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Biomedical subjects

P J Rettig

Publications and source records attributed to P J Rettig.

At least 19 recordsLinked to original sources
PubMed1996

Colonization with group B streptococci in pregnancy and adverse outcome. VIP Study Group.

OBJECTIVE: Our purpose was to study the association of cervicovaginal colonization with group B streptococci with pregnancy and neonatal outcome. STUDY DESIGN: A prospective study was conducted at seven medical centers between 1984 and 1989. Genital tract cultures were obtained at 23 to 26 weeks' gestation and at delivery. Prematurity and neonatal sepsis rates were compared between group B streptococci positive and negative women. RESULTS: Group B streptococci was recovered from 2877 (21%) of 13,646 women at enrollment. Heavy colonization was associated with a significant risk of delivering a preterm infant who had a low birth weight (odds ratio = 1.5, 95% confidence interval 1.1 to 1.9). Heavily colonized women given antibiotics effective against group B streptococci had little increased risk of a preterm, low-birth-weight birth. Women with light colonization were at the same risk of adverse outcome as the uncolonized women. Neonatal group B streptococci sepsis occurred in 2.6 of 1000 live births in women with and 1.6 of 1000 live births in women without group B streptococci at 23 to 26 weeks' gestation (p = 0.11). However, sepsis occurred in 16 of 1000 live births to women with and 0.4 of 1000 live births to women without group B streptococci at delivery (p < 0.001). CONCLUSIONS: Heavy group B streptococci colonization of 23 to 26 weeks' gestation was associated with an increased risk of delivering a preterm, low-birth-weight infant. Cervicovaginal colonization with group B streptococci at 23 to 26 weeks' gestation was not a reliable predictor of neonatal group B streptococci sepsis. Colonization at delivery was associated with sepsis.

Female↗
PubMed1991

Antepartum cultures for Ureaplasma urealyticum are not useful in predicting pregnancy outcome. The Vaginal Infections and Prematurity Study Group.

To test the hypothesis that genital colonization with Ureaplasma urealyticum would predict adverse pregnancy outcome, 4934 women from five medical centers were evaluated for vaginal colonization with U. urealyticum between 23 and 26 weeks' gestation and followed up to delivery. U. urealyticum colonization was associated with maternal age, parity, racial-ethnic group, martial status, income, education, smoking, number of sexual partners, and colonization with Trichomonas vaginalis, Mycoplasma hominis, and bacterial vaginosis. After adjustment for medical and sociodemographic factors in a multivariate analysis, there was no difference in the mean birth weight or proportion of low-birth-weight infants delivered by women who carried U. urealyticum and those who did not. U. urealyticum colonization at 23 to 26 weeks was not associated with preterm rupture of membranes, preterm labor, or preterm delivery. A positive vaginal culture for U. urealyticum in midgestation does not predict those women at risk for preterm labor, preterm delivery, preterm premature rupture of membranes, or delivery of a low-birth-weight infant.

Adolescent↗
PubMed1991

A randomized placebo-controlled trial of erythromycin for the treatment of Ureaplasma urealyticum to prevent premature delivery. The Vaginal Infections and Prematurity Study Group.

Ureaplasma urealyticum has been associated with low birth weight and histologic chorioamnionitis and it is a frequent isolate from the chorioamnion of patients who are delivered prematurely. In prior clinical trials using antibiotics active against U. urealyticum, antibiotic treatment was associated with reduced prematurity and increased mean birth weight. In this multicenter, randomized, double-blind clinical trial, pregnant women with U. urealyticum were treated with 333 mg of erythromycin base or placebo three times daily, starting between 26 and 30 weeks' gestation and continuing through 35 completed weeks of pregnancy. Women with urinary tract infection or Neisseria gonorrhoeae infection were excluded from the trial, and women with Chlamydia trachomatis or group B streptococci were excluded from these analyses. Erythromycin did not eliminate U. urealyticum from the lower genital tract. There were no significant differences between erythromycin- and placebo-treated women in infant birth weight or gestational age at delivery, in frequency of premature rupture of membranes, or in neonatal outcome.

Adult↗
PubMed1989

A sexually transmitted diseases curriculum in adolescent medicine.

We conducted a needs assessment and developed and evaluated a model curriculum on sexually transmitted diseases (STDs) for house officers on an adolescent medicine rotation. Residents thought it important for physicians to acquire skill in treating STDs during residency (mean rating, 4.4 on a five-point scale) and were willing to provide medical care for adolescents likely to have an STD (mean rating, 4.4). Knowledge was measured before and after presentation of both of the two curriculum levels. There were significant increases in knowledge after each level, with a mean increase of 4.4 (of 50 possible) points for level 1 and a mean increase of 1.8 (of 38 possible) points for level 2. This improved knowledge about STDs should reflect increased competence and enhanced willingness to treat STDs in adolescents.

Adolescent Medicine↗
PubMed1988

False positive results with the use of chlamydial antigen detection tests in the evaluation of suspected sexual abuse in children.

