Biomedical subjects

L Fenelon

Publications and source records attributed to L Fenelon.

17 recordsLinked to original sources

PubMed2005

Interventions to improve antibiotic prescribing practices for hospital inpatients.

BACKGROUND: Up to 50% of antibiotic usage in hospitals is inappropriate. In hospitals infections caused by antibiotic-resistant bacteria are associated with higher mortality, morbidity and prolonged hospital stay compared with infections caused by antibiotic-susceptible bacteria. Clostridium difficile associated diarrhoea (CDAD) is a hospital acquired infection that is caused by antibiotic prescribing. OBJECTIVES: To estimate the effectiveness of professional interventions that alone, or in combination, are effective in promoting prudent antibiotic prescribing to hospital inpatients, to evaluate the impact of these interventions on reducing the incidence of antimicrobial resistant pathogens or CDAD and their impact on clinical outcome. SEARCH STRATEGY: We searched the Cochrane Effective Practice and Organisation of Care (EPOC) specialized register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE from 1980 to November 2003. Additional studies were obtained from the bibliographies of retrieved articles SELECTION CRITERIA: We included all randomised and controlled clinical trials (RCT/CCT), controlled before and after studies (CBA) and interrupted time series (ITS) studies of antibiotic prescribing to hospital inpatients. Interventions included any professional or structural interventions as defined by EPOC. DATA COLLECTION AND ANALYSIS: Two reviewers extracted data and assessed quality. MAIN RESULTS: Sixty six studies were included and 51 (77%) showed a significant improvement in at least one outcome. Six interventions only aimed to increase treatment, 57 interventions aimed to decrease treatment and three interventions aimed to both increase and decrease treatment. The intervention target was the decision to prescribe antibiotics (one study), timing of first dose (six studies), the regimen (drug, dosing interval etc, 61 studies) or the duration of treatment (10 studies); 12 studies had more than one target. Of the six interventions that aimed to increase treatment, five reported a significant improvement in drug outcomes and one a significant improvement in clinical outcome. Of the 60 interventions that aimed to decrease treatment 47 reported drug outcomes of which 38 (81%) significantly improved, 16 reported microbiological outcomes of which 12 (75%) significantly improved and nine reported clinical outcomes of which two (22%) significantly deteriorated and 3 (33%) significantly improved. Five studies aimed to reduce CDAD. Three showed a significant reduction in CDAD. Due to differences in study design and duration of follow up it was only possible to perform meta-regression on a few studies. AUTHORS' CONCLUSIONS: The results show that interventions to improve antibiotic prescribing to hospital inpatients are successful, and can reduce antimicrobial resistance or hospital acquired infections.

Anti-Bacterial Agents↗

PubMed2001

Flow cytometric analysis of Clostridium difficile adherence to human intestinal epithelial cells.

Clostridium difficile is the most common cause of diarrhoea in hospitalised patients. Bacterial adherence to gut epithelial cells is a likely prerequisite to infection and toxin production. A novel flow cytometric method was developed for detecting adherence of C. difficile to human colonic and small intestinal epithelial cells (EC) and human intestinal cell lines. Small intestinal and colonic EC were isolated from biopsy specimens with mucolytic and chelating agents. Adherence of fluorochrome-labelled C. difficile to EC was measured by flow cytometry and was calculated as increase in median fluorescent intensity (deltaMFI). Cells with bacteria attached could be distinguished easily from cells alone or cells with unlabelled bacteria attached. Toxin-positive C. difficile adhered to colonic and small intestinal EC (deltaMFI mean 21.2 SD 16.7, n = 33 and 16.5 SD 20.7, n = 19 respectively). The toxin-negative strain also adhered to both epithelial cell types (deltaMFI 26.1 SD 32.5, n = 17 and 18.3 SD 31.3, n = 16). Adherence of toxin-positive C. difficile to the intestinal cell lines Caco-2 (deltaMFI 9.4 SD 4.4, n = 14) and HT29 (deltaMFI 8.1 SD 3.1, n = 12) was quantifiable, although at a significantly lower level than with primary colonic epithelial cells. Adherence of the toxin-negative strain was slightly lower, deltaMFI 6.5 SD 1.8, n = 9 with Caco-2 cells and deltaMFI 6.0 SD 2.0, n = 10 with HT29 cells. Adherence of C. difficile to epithelial cell lines was blocked with C. difficile antiserum, confirming specificity of adherence. In conclusion, flow cytometry is a useful approach to quantifying adherence of C. difficile to human colonic and small intestinal epithelial cells. Binding of toxin-negative as well as toxin-positive bacteria was detectable by this approach. Analysis of C. difficile adherence to target cells may have important implications for the understanding of the pathogenesis of C. difficile-related disease.

