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Biomedical subjects

R A Weinstein

Publications and source records attributed to R A Weinstein.

At least 127 records · Page 7Linked to original sources
PubMed1984

Pseudomonas in the sinks in an intensive care unit: relation to patients.

Sink drains in a medical-surgical intensive care unit (ICU) were cultured during six consecutive weeks as part of a seven month prospective study of acquisition of Pseudomonas aeruginosa by ICU patients. Isolates were typed serologically and by aminoglycoside and chlorhexidine susceptibility patterns. All 11 sinks contained multiple strains of P aeruginosa; some strains persisted for weeks while others were isolated once. Of the sink isolates 56% had high level resistance to gentamicin and tobramycin whereas none of the strains found in patients. In sink isolates chlorhexidine resistance correlated with aminoglycoside resistance and with the presence of a chlorhexidine dispenser at a sink. The sequence of recovery of phenotypically similar isolates suggested that sinks were the source of at most two acquisitions of P aeruginosa by patients during the six weeks. Our study confirms that sinks may be reservoirs for large numbers of highly resistant P aeruginosa but are rarely the source of organisms colonising patients in our ICU.

Aminoglycosides↗
PubMed1984

Eosinophilic meningitis and ibuprofen therapy.

We describe eosinophilic meningitis associated with ibuprofen therapy in a young woman who had no evidence of underlying illness. Discontinuation of ibuprofen was followed by prompt resolution of symptoms and disappearance of eosinophils from the CSF. Ibuprofen has been implicated previously in only five cases of aseptic meningitis--all in patients with an underlying autoimmune disease. No drug has been implicated previously as a cause of eosinophilic meningitis to our knowledge.

Adult↗
PubMed1983

Isolation guidelines for obstetric patients and newborn infants.

Available isolation guidelines for use in hospitals have often overlooked the infectious diseases and unique interactions of obstetric patients and their newborn infants. To help fill this void, we present our hospital's isolation policies for obstetric and neonatal patients and guidelines for maternal-infant contact and breast-feeding. These policies represent a multidisciplinary consensus of opinion and available epidemiologic data and have been found useful and practical in a single large teaching hospital. Other institutions should be able to adapt these guidelines to their own patient populations, personnel, and physical facilities.

Breast Feeding↗
PubMed1983

Severe, reversible neutropenia during high-dose mebendazole therapy for echinococcosis.

Two patients receiving oral high-dose mebendazole therapy for echinococcosis were found to have severe, reversible neutropenia, apparently due to marrow suppression; platelets and RBCs were also reversibly suppressed in one. High blood levels of mebendazole (239 ng/mL) in one patient may have resulted in the neutropenia and several toxic side effects, as well as a striking shrinkage of the patient's pulmonary and liver cysts. Neutropenia with high-dose mebendazole therapy may occur in up to 5% of patients and may be much more common than previously recognized. The WBC count should be monitored frequently during the first several weeks of therapy. Further experience will be needed to determine whether neutropenia is related to mebendazole levels.

Aged↗
PubMed1983

Broad-spectrum beta-lactam resistance in Enterobacter: emergence during treatment and mechanisms of resistance.

Of three patients with Enterobacter mediastinitis treated with cefamandole, two failed initial treatment due to emergence of strains resistant to cefamandole and third generation cephalosporins. Extracts of the sensitive strains showed inducible hydrolysis of cephalothin; resistant strains (wild and laboratory derived) showed constitutive hydrolysis of cephalothin and cefamandole and bound but did not hydrolyze cefotaxime and latamoxef (moxalactam). In one mutant, increased latamoxef resistance appeared due to non-enzymatic mechanism(s). The Enterobacter strain from the patient who was treated successfully with cefamandole yielded only low level resistant mutants with lower cephalosporin binding than obtained with the other strains.

Anti-Bacterial Agents↗
PubMed1983

Sarcoidosis of the pancreas.

A case of painful granulomatous infiltration of the pancreas occurred in a patient with well-documented sarcoidosis. In the few previous reports of symptomatic granulomatous pancreatitis, none occurred in a clear setting of sarcoidosis. Granulomatous pancreatitis alone has not been reported to cause exocrine or endocrine dysfunction and appears to improve with steroid therapy. Although distinctly rare, granulomatous involvement of the pancreas should be considered in the examination of patients with sarcoidosis and abdominal pain of unclear cause.

Female↗
PubMed1982

Meningorectal fistula as a cause of polymicrobial anaerobic meningitis.

A 49-year-old diabetic woman developed polymicrobial anaerobic meningitis secondary to a meningorectal fistula one year after receiving neutron beam therapy for a rectal adenocarcinoma. The meningitis was refractory to chloramphenicol and penicillin but responded to oral metronidazole. Sustained eradication of meningitis was achieved with continued metronidazole for 51/2 months, despite persistence of the fistula. Metronidazole may be a superior antimicrobial agent for polymicrobial anaerobic meningitis, especially when caused by a large or continuing bacterial inoculum. This meningorectal fistula is the first of its kind to our knowledge to be demonstrated by microbiologic, radiologic, and pathologic studies.

