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Biomedical subjects

Z Samra

Publications and source records attributed to Z Samra.

At least 73 records · Page 4Linked to original sources
PubMed1994

Bacteremia in patients without known underlying disorders.

Of 2030 consecutive patients with bacteremia, only 102 were free from underlying disorders. 43 were males, and the median age was 66 years. The sources of infection were the urinary tract (in 48%), lower respiratory tract (13%), endocarditis (7%), biliary tract (6%) and the meninges (5%). The most common pathogens were Escherichia coli (in 45% of patients), Streptococcus pneumoniae (21%), Staphylococcus aureus (9%) and hemolytic streptococci (9%). Overall mortality rate was 13%, 4% in patients with urinary tract infection and 19% in patients with other sources. Half of the deaths occurred within 2 days of hospitalization, and 75% of them within 4 days. All patients with septic shock and all patients with meningitis died. Other factors related to mortality were residence in a nursing home, low functional capacity, advanced age, high blood urea nitrogen and creatinine and low albumin, and infections caused by Staphylococcus aureus, Neisseria meningitidis and polymicrobial infections. A protective effect of appropriate antimicrobial antibiotic therapy could not be demonstrated. In conclusion, bacteremic patients with no known underlying disorder and source of their infection other than the urinary tract should be given maximum supportive treatment and should be closely watched.

Adult↗
PubMed1994

Fatal Shigella sepsis in a neutropenic patient.

Bacteremia during infection with Shigella is relatively rare and usually self-limited. Bacteremia during shigellosis bearing a high fatality rate has been reported in young infants and in persons with malnutrition or with the acquired immunodeficiency syndrome. We report a case of Shigella sonnei septicemia in a severely neutropenic patient who had fever, abdominal pain, diarrhea, malnutrition, and dehydration. She died after five days despite intensive care. We emphasize that Shigella should be considered among the possible pathogens causing sepsis in neutropenic patients.

Adult↗
PubMed1994

Childhood bacteremia in Israel: causes, age relation, predisposing factors and source.

To delineate the spectrum of childhood bacteremia in a tertiary medical center in Israel and to define the historical, clinical and environmental variables that affect it, 339 bacteremic episodes were studied. Ten of the episodes (3%) were polymicrobial and 148 (44%) were hospital acquired. Staphylococcus epidermidis (17%), Staph. aureus (10%), gram-negative bacilli and Haemophilus influenzae (7%) were the most frequent etiologic pathogens. Some organisms (e.g., H. influenzae, Streptococcus pneumoniae) caused mainly community-acquired bacteremia, while Klebsiella sp., Enterococcus faecalis, and Acinetobacter sp. caused mainly nosocomial bacteremia. Underlying conditions were noted in 72% of the bacteremic children. A source of the bacteremia was identified in 60% of the episodes; the most common was i.v.-line infection. Age, underlying condition, source and location in the hospital markedly affected the profile of microorganisms causing childhood bacteremia. Each of these variables defined 3-5 organisms that were most prominent. In each episode of suspected bacteremia, these variables should be considered, thus defining the most likely causative pathogen(s), which should be covered by appropriate empiric antimicrobial treatment.

Adolescent↗
PubMed1993

Antibiotic susceptibility and phage typing of methicillin-resistant Staphylococcus aureus clinical isolates from blood cultures of 692 patients in 15 Israeli hospitals.

Six hundred ninety-two clinical isolates of Staphylococcus aureus were collected from blood cultures of 692 patients in 15 Israeli hospitals over a two year period. Antibiotic sensitivity was tested by the standard disk diffusion technique. Of these isolates, 41.6% were methicillin-resistant (MRSA). All 288 MRSA isolates were sensitive to vancomycin and pristinomycin; 98.6% were sensitive to fucidine; 97.9% to imipenem; 79% to rifampicin; 63.6% to amikacin; 54.5% to augmentin; 36.4% to clindamycin; 12.6% to ciprofloxacin; 11.9% to cotrimoxazole and ofloxacin; 10.5% to gentamicin; 9.8% to erythromycin; and 8.4% to norfloxacin. Phage typing was determined by using the international set of phages. All the isolates that were sensitive to Group I phages, and 91.8% of those sensitive to Group II phages, were sensitive to methicillin. Of the isolates that were sensitive to Group III phages, 79.2% were methicillin-resistant and 72.4% of the latter were sensitive to phages 75/85. Of the isolates that were sensitive to Group III and miscellaneous phages, 50.7% were methicillin-resistant and 71% of the latter were sensitive to phages 75/85 as well.

