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Biomedical subjects

M S Favero

Publications and source records attributed to M S Favero.

At least 55 records · Page 3Linked to original sources
PubMed1991

Lack of plasma interleukin-1 beta or tumor necrosis factor-alpha elevation during unfavorable hemodialysis conditions.

Plasma interleukin-1 beta (IL-1 beta) and tumor necrosis factor-alpha (TNF-alpha) were determined by ELISA in 17 healthy controls, 23 HD patients, 10 continuous ambulatory peritoneal dialysis patients, and 15 chronic renal failure patients, as well as in 2 HD patients experiencing pyrogenic reactions. Another group of 10 chronic HD patients were dialyzed for 2.5 h, 5 with first-use Cuprophan membranes and 5 with first-use high-flux cellulose triacetate membranes. The mean bacterial and endotoxin concentrations of the dialysate used for HD treatments during the study period were 18,440 +/- 530 CFU/mL (mean +/- SEM) and 976 +/- 205 pg/mL, respectively. Blood specimens were obtained intradialysis and postdialysis for cytokine assay and were incubated to augment cytokine production. There was no difference in plasma IL-1 beta or TNF-alpha concentrations among the healthy controls, continuous ambulatory peritoneal dialysis patients, chronic renal failure patients, or HD patients. Neither cytokine increased significantly during or after HD. Two patients experiencing pyrogenic reactions had plasma TNF-alpha concentrations of 537 and 413 pg/mL, compared with matched controls of 6 and 0 pg/mL. Il-1 beta concentration did not differ from controls. We conclude that: (1) plasma IL-1 beta and TNF-alpha are not chronically elevated in chronic renal failure, continuous ambulatory peritoneal dialysis, or HD patients; (2) HD with new Cuprophan or cellulose triacetate membranes and high concentrations of dialysate endotoxin and bacteria does not cause elevation of circulating IL-1 beta or TNF-alpha; and (3) pyrogenic reactions might be mediated by TNF-alpha.

Female↗
PubMed1991

Enhanced release of TNF-alpha, but not IL-1 beta, from uremic blood after endotoxin stimulation.

Aberrant immunologic host defenses associated with uremia may be a cause of the high incidence of sepsis in chronic hemodialysis (CHD) patients. This investigation determined the cytokine response of blood from five nondialyzed chronic renal failure (CRF) patients, five CHD patients, and five healthy controls (HC) after in vitro stimulation with 1 ng/ml Escherichia coli 0113 endotoxin. Concentrations of the cytokines TNF-alpha and IL-1 beta were determined by ELISA and were similar in all baseline and unspiked samples. TNF-alpha concentrations in CRF and CHD spiked samples were similar to each other but significantly greater (p less than 0.01) than in HC spiked samples. IL-1 beta concentrations in CRF, CHD, and HC-spiked samples were not significantly different. We conclude that CRF and CHD patients have enhanced TNF-alpha response, which may be related to uremia and not dialysis-related factors. Uremia does not potentiate IL-1 beta release.

Cellulose↗
PubMed1991

Prevalence and incidence of human immunodeficiency virus among patients undergoing long-term hemodialysis. The Cooperative Dialysis Study Group.

PURPOSE: The purpose of this voluntary multicenter study was to estimate the prevalence and incidence of human immunodeficiency virus (HIV) infection and the risk of nosocomial transmission of HIV in hemodialysis patients in the United States. PATIENTS AND METHODS: In June 1986, we began collecting epidemiologic data, risk factor information, and serum for HIV antibody testing from long-term hemodialysis patients on entry into the study and 1 year later. RESULTS: Initial data and specimens were collected from 1,324 patients in 28 dialysis centers in 12 states. On entry, 26 were positive or equivocal by enzyme immunoassay; 13 of these were positive by Western blot assay (overall seroprevalence 0.98%). Seroprevalence was higher for patients tested in eight centers located in areas from which a high cumulative incidence of acquired immunodeficiency syndrome has been reported (500 or more cases per 1 million persons) than for patients in other areas (10 of 387 [2.6%] versus three of 937 [0.3%]; p = 0.00048). According to their dialysis records, all 13 of the Western blot-positive patients had received transfusions. Seropositive patients were not more likely to have received a transfusion than seronegative patients (13 of 13 versus 1,038 of 1,311; p = 0.08). The confidential risk factor questionnaire was completed by 1,206 (91%) patients including nine of 13 (69%) of the seropositive patients. A question on sharing needles for injection of drugs was answered by 1,158 patients; seropositive patients were more likely to report they had shared needles than seronegative patients (five of nine versus 17 of 1,149; p = 0.0000002). After 1 year of follow-up, data were collected from 667 patients, including 254 negative patients who underwent dialysis at centers with seropositive patients. None of the previously seronegative patients seroconverted, yielding an incidence rate of 0% (upper limit of 95% confidence interval = 0.45%). No case of possible nosocomial transmission was identified. CONCLUSION: These results suggest that use of long-standing infection control precautions is effective minimizing the risk of transmission of HIV in hemodialysis settings.