Female↗
PubMed1982

Gentamicin-resistant staphylococci as hospital flora: epidemiology and resistance plasmids.

In 1979, gentamicin-resistant (Gmr) Staphylococcus aureus was recovered from the clinical specimens of 22 epidemiologically unrelated hospitalized patients; 78% of the patients evaluated were also colonized with Gmr coagulase-negative staphylococci. Endonuclease fingerprinting was used to compare the Gmr plasmids within pairs of isolates of S. aureus and coagulase-negative staphylococci recovered from nine patients. Plasmids differed between pairs but were concordant within four pairs. Thus, in vivo interspecific plasmid transfer, although infrequent, may be important in the sporadic occurrence of Gmr S. aureus. To define the epidemiology of endemic Gmr coagulase-negative staphylococci, culture surveys were performed over two years. Gmr coagulase-negative staphylococci were acquired by 80% of the infants in a special-care nursery that previously had an outbreak of Gmr S. aureus. Among adult inpatients, a 48% colonization rate was related to prior exposure to antibiotics. In contrast, no colonization was found in outpatients or antepartum mothers.

Adult↗
PubMed1982

Structural and phenotypic varieties of gentamicin resistance plasmids in hospital strains of Staphylococcus aureus and coagulase-negative staphylococci.

We previously described a neonatal nursery epidemic of infections caused by a single strain of Staphylococcus aureus bearing a gentamicin resistance plasmid (Vogel et al., Antimicrob. Agents Chemother. 13:466-472, 1978). The same plasmid was present in two isolates of Staphylococcus epidermidis from the patients in this nursery and was transferable interspecifically from either S. aureus or S. epidermidis. During the ensuing 3 years, in the absence of further epidemics, we collected 162 gentamicin-resistant strains of S. aureus and coagulase-negative staphylococci from patients distributed throughout our hospital. Gentamicin resistance plasmids obtained from 41 representative S. aureus and coagulase-negative staphylococcal strains differed as determined by phenotypic and molecular analyses from the plasmid in the neonatal nursery epidemic. Nevertheless, these plasmids were structurally related to each other and to the plasmid of the original epidemic. Our results suggest an evolutionary relationship among these plasmids and support the hypothesis of a genetic reservoir of gentamicin resistance in coagulase-negative staphylococci transferable to S. aureus.

Coagulase↗
PubMed1982

Hospital outbreaks caused by Pseudomonas aeruginosa: importance of serogroup O11.

Suspected outbreaks caused by pseudomonas aeruginosa in 19 hospitals and two motels were studied. On the basis of epidemiological analysis, serological typing, and antibiotic resistance patterns, 17 were classified as single-strain outbreaks. Six were classified as common-source outbreaks: of these, three were caused by contaminated urological instruments or solutions, two involved bathing in contaminated whirlpools, and one was caused by contaminated lens prostheses implanted during eye surgery. The ability of P. aeruginosa to survive or grow in wet environments was important in each of these six outbreaks. Eight outbreaks were classified as cross-infection. Two involved the urinary tract and were caused by antibiotic-resistant strains. Six involved the respiratory tract, but only one was caused by an antibiotic-resistant strain. In 2 of the 17 single-strain outbreaks, the exact mode of transmission could not be determined. One was an outbreak of pseudobacteremia in which patient blood cultures were contaminated with a single strain, presumably during collection of specimens or culture processing, P. aeruginosa serogroup O11 caused 9 of 17 (53%) single-strain outbreaks, a surprising finding since this serogroup represents only about 8% of endemic hospital isolates of this species. Serotyping was very useful in epidemiological analysis, but antibiotic susceptibility patterns were less useful.

Anti-Bacterial Agents↗
PubMed1981

Hairy cell leukemia: association with disseminated atypical mycobacterial infection.

The cases of four patients with hairy cell leukemia and disseminated atypical mycobacterial infection (three with M. kansasii and one with M. intracellulare) are reported. These four patients were from a population of 38 patients with hairy cell leukemia evaluated at three institutions; there was an incidence figure of 10.5%. Despite infection with very drug-resistant strains, two patients showed marked clinical improvement following aggressive multiple drug therapy. Such infection should be suspected in a patient with hairy cell leukemia who has persistent fever without an obvious source. Tissue biopsy usually led to diagnosis; urine cultures were also positive in two patients.

Aged↗
PubMed1981

Comparison of endemic and epidemic nosocomial infections.

