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Biomedical subjects

J G Pastorek

Publications and source records attributed to J G Pastorek.

At least 55 records · Page 3Linked to original sources
PubMed1988

Randomized double-blind comparison of mezlocillin versus cefoxitin prophylaxis for vaginal hysterectomy.

One hundred patients undergoing vaginal hysterectomy were enrolled in a randomized double-blind comparative antibiotic prophylaxis study. Forty-six patients received mezlocillin and 54 patients received cefoxitin. No significant difference was found among patients who developed febrile morbidity. Failure rate for mezlocillin was 17 per cent and for cefoxitin, 15 per cent. There was an increase in colonization of Streptococcus faecalis and Enterobacter species in patients receiving three doses of cefoxitin prophylaxis.

Adult↗
PubMed1987

Acute pyelonephritis in pregnancy.

There were 107 episodes of pyelonephritis associated with pregnancy or the early puerperium occurring in 103 gravidas investigated retrospectively for information concerning prematurity, low birthweight, and antibiotic susceptibility patterns in the recovered microorganisms. No difference was found in the incidence of prematurity on low birthweight between that group and a control group of gravidas from the same population. Members of the Enterobacteriaceae genus were the most common bacterial isolates from the urine, with a large portion of E. coli being resistant to both ampicillin (33%) and cephalothin (13%). Treated pyelonephritis associated with pregnancy does not appear to predispose to prematurity or low birthweight in this population. Also, initial therapy with a first-generation cephalosporin may no longer be appropriate, because a significant number of isolates (11%) were resistant to cephalothin.

Adolescent↗
PubMed1987

Moxalactam versus clindamycin plus tobramycin for the treatment of puerperal infections.

Sixty women with the diagnosis of puerperal endometritis were randomized to receive either moxalactam (n = 29) or the combination of clindamycin and tobramycin (n = 31) as therapy for their infection. Endometrial bacteriology consisted of mixed flora, both aerobic and anaerobic gram-positive and gram-negative organisms. Clinical cure was achieved in 27 (93%) of the moxalactam-treated patients and 28 (90%) of those given combination therapy. The two failures of moxalactam therapy were associated with enterococcal infection. Failures of clindamycin/tobramycin therapy were due to enterococcal infection, abscess formation, and moderately severe diarrhea. This study indicates that moxalactam is as effective and safe as the combination of clindamycin/tobramycin for the treatment of postpartum endometritis.

Clindamycin↗
PubMed1987

Pelvic inflammatory disease during pregnancy.

Pelvic inflammatory disease associated with pregnancy is not commonly reported. We present three illustrative cases at ten, 13, and 26 weeks of gestation. Unlike pelvic abscess, which may be discovered at any stage of gestation, acute salpingitis during pregnancy occurs more commonly in the first trimester. Both processes are associated with substantial fetal wastage. Diagnosis may be difficult if the obstetrician is not aware that these infections can occur during pregnancy. The diagnosis is often made at laparotomy by a physician expecting appendicitis or another inflammatory condition. Since salpingitis during pregnancy, like salpingitis generally, is amenable to antibiotic therapy, surgery may be avoided if appropriate antibiotic therapy is quickly instituted. The pregnant patient and her fetus may be spared general anesthesia and the attendant risks of abdominal surgery.

Abdomen↗
PubMed1987

Severe uterine hemorrhage from blastomycosis of the endometrium. A case report.

A 32-year-old black woman presented in the emergency room with vaginal bleeding. Physical examination revealed a granulomatous lesion on the thigh and a breast abscess. Histopathologic examination and culture of an endometrial biopsy revealed Blastomyces dermatitidis. The breast abscess and thigh lesion were found to contain B. dermatitidis as well.

Abscess↗
PubMed1987

The pregnant hepatitis B carrier: evidence favoring comprehensive antepartum screening.

