Biomedical subjects

Z Samra

Publications and source records attributed to Z Samra.

At least 55 records · Page 3Linked to original sources

PubMed1997

Septic shock in bacteremic patients: risk factors, features and prognosis.

Of 4,289 episodes of bacteremia detected in 3,631 patients, septic shock was diagnosed in 453 episodes (10.5%). In 56% of shock episodes, septic shock developed more than 24 h after the first positive blood culture was taken. In a logistic regression analysis, variables predictive of septic shock were: advanced age [odds ratio (OR) of 1.015 for an increment of 1 year]; renal failure as an underlying disorder (OR = 1.47); neutropenia (OR of 2.26); curtailed functional capacity (OR of 1.54 for an increment of 1 category); unknown source of infection (OR = 1.66); anaerobic (OR = 2.86), polymicrobial bacteremia (OR = 1.54), or pathogens other than Streptococcus viridans (OR = 0.08 for Streptococcus viridans). The in-hospital mortality associated with septic shock was 80% vs 21% in episodes of bacteremia without shock, and shock episodes accounted for 31% of all deaths. The fatality rate in shock patients given appropriate empiric antibiotic treatment was 74.9% vs 84.7% in patients given inappropriate treatment (p = 0.01). Judging by the present results, host factors are more important determinants for development of septic shock in bacteremic patients than the type of pathogen. Even in patients with shock, appropriate empiric antibiotic treatment was associated with an improved chance of survival.

Adult↗

PubMed1997

Chlamydia trachomatis infection during pregnancy: can it cause an intrauterine infection?

In an attempt to prove the presence of intrauterine fetal chlamydial infection, sera from 26 laboring women, who tested positive for cervical chlamydial antigen in the first half of their pregnancies, and from 43 laboring women with no evidence of such infection, and sera from the cord of their delivered infants were tested for chlamydial IgA-, IgG- and IgM-specific antibodies. Nine (34.6%) of the 26 women with positive cervical infection and 5 (11.6%) of the 43 women with no identifiable cervical infection had significant antibody levels at the time of the delivery. Three of the 26 (11.5%) babies born to the mothers with positive cervical chlamydial infection early in the pregnancy and high antibody titer at delivery were found to have anti-chlamydial antibodies in their cord serum, indicating intrauterine infection; cord sera from the other 43 babies were negative for these antibodies. These findings suggest a low but possible risk of intrauterine infection in the presence of lower genital infection during pregnancy.

Adult↗

PubMed1997

Penicillin-resistant pneumococcal meningitis in Israel.

Penicillin-resistant Streptococcus pneumoniae (PRP) is of worldwide concern. Treatment failures and fatalities of meningitis caused by PRP have been reported in other locations but not yet in Israel. We describe an 11-month-old infant with meningitis caused by PRP who failed to respond to initial treatment with cefotaxime. Vancomycin treatment caused a prompt cure. The minimal inhibitory concentrations of the isolate to penicillin, cefuroxime and cefotaxime were 1.0, 4.0 and 1.0 micrograms/ml, respectively. New guidelines for the treatment of meningitis in Israel are suggested.

Anti-Bacterial Agents↗

PubMed1996

Factors associated with increased risk in inappropriate empiric antibiotic treatment of childhood bacteraemia.

UNLABELLED: To identify bacteraemic children who are at increased risk of inappropriate empiric antibiotic therapy, we performed univariate and multivariate analyses of prospectively-studied bacteraemic episodes. Appropriateness of therapy was defined according to the in vitro susceptibility of the isolate. Inappropriate empiric therapy was found in 38% of 516 bacteraemic episodes and was associated with higher mortality. The rate of inappropriate treatment was lower in neonates and infants (28% and 33%, respectively) but higher in children 1- to 5-years old (51%, P = 0.0029). The rate was dependent on the source of bacteraemia (range, 18%-70%, P = 0.0092), underlying conditions (range, 26%-53%, P = 0.0001), the specific paediatric section in which the child was hospitalized (range, 24%-70%, P = 0.0002), and the causative micro-organism (range, 15%-75%, P < 0.0001). Four clinical variables that independently and significantly affected the rate of inappropriate antibiotic treatment were identified by multivariate stepwise logistic regression analysis (odds ratios in parentheses): hospital-acquired bacteraemia (2.3), age of 1- to 5-years (2.1), cytotoxic therapy (1.8) and presence of central i.v. line (1.6). CONCLUSION: We defined bacteraemic children who are at risk of inappropriate empiric antibiotic therapy. Special efforts are needed to improve their treatment and consequently their outcome.

