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Biomedical subjects

T S Elliott

Publications and source records attributed to T S Elliott.

At least 55 records · Page 3Linked to original sources
PubMed1996

An audit of peripheral catheter care in a teaching hospital.

Post-insertion care of peripheral venous catheters (PVCs) in 100 patients on general medical and surgical wards of a teaching hospital was audited. A variety of methods were used to attach the PVC to the patients' skin including 'Vecafix' dressings, bandages and adhesive tape. Sixty-eight PVC were incorrectly attached, and of these 49 (71%) were associated with two or more symptoms or signs of inflammation at the insertion site. Of those PVC that were correctly attached only five out of 32 (16%) were associated with inflammation. There was a significant association between incorrect dressing application and inflammation (P < 0 center dot 01). Similarly, there was a direct relationship between inflammation and PVCs that had been in situ for greater than 48 h (P < 0 center dot 01). The results suggest that a significant reduction in the incidence of inflammation associated with PVC use may be achieved by correct application of dressings and replacing the catheters after 48 h in situ.

Bandages↗
PubMed1995

The potential reduction of microbial contamination of central venous catheters.

The microbial contamination of stopcock entry ports attached to central venous catheters (CVC) was determined using a specially designed swab. The swab was made of a highly porous material, Porex, and was designed to fit exactly into the entry port of stopcocks. The swab was used to determine the frequency of microbial contamination of entry ports attached to CVC in patients located on an Intensive Care Unit. Of the 200 swabs obtained 44 (22%) contained microorganisms. Coagulase-negative staphylococci were recovered from 43 of the swabs and diphtheroid bacilli from 1 swab. In vitro studies were carried out to investigate the efficiency of the swab in removing excess residual fluid and organisms from entry ports. The swab absorbed relatively large numbers of bacteria within seconds. When entry ports were inoculated with between 10(3) and 10(5) cfu of either Staphylococcus epidermidis or Klebsiella pneumoniae greater than 99% of the organisms were absorbed by the swab (P < 0.01). The absorbent swab was more efficient at removing S. epidermidis from the entry port when compared to a standard cotton swab (P < 0.01). In vitro this absorbent swab reduced the potential for catheter contamination resulting from migration of organisms from the entry port via the intraluminal route. The use of the swab in the clinical situation may reduce the incidence of CVC-related infections.

Catheterization, Central Venous↗
PubMed1995

An audit programme for central venous catheter-associated infections.

Central venous catheters (CVC) are commonly associated with both localized and systemic infection. This paper describes an audit programme which was designed to review clinical practice associated with the insertion and subsequent care of CVC and their possible relationship to the development of infection. The programme was produced by a joint working group of the Hospital Infection Society and the Research Unit of the Royal College of Physicians and is subdivided into an audit of hospital practices and patient management associated with the use of CVC. It consists of a number of questions designed to evaluate all areas of CVC use, including the assessment of the incidence of associated local and systemic infection. Use of the questionnaire should allow policies for CVC insertion and care to be reviewed thereby, facilitating improvements, which may in turn reduce the incidence of infection associated with CVC.

Catheterization, Central Venous↗
PubMed1995

Plasmid-mediated vanB glycopeptide resistance in enterococci.

Enterococcus faecium, which was highly resistant to vancomycin (MIC 256 mg/liter), but susceptible to teicoplanin (MIC 2 mg/liter), caused two distinct episodes of infection on a renal unit in the United Kingdom. Pulsed field gel electrophoresis (PFGE) indicated that a single strain caused the first episode, while the second episode, which occurred 1 year later, involved multiple strains, all of which were distinct from the original strain. Vancomycin resistance in all but one of these strains was mediated by transferable plasmids that carried the vanB glycopeptide resistance gene. Transfer either of resistance plasmids or the vanB resistance determinant itself to different strains occurred during the second episode. Plasmid-mediated vanB resistance has not been widely documented. A retrospective study of a reference collection revealed two other vanB-encoding plasmids from an E. faecalis and an E. faecium referred from two further UK centers. Although restriction analysis indicated no similarity between the plasmids from the three different centers, all contained a 2.1-kb EcoRV fragment that hybridized with a probe for the vanB gene. This suggests that there has been dissemination of a conserved glycopeptide resistance determinant, of which vanB is a part.

Anti-Bacterial Agents↗
PubMed1995

The emergence of Trichophyton tonsurans tinea capitis in Birmingham, U.K.

