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P Turgeon

Publications and source records attributed to P Turgeon.

At least 19 recordsLinked to original sources
PubMed1999

Cefotaxime, desacetyl-cefotaxime, and bactericidal activity in spontaneous bacterial peritonitis.

We have prospectively studied 13 episodes of spontaneous bacterial peritonitis (SBP) in 12 patients treated with cefotaxime (CTX) 2 g intravenously every 8 h (mean duration, 5.3 days). Ascitic fluid was inoculated at the bedside. The cultures were done before, during (day 3 after CTX initiation), and 48-72 h (mean, 56 h) after the end of therapy. All SBP episodes were monomicrobial. During treatment, the concentrations of CTX and desacetyl-cefotaxime (d-CTX) in ascitic fluid were high in all 13 SBP episodes, and d-CTX was still present in 6 patients who had residual ascitic bactericidal titer (ABT) activity after the last dose of CTX. ABTs were >/=1:128 during CTX therapy in 12 episodes and were measurable in 7 patients after the last dose. All patients were cured. The present study provides scientific rationale to the clinical studies that suggest treating SBP episodes with lower doses of antibiotics and shorter treatment duration.

Adult↗
PubMed1996

Management of intra-abdominal infections. The case for intraoperative cultures and comprehensive broad-spectrum antibiotic coverage. The Canadian Intra-abdominal Infection Study Group.

OBJECTIVE: To test the hypothesis that comprehensive broad-spectrum empirical antimicrobial therapy is superior to limited-spectrum empirical antimicrobial therapy in intra-abdominal infections. DESIGN: Prospective, randomized, double-blinded study. SETTING: University-affiliated hospitals in Canada. PATIENTS: Two hundred thirteen patients with intra-abdominal infections and planned operative or percutaneous drainage. INTERVENTION: Limited-spectrum empirical antimicrobial therapy consisted of cefoxitin sodium, 2 g, intravenously, every 6 hours (n = 109). Comprehensive broad-spectrum empirical antimicrobial therapy consisted of a combination of imipenem and cilastatin sodium, 500 mg, intravenously, every 6 hours (n = 104). MAIN OUTCOME MEASURES: Failure to cure the intra-abdominal infection (persistence of infection or death). RESULTS: Of initial isolates, 98% were sensitive to imipenem plus cilastin sodium compared with 72% for cefoxitin. No difference was found in the failure rate between treatment groups. Among various reasons for failure (including technical), 12 of 80 patients in the limited-spectrum empirical antimicrobial therapy group had resistant organisms at a second intervention compared with 1 of 74 in the comprehensive broad-spectrum empirical antimicrobial therapy group (P < .003, chi 2). One death in the limited-spectrum empirical antimicrobial therapy group was due to autopsy-proved disseminated Pseudomonas aeruginosa (blood, peritoneum, lung, and pleural fluid) that was resistant to cefoxitin, and the other was associated with peritonitis due to cefoxitin-resistant Enterobacter cloacae. One death in the comprehensive broad-spectrum empirical antimicrobial therapy group was associated with peritonitis from Clostridium perfringens that was sensitive to imipenem plus cilastin sodium, and the other was associated with peritonitis from Pseudomonas aeruginosa that was resistant to imipenem plus cilastin sodium. CONCLUSION: Treatment failure of intra-abdominal infection may be due, in part, to the presence of resistant pathogens at the site of infection. Therefore, routine culture of these sites seems worthwhile and empirical therapy should be as comprehensive as possible and should cover all potential pathogens.

Abdomen↗
PubMed1994

Longitudinal study of susceptibilities of species of the Bacteroides fragilis group to five antimicrobial agents in three medical centers.

A total of 579 clinical isolates of the Bacteroides fragilis group collected from three Canadian hospitals were tested for susceptibility to five antimicrobial agents by using an agar dilution method. During the 4-year survey, isolates from intra-abdominal infections were collected from the following sites: abdominal abscesses (48%), peritoneal fluid (39%), blood (10%), and bile (3%). B. fragilis was the most prevalent species (35.4%), followed by B. thetaiotaomicron (19.2%), B. ovatus (15.9%), and B. vulgatus (11%). No metronidazole- or imipenem-resistant strains were found during the survey. Resistance profiles varied among the different species tested: 7.8, 2.9, and 7.3% of B. fragilis strains (n = 205) and 68.1, 17.2, and 9.4% of non-B. fragilis strains (n = 373) were resistant to cefotetan, cefoxitin, and clindamycin, respectively. B. fragilis and B. vulgatus demonstrated lower resistance rates than B. thetaiotaomicron, B. ovatus, B. distasonis, and B. caccae. During the study, rates of resistance to cefotetan and clindamycin fluctuated but rates of resistance to cefoxitin increased, particularly at one center. These data indicate a need to determine the susceptibility patterns of the B. fragilis group periodically at each hospital.

Bacteroides fragilis↗
PubMed1994

Pneumococcal resistance to antimicrobial agents in the province of Québec, Canada.

The serogroup/serotypes (SGTs) and antimicrobial susceptibilities to 10 antimicrobial agents of 110 clinical strains of Streptococcus pneumoniae were determined. Strains intermediately resistant or highly resistant to penicillin G (80 of 110) belonged predominantly to SGTs 23 (45.0%), 19 (13.7%), 6 (10.0%), 9 (6.2%), and 14 (3.7%). The MICs of all cephalosporins, tetracycline, trimethoprim-sulfamethoxazole, and chloramphenicol increased along with the MICs of penicillin G. However, erythromycin resistance and clindamycin resistance were observed more frequently among the intermediately penicillin-resistant strains. Multiple resistance was observed for 32 strains, of which 25 were highly resistant to penicillin G and belong to SGT 23F. All strains were susceptible to vancomycin.

