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Biomedical subjects

R J Sherertz

Publications and source records attributed to R J Sherertz.

51 records · Page 3Linked to original sources
PubMed1985

An outbreak of infections with Acinetobacter calcoaceticus in burn patients: contamination of patients' mattresses.

During a 21-month period Acinetobacter calcoaceticus was the most common organism causing infections in a university burn center. Forty-three of 103 patients admitted became infected with this organism. Risk factors associated with burn wound colonization with Acinetobacter included larger burns and Foley catheter use; however, only a longer duration of hospitalization was an independent discriminator of colonization. Infection-control measures, including strict isolation and closure and repainting of the burn unit, did not prevent the transmission of Acinetobacter. An investigation found that wet mattresses served as environmental reservoirs of Acinetobacter. This finding led to a policy of discarding each patient's mattress on the day of the patient's discharge from the burn unit. Life table analysis demonstrated that this intervention led to a reduced risk of burn wound colonization with Acinetobacter (P less than .05) and ultimately resulted in the complete elimination of the organism from the burn unit.

Acinetobacter↗
PubMed1984

Nonurban male homosexuals: epidemiologic, immunologic and virologic characteristics.

Twenty asymptomatic male homosexuals living in North Carolina were evaluated looking at epidemiologic, immunologic and virologic characteristics. In ten subjects selected for inhalant nitrite use a significantly higher frequency of multiple drug abuse and a trend toward greater sexual promiscuity was found in comparison with ten nonnitrite users. None of the 20 subjects had chronic lymphadenopathy. Cytomegalovirus (CMV) was not found in urine, blood or throat washings, but was found in 29% of the subjects' semen specimens--a finding that was significantly linked (P less than .05) to the presence of CMV IgM antibody in serum. There were no abnormal helper lymphocytes: suppressor T lymphocyte ratios (all greater than 1.3) and lymphocyte mitogen stimulations were not different from heterosexual controls in contrast to frequent abnormalities reported in male homosexuals in metropolitan areas. If these immunologic findings are reproducible, they may be important in understanding why the Acquired Immunodeficiency Syndrome has clustered in large cities.

Adult↗
PubMed1984

Transmission of hepatitis A by transfusion of blood products.

The transmission of hepatitis A by blood products has been thought to occur rarely or not at all. By measuring IgM antibody to hepatitis A virus, we diagnosed a case of hepatitis A transmitted by the transfusion of a unit of fresh frozen plasma. Since the commercial availability of methods for measuring IgM antibody to hepatitis A, four other well-defined cases of hepatitis A transmitted by blood products have been reported in the literature. We detail our case and the natural history and importance of this clinical entity.

Adult↗
PubMed1983

A three-year study of nosocomial infections associated with Pseudomonas aeruginosa.

During a 3-year study period in a university teaching hospital, 417 nosocomial infections associated with Pseudomonas aeruginosa were documented in 321 patients. The overall rate of P. aeruginosa nosocomial infection was 5.3 cases per 1,000 patients. Residence on the surgery or medicine service, advanced patient age, and exposure to the burn, surgery, or medicine intensive care units correlated with higher rates of infection. The most common sites for P. aeruginosa infection were the lower respiratory tract, urinary tract, blood stream, and surgical wounds. Nosocomial P. aeruginosa lower respiratory tract and blood stream infections were significantly associated with exposure to certain intensive care units, whereas P. aeruginosa urinary tract infections more commonly occurred on the neurology and neurosurgery services. Results of live antigen serotyping showed that serotype 6 was most common, followed by serotypes 1 and 11. Serotype 6 correlated with resistance to carbenicillin, gentamicin, and tobramycin, and serotype 11 correlated with resistance to carbenicillin. Two-thirds of the isolates tested were sensitive to carbenicillin, gentamicin, and tobramycin, but 13.2% were resistant to all three of these drugs. P. aeruginosa isolates resistant to all three drugs were associated with urinary tract infections.

Adolescent↗
PubMed1983

Environmental study of a methicillin-resistant Staphylococcus aureus epidemic in a burn unit.

During an outbreak of infections caused by methicillin-resistant (MR) Staphylococcus aureus in our burn unit, we conducted an extensive 10-week study to define the environmental epidemiology of the organism. The inanimate environment in patient rooms and adjacent areas was examined by using volumetric air samplers and Rodac plates. Airborne and surface level contamination with MR S. aureus was quantitated, and overall, MR S. aureus comprised 16, 31, and 40% of all bacterial growth from air, elevated surfaces, and floor surfaces, respectively. Mean air, elevated surface, and floor surface MR S. aureus contamination in rooms of MR S. aureus-infected burn patients were 1.9 MR S. aureus per ft3 (ca. 0.028 m3), 20 MR S. aureus per Rodac plate and 48 MR S. aureus per Rodac plate, respectively. Peak patient room environmental contamination levels were 6.9 MR S. aureus per ft3 of air, 70 MR S. aureus per Rodac plate per elevated surface and 138 MR S. aureus per Rodac plate per floor surface. Environmental contamination levels in the adjacent work areas were considerably lower than in infected patient rooms. There was ample opportunity for contamination of personnel through the inanimate environment in this unit.

