Biomedical subjects

L O Gentry

Publications and source records attributed to L O Gentry.

At least 19 recordsLinked to original sources

PubMed2006

Epidemiology and incidence of Clostridium difficile-associated diarrhoea diagnosed upon admission to a university hospital.

Patients with Clostridium difficile-associated diarrhoea (CDAD) may initially develop symptoms in the community and be subsequently diagnosed at hospital admission. At the present time there is no national surveillance system and no standardized case definition of CDAD in the USA, and baseline data on the incidence and epidemiology of CDAD are scarce. The objective of this study was to report the incidence of CDAD at a tertiary care hospital, and to determine the epidemiology of cases diagnosed within 48h of hospital admission, compared with cases of nosocomial CDAD diagnosed 48h or more after hospitalization. The average incidence was 4.0 cases/10 000 patient-days for CDAD on admission and 7.0 cases/10 000 patient-days for nosocomial CDAD. A significant difference was observed in CDAD rates on admission compared with nosocomial CDAD rates (P=0.017), but no differences were observed over time for either rate. Overall, 44% of cases had CDAD on admission and 56% of cases had nosocomial CDAD. Fifty-six (62%) patients with CDAD on admission had been admitted to the same hospital and 24 (27%) had been admitted to another hospital within the previous 90 days. Only eight (9%) patients had not been exposed to any healthcare services in the 90 days preceding hospital admission. A standardized case definition of healthcare-associated CDAD should include previous hospitalizations. Admitting physicians should consider C. difficile in the differential diagnosis of patients admitted with diarrhoea, with or without a history of admission to healthcare facilities.

Adult↗

PubMed2006

Comparison of risk factors for candidemia versus bacteremia in hospitalized patients.

BACKGROUND: Classic risk factors for candidemia include use of total parenteral nutrition (TPN), hospital location, use of central venous catheter, and others. Unfortunately, most of these variables are now also risk factors for antibiotic-resistant bacteria. Thus, use of these risk factors to identify patients at high risk for candidemia is difficult. The purpose of this study was to compare these classic risk factors for candidemia in patients with bloodstream infections to determine the relative strength of these predictors in differentiating patients with candidemia and bacteremia. METHODS: Clinical data were collected from the medical charts of patients who had been hospitalized between 2002 and 2004. Patients with their first episode of candidemia or bacteremia during their hospital stays were included. Risk factors were assessed using a multivariate logistic regression model and internally validated using a bootstrap analysis. A p-value < 0.05 was considered significant. RESULTS: A total of 164 patients (82 with candidemia) were evaluated. According to the logistic analysis, patients who had stayed in the intensive care unit (ICU) (OR = 6.24; 95% CI: 2.58-15.09) or had been using TPN (OR = 4.69; 95% CI: 1.76-12.48) were more likely to have candidemia than bacteremia. While patients with pulmonary (OR = 0.15; 95% CI: 0.055-0.39) or cardiac disease (OR = 0.21; 95% CI: 0.086-0.51) had a greater chance to have bacteremia than candidemia (p < 0.01 for all variables). These results were further validated using bootstrap analysis. CONCLUSION: Among classic risk factors for candidemia, the ICU location at the time of culture and TPN use were most predictive of candidemia while certain medical disorders predicted patients at the highest risk for bacteremia. These results can be used to help identify patients most likely to benefit from empiric antifungal therapy.

Adult↗

PubMed2006

Risk factors for postoperative chest wound infections due to gram-negative bacteria in cardiac surgery patients.

Gram-negative bacteria account for up to 35% of postoperative sternal wound infections (SWI) in patients undergoing cardiac surgery. Despite this, risk factors for Gram-negative SWI have not been investigated. The objective of this study was to define risk factors associated with Gram-negative SWI in patients undergoing cardiac surgery. 2590 patients undergoing cardiac surgery between 2002-2005 were prospectively monitored for development of SWI. Patient, operative, and post-operative risk factors were compared among patients that developed Gram-negative SWI and Gram-positive SWI to uninfected controls using univariate and multivariate analysis. A p < 0.05 was considered significant. Surgical site infections developed in 152 (5.9%) patients. Isolates were recovered from the sternum for 128 (5.0%) patients, from the leg donor site for 19 (0.73%) patients, and from the sternum and donor site for 5 (0.19%) patients. Gram-positive pathogens were isolated from 83 (3.3%) patients, Gram-negative pathogens from 42 (1.6%) patients, and mixed pathogens from 27 (1.0%) patients. Hospital admission greater than 48 hours before surgery (OR: 2.25; 95% CI: 1.11 - 4.58), ventilator-dependency preoperatively (OR: 5.32 95% CI: 2.22 - 12.75), and thoracentesis procedure postoperatively (OR: 3.71; 95% CI: 1.45 - 9.49) and diabetes (OR: 2.04; 95% CI: 1.17 - 3.55) were identified as significant risk factors for SWI due to Gram-negative bacteria using multivariate logistic regression. Diabetes, increased age, and peripheral vascular disease were identified as significant risk factors for SWI due to Gram-positive bacteria (p < 0.05, each). The risk factors associated with Gram-negative SWI differed significantly from those associated with Gram-positive SWI. Risk factors associated with Gram-negative SWI were identified. Unique interventions may be necessary to prevent Gram-negative SWI in cardiac surgery patients.

