Biomedical subjects

R R Muder

Publications and source records attributed to R R Muder.

78 records · Page 5Linked to original sources

PubMed1983

Simultaneous infection with Legionella pneumophila and Pittsburgh pneumonia agent. Clinical features and epidemiologic implications.

Nosocomial pneumonia caused simultaneously by two organisms, Legionella pneumophila and the Pittsburgh pneumonia agent, was documented in seven patients in one institution. In all seven cases, both organisms were demonstrated by isolation from culture or visualization by direct immunofluorescence. Four patients died as a result of pneumonia, including two who received erythromycin therapy. The hospital water distribution system appeared to be the reservoir for both L. pneumophila and Pittsburgh pneumonia agent. These seven cases constituted 26.9 percent and 17.9 percent of the cases of Pittsburgh pneumonia agent and Legionnaires' disease, respectively, at one institution. Given this relatively high incidence of dual infection, it is likely that the mode of transmission for both organisms is identical. Dual infection may account for some cases of antibody response to more than one Legionella species. Historical parallels of the discovery of L. pneumophila and Pittsburgh pneumonia agent are reviewed.

Cross Infection↗

PubMed1983

Pneumonia due to the Pittsburgh pneumonia agent: new clinical perspective with a review of the literature.

We review the current knowledge concerning this newly recognized pathogen, Pittsburgh pneumonia agent (PPA), and present a new, comprehensive perspective of PPA based on our extensive clinical experience: 1) PPA pneumonia is more common and affects a broader range of patients than previously appreciated. 2) In the general population, the disease is not distinguishable from acute pneumonia due to other causes. Because specialized diagnostic tests are required for detection, it is likely that many cases in other hospitals go unrecognized. 3) Diagnosis is important, as erythromycin appears to improve outcome, whereas beta-lactam antibiotics and aminoglycosides, frequently used as empiric therapy for nosocomial bacterial pneumonias, do not. 4) The presence of both PPA and L. pneumophila in the same environmental sites, and the discovery of seven cases of simultaneous infection by both organisms suggest that both organisms are likely to share a common reservoir within the hospital and a common mode of transmission. 5) PPA infection occurs in a more debilitated population than does Legionnaires' disease. This may represent differences in intensity of exposure to the two organisms or may reflect inherent differences in virulence.

Bacterial Infections↗

PubMed1982

Determination of cefoperazone concentration in serum and muscle tissue with a versatile high-pressure liquid chromatographic method.

A rapid, specific, and reproducible high-pressure liquid chromatographic method was developed for the determination of cefoperazone concentration in serum and tissue. The assay uses a simple methanol extraction, with cefoxitin as the internal standard. The limits of detection are 1 to 150 micrograms/ml; the maximum coefficient of variation is 7.4%. Using the same chromatography column, muBondapak phenyl, and mobile-phase 0.005 M tetrabutylammonium buffer-acetonitrile (80:20), the method can be easily adapted for the analysis of cefoxitin and moxalactam.

Cefoperazone↗

PubMedDate not supplied

Recurrent methicillin-resistant Staphylococcus aureus osteomyelitis: combination antibiotic therapy with evaluation by serum bactericidal titers.

OBJECTIVE: To report on a patient with recurrent methicillin-resistant Staphylococcus aureus (MRSA) osteomyelitis and bacteremia successfully treated with combination antibiotic therapy. CASE SUMMARY: Two sets of blood cultures from a 55-year-old man with fever, malaise, and low back pain grew MRSA. Radiologic studies of the spine showed bony changes consistent with osteomyelitis. Soon after completing 6 weeks of vancomycin, the patient experienced a recurrence of back pain. Laboratory values included an increase in the sedimentation rate to 53 mm/h and positive blood cultures for MRSA. Vancomycin, gentamicin, and rifampin were administered for 8 weeks. Serum inhibitory and bactericidal titers were more than 1:1024 for both the peak and trough concentrations. Radiologic studies of the spine showed healing osteomyelitis. Two years after completion of antibiotic therapy, the infection has not recurred. DISCUSSION: Antibiotic therapy alone was attempted because the patient was considered a risky surgical candidate. Serum inhibitory and bactericidal titers documented the high in vivo activity of the vancomycin, gentamicin, and rifampin combination. Initiation of vancomycin, gentamicin, and rifampin combination. Initiation of vancomycin therapy led to disappearance of the fever and back pain. Cure was documented by sustained normalization of the erythrocyte sedimentation rate and radiologic evidence of healing. CONCLUSIONS: Combination antibiotic therapy with vancomycin, rifampin, and low-dose gentamicin (1 mg/kg q12h) may be useful for deep-seated tissue infection caused by MRSA.

Anti-Bacterial Agents↗

PubMedDate not supplied

Reduction in nosocomial intravenous device-related bacteremias after institution of an intravenous therapy team.

In November 1991, an intravenous therapy team was instituted on the medical/surgical wards of a 330-bed acute care Veteran's Affairs Medical Center. Before this, IV insertions/care were performed by house officers and registered nurses. Intravenous-related bacteremias decreased from 4.6/1000 patient discharges to 1.5/1000 patient discharges (P < 0.005) after institution of the IV team. There was no significant difference in the IV-related bacteremia rate in critical care areas where housestaff and nurses continued to care for lines (7.9 versus 6.2 per 1000 patient discharges). The expertise of an IV therapy team is effective in decreasing morbidity and mortality related to IV insertions. The authors estimated a savings of $124,906 when considering reduction of bacteremias.

Bacteremia↗

PubMedDate not supplied

Complications related to intravenous midline catheter usage. A 2-year study.

The introduction of the Landmark midline catheter (Menlo, Co., CA) brought an alternative to central line catheter placement for prolonged intravenous access. The study was initiated in 1993 to observe for complications, including hypersensitivity-like reactions. The authors hypothesized this i.v. modality would decrease the need for central i.v. lines and accompanying complications. At the time of catheter insertion, the i.v. team nurses completed a survey form that included demographics, underlying disease, and risk factors for infection. The catheter tip was cultured at the time of removal. In the second phase of the study, the authors focused specifically on hypersensitivity-like reactions. During a 2-year period, 248 patients had 334 midline catheters. Patient ages ranged from 23 to 98 years (mean age, 65 years). The bacteremia rate was 0.3%; the colonization rate was 0.9%. Factors associated with infection/ colonization included: length of time in place, chemotherapy, and lack of antibiotic administration. In the second phase of the study, during which an additional 170 catheters were placed in 131 patients, no hypersensitivity-like reactions were noted. The midline catheter appears to be a safe method of i.v. fluid administration for patients with limited peripheral vein access who need extended i.v. therapy.

Adult↗