Anti-Bacterial Agents↗
PubMed1993

Diagnosis of Mycoplasma pneumoniae infection by specific IgM antibodies using a new capture-enzyme-immunoassay.

A total of 1226 sera from 1055 patients with respiratory tract infections were tested. IgM antibodies were detected by an antibody-capture enzyme-immunoassay (Mp TEST, Diatech Diagnostica Ltd, Israel). Acute infection with IgM antibodies to Mycoplasma pneumoniae was detected in 211 patients. Presence of IgM was closely associated to some or all pneumonia-related symptoms. Eighty-one of IgM-positive patients treated with tetracycline or erythromycin responded positively. Of the 211 patients, 63 (30%) had low levels and 23 (11%) had moderate levels of IgM antibodies already in the first serum sample. In these 86 patients (41%) the complement fixation (CF) test was negative or very low positive. Thus in these cases, the CF test would have missed the early diagnosis in the first serum samples.

Antibodies, Bacterial↗
PubMed1993

An outbreak of multiresistant Klebsiella in a neonatal intensive care unit.

An outbreak of multiresistant Klebsiella pneumoniae occurring in a neonatal intensive care unit is described. All infections developed at least 5 days after admission to the unit (range, 5-40 days). Four infants had septicaemia and one had urinary tract infection. Three of the infected infants died. All klebsiella isolates were resistant to ampicillin, cefotaxime, cefuroxime, co-amoxiclav, mezlocillin, chloramphenicol, gentamicin, and ceftazidime (except in two); all were susceptible to imipenem, amikacin and quinolones. An extensive case-control study identified the following significant risk factors for colonization: prematurity; presence of indwelling catheters; previous antibiotic treatment; and parenteral nutrition. The outbreak was controlled with re-emphasis on strict handwashing practices, cohorting, closure of the unit to outborn admissions, and changing the regimen of empirical antibiotic therapy. Physicians should be aware of multiresistant Klebsiella spp. and change treatment whenever clinically indicated, even before culture results are available.

Cross Infection↗
PubMed1993

A randomized, double-blind study comparing cefixime and trimethoprim-sulfamethoxazole in the treatment of childhood shigellosis.

We compared the clinical and bacteriologic response of 5-day treatment with cefixime, 8 mg/kg per day, with the response to trimethoprim-sulfamethoxazole (TMP-SMX), 10-50 mg/kg per day, the currently recommended therapy. Of the assessable children with acute, culture-proven shigellosis, 38 received cefixime and 39 received TMP-SMX. Pretreatment data on the two study groups were similar. In the first group, all isolates were susceptible to cefixime; in the TMP-SMX group, 32 isolates were resistant and 7 were susceptible to TMP-SMX. Clinical response (day 5) showed cure, improvement, and failure in 89%, 8%, and 3%, respectively, of the cefixime group, and in 25%, 44%, and 31%, respectively, of the TMP-SMX-resistant group (p < 0.001). Bacteriologic cure (day 3) occurred in 78% and 23% of the cefixime and TMP-SMX-resistant groups, respectively (p < 0.001). Clinical or bacteriologic relapse (day 12) was infrequent in both groups. The response to treatment of the cefixime and the TMP-SMX-susceptible groups was similar. No significant side effects were noted. We conclude that cefixime is superior to TMP-SMX in the treatment of suspected shigellosis in areas with a high rate of resistance to TMP-SMX.

Adolescent↗
PubMed1993

Mycobacterium simiae infection in Israeli patients with AIDS.

Mycobacterium simiae is an environmental organism that has rarely been associated with human disease. In Israel M. simiae is frequently isolated from clinical specimens, and it usually colonizes damaged lungs. Until now, only two cases of AIDS patients with M. simiae infection have been reported, and these patients were coinfected with Mycobacterium avium complex. Two Israeli patients with AIDS complicating hemophilia developed prolonged fever that was unresponsive to therapy with broad-spectrum antibiotics. One of them had cavitary pulmonary infiltrates. M. simiae was isolated from blood in both cases and from sputum and bone marrow in one case. The identity of the mycobacterium was confirmed at three reference laboratories. Both patients died of the infection. Thus, the possibility of M. simiae infection should be considered for AIDS patients who live in areas where this mycobacterium is prevalent.

