Biomedical subjects

Thomas G Fraser

Publications and source records attributed to Thomas G Fraser.

8 recordsLinked to original sources

PubMed2006

Newer antibiotics for serious gram-positive infections.

Four newer antibiotics are available to treat gram-positive bacterial infections that are resistant to traditional antibiotics and to vancomycin. They should preferably be used with the help of an infectious-disease consultant: specific therapy should be chosen on the basis of the bacteria involved, the site of infection, whether the patient has kidney or liver disease, other medications the patient is taking, and side effects that develop.

Acute Disease↗

PubMed2006

The use of real-time polymerase chain reaction for rapid diagnosis of skeletal tuberculosis.

We identified Mycobacterium tuberculosis DNA using real-time polymerase chain reaction on a specimen from an osteolytic lesion of a femoral condyle, in which the frozen section demonstrated granulomas. The process was much more rapid than is possible with culture. The rapid detection of M tuberculosis and the concomitant exclusion of granulomatous disease caused by nontuberculous mycobacteria or systemic fungi are necessary to appropriately treat skeletal tuberculosis. The detection and identification of M tuberculosis by culture may require several weeks using traditional methods. The real-time polymerase chain reaction method used has been shown to be rapid and reliable, and is able to detect and differentiate both tuberculous and nontuberculous mycobacteria. Real-time polymerase chain reaction may become a diagnostic standard for the evaluation of clinical specimens for the presence of mycobacteria; this case demonstrates the potential utility of this assay for the rapid diagnosis of skeletal tuberculosis.

Antitubercular Agents↗

PubMed2005

Inflammatory pseudotumor of the testis: a novel presentation of acute retroviral syndrome.

Inflammatory pseudotumors are a rare entity, the etiology of which is not well understood. It has been postulated that these non-neoplastic lesions are the result of a reaction to trauma, surgery, infection or local irritation, though in many cases an underlying cause is never found. In this case, a 30-year-old man with previously undiagnosed human immunodeficiency virus presented with a 2-week history of painless right testicular mass measuring 1 x 1 cm. The patient underwent right radical orchiectomy with histopathological analysis revealing an inflammatory pseudotumor of the testis. Further work up pointed to acute retroviral syndrome as the likely cause.

Adult↗

PubMed2005

Anti-infective therapy at the end of life: ethical decision-making in hospice-eligible patients.

Clear guidelines addressing the ethically appropriate use of anti-infectives in the setting of hospice care do not exist. There is lack of understanding about key treatment decisions related to infection treatment for patients who are eligible for hospice care. Ethical concerns about anti-infective use at the end of life include: (1) delaying transition to hospice, (2) prolonging a dying process, (3) prescribing regimens incongruent with a short life expectancy and goals of care, (4) increasing the reservoir of potential resistant pathogens, (5) placing unreasonable costs on a capitated hospice system. Although anti-infectives are thought to be relatively safe, they can place a burden on patients and be inconsistent to particular care plans. The current complex, and at times fragmented, medical care often fails to address these issues in decision-making. In many ways, the ethics governing the end of life decisions related to dialysis, hydration/nutrition, and hypercalcemia parallel those of anti-infectives. In this article we articulate important elements in ethical decision-making in the application of anti-infectives for patients who are eligible for hospice care, and we point to the need for prospective studies to help refine particular guidelines in these cases.

Adult↗

PubMed2005

Vancomycin and home health care.

The Hospital Infection Control Practices Advisory Committee published guidelines for prudent use of vancomycin to combat increasing resistance to antimicrobial drugs. Studies examining compliance with these guidelines primarily involve hospitalized patients. The growing practice of home use of antimicrobial drugs led to this retrospective cohort study that evaluated parenteral vancomycin use in patients receiving it through a homecare agency. We found that 39.2% of outpatients received vancomycin outside the guidelines, mainly because of prolonged empiric therapy, dosing convenience, and prolonged use after surgery. Patients were more likely to receive vancomycin appropriately if they were >65 years of age, had a history of malignancy, or were discharged from a medical service. In addition, obtaining wound cultures and attempting a microbiologic diagnosis led to more appropriate vancomycin use. Recommendations for prudent vancomycin use are often overlooked when selecting antimicrobial drugs for home infusion. The public health impact of this practice remains unknown.

Adult↗

PubMed2005

The emergence of methicillin-resistant Staphylococcus aureus in the community.

Infections with methicillin-resistant Staphylococcus aureus (MRSA), long endemic in hospitals and nursing homes, are now being reported in the community as well. While we await further epidemiological and microbiological study of this emerging pathogen, current clinical practice requires a reconsideration of the empiric use of beta-lactam agents for the seriously ill patient with a gram-positive infection.

Adult↗

PubMed2004

Multidrug-resistant Pseudomonas aeruginosa cholangitis after endoscopic retrograde cholangiopancreatography: failure of routine endoscope cultures to prevent an outbreak.

BACKGROUND: Nosocomial infections due to medical devices are of increasing concern to infection control practitioners. Attempts to prevent such infections have included surveillance cultures of endoscopes and bronchoscopes. In July 2002, the infectious disease consultation service was asked to see three patients with sepsis due to multidrug-resistant Pseudomonas aeruginosa after endoscopic retrograde cholangiopancreatography (ERCP). OBJECTIVE: To describe an outbreak of multidrug-resistant P. aeruginosa sepsis after ERCP at an institution that performs routine surveillance cultures of endoscopes. DESIGN: A traditional outbreak investigation supplemented by pulsed-field gel electrophoresis (PFGE) was undertaken, including a case-control analysis based on the hypothesis that all infected individuals had their ERCP performed with the same endoscope. SETTING: A tertiary-care academic medical center. RESULTS: The case-control analysis confirmed the hypothesis that undergoing ERCP with the implicated endoscope was associated with a culture positive for Pseudomonas (P = .01). The available strains were identical by PFGE. This outbreak occurred despite a negative surveillance culture of the implicated endoscope 1 month earlier. CONCLUSIONS: Infectious morbidity can occur after endoscopy despite negative surveillance cultures. The practice of routine endoscope cultures does not prevent device-related infectious morbidity.

Aged↗

PubMed2003

Persistent methicillin-resistant Staphylococcus aureus bacteremia due to a prostatic abscess.

This report describes a patient with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia secondary to a prostatic abscess. The literature describing complications of S. aureus bacteremia and the bacteriology of prostatic abscesses is reviewed. This was found to be the first report of a patient with persistent MRSA bacteremia maintained by a prostatic focus.

Abscess↗