Adolescent↗

PubMed1996

Treatment of Candida nail infection with terbinafine.

BACKGROUND: Terbinafine is a highly potent drug against dermatophytes. Data regarding its effectiveness against Candida species are few and variable. OBJECTIVE: Our purpose was to evaluate the efficacy and safety of oral terbinafine in patients with Candida nail infection. METHODS: In an open-label uncontrolled study, 20 patients completed 16 weeks of treatment with terbinafine, 250 mg/day, and an additional 8 weeks with placebo. Efficacy was assessed clinically and mycologically at weeks 0 (baseline), 4, 8, 16, 24, 36, and 48. Routine laboratory studies were performed at baseline and weeks 4, 8, and 16. RESULTS: At the end of the trial 60% of target nails were cured clinically and mycologically; in 10% there was mycologic cure with residual clinical signs, in 25% a moderate improvement (> 50%), and failure in only 5% (one patient). Most nails were infected by Candida parapsilosis. Two of 28 patients showed mild reversible elevation of liver enzymes 1 month after initiation of terbinafine treatment. CONCLUSION: The administration of terbinafine for 16 weeks is effective in the treatment of Candida nail infection. Liver enzyme values should be determined during the first month of treatment.

Administration, Oral↗

PubMed1996

A prospective study of Gram-negative bacteremia in children.

BACKGROUND: Hospital- and community-acquired Gram-negative bacteremia is a significant cause of mortality and morbidity in pediatric medical centers. Gram-negative organisms are isolated in > 50% of pediatric patients with bacteremia. OBJECTIVES: To analyze clinical and epidemiologic variables associated with Gram-negative bacteremia in a tertiary children's medical center. METHODS: A 6-year prospective study of children with Gram-negative bacteremia in a tertiary care children's medical center in Israel. RESULTS: Three hundred seventy-four episodes of Gram-negative bacteremia were studied during 6 years. The predominant isolates were Klebsiella pneumoniae, Pseudomonas aeruginosa and Escherichia coli, which accounted for 109, 81 and 79 episodes (26, 20 and 19%), respectively. Of all episodes 43% occurred in neonates and infants younger than 2 years and 47% were hospital-acquired. Underlying conditions mainly acute leukemia and lymphoma, were present in 55% of the patients. Urinary tract infection followed by lower respiratory tract infection were the most common identified sources of bacteremia. Central intravenous catheters were associated with 53% of the episodes. The crude mortality was 11.4%. Increased mortality was significantly associated with acute leukemia, neutropenia, hospital-acquired infections and previous corticosteroid therapy (P = 0.03, 0.003, 0.006 and 0.01, respectively). Increased antibiotic resistance of hospital-acquired vs community-acquired isolates was noted; 44 to 77% resistance of nosocomial Klebsiella and Enterobacter sp. to second and third generation cephalosporins and 18% were resistant to amikacin. CONCLUSIONS: Klebsiella pneumoniae is currently the most common organism causing Gram-negative bacteremia in children. Because of the relatively high resistance of Gram-negative organisms to second and third generation cephalosporins, we suggest that empiric antibiotic therapy for Gram-negative bacteremia include a combination of an aminoglycoside and an anti-Pseudomonas beta-lactam.

Adolescent↗

PubMed1996

Incidence and severity of group A streptococcal bacteremia in a medical center in Israel, 1981-1994.