Adolescent↗
PubMed1990

Prolonged survival of Pseudomonas cepacia in commercially manufactured povidone-iodine.

Pseudomonas cepacia organisms were recently recovered from a povidone-iodine antiseptic solution. During the subsequent investigation, laboratory studies were initiated to determine the survival time of these organisms in the iodophor solution, which contains 1% titratable iodine. The solution was sampled weekly upon receipt in our laboratory, and P. cepacia was subsequently recovered through 29 weeks of sampling. Current laboratory data and lot production date information from the manufacturer indicate that P. cepacia survived for up to 68 weeks from the time of manufacture. Scanning electron microscopic examination of contaminated solution demonstrated bacterial cells embedded in extracellular material.

Colony Count, Microbial↗
PubMed1990

Effect of disinfectants on pseudomonads colonized on the interior surface of PVC pipes.

We investigated the effect of disinfectants on microbial contamination present on the interior surface of polyvinyl chloride (PVC) pipes filled with 600 ml of water contaminated with Pseudomonas pickettii and P. aeruginosa. After eight weeks, water was removed, and the test pipes exposed to various types of aqueous disinfectants. Disinfectant samples were removed, neutralized, and examined for recovery of microorganisms by membrane filtration. After seven-days exposure, disinfectant solutions were removed and pipes filled with sterile distilled water. Water was examined by membrane filtration at seven-day intervals to determine whether the organisms had survived in the pipes. Colonization of PVC surfaces were examined during each study phase by scanning electron-microscopy (SEM). P. aeruginosa was isolated directly from iodophor disinfectant, phenolic germicide, and iodophor antiseptic solutions. After addition of sterile water, P. aeruginosa was recovered from PVC pipes previously exposed to chlorine, phenolic, quaternary-ammonium, and iodophor disinfectants; P. pickettii was recovered from water in pipes treated with iodophor disinfectant, chlorine, and ethanol. The existence of glycocalyx-like cellular masses on the interior wall of PVC pipes most likely protected embedded organisms from the microbicidal action of some of the disinfectants tested and served as the reservoir for continuous contamination.

Colony Count, Microbial↗
PubMed1989

Growth and endotoxin production of Yersinia enterocolitica and Enterobacter agglomerans in packed erythrocytes.

Since 1987, the Centers for Disease Control investigated six cases of transfusion-associated sepsis. All six patients developed septic shock after receiving units of packed erythrocytes (PRBCs) contaminated with Yersinia enterocolitica (five patients) and Enterobacter agglomerans (one patient); three of the blood recipients died. We studied the growth and endotoxin production of Y. enterocolitica and E. agglomerans in units of PRBCs stored at 4 degrees C for 60 days. When PRBCs were inoculated with 0.1 to 1.0 CFU of these organisms per ml, both Y. enterocolitica and E. agglomerans entered log-phase growth 2 to 3 weeks after inoculation; generation times were 15 and 22 h, respectively. Endotoxin was first detected at 3 weeks following inoculation, and the concentration paralleled the log phase of growth of the strains tested. These data show that prolonged storage of PRBCs at 4 degrees C provides conditions that allow these two organisms to grow and subsequently produce high concentrations of endotoxin.

Blood Transfusion↗
PubMed1988

Reuse of hemodialyzers. Results of nationwide surveillance for adverse effects.

In 1986, the Centers for Disease Control, in collaboration with the Health Care Financing Administration, surveyed 1350 chronic hemodialysis centers in the United States to ascertain practices associated with the reuse of disposable hemodialyzers and the frequency of pyrogenic reactions and septicemia among patients. Reuse of hemodialyzers was reported by 63% of the centers. Centers that used RenNew-D (n = 5) for reprocessing hemodialyzers, compared with centers that did not reuse (n = 495), were more likely to report pyrogenic reactions (60% vs 13%) and episodes of septicemia (100% vs 55%) among their patients. Reusing hemodialyzers more than 20 times and, in some instances, also using manual reprocessing systems was significantly associated with clustering of pyrogenic reactions regardless of the type of germicide used. To detect membrane leaks developing after multiple reuses, air-pressure-leak tests should be performed on all reprocessed hemodialyzers.

Disinfectants↗
PubMed1988

Prevalence of nontuberculous mycobacteria in water supplies of hemodialysis centers.

Infection of hemodialysis patients with nontuberculous mycobacteria (NTM) has been associated with water used in reprocessing hemodialyzers. This study was conducted to determine the prevalence of NTM and other bacteria in water samples collected over a 13-week period from 115 randomly selected dialysis centers in the United States. Total viable counts were determined by membrane filter assays; increased recovery of NTM was obtained by dosing a portion of each water sample with 1% formaldehyde (HCHO) before filtering. NTM were widely distributed and occurred with a high frequency in water supplies in dialysis centers. NTM were detected in water from 95 centers (83%), and 50% of all samples examined contained NTM. The results of this study support recommendations to use 4% HCHO or a chemical germicidal equivalent for disinfecting dialyzers that are to be reused.