Bacterial Adhesion↗

PubMed2000

Letters to the editor

Journal Article↗

PubMed2000

Nosocomial infective endocarditis.

SUMMARY: Nosocomial infective endocarditis (NIE) is a rare complication of nosocomial bacteraemia; however, it is an infection of great importance because of its high mortality and because in many cases it is potentially preventable. Whilst many aspects of NIE are similar to community-acquired infective endocarditis (CIE), there are important differences between the two, most notably the predisposing factors, microbial aetiology and prognosis. The diagnosis of NIE is often difficult as many patients have severe underlying disease and coexistent infection elsewhere. Many of these infections could potentially be prevented by the identification of high risk patients, careful assessment of positive blood cultures and effective treatment of bacteraemia in high risk patients. The use of prophylactic antimicrobials in the prevention of infective endocarditis is unproven, however, it is recommended that prophylaxis be considered for certain invasive hospital-based procedures.

Anti-Bacterial Agents↗

PubMed2000

VRE in the Republic of Ireland: clinical significance, characteristics and molecular similarity of isolates.

There have been increasing reports worldwide of vancomycin resistant enterococci (VRE) since they were first noted over ten years ago. This study sought to investigate the clinical significance of VRE in Ireland and to compare the phenotypic, genotypic and molecular characteristics of isolates recovered from patients in different institutions. The relative contribution of inter-hospital transmission of strains to the dissemination of VRE in Ireland was assessed. Hospital surveillance for VRE is not well established in Ireland. The organism has been detected in seven hospitals. Detection has been predominantly in oncology inpatients in large tertiary referral hospitals in the Dublin metropolitan area in whom strains generally represent asymptomatic gastrointestinal tract colonization. The predominant species is E. faecium with the Van A resistance phenotype. Twenty-seven (87) of 31 isolates from one unit were shown to be of the same or closely related strain as were 10 (63%) of 16 from another unit, indicating significant nosocomial transmission within institutions. There was no evidence for inter-hospital transmission of VRE. VRE is established in Ireland and nosocomial transmission readily occurs. Regular surveillance for VRE is indicated in high-risk populations in large institutions, specific risk factors for the acquisition of VRE need to be defined and optimal control and preventative strategies need to he instituted to detect and preempt the spread of this organism.

Adolescent↗

PubMed1999

Unusual infections and novel therapy in the immunocompromised host.

Many of the reports of infection in immunocompromised patients over the past year have been caused by unusual bacterial pathogens or fungi, which are often multiresistant and difficult to treat. Although many difficulties still remain some progress has been made over the past year in the development of new antimicrobial agents and alternative therapies.

Journal Article↗

PubMed1998

Strategies for prevention of infection in short-duration neutropenia.

Although infection continues to be a major cause of morbidity and mortality in neutropenic patients, newer strategies have resulted in a shorter duration of neutropenia. The prime risk to patients with short-duration neutropenia (defined as neutropenia of less than 14 days) is bacterial infection, which is reduced by the administration of prophylactic antibiotics, and possibly by the use of clean food, sterile water, and protection against transmission of organisms from healthcare workers' hands.

