from 11 months to 10 years. Treatment failures were observed on 34 patients: 10 loco-regional relapses, 21 distant metastatizations, and 3 tumors in the other breast. Analysis of actuarial survival curves shows a statistically significant difference between patients with 1 to 3 positive axillary nodes and patients with 4 or more, but no difference with regard to the volume of the tumor and the patient's age. Comparison of disease-free period curves shows statistically significant differences between patients aged below and over 55 years, tumor of less or more than 2 cm, and 4 or fewer axillary nodes. These results are comparable to those in the literature and form a contribution to a Swiss study of post-operative adjuvant chemotherapy in breast cancer with positive axillary nodes.
Adult↗
Controversies in the use of passive immunotherapy for bacterial infections in the critically ill patient.
Several preparations of standard immunoglobulins for intravenous use have been tested as adjunctive therapy for bacterial infections in premature neonates and in critically ill adults after major surgery, trauma, and burn. The use of intravenous immunoglobulins in these settings is controversial because the efficacy and cost-effectiveness of this treatment are still not definitively established. Specific preparations of immunoglobulins against Pseudomonas aeruginosa for intramuscular administration have shown promising efficacy, and preparations for intravenous administration are now under investigation. Cross-protection against a wide range of gram-negative infections has been attempted by the administration of antiserum to the core glycolipid of lipopolysaccharide prepared from volunteers immunized with the J5 mutant of Escherichia coli 0111. Treatment with this preparation improved the survival rate of patients with gram-negative bacteremia and, when administered prophylactically to high-risk surgical patients, prevented shock and death related to gram-negative infections. The mechanism of protection of the J5 antiserum is not clearly understood because of our inability to measure the actual protective antibody in polyclonal J5 antiserum. Thus, the preparation of readily available cross-protective hyperimmune immunoglobulins is hampered because there is presently no method of selecting appropriate donors or high-titered plasma pools.
Bacterial Infections↗