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Biomedical subjects

M Svanbom

Publications and source records attributed to M Svanbom.

At least 19 recordsLinked to original sources
PubMed1985

Prediction of staphylococcal etiology among patients with septicemia with or without endocarditis by multivariate statistical methods.

Multivariate statistical methods, multiple regression (RA) and automatic interaction detector analysis (AID) were used to study the possibility of an early prediction of staphylococcal etiology in 249 of 851 patients with verified septicemia or endocarditis. The variables included pertinent symptoms and signs and laboratory data available soon after admission. 10 of the 70 variables initially studied showed simple, or in various combinations, a statistically significant partial correlation to staphylococcal etiology in the AID. The highest predictive value with a high probability for staphylococcal etiology was recorded for combinations of the variables: i.v. narcotic addiction and septic pulmonary embolism; non-addiction, wound infection, and hospitalization within 4 weeks; non-addiction, absence of skin infection, presence of foreign body, and age less than 60 yr. Staphylococcal etiology was contradicted by the absence of i.v. narcotic addiction, skin infection, foreign body, septic skin manifestation, surgical procedure within 4 weeks, joint symptom and a C-reactive protein less than or equal to 10 mm. Thus, a prediction of etiology may be valuable in choosing therapy before definite confirmation by positive blood cultures or when blood cultures remain sterile.

Adolescent↗
PubMed1983

Intravenous drug addiction--staphylococcal septicemia--pulmonary embolism: a triad pathognomonic for tricuspid valve endocarditis?

28 patients (29 episodes) presenting the triad of intravenous narcotic drug addiction, Staphylococcus aureus septicemia and septic pulmonary embolism were examined for the presence of tricuspid valve endocarditis. In a prospective study, 12/13 patients examined by echocardiography had vegetations on the tricuspid valve, in 6 detected by M-mode, in 5 by 2-D technique, and in one by both methods. In 4 patients with tricuspid endocarditis, no significant murmurs were heard. Similarly, in a retrospective study, 5/16 patients not subjected to echocardiography had no murmurs consistent with tricuspid valve endocarditis. One of these patients died. In 2/16 patients the diagnosis was verified at autopsy and in 1 at heart surgery. In both groups, altogether 11 patients never developed murmurs, in 7 of them despite demonstrable vegetations. Therefore, we consider the triad to be pathognomonic for tricuspid valve endocarditis, provided that no peripheral source of emboli is present. Consequently, patients fulfilling these criteria should be treated as suffering from endocarditis. Echocardiographic examination does not seem necessary in patients with a typical clinical picture but may be helpful when chest X-rays are inconclusive or complications are suspected.

Adult↗
PubMed1983

Antibiotic treatment of staphylococcal septicaemia and endocarditis in a Swedish hospital.

In a retrospective study covering the years 1977 to 1981, the results of antibiotic treatment in 123 patients with staphylococcal septicaemia with or without endocarditis have been analysed. 80 patients (mean age 60 years) were non-drug addicts (Group I) and 43 (mean age 28 years) were drug addicts (Group II). Underlying conditions other than drug abuse were noted in 74 patients in Group I and in only 7 in Group II.S. aureus was isolated from 117 patients and S. epidermidis in 6, all of them in Group I. 91 strains were penicillinase producers, but all susceptible to isoxazolyl-penicillins. In Group I verified or highly suspected endocarditis was registered in 12 patients (15%), always left-sided, as against in 31 (72%) in Group II, of whom 25 had tricuspid valve engagement. In the multivariate pattern of antibiotic treatment 3 groups may be discerned; 1) Cloxacillin, alone (35 patients) or in a combination (57), 2) Penicillin G, alone (6) or in a combination (12), and 3) Lincomycin or clindamycin, a cephalosporin or co-trimoxazole, alone (4) or in combination (9). Additive agents were mostly an aminoglycoside or fusidic acid. Out of the 45 patients in the whole material who received single therapy 9 patients (20%) died, and out of the 78 patients who received combined therapy 13 patients (16.6%) died. In the cloxacillin group 11.8% died, compared to 35% who initially received other antibiotics. In 70 patients the initial therapy had to be changed, in 39 due to adverse drug reactions and in 31 due to therapeutic failures or for unexplained reasons. In these cases linco- or clindamycin, more rarely rifampicin or vancomycin, were used. In Group I, 20 patients (25%) died, 8 of them with endocarditis. Sequels, relapses or reinfections were noted in 21 (25%), and 39 (50%) had an uneventful course. In Group II, 2 patients (5%) died, both with endocarditis. Sequels, relapses or reinfections occurred in 11 (25%), and 30 (70%) had an uneventful course. From this unstructured material no definite conclusions can be drawn. However, the lower mortality rate in the cloxacillin group suggests this regimen to be superior. The addition of other antibiotics did not appear to influence the clinical outcome. There was a more favourable outcome in addicts than in non-addicts, despite the same general principles of antibiotic treatment. Thus, for the outcome the characteristics of the patient group seemed to have more influence than the choice of antibiotic treatment.

Adolescent↗
PubMed1979

Bacterial endocarditis. II. A prospective study with clinical, laboratory and therapeutic observations.