Epidemics account for a small proportion of preventable infections acquired in hospitals, but they have been important in defining sources, modes of spread, and methods for prevention and control of nosocomial infections. To characterize hospital-based epidemics, 265 consecutive outbreaks investigated by the Center for Disease Control between 1956 and 1979 were reviewed. Pseudoepidemics were found in 11 percent of the investigations, most often resulting from errors in processing microbiologic specimens or from surveillance artifacts. In 223 actual epidemics, the pathogens most commonly involved were Staphylococcus aureus (19 percent), tribe Klebsielleae (14 percent), Salmonella (13 percent), hepatitis B virus (8 percent), enteropathogenic Escherichia coli (5 percent), Pseudomonas (4 percent) and group A streptococci (4 percent). Sites of epidemic infection were closely linked to the responsible pathogens. Gastroenteritis (21 percent), skin infection (18 percent), bacteremia (12 percent), meningitis (11 percent) and hepatitis (10 percent), infrequent causes of endemic nosocomial infections, were frequently involved in epidemics. Over the 25-year period reviewed, staphylococcal epidemics and outbreaks of gastroenteritis due to Salmonella and Esch. coli declined in frequency and those due to gram-negative bacilli and hepatitis B virus increased. Since 1970, clusters of primary bacteremia were the most frequently investigated type of epidemic. Many epidemic strains of staphylococci obtained since 1975 or Enterobacteriaceae obtained since 1970 exhibited unusual drug resistance. Specific site-pathogen combinations were closely associated with characteristic reservoirs and modes of spread.

Cross Infection↗
PubMed1981

Strategies for prevention and control of multiple drug-resistant nosocomial infection.

Multiple drug-resistant bacteria are common in the hospital and are often isolated from patients on admission. Spread in hospital and occasional epidemics result from transient contamination of the personnel's hands, environmental contamination and excessive use of antibiotics. Traditional control measures have relied on improved asepsis and handwashing, isolation (or cohorting) of infected and colonized patients, antibiotic control and elimination of any significant environmental sources. Newer approaches have focused on ways of preventing (or eliminating) patient carriage of multiple drug-resistant strains. We have tailored selected barrier-type "antibiotic resistance precautions" for everyday use to control endemic aminoglycoside resistant gram-negative bacilli. We detail our multifaceted approach and suggest its ongoing use for key multiple drug-resistant strains, in "epi-centers," such as intensive care units, for potential heavy shedders of multiple drug-resistant strains, and when certain epidemic thresholds are reached.

Aminoglycosides↗
PubMed1980

Endemic aminoglycoside resistance in gram-negative bacilli: epidemiology and mechanisms.

Isolates of gentamicin-resistant gram-negative bacilli from clinical specimens peaked at nine to 10 per month in 1973-1974. Instituting barrier-type precautions during 1974-1977 was associated with a sustained 87% reduction in resistant Enterobacteriaceae. The number of resistant Pseudomonadaceae fell temporarily by 28%, paralleling gentamicin usage. During an endemic 15-month period in 1976-1977 nonenzymatically mediated resistant Pseudomonas aeruginosa often emerged after aminoglycoside therapy in patients who had prior carriage of sensitive strains of the same serotype (P = 0.002); this resistance was associated with wound or sputum isolates (P = 0.003). Resistant Enterobacteriaceae more often demonstrated the converse, that is, spread of urinary tract isolates with enzymatically mediated resistance from patients not on aminoglycoside therapy. These findings suggest that control measures to minimize occurrence of resistant bacilli include barrier-type precautions for patients with resistant Enterobacteriaceae, evaluation of transfers and readmissions as a source of resistant organisms, and reduction of aminoglycoside use to decrease the selection of nonenzymatic resistance.

Amikacin↗
PubMed1980

Identity and interspecific transfer of gentamicin-resistance plasmids in Staphylococcus aureus and Staphylococcus epidermidis.

The hypothesis that emergence of gentamicin-resistant strains of Staphylococcus aureus and Staphylococcus epidermidis in a neonatal special care nursery was the result of transfer of a single plasmid between these two species was examined. In experiments with mixtures of staphylococci, either in mixed cultures or on human skin, isolates of S. aureus and S. epidermidis transferred their gentamicin-resistance plasmids both intra- and interspecifically. By electron microscopy, the molecular masses of the plasmids from S. aureus and S. epidermidis were the same, 12.2 +/- 0.36 (standard deviation) and 12.3 +/- 0.56 megadaltons, respectively. Restriction endonuclease analysis of the plasmids from five isolates of S. aureus and two isolates of S. epidermidis, with use of the enzymes HaeIII, EcoRI, XbaI, and HindIII, showed no differences in the digestion patterns of the seven gentamicin-resistance plasmids. The results supported the hypothesis that plasmid transfer between S. aureus and S. epidermidis occurs in nature.

Conjugation, Genetic↗