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Biomedical subjects

P A Gross

Publications and source records attributed to P A Gross.

At least 19 recordsLinked to original sources
PubMed1992

Applying a standard of care to the quality assessment of bacteremia.

OBJECTIVE: To identify an indicator of appropriate antibiotic use for bacteremia that is scientifically sound, that is noncontroversial, and that can be broadly applied as an index of the quality of care. DESIGN: Retrospective review of consecutive cases of significant documented bacteremias. SETTING: Suburban tertiary-care hospital. RESULTS: Two hundred ninety-one of 300 (97%) patients received appropriate antibiotics within 48 hours after the final antibiotic sensitivity report was placed on the hospital chart. Therapy was not appropriate in 6 patients with methicillin-resistant Staphylococcus aureus and in 3 patients with enterococcal bacteremia. INTERVENTIONS: Following this study, we instituted a program to prospectively monitor antibiotic use in bacteremias. During the most recent 1-year period, the infectious disease fellow or pharmacist called the attending physician to change antibiotics in 84 of 731 (11.5%) patients with bacteremia. The program was well-accepted by attending physicians. CONCLUSIONS: A scientifically sound, non-controversial standard of care was identified and used to evaluate the appropriateness of antibiotic use. When this standard was applied prospectively and incorporated into the hospital's routine operations, the quality of care was improved.

Anti-Bacterial Agents↗
PubMed1992

Influenza virus vaccine: a need for emphasis.

Each year, there are more than 20,000 influenza associated deaths during influenza virus epidemics. There is an increase in hospital admission for patients with pneumonia, exacerbation of chronic obstructive pulmonary disease, croup, and congestive heart failure, and an increase in school and industrial absenteeism. Yet only 30% of the high-risk target population receives influenza vaccination annually. Health care providers and patients are reluctant to use vaccine despite its generally excellent record of safety and its approximately 70% efficacy when vaccine and epidemic strains match. The continuing change in antigenic composition of the influenza A virus and waning immunity requires annual vaccination. Vaccine composition and target groups are reviewed. Strategies for improving vaccine usage are emphasized.

Adolescent↗
PubMed1979

Neutralization test in influenza: use in individuals without hemagglutination inhibition antibody.

In influenza immunization trials, patients who were seronegative by the hemagglutination inhibition test could be divided into two groups according to preimmunization levels of neutralizing (Neut) and neuraminidase inhibition (NI) antibodies. The group with low levels of Neut and NI antibodies usually developed adequate levels of hemagglutination inhibition antibody after one dose of vaccine, and the group with undetectable Neut and NI antibodies did not.

Antibodies, Viral↗
PubMed1979

Leukopenia due to penicillin and cephalosporin homologues.

Leukopenia is an infrequently recognized complication of penicillin-related antibiotic and cephalosporin therapy. We describe our experience with nine individuals and reviewed reports of 11 cases from the literature. Seventy-six percent of cases occurred in individuals receiving 150 mg/kg/day or more of the various penicillin and cephalosporin homologues; 67% received these high doses for two or more weeks before the onset of leukopenia. Leukopenia was unusual within the first week of antibiotic treatment. Standard medical texts often recommend blind administration with 12 to 23 g/day of these antibiotics regardless of weight. It is suggested that these antibiotics be administered according to a maximum milligram per kilogram per day dosage as is done in children. Beyond the first week of administration, careful monitoring of the blood cell count should be conducted for those receiving high doses of these antibiotics.

Adolescent↗
PubMed1978

Disseminated Cryptococcus treated with transfer factor.

Cardiac toxic reactions and pulmonary consolidation in the left lower lobe developed in a patient who was receiving amphotericin B therapy for cryptococcal meningitis. Following surgical resection of the lobe, multiple subcutaneous cryptococcal abscesses appeared. Flucytosine administered intravenously failed to eradicate the lesions. Transfer factor therapy and multiple drainage procedures elimniated the skin abscesses. Transfer factor therapy was administered for one year; the patient was asymptomatic 16 months after therapy was discontinued.

