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Raul Colodner

Publications and source records attributed to Raul Colodner.

At least 19 recordsLinked to original sources
PubMed2006

Are blood cultures necessary in the management of women with complicated pyelonephritis?

OBJECTIVES: Data from previous studies suggest that blood cultures in women with uncomplicated acute pyelonephritis (APN) are of limited value. Our objective was to assess the role of blood cultures in the management of complicated APN in women, and to examine the demographic and clinical characteristics, and the outcome as related to the bacteremic status of these patients. METHODS: Data from medical records of 158 women hospitalized with complicated APN over a 2-year period were analyzed retrospectively. It included demographic, clinical and laboratory data, details of the empiric antimicrobial therapy, urine and blood culture results, complications and clinical outcome. RESULTS: Out of 158 women with complicated APN, in 155 (98%) pathogens grew in the urine culture, and 33 (20.9%) of them had bacteremia. In the great majority of patients (98.7%), the blood cultures were sterile, or contained the same phenotypically profiled pathogen that was isolated from the urine. Only in two patients (1.3%), the blood cultures grew pathogens different from those found in the urine. The initial empiric antimicrobial therapy was not changed in any of the patients. No significant difference existed between the bacteremic and nonbacteremic patients in the demographic and clinical characteristics, the severity of disease or the outcome. CONCLUSION: In the management of complicated APN, routine cultures of blood should be reevaluated.

Adolescent↗
PubMed2005

Acute otitis media in infants less than three months of age: clinical presentation, etiology and concomitant diseases.

OBJECTIVE: Acute otitis media (AOM) in the neonatal period can be difficult to diagnose. This infection can be isolated and localized, or it may be associated with serious bacterial infections or other illnesses. The objectives of this study were to determine the clinical presentation, etiology, susceptibility pattern, and frequency of bacteremia, meningitis and other serious bacterial infections associated with the first episode of AOM in young infants. METHODS: From July 2002 to August 2004, infants less than 12 weeks of age with confirmed AOM underwent tympanocentesis with culture of the middle ear fluid. Sepsis work-up was performed in all infants, and they were admitted to the pediatric department. Parenteral antibiotic therapy with a combination of ampicillin and gentamicin was initiated. RESULTS: Sixty-eight infants were diagnosed with AOM. The median age was 43+/-17 days, 17 infants (25%) were less than 4 weeks of age. Fever was present in 45 (66%) of the patients. Meningitis or bacteremia was not diagnosed in any of the cases. Concomitant urinary tract infection was diagnosed in six (8.8%) cases and broncholitis in seven (10.4%). Forty-seven bacterial pathogens were isolated from the middle-ear fluid. Streptococcus pneumoniae was the leading pathogen with 18 isolates (38%), followed by non-typable Haemophilus influenzae with nine (19%). Fourteen of the S. pneumoniae (78%) isolates were susceptible to penicillin and the other four (22%) were intermediately resistant. Three (33%) of the nine H. influenzae isolates were beta-lactamase producers. CONCLUSIONS: In our study, AOM in infants less than 3 months of age is a localized infection and it is not associated with severe bacterial infections. S. pneumoniae and H. influenzae are the leading pathogens. In our region, most of S. pneumoniae strains are still susceptible to penicillin. Although only small number of patients were under 4 weeks of age, the results of the present study raise the question of whether the current policy of a full sepsis work-up in neonates with AOM is relevant.

Acute Disease↗
PubMed2005

Who are you--Staphylococcus saprophyticus?

Staphylococcus saprophyticus is a leading cause of cystitis in young women. S. saprophyticus shares many clinical features of urinary tract infection caused by Escherichia coli, but differs in pathogenesis, seasonal variation, and geographic distribution. This review summarizes what is known and what still needs to be learned about this microorganism.

Cystitis↗
PubMed2005

Extended-spectrum beta-lactamases: a challenge for clinical microbiologists and infection control specialists.

