PubMed Health⌕ Search

Biomedical subjects

R P Wenzel

Publications and source records attributed to R P Wenzel.

At least 235 records · Page 13Linked to original sources
PubMed1985

Pneumonia treated with imipenem/cilastatin.

In an open, prospective, multicenter trial the efficacy and tolerance of imipenem/cilastatin for the treatment of bacterial pneumonia was investigated. Forty-three adults were studied: 29 with nosocomial and 14 with community-acquired infections. Significant underlying disease was present in 91 percent of patients. Nosocomial infection was frequently associated with endotracheal intubation (48 percent), prior antibiotic therapy (48 percent), and recent surgery (31 percent). Most frequent sputum isolates included Pseudomonas aeruginosa (10, all nosocomial), Hemophilus influenzae (10), Escherichia coli (eight), Staphylococcus aureus (seven), and Streptococcus pneumoniae (six). Treatment with imipenem/cilastatin was associated with clinical cure in 93 percent of patients. Two of three failures and one superinfection occurred in association with isolates of Pseudomonas aeruginosa resistant to imipenem. Overall, six of 10 strains of Pseudomonas aeruginosa isolated prior to therapy developed resistance to imipenem after an average of 10 days of therapy. Adverse effects occurred in nine patients (21 percent) and included one case of pseudomembranous colitis. Monotherapy with imipenem/cilastatin of serious lower respiratory tract infections was relatively safe and highly effective with the exception of disease associated with P. aeruginosa.

Adult↗
PubMed1985

Mycotic pseudoaneurysm of an aortic bypass graft and contiguous vertebral osteomyelitis due to Aspergillus fumigatus.

Fungal osteomyelitis is rare in patients who are not immunocompromised. This report documents that Aspergillus vertebral osteomyelitis may, however, be associated with infection of an adjacent prosthetic vascular graft in the absence of overt immunosuppression. A 73-year-old man is described with a mycotic pseudoaneurysm of a Dacron aortic bypass graft and contiguous vertebral osteomyelitis due to Aspergillus fumigatus. The patient was successfully treated with resection of the infected graft and administration of amphotericin B in a total dose of 2 g. Infection may have occurred intraoperatively as a result of inoculation with airborne fungal elements.

Aged↗
PubMed1985

Comparative activity of seven extended-spectrum cephalosporins against gram-negative bacilli from blood cultures.

One hundred sequential Gram-negative rod isolates from patients with hospital-acquired bloodstream infections were tested against seven new cephalosporins. Duplicate broth microdilution tests indicated superior activity for ceftazidime with 97% of strains susceptible to 16 mg/l. Less in-vitro activity was demonstrated cefotaxime (91% susceptible to 16 mg/l, P = 0.07), latamoxef (moxalactam) (90%, P = 0.04), cefoperazone (90%, P = 0.04), ceftriaxone (87%, P = 0.008), cefmenoxime (80%, P = 0.0001), and ceftizoxime (79%, P less than 0.0001). With the exception of cefoperazone, the newer drugs had mean MICs of less than or equal to 0.6 mg/l against Enterobacteriaceae. Ceftazidime and cefoperazone had highest activities against Pseudomonas aeruginosa with MIC90S of 4 and 16 mg/l, respectively. A comparison of recently published data shows important geographic differences in MIC90 data for the new cephalosporins against specific species.

Cefmenoxime↗
PubMed1985

Association of slime with pathogenicity of coagulase-negative staphylococci causing nosocomial septicemia.

To assess the role of slime in the pathogenesis of nosocomial bloodstream infections caused by coagulase-negative staphylococci, we compared the characteristics of 27 nosocomial bloodstream isolates with those of 27 skin isolates from non-hospital personnel. Of 27 bloodstream isolates, 14 were judged to be significant by a clinical index, and 13 were contaminants. Slime production was observed in 13 of 14 significant isolates but in only 3 of 13 contaminants (P = 0.0003) and 4 of 27 skin isolates (P = 0.0001). The 14 pathogens were identified as Staphylococcus epidermidis. Only 7 of 13 contaminants and 9 of 27 skin isolates belonged to the same species (P less than 0.006). Slime-producing strains of S. epidermidis represented 13 of 14 pathogens but only 2 of 13 contaminants (P less than 0.0003). Neither adherence to Teflon catheters nor phagocytosis and killing of coagulase-negative staphylococci by polymorphonuclear leukocytes was significantly influenced by slime production. Nevertheless, the identity of the organism and the slime production test predicted the clinical significance of blood isolates of coagulase-negative staphylococci with an overall accuracy of 89%.

Coagulase↗
PubMed1985

Rabies: a review and current approach for the clinician.

Rabies is an acute viral encephalomyelitis with virtually a 100% case fatality rate. Only three cases of human survival after rabies have been documented. The current epizootic of raccoon rabies in the United States centered over the South Atlantic states mandates a working knowledge of rabies management and postexposure prophylaxis by health care professionals. Recently, important advances in rapid and accurate diagnosis and improvements in homologous vaccines make rabies a preventable disease in the United States.