Acute Disease↗

PubMed1998

Unusual infections and new diagnostic methods in the immunocompromised host.

Over the past year, considerable progress has been made in the understanding of the pathogenesis of a variety of infections found in the immunocompromised host. Some interesting organisms not previously described in this setting have been implicated as being causative of disease. Molecular methods for the detection of many organisms increase our ability to diagnose infection in these patients, and also make the accurate monitoring of infection during treatment possible.

Journal Article↗

PubMed1996

Chaetomium pneumonia in patient with acute myeloid leukaemia.

A patient with relapsed refractory acute myeloid leukaemia developed typical fungal lung lesions despite intravenous amphotericin B prophylaxis. Chaetomium globosum was cultured from the resected right lower lobe. Histology showed branching hyphae negative for common Aspergillus species by immunohistochemical staining. Previous reports of invasive disease caused by Chaetomium and some applications of immunohistochemical staining for Aspergillus are discussed.

Adult↗

PubMed1994

Cytomegalovirus myocarditis following liver transplantation.

Cytomegalovirus (CMV) infections are commonly found in patients on immunosuppressive therapy following liver transplantation. However, acute myocarditis is an extremely rare manifestation of CMV infection in this setting. We report the case of a patient who developed acute myocarditis with severe biventricular failure with a cardiac ejection fraction of less than 10%, 6 weeks following orthotopic liver transplantation. Systemic CMV infection was diagnosed on the basis of a clinical viraemia, the presence of CMV antigen in urine, blood, and throat swab, and an associated four-fold rise in serum antibody titres to CMV. A full recovery ensued following treatment with standard anti-cardiac failure therapy and a 10 day course of intravenous ganciclovir.

Adult↗

PubMed1991

Trends in skiing injury type and rates in Australia. A review of 22,261 injuries over 27 years in the Snowy Mountains.

OBJECTIVE: To show the trends in the rate and type of skiing injuries in Australia. DESIGN: A retrospective analysis of skiing injuries in the Snowy Mountains from 1962 to 1988. SETTING: All injuries were seen and treated at the Ski Injury Clinic in Perisher Valley. PATIENTS: A total of 22,261 injuries were seen over this 27 year period (data for 1963, 1964, 1966, 1977, 1978, 1981 and 1982 were missing). INTERVENTIONS: Injured skiers were treated at the Clinic with a small number sent to main centres for tertiary care. MAIN OUTCOME MEASURES: The overall injury rate (1962-1988) and the specific injury rate for six subgroups of injuries (1974-1988) were calculated. RESULTS: The overall injury rate declined dramatically over this period. The incidence of tibial fractures, ankle injuries and lacerations also declined. Upper body injuries continue to rise although this trend was not statistically significant. There was a statistically significant increase in knee injuries. CONCLUSIONS: The trends reported here are similar to those overseas except that the incidence of thumb injuries has not changed in Australia. The changes in the rates of lacerations, and tibial and ankle injuries can be related to improvements in ski bindings and boots.

Ankle Injuries↗

PubMed1991

The in-vitro activity of clarithromycin and other macrolides against the type strain of Chlamydia pneumoniae (TWAR).

The activity of oxytetracycline and seven macrolide antibiotics was investigated against a prototype strain of Chlamydia pneumoniae in cell culture. Following incubation, inoculated cell monolayers were fixed in methanol and stained with a genus specific immunofluorescent monoclonal antibody before examination for inhibition of inclusion formation. The most active agent was clarithromycin (MIC 0.007 mg/l), followed by erythromycin (0.06 mg/l). Other macrolides were less active; josamycin and roxithromycin (0.25 mg/l), midecamycin acetate and azithromycin (0.5 mg/l) and spiramycin (4.0 mg/l). The MIC of oxytetracycline was 0.25 mg/l. Clinical evaluation of clarithromycin for C. pneumoniae lower respiratory infection is indicated.

Anti-Bacterial Agents↗

PubMed1991

Cephalexin induced toxic epidermal necrolysis.

