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M S Terpenning

Publications and source records attributed to M S Terpenning.

17 recordsLinked to original sources
PubMed1992

Increasing resistance of enterococci to ciprofloxacin.

We determined that resistance to ciprofloxacin has emerged in enterococci over the last 5 years in our hospital, mainly in strains demonstrating the phenotype of high-level gentamicin resistance. All high-level-gentamicin-resistant isolates from 1985 and 1986 were susceptible, whereas 24% of isolates from 1989 and 1990 were resistant to ciprofloxacin. Plasmid and genomic DNA typing showed at least six unique strains exhibiting resistance, but one type accounted for 80% of recent resistant isolates, suggesting a role for cross infection in the emergence of resistance.

Ciprofloxacin↗
PubMed1992

Infective endocarditis.

This article examines the presentation, diagnosis, and treatment of infective endocarditis in elderly persons. Special problems that cause complications and mortality to be higher in older patients than younger patients also are discussed. Areas of active debate and research are mentioned, including the use of diagnostic echocardiography, treatment of specific bacterial species, sources of iatrogenic endocarditis, and antibiotic prophylaxis.

Aged↗
PubMed1991

Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility.

OBJECTIVE: To assess methicillin-resistant Staphylococcus aureus (MRSA) colonization, transmission, and infection over a 1-year period in a long-term care facility with endemic MRSA. DESIGN: Monthly surveillance for MRSA colonization of nares, perineum, rectum, and wounds. SETTING: Long-term care facility attached to an acute care Veterans Affairs medical center. PATIENTS: All 341 patients in the facility had monthly surveillance cultures for 1 year. OUTCOME MEASUREMENTS: Colonization and infection with MRSA. MAIN RESULTS: The monthly MRSA colonization rate was 23% +/- 1.0%; colonization occurred most commonly in the nares and wounds. Poor functional status was associated with MRSA colonization. Most patients (65%) never acquired MRSA; 25% of patients were already colonized at admission to the facility or at the start of the study, and only 10% of newly admitted patients acquired MRSA while in the facility. These latter patients acquired several different strains in a pattern of acquisition similar to that generally seen within the facility. In the course of 1 year, only nine patients who acquired MRSA had a roommate with the same phage type; no clustering was evident, and none of these patients developed infection. Nine other patients (3%) developed MRSA infection; five of these patients required hospitalization, but none died as a result of infection. CONCLUSIONS: In the long-term care facility in which our study took place, MRSA was endemic, and the infection rate was low. In such settings, the cost effectiveness of aggressive management of MRSA (widespread screening for MRSA and eradication with antimicrobial agents) needs to be assessed.

Aged↗
PubMed1991

Why aging leads to increased susceptibility to infection.

The elderly are predisposed to various infections through a multitude of factors. Although intrinsic, unalterable defects occur in the aging immune system and nonspecific host defenses, there are factors that physician and patient can concentrate on to reduce the risk of infection. For example, meticulous attention to skin care can reduce the risk of soft tissue infection. Improvement in oral hygiene and relief of xerostomia might promote recolonization with normal oral flora. Correction of urinary tract obstruction where possible, relying on the use of indwelling urinary catheters only when necessary, can significantly reduce the risk of UTIs. Medications that impair cognitive function should be prescribed judiciously, since they can promote aspiration with subsequent pneumonia, xerostomia, and urinary retention. Correction of protein malnutrition may improve cell-mediated immunity and skin integrity, thereby reducing the risk of infection. The signs and symptoms of infection in the aged may be subtle. Therefore, the primary care physician should approach this susceptible population with a heightened clinical suspicion, thus expediting possibly life-saving early diagnosis and treatment.

Aged↗
PubMed1990

Staphylococcus aureus nasal colonization in a nursing home: eradication with mupirocin.

