James A. Reinarz

Chronic Osteomyelitis caused by Staphylococcus Aureus: Controlled Clinical Trial of Nafcillin Therapy and Nafcillin-Rifampin Therapy

A controlled trial of treatment of chronic osteomyelitis caused by Staphylococcus aureus compared nafcillin alone with nafcillin plus rifampin for a six-week period. Treatment was well tolerated, the only adverse effect being mild neutropenia in four of 18 patients; no toxicity was observed from rifampin. Eight of ten patients in the combined treatment group had a favorable clinical response (with follow-up of two to four years) as compared to four of eight in the nafcillin group (P=.2). Despite the failure to show a statistically significant advantage of rifampin plus nafcillin, we conclude that the combination, along with appropriate surgery, should be considered for patients with chronic staphylococcal osteomyelitis.

Peritonitis during peritoneal dialysis the role of the preheating water bath.

Peritoneal dialysis has several potential complications including peritoneal infection. Assessment of this complication at UTMB during 116 patient hospitalizations revealed clinical peritonitis with positive bacterial cultures in 25% and positive peritoneal cultures in 45%. Because of the high incidence of peritonitis, an epidemiological evaluation strongly suggested a causal relationship with water baths used to preheat the dialysis solutions. To decrease exogenous contamination during preheating, the water baths were filled with 0.25% acetic acid which was changed every 8 hr. Analysis of the 50 subsequent hospitalizations indicated that clinical peritonitis was reduced to 10% (P < 0.05) and positive cultures to 28% (P < 0.02). The clinically important nosocomial infection may be prevented to a significant extent by aseptic care of dialysis bottles and tubing and by use of bacteriostatic solutions in the preheating water bath.

Total and Specific Immunoglobulin Response to Acute and Chronic Urinary Tract Infections in a Rat Model

Total and specific levels of immunoglobulins IgG, A and M were determined by an enzyme-linked immunosorbent assay (ELISA) in a rat model of urinary tract infections (cystitis) during the early and late phases of infection. The early response was characterized by rapid rise in IgM in serum and urine. This response decreased rapidly and was undetectable in urine after eight weeks. Correlation between total serum and urine levels of IgM was not found although a chronological relationship was observed. Total and specific serum and urine IgA responses were erratic. Concentrations of IgA were low and this antibody class was undetectable in urine until the infection had been established for six weeks. In contrast, total serum and urine IgG increased in concentration at five days post infection and reached total maximum by weeks four to eight, then declined, but remained detectable over 24 weeks. Specific IgG titers remained elevated in serum but declined in urine between four and 10 weeks. A correlation between total serum and total urine IgG was found. Also, bacteria generated a concomitant nonspecific response, a part of which was detected against a common antigen expressed on E. coli J5 strain that cross-reacts with a number of gram negative genera. The results show that IgM chronologically is the first antibody to appear in increased amounts in the serum and urine, followed by IgG. The data also suggests a relationship exists between total serum IgG and total urine IgG which may affect the hosts ability to eliminate urinary infection.

Enhanced recovery of pseudomonas from blood cultures

Abstract Pseudomonas and staphylococcal septicaemia are frequent complications of paediatric patients with significant burns. Early diagnosis and appropriate treatment afford the greatest likelihood of clinical response. Blood cultures from these patients may be negative or may become positive only after prolonged incubation. To evaluate more rapid culture methods for precise diagnosis, an in vitro study was done. The effects of venting and/or rotating on low inocula blood cultures was evaluated. Both venting and rotating contributed to more rapid bacterial growth and the effects were additive, affording a much more rapid and, therefore, potentially more useful culture method.

A new method for oral administration of nystatin in paediatric burn patients

Abstract A new method for the topical administration of an antimycotic agent—nystatin—to the oral mucosa is described. The commercially available forms of this drug have a bitter, unpleasant taste, and as a result, are normally not well tolerated by paediatric patients. The new formulation involves mixing nystatin oral suspension with one of the commercially available presweetened soft drink mixes. The resultant mixture is then frozen in the form of popsicles. This reformulation has the advantage of being readily accepted by the child and also provides an increased time of exposure in the oral cavity. In vitro studies validated and quantified the antimycotic action of both the original oral suspension and the new formulation. The new formulation provides a preferable method for the administration of nystatin to paediatric burn patients and may be useful for the administration of other unpalatable drugs to children as well as adults.