Abscess↗
PubMed1978

Influenza immunization in immunosuppressed children.

Optimal influenza immunization of individuals with malignancy and other immunodeficient states requires and understanding of responses to currently recommended regimens. Children with acute lymphocytic leukemia and other malignancies between three and 17 years of age were immunized with bivalent influenza vaccine containing A/New Jersey/76 and A/Victoria/75. Folowing a two-dose immunization schedule, only 37% (25468) on cancer chemotherapy seroconverted to a hemagglutination inhibition titer greater than or equal to 20 for A/NJ/76; the seroconversion rate in those not on chemotherapy was 92% (68/74, P less than 0.001). The immune response to the A/Vic/75 antigen was also related to a history of recent chemotherapy. There was no correlation between the immune response and the peripheral white blood cell count except at counts less than or equal to 1,000. The optimum time to immunize children with malignancies is when they have been off chemotherapy for one month and have peripheral white blood counts greater than 1,000.

Adolescent↗
PubMed1978

Surveillance for postoperative wound infections: practical aspects.

Intensive surveillance for postoperative wound infections was conducted for one month on three separate occasions at the Veterans Administration Hospital, West Haven, Connecticut. The mean wound infection rates for clean, clean-contaminated, contaminated, and dirty wounds were 6, 11, 17 and 18%, respectively. During the second survey, the clean-contaminated rate was 25% and was significantly higher than at other periods (p less than 0.05). Most of these infections occurred on a single surgical subspecialty service. The methods used to conduct intensive wound surveillance and the need for close liaison between the infection control team and the surgical service is emphasized. Current problems with wound surveillance are reviewed.

Connecticut↗
PubMed1977

A controlled double-blind comparison of reactogenicity, immunogenicity, and protective efficacy of whole-virus and split-product influenza vaccines in children.

A double-blind randomized study with bivalent influenza virus vaccines was conducted to compare the local and systemic reactions and immunogenicity of a whole-virus vaccine and a split-product vaccine in children. Fevers of greater than 100 F were more frequent after vaccination with whole-virus than split-product vaccine especially in children one to four years old (69% vs 22%; P less than 0.01). Fevers of greater than or equal to 103 F did not occur in children who previously had been given influenza virus vaccine, even in the absence of preexisting homologous serum antibody. The immune response to the A/Port Chalmers/1/73 antigen in the vaccine was similar after administration of either whole-virus or split-product vaccine. However, split-product vaccine induced significantly less hemagglutination-inhibiting antibody to B/Hong Kong/5/72 virus in children younger than 10 years who had not been previously immunized; only 43% developed detectable antibody vs. 100% of those vaccinated with whole virus vaccine (P less than 0.01). These studies indicate that (1) in young children whole-virus vaccine causes fever more frequently than split-product vaccine; (2) young children previously vaccinated with influenza virus vaccine are unlikely to experience fever subsequent to immunization with a related antigen; and (3) split-product vaccine induces less antibody to B/Hong Kong/5/72 virus than whole-virus vaccine in immunologically unprimed young children.

Antibodies, Viral↗
PubMed1977

Clinical reactions and serologic responses in healthy children aged six to 35 months after two-dose regimens of inactivated A/New Jersey/76 influenza virus vaccines.

