Arthur White

Propionibacterium acnes: Pathogen in central nervous system shunt infection: Report of three cases including immune complex glomerulonephritis

Propionibacterium acnes is a pleomorphic gram-positive anaerobic rod usually isolated as a contaminant from skin. We report three cases of P. acnes infection of central nervous system shunts for hydrocephalus. The organism was seen repeatedly on gram stain in a specimen of shunt fluid in all three cases; initially, it was regarded as a contaminant. In addition, two of the patients had precipitins to extracts of their organism. Serum from normal control subjects had no such precipitins. One of the patients had an immune-complex glomerulonephritis--an entity not previously associated with anaerobic organisms. All three patients recovered after removal of the shunt and treatment with antibiotics. P. acnes is a significant pathogen in patients with central nervous system shunts.

Solid-Phase Radioimmunoassay for Immunoglobulin G Staphylococcus aureus Antibody in Serious Staphylococcal Infection

Clinical features of 99 patients with staphylococcal infection were reviewed, and sera were tested by solid-phase radioimmunoassay and gel diffusion for staphylococcal antibodies to ascertain whether these variables predict the extent of infection and the need for prolonged therapy. Clinical features, including the presence of a primary site of infection or a continuous pattern of bacteremia, were not sufficient for differentiating endocarditis or complicated bacteremia from uncomplicated bacteremia. Patients with uncomplicated bacteremia were cured by 3 weeks of antibiotic therapy. Positive serologic tests for staphylococcal antibody helped distinguish patients with endocarditis or complicated bacteremia from patients with uncomplicated bacteremia. Radioimmunoassay was more sensitive than gel diffusion for identifying patients with complicated bacteremia. Our results indicate that patients with a positive antibody result 14 days after the onset of infection should be considered to have endocarditis or complicated bacteremia, but a negative antibody result would support short-term antibiotic therapy.

Studies on the origin of drug-resistant staphylococci in a mental hospital

Abstract A study was made of the effect of antibiotics on staphylococci from patients in a mental hospital where drugs had been used infrequently and the staphylococci were largely susceptible. Erythromycin, to which all cultures before treatment were susceptible, caused a complete suppression of the carrier state, and only a few resistant strains appeared subsequently. Penicillin, to which 10 per cent of strains were resistant before treatment, caused a drop in the carrier rate to 60 per cent, but the fall was limited at this point by an increase in strains resistant to penicillin. Tetracycline, to which 4 per cent of strains were resistant before treatment, caused a fall in carrier rates to 20 per cent at which point increase in resistant strains prevented further reduction. Following treatment, the carrier rates in treated patients increased and the frequency of resistant strains diminished. Treated non-carriers and non-treated carriers on the same ward did not change during therapy experiments. Successive treatment of patients with penicillin and tetracycline caused the appearance of a group of cultures resistant both to penicillin and tetracycline, of which a majority did not react with phage (no type). A high proportion of strains of phage type 52–80 susceptible to penicillin and tetracycline initially present in the ward completely disappeared after use of these agents.

KANAMYCIN: PHARMACOLOGICAL, MICROBIOLOGICAL, AND CLINICAL OBSERVATIONS*

Studies have been made in this laboratory of the absorption and excretion, microbiological, and clinical effects of kanamycht They indicate that substantially nontoxic doses provide serum and urine concentrations many times higher than in vitro inhibitory and bactericidal concentrations for many common pathogenic bacteria. Clinical studies, principally in cases of severe staphylococcal infection, have demonstrated significantly beneficial effects. The following report consists of a description of these observations.

The effect of antimicrobial drugs on the staphylococcal flora of hospital patients.

Excerpt An understanding of the role of drug resistance in current problems with staphylococcal infections will depend in part upon knowledge of the way in which antimicrobial therapy causes drug-r...

THE USE OF GENTAMICIN AS A NASAL OINTMENT.

Topical application of gentamicin was effective in reducing carrier rates in nasal carriers of coagulase-positive staphylococci.Reduction of carrier rates was accompanied by a reduction in the frequency of isolation of staphylococci from the skin and from the air around carriers.Topical application was effective in reducing carrier rate and dissemination of staphylococci in carriers of a wide variety of phage types and in carriers of staphylococci resistant to many of the available antibiotics.Le Uso de Gentamicina Como Unguento NasalLe application topic de gentamicina esseva efficace in reducer le proportion de portatores de staphylococcos coagulase-positive.Iste reduction esseva accompaniate de un reduction del frequentia del isolation de staphylococcos ab le pelle e le aere circum le portatores.Le application topic esseva efficace in reducer le proportion de portatores e. le dissemination de staphylococcos per portatores in le caso de un extense varietate de phagotypos, incluse staphylococcos resistente contra multes del currentemente existente antibioticos.

Prevention of infections of skin and skin structures

Treatment of nasal carriers of coagulase-positive staphylococci with a wide variety of topical systemic antibiotics suppressed these organisms only during treatment. Treatment of methicillin-sensitive or methicillin-resistant staphylococci with oral rifampin plus cloxacillin, vancomycin, fusidic acid, or trimethoprim-sulfamethoxazole eradicated the colonizing Staphylococcus aureus in approximately 80 percent of studies. An alternative approach is replacement of virulent S.aureus with the 502 A S. aureus strain. The latter approach has aborted epidemics of staphylococcal diseases in newborn nurseries and has prevented recurrent furunculosis.

Case Report: Multiple recurrences of nocardial pneumonia

A 47-year-old patient without underlying disease was first treated for nocardial pneumonia in 1970. She has had three relapses of nocardial pneumonia despite treatment with sulfasoxazole and tetracycline for nine, 15, and 12 months for the first three episodes. Therapy was continued two, 12, and nine months after chest roentgenograms returned to normal. The recurrences occurred two, 39, and 11 months after therapy was discontinued.

Serum and Subcutaneous Chamber Fluid Dynamics of Penicillins After Single Large Parenteral Doses

Serum and subcutaneous chamber fluid (CF) dynamics of penicillin G, ampicillin, and amoxicillin were studied in rabbits after single large parenteral doses comparable to doses used in treating gonorrhea and endocarditis. The effects of parenteral probenecid and of injection of an antibiotic directly into a subcutaneous chamber (“intrachamber” injection) also were studied. Peak serum antibiotic concentrations exceeded peak CF concentrations and occurred sooner. Antimicrobial activity persisted longer in CF than in serum. Percent penetration [100 × (CF peak/serum peak)] of CF was least after intramuscular ampicillin and amoxicillin, was greatest after intrachamber ampicillin and intrąmuscular aqueous procaine penicillin G, and was related to duration of antibiotic concentration gradients from serum to CF. Intramuscular aqueous crystalline penicillin G resulted in higher serum and CF penicillin G concentrations than intramuscular aqueous procaine penicillin G, which prolonged the duration of penicillin G in serum and CF. Amoxicillin diffused into CF more readily than ampicillin. Probenecid resulted in higher early serum and CF antibiotic concentrations, but had little or no effect on duration of antibiotic activity. Intrachamber ampicillin resulted in more prolonged serum and CF ampicillin activity than intramuscular ampicillin, but much lower peak serum concentrations. The data suggest a possible means by which probenecid improves the efficacy of gonorrhea therapy with aqueous procaine penicillin G. Intrachamber administration of penicillins could be useful in treating experimental infections requiring prolonged therapy.

Staphylococcal Teichoic Acid Antibodies in Serums of Patients with Diphtheroid Endocarditis

Excerpt To the editor: Earlier studies in this laboratory showed the usefulness of the double diffusion in agar (Ouchterlony) method for the detection of antibodies to ribitol teichoic acids in the...