Recent reports have emphasized an increase in both infection and colonization with methicillin-resistant Staphylococcus aureus (MRSA) in institutionalized older patients. We studied whether or not local treatment with mupirocin ointment could eliminate nasal colonization with S aureus. A total of 102 patients in a Veterans Administration nursing home were screened for S aureus nasal colonization. Thirty-nine patients (38.2%) were colonized, 18 with methicillin-sensitive Saureus (MSSA) and 21 with MRSA. Almost half of all colonized patients were in the most dependent functional category and there was a significant association of MRSA colonization, but not MSSA colonization, with poor functional status. Colonized patients were treated with mupirocin ointment applied to the anterior nares twice daily for seven days. After treatment, MSSA persisted in only two patients and MRSA in only one patient; thus, nasal colonization was eliminated in 91.4% of colonized patients. At one month and two months follow-up, 11 patients became transiently recolonized and three became persistently recolonized with S aureus. Mupirocin was well tolerated with no side effects noted. Mupirocin ointment may be useful in controlling nasal colonization with S aureus in the nursing home setting.

Activities of Daily Living↗
PubMed1990

Increasing resistance of Staphylococcus aureus to ciprofloxacin.

We demonstrated the marked emergence of resistance to ciprofloxacin among Staphylococcus arueus strains isolated at the Ann Arbor Veterans Administration Medical Center. All S. aureus isolates tested from 1984 to 1985 were susceptible, whereas 55.1% of methicillin-resistant and 2.5% of methicillin-susceptible strains from 1989 had high-level resistance to ciprofloxacin.

Ciprofloxacin↗
PubMed1990

Monokine production by malnourished nursing home patients.

Protein malnutrition is associated with a decreased febrile and acute phase response to infection and increased mortality. To elucidate a cause for this poor response, we assessed the effect of chronic protein malnutrition on monocyte production of the pyrogens interleukin-1 (IL-1) and tumor necrosis factor (TNF). Thirteen malnourished nursing home residents, 11 age-matched controls, and 9 young controls were studied. Production of IL-1 and TNF in vitro was not diminished in the malnourished group when compared with the age-matched and young controls. Causes other than diminished IL-1 or TNF production should be sought to explain decreased resistance to infection in the malnourished nursing home resident.

Adult↗
PubMed1990

Prosthetic joint infections in the elderly.

PURPOSE: The aim of this study was to review risk factors, presenting symptoms and signs, organisms causing infection, treatment modalities, and outcomes in elderly patients with infection of prosthetic joints. PATIENTS AND METHODS: Patients over 60 years of age treated at the University of Michigan Hospital or Ann Arbor Veterans Administration Medical Center from 1977 to 1987 who had a diagnosis of prosthetic joint infection were reviewed. Early infections were defined as those occurring within 12 months of insertion of the prosthesis; late infections were those occurring more than 12 months after insertion. RESULTS: Fifty-one episodes of infection in 38 elderly patients were reviewed. There were 20 infections in prosthetic hips and 31 infections in prosthetic knees. Twenty-seven infections occurred early and 24 occurred late. Coagulase-negative staphylococci, Staphylococcus aureus, and Group D enterococci were the organisms most commonly isolated (33%, 27%, and 24% of episodes, respectively). Pseudomonas aeruginosa and other gram-negative bacilli were the causative organisms in approximately a third of the infections, and anaerobic organisms were noted in almost one fourth of episodes. In 33 episodes, the infected device was eventually completely removed, but infection resolved in only 20 of these 33 episodes (61%). In 18 episodes treated without removal of the device, none resolved. Outcome was poor; only five patients could walk without assistance, six patients developed contiguous osteomyelitis, two required amputation, and three died. CONCLUSIONS: Infection of prosthetic joints in elderly patients is a serious disease with poor functional outcome. The device has to be removed in order to clear the infection, and even then the infection is often difficult to eradicate.

Aged↗
PubMed1989

Intermittent urethral catheterization in the elderly.

