Aspiration of barnyard manure.
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Accidents, Occupational↗
Biomedical subjects
T F Keys
Publications and source records attributed to T F Keys.
The aminoglycosides. Streptomycin, kanamycin, gentamicin, tobramycin, amikacin, netilmicin, sisomicin.
Despite their toxicity, the aminoglycosides remain useful and are often the first choice in the treatment of serious infections due to gram-negative bacilli. Nephrotoxicity has restricted the indications for neomycin to topical and oral use. Emergence of resistant organisms has limited the use of streptomycin to a few specific conditions. Gentamicin, tobramycin, and amikacin are effective against a broad spectrum of gram-negative bacilli including Pseudomonas aeruginosa. Amikacin is the aminoglycoside of choice when gentamicin resistance is prevalent.
Amikacin↗
Antimicrobial agents in urinary tract infections.
Effective antimicrobial therapy for most urinary tract infections has been available since the sulfonamide era. Innovations in chemotherapy now include single-dose treatment of acute bacterial cystitis and acute urethral syndrome and effective suppression of recurrent bacteriuria with low-dose antimicrobial agents.
Acute Disease↗
Limitations of the antibody-coated bacteria test in patients with neurogenic bladders.
A Fairley washout test and antibody-coated bacteria (ACB) test were performed for 35 urinary tract infections in 32 patients with neurogenic bladder dysfunction. The Fairley test result was used as a standard reference and was combined with clinical and ureteral catheterization culture findings when doubt existed. The Fairley test localized 35 infections: 9 to the kidney, 24 to the bladder, and 2 to the prostate. The ACB test results were positive in five of the nine renal infections and negative in four. In three of the four patients with negative results, radiological, clinical, or ureteral culture evidence of upper urinary tract infection supported localization to the upper urinary tract. Of the 26 infections localized by the Fairley test to the lower urinary tract, 20 showed negative and six showed positive ACB test results. Two of the six patients with positive results had prostate infections; the other four had chronic or recurrent cystitis. The ACB test cannot be relied on alone to localize urinary tract infections in patients with neurogenic bladder dysfunction.
Antibody-Coated Bacteria Test, Urinary↗
Antimicrobial prophylaxis for patients with congenital or valvular heart disease.
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Animals↗
Incidence of wound infection for common general surgical procedures.
Postoperative wound infection remains a ubiquitous problem with serious consequences, especially with regard to prolonged convalescence and in a source of physical and financial burden to the patient. Wound infection occurred in 13 of 1,346 of the patients during a single recent 12 month period with commonly performed surgical procedures at a large midwestern hospital. The bacteriologic findings of these infections was diverse.
Humans↗
Renal toxicity during therapy with gentamicin or tobramycin.
Twenty-seven patients who had normal pretherapy renal clearance by the [125I]iothalamate test were randomly assigned either gentamicin or tobramycin for therapy of infections due to susceptible bacteria. No patients were critically ill or had evidence of bacteremia. Mean age and duration of therapy were 51 years and 14 days, respectively, for 15 patients treated with gentamicin, and 45 years and 13 days for 12 patients treated with tobramycin. At the completion of therapy, six (40%) gentamicin and seven (58%) tobramycin patients had a decrease in renal clearance of at least 14% below baseline. The mean decrease was 26% in the gentamicin group and 23% in the tobramycin group. Simultaneous increases in serum creatinine concentrations (greater than or equal to 0.2 mg/dl) occurred in only 4 (31%) of the 13 patients. Of four patients who had renal clearance studies repeated 3 weeks to 6 months after therapy, two had stable function, but at 16 to 19% below baseline. Mean urinary concentration of N-acetyl glucosaminidase and alanine aminopeptidase increased faster and to higher levels with gentamicin than with tobramycin. However, on an individual patient basis, they were not predictive of a decrease in renal clearance in either therapy group.
Acetylglucosaminidase↗
Treatment of primary pulmonary blastomycosis: results of long-term follow-up.
Twenty-three patients with pulmonary blastomycosis were seen from 1950 to 1975, and long-term follow-up, ranging from 2 to 21 years, was available for 19 patients. Four major treatment groups were identified: surgery alone (eight patients), amphotericin B alone (four patients), surgery and amphotericin B (three patients), and observation (four patients). Six of eight patients who had surgical resection alone were cured; one patient died of cardiopulmonary complications in the immediate postoperative period, and one had a relapse 15 years later. The remaining 11 patients in the three other treatment groups were cured. Although systemic therapy with amphotericin B is clearly indicated for progressive, disseminated, or incompletely resected disease, a period of observation is indicated for nonprogressive or totally resected pulmonary blastomycosis.
