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Biomedical subjects

W R Gransden

Publications and source records attributed to W R Gransden.

At least 19 recordsLinked to original sources
PubMed1991

Predictors for bacteraemia.

In a study of 4104 episodes of septicaemia seen at St Thomas's Hospital between 1969 and 1989, predictors for the condition, other than age and hospital service, were difficult to identify, mainly as a result of the limited data available on the denominator groups. The collection of a small number of simple and readily assessed items of information on all patients with septicaemia did, however, allow the identification of some associations between certain groups of patients and particular species of bacteria and foci of infection. Until there is a substantially larger amount of accurate, complete and computerized data on all hospital patients, further recognition of predictors for bacteraemia will prove difficult to develop.

Adolescent↗
PubMed1991

4-Quinolone-resistant Neisseria gonorrhoeae in the United Kingdom.

The auxotype, serogroup and antimicrobial susceptibility of 977 clinical isolates of Neisseria gonorrhoeae obtained at St Thomas' Hospital, London, during 1989 were determined; 23 isolates from 15 patients were resistant to 4-quinolones. Twelve of the patients acquired their infection in the UK and these strains were generally sensitive to other antimicrobial agents; strains from 10 patients were of serogroup IB-6. Three patients acquired their strains outside the UK and these isolates were multi-resistant and of different serogroups.

Ciprofloxacin↗
PubMed1990

The computerized documentation of septicaemia.

At St Thomas' Hospital for the past 20 years, medical microbiologists have documented all cases of septicaemia, as part of the routine service offered by the department. These records are used in the day-to-day management of patients and have provided much research and teaching material. When the number of paper records became so large that manual extraction of data was impossible we computerized the records. In 1986 information from the paper charts was transferred to a microcomputer, and since the beginning of 1988 the details of each new case have been added to this computer file at the end of the septicaemic episode. At present, collection of data during the course of a patient's illness continues on paper, but it is hoped that in future this process will also be computerized. Apart from our own data, little computerized information is to be found on patients or the treatment they receive, both within our hospital and nationally. The present system can be viewed as a prototype for other groups of patients.

Hospital Information Systems↗
PubMed1990

The causative organisms of septicaemia and their epidemiology.

During the 20 years, 1969-88, nearly 4000 episodes of septicaemia were studied prospectively at St. Thomas' Hospital. Forty percent were community-acquired and 60% hospital-acquired. Overall the commonest isolate was Escherichia coli (22%). In community-acquired bacteraemias, Esch. coli, Streptococcus pneumoniae and Staphylococcus aureus accounted for almost 60% of episodes, and the commonest foci of infection were the urinary tract (Esch. coli) and the respiratory tract (Str. pneumoniae). Esch. coli was particularly common in diabetic patients and Str. pneumoniae in alcoholics. In hospital-acquired septicaemia, Esch. coli and Staph. aureus accounted for 40% of episodes, but a further 30% were caused by enterobacteria other than Esch. coli, and Pseudomonas aeruginosa. The commonest foci of infection were the urinary tract, often with catheterization or instrumentation, and intravascular access sites, from which episodes of septicaemia were increasingly caused by coagulase-negative staphylococci.

Adolescent↗
PubMed1990

The antibiotic sensitivity of bacteria isolated from the blood of patients in St Thomas' Hospital, 1969-1988.

We have monitored the antibiotic sensitivity of bloodstream isolates of common bacteria over a period of 20 years. Among the Gram-positive bacteria, the proportion of isolates of Staphylococcus aureus resistant to methicillin, erythromycin, fusidate, or gentamicin has increased marginally, while that of coagulase-negative staphylococci (mostly Staph. epidermidis) has increased markedly. Enterococci are becoming serially more resistant to high concentrations of aminoglycosides. The Enterobacteriaceae have become considerably less sensitive to ampicillin (and amoxycillin) and trimethoprim but more sensitive to the aminoglycosides, whilst their susceptibility to cefotaxime, ceftazidime, cefepime, cefpirome, imipenem, meropenem and temocillin has remained constant. We have some evidence that in-vitro resistance is clinically relevant since the mortality rate rises if inappropriate antibiotics are used empirically. Although many drug regimens could be used, we are able to recommend initial therapy with a combination of gentamicin and cefuroxime for most of our patients, the exceptions being those known to be infected with resistant organisms before the onset of septicaemia.

Coagulase↗
PubMed1989

Neurological presentations of native valve endocarditis.

In a prospective study of 178 episodes of community-acquired native valve infective endocarditis seen at St Thomas' Hospital between 1969 and 1987, 59 patients (33 per cent) presented with neurological disorders that included meningitis, toxic confusion, major thromboembolic phenomena and headache. A neurological presentation occurred in 54 per cent of all cases of staphylococcal endocarditis, but in only 19 per cent of episodes of 'viridans' streptococcal and enterococcal endocarditis. Overall one-third of patients with staphylococcal endocarditis presented with clinical features of meningitis (40 per cent with no cardiac murmur). The mortality rate for community-acquired native valve endocarditis was higher for those with a neurological presentation than without.

Adolescent↗
PubMed1988

Epidemic multiresistant Escherichia coli infection in West Lambeth Health District.

A year-long outbreak of multiresistant Escherichia coli K52 H1, predominantly serogroup O15, is reported from south east London. Most patients had urinary tract infections, some with septicaemia; but some cases of septicaemia were associated with pneumonia, meningitis, and endocarditis--unusual infections for E coli. 3 of these patients died. The organism was acquired in the community, and its source is still being investigated.

Adolescent↗
PubMed1988

Meningitis after trans-sphenoidal excision of pituitary tumours.

Between 1974 and 1986, eleven of 114 patients undergoing trans-sphenoidal removal of pituitary tumours developed meningitis despite prophylaxis, usually with chloramphenicol. Nine patients had cerebrospinal fluid rhinorrhoea and one died. A variety of pathogens was isolated, including enterobacteria, and four of the eleven were resistant to the antibiotics given as prophylaxis. Enterobacterial meningitis was always associated with infection of the sphenoidal sinus involving the muscle graft or nasal pack (five cases), and removal of the muscle graft was necessary in three cases despite the use of appropriate antibiotics.

Adult↗
PubMed1986

An outbreak of Serratia marcescens transmitted by contaminated breast pumps in a special care baby unit.

Laboratory surveillance of clinical isolates for Serratia spp. revealed a sudden increase from babies in the Special Care Baby Unit (SCBU). It was established that breast-milk pumps on the post-natal wards were being disinfected inadequately, resulting in contamination of milk and cross-infection within the SCBU. Thirty babies were colonized and no deaths were attributable to the organism. Rectal carriage by the babies was common and often prolonged. The outbreak was brought under control when the method of disinfection of the pumps was changed from soaking in hypochlorite solution to washing at 80 degrees C.

Bacterial Infections↗