The presence of rectal or genital infection with Chlamydia trachomatis in children is frequently considered an indicator of sexual abuse. The diagnosis of chlamydial infection in these children has been complicated by the use of antigen detection methods instead of culture. We report five cases in which the use of chlamydial antigen detection tests in the evaluation of suspected child abuse gave false positive results. An enzyme immunoassay was used in two cases (Chlamydiazyme; Abbott Diagnostics) and a direct fluorescent antibody test was used in the remaining three cases (Microtrak; Syva). The sites examined were the urethra, vagina and rectum. In all cases chlamydial cultures obtained several days later with no interim antibiotic therapy were negative. Four of the five children examined were probably victims of sexual abuse. The enzyme immunoassay and direct fluorescent antibody tests have been evaluated primarily for urethral and cervical cultures from adults; neither test has been approved or evaluated for rectal or genital sites in children. At these sites use of both tests may be associated with a large proportion of false positives caused by contamination with fecal flora which can cross-react with the antibodies used in the test. These tests also have limited utility in populations where the prevalence of chlamydial infection is low (less than 10%), as has been reported for sexually abused children. Because of the medicolegal implications only "gold standard" methods (i.e. culture) performed by a competent laboratory should be used in evaluating chlamydial infection in sexually abused children.

Antigens, Bacterial↗
PubMed1988

Perinatal infections with Chlamydia trachomatis.

Much has been relearned and learned anew about perinatal chlamydial infections during the past 10 to 15 years. The adverse effects of infection on pregnancy outcome have been suggested but not fully documented or explained. Epidemiologic, biologic, and immunologic correlates of risk for infection and complications of pregnancy due to C. trachomatis are not yet fully understood. Increased appreciation of the importance of this organism in pregnancy, coupled with more facile methods for diagnosing infection and with further research using modern molecular techniques, promises to add greatly to the completeness of our knowledge and to our eventual complete control of this infection in pregnancy.

Chlamydia Infections↗
PubMed1987

An outbreak of necrotizing enterocolitis. Association with transfusions of packed red blood cells.

Of 187 newborns admitted to a 33-bed, level III neonatal intensive care unit between January 1, 1985 and June 23, 1985, 33 developed necrotizing enterocolitis during their hospital stay. Twenty of the 33 newborns (61%) had onset of symptoms between April 1 and June 23, suggesting clustering during this period. A case-control study, with matching on birth weight class, approximate date of admission to the unit and approximate duration of stay, failed to reveal any association of the syndrome with type or timing of feeding, perinatal hypoxic events, as determined by apgar scores and labor history, or specific microbial organisms. By contrast, however, transfusion of packed red blood cells was highly and significantly associated with the syndrome (odds ratio = 15.1, 95% confidence interval = 2.59-92.51). In addition, therapy with caffeine, with theophylline, and with furosemide were moderately associated with the syndrome, although not significantly so. During this outbreak period, the incidence of necrotizing enterocolitis by birth weight was 30.6% in infants less than 1,500 gm, 10.8% in infants 1,500-2,500 gm, and 11.9% in infants 2,500 gm or more. These findings confirm the importance of low birth weight as a risk factor for development of the syndrome and suggest that insults to volume homeostasis, such as transfusion and use of diuretics, need to be considered as possible mechanisms whereby necrotizing enterocolitis is initiated.

Birth Weight↗
PubMed1987

Measles spread in medical settings: an important focus of disease transmission?

During the period September 1981 to August 1985, we investigated every reported case of measles in Oklahoma to confirm the diagnosis, to determine the source, and to identify contacts to prevent spread of the disease. During this time, 33 serologically and/or epidemiologically confirmed cases were investigated. Nine (27%) persons acquired measles in a medical office or clinic waiting area. Eight of these recalled direct face-to-face contact with a source. An additional six (18%) cases were associated with exposure to these medically acquired cases, for a total of 45% that were the direct or indirect result of exposures in medical waiting rooms. The medical waiting room is a location where a reservoir of susceptible individuals may congregate, allowing for potential exposures to measles and other infectious diseases. Because many persons in these settings are too young to have received routine measles vaccination, other measures to decrease exposures in this setting may be necessary to achieve the goal of measles elimination in the United States.

Ambulatory Care Facilities↗
PubMed1985

Fatal gastroenteritis associated with coronaviruslike particles.

The role of human enteric coronaviruses in infantile gastroenteritis is controversial. We detected coronaviruslike particles in the intestinal contents and within the epithelial cells of the ileum in a 15-month-old infant who had postmortem evidence of severe enteritis. Ultrastructural findings consistent with in vivo coronavirus replication in the human small intestine support a causative role for this agent in gastroenteritis.

Autopsy↗
PubMed1984

Antibiotic therapy of fulminant E. coli K1 sepsis in infant rabbits.

A model of overwhelming E. coli K1 sepsis and early meningitis was developed in infant rabbits and used to compare clinical and bacteriologic efficacy of ampicillin, moxalactam, cephalothin and chloramphenicol. Intraperitoneal injection of 10(7) E. coli K1 into 1- or 2-wk-old rabbits produced a rapidly progressive infection which, if left untreated, produced bacteremia in 100% of animals, meningitis in 78%, and mortality in 100%. Therapy was initiated 4 h after ip infection at which time mean bacterial concentration (log10 CFU/ml) ranged from 4.4-4.8 in the blood and from 1.8-2.3 in the cerebral spinal fluid (CSF). Pre-treatment frequency of bacteremia (100%) and meningitis (17-23%) was similar for all experimental groups. Antibiotic concentrations in blood and CSF 2 h after a dose exceeded the E. coli minimum inhibitory concentration with the exception of CSF cephalothin, which was undetectable. Moxalactam, ampicillin, and chloramphenicol significantly reduced the incidence of bacteremia and meningitis relative to cephalothin or saline controls (P less than 0.02). Mortality rates among the former three groups were high (64-82%) but significantly less than in saline or cephalothin-treated rabbits (100%). In this neonatal model of fulminant sepsis with early meningitis, moxalactam provided no therapeutic advantage over ampicillin or chloramphenicol.

Animals↗