Adult↗
Legionnaires' disease: a review of the epidemiology and clinical manifestations of a newly recognized infection.
During the 2-year period 1977 through 1979, 26 patients with Legionnaires' disease were seen at the Mayo Clinic and affiliated hospitals. The patients ranged in age from 17 to 81 years with a median of 51 years. Twelve (46%) were immunologically compromised. Most of the other patients had underlying chronic tobacco bronchitis. Hectic fever, cough, and diarrhea were common symptoms. Chest radiographs showed patchy perihilar infiltrates that often progressed to consolidation. Diagnosis was made by indirect fluorescent antibody testing in 15 patients (58%), but in no case was the test diagnostic during the first week of illness. In seven patients the diagnosis was established by positive direct flourescent antibody testing of lung tissue, in two cases by culture of lung tissue, and in one case each by direct fluorescent antibody positivity of sputum or bronchial washing. Of the 26 patients, 3 (12%) required hemodialysis for acute renal failure and 5 (19%) died. A favorable clinical response to therapy with erythromycin was noted. The differential diagnosis of Legionnaires' disease must include other bacterial pneumonias, as well as mycoplasma, psittacosis, Q fever, and viral pneumonia. For critically ill patients, open-lung biopsy may be necessary to provide a rapid diagnosis. Current evidence suggests that erythromycin alone or in combination with rifampin is the treatment of choice. A 3-week course of therapy is recommended in order to prevent relapse.
Adolescent↗
Bacteriuria during closed urinary drainage: an evaluation of top-vented versus bag-vented systems.
For a 10-month period a top-vented closed urinary drainage system was evaluted and compared to a conventional bag-vented drainage system. The study involved random assignment of either system to all adult patients who required urinary catheterization. Criteria for exclusion included acute or chronic genitourinary tract infection and surgical interference with bladder function. The end point of the study was removal of any part of the system after at least 24 hours or a positive urine culture (greater than 10,000 colonies per ml. urine). The series included 236 patients. Distributions of patient age, sex and hospital service assignment (medical or surgical), antibiotic usage and duration of catheterization were similar in both study groups. Of 113 patients with the top-vented system 16 (14.2 per cent) acquired bacteriuria, whereas 13 of 123 (10.6 per cent) with the bag-drainage system acquired bacteriuria. No significant difference was noted. Antibiotics were used in 202 of 236 patients (86 per cent). Although usage delayed the appearance of bacteriuria in both groups isolates were more frequently yeasts and gram-negative organisms other than Escherichia coli.
Adolescent↗
Sputum counterimmunoelectrophoresis in the diagnosis of pneumococcal pneumonia.
Fifty-six patients with pneumonia were grouped according to degree of clinical certainty that the etiologic agent was Streptococcus pneumoniae. Of 14 patients with definite or probable pneumococcal pneumonia, 12 had pneumococcal antigens detected in sputum by counterimmunoelectrophoresis (CIE), 13 had a positive sputum culture, and 12 had a Gram-stained smear of sputum suggestive of the diagnosis. Of 9 patients with definite nonpneumococcal pneumonia, none had pneumococcal antigens detected by CIE, but one had pneumococci isolated from sputum culture, and one had a Gram stain of sputum suggestive of pneumococci. Of 34 control patients without pneumonia, five had a positive CIE, 11 had a positive culture, and 15 had a positive Gram stain. When used to differentiate pneumococcal from other types of pneumonia, CIE of sputum appears to be a sensitive and specific test. Among patients without pneumonia, however, CIE lacks specificity. Additionally, sputum Gram stain may correlate as well as CIE with pneumococcal pneumonia, but further substantiation of this observation is necessary.
Antigens, Bacterial↗
Central nervous system histoplasmosis with obstructive hydrocephalus.
A case of central nervous system histoplasmosis complicated by obstruction of the fourth ventricle is described. The patient rarely exhibited systemic symtoms of infection despite positive cultures for Histoplasma capsulatum from bone marrow, blood and urine. Infection recurred despite the administration of a total of 5 g of systemic amphotericin B. An additional course combined with intrathecal amphotericin B was terminated because of transverse myelitis.
Adolescent↗
Gallium scanning for the detection of abdominal abscesses.