Adult↗
PubMed1983

Infections associated with subclavian Uldall catheters.

During a 12-month period, the use of a subclavian vein Uldall catheter (UC) for hemodialysis or plasmapheresis in 27 patients was studied prospectively. Ten patients had ten UC site infections. Organisms associated with these infections included Staphylococcus epidermidis (five), Staphylococcus aureus (four), Proteus mirabilis (two), and Enterococcus (one). The four S aureus infections occurred 1, 2, 4, and 9 days after UC insertion, whereas the five S epidermidis infections occurred 6, 17, 17, 26, and 97 days after insertion. Five patients had associated bacteremias; in one of these patients, the bacteremia was the major cause of death. The incidence of UC site infection and bacteremia based was higher than the incidence of infection reported with any other type of vascular access for hemodialysis. Further studies are necessary to define whether the UC should be routinely employed for temporary vascular access.

Bacterial Infections↗
PubMed1982

Pharmacokinetics of intravenous chloramphenicol sodium succinate in adult patients with normal renal and hepatic function.

The pharmacokinetics of chloramphenicol (CAP) and total chloramphenicol succinate (CAPS) were studied in eight hospitalized adult patients with normal renal and hepatic function receiving intravenous chloramphenicol sodium succinate therapy. The steady-state peak concentrations of CAP (8.4-26.0 micrograms/ml) occurred at an average of 18.0 min (range 5.4-40.2) after cessation of the chloramphenicol sodium succinate infusion. Unhydrolyzed CAPS prodrug, representing 26.0 +/- 7.0% of the dose, was recovered unchanged in the urine indicating that the bioavailability of CAP from a dose of intravenous chloramphenicol succinate is not complete. A pharmacokinetic model was developed for simultaneous fitting of CAP and CAPS plasma concentration data. Pharmacokinetic parameters determined by simultaneous fitting were: V, 0.81 +/- 0.18 liters/kg; t1/2, 3.20 +/- 1.02 hr; CLB, 3.21 +/- 1.27 ml/min/kg for chloramphenicol; and V, 0.38 +/- 0.13 liters/kg; t1/2, 0.57 +/- 0.12 hr; CLB, 7.72 +/- 1.87 ml/min/kg for total chloramphenicol succinate.

Adult↗
PubMed1982

The prevalence of Clostridium difficile and toxin in a nursery population: a comparison between patients with necrotizing enterocolitis and an asymptomatic group.

During a period when certain neonates in our nursery developed necrotizing enterocolitis, we studied stool specimens from a population of symptomatic and asymptomatic patients for the presence of Clostridium difficile and its toxin. The presence of the organism among nursery personnel and in the nursery environment was also evaluated. Results showed that five symptomatic neonates and 17 asymptomatic neonates in a population of 37 patients studied in our neonatal intensive care and intermediate care nurseries had positive stool cultures for C. difficile. Toxin was detected in stool from four of five symptomatic patients and was present at dilutions of greater than 1/125 in stool from six asymptomatic patients who were culture positive for C difficile. The organism was not found in stool samples from any nursery personnel but was recovered from the hand culture of a nursery worker and from the inanimate environment. Although our findings support the notion of nosocomial spread of C difficile, we were unable to clearly implicate the organism as the cause of necrotizing enterocolitis in our nursery.

Bacterial Toxins↗
PubMed1978

Cephalosporin antibiotics in therapy of experimental Streptococcus pneumoniae and Haemophilus influenzae meningitis in rabbits.

Six cephalosporin antibiotics (cefamandole, cefazolin, cephacetrile, cephalothin, cephaloridine, and cephradine) and two penicillin (ampicillin and penicillin G) were evaluated in vitro and in a rabbit model of experimental meningitis due to Haemophilus influenzae or Streptococcus pneumoniae. The percentage penetration ([concentration in cerebrospinal fluid/concentration in serum] X 100%) of these antibiotics varied from 0.7% for cephalothin to 17% for cephaloridine. The penetration varied inversely with binding to serum proteins. The bactericidal rate of all of the cephalosporin antibiotics was similar in vitro and in vivo to that of penicillin G. However, as demonstrated with cephalothin, concentrations considerably above the minimal bactericidal concentration (as determined in broth) were necessary to initiate the bactericidal effect. Cefamandole was found to be as effective as ampicillin in the therapy of H. influenzae meningitis in rabbits.

Ampicillin↗
PubMed1978

Factors influencing the penetration of antimicrobial agents into the cerebrospinal fluid of experimental animals.

