Theodore Sacks

A Multivariate Analysis of Risk Factors for Acquiring Bacteriuria in Patients With Indwelling Urinary Catheters for Longer Than 24 Hours

Data related to risk factors for catheter-acquired bacteriuria were collected prospectively on 112 patients consecutively catheterized for greater than 24 hours at the Hadassah University Hospital. Logistic regression analysis indicated that factors independently associated (p less than or equal to 0.05) with a higher risk of catheter-acquired bacteriuria were as follows: hospitalization in orthopedics or urology, ethnic origin (Arabs greater than Jews), insertion of a catheter after the sixth day of hospitalization, catheterization outside the operating theatres, lack of administration of systemic antibiotics, unsatisfactory catheter care, and prolonged duration (greater than or equal to 7 days) of catheterization before infection occurred. The risk associated with catheterization outside the operating theater could be explained by its correlate, that is, catheterization for incontinence/obstruction as opposed to output measurement. Life-table analyses demonstrated that the daily risk for acquiring bacteriuria during the first six days of catheterization was higher among patients ultimately catheterized for greater than or equal to 7 days than among those ultimately catheterized for less than 7 days (P less than 0.05).

INVASIVE PNEUMOCOCCAL INFECTIONS : A COMPARISON BETWEEN ADULTS AND CHILDREN

&NA; Abbreviations used in this article: CSF, cerebrospinal fluid; HIV, human immunodeficiency virus; IPI, invasive pneumococcal infections; MIC, minimal inhibitory concentration.

Multivariate analysis of determinants of postoperative wound infection in orthopaedic patients.

In a prospective study of 376 orthopaedic patients, the relative contribution of host factors and patient-care variables to the risk of postoperative wound infection was evaluated. Host factors studied were age, sex, ethnic origin and diagnosis. The number of operations, the insertion of an open drain, the use of prophylactic antibiotics and the length of the operation were the patient-care variables studied. Of the risk factors identified, the performance of more than one operation during an admission had the highest risk coefficient, followed by the presence of an open drain, internal fixation of a fracture, and spine fusion. Within the group of operations for internal fixation, those for fractures of the femur had the highest risk of infection. In spine fusions those operations lasting 5 or more hours were associated with a high risk of infection. The length of stay of infected patients was on average 17.9 days longer than that of their individually-matched non-infected controls.

Antibacterial activity of human amniotic fluid

Abstract Amniotic fluid samples from 25 of 28 women examined were found to possess antibacterial activity. This activity was directed against both gram-positive and gram-negative organisms and appeared to be related to the presence of varying combinations of different antibacterial factors. Lysozyme-like activity was present in only 9 of 24 fluid samples. Other factors differed in their heat stability and molecular weights.

Bone and joint perfusion with antibiotics in the treatment of experimental staphylococcal infection in rabbits.

Bmucterimul imifectiomis of bones amid joimits prescmmt mi timermupeutic cimmullemmge, to ssimichm mimi efficiemit respomise cnn only be made if timere is ummdcrstmummdimmg (If time mmtuture of time patimological I)roccss. Timerapeutically, cimrommic osteornyclitis is more mi problem of chmrommic ischmemimu timami one of chrommic sepsis . Time bacterimu, trmuppcd imm time avmisculmur dead bomme or imi cmumicellous spaces by fibrimi clot, are protected botim from time body clefemise mecimmummisms timid from chemotimerapeutic agemmts. Timere is a lmuck of c!iffusiomm of tetracyclimmes immto dead bomic . As time chronic osteomyclitis comitimmues pr(Ilifermutivc grmumiulmutiomm tissue, once imigimly vmusculmur, matures to become demise scar tissue This mivmusculmur tissue formsa is-mill muroummd time infected mirea wimicim is impe’mmetrmublc to ammtibiotics admimmistered by time regular route. Evemi time most rmudical surgical d#{233}bridcmcmmt fmuils to eradicate all time orgammisms hidden in time cmummcellous sj)accs. Time occurremice of mu commsiderable reverse flossfrom time large peripimeral veins immto time marross of lommg bones has been suggested by miumerous autimors 3.8 Vemmous cimmummimels imi time felimme femur is-crc visualized rocmmtgemmograpimically after immjectiomm of contrast mmiterial imito the l)osterior tibia! artery, ssitim mu proximal tourniquet beimig used Oh time thigh. By use of roentgemiograplmic amid tracer tecimrmiques, time collmutcral circulmutiomi timrough the vemmous chmammnels of time carmimme femur is-crc demonstrated 2#{149} By time production of proximal vemious obstructiomm, a collateral circulation is-as developed arid demommstrated as reversal of blood flow timrougim the small tributaries of time femoral vein timat emiter time distal femoral metaphysis ; the reversed floiv folloised time central medullary venous system amid cvemmtually drained through time mmormmul cimamimiels from time proximal end of time femur. Time present paper reports time reproduction of similar pimenomena in the himmd limbs of rabbits and their applicmution to time ammtibiotic treatment of experimental infectiomms of bomme amid joint.

