[Intravenous injections of tartaric acid sublimate in streptococcus pyogenes and staphylococcus aureus infections. 1899].
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S. aureus causative agent is relatively pathogenic to humans and is found on the skin and mucosa of up to 40% of all population. Burn injuries are infected with S. aureus in 30% of cases; however, in many cases the injuries heal without the antibiotic therapy, solely by applying dressing with antiseptic solutions, early removal of necrotic masses and covering the injury with a skin graft. In 2000, in the Division of Plastic Surgery and Burns of our institution, the frequency of S. aureus infection among patients with burns was 47%, of which methicillin-resistant S. aureus - 45%. The study included 100 patients who had S. aureus grown in the samples of their injuries. The article compares the severity of the trauma and the results of treatment in groups of patients with methicillin-resistant S. aureus and methicillin-sensitive S. aureus.
The therapeutic results of 41 cases of S. aureus infected burn wound (average 2.1% TBSA, approximately 200 cm2) treated with Mupirocin are reported in this paper. The effects of Mupirocin was obviously superior to that of SD-Ag used in control group. During the observation period the total effective rate of the studied group was 88.9% (control group: 70%, P < 0.05) and the bacterial clearance rate of S. aureus from the wound was 88.8% (control group: 40% P < 0.05). The sensitivity of 30 strains of S. aureus isolated from burn wounds to 11 varieties of antibiotics indicated that the sensitive rate to Mupirocin was as high as 92.68%, only lower that Vanconmycin. The bacteriological assay (MIC < or = 0.25 mg/L, MIC < or = 4 mg/L) also showed high sensitivity of S. aureus to Mupirocin. We suggest Mupirocin be the first choice of topical antibacterial agents for burn wound with S. aureus infection, especially for infection with MRSA.
A young woman did not seek emergency treatment after a minor automobile collision as she thought that she had been spared serious injury by the inflation of the driver's-side airbag. She had a benign-looking erythema on her neck which, over the next several days, became a second-degree chemical burn infected with Staphylococcus aureus. The burn and subsequent infection took several weeks to heal and the patient had to endure a prolonged course of antibiotics, nonsteroidal antiinflammatory drugs, and continued irrigation. This case exemplifies why alkali chemical burns from an automotive airbag should be treated aggressively, despite their benign appearance, as they may take several days to evolve. Physicians should be warned that careful follow-up examination of patients seen in the hospital emergency department or in the physician's office is necessary to abate any hidden sequelae. Of course, the opportunity to decrease morbidity is lost if the patient does not seek emergency treatment.
Staphylococcus aureus is an important pathogen of humans and other animals, causing bacteremia, abscessation, toxemia, and other infectious diseases. An animal model using CD-1 mice was developed to study the pathogenesis of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive Staphylococcus aureus (MSSA). When inoculated into the CD-1 mouse model, it was shown that both MSSA isolates, (HR 78 and CSA-1) and MRSA isolates (MRSA 456 and MRSA 457) led to chronic infection of the kidney. Female CD-1 mice inoculated with MRSA 456 proved to be more susceptible to infection and mortality than their male counterparts. Castrated mice became more susceptible to infection than intact male mice, suggesting a hormonal involvement in the infection process.
Isolates from 100 monomicrobial Staphylococcus aureus infections were tested for the production of TSST-1 and the enterotoxins A, B and C, which were found to be synthesized as a single toxin in 34 strains, or in combination of two or more toxins in 26. Acute phase sera and one or two further serum samples from 60 patients with toxigenic (either enterotoxins and/or TSST-1) S. aureus isolates were tested for humoral immune responses. Such immune responses occurred more frequently in septicemic than in localized staphylococcal infections, and more frequently against TSST-1 and the other enterotoxins than against enterotoxin A. Furthermore, the data suggest an immunological non-responsiveness to enterotoxin A in a considerable portion of the patients. The retrospective screening of the records of 15 selected patients for symptoms of Toxic-Shock-Syndrome revealed one case of probable TSS.
Epidemiologic investigation of 20 Staphylococcus infections among valvular and aortocoronary bypass graft patients indicated a broad spectrum of clinical illness in these two groups. The highest infection rate (9.3%) and case specific mortality rate (54.5%) were noted among those patients undergoing cardiovalvular replacement surgery with protheses. The median onset of infection was 6 days suggesting infection during the intraoperative period. Using the epidemiologic data from this investigation, a transmission pattern was formulated and a series of control measures designed to interdict the routes of transmission were instituted wigh marked success. These measures significantly reduced the incidence of S. epidermidis infections among these high risk patients.
