Marinella Cummings

Risk factors for prematurity and premature rupture of membranes a prospective study of the vaginal flora in pregnancy

Prematurity remains a major cause of perinatal mortality in the United States. Some research has indicated that infectious agents play a role in either initiating preterm labor, causing premature rupture of the membranes, or preventing tocolysis. This study attempted to determine if the presence of various vaginal pathogens in early pregnancy was associated with the subsequent development of premature rupture of membranes or preterm labor. We found that among 233 evaluable patients those with Trichomonas vaginalis were significantly more likely to have premature rupture of the membranes (p less than 0.03), and those with Bacteroides sp. were more likely to be delivered of their infants before 37 weeks (p less than 0.03) and to have infants weighing less than 2500 gm (p less than 0.05). Those with Ureaplasma urealyticum more frequently began preterm labor (p less than 0.05). Preterm premature rupture of the membranes was found significantly more often among patients with Bacteroides sp. Stepwise multiple logistic regression analysis indicated that those associations were not related to the number of previous abortions, deliveries, or preterm deliveries or to maternal age. We conclude that microbiologic screening in early pregnancy may aid in the assessment of patient risk for preterm delivery.

Mycoplasma hominis and Ureaplasma urealyticum in neonates with suspected infection

The role of genital mycoplasmas in the pathogenesis of neonatal infection is incompletely understood. We performed nasopharyngeal, blood and cerebrospinal fluid (CSF) cultures for Mycoplasma hominis and Ureaplasma urealyticum in 69 neonates who underwent a diagnostic workup for suspected sepsis. The mean gestational age was 35.9 weeks (range, 25 to 42 weeks) with a mean birth weight of 2386 g (range, 652 to 4420 g). Twenty-seven infants (39.1%) had positive nasopharyngeal cultures; 6 were positive for M. hominis, 10 for U. urealyticum and 11 for both organisms. Seven (26%) of these 27 patients developed chronic lung disease compared with 2 (4.7%) infants in the non-colonized group. Nine infants had positive CSF cultures for M. hominis and one infant had a positive CSF culture for U. urealyticum. All blood cultures were sterile. One of the infants with a positive CSF culture for M. hominis had clinical evidence of systemic infection. All of the infants were treated with antibiotic agents that were not active against mycoplasmas. These data indicate that genital mycoplasmas can be found commonly in the CSF and nasopharynx of infants with suspected sepsis. Their etiologic role in the causation of infection and chronic lung disease, however, remains unclear.

Comparison of methods for the detection of treponema pallidum in lesions of early syphilis.

Background: The clinical diagnosis of primary and secondary syphilis can be difficult because of the wide variability of lesions. The available laboratory tests (dark‐field microscopy and direct fluorescent antibody) require specialized microscopes and skilled technicians, and serologic tests are insensitive in early infection. Methods: Dark‐field microscopy and monoclonal antibody staining were compared to a new solid‐phase enzyme‐linked immunosorbent assay (Visuwell test) for detection of T. pallidum in lesion exudate of 188 patients with genital lesions. Results: Sixty‐four patients (34%) had lesions of early syphilis diagnosed by either dark‐field, monoclonal antibody staining, or both. The Visuwell test and dark‐field examination were positive in 52 (81.3%) and 55 (85.9%) of the 64 patients, respectively, whereas the monoclonal antibody staining technique demonstrated the presence of T. pallidum in 59 (92.2%) of the 64 patients. The Visuwell test gave a negative result in 111 of 124 patients who had negative dark‐field and direct fluorescent antibody test results (89.5% specificity). Conclusions: The Visuwell test is an alternative method for evaluating genital ulcers but is less sensitive and specific than existing tests.

Comparison of ofloxacin and ceftriaxone in the treatment of uncomplicated gonorrhea caused by penicillinase-producing and non-penicillinase-producing strains.

Eighty-nine patients with uncomplicated gonorrhea, including 31 patients (34.8%) infected with penicillinase-producing strains of Neisseria gonorrhoeae, were treated with oral ofloxacin (single 400-mg dose) or intramuscular ceftriaxone (250-mg dose). All 47 patients who received ofloxacin and 41 of 42 patients who received ceftriaxone were cured.

Susceptibility of dematiaceous fungi to amphotericin B, miconazole, ketoconazole, flucytosine and rifampin alone and in combination

The dematiaceous fungi comprise a group of organisms that are deeply pigmented and found in soil or on decaying organic material, such as wood. The majority of infections with these fungi presumably results from traumatic inoculation. Although various forms of infection have been appreciated for some time, none of the presently available antifungal drugs have been shown to have predictable activity against these organisms. We report on the activity in vitro of various antifungal agents alone and in combination against various dematiaceous fungi.