Canada↗
PubMed1988

[Comparative efficacy of antibiotic prophylaxis using cefoxitin in one or in three doses in cesarean section].

To compare the effectiveness of three doses and of a single dose of cefoxitin, a second-generation cephalosporin, in preventing infection after nonelective cesarean section, we carried out a prospective study in 255 women who underwent the procedure between March 1983 and February 1985. The rate of postoperative infection was 7% in the group that received three doses and 8% in the one-dose group. The sensitivity and specificity of perioperative cultures were low. The rate of asymptomatic bacteriuria was high, at 20%, but few symptomatic urinary tract infections were found. Routine antibiotic prophylaxis with a single dose is suggested for all nonelective cesarean sections.

Adult↗
PubMed1987

Comparison of agar disk diffusion, microdilution broth, and agar dilution for testing antimicrobial susceptibility of coagulase-negative staphylococci.

A collection of 120 oxacillin-susceptible and 120 oxacillin-resistant coagulase-negative staphylococci (CNS) from six tertiary care hospital laboratories were tested by agar disk diffusion, three microdilution broth systems (Sensititre, Dynatech, and Alpkem), and the Vitek AutoMicrobic system for comparison with reference agar dilution results. The antimicrobial agents tested were oxacillin, cefazolin, cefotaxime, cefuroxime, cefamandole, fusidic acid, rifampin, and vancomycin. Incubation was at 30 or 35 degrees C for 24, 48, and 72 h. The broth media were supplemented with 2% NaCl for some antimicrobial agents, and the agar dilution method was used with and without the addition of 4% NaCl. The CNS were identified to species by the method of Kloos and Schleifer. The results showed a lack of concordance between two hospitals with respect to oxacillin susceptibility testing by agar dilution with no NaCl supplement. The reasons are not clear but may be related to variations in media. The 4% NaCl supplement or extended incubation to 48 h eliminated this difference. The cefazolin and cefotaxime susceptibility results in the agar disk diffusion test were unreliable if accepted at face value. Cefamandole testing correlated well with the reference method regardless of the method used, and salt supplementation is not recommended. Most of the oxacillin-resistant CNS were resistant to the other beta-lactam drugs except cefamandole. Of 22 CNS resistant to cefamandole, 21 were S. haemolyticus.

Anti-Bacterial Agents↗
PubMed1985

Predictors of asymptomatic gonorrhea among patients seen by private practitioners.

Nineteen physicians participating in a program for detecting and treating gonorrhea and other sexually transmitted diseases (STD) in high-risk groups filled out encounter forms for the initial visits by the first 3144 patients. This information was used to describe the program users and, by means of logistic regression analysis, to identify predictors of gonorrhea in asymptomatic patients. Overall, 17.3% of the users had culture-proved gonorrhea. Of the symptomatic patients 24.5% had gonorrhea. Of the asymptomatic patients 20.4% of those with a history of contact with a known or suspected case of STD had the disease, and 5.3% of those without a history of contact had the disease. The independent predictors of gonorrhea identified were, in order of importance, a history of contact with a case of STD and being aged less than 30 years. These predictors underline the importance of contact tracing, an underused but productive method of gonorrhea control that can be used effectively in private practice.

Adolescent↗
PubMed1985

Optic disk findings in hypervitaminosis A.

Three cases of papilledema secondary to chronic excessive vitamin A intake are presented, and the optic disk changes are documented with intravenous fluorescein angiography. Two of the three patients reported in this study were symptomatic with blurred vision and systemic complaints. The symptoms of blurred vision and systemic complaints disappeared within one week, and papilledema resolved over several months after discontinuance of vitamin A. The fluorescein angiographic changes observed in the optic disk of patients with hypervitaminosis A are similar to those associated with other known causes of papilledema. Since vitamin A is a nonprescription drug, and its indiscriminate use is potentially great, any history of vitamin ingestion should be elicited during the evaluation of papilledema.

Adult↗
PubMed1983

[Use of cephalosporins as antibiotic prophylaxis in cesarean section].

Cefoxitin, a second-generation cephalosporin, was compared with cefazolin, a first-generation cephalosporin, and a placebo in a prospective, double-blind study of antibiotic prophylaxis in women undergoing nonelective cesarean section. In the groups that received cefazolin or the placebo there eas no statistically significant change in colonization of the cervix by aerobic bacteria by the fourth day after the operation, but there was a statistically significant increase in colonization by anaerobes. Cefoxitin had the opposite effect. Of the 14 postoperative infections in 11 patients, significantly more were in patients who had received the placebo; the numbers were too small to show a difference in effectiveness between the two antibiotics. Of the microorganisms implicated as the infectious agents, group B Streptococcus was the most frequent aerobe, and Peptostreptococcus and Bacteroides bivius were the most frequent anaerobes. Among the 15 patients for whom at least one perioperative specimen yielded positive culture results, a postoperative infection developed in 5 of the 6 who received the placebo, 2 of the 4 who received cefazolin and 1 of the 5 who received cefoxitin.

Aerobiosis↗