The prevalence of hepatitis B surface antigen among 15,399 gravidas screened in the prenatal clinic at Charity Hospital of Louisiana in New Orleans was 0.88%. The race-specific prevalence was 0.56% for whites, 0.62% for blacks, and 8.8% for Orientals. Identifiable risk factors could not be found for approximately half of the hepatitis B surface antigen-positive women. Comprehensive antepartum hepatitis B screening is recommended, based upon the significant risk of perinatal transmission to the neonate and upon the failure of selective screening to identify the majority of maternal hepatitis B surface antigen carriers in our population. The cost-effectiveness of general antepartum screening compares favorably with current blood bank hepatitis screening costs.

Carrier State↗
PubMed1987

Tobramycin dosing in the puerperal patient.

Serum levels of tobramycin were determined with an enzyme immunoassay technique in 20 puerperal women with postcesarean endometritis who were being treated with metronidazole-tobramycin. Ideal dosing was then calculated to attempt to provide peak serum levels between 5 and 8 micrograms/mL and trough serum levels less than 2 micrograms/mL. In eight patients, therapeutic serum levels could not be attained even at doses greater than the package-insert recommendation of 3 mg/kg/d. Therapeutic levels were achieved in five patients with doses between 3 and 5 mg/kg/d and in seven patients only at doses above the maximum recommended daily dose of 5 mg/kg. The puerperal patient appears to usually require much higher dosages of tobramycin than usual, and serum levels must be monitored for therapeutic reasons rather than for toxicity.

Cesarean Section↗
PubMed1986

The microbiology of premature rupture of the membranes.

The foregoing discussions bring to mind several salient facts: Although numerous barriers to infection exist, this aspect is understood incompletely. Conclusions on the pathogenicity or nonpathogenicity of certain organisms are often made from studies with very small numbers of patients, or in very specific patient populations. When such entities as low birth weight, premature labor, and PROM, which are all obviously related to some extent, are studied, very complicated analyses on large numbers of patients are required. Most of the organisms discussed are considered to be sexually transmitted. Because STDs are generally recognized to travel together in the same patient populations, the statistics necessary to separate one organism from another are complex indeed. The previous discussion notwithstanding, it is extremely difficult to form a solid conclusion about relation of these organisms to PROM with confidence. Many more patients need to be studied through many more pregnancies. In addition, differences among population subgroups make extrapolation extremely difficult. Currently the Louisiana State University is participating in a large, multicenter, collaborative study under the auspices of the National Institutes of Health. This study should provide an adequate data base concerning most of the isolates discussed and potential adverse outcomes of pregnancy. Then definitive statements may be made regarding both the screening of pregnant women and initiation of selective therapy. Specific management recommendations are discussed by Nagey and Saller in this symposium.

Amniotic Fluid↗
PubMed1985

Comparison of ticarcillin plus clavulanic acid with cefoxitin in the treatment of female pelvic infection.

Ninety-three female patients with post-cesarean endometritis, post-hysterectomy pelvic cellulitis, and other miscellaneous moderately severe pelvic soft-tissue infections were treated in a randomized fashion with either ticarcillin plus clavulanic acid or cefoxitin. Of the 47 patients treated with ticarcillin plus clavulanic acid, 38 had clinical cures, four showed improvement, therapy failed in three, and two were nonevaluable, for a failure rate of 6.7 percent. Of the 46 patients treated with cefoxitin, 33 had clinical cures, five showed improvement, therapy failed in seven, and one was nonevaluable, for a failure rate of 15.6 percent. Bacteriologically, the addition of clavulanic acid to ticarcillin was found to broaden the antibacterial spectrum to include some Escherichia coli, most Klebsiella, many coagulase-negative staphylococci, and all isolates of Staphylococcus aureus. Adverse reactions were few, with only one patient having therapy with cefoxitin discontinued because of side effects. It is concluded that ticarcillin plus clavulanic acid is quite suitable for antibiotic therapy of female pelvic soft-tissue infection, based on the (expanded) coverage of both aerobic and anaerobic bacterial species.

Adolescent↗
PubMed1985

Aztreonam plus clindamycin as therapy for pelvic infections in women.