Aged↗

PubMed2000

Prevalence of nasal colonization with methicillin-resistant Staphylococcus aureus in selected patient populations.

Methicillin-resistant Staphylococcus aureus nasal colonization was investigated in patients arriving for elective cardiovascular surgery, renal patients admitted for arteriovenous graft surgery, and patients transferred to our hospital from other institutions. Renal patients were significantly more likely to be colonized and represent a potential source of MRSA to our institution.

Adult↗

PubMed1997

Multicenter, randomized study comparing levofloxacin and ciprofloxacin for uncomplicated skin and skin structure infections.

BACKGROUND: The fluoroquinolone, levofloxacin, is active against most common pathogens in skin and skin structure infections. METHODS: The efficacy, tolerability, and safety of levofloxacin and ciprofloxacin were compared in a randomized, open-label, multicenter trial of patients with uncomplicated skin and skin structure infections. Of 469 patients treated, 231 received levofloxacin (500 mg qd) and 238 were given ciprofloxacin (500 mg bid). RESULTS: Overall clinical success rates (cured plus improved) for levofloxacin and ciprofloxacin were 98% and 94%, respectively (95% confidence interval [CI], -7.7, 0.7). Overall microbiologic eradication rates by patient were 98% in the levofloxacin group and 89% in the ciprofloxacin group (95% CI, -14.5, -2.7), whereas eradication rates by pathogen were 98% and 90%, respectively (95% CI, -12.6, -3.7). The eradication rate for Staphylococcus aureus was 100% in the levofloxacin group and 87% in the ciprofloxacin group (95% CI, -20.2, -5.1). Treatment-emergent adverse events were comparable, with drug-related adverse events reported in 6% of levofloxacin patients and 5% of ciprofloxacin patients. CONCLUSIONS: Levofloxacin is as effective and safe as ciprofloxacin in the treatment of uncomplicated skin and skin structure infections.

Administration, Oral↗

PubMed1996

Management of invasive candidal infections: results of a prospective, randomized, multicenter study of fluconazole versus amphotericin B and review of the literature.

We conducted a prospective, randomized, multicenter study comparing fluconazole and amphotericin B in the treatment of candidal infections. One hundred and sixty-four patients (60 of whom were neutropenic) with documented or presumed invasive candidiasis were assigned to treatment with either fluconazole (400 mg daily) or amphotericin B (25-50 mg daily; 0.67 mg/kg daily for neutropenic patients). Clinical response and survival rates were assessed at 48 hours, after 5 days, and at the end of therapy. Overall response rates to fluconazole and amphotericin B were similar (66% and 64%, respectively). There were no differences in response as related to site of infection, pathogen, time to defervescence, relapse, or survival rates between the groups. Adverse effects were more frequent with amphotericin B (35%) than with fluconazole (5%; P < .0001). The results of this study confirm that fluconazole is as effective as but better tolerated than amphotericin B in the treatment of candidal infections.

Adolescent↗

PubMed1995

Scopulariopsis endocarditis associated with Duran ring valvuloplasty.

Fungal endocarditis is rare and is usually caused by Aspergillus and Candida species. We present a patient with endocarditis caused by Scopulariopsis brevicaulis. The patient had a history of mitral valve disease and, 1 year earlier, had undergone valvuloplasty with the placement of a prosthetic Duran ring in the mitral valve position. S. brevicaulis was cultured from samples of a large vegetation on the mitral valve apparatus. The mitral valve was replaced with a St. Jude mechanical prosthesis. The patient was treated with amphotericin B but was later switched to oral itraconazole when antibiotic tests indicated susceptibility to that agent. We believe this is the 1st reported case of endocarditis caused by Scopulariopsis.