The anthropophilic fungus Trichophyton tonsurans is a cause of tinea capitis in children. Since the 1950s the organism has spread from Central to North America. A similar recent emergence of T. tonsurans has not been reported previously in the U.K. T. tonsurans was found to have become the predominant cause of tinea capitis in Birmingham, U.K., accounting for 72% of infections investigated in 1993. The symptoms and signs of the infection were variable and accurate diagnosis may be initially difficult. It is, thus, important to be aware of the emergence of T. tonsurans in the U.K., so that an early diagnosis can be made to facilitate appropriate treatment and to prevent spread of infection to close contacts.

Adolescent↗
PubMed1994

Modification of central venous catheter polymers to prevent in vitro microbial colonisation.

The efficacy of an antimicrobial catheter for the prevention of bacterial colonisation was investigated. The catheter was hydrophilic coated (Hydrocath) and impregnated with the quaternary ammonium antimicrobial agent, benzalkonium chloride (BZC). Microbial colonisation of this central venous catheter was compared to that of polyurethane catheters with or without a hydrophilic coating. Adherence of five strains of Staphylococcus epidermidis to the three catheter types was determined with a microbial colonisation model. Adherence of three strains of Staphylococcus epidermidis to Hydrocath catheters was significantly reduced in comparison to polyurethane catheters (p < 0.01). BZC-impregnated Hydrocath catheters prevented bacterial colonisation of both the internal and external catheter surfaces (p < 0.01). These results were confirmed by scanning electron microscopy. The findings demonstrate that hydrophilic-coated Hydrocath catheters can inhibit bacterial adherence in vitro. Bacterial colonisation was further restricted by the addition of BZC to these coated catheters.

Bacterial Adhesion↗
PubMed1994

Guidelines for good practice in central venous catheterization. Hospital Infection Society and the Research Unit of the Royal College of Physicians.

Central venous catheters (CVC) are commonly used in clinical practice and are associated with several complications, including early and late onset infection. In these guidelines, an outline of good practice for the use of CVC and the prevention of associated infections is presented. Definitions of both localized and systemic catheter-related sepsis are given. Subsequent good practice in relation to the insertion of CVC, including patient preparation, planned duration of catheterization, catheter materials and design of the CVC, are presented. Skin fixation and insertion site care, including the use of dressings and administration sets, as well as an approach to flow obstructions, are also reviewed. The clinical and microbiological diagnosis of catheter-related sepsis and its treatment is next presented. Finally, guidelines for CVC removal and replacement are given. The guidelines are designed to facilitate the development of good practice in the use of CVC, allowing appropriate protocols to be formulated and to reduce infection risk.

Bacteremia↗
PubMed1994

Influence of surface morphology on in vitro bacterial adherence to central venous catheters.

The detailed surface topography of five polyurethane central venous catheters (CVC) (Hydrocath, Deltacath, Certofix trio, Arrow-Howes and Multicath three) was examined by scanning electron microscopy and laser profilometry. The results were correlated with the ability of Staphylococcus epidermidis to adhere to each CVC. Hydrocath CVC had the smoothest surface, as determined by profile peak values of 0.17 microns (Ra) and 0.94 microns (Rz). These CVC also had the lowest number of staphylococci adhering to the surface. In contrast, Certofix trio CVC had an irregular surface (Ra 1.29 microns and Rz 6.35 microns) which was confirmed by scanning electron microscopy. These latter CVC had significantly more bacteria colonizing their surface compared with Hydrocath and Arrow-Howes CVC (P < 0.01). The results suggest that a CVC with a smooth surface, absent of surface defects, may reduce the risk of colonization with bacteria and therefore subsequent sepsis.

Bacterial Adhesion↗
PubMed1994

Selective decontamination of the digestive tract reduces gram-negative pulmonary colonization but not systemic endotoxemia in patients undergoing elective liver transplantation.

OBJECTIVE: To examine the effect of selective antibiotic decontamination of the digestive tract in patients undergoing elective orthotopic liver transplantation. DESIGN: Prospective, randomized, concurrent allocation to either selective decontamination or standard antibiotic prophylaxis. SETTING: Operating theater and intensive care unit at a tertiary referral, university teaching hospital. PATIENTS: Fifty-nine adult patients were recruited into the study and underwent liver transplantation. INTERVENTIONS: Thirty-two patients were randomized to standard treatment (control group) and 27 patients were randomized to receive selective decontamination. After early deaths and exclusions, 31 controls and 21 decontamination patients were available for analysis. MEASUREMENTS AND MAIN RESULTS: Portal and systemic endotoxemia, colonization and infection rates, severity of illness (organ system failures, Acute Physiology and Chronic Health Evaluation II score, Therapeutic Intervention Scoring System score), antibiotic costs, and hospital survival rates were measured. Selective decontamination significantly reduced pulmonary infections and enteric, aerobic, and Gram-negative bacillary colonization without facilitating the emergence of resistant organisms, but selective decontamination had no effect on endotoxemia or the development of organ system failures. The financial costs of the selective decontamination regimen outweighed the advantages gained from an associated reduction in antibiotic usage. CONCLUSION: The failure of selective decontamination to enhance survival rates in many studies of the regimen in critically ill patients may, in part, be related to the inability of selective decontamination to abolish endotoxemia.