Aztreonam, a new monobactam antibiotic with specific gram-negative aerobic activity, was used in combination with clindamycin in the treatment of 40 women with pelvic infection, including post-partum endometritis, pelvic inflammatory disease, and post-hysterectomy pelvic cellulitis. Clinical cure was achieved in 87 percent of patients. Failure was related to the limited gram-positive aerobic spectrum of clindamycin. All aerobic gram-negative enteric organisms were sensitive in vitro to less than 0.125 microgram/ml of aztreonam.

Adult↗
PubMed1985

Maternal death associated with sickle cell trait.

A case report is presented of a patient with sickle cell trait who died an abrupt intrapartum death precipitated by probable peripartal cardiomopathy and apparently aggravated by intravascular sickling. Notable autopsy findings included massive sicklemia in all organ systems.

Adolescent↗
PubMed1984

Short-course parenteral antibiotic therapy for pyelonephritis in pregnancy.

A short-term course of an intravenous cephalosporin (cefuroxime) was used as therapy in 24 cases of pyelonephritis due to susceptible organisms in 23 pregnant women. Clinical cure was achieved in 96% of patients, and there were no adverse reactions to the drug. Bacteriologic cure was documented in 52% of those clinical cures, whereas 26% were considered to have bacterial colonization. However, 50% of those patients with bacteriologic cure subsequently had bacteriuria or pyelonephritis caused by other organisms. We conclude that women who have pyelonephritis in pregnancy are at high risk for subsequent urinary tract disease, even if adequately treated for their index infection. Short-term parenteral antibiotic therapy, followed by long-term oral suppressive therapy, is probably the treatment of choice for pyelonephritis complicating pregnancy.

Administration, Oral↗
PubMed1983

Acute bacterial endocarditis in pregnancy. A report of three cases.

Acute bacterial endocarditis, a fulminating disorder most often caused by Staphylococcus aureus, is uncommon in pregnancy. However, the frequency of this disease may be increasing due to the prevalence of intravenous drug abuse. Three cases occurred during pregnancy at Charity Hospital, New Orleans; all three patients were intravenous drug abusers. One patient had polymicrobial disease.

Acute Disease↗
PubMedDate not supplied

Group B streptococcal colonization in the diabetic gravida patient.

Previous reports have suggested that pregnant diabetic patients have higher carriage rates of group B Streptococcus (GBS) than nondiabetic gravidas. In order to evaluate this in our population, we cultured the posterior pharynx, endocervix, vagina, and rectum of 101 diabetic pregnant women and 100 nondiabetic gravida patients. The colonization rate of GBS was higher in the diabetic population, 31.7%, than in the nondiabetic group 19.0%, (p < 0.039). The vagina was the site most often positive in both diabetic and nondiabetic populations (23.8% and 17.0%, respectively, p = NS). The second site to culture positive overall and the only individual site that was positive significantly more often in diabetics was the rectum (16.9% versus 7.0%, p < 0.05). Differences in colonization rates were not evident when insulin requirement and diabetic classes were considered.

Adult↗
PubMedDate not supplied

Antibiotic therapy for postcesarean endomyometritis.

Puerperal uterine infection, or endomyometritis, occurs more commonly after cesarean section than after vaginal birth. With the rate of cesarean delivery almost 25% of all births in this country, such infection is relatively common. The classic therapy for postcesarean endomyometritis is the combination of clindamycin and an aminoglycoside, usually gentamicin or tobramycin. This regimen has requisite antimicrobial activity against the aerobes and anaerobes of the cervicovaginal flora that usually cause this illness. In the last decade, however, the availability of broad-spectrum beta-lactam antibiotics has enabled the clinician to combat postcesarean infection with single-agent antimicrobial chemotherapy, or monotherapy. "Higher-generation" cephalosporins such as cefoxitin, cefotetan, and moxalactam, as well as the semisynthetic penicillins ticarcillin, piperacillin, and mezlocillin, have all been used alone in the therapy for postpartum infection. The addition of a beta-lactamase inhibitor to this class of drugs now offers a further resource to the practitioner if beta-lactamase-mediated antibiotic resistance arises in the patient population being treated.

Anti-Bacterial Agents↗