To determine recent trends in the incidence and severity, group A streptococcal (GAS) bacteremia was studied over the last 14 years (1981-1994). There were 116 events of GAS bacteremia, representing 1.7% of all bacteremic episodes, without an increase in recent years. A total of 108 patients were available for study. Underlying conditions were found in 95 patients (88%), including mainly malignant diseases, chronic obstructive pulmonary disease, congestive heart failure and diabetes mellitus. A source of the bacteremia was noted in 71 patients (66%), with skin and soft tissue infection being the major portal of entry. All isolates were susceptible to penicillin. Overall mortality was 21%. Mortality had not increased in recent years, but depended significantly on several clinical factors: increased age; admission temperature; source of bacteremia (highest for GAS bacteremia without an identified source); and underlying conditions (highest for diabetes mellitus and chronic pulmonary disease, absent for patients with no underlying disease). This study shows that neither the incidence nor the severity of GAS bacteremia has increased in recent years. Severity is significantly affected by the source of bacteremia and the presence of underlying conditions.

Adolescent↗

PubMed1996

Helicobacter pylori infection and blood groups.

OBJECTIVES: Bacterial attachment is a prerequisite for colonization of the gastric epithelial surface. Recently, it was demonstrated that the receptor for Helicobacter pylori is the blood group antigen Lewis b, which is exposed only in blood group O. We prospectively examined the prevalence of blood groups in H. pylori-positive and -negative patients. To avoid a genetic bias, we compared blood group prevalence of our patients with the general population of Israel. METHODS: In the 187 consecutive patients we studied, in addition to regular upper endoscopy, H. pylori status and blood group. Exposure to H. pylori was diagnosed when the results of two or more of three methods were found to be positive. RESULTS: Exposure was found in 123 patients and 64 negative. The groups were similar in average age and origin, and no significant difference was demonstrated for blood group. Blood group distribution between any given origin was not significantly different in our patients and in a sample of 182,701 blood donors. CONCLUSIONS: Positivity for H. pylori was not associated with blood group O. Our observation does not support the conclusion that the receptor for H. pylori in the gastric mucosa is the blood group antigen Lewis b.

Adolescent↗

PubMed1995

Long-term survival following bacteremia or fungemia.

OBJECTIVE: To delineate long-term survival after an episode of bacteremia or fungemia and risk factors for mortality. DESIGN: Cohort study. SETTING: A 900-bed university hospital in Israel. PATIENTS: Study group comprising 1991 patients 18 years of age or older in whom bacteremia or fungemia were detected between March 1988 and October 1992, and a control group comprising 1991 inpatients without any infectious diseases, matched for age, sex, department, date of admission, and underlying disorders. INTERVENTIONS: None. MEASUREMENTS: Interval from the date of the first positive blood culture (study group) or from date of the identical hospital day (in the matched control patient) to the date of death as recorded in the Israeli National Population registry or, if alive, to June 1, 1994. RESULTS: The median age of patients was 72 years. In the study group, the mortality rate was 26% at 1 month, 43% at 6 months, 48% at 1 year, and 63% at 4 years, and the median survival was 16.2 months. In the control group, the mortality rate was 7% at 1 month, 27% at 1 year, and 42% at 4 years, and the median survival was greater than 75 months (P < .001). Factors significantly and independently associated with mortality in bacteremic patients were functional class (median survival, 0.5 month in bedridden patients), septic shock (median survival, 0.2 month), serum albumin (median survival, 1.1 months in the lowest quartile), serum creatinine (median survival, 2.9 months in the highest quartile), age (median survival, 2.9 months in the highest quartile [age > 80 years]), inappropriate empirical antibiotic treatment (median survival, 4.9 months), nosocomial infection (median survival, 9.6 months), and malignancy (median survival, 2.4 months). CONCLUSIONS: Bacteremia is associated with high short-term mortality, but also a sign of severely curtailed long-term prognosis, especially in patients with low functional capacity, low serum albumin, high serum creatinine, nosocomial infections, malignancy, inappropriate antimicrobial treatment, and septic shock and in elderly patients.