Adult↗
PubMed1994

Antibiotic-induced release of endotoxin from bacteria in vitro.

The ability of cefotaxime, ciprofloxacin, piperacillin and tobramycin to cause release of endotoxin was examined in vitro with cultures of Enterobacter cloacae and Escherichia coli. Endotoxin was measured by a quantitative limulus amoebocyte lysate assay and its presence was confirmed by silver staining of the lipopolysaccharide moiety following SDS-PAGE. The morphology of the bacteria during antibiotic exposure was examined by scanning electronmicroscopy. Cefotaxime, ciprofloxacin and piperacillin caused significant endotoxin release, correlating with their ability to affect cell-wall morphology, causing filamentation, wall breakage and cell lysis. In contrast, little endotoxin was released when bacteria were exposed to tobramycin and no morphological changes were observed when bacteria were exposed to bactericidal concentrations of this aminoglycoside. Its antimicrobial spectrum and bactericidal activity make tobramycin an appropriate agent for treatment of sepsis caused by gram-negative bacteria and its lack of propensity to elicit excessive release of endotoxin may avoid exacerbation of endotoxin-related shock in sepsis.

Anti-Bacterial Agents↗
PubMed1994

Development of o.a.s.i.s., a new automated blood culture system in which detection is based on measurement of bottle headspace pressure changes.

o.a.s.i.s. (Unipath Ltd., Basingstoke, United Kingdom) is a new automated blood culture system. The metabolism of microorganisms is detected by measuring changes in the pressure of the headspace of blood culture bottles. These changes are measured by monitoring the position of a flexible sealing septum, every 5 min, with a scanning laser sensor. This noninvasive system can detect both gas absorption and production and does not rely solely on measuring increasing carbon dioxide levels. A research prototype instrument was used to carry out an evaluation of the media, the detection system, and its associated detection algorithm. In simulated blood cultures, o.a.s.i.s. supported growth and detected a range of clinical isolates. Times to positivity were significantly shorter in o.a.s.i.s. than in the BACTEC 460 system. Results of a clinical feasibility study, with a manual blood culture system as a control, confirmed that o.a.s.i.s. was able to support the growth and detection of a variety of clinically significant organisms. On the basis of these findings, full-scale comparative clinical trials of o.a.s.i.s. with other automated blood culture systems are warranted.

Adolescent↗
PubMed1993

Line-associated bacteraemias.

Sepsis associated with intravascular catheters is a significant cause of morbidity and mortality in England and Wales. Almost 4000 cases of line-associated bacteraemia were reported to the PHLS Communicable Disease Surveillance Centre in 1991. The clinical and laboratory criteria used to diagnose these infections are reviewed and several approaches to the prevention of catheter-related sepsis are described, including the use of smooth antimicrobial polymers and electrical charge. The strict application of appropriate aseptic techniques is still, however, the most important factor in reducing the incidence of sepsis.

Bacteremia↗
PubMed1993

F1Fo-ATPase subunit e gene isolated in a screen for diet regulated genes.

Described is a protocol for isolating genes differentially regulated by the level of an essential nutrient in the diet. One gene, designated LFM-1 (Low Fat Mammary), was identified by subtractive hybridization and plus/minus screening in a lambda-cDNA library constructed with mRNA from mammary glands of virgin, tumor-free Balb/c mice fed a low fat diet; a second gene, stearoyl CoA desaturase, known to be regulated by the level of fat intake, was also isolated. The procedure can be modified for use with other constituents. The differential expression of LFM-1 was noted in mammary glands, liver, and kidney but not other tissues of mice fed low fat compared to high fat. LFM-1 is 86% identical to the gene encoding the e subunit of bovine F1-Fo ATPase and 89% identical to an UV-light induced gene (DDIU4) from Chinese hamster fibroblasts. Differential hybridization analyses indicated that LFM-1 may belong to a gene family.

Amino Acid Sequence↗