Studies on the antimicrobial activity of amniotic fluid

Sixty-one amniotic fluid samples from women in their second and third trimesters of pregnancy were examined for antimicrobial activity. Seventy per cent of the fluids were found to be active. The factor or factors responsible for this activity were present in low concentrations. The presence of spermine in the fluids accounted for some of the antimicrobial activity.

INFECTIONS WITH CHRYSEOMONAS LUTEOLA (CDC GROUP VE-1) AND FLAVIMONAS ORYZIHABITANS (CDC GROUP VE-2)

We have described 15 cases of infection due to Chryseomonas luteola and Flavimonas oryzihabitans isolated between May 1990 and May 1994. These infections were often associated with the presence of a foreign body, especially central venous access and joint prosthesis. The high frequency of isolating C. luteola and F. oryzihabitans probably expresses the awareness of the clinicians and the laboratory to the importance of these bacteria, especially in patients with the presence of a foreign material.

Bactericidal Effect of Combinations of Antimicrobial Drugs and Antineoplastic Antibiotics Against Staphylococcus aureus

Six antineoplastic antibiotics were tested against ten strains of Staphylococcus aureus. Four showed bacteriostatic and/or bactericidal activity against each of the ten strains, and two were only bacteriostatic for seven and nine strains, respectively. Using the cellophane transfer technique, combinations of these antineoplastic antibiotics with 16 antibacterial drugs were screened for combined bactericidal activity. Synergism or antagonism was demonstrated in about one-third of the combinations. Checkerboard titrations and killing curves confirmed these findings and indicated that the effective concentrations of the antibacterial agents were similar to those attainable in the serum after therapeutic doses of these drugs. Although the pharmacokinetics of the six antineoplastic antibiotics in humans are not fully known, at least one of them has a peak serum level corresponding to those values at which a bactericidal effect was produced in vitro.

Penetration of Parenterally Administered Gentamicin into the Cerebrospinal Fluid in Experimental Meningitis

The penetration of parenterally administered gentamicin into the CSF was examined in dogs. The experiments were carried out in three stages: (1) in healthy dogs, (2) in dogs with meningitis, and (3) during recovery from the acute inflammation. Gentamicin was found to penetrate poorly into the CSF, reaching mean peak levels of 0.7 mug/ml in healthy dogs. During the height of the meningeal inflammation the mean peak gentamicin level in the CSF was 0.9 mug/ml. The ratio of mean maximum CSF to mean maximum serum levels of gentamicin was 5.8% in healthy dogs, and 11.3% in dogs with meningitis. Thus, inflammation increases the penetration of parenterally administered gentamicin into the CSF, but therapeutically adequate levels for gram-negative bacillary meningitis are not achieved.

In vitro Susceptibility of Mycobacteria Species Other than Mycobacterium tuberculosis to Amikacin, Cephalosporins and Cefoxitin

The susceptibility of different species of mycobacteria, other than M. tuberculosis, to a range of cephalosporins and to amikacin was studied. Susceptibility patterns varied with species. M. fortuitum, M. marinum and M. szulgai were the most susceptible species to amikacin and to cefoxitin, where as M. kansasii, M. scrofulaceum and MAIS complex the most resistant. Cefoxitin appears to be much more active against mycobacteria than the other cephalosporins used in this study. Most of the cefoxitin-sensitive mycobacteria were inhibited by concentrations which can be easily attained in serum on standard dosage schedules.