Adult↗

PubMed1994

Prosthetic valve endocarditis: superiority of surgical valve replacement versus medical therapy only.

The objective of our study was to assess the long-term outcome of patients with prosthetic valve endocarditis. We used a multicenter, prospective, observational study design. Six university teaching hospitals with high volume cardiothoracic surgery participated. Seventy-four patients with prosthetic valve endocarditis as defined by explicit, objective criteria were selected for participation. All patients were followed up prospectively for 1 year. Thirty-one percent and 69% had development of endocarditis within 60 days of valve insertion ("early") and after 60 days ("late"), respectively. The most common causes were Staphylococcus epidermidis (40%), Staphylococcus aureus (20%), streptococcal species (18%), and aerobic gram-negative bacilli (11%). Physical signs of endocarditis (new or changing murmur, stigmata, emboli) were seen in 58%. At 6 months and 12 months, mortality was 46% and 47%, respectively. Surgical replacement of the infected valve led to significantly lower mortality (23%) as compared with medical therapy alone (56%), as assessed by both univariate and multivariate analyses (p < 0.05). Improved outcome was seen for the surgical group even when controlling for severity of illness at time of diagnosis. From these findings we conclude that accurate assessment of outcome in prosthetic valve endocarditis requires long-term follow-up of at least 6 months following diagnosis. Surgical therapy warrants greater scrutiny; evaluation in controlled clinical trials is appropriate.

Adult↗

PubMed1994

Fluconazole susceptibilities of Candida species and distribution of species recovered from blood cultures over a 5-year period.

The distribution and fluconazole susceptibilities of Candida species isolated over a 5-year period were investigated. Susceptibilities were determined by using a new microtiter procedure and the National Committee for Clinical Laboratory Standards (NCCLS) proposed standard. The new method correlated well with the NCCLS proposed standard and gave very clear end points. Results indicate that there are species-related differences in MICs as reflected in the MICs for 90% of species tested. Candida albicans is most susceptible to fluconazole, while Candida glabrata is among the least susceptible. These findings coincided with the observation of a shift in distribution of yeast species recovered from blood cultures from 1987 to 1992. C. albicans was the predominant species (87%) in the pre- or early fluconazole years but decreased to only 31% of the isolates in 1992. Thus, Candida species for which MICs of fluconazole were higher have become more prominent in recent years. Significantly, throughout this period, MICs for each species did not change appreciably.

Candida↗

PubMed1994

Dermatologic manifestations of infectious diseases in cardiac transplant patients.

Infection remains a significant cause of morbidity and mortality in cardiac transplant patients. Skin infections are not uncommon in these patients. Although usually caused by secondary dissemination after initial infection of another organ system, some skin infections may be primary infections, such as bacterial infections caused by the use of intravenous catheters or fungal infections in severely immunosuppressed patients. Nevertheless, the presence of skin lesions in a transplant patient may indicate infection in a primary site or another deep-seated focus of infection.

Animals↗

PubMed1993

Prosthetic valve endocarditis resulting from nosocomial bacteremia. A prospective, multicenter study.

OBJECTIVE: To determine the incidence of endocarditis in bacteremic patients with prosthetic heart valves and the risk factors for and the effect of duration of antibiotic therapy on development of endocarditis in such patients. DESIGN: Multicenter, prospective observational study. SETTING: Six university teaching hospitals with high-volume cardiothoracic surgery. PARTICIPANTS: One hundred seventy-one consecutive patients with prosthetic heart valves who developed bacteremia during hospitalization. MEASUREMENTS AND MAIN RESULTS: Patients were evaluated when they were identified as having bacteremia and 1, 2, 6, and 12 months after its occurrence. Of 171 patients, 74 (43%) developed endocarditis: Fifty-six (33%) had prosthetic valve endocarditis at the time bacteremia was discovered ("endocarditis at outset"), whereas 18 (11%) developed endocarditis a mean of 45 days after bacteremia was discovered ("new endocarditis"). Mitral valve location and staphylococcal bacteremia (Staphylococcus aureus or S. epidermidis) were significantly associated with the development of "new" endocarditis. All 18 cases of new endocarditis were nosocomial, and in 6 of these cases (33%) bacteremia was acquired via intravascular devices. Twenty-one patients without evidence of endocarditis at the time of bacteremia received short-term antibiotic therapy (< 14 days); 1 patient (5%) developed endocarditis. Eleven of 70 patients (16%) who received long-term antibiotic therapy (> 14 days) developed endocarditis (P > 0.2). CONCLUSIONS: Bacteremic patients with prosthetic heart valves were at notable risk for developing endocarditis, even when they received antibiotic therapy before endocarditis developed and regardless of the duration of such therapy. Intravascular devices were a common portal of entry.

