Wendell H. Hall

RECURRENT PNEUMONIA IN MULTIPLE MYELOMA AND SOME OBSERVATIONS ON IMMUNOLOGIC RESPONSE

Excerpt Over a period of several years, many patients with multiple myeloma and recurrent episodes of bacterial pneumonia have been observed at the University of Minnesota and the Minneapolis Veter...

Staphylococcal Enterocolitis—Treatment with Oral Vancomycin

Excerpt An increased prevalence of staphylococcal enterocolitis, arising as a serious complication of antibiotic therapy, has recently been reported in hospital patients. We have observed 109 patie...

Comparative Activities of the Oxa-β-Lactam LY127935, Cefotaxime, Cefoperazone, Cefamandole, and Ticarcillin Against Multiply Resistant Gram-Negative Bacilli

A total of 91 multiply resistant bacterial strains, including Klebsiella pneumoniae (32 strains), Pseudomonas aeruginosa (16 strains), and Serratia marcescens (43 strains), were collected during hospital epidemics of nosocomial infection from 1975 to 1979. These strains were resistant to gentamicin, tobramycin, cephalothin, chloramphenicol, and ampicillin. Their susceptibility to three new broad-spectrum β-lactams, LY127935 (a 1-oxa-β-lactam), cefotaxime (HR 756), and cefoperazone (T 1551), was compared with the susceptibility of random strains of nine species of aerobic gram-negative bacilli collected in the same hospital in 1979. Susceptibility to cefamandole and ticarcillin was also determined. Strains of staphylococci and streptococci from that hospital and two nearby city-county hospitals were also compared for the three new cephalosporins and other effective antibiotics. The agar dilution method was used to measure the minimum inhibitory concentration for each antibiotic. The multiply resistant strains (minimum inhibitory concentration for gentamicin ≥ 8 μg/ml) usually were as susceptible to the three new broad-spectrum β-lactams as were non-multiply resistant strains. Both Klebsiella pneumoniae and Serratia marcescens, including multiply resistant and non-multiply resistant strains, were most susceptible to the 1-oxa-β-lactam LY127935 and cefotaxime. P. aeruginosa (both multiply resistant and non-multiply resistant strains) were most susceptible to cefoperazone. All three new β-lactams were active against non-multiply resistant strains of Escherichia coli, Enterobacter spp., Proteus spp., and Citrobacter spp. Providencia stuartii were most susceptible to cefotaxime and the 1-oxa-β-lactam LY127935. The three new β-lactams were all less active against staphylococci (especially methicillin-resistant Staphylococcus aureus) than cephalothin. Streptococcus pyogenes and S. pneumoniae were very susceptible to cefotaxime and cefoperazone, though less susceptible to LY127935. None of the three new β-lactams was active against S. faecalis. All were very active against both penicillinase-positive and -negative strains of Neisseria gonorrhoeae.

The Treatment of Severe Staphylococcal Infections with Vancomycin

Excerpt The efficacy of vancomycin (Vancocin®—Lilly) in the treatment of severe staphylococcal infections is becoming well established. According to several authors it is now the agent of choice if...

Bacterial endocarditis following open heart surgery

Abstract From 1954 to 1967 13 cases of bacterial endocarditis were found after open heart surgery at the University of Minnesota Hospitals. Among the 2,288 immediate survivors of the first 2,500 operations the incidence of postoperative bacterial endocarditis was only 0.5 percent. Operative procedures included 1,081 repairs of ventricular septal defect and replacement of 353 mitral valves and 331 aortic valves with prostheses. Four of the 13 cases of bacterial endocarditis occurred after repair of congenital ventricular septal defects; the remaining 9 cases occurred after intracardiac valve repair or replacement. This brings the total number of reported cases of endocarditis occurring on ball valve prostheses to 97, with a mortality rate of 72 percent. The incidence, clinical features, prophylaxis and treatment of bacterial endocarditis following open heart surgery are reviewed.

A STUDY OF 23 CASES OF REITER'S SYNDROME

Excerpt The recent treatment of rheumatoid arthritis with hormones has stimulated interest in a group of similar conditions of unknown etiology. Among the latter is Reiters syndrome, characterized...

Antibiotic Concentrations in Ascitic Fluid of Patients with Ascites and Bacterial Peritonitis

Thirty-six paired specimens of serum and ascitic fluid from 21 patients with peritonitis and ascites, most with sponetaneous bacterial peritonitis and alcoholic cirrhosis, were assayed for antibiotic content. Antibiotics assayed and number of determinations were gentamicin, 14; tobramycin, 7; ampicillin, 5; clindamycin, 3; penicillin G, 2; cephalothin, 2; chloramphenico, 2; and cefazolin, 1. In 31 pared specimens the ascitic fluid antibiotic concentration was about one half or more of the simultaneous serum level and in 17 assays exceeded 90% of the serum level. All antibiotics studied penetrated ascitic fluid equally well. Clinical response to antibiotic therapy was good in 12 of 16 patients with culture-proven bacterial peritonitis. Antibiotic levels in ascitic fluid exceeded the minimal inhibitory concentration of the infecting organisms in all but one patient who responded. Direct intraperitoneal instillation of antibiotics does not appear to be necessary routinely; however, there may be an initial lag of several hours before antibiotic concentrations is ascites achieve therapeutic levels.

Cephalosporin and Aminoglycoside Concentrations in Peritoneal Capsular Fluid in Rabbits

To study the penetration of antibiotics into peritoneal tissue fluid, a subcutaneous tissue capsule model was modified by implanting multiple, perforated spherical capsules in the peritoneal cavity of rabbits. Capsules became vascularized, encased in connective tissue, and filled with fluid having a mean protein concentration of 3.6 g/100 ml. Capsular fluid was obtained by percutaneous needle aspiration and assayed for antibiotic by the disk plate bioassay technique. Cephalosporins were administered intramuscularly at a dose of 30 mg/kg. Mean peak concentrations of cephaloridine and cefazolin were significantly higher than cephalothin and cephapirin in capsular fluids, but the percent penetration (ratio of capsular mean peak to serum mean peak) ranged from 8.7 to 16.9% and was not significantly different among the cephalosporins. At 24 h the capsular concentration of cefazolin was significantly greater than for the other cephalosporins (P < 0.001). Lower rabbit serum protein binding observed at high in vivo concentrations may have enabled cefazolin to penetrate capsular fluid, but in vitro protein binding studies did not confirm a decrease in serum protein binding at high concentrations within the clinical range. Kanamycin and amikacin showed comparable capsular fluid peak concentrations as did gentamicin and tobramycin. The percent penetration ranged from 15.2 to 34.5% for the aminoglycosides. The only statistical difference was that amikacin penetration was significantly higher than that for tobramycin. Mean capsular concentrations of amikacin, cefazolin, and cephaloridine compared most favorably with the minimum inhibitory concentration of gram-negative bacilli at the dosages used in this study. Images

In vitro Sensitivity of Brucella to Streptomycin : Development of Resistance during Streptomycin Treatment.

Summary 1. A method for the in vitro testing of sensitivity of brucella to streptomycin is described. 2. The streptomycin sensitivity of 40 cultures of brucella isolated from humans is given. 3. Studies are reported concerning a strain by Br. abortus which developed marked resistance to streptomycin during the treatment of a patient having subacute bacterial endocarditis.

Allergic Hepatitis Caused by Propionyl Erythromycin Ester of Lauryl Sulfate

THE problem of drug-induced liver injury is becoming increasingly important with the introduction of new drugs and poisons. Two recent reviews1 , 2 have listed the agents that have been implicated ...