Disinfection↗
PubMed1988

Efficacy of chemical dosing methods for isolating nontuberculous mycobacteria from water supplies of dialysis centers.

Investigations of nontuberculous mycobacterium (NTM) infections associated with various environmental sources have been hampered by the lack of adequate techniques for selective isolation of these organisms from environmental fluids. This study compared chemical dosing techniques for recovery of NTM from water samples collected from 115 randomly selected dialysis centers. Cell suspensions of NTM group II and IV isolates and gram-negative bacteria were exposed to solutions containing sodium hypochlorite (0.2 micrograms/ml of free available chlorine), formaldehyde (1, 0.75, or 0.5%), oxalic acid (1.25%), cetylpyridinium chloride (25 micrograms/ml), or cetyltrimethylammonium bromide (100 micrograms/ml). Results of standard membrane filtration assays with laboratory test strains and water samples from dialysis centers showed that 5 min of exposure to 1% formaldehyde effectively reduced gram-negative bacterial populations and allowed increased recovery of NTM in environmental fluids containing mixed microbial populations.

Cetrimonium↗
PubMed1988

Comparative evaluation of selective media for isolation of Pseudomonas cepacia from cystic fibrosis patients and environmental sources.

Pseudomonas cepacia has recently emerged as an important pathogen affecting cystic fibrosis (CF) patients. We evaluated three selective media to assess their comparative potential for identification of patients colonized with P. cepacia and for efficacy of detection of P. cepacia in environmental fluids. Test organisms included P. cepacia isolates from CF patients (10 each from two CF centers), non-CF patients (10 isolates), and environmental sources (10 isolates). Microbiologic assays were done by the membrane filter procedure; filters were placed on P. cepacia medium (PCM), OFPBL, TB-T, MacConkey agar (MAC), and blood agar (BA) or Standard Methods (SM) sugar, and colonies were counted after incubation at 30 or 35 degrees C for 72 h. Mean recovery efficiencies (MREs) (mean CFU/ml on selective media compared with CFU/ml on BA controls) for environmental and non-CF P. cepacia and patient isolates from one CF center showed a rank order of PCM greater than OFPBL greater than TB-T; for isolates from a second CF center, a rank order of PCM greater than TB-T greater than OFPBL was obtained. MREs for CF center isolates were generally lower than for non-CF patients or environmental isolates on P. cepacia-selective media. With MAC, the MREs for each group of CF isolates were extremely low (14 and 2%) compared with those for non-CF patient (47%) or environmental (84%) isolates. In laboratory and field studies, PCM and OFPBL showed good selectivity against bacteria commonly associated with CF patient respiratory secretions. These findings show that selective media should be used in clinical settings where P. cepacia is sought. With environmental fluids from CF centers, P. cepacia-selective media showed low selectivity against a variety of gram-negative water bacteria and appeared to afford little advantage over SM agar for isolating P. cepacia from environmental samples.

Culture Media↗
PubMed1985

Hepatitis B vaccine use in chronic hemodialysis centers in the United States.

The Centers for Disease Control surveyed 1,255 chronic hemodialysis centers in the United States in 1983 to assess the use of hepatitis B vaccine as well as the risk of acquiring hepatitis B among both patients and staff. The response rate to a mailed questionnaire was 90%. Seventy-one percent of the centers reported that they gave vaccine, but only an estimated 6% of susceptible patients and 32% of susceptible staff received all three doses of vaccine. Centers more likely to give vaccine included those that provided dialysis to large patient populations and those that provided dialysis for hepatitis B surface antigen-positive patients. As a result of vaccine administration, the overall prevalence of antibody to hepatitis B surface antigen increased significantly, to 18% for patients and 39% for staff. Extensive use of the vaccine in the future, combined with infection control practices, could virtually eliminate the risk of acquiring hepatitis B virus infection in hemodialysis centers.

Ambulatory Care Facilities↗
PubMed1985

Recommended precautions for patients undergoing hemodialysis who have AIDS or non-A, non-B hepatitis.

Precautions used for dialysis patients who have acquired immunodeficiency syndrome or non-A, non-B hepatitis are based on infection control strategies developed for the control of hepatitis B in dialysis centers. Specifically, these recommendations include identifying infected patients; isolating (except for non-A, non-B hepatitis patients) patients, and separating staff, and equipment; applying blood precautions and aseptic techniques; and using good environmental control procedures. AIDS patients can be safely dialyzed by either hemodialysis or peritoneal dialysis in hospital-based or free-standing centers, or at home without risk of AIDS transmission to other patients or to staff members, if precautions that have been developed for the control of hepatitis B infection in dialysis units are employed. Further, the type of dialysis treatment, or modality, should be based on the needs of the patient and not on a fear of risk of disease transmission.

Acquired Immunodeficiency Syndrome↗