Adult↗

PubMed1993

Diagnosis and management of the diabetic foot ulcer.

Infected leg ulcers in patients with diabetes mellitus are a common and potentially serious problem. Neuropathy and vascular disease associated with diabetes mellitus allow the possibility of significant microbial invasion. Infections in diabetic patients are usually polymicrobial reflecting the normal flora of the foot skin. Curettage of the base of foot ulcers and deep tissue cultures are the most reliable methods for identifying the true pathogens, which are aerobic Gram-negative bacilli, anaerobes, and Staphylococcus aureus. Empirical antibiotic therapy should be directed against these pathogens. Once culture and sensitivity results are available, therapy should be targeted specifically for the pathogens present to prevent long-term use of broad-spectrum antibiotics. Preventive care of the foot in patients with diabetes mellitus is extremely important and may reduce complications associated with infections of the foot.

Bacteria↗

PubMed1993

Cardiac transplantation and related infections.

Infection is a serious cause of morbidity and mortality in the cardiac transplant patient. Early infections within the first month after transplantation are usually caused by nosocomial pathogens, such as Pseudomonas aeruginosa, Staphylococcus aureus, Enterococci, and members of Enterobacteriaceae and include pneumonia, urinary-tract and would infections, and bacteremia associated with the use of intravascular devices. Late infections, usually occurring after the first month and within the first year of transplantation, are commonly caused by cytomegalovirus, Pneumocystis carinii, Legionella, and fungi. Because cardiac transplantation has become a well-established treatment for patients with end-stage heart disease, more physicians will be treating these patients and will need to be familiar with the types of infectious complications associated with transplantation.

Catheterization↗

PubMed1993

Ofloxacin treatment of difficult infections of the skin and skin structure.

We report an open evaluation of ofloxacin therapy, 400 mg every twelve hours (parenterally followed by oral treatment) in hospitalized subjects with infections of the skin and skin structure that were recalcitrant. There were 105 evaluable subjects with an average age of fifty-five years, thirty-two (30 percent) of whom had diabetes mellitus, and in sixty-one (58 percent), a regimen of parenteral antibiotics (typically combinations involving aminoglycosides) had recently failed. There were 115 pathogens isolated; the most common were Enterobacteriaceae (fifty-five), Staphylococcus aureus (thirty), coagulase-negative Staphylococcus (ten), and Pseudomonas aeruginosa (ten). Overall, 103 (90 percent) pathogens were eradicated by therapy, and twelve (10 percent) persisted, including four coagulase-negative Staphylococcus which emerged as resistant during therapy. For thirty-five (33 percent) subjects, colonization or superinfection was documented; seven of these organisms (five Enterococcus, one S. aureus, and one P. aeruginosa) were resistant to treatment with ofloxacin. Clinical response was rated as cure in seventy (67 percent) subjects, improvement in twenty-one (20 percent) subjects, and failure in fourteen (13 percent). Failures were accompanied by persistence of the original pathogen (eight), persistent or resistant superinfection (six), or both (one). Adverse effects were infrequent, mild, and self-limiting. There was one death during the study, attributed to septic shock after postoperative abdominal leak, and not related to ofloxacin therapy. Intravenous/oral ofloxacin is effective and safe for the treatment of many difficult infections of the skin and skin structure, including those in diabetic subjects and in patients in whom previous parenteral therapy may have failed.

Abscess↗

PubMed1992

Multicenter open-label study of parenteral ofloxacin in treatment of pyelonephritis in adults.

The efficacy and safety of parenteral ofloxacin were evaluated in an open, multicenter study of hospitalized patients with pyelonephritis. The patients received ofloxacin 400 mg IV as an initial dose followed by ofloxacin 200 mg IV b.i.d. for a minimum of three days. The patients could then continue ofloxacin orally 200 mg b.i.d. for a total of seven to fourteen days. The most common pathogens isolated were Escherichia coli, Enterobacter cloacae, and Klebsiella pneumoniae. Microbiologic eradication was achieved in 65 of 66 evaluable patients (98%), and clinical cure or clinical improvement was noted in all patients. Of 82 patients evaluable for safety, 12 (15%) reported drug-related adverse events, the most frequent of which was pruritus or rash. None of the patients experienced drug-related central nervous system symptoms. Ofloxacin is well tolerated and highly effective in the treatment of pyelonephritis.