In collaborative clinical trials, two-dose regimens of four monovalent A/New Jersey (NJ)/76 influenza virus vaccines were evaluated in 89 children aged six to 35 months. Clinical reactions to vaccination consisted primarily of low-grade fever. Rectal temperatures of between 100 F and 102 F occurred less frequently after inoculation with split-product vaccines (seven [23%] of 31 children) than whole-virus vaccines (19 [33%] of 58). After administration of single doses of vaccines, titers of hemagglutination-inhibiting (HAI) antibody reached greater than or equal to 1:20 in three (13%) of the 23 recipients of split-product vaccines and in 23 (51%) of the 45 recipients of whole-virus vaccines. After administration of two doses, 89%-94% of recipients of Parke, Davis and Company (PD, Detroit, Mich.), Merrell-National Laboratories (Cincinnati, Ohio), and Merck Sharp and Dohme (West Point, Pa.) vaccines, but only 50% of the recipients of Wyeth Laboratories (Philadelphia, Pa.) vaccine, had titers of HAI antibody of greater than or equal to 1:20. Single doses of more reactogenic whole-virus vaccines may be justifiable for rapid immunization of young children during epidemics of influenza. Given in a two-dose regimen, however, PD split-product vaccine was immunogenic and was the most well-tolerated vaccine tested in this age group.

Antibodies, Viral↗
PubMed1977

Response of children with cardiac disease to the bivalent influenza A vaccines.

During the recent nationwide trials of influenza vaccine, 121 children with cardiac disease, aged three to 18 years, were evaluated with respect to their immune response and reaction rate after administration of a whole-virus or split-virus bivalent influenza A/New Jersey/76-A/Victoria/75 vaccine given as a single dose or two divided doses. The serologic response of the cardiac children did not differ significantly from that of the total group of high-risk children or normal children who recived the same vaccine. The major reaction to the vaccines was fever, which occurred in one-fourth to one-half of children receiving the whole-virus vaccines. The split-virus vaccines were generally well tolerated. The reaction index of the cardiac children was slightly lower than that of the normal children receiving the same vaccine during the single-dose trial but higher during the two-dose trial. The second dose was generally better tolerated than the first dose. Reactions in the children with cardiac disease could not be adequately evaluated according to specific diagnoses or functional disabilities.

Adolescent↗
PubMed1977

Multicenter two-dose trials of bivalent influenza A vaccines in asthmatic children aged six to 18 years.

Data from all of the vaccination centers that immunized asthmatic children six to 18 years old with bivalent influenza A/New Jersey/76 and A/Victoria/75 vaccines were analyzed. Systemic reaction indexes were somewhat higher in asthmatic children receiving the first dose of whole-virus vaccines than in similar vaccinees without asthma. Antibody levels after immunization, while different in some instances, did not show any significant trends toward either hypo- or hyperresponsiveness in the asthmatic children.

Adolescent↗
PubMed1977

Comparative evaluation of different types of blood culture media for isolation of aerobes.

The possible advantage of hypertonic sucrose medium over isotonic medium for isolating aerobic organisms from blood was studied. Approximately 50 ml of medium and 5 ml of blood inoculum were present in each culture bottle. In the first phase of the study, supplemented peptone broth (SPB) was compared with brucella broth containing 10% sucrose (BB-10S). There were 194 significant clinical isolates in at least one of the two bottles in each set during a 7-month period; 160 (82%) of the isolates grew in SPB, whereas 191 (98%) grew in BB-10S (P less than 0.01). Of the 158 isolates that grew in both media, 13 (8%) appeared earlier in BB-10S, whereas none did so in SPB. In the second phase of the study, SPB with 10% sucrose (SPB-10S) was compared with BB-10S. There were 187 isolates during a 9-month period; 173 (93%) grew in SPB-10S compared with 179 (96%) for BB-10S. In this comparison there was no apparent difference in the time interval required for recovery of organisms. The two hypertonic sucrose media (SPB-10S and BB-10S) were comparable for isolating organisms under aerobic conditions and superior to the nonhypertonic medium (SPB).

Aerobiosis↗
PubMed1977

Bacteremia in a community hospital: spectrum and mortality.

