Jay P. Sanford

Changing pharyngeal bacterial flora of hospitalized patients. Emergence of Gram-negative bacilli.

Abstract The prevalence of gram-negative bacilli among the oropharyngeal bacterial flora was low in physiologically normal subjects despite hospital exposure but rose markedly in patients with illnesses of varying severity. This increased prevalence was not correlated with antibiotic administration or inhalation therapy, was not dependent on duration of hospitalization and correlated best with the clinical severity of illness. Increased exposure to these organisms alone does not adequately explain these findings, suggesting that pharyngeal clearance mechanisms are impaired in these patients. Since most bacterial pneumonias begin with the aspiration into the lung of bacteria present in the upper respiratory tract, this alteration in the pharyngeal flora of ill patients may represent an important initial step in the pathogenesis of pneumonia due to gram-negative bacilli.

Localization of Urinary-Tract Infections by Detection of Antibody-Coated Bacteria in Urine Sediment

Abstract To evaluate the presence of antibody-coated bacteria in the urinary sediment as a means of localizing the site of urinary-tract infection, the results of examinations for antibody-coated bacteria were correlated with a direct method for localizing the infection site, the bladder washout. In 25 patients, the findings by both technics agreed; in only one case was there disagreement. In three patients the bladder-washout technic gave uninterpretable results. Thus, the presence of antibody-coated bacteria correlates closely with upper-urinary-tract involvement — i.e., renal bacteriuria. The technic appears to be a sensitive, reliable, noninvasive means of differentiating infection of the upper from that of the lower urinary tract. (N Engl J Med 290:591–593, 1974)

Adherence of bacteria to heart valves in vitro.

The abilities of 14 strains of aerobic gram-positive cocci and gram-negative bacilli to adhere in vitro to human or canine aortic valve leaflets were compared. 2-mm sections of excised valve leaflets were obtained by punch biopsy and were incubated under standardized conditions in suspensions of bacteria. Valve sections were subsequently washed and homogenized, and quantitative techniques were used to determine the proportions of bacteria from the initial suspensions that had adhered to the valve sections. Comparable results were obtained when these adherence ratios were determined by two independent methods based either on measurements of bacterial viability or of radioactivity in 51Cr-labeled bacteria. For each bacterial strain, the adherence ratio was constant over a wide range of concentrations of bacteria in the incubation medium. Strains of enterococci, viridans streptococci, coagulase-positive and coagulase-negative staphylococci and Pseudomonas aeruginosa (adherence ratios 0.003-0.017) were found to adhere more readily to valve sections than strains of Escherichia coli and Klebsiella pneumoniae (adherence ratios 0.00002-0.00004). The organisms that most frequently cause bacterial endocarditis were found to adhere best to heart valves in vitro, suggesting that the ability to adhere to valvular endothelium may be an important or essential charcteristic of bacteria that cause endocarditis in man.

Evaluation of the positive urine culture; an approach to the differentiation of significant bacteria from contaminants.

Abstract 1.1. A method for quantitative bacterial counts, using the agar pour plate technic as a part of the procedure for urine cultures, is described. This procedure offers advantages in the rational management of infections of the urinary tract. It also permits a more reliable evaluation of therapy. 2.2. A degree of bacteriuria approximating 1,000 viable organisms/ml. of urine is required for the certain diagnosis of infection. Extraluminal infections or subsiding urogenital infections may be associated with a lower urinary concentration of bacteria. 3.3. Quantitative studies have shown that the presence of a moderate number of bacteria on a stained smear is highly suggestive of significant bacteriuria. Pyuria during infection is variable and fails to correlate closely with clinically significant bacteriuria.

Mycobacterium fortuitum—A Human Pathogen

Abstract Mycobacterium fortuitumis often considered to be merely a saprophytic organism in spite of adequate evidence to the contrary. To illustrate the clinical manifestations and relative frequen...

Serratia marcescens infections from inhalation therapy medications: nosocomial outbreak.

Abstract An outbreak of nosocomial infections caused by non-pigmentedSerratia marcescensis described. There were 655 bacterial isolates from 374 patients during a 10-month period; 50.4% of isolates...

Tetanus — Forgotten but Not Gone

With so much concern about threats from emerging new infections and from antimicrobial resistance in common organisms, it is easy to become complacent about infections that are under control and ha...

Absence of serum gamma globulins in an adult.

THE syndrome of low serum gamma globulin in the presence of relatively normal quantities of the other protein factors has recently been described in children, but has not heretofore been observed i...

HOSPITAL-ACQUIRED URINARY-TRACT INFECTIONS.

Excerpt Advances in antimicrobial therapy have been accompanied by an increased frequency of infections due to micro-organisms which are resistant to commonly utilized antibiotics. Although such re...

Local immune response in experimental pyelonephritis

Experiments using an in vitro method of assessing protein synthesis by (14)C amino acid incorporation were designed to determine whether pyelonephritic kidneys were capable of local antibody production. Unilateral pyelonephritis was produced in rabbits by intravenous injection of E. coli 0-75 while one ureter was transiently occluded. The capability of protein and immunoglobulin synthesis by pyelonephritic kidneys, contralateral kidneys, normal kidneys, and spleens from normal and pyelonephritic animals was measured. Enhanced protein and immunoglobulin syntheses by pyelonephritic kidneys were first detected by the 11th day after infection and persisted through day 120. In individual experiments the pyelonephritic kidney produced 6-170 times more soluble protein than did the contralateral, uninfected kidney. In seven experiments, IgG comprised a mean of 72% of the total protein synthesized by the pyelonephritic kidney, compared with a mean of 19% in the contralateral kidney. IgA accounted for 10 and 9%, respectively. In these experiments 0.6-17% of the synthesized IgG was precipitable by somatic antigen of the E. coli 0-75. The capability of the pyelonephritic kidney to synthesize soluble protein was quantitatively similar to that of spleens from infected animals. The proportion of synthesized protein which was immunoglobulin G, however, was greater in the pyelonephritic kidney than in the spleen. Furthermore, specific antibody synthesis by the pyelonephritic kidney persisted longer than did synthesis by the spleen of the same animal. These studies provide evidence that in experimental pyelonephritis a significant local immune response occurs which is represented primarily by the production of IgG. Local immunoglobulin formation and specific antibody synthesis may be important factors in determining patterns of host resistance.