AIDS-Related Opportunistic Infections↗
PubMed1993

Recent trends in the epidemiology of Shigella species in Israel.

Trends in the epidemiology of infections due to Shigella species over a period of 6 years (1986-1991) in Israel were studied by analysis of the results of 51,300 stool cultures, of which 2,987 yielded Shigella species. In a university hospital, the relative prevalence of Shigella sonnei in patients with shigellosis increased over the years from 60% in 1986 to 91% in 1991 (r = 0.93; P = .007); concomitantly, the prevalence of Shigella flexneri decreased from 29% to only 8% (r = -0.80; P < .05). In the community, the increase in prevalence of S. sonnei was more moderate and occurred only from 1989 to 1991. Since 1990, S. sonnei has been isolated from more hospitalized patients than has S. flexneri, in contrast to their rates of isolation in the past. The increase in prevalence of S. sonnei was most prominent among children, in whom it caused 94% of shigella infections in 1991. Shigella boydii and Shigella dysenteriae remained relatively rare, causing approximately 5% and approximately 1%, respectively, of the cases of shigella infection. Concomitantly, the antimicrobial resistance of S. sonnei has become significantly greater, and it is currently 2.7 and 1.6 times higher than that of S. flexneri to trimethoprim-sulfamethoxazole and ampicillin, respectively. We conclude that the relative frequency of S. sonnei is increasing, especially in hospitalized patients, and hypothesize that this may be related to its increasing antimicrobial resistance. These trends have clinical implications.

Adult↗
PubMed1993

Bacterial vaginosis in pregnancy treated with yoghurt.

As various drugs might have an effect on the fetus during pregnancy, the use of drugs should be minimized in the pregnant woman. Since bacterial vaginosis (BV) can be associated with prematurity and postpartum complications, we searched for alternative therapy for its cure during pregnancy. Commercial yoghurt incorporates both factors necessary for maintaining the protective mechanism of the vagina, vaginal pH and lactobacillus. A total of 32 women with BV in the first trimester of pregnancy were treated with intravaginal application of yoghurt. The result was favorable indicating that the continuous correction of vaginal pH and lactobacillus flora is crucial for normal vaginal ecology. During pregnancy, a local treatment restoring the normal acidity and vaginal flora, without systemic effect, may be preferable to any other treatment.

Adult↗
PubMed1992

IgA antichlamydia antibodies as a diagnostic tool for monitoring of active chlamydial infection.

Chlamydia trachomatis isolation in culture is the best means of chlamydial infection diagnosis. Antichlamydial antibodies, if present, may also serve as diagnostic markers. In eleven patients with positive C. trachomatis culture and serological positive response, specific IgA and IgG antibody titers were measured before and after treatment. In all cases, cultures became negative after treatment and IgA titers decreased rapidly, while IgG levels remained high. Thus, presence of specific IgA antibodies in a single sample may serve as a diagnostic tool for monitoring of active chlamydial infection.

Adult↗
PubMed1992

Patterns of multiple resistance to antibiotics in gram-negative bacteria demonstrated by factor analysis.

Principal component analysis was used to demonstrate the main associations between patterns of resistance to antibiotic drugs in 670 gram-negative bacteria consecutively isolated from blood cultures over a period of two years. Six factors were derived, which accounted for 84% of the total variance of the original matrix. Each factor represented an association between resistance to certain antibiotics as follows: factor 1: aztreonam, third generation cephalosporins and aminoglycosides; factor 2: first and second generation cephalosporins; factor 3: tetracycline and chloramphenicol; factor 4: ampicillin and ureidopenicillins; factor 5: trimethoprim/sulfamethoxazole; factor 6: fluoroquinolones. On two-way analysis of variance the difference in the factor scores was significant between bacteria for all factors except factor 5. The difference in factor scores between community and hospital acquired strains was significant only for factors 1, 2 and 6. Only the score of factor 6 showed a clear trend to increase with time during the two-year study period. Patients who were treated with antibiotics prior to bacteremia had higher scores for all factors, the difference being most marked in patients treated with fluoroquinolones. Factor analysis can be used to describe phenotypic associations between resistance to antibiotics, and the factor score used to compare groups of isolates and to demonstrate temporal and other trends.