Adult↗

PubMed1995

Bacteraemia in a community and a university hospital.

Four hundred and forty-one and 1048 episodes of bacteraemia were prospectively surveyed over a period of 18 months in two hospitals, a 450 bed community hospital and a 900 bed tertiary care urban university hospital. Incidence of bacteraemia was 2.18 per 1000 hospitalization days (10.1 per 1000 admissions) in the community hospital and 2.64 per 1000 hospitalization days (12.0 per 1000 admissions (P < 0.004)) in the university hospital. Sixty six and 62% of episodes of bacteraemia were community acquired. The majority of bacteraemic episodes originated on the internal medicine wards of both hospital--46.7% and 58.7% respectively; the incidence of bacteraemia in the medical divisions of both hospitals was 23.1 and 17.5 per 1000 admissions respectively (P < 0.01). Overall mortality rates were 22% and 26.7% respectively. 39.9% and 44% of all isolates were Gram-positive pathogens. Escherichia coli was the commonest Gram-negative pathogen in both hospitals, particularly the community hospital--47.5% vs 32.8% (P < 0.005) of all Gram-negative pathogens, while Pseudomonas spp. were significantly more common in the university hospital--18.5% vs 11.8% (P < 0.02). Non-enterococcal streptococci were more common in the community hospital while enterococci were far more common at the university hospital--15.1% vs 1% of all Gram-positive pathogens (P < 0.05). Staphylococcus epidermidis was more common among the community hospital Gram-positive bacteraemias--31.1% vs 18.6% (P < 0.005). For almost all genera and species, antibiotic resistance was higher at the university hospital. Twenty nine point four per cent of Staphylococcus aureus isolates from the university hospital were methicillin resistant compared to 2.4% at the community hospital (P < 0.005). 29.4% of all Streptococcus pneumoniae isolates at the university hospital were penicillin resistant while no resistance was found at the community hospital. A high resistance rate to ofloxacin was found at the university hospital among S. aureus and Pseudomonas sp. Sources of bacteraemia did not differ significantly between the two hospitals. In conclusion, although outcome did not differ significantly for the two hospitals, there were significant differences between blood culture isolates in these two different settings. These differences may influence clinical decision-making about antibiotic therapy for patients in these hospitals.

Adult↗

PubMed1995

Increasing antimicrobial resistance of Shigella isolates in Israel during the period 1984 to 1992.

Recent (1984 to 1992) trends in the antimicrobial resistance of Shigella isolates in Israel were studied by analyzing the results of 106,000 stool cultures, 3,511 of which yielded Shigella spp. Over the study period, resistance to trimethoprim-sulfamethoxazole (TMP-SMX) increased from 59 to 92% (P = 0.0038) and that to ampicillin increased from 13 to 86% (P < 0.0001). Resistances to nalidixic acid, chloramphenicol, and broad-spectrum cephalosporins remained low. Shigella sonnei, which currently accounts for 90% of Shigella infections, was more resistant than S. flexneri to TMP-SMX (81 versus 57%, P < 10(-6)), ampicillin (42 versus 32%, P < 10(-5)), and tetracycline (38 versus 28%, P < 10(-5)). S. boydii and S. dysenteriae were relatively rare. Seasonality in antimicrobial resistance was found, with summer isolates being less resistant to TMP-SMX, ampicillin, or both than isolates obtained over the rest of the year (P < 10(-5)). We conclude that the resistance of shigellae, especially S. sonnei, to TMP-SMX and ampicillin is increasing to approximately 90%. Resistance should be recorded locally, and empiric therapy for suspected shigellosis should be changed accordingly.

Ampicillin↗

PubMed1995

Laser versus loop electrosurgical excision in vulvar condyloma for eradication of subclinical reservoir demonstrated by assay for 2'5' oligosynthetase human papillomavirus.

