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Biomedical subjects

J Wüst

Publications and source records attributed to J Wüst.

At least 37 records · Page 2Linked to original sources
PubMed1994

[Omeprazole/amoxicillin: improved eradication of Helicobacter pylori in smokers because of N-acetylcysteine].

Colonization of Helicobacter pylori (HP) beneath the protective film of gastric mucus enables the organism to survive in the hostile environment of the gastric mucosa. N-acetylcysteine (NAC), a sulfhydryl compound with potent mucolytic activity, induces a reduction of gastric barrier mucus thickness of about 75% and reduces mucus viscoelasticity. We therefore tested the hypothesis whether better eradication results could be achieved by addition of NAC to omeprazole/amoxicillin (OME/AMOX). 34 HP positive outpatients with endoscopically documented recurrent duodenal ulcer were included in an ongoing, prospective, randomized trial. Exclusion criteria were: alcoholism, previous gastric surgery, or intake of antibiotics, OME, bismuth salts, corticosteroids or NSAIDs within 4 weeks before study entry. Patients currently smoking > 10 cigarettes/day were classified as smokers. HP infection was confirmed by histology (3 biopsy specimens from gastric antrum and 2 from gastric body; H&E, Giemsa) and at least positive rapid urease test or culture. All 34 patients underwent ulcer therapy with OME (20 mg per day) for 20 days (d 1-20). Group A: in 17 patients (5 females, 12 males, mean age 46 [29-74] years; 8 smokers, 9 nonsmokers) the subsequent eradication therapy, consisting of oral OME (40 mg bid) and AMOX solute (750 mg tid) for 10 days, was combined with NAC solute (2 x 600 mg bid (d 21-30). Group B: 17 patients (2 females, 15 males, mean age 39 [19-70] years; 11 smokers, 6 nonsmokers) underwent eradication therapy without NAC (d 21-30). Control endoscopy was done after a minimal interval of 30 days from the end of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylcysteine↗
PubMed1994

[Omeprazole/amoxicillin: impaired eradication of Helicobacter pylori in smoking but not in premedication with omeprazole].

The efficacy of high dose omeprazole/amoxicillin (OME/AMOX) for eradication of Helicobacter pylori (HP) is controversial. Reported eradication rates range from 0% to 90%. Different therapy schedules and unknown factors may be crucial; in particular, pretreatment with OME has been thought to endanger HP eradication by subsequent OME/AMOX. Preliminary findings suggested that smoking may impair eradication with OME/AMOX. The aims of this study were (1) to establish whether HP eradication rates differ depending on whether eradication with OME/AMOX was performed before or after ulcer therapy with OME, (2) to determine whether smoking impairs HP eradication by OME/AMOX and (3) to evaluate the efficacy of OME/AMOX in our population. 52 HP positive outpatients with endoscopically documented recurrent duodenal ulcer were included. Exclusion criteria were: alcoholism, previous gastric surgery, or intake of antibiotics, OME, bismuth salts, corticosteroids and NSAIDs within four weeks before study entry. Patients currently smoking > 10 cigarettes/day were classified as smokers. HP infection was confirmed by histology (3 biopsy specimens from the gastric antrum and 2 from the gastric body; H&E, Giemsa) and at least positive rapid urease test (CLO) or culture. Eradication therapy consisted of oral OME (40 mg bid) and AMOX solute (750 mg tid) for 10 days (OME/AMOX). This therapy preceded (group A) or followed (group B) ulcer therapy with OME (20 mg per day for 20 days). In group A 17 patients (2 females, 15 males, mean age 39 [19-70]; 11 smokers, 6 nonsmokers) underwent ulcer therapy with OME (d 1-20) before OME/AMOX d 21-30).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

In vitro activity of ceftriaxone combined with tazobactam against anaerobic bacteria.

The in vitro activity of ceftriaxone combined with tazobactam against 190 strains of anaerobic bacteria was compared with that of amoxicillin with clavulanic acid, ampicillin with sulbactam, piperacillin alone and with tazobactam, cefoxitin, and imipenem, i.e. beta-lactam antibiotics established in the treatment of anaerobic infections. All anaerobes tested were susceptible to < or = mg/l ceftriaxone when tazobactam was added at fixed ratios (ceftriaxone to tazobactam) of 2:1 and 8:1 and at constant concentrations of 2,4 and 8 mg/l, respectively. When 4 mg/l tazobactam was added, the MICs of ceftriaxone for 83 of 94 strains of the Bacteroides fragilis group were reduced by a factor of 8 to 512; for eight strains, this reduction was two to fourfold. Only the MICs of ceftriaxone for three Bacteroides fragilis strains were not influenced.