Animals↗
PubMed1984

Catheter-associated bacteriuria. Failure to reduce attack rates using periodic instillations of a disinfectant into urinary drainage systems.

We assessed the efficacy of periodic instillations of hydrogen peroxide into urinary drainage systems in the prevention of catheter-associated bacteriuria in a prospective and randomized clinical study of 668 patients with indwelling urethral catheters. Bacteriuria was documented in 68 (10%) of the 668 patients after a mean duration of four days of catheterization. There was no difference between the hydrogen peroxide group and the control group in the mean duration of catheterization before the onset of bacteriuria, in the attack rate for bacteriuria, or in the spectrum of etiologic agents recovered. Bag contamination with the same organism responsible for bacteriuria preceded infection in only five (7%) of the 68 patients, three patients using hydrogen peroxide and two in the control group. We conclude that infections arising intraluminally from contamination of the drainage bag are uncommon among catheterized patients and that the periodic instillation of disinfectants into closed sterile drainage systems is not effective in reducing the incidence of catheter-associated bacteriuria.

Bacteria↗
PubMed1984

Hospital-acquired bloodstream infections with Staphylococcus epidermidis. Review of 100 cases.

During a seven-year study period, 1976 to 1982, this prospective surveillance program detected 108 episodes of nosocomial bacteremia caused by coagulase-negative staphylococci (seven per 10,000 admissions). Chart reviews were subsequently performed in 100 patients primarily to define the patient population and determine outcome of infection. Seventy-two patients had at least two culture bottles that showed growth of coagulase-negative staphylococci plus one or more cultures that showed growth at another site or on a vascular catheter. Most of the patients were in the early or later stages of life: 20 were premature infants, 20 additional infants were under one year of age, and 35 patients were 50 years of age or older. Seventy-three patients were in intensive care areas at the time of the infection. The mortality for the 100 patients studied was 34 percent, with a rate of 9 percent per week after infection. Ninety-three patients had arterial or central lines in place prior to bacteremia and, in 36 reviewed, the mean duration of use of each type of catheter (5.1 days or more) was longer than recommended. In 56 percent of 46 catheters cultured semiquantitatively, there was growth of coagulase-negative staphylococci. The presence of coagulase-negative staphylococci in the blood is associated with significant mortality in hospitalized patients. No longer can their presence in the blood be disregarded as mere contaminants, especially in patients in critical care units.

Adolescent↗
PubMed1984

Polymicrobial bloodstream infections related to prolonged vascular catheterization.

Between June 15 and August 7, 1982, six patients in a medical ICU developed primary nosocomial bloodstream infections. Nine different organisms were isolated during this epidemic. In three patients, contamination of intravascular lines was documented; and in the other three, the relationship was strongly suggested. The infected patients were compared to three groups of randomly selected controls: group A from the epidemic period; group B from the pre-epidemic period; and group C from both periods and matched for underlying disease. The infected patients had indwelling arterial and pulmonary artery catheters in place almost twice as long (6.3 +/- 2.8 days and 6.8 +/- 3.9 days, respectively) as most controls. Our evidence suggests that the guideline for changing catheters may have been ignored when the resident house staff changed. This is the first outbreak related to vascular catheters in which several different organisms were involved; it represents a new type of epidemic related to a common technique problem rather than a common source reservoir.

Adolescent↗
PubMed1984

Cefsulodin sodium therapy in cystic fibrosis patients.

Cefsulodin sodium is a narrow-spectrum cephalosporin with marked in vitro activity against clinical isolates of Pseudomonas aeruginosa. We have studied the antibiotic in a clinical trial in 10 patients admitted to the Pediatric Ward of the University of Virginia Medical Center with cystic fibrosis and recurrent acute lower respiratory tract infections with P. aeruginosa isolated from their sputa. The patients received 500 to 1,500 mg of cefsulodin every 6 hours by intravenous infusion for 10 to 22 days. Mean peak drug levels in plasma after 500, 1,000, and 1,500 mg were 46, 71, and 90 micrograms/ml, respectively, and the mean minimal inhibitory concentration of all organisms was 7.5 micrograms/ml. Detectable levels of cefsulodin in sputa were found in approximately half of the random samples and ranged from 2 to 5 micrograms/ml. The clinical response was satisfactory in nine (90%) of the patients. One patient gained weight and had improved pulmonary function tests but showed no reduction in sputum production and no improvement in arterial blood gas values. In pulmonary function tests, four of five patients tested showed an average 43% increase in forced vital capacity after initiation of therapy and five of five had an average 51% increase in forced expired volume in 1 s. No adverse effects were observed.

Adolescent↗
PubMed1984

In vitro activities of teichomycin, fusidic acid, flucloxacillin, fosfomycin, and vancomycin against methicillin-resistant Staphylococcus aureus.