We studied, in an open clinical trial, 28 women with giant solitary human papillomavirus (HPV) lesions of the vulva that were treated by both laser and the loop electrosurgical excision procedure (LEEP), and analyzed the biopsy specimens of normal skin adjacent to the lesions for papillomavirus sequences by Southern blot hybridization and 2'-5' oligo-A synthetase (interferon) activity. The patients were reexamined after 3 weeks when a second treatment to the still infected areas was reapplied. They were reexamined for recurrence after 3 months: 4 patients harbored HPV-DNA genomes on the laser-treated side, adjacent to the original lesion, compared to 1 patient who developed recurrence on the LEEP side in a more distant, previously untreated, area. The optimal extent of laser or LEEP treatment necessary to reduce recurrence of vulvar condyloma remains to be established. Good in situ hybridization tests combined with the polymerase chain reaction and measurements of oligosynthetase activity to determine the types of cells involved at different sites of infection and to assess harboring of latent HPV genomes in histologically normal tissue are necessary in order to plan proper HPV treatment modality strategies.

2',5'-Oligoadenylate Synthetase↗

PubMed1995

Prognostic significance of the neutrophil count in immunocompetent patients with bacteraemia.

To examine the prevalence of neutropaenia in immunocompetent, bacteraemic patients, and whether it carries an independent risk for mortality, we surveyed 2096 bacteraemic patients without malignant diseases, and who were not receiving cytotoxic drugs. The granulocyte count on the day of the first positive blood culture was < 1 x 10(9) cells/l in 33 patients (1.7%, group 1); 1.0-4.0 x 10(9) cells/l in 154 patients (7.9%, group 2); 4.0-8.0 x 10(9) cells/l in 564 patients (29%, group 3); 8.0-20.0 x 10(9) cells/l in 1034 patients (53%, group 4); and > 20.0 x 10(9) cells/l in 163 patients (8.4%, group 5). The mortality rates in the five groups were 39.4%, 18.8%, 18.1%, 25.7% and 25.8%, respectively (p = 0.0001). The main pathogens in group 1 were Staphylococcus aureus in 25% of patients and Pseudomonas sp. in 23%. Mortality in group 1 patients was higher than in the other patients (odds ratio 1.4, 95% CI 1.1-1.9]. Mortality was also significantly higher in group 2 patients with high blood urea nitrogen. The percentage of neutropaenia, septic patients without known risk factors for neutropaenia is small, but their mortality is high. Overall mortality in patients with relative neutropaenia (1.0-4.0 x 10(9) cells/l) is low, but a subgroup of patients with high blood urea nitrogen is at considerable risk for a fatal outcome. High leucocyte counts are also a marker of increased risk for mortality, but this association is not an independent prognostic factor.

Adolescent↗

PubMed1994

Prevalence of genital chlamydia and mycoplasma infection in couples attending a male infertility clinic.

To investigate the prevalence of genital mycoplasma (Ureaplasma urealyticum and Mycoplasma hominis) and Chlamydia trachomatis infections in infertile and fertile couples, 135 infertile couples from a male infertility clinic and 88 fertile couples from a prenatal care clinic were randomly screened. Semen, urethral and cervical smears were cultured for genital mycoplasma and chlamydia. Antichlamydia IgA, IgG and IgM antibodies were tested in blood and semen. Although the overall prevalence of Ureaplasma urealyticum was higher than that of Mycoplasma hominis, the prevalence of Mycoplasma hominis was significantly higher in the infertile men and women. The prevalence of Chlamydia trachomatis, positive culture was higher in infertile couples, but this difference was not significant. The prevalence of serum-specific IgG was significantly higher in infertile than in fertile women (11.9 vs 3.4%, p < 0.05). Specific semen IgA was significantly higher in infertile than in fertile men (8.9 vs 1.1%, p < 0.015). A low rate of concordance between partners was found in Mycoplasma and Chlamydia culture, and in the same patient between seminal IgA and urethral culture. In conclusion it is necessary to check both culture and serology findings in both partners.