Administration, Oral↗

PubMed1992

Oral ofloxacin for infections caused by bacteria resistant to oral antimicrobial agents.

We conducted an open trial of oral ofloxacin, 400 mg q 12 hr, in the treatment of infections caused by Pseudomonas aeruginosa and other bacteria resistant to traditional oral antibiotics. There were 53 evaluable subjects, 30 having infection of the skin/skin structure, 13 of the respiratory tract, six of bone, and four complicated infections of the genitourinary tract. Most subjects (72%) had previously failed a course of antibiotic therapy for their infections. Ofloxacin therapy was administered an average of 45 days per patient, and was well tolerated. Clinical success was observed in 40 (74%) subjects, with failure in 13 (26%). Responses ranged from 50% success for six lower respiratory tract infections to 100% success for six cases of osteomyelitis. There were 28 P. aeruginosa with 22 Gram-positive and 24 other Gram-negative infections. Of 28 cases in which P. aeruginosa was implicated as a pathogen, 19 (68%) were successfully treated with ofloxacin therapy. Overall, 63 (85%) of 74 pathogens were eradicated. Of the 11 persistent organisms, five were P. aeruginosa in which resistance to ofloxacin emerged during therapy. Our data imply ofloxacin to be effective for infections due to ofloxacin-susceptible organisms other than P. aeruginosa; for this pathogen, ofloxacin therapy is associated with a high degree of failure. If ofloxacin is used for infection due to P. aeruginosa, microbiologic surveillance is necessary for cases that either fail to respond or relapse clinically.

Administration, Oral↗

PubMed1992

Therapy with newer oral beta-lactam and quinolone agents for infections of the skin and skin structures: a review.

Amoxicillin/clavulanic acid, cefuroxime axetil, ciprofloxacin, and ofloxacin are each effective against many bacteria that cause infections in the skin and skin structures. Amoxicillin/clavulanic acid is potent against staphylococci, streptococci (including enterococci), and anaerobes, although adverse gastrointestinal reactions are common. Cefuroxime axetil is similarly effective yet is used only rarely because of its more common use in infections of the respiratory tract and the prevalent use of second-generation cephalosporins in surgical prophylaxis. The newer quinolones ciprofloxacin and ofloxacin are effective against staphylococci, Enterobacteriaceae, and Pseudomonas aeruginosa and exhibit only low toxicity; these agents have been used in many difficult tissue infections--notably, chronic infected ulcers in diabetic patients. Oral antimicrobial therapy, when chosen on the basis of culture and susceptibility results and combined with surgical debridement and local management, may be effective for many problematic infections of the skin and skin structures heretofore treated with parenteral antibiotics.

Administration, Oral↗

PubMed1992

Ecological effects of short-term ciprofloxacin treatment of travellers' diarrhoea.

Forty-two subjects travelling to Mexico for 11 days were enrolled in a randomized, double-blind, placebo-controlled trial comparing ciprofloxacin 250 mg twice daily for three days or placebo for treatment of travellers' diarrhoea. Seventeen (41%) subjects were randomized to treatment. By the last treatment day, all seven evaluable subjects in the ciprofloxacin group, and three of eight evaluable subjects in the placebo group were cured (P = 0.04). The mean time to cure was 26 h for ciprofloxacin and 60 h for placebo-treated patients (P = 0.03). Faecal specimen were collected pre-travel, after four days in Mexico, 48 h post-travel and four weeks post-travel. Potentially pathogenic Escherichia coli strains carrying diarrhoeagenic virulence genes were detected by DNA hybridization tests, during or after travel, in 41% of treated and 31% of asymptomatic travellers. Travel, irrespective of diarrhoea and type of treatment, had a minor impact on the aerobic and anaerobic microflora. In travellers with ongoing diarrhoea, a suppression of the numbers of anaerobic bacteria was found, but the microflora was otherwise virtually unaffected. Significantly increased frequencies of E. coli resistant to ampicillin, doxycycline, chloramphenicol and co-trimoxazole were found during and after travel in all categories of travellers, though more frequently in subjects who experienced diarrhoea. The susceptibility of Bacteroides spp. remained unchanged. The sensitivity of E. coli to ciprofloxacin was not affected by travel, except in four ciprofloxacin-treated subjects who acquired multiresistant E. coli with ciprofloxacin MICs of > or = 0.125 mg/L post-travel. Bacteroides strains with MICs of > or = 64 mg/L were isolated post-travel from four ciprofloxacin-treated patients, and from one of the other 34 travellers not treated with ciprofloxacin.

Administration, Oral↗