Staphylococcus aureus causes persistent, recurrent infections (e.g., osteomyelitis) by forming biofilms. To survey the antibody-mediated immune response and identify those proteins that are immunogenic in an S. aureus biofilm infection, the tibias of rabbits were infected with methicillin-resistant S. aureus to produce chronic osteomyelitis. Sera were collected prior to infection and at 14, 28, and 42 days postinfection. The sera were used to perform Western blot assays on total protein from biofilm grown in vitro and separated by two-dimensional gel electrophoresis. Those proteins recognized by host antibodies in the harvested sera were identified via matrix-assisted laser desorption ionization-time of flight analysis. Using protein from mechanically disrupted total and fractionated biofilm protein samples, we identified 26 and 22 immunogens, respectively. These included a cell surface-associated beta-lactamase, lipoprotein, lipase, autolysin, and an ABC transporter lipoprotein. Studies were also performed using microarray analyses and confirmed the biofilm-specific up-regulation of most of these genes. Therefore, although the biofilm antigens are recognized by the immune system, the biofilm infection can persist. However, these proteins, when delivered as vaccines, may be important in directing the immune system toward an early and effective antibody-mediated response to prevent chronic S. aureus infections. Previous works have identified S. aureus proteins that are immunogenic during acute infections, such as sepsis. However, this is the first work to identify these immunogens during chronic S. aureus biofilm infections and to simultaneously show the global relationship between the antigens expressed during an in vivo infection and the corresponding in vitro transcriptomic and proteomic gene expression levels.
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A retrospective report regarding MRSA infections, related to wards and physicians in the hospital, was carried out. The number of the patients infected by MRSA in every wards was compared. Less patients with MRSA infection ware observed in the orthopaedic ward. An epidemiologic study using culture sampling of MRSA was performed at the isolated room for the patient with MRSA infection. Positive cultures were also detected in several areas in the ward, in addition to that room. Then the infection risk of every places in the hospital was suspected. Four cases of orthopaedic patients with MRSA were described.
Blood cells infiltrating secretory parenchyma of bovine mammary glands experimentally infected with Staphylococcus aureus were studied. Quantitative cytology demonstrated lymphocytes, plasma cells, monocytes, macrophages, and neutrophils more numerous in infected than control quarters and more prevalent at 10 than 2 days postinfection. These cells preferentially infiltrated the zone of the infected quarter closest to the gland cistern. Lymphocytes tended to remain associated with the epithelium, and many were within spaces between swollen secretory cells. Monocytes entered between alveolar epithelia and appeared to mature into macrophages and migrate to lumina where they contained milk constituents, degenerate neutrophils, and cocci. Neutrophils were observed primarily in alveolar lumina where many degenerated. Some neutrophils in various stages of degeneration also were lodged in the alveolar epithelium. Plasma cells were prevalent in infected tissue stroma, and most contained Immunoglobulin A which became more numerous as infection progressed. Our observations provide quantitative and ultrastructural information on cell types in bovine mastitis and are consistent with the concept of a cellular immune response to Staphylococcus aureus invasion.
BACKGROUND AND OBJECTIVE: Patients with diabetic foot infection (DFI) have a high rate of infection, up to 40%, with methicillin-resistant Staph. aureus (MRSA). Having noticed a definite increase of such patients in our special unit, we initiated a drastic change of hygienic measures and here report the results. PATIENTS AND METHODS: 788 patients with DFI (mean age 67.3 [32-90] years, 62% males) were admitted between 1.1.1999 and 31.7.2000. Before 31.7.1999, the following hygienic measures had been in place: cohort isolation, protective closing, implementation of general hygienic rules. Since 1.8.1999, modified measures have been undertaken: primary single-patient isolation, concentration in one ward of all patients with MRSA, medical care only by trained personnel, admission of patients only after microbiological results were known or primary solitary isolation. Algorithms were used for the transmission of all necessary information. RESULTS: MRSA was demonstrated in 64 patients. The number of infections during the hospital stay, before and after the change of hygienic measures were 9 (27%) and 2 patients (8%), respectively. The sites of MRSA colonisation and proven eradication were: nasopharynx only, 3 with 67% eradication; MRSA in a wound, 25 with 28% eradication. In comparison to the yearly statistic on wound healing in DFI 1999 (n=613) the following results are shown (patients with MRSA in brackets): healing rate with conservative treatment 61.5% (20%), minor-amputation 30.5% (52%), major-amputation 4.5% (22%), death 3.5% (6%). CONCLUSIONS: The rate of new infections were dramatically reduced by changing the hygienic measures. The rate of successful sanitation was unsatisfactoy. Patients with MRSA showed markedly poorer treatment results in respect to wound healing.
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