Since first reported in Europe in the early 1980s, extended-spectrum beta-lactamases (ESBLs) have spread worldwide. When producing these broad-spectrum plasmid-encoded enzymes, organisms become highly effective at inactivating penicillins, most cephalosporins, and aztreonam. Mainly produced by Klebsiella spp, ESBLs have been isolated worldwide in different species, most of them belonging to the Enterobacteriaceae. ESBL-producing bacteria can appear as in vitro susceptible to beta-lactams by conventional laboratory methods, making the laboratory diagnosis problematic. Once detected, all beta-lactams except carbapenem and beta-lactamase inhibitor compounds should be reported as resistant. In addition, organisms harboring ESBLs are frequently resistant to other antibiotic classes, such as fluoroquinolones and aminoglycosides. Because of the very limited remaining alternatives for treatment and ESBLs significant prevalence worldwide, infection control remains the best way to deal with this bacterial resistance mechanism.

Anti-Bacterial Agents↗
PubMed2005

Virulence genotype and phylogenetic origin in relation to antibiotic resistance profile among Escherichia coli urine sample isolates from Israeli women with acute uncomplicated cystitis.

To clarify the virulence and phylogenetic implications of antimicrobial agent resistance in Escherichia coli, 100 E. coli isolates from urine samples of Israeli women with acute uncomplicated cystitis were analyzed by molecular phylotyping and virulence genotyping for comparison with resistance phenotypes. The differences between the isolates that were resistant and susceptible to trimethoprim-sulfamethoxazole and ampicillin were minimal. In contrast, ciprofloxacin resistance was associated with greatly reduced inferred virulence and categorical shifts away from the highly virulent phylogenetic group B2, which explained much of the virulence effect. The results of amplification fingerprinting suggested that most ciprofloxacin-resistant isolates represented unique clonal groups and were not derived from clonal groups with more highly virulent susceptible isolates. These findings suggest that virulence and antimicrobial resistance are not mutually exclusive in E. coli clinical isolates. Instead, the relationship between virulence and antimicrobial resistance varies according to the particular resistance phenotype; for ciprofloxacin resistance, the relationship is strongly influenced by phylogenetic background. The basis for the concentration of ciprofloxacin resistance in non-B2 phylogenetic groups remains unknown.

Acute Disease↗
PubMed2005

Spontaneous conversion to quinolone and fluoroquinolone resistance among wild-type Escherichia coli isolates in relation to phylogenetic background and virulence genotype.

Human clinical isolates of Escherichia coli that are resistant to quinolone or fluoroquinolone agents typically exhibit fewer extraintestinal virulence factors (VFs) than susceptible isolates, along with a different phylogenetic background. To experimentally assess the basis for this as-yet-unexplained phenomenon, 40 E. coli strains (20 E. coli Reference collection members and 20 Israeli cystitis isolates) were subjected to serial selective passaging to obtain derivatives resistant to nalidixic acid (NA) and ciprofloxacin (C). PCR-based VF profiling and phylotyping were performed on the parents and their respective resistant derivatives. All 40 susceptible parent strains yielded NA- and C-resistant derivatives after a median of 6 (range, 4 to 12) serial selective passages on agar plates containing increasing concentrations of NA and C. The numbers of passages required for resistance did not differ by collection origin, phylogenetic group, basal VF profile, source (urine versus fecal), or host group (human versus animal). With the development of C resistance, only one VF was lost in a single strain. Resistant derivatives exhibited the same phylotype as their susceptible parents. These findings suggest that the sparse VF profiles and the low-virulence phylogenetic background of NA- and C-resistant E. coli clinical isolates probably are not attributable to the loss of VFs from intrinsically high-virulence strains during conversion to resistance or to enhanced emergence of drug resistance among intrinsically low-virulence strains. A more likely explanation is the importation of resistant strains from an as-yet-undefined low-virulence external selection reservoir.

Anti-Infective Agents↗
PubMed2005

Distribution and characteristics of Escherichia coli clonal group A.

Among 1,102 recent Escherichia coli clinical isolates, clonal group A was identified in 17 of 20 (U.S. and non-U.S.) geographic locales, mainly among U.S. isolates (9% vs. 3%; p < 0.001) and those resistant to trimethoprim-sulfamethoxazole (10% vs. 1.7%; p < 0.001). The extensive antimicrobial resistance and virulence profiles of clonal group A may underlie its recent widespread emergence.

Anti-Infective Agents↗
PubMed2005

Pharyngotonsillitis due to Arcanobacterium haemolyticum in northern Israel.