Flucloxacillin, fosfomycin, fusidic acid, teichomycin, and vancomycin were tested against 50 clinical isolates of methicillin-resistant Staphylococcus aureus by a broth macrodilution technique. Teichomycin had a narrow range of activity, similar to that of vancomycin (0.5 to 2.0 micrograms/ml). Fusidic acid had the lowest range of inhibitory activity, with 50 and 90% MICs of 0.19 and 0.35 micrograms/ml, respectively. Flucloxacillin and fosfomycin showed less activity, with MICs up to 32 micrograms/ml.

Anti-Bacterial Agents↗
PubMed1983

Nosocomial urinary tract infections: secular trends, treatment and economics in a university hospital.

During a 71-month interval 3,024 nosocomial urinary tract infections were identified by prospective surveillance at our hospital. The annual attack rate varied between 2.0 and 3.1 per 100 admissions. Gram-negative bacilli caused 74 per cent of all urinary infections and recurrent infections in the hospital accounted for only 1 per cent. The most frequent pathogens were Escherichia coli (24 per cent), Pseudomonas aeruginosa (8 per cent), Streptococcus faecalis (7 per cent), Klebsiella pneumoniae (6 per cent) and Proteus mirabilis (6 per cent). Candida species caused 10 per cent of the infections and may represent a hospital-acquired pathogen of increasing importance. The burn unit had a significantly higher proportion of Enterobacter infections (21 per cent) than any other service (p less than 0.05). The plastic surgery service had more Serratia infections (24 per cent), whereas obstetrics and gynecology had more Escherichia coli infections (47 per cent) relative to other hospital services. More than 99 per cent of the patients with nosocomial urinary tract infections received antimicrobial drugs; in 63 per cent the chart documented that drug therapy was prescribed specifically for treatment of the urinary infections. Hospital-acquired urinary infections added approximately 1 million dollars to hospital expenses during the study interval. Estimates were made of the economic benefits of successful control programs.

Cross Infection↗
PubMed1983

Urinary tract etiology of bloodstream infections in hospitalized patients.

During a 23-month study, we identified 1,233 patients with nosocomial urinary tract infections (UTIs) among 40,718 consecutive admissions by using a standardized, prospective system of hospital-wide surveillance. Nosocomial bloodstream infections (BSIs) occurred in 565 patients, 32 of whom had BSIs originating from UTIs, for an attack rate of 2.7 per 100 patients with nosocomial bacteriuria. Patients with UTIs due to Serratia marcescens were most likely to develop secondary BSIs (rate, 16 per 100) compared to patients with nosocomial UTIs due to other organisms (rate, less than or equal to 4.3 per 100; P less than 0.05). Furthermore, the median interval between documentation of UTI and of secondary BSI was 24 days for patients with infections due to S marcescens compared to one day for the entire group (P less than 0.005). Risk factor analysis indicated that men with UTIs were more likely to develop secondary BSIs than were women (P less than 0.05). Intensified infection control efforts are particularly necessary with high-risk groups such as bacteriuric men--especially among those patients with UTIs due to S marcescens--to reduce the incidence of secondary, hospital-acquired BSIs.

Adult↗
PubMed1982

Rates of hospital-acquired bloodstream infections in patients with specific malignancy.

Prospective surveillance of hospitalized patients with leukemia or solid tumors was performed in order to define the rate of nosocomial bloodstream infection according to specific diagnosis. During the 38-month study, there were 842 nosocomial blood stream infections in 704 patients, 22% of whom had leukemia or solid tumors. In the patients with malignancy, the diagnoses associated with the highest rate of bloodstream infections were chronic myeloid leukemia (18.4/100 patients), acute lymphocyte leukemia (17.7/100), promyelocytic and undifferentiated leukemia (16.1/100) and acute monocytic/myelomonocyte (13.8/100). In 76% of patients with chronic lymphocytic, chronic myeloid, or undifferentiated leukemia, the peripheral blood polymorphonuclear leukocyte count at the time of bacteremia was less than 100 cells/mm-3. In contrast to patients with leukemia, those with solid tumors, as a group, were at no greater risk of bloodstream infection than those without malignancy. In preparation for prophylactic trials of antibiotics or immunotherapy this study has more clearly defined the risk of bloodstream infection in cancer patients.

Cross Infection↗
PubMed1982

High risk of hospital-acquired infection in the ICU patient.

Patients admitted to the ICU have a higher risk of nosocomial infection than other hospitalized patients. Whereas general medical/surgical ward patients have a 6% overall risk of acquiring an infection during their hospital stay, critically ill patients in the ICU have an 18% risk (P greater than 0.001). During this 2-year study, 440 of 2441 patients admitted to an ICU developed nosocomial infections. Patients who had prolonged ICU stays and those on the obstetrics and gynecology, orthopedics, and general surgery services were more likely to become infected. The most common bloodstream pathogens were Staphylococcus epidemidis, Staphylococcus aureus, and Serratia and Pseudomonas species.

Cross Infection↗