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Cephalexin↗

PubMed1990

Preparation of species-specific murine monoclonal antibodies against the yeast phase of Paracoccidioides brasiliensis.

A panel of four murine monoclonal antibodies showing species specificity for the yeast phase of the pathogenic dimorphic fungus Paracoccidioides brasiliensis was produced by using a modification of the standard monoclonal antibody technology. This involved the use of the immunosuppressive drug cyclophosphamide to suppress the immune response of test animals to fungi showing cross-reactivity, i.e., to Histoplasma capsulatum. One monoclonal antibody, P4, which had a high titer by enzyme-linked immunosorbent assay, was shown to recognize a linear antigenic epitope of P. brasiliensis at a molecular size of 70,000 to 75,000 daltons by Western blot (immunoblot) analysis. The potential use of these monoclonal antibodies, which are the first species-specific probes to P. brasiliensis that have been produced, in the field of serodiagnosis is discussed.

Animals↗

PubMedDate not supplied

Staphylococcus aureus sensitivity to various antibiotics--a national survey in Ireland 1993.

The sensitivity of Staphylococcus aureus (S. aureus) to methicillin, penicillin, gentamicin, erythromycin, ciprofloxacin, fusidic acid and mupirocin was tested in 1152 clinical isolates from nine hospital microbiology departments. In all cases standard methods for culture and sensitivity were employed using either the Stokes' or a modified Stokes' method for susceptibility testing. The isolates were recovered from 1150 patients (606 men, 544 women; mean age: 41 years) and only those deemed relevant to the patient's clinical condition were included. Of the total 1152 isolates, 454 were regarded as hospital acquired, 506 were community acquired and the source of the remaining 192 isolates was unknown. The overall percentages of S. aureus sensitive to the tested antibiotics were as follows: methicillin 85%, penicillin 8%, gentamicin 89%, ciprofloxacin 85%, erythromycin 80%, fusidic acid 96%, mupirocin 98%. The sensitivity of the methicillin resistant strains to the other antibiotics tested was generally low except for fusidic acid and mupirocin, both of which retain good activity against methicillin resistant S. aureus (MRSA).

Aged↗

PubMedDate not supplied

Preparation of murine monoclonal antibodies against the yeast phase of the dimorphic fungus Sporothrix schenckii.

Three murine monoclonal antibodies (Mabs) were raised against a cytoplasmic antigen of the yeast phase of the pathogenic fungus Sporothrix schenckii using a modification of standard hybridoma technology incorporating the immunosuppressive drug cyclophosphamide. When tested for species-specificity within the pathogenic dimorphic fungi one of these Mabs (S5) showed little cross-reactivity by enzyme-linked immunosorbent assay and Western blot, though there was some recognition of Paracoccidioides brasiliensis antigen. This Mab recognized a 70-75 kDa molecule on reduced Western blots of S. schenckii antigen. The other two Mabs (S12 and S15) showed cross-reactivity with all dimorphic fungal antigens tested, though they appeared to recognize a molecule of similar molecular weight. This is the first report of any attempt to raise species-specific Mabs against this important causative agent of dermatological disease.

Animals↗

PubMedDate not supplied

Preparation of monoclonal antibodies that differentiate between Histoplasma capsulatum variant capsulatum and H. capsulatum variant duboisii.

The immunosuppressive drug cyclophosphamide was used to facilitate the production of monoclonal antibodies (Mabs) which differentiated between the yeast phase of the two variants of the dimorphic fungus Histoplasma capsulatum by both enzyme-linked immunosorbent assay and Western blot. Two Mabs are described, identifying epitopes on a 70-75 kDa molecule, which are specific to H. capsulatum var. capsulatum and which do not identify epitopes of H. capsulatum var. duboisii. These Mabs have potential use in the epidemiology and serodiagnosis of histoplasmosis in areas where both classical and African forms of the disease occur.

Animals↗