Ampicillin↗
PubMed1992

Bacteremia and fungemia of unknown origin in adults.

Two hundred fifteen (23%) of 955 episodes of bacteremia (defined as including fungemia) detected in adult patients during 2 years were of unknown origin. Sixty-six percent of episodes of unknown origin were hospital acquired. The median age of patients with bacteremia of unknown origin was 65 years, and their most common underlying disorders were solid malignancy (28% of patients) and diabetes mellitus (18%). Only three factors were associated with bacteremia of unknown origin (as opposed to episodes with a known source): peripheral venous catheterization, hemodialysis, and plasmapheresis. Gram-negative bacteria were isolated from the blood in 62% of episodes of unknown origin; 10% of episodes were polymicrobial. Staphylococci were isolated from 67% of patients undergoing hemodialysis and from 37% of those with diabetes; Pseudomonas species from 15% of patients with hospital-acquired episodes; and Candida species from 21% of patients with a central venous catheter. Fifteen percent of episodes in cancer patients were polymicrobial. Empirical antibiotic treatment was inappropriate in 49% of episodes of unknown origin and in 35% of episodes with a known source (P less than .001). Death rates were 44% and 25% in episodes of unknown and known origin, respectively. An unknown source of bacteremia was independently associated with a fatal outcome.

Adolescent↗
PubMed1992

Risk factors for mortality due to bacteremia and fungemia in childhood.

To define risk factors for mortality due to bacteremia and fungemia of childhood, 242 episodes (for which the mortality rate was 19%) were studied prospectively by univariate and multivariate analyses. The mortality rate was higher in neonates (23%) and in individuals 10-18 years old (26%) than in infants and young children (10%-16%). The mortality rate was 29% for children who had neutropenia, 29% for those who had received therapy with steroids, 26% for those who had received antibiotics, and 75% for those who were in septic shock. The fatality rates for polymicrobial bacteremia (40%), recurrent bacteremia (67%), and hospital-acquired bacteremia (28%) were higher than those for other types of bacteremia; the fatality rate was related to inappropriate empiric antibiotic treatment or to the specific organism isolated (mortality rates associated with the latter ranged from 0 to 60%). Seven variables that independently and significantly affected mortality were defined with use of multivariate logistic regression analysis: septic shock (odds ratio [OR], 26.4); polymicrobial (OR, 5.4), recurrent (OR, 4.5), or hospital-acquired (OR, 4.3) bacteremia; candidemia (OR, 3.6); inappropriate antibiotic treatment (OR, 2.4); and neutropenia (OR, 2.3). These variables should be considered for adequate management of bacteremic patients who are at high risk for death.

Adolescent↗
PubMed1992

Patients at risk for inappropriate antibiotic treatment of bacteraemia.

In order to define patients at high risk for inappropriate antibiotic treatment of bacteraemia, we compared 682 bacteraemic patients, treated with an antibiotic drug to which the infecting micro-organism was susceptible, with 419 patients who were inappropriately treated. On a multivariate logistic regression analysis including only clinical variables, four factors were found to be both significantly and independently associated with inappropriate antibiotic treatment: hospital-acquired bacteraemia (odds-ratio (OR) of 1.9), antibiotic treatment in the month prior to the bacteraemia (OR 1.9), residence in a nursing home (OR 1.8), and the presence of a central line (OR 1.7). A second model, including bacteriological data, showed four micro-organisms to be independently associated with inappropriate antibiotic treatment: Candida sp. (OR 14.2), Acinetobacter sp. (OR 5.0), Enterococcus sp. (OR 3.6) and Pseudomonas sp. (OR 2.2). In this model, only two clinical features were included: hospital-acquired infection and previous antibiotic treatment. Special efforts should be made to improve empirical antibiotic treatment in the groups defined above, and to facilitate early laboratory diagnosis of the micro-organisms associated with inappropriate treatment.

Anti-Bacterial Agents↗