Bacteria, Anaerobic↗
PubMed1994

Propionibacterium acnes as a cause of aggressive aortic valve endocarditis and importance of tissue grinding: case report and review.

A case of prosthetic valve endocarditis with Propionibacterium acnes is described. The diagnosis was documented by histology and isolation of P. acnes from both blood and anulus tissue. Grinding of the tissue, which was first omitted to avoid contamination, was indispensable for cultivating the agent. The literature for P. acnes endocarditis is reviewed.

Aged↗
PubMed1994

The role of two-segment bronchoalveolar lavage in the diagnosis of pulmonary infections.

STUDY OBJECTIVE: To determine if performing bronchoalveolar lavage (BAL) from more than one lung segment augments the diagnostic yield in patients with pulmonary infection. PATIENTS AND STUDY DESIGN: Seventy-six patients who underwent bisegmental BAL for the diagnosis or exclusion of pulmonary infection were studied prospectively. MAIN RESULTS: In patients with AIDS, the concentration of Pneumocystis carinii was higher in the upper lobes than in the middle lobes, regardless of whether the patients had been receiving pentamidine prophylaxis. In patients without HIV infection, the number of P carinii clusters was much lower. In 2 of 5 HIV-negative patients, P carinii organisms were detectable but in one of two lavage specimens, whereas in only 1 of 19 AIDS patients, P carinii organisms were not found in both lavaged segments. In bacterial pneumonia, BAL fluid from a segment of the radiologically most involved area had a much higher cell concentration, percentage of neutrophils, and concentration of bacteria than from the segment that was not or less severely involved on chest radiograph. In two of nine patients with AIDS and cytomegalovirus (CMV) pneumonia, cytopathogenic CMV effects were not found in both lavaged segments. In one of eight patients, mycobacteria could be cultured only from one of two radiologically involved segments. CONCLUSION: An increase in the diagnostic sensitivity by performing BAL in two lung segments is limited to cases where P carinii pneumonia is a relevant consideration in immunocompromised patients without HIV infection. In bacterial pneumonia, BAL can be performed in a single radiographically involved lung segment without a loss in diagnostic sensitivity. Since our study population of patients with CMV pneumonitis, mycobacterial infections, and fungal infections was small, no reliable conclusions are possible and BAL of more than one lung segment seems justified until more information is available.

AIDS-Related Opportunistic Infections↗
PubMed1993

[A trial of modified triple therapy for the eradication of H. pylori in recurrent duodenal ulcer].

In a prospective trial we examined the efficacy and acceptability of a modified triple therapy in H. pylori (HP)-positive patients with recurrent duodenal ulcer disease. Oral administration of amoxicillin for two weeks was substituted for one single injection of intramuscular depot penicillin (benzathine penicillin G). Additionally, patients were given ornidazole 500 mg tid for 14 days and 120 mg colloidal bismuth sub-citrate qid for 28 days. The patients were investigated for H. pylori colonization using a rapid urease test (CLO), histology (H&E-, Giemsa stain), culture (including determination of the minimal inhibitory concentrations for metronidazole, penicillin G and amoxicillin) and H. pylori serology (Cobas Core Anti-H. pylori EIA, F. Hoffmann-La Roche). Control endoscopies using the same methods were performed 1 and 6 months after eradication therapy. The eradication rate was 50% and the ulcer healing rate 90% 1 month after therapy. Ulcers recurred in 2/3 of patients with persistent infection vs 0/5 of HP-eradicated patients after 6 months. Both successfully HP-eradicated patients and patients with treatment failure exhibited comparable decreases in mean serum IgG anti-HP concentration within 2 months. Discrimination between the two groups and hence identification of the eradication success by serology was not possible within a time period of 2 months. After 6 months, serum IgG anti-HP concentrations in non-HP-eradicated patients returned to pre-therapy values, in HP-eradicated patients the concentrations further decreased. The above-described modified triple therapy against HP cannot be recommended as a standard therapy, mainly because of the insufficient eradication effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

[Community-acquired Acinetobacter pneumonia].

We report the history of a 38-year-old male native of Sri Lanka admitted to the emergency ward because of chest pain and shortness of breath. On physical and radiographic examination a bilateral predominantly right-sided pneumonia was found. The patient was admitted to the medical ICU and an antibiotic regimen with amoxicillin/clavulanic acid and erythromycin was initiated. Shortly afterwards septic shock developed. The patient was intubated and received high doses of catecholamines. He died 30 hours after admission to the hospital. Cultures from sputum, tracheal aspirate and blood grew Acinetobacter baumanni. Acinetobacter is an ubiquitous gram-negative rod with coccobacillary appearance in clinical specimens, that may appear gram-positive due to poor discoloration on Gram-stain. It is a well known causative agent of nosocomial infections, particularly in intensive care units. Community-acquired pneumonias, however, are quite rare. Sporadic cases have been reported from the US, Papua-New Guinea and Australia. Interestingly, these pneumonias are fulminant and have a high mortality. Chronic obstructive lung disease, diabetes, and tobacco and alcohol consumption appear to be predisposing factors. Due to the rapid course and poor prognosis, prompt diagnosis and adequate antibiotic treatment are indicated. Antibiotics use for community-acquired pneumonias, such as amoxicillin/clavulanic acid or macrolides, are not sufficient. Appropriate antibiotics for the initial treatment of suspected Acinetobacter infections include imipenem and carboxy- and ureidopenicillins combined with an aminoglycoside.