Colonization of sexually abused children with genital mycoplasmas

Although sexually abused children are usually evaluated only for the presence of infections with Neisseria gonorrhoeae and Treponema pallidum, they are also at risk for acquiring other sexually transmitted organisms prevalent in the adult population. Accordingly, we examined pharyngeal, anorectal and genital specimens from 50 children who had been sexually abused and from 40 healthy children who served as controls; these specimens were cultured for Mycoplasma hominis and Ureaplasma urealyticum. M. hominis was isolated from the anorectal and vaginal cultures of 11 (23%) and 16 (34%), respectively, of 47 abused girls as compared with three (8%) and six (17%), respectively, of 36 controls. U. urealyticum was isolated from the anorectal and vaginal cultures of nine (19%) and 14 (30%), respectively, of the abused girls as compared with one (3%) and three (8%), respectively, of 36 controls. Colonization with genital mycoplasmas was not associated with any symptoms.

Susceptibility of Multiply Antibiotic-Resistant Pneumococci to the New Beta-Lactam Drugs and Rosaramicin

Eight new beta-lactam antibiotics and rosaramicin were tested for their activity against penicillin-susceptible and multiply resistant pneumococci. All of the beta-lactam drugs were 50- to 150-fold less active against the drug-resistant pneumococci when compared with their activity against penicillin-susceptible pneumococci. Rosaramicin activity was similar to that of erythromycin.

Comparative evaluation of ofloxacin and metronidazole in the treatment of bacterial vaginosis

BACKGROUND AND OBJECTIVES The epidemiology and etiology of bacterial vaginosis is poorly understood. Many antimicrobial agents have been studied and suggested as treatment alternatives for this infection. Fluoroquinolones have in vitro activity against some of the organisms associated with bacterial vaginosis and may provide another treatment option. STUDY DESIGN Women who presented with symptomatic bacterial vaginosis were randomly assigned to receive either oral ofloxacin 300 mg twice a day or oral metronidazole 500 mg twice a day for seven days. Twenty-seven of the 31 patients who were enrolled in this double-blinded study were evaluable. RESULTS Fourteen women received ofloxacin. At follow-up, four had no residual symptoms, seven noted a reduction in symptoms, and three had no change in symptoms. Eight (57%) of the 14 women who received ofloxacin had secretions at follow-up that satisfied the criteria for the diagnosis of bacterial vaginosis. Thirteen women received metronidazole. Nine had no residual symptoms and four noted a reduction in symptoms. Eleven (85%) of the 13 women had normal vaginal secretions and two (15%) had secretions that were improved. None of the women who received metronidazole had secretions at follow-up that met the criteria for the diagnosis of bacterial vaginosis. CONCLUSION We conclude that ofloxacin is less effective than metronidazole in the treatment of bacterial vaginosis.

Evaluation of ofloxacin in the treatment of uncomplicated gonorrhea.

In an open study, a single oral dose of 400 mg of ofloxacin was administered to 40 men and 20 women who required treatment for uncomplicated gonococcal infection. Thirty-six men and 13 women were evaluable. Ofloxacin eradicated 49 of 49 urethral or endocervical gonococcal infections and 1 of 1 pharyngeal infection. There were 55 pretreatment isolates of Neisseria gonorrhoeae available for antimicrobial susceptibility testing. Twenty-four (43.6%) produced penicillinase. Eighteen (32.7%) isolates that did not produce penicillinase had penicillin MICs greater than or equal to 1.0 micrograms/mL. Twelve (21.8%) isolates had tetracycline MICs greater than or equal to 16 micrograms/mL. The geometric mean minimal inhibitory concentrations (range) for 55 pretreatment N. gonorrhoeae isolates were: ofloxacin, 0.014 (.0078-.03) micrograms/mL; penicillin, 6.30 (.125-128) micrograms/mL; and tetracycline 1.61 (.03-128) micrograms/mL. There were few side effects. Ofloxacin appears to be an effective and safe oral therapy for the treatment of infections caused by N. gonorrhoeae including infections due to penicillin- and tetracycline-resistant strains.

Synergistic Effect of N-Formimidoyl Thienamycin with Gentamicin and Amikacin Against Streptococcus faecalis

The in vitro activities of N-formimidoyl thienamycin alone and in combination with amikacin and gentamicin were tested against 10 strains of Streptococcus faecalis. Synergy was demonstrated in 35% of the combinations tested by the microtiter checkerboard technique; 50% were found to be synergistic with time killing curves.