The use of gallium scanning for the diagnosis of abdominal abscesses was studied in 59 cases in which the diagnosis was verified by laparotomy or autopsy. In 23 of the cases the patients were subsequently found to have abdominal abscesses and 11 patients had abdominal malignancies. Excluding the latter group, the scan was specific for abscess in 86 per cent of the cases and sensitive for abscess in 67 per cent. Recent abdominal incisions, concurrent intestinal, hepatic, biliary and pancreatic inflammatory conditions, without abscess, seldom caused gallium accumulation. False-negative scans (18 per cent) occurred more frequently than false-positive scans (8 per cent) and were seen in patients with large (often palpable) masses of short evolution and with secondarily infected lesions such as hematomas and pseudocysts. The gallium scan was of little help in the search for abdominal lesions in patients with obscure febrile illnesses without abdominal symptoms or signs.
Abdomen↗
Nonvalue of neomycin instillation after intermittent urinary catheterization.
This study evaluated weekly urine cultures of patients with neurogenic bladder disease who underwent intermittent urinary catheterization for bladder retraining. One group of 53 patients in 1974 received regular instillations of 0.1% neomycin after each catheterization. A similar group of 55 patients in 1975 did not receive neomycin and constituted a control group. Distribution of age, sex, diagnosis, and duration of bladder retraining was comparable in both groups. Quantitative bacterial colony counts of 10(4) to 10(5) or greater per ml of urine were considered significant. There was no difference in the incidence of bacteriuria between the neomycin-treated group and the control group (53 versus 49%, respectively), and most patients in each group had colony counts >10(5)/ml. Escherichia coli was seen less frequently in neomycin-treated patients (43.4 versus 62.5%), but a greater percentage of infections due to Pseudomonas aeruginosa, group D streptococci, and yeasts was noted in the neomycin-treated group than in the control group (41.5 versus 22.5%).
Bacteriuria↗
How to cope with infectious pneumonia in the immunologically compromised patient.
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Aged↗
Gentamicin-resistant Pseudomonas aeruginosa: Mayo Clinic Experience, 1970-1976.
During the period 1970 through 1976, there were 144 patients from whom gentamicin-resistant Pseudomonas aeruginosa (minimum inhibitory concentration [MIC], more than 5 microgram/ml) was isolated. In 20(21 percent) of the 95 patients who acquired such organisms within our institutions, the occurrence was considered clinically significant. Factors that favored the appearance of gentamicin-resistant P. aeruginosa included prolonged hospitalization, previous antibiotic treatment, increased gentamicin usage, underlying disease, and instrumentation (70 percent). Virulence of gentamicin-resistant isolates appeared less than that of susceptible organisms, with bacteremia due to these isolates occurring in only three cases. Resistant isolates with MICs for gentamicin of 8 to 16 microgram/ml were more susceptible to tobramycin than to amikacin, whereas isolates with MICs for gentamicin of 64 microgram/ml or greater were more susceptible to amikacin than to tobramycin. Eighty percent of all strains were susceptible to 128 microgram/ml or less of carvenicillin. Favorable results occurred in 12 or 13 cases treated with gentamicin plus carbenicillin, whereas treatment with either of these agents alone resulted in failure or relapse in 7 of 14 cases.
Amikacin↗
A sporadic case of pneumonia due to legionnaires disease.
A recently recognized sporadic case of "legionnaires' disease" occuring in Minnesota is described. The patient, a previously healthy 58-year-old woman, became seriously ill with progressive pneumonia in the spring of 1977. Her illness was unresponsive to the usual antibiotics (penicillin and cephalothin) prescribed for community-acquired bacterial pneumonia. Treatment with doxycycline appeared to be effective. Diagnosis was made by special serologic studies performed at the Center for Disease Control, Atlanta. As reported in the epidemic form of the disease, no secondary cases were noted in family, associates, or hospital workers exposed to the patient during her acute illness. This disease may be more common than has previously been recognized, for serologic test for the unusual bacterium have only recently become available.
Acute Disease↗
Antimicrobials commonly used for urinary tract infection: sulfonamides, trimethoprim-sulfamethoxazole, nitrofurantoin, nalidixic acid.
Sulfonamides, trimethoprim-sulfamethoxazole, nitrofurantoin, and nalidixic acid are excreted in the urine in high concentration and, with the exception of Pseudomonas aeruginosa and Serratia marcescens, are all active in vitro against usual aerobic gram-negative bacteria. They are useful for treatment of uncomplicated lower urinary tract infections in an outpatient setting but are probably not indicated for acute upper tract infections, especially in the hospitalized patient. Trimethoprim-sulfamethoxazole is a very effective combination agent in vitro, has appealing pharmacokinetic properties, and is usually well tolerated by patients. However, it is more expensive than the sulfonamides and is ordinarily not indicated for initial treatment. A sulfonamide is in our view still the agent of first choice, with either nitrofurantoin or nalidixic acid as an alternative if sulfonamides cannot be tolerated.
Anti-Infective Agents, Urinary↗