Acinetobacter↗
PubMed1993

Evaluation of two enzyme immunoassays for rapid detection of group B streptococci in pregnant women.

The performance of two enzyme immunoassays for rapid detection of group B streptococci (GBS) was evaluated in comparison to culture using cervical swabs from 191 pregnant women. Ten percent of the women harboured GBS. There were two positive results in the Icon assay (Hybritech), both in women with heavy growth in the culture, and four positive results in the Quidel assay (Quidel), two in the women with heavy colonization and one each in women with moderate and light growth of GBS respectively. The sensitivity of both assays was low, being 11% (2/18) for the Icon assay and 24% (4/17) for the Quidel assay. The specificity of both assays was 100%. Both assays could detect > or = 10(6) group B streptococci per swab. A positive result justifies ampicillin prophylaxis due to the high risk for the newborn. A negative result should be confirmed by rapid culture techniques.

Carrier State↗
PubMed1993

Isolation of gram-positive rods that resemble but are clearly distinct from Actinomyces pyogenes from mixed wound infections.

Beginning in 1990, gram-positive rods resembling Actinomyces pyogenes were found with increasing frequency in mixed cultures from various infectious processes, most of them from patients with otitis, empyema, pilonidal cysts, perianal abscesses, and decubitus ulcers. Ribotyping and hybridization showed that these gram-positive rods could be divided into five groups not related to known Actinomyces species. Biochemical markers for reliable differentiation into these groups, however, could not be found. Therefore, naming new species is not warranted unless parameters are discovered that allow identification without DNA hybridization. These gram-positive rods have been isolated only in mixed cultures with anaerobes, Staphylococcus aureus, Streptococcus "milleri," enterococci, and gram-negative rods. Their exact role in these possibly synergistic infections needs further investigation.

Adult↗
PubMed1992

Comparison of the E test and a reference agar dilution method for susceptibility testing of anaerobic bacteria.

The susceptibility of 146 recent clinical isolates of gram-negative and gram-positive anaerobes was determined by the E test (AB Biodisk) on both Wilkins-Chalgren and PDM ASM II (AB Biodisk) agar. Results of the E test were compared with results obtained by the NCCLS agar dilution method using Wilkins-Chalgren agar. Incubation was for 20 hours and 44 hours in the E test and for 44 hours in the NCCLS method. In general, 44 hour results were more reliable; however, NCCLS readings were made only once after 44 hours. After two days of incubation, 91% of E test results on Wilkins-Chalgren agar were within one dilution and 98% within two dilutions of the corresponding NCCLS values; on PDM agar these values were 89% and 98%, respectively. Major and very major discrepancies combined were less than 1%.

Anti-Bacterial Agents↗
PubMed1992

Comparative in vitro activity of Ro 40-6890, Ro 41-3399, and other antimicrobial agents against anaerobic bacteria.

The in vitro activity of the ester Ro 41-3399 and its free active acid Ro 40-6890 was tested against 189 strains of anaerobic bacteria in comparison to other oral cephalosporins and to antimicrobial agents established in the treatment of anaerobic infections. Prevotella, Porphyromonas, Peptostreptococcus, Fusobacterium and Clostridium spp. were susceptible to Ro 40-6890, with few exceptions. Due to its lack of activity against the major pathogens of the Bacteriodes fragilis group, Ro 40-6890 does not promise to be of major use in the treatment of infections caused by anaerobes.

Amoxicillin↗
PubMed1991

[The sensitivity of anaerobic bacteria to chemotherapeutic agents (Zurich, 1991)].