In a prospective study 31 cases of proved and 10 of highly suspected bacterial endocarditis were analysed. Valve incompetence was the usual consequence but stenosis occurred in 3 cases, all fatal. Congestive heart failure developed in two-thirds. Secondary manifestations were common and as often caused by alpha-streptococci as by other bacteria. Initial antibiotic treatment was mainly applied according to a fixed schedule, generally with continuous intravenous infusion, followed by oral therapy. In 10 patients, the infection was still active after 6 weeks of therapy. Therefore, we now use intermittent injections or infusions for at least 4--6 weeks. Within a year, 9 patients died from uncontrolled infection together with congestive heart failure, and 1 from heart failure and active chronic endocarditis. In 4, myocardial abscesses or inflammations were found. All 10 had underlying factors or advanced stages of the disease. Of 18 patients with alpha-streptococci or enterococci none died from endocarditis, as against 10 of 23 with other or unknown bacteria. Follow-up yielded valuable information on one-third of the patients. The mortality during the initial hospital stay was 22%, after 1 year 24% and after 5 years 39%.

Adolescent↗
PubMed1979

Cefamandole nafate: an evaluation of antibacterial activity, serum levels, clinical effect, and incidence of side reactions in 58 patients.

35 males and 23 females with skin and soft tissue infection, lower respiratory tract infection, urinary tract infection or septicemia with known etiology were treated with cefamandole nafate. The patients were to a large extent (30%) alcoholics and/or drug abusers. Cefamandole was given intravenously as 4 daily doses of 1 g in 52 cases and of 2 g in 6 cases for 8 to 16 (mean 10) days. The effect was considered to be good in 40 patients (70%). Adverse reactions, mostly slight and transient, were seen in 22 patients (38%). Peak serum levels varied from 26 to 82 (mean 50) micrograms/ml after 1 g doses and from 68 to 100 micrograms/ml after 2 g. Previous statements of a better in vitro activity of cefamandole than of older cephalosporins against some gram-negative bacilli were corroborated.

Adolescent↗
PubMed1979

Septicemia I. A prospective study on etiology, underlying factors and sources of infection.

In a prospective study, 110 cases of proved and 41 of probable septicemia were analysed. Underlying diseases or factors were common, also in young patients, often narcotic drug or alcohol abusers. In one third, septicemia was probably hospital-acquired. Streptococci, staphylococci and gram-negative enteric rods were most common, followed by pneumococci and haemophilus species. Staphylococci and gram-negative enteric rods dominated in patients hospitalized at or before the onset of disease, and staphylococci in patients with vascular foreign bodies and in drug addicts. Enteric rods were common in elderly patients with urogenital disease, especially after instrumentation. Among streptococci, alpha-streptococci dominated; they did not emanate as often from dental foci as expected. In 2 of 3 asplenic patients with extensive hemorrhages pneumococci were found. Bacteria of low virulence and fungi occurring as opportunists were rare. Mixed infections, present in 4 cases, were severe. Portals of entry could often be proved or assumed. In half of all patients, the same organism was isolated from a primary focus as from blood. The importance of underlying illnesses and factors and of invasive procedures was evident. A tentative etiological diagnosis could often be made, based on case history, underlying factors and the probable portal of entry.

Adult↗
PubMed1978

Bacterial endocarditis. I. A prospective study of etiology, underlying factors and foci of infection.

In a prospective clinical and bacteriological study of 192 consecutive patients with septicemia admitted during the period 1967--1971 to a hospital for infectious diseases, 31 cases of proved (group I) and 10 with probably (group II) bacterial endocarditis were observed and analysed with regard to a variety of factors. The incidence of bacterial endocarditis was 3 per 1 000 admissions. The mean age of the patients was 52.6 years; there was no sex predominance. In about one third of the patients apparently normal valves were involved. Underlying non-cardiac factors were present in two thirds, even in younger age groups, in which chronic alcoholism and intravenous drug abuse were frequent. Secondary manifestations from various organs were noted in about three quarters of the patients, in one quarter already on admission. alpha-Hemolytic streptococci and staphylococci were most commonly isolated, followed by gram-negative enteric rods, beta-hemolytic streptococci, enterococci, and pneumococci. A probable portal of entry could be assumed in 80% of the patients and could often be related to the type of bacteria involved. In some cases, diagnostic or therapeutic procedures preceded the disease. A subacute course of the endocarditis was observed in one third of the patients and all these had alpha-hemolytic streptococci or enterococci. The aortic and mitral valves were equally often involved and equally often infected by alpha-hemolytic streptococci. In 4 patients, 3 of whom were drug addicts, the tricuspid valve was probably involved; all were infected by staphylococci. In one case autopsy revealed a mural endocarditis.

Adolescent↗
PubMed1977

Two-stage replacement of tricuspid valve in active endocarditis.

One month after a 21-year-old female drug addict with tricuspid staphylococcal endocarditis seemed to have been cured by antibiotic therapy she relapsed. Further antibiotic treatment for one month failed to control the infection. Tricuspidectomy was when performed and the infection was eliminated. A valve prosthesis was inserted 3 months later. She recovered and is now fully restored to health. We recommend this two-stage surgical technique in similar cases.

Adult↗
PubMed1975

Circulating immune complexes in a patient with prolonged gonococcal septicemia.

A case of prolonged gonococcal speticemia is presented. Lack of genital symptoms, of demonstrable gonococcal antibodies in whole serum, and initially also of skin lesions contributed to a delayed diagnosis that was finally confirmed by positive blood culture. Evidence of circulating immune complexes was obtained by the demonstration of gonococcal IgG antibodies after dissociation of serum by gradient centrifugation of pH 4.0. The possibility that circulating immune complexes may contribute to the symptomatology of gonococcal septicemia is pointed out.

Adult↗