The problem of bacteremia was studied at our 500-bed community hospital during 1974-1975. All patients with positive blood cultures for clinically significant organisms were analyzed with respect to age, sex, host factors, type, dose, and time of institution of therapy with antibiotics, and mortality. Of 142 episodes of bacteremia, outcome according to underlying host factors showed that 12/15 died in the rapidly, fatal group, 12/24 died in the ultimately fatal group, and in the nonfatal group 25/103 died. Mortality for Gram-positive bacteremia was 37% (7/54) for Gram-negative bacteremia in the nonfatal group. In addition to underlying host factors, inappropriate antibiotic therapy also contributed to higher mortality in patients with gram-negative bacteremia.

Adolescent↗
PubMed1976

Administration of tobramycin and gentamicin by the intravenous route every 6 hr in patients with normal renal function.

The feasibility and safety of administration of tobramycin and gentamicin in every 6 hr rather than every 8 hr was studied in 18 patients with normal renal function. Eleven patients received tobramycin in a dose of 1.0-3.2 mg/kg every 6 hr, and seven received gentamicin in a dose of 1.4-2.0 mg/kg every 6 hr. The mean peak serum concentrations, excluding the levels in the three children given tobramycin, were 5.5 and 5.8 mug/ml in each group, respectively, after maximal dosage; trough levels 2 hr before the next dose were less than or equal to 1.8 mug/ml in both groups of patients. Neither drug accumulated in the serum when the dosage regimen was maintained for three to 19 days. There was no evidence of nephrotoxicity or ototoxicity. Administration of tobramycin and gentamicin every 6 hr seems to be a reasonable program for patients with normal renal function, pending further studies on safety.

Adolescent↗
PubMed1976

Polymicrobic bacteriuria: significant association with bacteremia.

Current clinical practice states that a urine culture yielding three or more isolates must be considered a contaminated specimen and discarded. The validity of this practice was tested by reviewing all patients at the West Haven Veterans Administration Hospital with positive blood cultures for 1 year to determine how many were associated with polymicrobic bacteriuria (two or more urine isolates each present at greater than 10(5) colonies/ml). During 1973 there were 18 patients who had bacteremia associated with a urinary tract infection in which the same organism with the identical antibiogram was found in both the blood and the urine of these 18 patients with monomicrobic bacteremia 11(61%) had polymicrobic bacteriuria, with a mean of an additional 1.75 urinary pathogens present in significant quantities. In these patients with polymicrobic bacteriuria, an indwelling bladder catheter was present for a mean period of 4.4 months before the episode of bacteremia. Only 5 of the 11 patients with polymicrobic bacteriuria had temporally associated urinary tract manipulation. Monomicrobic bacteriuria occurred in seven patients (39%). The mean indwelling bladder catheter time was 0.9 days, and urinary tract manipulation near the time of bacteremia occurred in all seven patients. Prospectively, nine other patients with polymicrobic bacteriuria were recultured by one of us to be certain that appropriate collection and transportation methods were used; the presence of polymicrobic bacteriuria was repeatedly demonstrated in 7(78%). This study illustrates the clinical importance of polymicrobic bacteriuria.

Aged↗
PubMed1976

Endemicity of multiple staphylococcal phage types: relation of two common source outbreaks.

An outbreak of Staphylococcus aureus bacteremia occurred among patients treated in the hemodialysis unit in 1971. A second outbreak of S. aureus peritonitis occurred in 1973 in patients with chronic indwelling peritoneal catheters cared for together in the medial intensive care unit. Although the attending personnel, patients, and geographical locations were different in each outbreak, the following similarities were notes: (1) more than one phage type was epidemic: (2) an exogenous mode of spread with cross-contamination between personnel and patient as well as between patient and patient, and (3) breaks in sterile technique when handling the arteriovenous shunt site or the peritoneal catheter were made without the staff conducting the procedure being aware of their occurrence. Culture surveys of the same phage types found during the two epidemics. Thus, an endemic reservoir of several different staphylococcal phage types was present. Careful, consistent application of aseptic technique when handling either arteriovenous shunts or peritoneal catheters and hand washing in between patients was required to prevent the endemic strains from becoming epidemic.

Asepsis↗