There have been numerous reports on resistance of anaerobic bacteria against antimicrobial agents. Therefore, to assess the situation in Zurich, 187 anaerobic strains of various bacterial genera, isolated from clinical specimens during winter 1990/91, were tested for their susceptibility to antimicrobial agents active against anaerobic bacteria. Besides the Bacteroides fragilis group, which is naturally resistant against penicillin, 30% of isolates of other Bacteroides species were also resistant against penicillin. In general, anaerobes have remained susceptible to cefoxitin, chloramphenicol, clindamycin, imipenem, the 5-nitroimidazoles (metronidazole, ornidazole) as well as combinations of beta-lactam antibiotics with beta-lactamase inhibitors (clavulanic acid, sulbactam and tazobactam). Because rare strains resistant against cefoxitin, clindamycin and beta-lactams plus beta-lactamase inhibitors can be found, at least isolates from specific clinical situations should be tested for antimicrobial susceptibility. These are strains isolated from patients with brain abscess, endocarditis, osteomyelitis, arthritis, infected implants and prosthesis as well as those from persisting or recurrent bacteremia. Because the agar diffusion test yields unreliable results, minimal inhibitory concentration should be determined. Maybe the new 'E test' or the spiral gradient procedure can be used after evaluation.

Anti-Bacterial Agents↗
PubMed1991

[Actinomycosis--clinical and therapeutic considerations based on 2 personal case reports].

We report on two patients with actinomycosis. The first case was a 45-year-old cachectic man with extensive bilateral pulmonary infiltrates. The lesions remained unclear for 18 months and only open lung biopsy with microscopic and cultural evaluation led to the diagnosis of actinomycosis. In the second case, classic cervico-facial actinomycosis in a 69-year-old farmer is described. Diagnosis was established on the basis of microscopic findings of "sulphur granules" eroding the mandible. Furthermore, the clinical presentation, with an indurated swelling of the jaw and intraoral fistula formation, was typical. The patient had a severe combined aortic valve lesion and died after ventricular fibrillation during hospitalization. Diagnosis could not be confirmed by culture, probably due to antibiotic prophylaxis against endocarditis during tooth extraction on the first day of admission. Diagnostic difficulties and microbiologic aspects are discussed, with special focus on the rare species of Actinomyces meyeri which was cultured from biopsy specimens from the lung of the first patient. So far this species has been described in only 13 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Actinomycosis↗
PubMed1991

[Bacterial sensitivity to chemotherapeutic agents (Zurich, 1990)].

This paper describes the incidence of susceptibility of gram-negative and positive bacteria towards antibacterial agents. The data are based on all susceptibility tests performed at the Department of medical microbiology of the University of Zurich. The evaluation of the results from 1975 to 1990 shows that susceptibilities against the antimicrobial agents tested have not changed markedly in this period. These tables may be a help for the physician in his decision for a "calculated chemotherapy" of bacterial infections.

Anti-Bacterial Agents↗
PubMed1991

[The problems of rapid diagnosis of Clostridium difficile as causative agent of antibiotic-associated pseudomembranous colitis].

This paper compares three common methods for the detection of Clostridium difficile, i.e. latex agglutination, culture and cytotoxic activity. The sensitivity of the latex agglutination test alone is 70%, of the culture 100% and of the cytotoxin test 66%. Specificities are 93, 96 and 100%, respectively. The latex agglutination has positive and negative predictive values of 58 and 96%; the respective values for the culture are 77 and 100%, for the cytotoxin assay 100 and 96%. Whereas all tests are fairly reliable for the exclusion of diarrhea associated to Clostridium difficile (CAD), the positive predictive values of latex agglutination and culture are too low. If one requests two positive test results for proof of CAD, about two third of all cases are detected by any combination of laboratory tests, while the specificity approaches 100%. We recommend that two of the three tests are performed; the choice is influenced by the possibilities of the laboratory.

Bacterial Proteins↗
PubMed1991

Interpretive criteria for disk diffusion susceptibility testing of sparfloxacin.

Sparfloxacin disk susceptibility test criteria for the NCCLS and ICS/DIN methods were determined by testing 400 bacterial wild-type isolates. Disks containing 5 micrograms of the drug could be used satisfactorily in both procedures. The following interpretive zone size breakpoints for the NCCLS and ICS/DIN methods were proposed: less than or equal to 18 and 20 mm respectively for resistance (MIC greater than 1 mg/l), and greater than or equal to 23 and 25 mm respectively for susceptibility (MIC less than or equal to 0.5 mg/l). These criteria were based on preliminary maximum serum concentrations of approximately 1.5 mg/l after a single oral dose of 400 mg of the drug. Regression equations for both methods correlating MICs and zone sizes based on test results for 361 organisms are presented. The equations allow calculation of breakpoints for higher or lower serum peak levels. Sparfloxacin was two to four times more active than ciprofloxacin against gram-positive cocci, and showed equal activity against gram-negative rods. Zone diameter quality control values for Escherichia coli ATCC 25922 were 26-30 mm (NCCLS) and 30-33 mm (ICS/DIN), and for Staphylococcus aureus ATCC 29213 27-28 mm (NCCLS) and 29-31 mm (ICS/DIN).

Anti-Infective Agents↗