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Biomedical subjects

W S Joseph

Publications and source records attributed to W S Joseph.

12 recordsLinked to original sources
PubMed1992

Treatment of lower extremity infections in diabetics.

The infected diabetic lower extremity has enjoyed a surge in popularity in the medical literature. There have been numerous papers outlining classification systems for ulcer depth, surgical approaches, and microbiology. Discussions on antibiotic use have usually been directed toward therapy of the "diabetic foot infections" as a group, without regard to differences in severity and location of these infections. These infections can vary from the most superficial of processes to a severe life- and limb-threatening sepsis. The author presents a review of the processes involved in the diabetic lower extremity infection and suggests a classification system for selection of empiric antibiotic therapy based on the severity of the infection.

Algorithms↗
PubMed1991

Treatment of lower extremity infections in diabetics.

Despite recent medical advances in the treatment of diabetes mellitus, foot infection remains a major cause of morbidity and mortality in patients with this disorder. Three main factors are responsible for this: neuropathy, angiopathy and immunopathy. Neuropathy is probably the most important factor: minor irritations and trauma can lead to limb-threatening infections without the patient feeling the changes. Angiopathy plays only a minor role, while immunopathy has implications for antibiotic treatment, in that bactericidal agents are needed. A classification scheme that incorporates clinical and laboratory findings can direct the selection of empirical antibiotic therapy in patients with foot infections. These infections may be defined as mild, moderate and severe. In less severe cases, there are effective oral agents that can stop the progress of the infection and obviate the need for patient hospitalisation. Moderate to severe infections require hospitalisation with the use of parenteral agents. With some of the new broad spectrum drugs, single agent therapy is now possible, eliminating the need for expensive, potentially toxic combinations. Antibiotics, however, are only part of the cure. Aggressive surgical debridement followed by conscientious local wound care plays an equal role. The ultimate goal is foot salvage, and the clinical judgement of the practitioner is paramount in determining the treatment strategies needed to achieve this objective.

Algorithms↗
PubMed1990

Bite wound infections of the lower extremity.

Animal bite wounds of the lower extremity are considered high-risk wounds for infection, especially in the medically compromised individual. Management should be aggressive. Copious irrigation and debridement of the wound clearly proves to be of greater value in the prevention of infection than the indiscriminate use of so-called "prophylactic" antibiotic agents. Frankly infected wounds must also be managed aggressively, incorporating the use of antibiotics to eradicate the infection. Empiric use of an agent containing clavulanic acid or sulbactam is suggested until results are obtained from the bacterial culture and sensitivity. Tetanus prophylaxis should be considered for every bite wound, whereas rabies prophylaxis is warranted in selected cases.

Adult↗
PubMed1990

Microbiology and antimicrobial therapy of diabetic foot infections.

Infections of the foot in the person with diabetes are the result of a complex myriad of pathophysiologic alterations. Neuropathy, vascular disease, and host immune alterations all interact to present a fertile ground for significant microbiologic invasion. When infection occurs, it is commonly due to a mixed flora of aerobic and anaerobic organisms, although "pure" aerobic or anaerobic infections are sometimes seen. Treatment of these infections requires a broad approach, including surgery, local care, and antibiotics. Most often, treatment against aerobic and anaerobic pathogens will be necessary. These infections can be divided into two categories based on clinical appearance. Severe life- or limb-threatening infections can present with massive cellulitis of the foot and leg, high fever, significantly elevated white blood count, septicemia, and tissue gas. Appropriate antibiotics in this setting include either combination or single-agent therapy. Imipenem/cilastatin offers coverage of all usual pathogens along with potentially lower toxicity and lower cost than combinations. Combinations containing clindamycin and aztreonam or ciprofloxacin may be useful for patients allergic to beta-lactam antibiotics. Less severe infections can usually be treated with a single-agent antibiotic such as ticarcillin/clavulanic acid or ampicillin/sulbactam. Cephalosporins with anaerobic activity, including cefoxitin, cefotaxime, and ceftizoxime, can be used in areas where enterococci are not a major problem.

Anti-Bacterial Agents↗
PubMed1989

Clinical and laboratory diagnosis of lower extremity infections.

By following a systematic approach to the patient history, physical examination, and laboratory analysis in cases of infections, rapid and accurate therapeutic intervention becomes possible. This action can prevent possibly devastating infectious complications, ranging from partial amputation to death. The current litigious climate dictates thorough evaluation and documentation of all infectious diseases of the lower extremity.

Bacterial Infections↗
PubMed1988

Clinical imaging with indium 111 oxine-labeled leukocyte scan: review and case report.

The clinical use and mechanisms of action of technetium 99m pyrophosphate, gallium 67 citrate, and indium 111 oxine have been presented. The diagnosis of osteomyelitis in the lower extremity can often be made on the basis of clinical, laboratory, and conventional radiographic evaluations. In the case report of diabetic osteolysis, initial evaluations revealed osteomyelitis. The use of scanning involving leukocytes labeled with technetium and indium 111 oxine lessened the possibilities of an osseous infection. Studies show the sensitivity, specificity, and accuracy of scans using leukocytes labeled with indium 111 oxine to be superior to those of any other form of nucleotide imaging, but further clinical research is needed.

Adult↗
PubMed1986

Comparative in vitro antimicrobial activity of carumonam, a new monocyclic beta-lactam.

The antimicrobial activity of carumonam (formerly RO-17-2301), a monocyclic beta-lactam antibiotic, was compared with those of aztreonam, cefotaxime, cefoperazone, ceftazidime, piperacillin, and gentamicin against 455 bacterial isolates. Carumonam did not possess activity against gram-positive cocci and was generally comparable to aztreonam and ceftazidime for most gram-negative bacilli. However, carumonam was the most active beta-lactam against gentamicin-resistant Pseudomonas aeruginosa strains (90% MIC, 8 micrograms/ml).

Anti-Bacterial Agents↗
PubMed1986

In vitro activity of A-56619 and A56620, two new aryl-fluoroquinolone antimicrobial agents.

The in vitro antimicrobial activity of two new aryl-fluoroquinolone antibiotics, A-56619 and A-56620, was compared with those of norfloxacin and several other antibiotics against 448 bacterial isolates. A-56620 was the most active agent tested. The usual 90% MIC of A-56620 was less than or equal to 2 micrograms/ml, except for enterococci, gentamicin-resistant Serratia marcescens, and gentamicin-resistant Pseudomonas aeruginosa, for which the 90% MIC was 4 micrograms/ml. A-56619 and norfloxacin were generally severalfold less active than A-56620. Cross resistance was observed between the quinolone antibiotics and other unrelated antibiotic classes.

Anti-Bacterial Agents↗
PubMed1986

Osteomyelitis.

Explore the source record for details and available documents.

Adult↗
PubMedDate not supplied

Infections complicating puncture wounds of the foot.

Pedal puncture wounds are a relatively common injury seen predominantly during the warm weather months and in children. Although most of these injuries heal completely with no sequelae, up to 10% may become infected and produce late complications. Of these, osteomyelitis caused by P. aeruginosa is the most devastating, and it may progress to bone destruction that will require extensive surgical debridement. If instituted early, adequate primary care usually provides the best chance of prevention of these infections.

Anti-Bacterial Agents↗