Successful therapy of bacterial meningitis is dependent upon achieving adequate antibacterial activity in the CSF. The percent penetration (CSF concentration/serum concentration X 100) of various antimicrobial agents was determined in a rabbit model of bacterial meningitis. The percent penetration of the penicillin and cephalosporin derivatives was found to vary inversely with the protein binding of the respective drugs. Esterification of ampicillin increased its lipid solubility and likewise increased the penetration into the CSF. Probenecid competitively inhibits the active transport efflux of various organic acids from the CSF and increased the CSF concentrations of penicillin and cephalosporin derivatives. The percent penetration of all drugs was increased in the presence of the inflamed meninges.

Animals↗
PubMedDate not supplied

Comparison of cefpimizole with cefotaxime and penicillin G for treatment of uncomplicated gonorrhea.

One hundred sixteen patients (92 men and 24 women) with suspected uncomplicated gonorrhea were randomized in a double-blind manner to receive intramuscular treatment with 1.0 g of cefpimizole, 1.0 g of cefotaxime, or 4.8 x 10(6) units of aqueous procaine penicillin G (APPG) with 1 g of oral probenecid. Seventeen percent were nonassessable (cultures negative, co-existing syphilis, etc.). Infection sites in 96 assessable patients were urethra (78), cervix (17), pharynx (two), and rectum (two). Of 52 patients treated with cefpimizole, 46 (88%) were bacteriologically cured, as compared with 100% (24 of 24) treated with APPG (P = 0.18) and 90% (18 of 20) treated with cefotaxime (P greater than 0.20). On a weight basis the in-vitro activity of cefpimizole against Neisseria gonorrhoeae was similar to that of APPG. Pain at the injection site was reported by 52% of patients treated with cefpimizole as compared with 27% of those given cefotaxime (P = 0.008) and 17% of those given APPG (P = 0.002). No major organ toxicity was found with cefpimizole, cefotaxime, or APPG. Thus, for acute uncomplicated gonorrhea cefpimizole is similar in efficacy to cefotaxime and APPG but has a higher frequency of pain at the injection site.

Adult↗
PubMedDate not supplied

"Cloud" health-care workers.

Certain bacteria dispersed by health-care workers can cause hospital infections. Asymptomatic health-care workers colonized rectally, vaginally, or on the skin with group A streptococci have caused outbreaks of surgical site infection by airborne dispersal. Outbreaks have been associated with skin colonization or viral upper respiratory tract infection in a phenomenon of airborne dispersal of Staphylococcus aureus called the "cloud" phenomenon. This review summarizes the data supporting the existence of cloud health-care workers.

Bordetella pertussis↗
PubMedDate not supplied

Guidelines for the management of intravascular catheter-related infections.

These guidelines from the Infectious Diseases Society of America (IDSA), the American College of Critical Care Medicine (for the Society of Critical Care Medicine), and the Society for Healthcare Epidemiology of America contain recommendations for the management of adults and children with, and diagnosis of infections related to, peripheral and nontunneled central venous catheters (CVCs), pulmonary artery catheters, tunneled central catheters, and implantable devices. The guidelines, written for clinicians, contain IDSA evidence-based recommendations for assessment of the quality and strength of the data. Recommendations are presented according to the type of catheter, the infecting organism, and the associated complications. Intravascular catheter-related infections are a major cause of morbidity and mortality in the United States. Coagulase-negative staphylococci, Staphylococcus aureus, aerobic gram-negative bacilli, and Candida albicans most commonly cause catheter-related bloodstream infection. Management of catheter-related infection varies according to the type of catheter involved. After appropriate cultures of blood and catheter samples are done, empirical i.v. antimicrobial therapy should be initiated on the basis of clinical clues, the severity of the patient's acute illness, underlying disease, and the potential pathogen(s) involved. In most cases of nontunneled CVC-related bacteremia and fungemia, the CVC should be removed. For management of bacteremia and fungemia from a tunneled catheter or implantable device, such as a port, the decision to remove the catheter or device should be based on the severity of the patient's illness, documentation that the vascular-access device is infected, assessment of the specific pathogen involved, and presence of complications, such as endocarditis, septic thrombosis, tunnel infection, or metastatic seeding. When a catheter-related infection is documented and a specific pathogen is identified, systemic antimicrobial therapy should be narrowed and consideration given for antibiotic lock therapy, if the CVC or implantable device is not removed. These guidelines address the issues related to the management of catheter-related bacteremia and associated complications. Separate guidelines will address specific issues related to the prevention of catheter-related infections. Performance indicators for the management of catheter-related infection are included at the end of the document. Because the pathogenesis of catheter-related infections is complicated, the virulence of the pathogens is variable, and the host factors have not been well defined, there is a notable absence of compelling clinical data to make firm recommendations for an individual patient. Therefore, the recommendations in these guidelines are intended to support, and not replace, good clinical judgment. Also, a section on selected, unresolved clinical issues that require further study and research has been included. There is an urgent need for large, well-designed clinical studies to delineate management strategies more effectively, which will improve clinical outcomes and save precious health care resources.

Anti-Infective Agents↗