BACKGROUND: Arcanobacterium haemolyticum is a well-recognized but uncommon cause of pharyngitis and skin rash in adolescents and young adults. To date, no data regarding its frequency in Israel have been published. OBJECTIVE: To establish the frequency of A. haemolyticum in throat cultures in a northern Israeli population and to estimate the clinical significance of this pathogen in patients with sore throat. METHODS: We examined suspected colonies for A haemolyticum by gram stain, catalase test and reverse CAMP test in 518 throat cultures sent to the microbiologic laboratory of HaEmek Medical Center. RESULTS: Of the throat cultures tested, A. haemolyticum was recovered from one patient (0.2%). In contrast, group A Streptococcus (Streptococcus pyogenes) was recovered from 135 patients (26%). CONCLUSION: A hemolyticum is an uncommon pathogen implicated in acute pharyngitis, therefore routine screening in throat swabs is not required.

Actinomycetaceae↗
PubMed2004

Susceptibility of Streptococcus pyogenes to two macrolides in northern Israel.

In the present study, the minimal inhibitory concentration (MIC) of azithromycin and roxithromycin for 200 Streptococcus pyogenes isolates from outpatients with tonsillopharyngitis were determined using Etest. All but one (99.5%) of the isolates were sensitive to both antibiotics; the MIC of the resistant isolate being 12 mg/l to azithromycin and 32 mg/l to roxithromycin. In this region, macrolides remain the drug of choice for the treatment of patients with S. pyogenes tonsillitis who present allergy to penicillin. The routine testing of susceptibility of S. pyogenes to macrolides in northern Israel is not justified.

Anti-Bacterial Agents↗
PubMed2004

Improved antimicrobial susceptibility of community-acquired uropathogens in northern Israel (1995-1999-2002).

Since antimicrobial therapy for the treatment of community-acquired urinary tract infection is given empirically, knowledge of local antimicrobial sensitivity patterns is essential for clinicians. This study compares the susceptibility to antimicrobial drugs, of all urinary isolates from outpatients processed at the Ha'Emek Medical Center during 1995, 1999 and 2002. No significant changes in the susceptibility to ceftriaxone and ciprofloxacin were seen over this period of time. There was a significant increase in susceptibility to amoxycillin-clavulanate, TMP-SXZ, cefuroxime and nitrofurantoin. MIC(90) values of all drugs except amoxicillin-clavulanate remained stable. In contrast to a worldwide increase in resistance, we observed not only a halt in this trend, but also an improvement in antimicrobial susceptibility of uropathogens in northern-Israel.

Community-Acquired Infections↗
PubMed2004

Streptococcal necrotizing fasciitis with toxic shock syndrome following cervical adenitis.

In the recent years an increase of serious invasive infections due to Group A Streptococcus have been reported. Necrotizing fasciitis is a rapidly progressive soft tissue infection characterized by necrosis of the subcutaneous tissues and superficial fascia. We report a case of necrotizing fasciitis and toxic shock syndrome following cervical adenitis in a previously healthy 11-month-old boy. Cultures from blood and the necrotic lymph node grew Group A Streptococcus. Group A Streptococcus belonging to M1 serotype and producing streptococcal pyrogenic exotoxin, SPE A was identified. Full recovery was achieved by aggressive treatment, which included intensive care support, extensive surgical debridement of necrotic lesions and antibiotic treatment with the combination of penicillin and clindamycin.

Fasciitis, Necrotizing↗
PubMed2004

Azithromycin as an alternative to nalidixic acid in the therapy of childhood shigellosis.

In an outbreak of shigellosis in a kibbutz in Northeastern Israel, oral nalidixic acid failed clinically in 35% and microbiologically in 28.4% of 14 children as compared with no clinical and microbiologic failure in 25 children who were treated with oral azithromycin (P < 0.01 and 0.012, respectively). Thus azithromycin could be a suitable alternative to nalidixic acid.

Administration, Oral↗
PubMed2004

Identification of the emerging pathogen Vibrio vulnificus biotype 3 by commercially available phenotypic methods.