Adult↗

PubMed1994

The effect of topical ceftazidime on pseudomonas keratitis in rabbits.

Ceftazidime is a beta-lactam antibiotic highly effective against Pseudomonas aeruginosa infection. Using a rabbit model of Pseudomonas keratitis, 10(3) bacteria (in 20 microliters) were injected unilaterally into the corneal stroma of albino rabbits. Twenty-six hours after inoculation, topical Ceftazidime (50 mg/ml) drops were administered for 48 h, following which the corneal tissue was cultured. Eighteen of 20 corneal cultures (90%) from rabbits treated with Ceftazidime drops were negative. In comparison, all untreated control group cultures showed florid bacterial growth. These results suggest that topical Ceftazidime may be a useful agent in the treatment of P. aeruginosa keratitis.

Administration, Topical↗

PubMed1994

Autologous cord blood transfusion.

Newborn piglets were exsanguinated (60% of blood volume) and retransfused 1 h later. One test group received adult pig red blood cells, the other piglet cord blood cells; controls were infused with plasma. While all controls died, satisfactory results were achieved in piglets transfused with either adult or foetal blood. The feasibility of collecting human cord blood for transfusion was assessed in 100 samples of human cord blood. Blood was collected aseptically and aerobic and anaerobic cultures set up. All samples of cord blood were sterile, and all were Mycoplasma negative. Coagulation parameters were analysed in eight cord plasma samples stored at -20 degrees C for 45 days. No significant abnormalities were found immediately after birth or after storage.

Animals↗

PubMed1994

Efficacy of the placental barrier for immunoglobulins: correlations between maternal, paternal and fetal immunoglobulin levels.

The relationship of immunoglobulin levels in fetal and parental blood for those classes showing a high degree of placental impermeability was investigated in 430 mothers, their newborn infants (cord blood) and their husbands. Levels of IgA, IgD and IgM in maternal serum were unrelated to the sex of the offspring. IgE levels were significantly higher in mothers of male infants than in mothers of female infants (53 versus 40 IU/ml, p < 0.02). Significant correlations between maternal-fetal (r = 0.37; p < 0.01), paternal-fetal (r = 0.12; p < 0.02) and maternal-paternal IgE levels were found (r = 0.17; p < 0.02). For the levels of other immunoglobulins studied, the maternal-fetal correlations were not significant. The results support the effectiveness of the placental barrier for IgA, IgD, IgE and IgM. The significant correlation between IgE levels in mothers-newborns, fathers-newborns and mothers-fathers may be explained by the influence of the home milieu on the entire family, including the fetus.

Adult↗

PubMed1994

Mycoplasma and Chlamydia in adenoids and tonsils of children undergoing adenoidectomy or tonsillectomy.

The prevalence of mycoplasmal and chlamydial infection was assessed in 83 children undergoing adenoidectomy, tonsillectomy, or both procedures for recurrent adenotonsillitis or obstructive symptoms. Throat smears (surface specimens) and minced adenoids and tonsils (core specimens) were cultured for Mycoplasma spp and for Chlamydia spp. Isolation rates in adenoidal specimens were as follows: Mycoplasma hominis, surface 7.1% core 2.9%; and Ureaplasma urealyticum, surface 1.4%, core 2.9%. Mycoplasma hominis was also found in tonsillar specimens: surface 14.3%, core 20%. Chlamydia trachomatis was isolated only from a single core adenoidal specimen. The rate of mycoplasma isolation was significantly higher in children with recurrent adenotonsillitis (34.5%) than in those with obstructive symptoms (3.7%). Our findings document colonization of genital mycoplasmas in adenoids and tonsils of children with recurrent adenotonsillitis. Further studies are needed to evaluate the possible pathogenetic role of these microorganisms in adenotonsillar infection.

Adenoidectomy↗