Thirty-five elderly patients receiving intermittent urethral catheterization in a Veterans Administration Hospital and attached nursing home care unit were prospectively studied for development of bacteriuria and/or urinary tract infection. Thirty-one of the 35 patients (88.6%) developed urinary tract colonization. The mean time from initiation of catheterization to development of colonization was 5.7 +/- 1.3 days. Persistent bacteriuria with one or several different microorganisms developed in 17 patients. The most common colonizing organisms were coagulase negative staphylococci, Klebsiella pneumoniae, and enterococcus. Four patients (11%) developed symptomatic urinary tract infection. Although urinary tract colonization was common in patients receiving intermittent urethral catheterization, especially in those with poor functional status, infection was uncommon. Based on these results, intermittent urethral catheterization appears to be a safe and effective method of bladder drainage in elderly male patients when performed with sterile techniques over short periods of time in the nursing home or hospital setting.

Aged↗
PubMed1989

Anaerobic bacteremia in the elderly.

Anaerobic bacteremia occurred in 68 patients over the age of 60 in a university hospital. These elderly patients were more likely than younger patients to have an underlying malignancy. Anaerobes involved included Bacteroides fragilis group (64 isolates), Bacteroides melaninogenicus group (11) and Clostridium species (11). Polymicrobial bacteremia was common, occurring in 32.3% of patients. Mortality in patients who had surgery to remove the source of anaerobes was 43.3%, compared to 81.7% in patients with no surgical treatment. Overall mortality was 66.1%, much higher than noted in younger populations.

Aged↗
PubMed1988

Enterococcal infections: an increasing problem in hospitalized patients.

We studied 157 episodes of infection or colonization with enterococci in 122 patients over a six-month period. One hundred twelve episodes (71.3%) occurred in patients over age 60 years. The most common sites for isolation of enterococci were the urinary tract, and bone and soft tissue. Nosocomial acquisition of enterococci occurred in 74.7% of all infections, and an additional 21% of episodes occurred in patients who had been transferred from another hospital or were regularly seen in the clinic. The overall mortality was 19.6%; 71.4% of those with bacteremia died. Enterococci appear to be significant pathogens, especially in older men in veterans' acute care hospitals and nursing home care units.

Aged↗
PubMed1988

Hospital-acquired infective endocarditis.

Nosocomial endocarditis occurred in 22 patients who were discharged from a university hospital, a veterans' hospital, and a community hospital during the period of January 1976 to December 1985. Nosocomial episodes were 14.3% of the total endocarditis cases seen. Fourteen (63.6%) of 22 nosocomial endocarditis episodes occurred in patients over the age of 60 years, compared with 39 (29.5%) of 132 episodes of community-acquired endocarditis during the same period. Nosocomial endocarditis was due predominantly to Staphylococcus aureus or coagulase-negative staphylococci (77.4%) and, less often, to streptococci (13.6%). Intravascular devices were the source of bacteremia in ten (45.5%) of the nosocomial endocarditis episodes. The overall mortality rate was 40.9%, 50% in patients over the age of 60 years. Improved care of intravascular devices or prophylaxis before procedures could probably have prevented endocarditis in 12 of the 22 patients.

Catheters, Indwelling↗
PubMed1987

High-level aminoglycoside-resistant enterococci. Colonization of nursing home and acute care hospital patients.

Enterococci with high-level resistance (HLR) to gentamicin sulfate and other aminoglycosides have emerged as pathogens in recent years. More than half of all current isolates of enterococci at the Ann Arbor (Mich) Veterans Administration (VA) Medical Center are HLR strains. We determined the rate of colonization with HLR enterococci in patients in the acute care hospital, the attached nursing home, and a private nursing home. We also studied the factors related to colonization and the molecular relatedness of strains of HLR enterococci in these settings. In the VA facilities, 47.4% of patients in the nursing home and 36.1% of patients in the acute care hospital were colonized, compared with a 4.3% colonization rate in the private nursing home. Intravenous or Foley catheters and bedridden status were associated with colonization in the acute care setting; the need for advanced nursing care and prior antibiotic therapy were associated with colonization in the nursing home. Environmental surfaces were contaminated with HLR enterococci in both VA settings. Plasmid analysis of HLR strains revealed identity between both patient and environmental strains in the nursing home care unit and the acute care hospital. Nursing home patients, with their high rate of colonization with HLR enterococci and their frequent movement into the acute care hospital, may play a role as a reservoir for subsequent transmission of HLR enterococci.

Cross Infection↗