Identification of the emerging pathogen Vibrio vulnificus biotype 3 has become a challenge for clinical laboratories in the last few years. In this study, the abilities of five commercial systems to identify this new species have been evaluated for the first time, using a unique collection of strains. Fifty-one well-documented wild strains of V. vulnificus biotype 3 were processed using API 20 NE, GNI+ Vitek 1 cards, ID-GNB Vitek 2 cards, Neg Combo 20 Microscan panels, and NMIC/ID-5 BD Phoenix panels. The numbers of strains identified as V. vulnificus by ID-GNB, NMIC/ID-5, and GNI+ were 50 (98.0%), 46 (90.2%), and 7 (13.7%), respectively. Neg Combo 20 Microscan panels and API 20 NE were unable to identify any of the strains of this emerging pathogen to the species level and mostly misidentifies them as other species of the Vibrionaceae family. Data on the phenotypic pattern of V. vulnificus biotype 3 when processed in all five systems as presented here could help clinical laboratories in identifying this new pathogen.

Automation↗
PubMed2003

Long-term follow-up of women hospitalized for acute pyelonephritis.

Long-term outcome of acute pyelonephritis (AP) in adults is unknown. We evaluated the frequency of renal damage 10-20 years after hospitalization for AP in adult women and the utility of technetium Tc 99m-labeled dimercaptosuccinic acid (Tc 99m-DMSA) scanning for detection of renal scars; 63 of 203 women hospitalized with AP during 1982-1992 were included in the study. Tc 99m-DMSA scanning detected renal scarring in 29 women (46%). Multivariate analysis showed that pregnancy and hypoalbuminemia (albumin level, <3.2 g/dL) at hospitalization were independent risk factors for subsequent development of renal scars. At follow-up, hypertension was observed in approximately one-fifth of patients, regardless of renal scarring status. Four women with scars had a glomerular filtration rate of < or =75 mL/min; none of them developed severe renal impairment. In conclusion, the risk of developing renal scarring after AP in adult women is high. However, clinically relevant renal damage is rare 10-20 years after AP. Tc 99m-DMSA scanning is useful for detecting renal scars in adults but is not routinely needed in practice.

Acute Disease↗
PubMed2003

Clinical predictors of streptococcal pharyngitis in adults.

BACKGROUND: Acute pharyngitis in children is one of the most frequent illnesses for which primary care physicians are consulted. It is caused more frequently by viruses than by bacteria, but it is difficult to differentiate the causative agent by clinical signs alone. Group A Streptococcus accounts for 30% of children with a sore throat, and only in these cases is antibiotic therapy definitely indicated. However, the frequency and symptomatology of streptococcal pharyngitis in adults is not well established. OBJECTIVES: To examine the clinical features that could distinguish sore throat caused by beta-hemolytic group A Streptococcus in adults. METHODS: Patients aged over 16 years old (n = 207) who presented with a sore throat to community clinics were examined and throat cultures were taken. The microbiologic confirmation of Group A Streptococcus was correlated with symptoms and clinical signs by univariate analysis. RESULTS: About 24% of the patients with positive cultures were younger individuals. Chills, absence of cough, pain in swallowing, absence of rhinitis, headache, vomiting, tonsillar exudate, oral malodor, fever > 38 degrees C and sweats had high sensitivity but low specificity for streptococcal pharyngitis. Univariate analysis suggested that chills and pharyngeal exudate had the greatest predictive value for streptococcal pharyngitis (P = 0.044, odds ratio 2.45; P = 0.001, OR 5.49, respectively). When compared with a published scoring method (Centor criteria), large inconsistencies were found. CONCLUSION: Our adult population had a relatively high prevalence of group A Streptococcus, and their presentation differed from that of pediatric patients. In primary care, a throat swab culture is not necessary in adults with a low score (0-1 points).

Acute Disease↗
PubMed2003

Vibrio vulnificus necrotizing fasciitis of the calf presenting with compartment syndrome.

We describe a 17-year-old boy with congenital spherocytosis and iron overload who presented with compartment syndrome of the calf as the initial manifestation of Vibrio vulnificus infection after minor trauma in a contaminated fish pond. The disease was complicated by necrotizing fasciitis requiring above the knee amputation. Childhood diseases associated with iron overload pose an increased risk for complicated V. vulnificus infections.

Adolescent↗