Showing papers by "Ian Phillips published in 1990"
TL;DR: The most common focus of infection leading to nosocomial and community-acquired bacteremia due to E. coli was the urinary tract, and the adverse influence of inappropriate initial therapy on outcome was more marked in the latter half of the study.
Abstract: Escherichia coli accounted for 861 (23.901o) of 3,605 episodes of bacteremia in an 18-year prospective survey at St. Thomas' Hospital, a proportion that changed little during the survey. The most common focus of infection leading to nosocomial and communityacquired bacteremia due to E. coli was the urinary tract. IWenty-six percent of adult female patients with E. coli bacteremia resulting from a urinary tract infection were diabetic. The 0 antigen serotypes identified most often were 06, 02, 01, 04, 015, and 075; the multiply resistant 015 serotype of E. coli was implicated in a community outbreak of urinary tract infection. Ampicillin resistance in strains causing community-acquired infection increased to the same level as that of strains causing nosocomial infection (almost 5007). The overall mortality was 20.7% and was greater in the presence of shock (52.4% vs. 15.3%o). Death due to infection occurred in 2.6%o and 10.3%, respectively, of cases with urinary tract and non-urinary tract foci. The adverse influence of inappropriate initial therapy on outcome was more marked in the latter half of the study.
142 citations
TL;DR: The commonest foci of infection were the urinary tract, often with catheterization or instrumentation, and intravascular access sites, from which episodes of septicaemia were increasingly caused by coagulase-negative staphylococci.
Abstract: During the 20 years, 1969-88, nearly 4000 episodes of septicaemia were studied prospectively at St. Thomas' Hospital. Forty percent were community-acquired and 60% hospital-acquired. Overall the commonest isolate was Escherichia coli (22%). In community-acquired bacteraemias, Esch. coli, Streptococcus pneumoniae and Staphylococcus aureus accounted for almost 60% of episodes, and the commonest foci of infection were the urinary tract (Esch. coli) and the respiratory tract (Str. pneumoniae). Esch. coli was particularly common in diabetic patients and Str. pneumoniae in alcoholics. In hospital-acquired septicaemia, Esch. coli and Staph. aureus accounted for 40% of episodes, but a further 30% were caused by enterobacteria other than Esch. coli, and Pseudomonas aeruginosa. The commonest foci of infection were the urinary tract, often with catheterization or instrumentation, and intravascular access sites, from which episodes of septicaemia were increasingly caused by coagulase-negative staphylococci.
82 citations
TL;DR: Monitoring of bloodstream isolates of common bacteria over a period of 20 years has shown some evidence that in-vitro resistance is clinically relevant since the mortality rate rises if inappropriate antibiotics are used empirically.
Abstract: We have monitored the antibiotic sensitivity of bloodstream isolates of common bacteria over a period of 20 years. Among the Gram-positive bacteria, the proportion of isolates of Staphylococcus aureus resistant to methicillin, erythromycin, fusidate, or gentamicin has increased marginally, while that of coagulase-negative staphylococci (mostly Staph. epidermidis) has increased markedly. Enterococci are becoming serially more resistant to high concentrations of aminoglycosides. The Enterobacteriaceae have become considerably less sensitive to ampicillin (and amoxycillin) and trimethoprim but more sensitive to the aminoglycosides, whilst their susceptibility to cefotaxime, ceftazidime, cefepime, cefpirome, imipenem, meropenem and temocillin has remained constant. We have some evidence that in-vitro resistance is clinically relevant since the mortality rate rises if inappropriate antibiotics are used empirically. Although many drug regimens could be used, we are able to recommend initial therapy with a combination of gentamicin and cefuroxime for most of our patients, the exceptions being those known to be infected with resistant organisms before the onset of septicaemia.
44 citations
TL;DR: During an outbreak of infection with ampicillin-resistant, TEM-1 beta-lactamase-producing Escherichia coli serotype O15, some strains were noted to differ from the majority in that they showed reduced susceptibility to amoxycillin/clavulanic acid (Augmentin), ureidopenicillins and first generation cephalosporins and produced increased amounts of beta-filtration.
Abstract: During an outbreak of infection with ampicillin-resistant, TEM-1 β-lactamase-producing Escherichia coli serotype O15, some strains were noted to differ from the majority in that they showed reduced susceptibility to amoxycillin/clavulanic acid (Augmentin), ureidopenicillins and first generation cephalosporins and produced increased amounts of β-lactamase. The plasmid from one such isolate was compared with that from an isolate that produced normal amounts of β-lactamase. Restriction analysis with EcoRI revealed extra fragments in the plasmid from the β-lactamase hyperproducer and use of DNA-DNA hybridisation with a biotinylated TEM-1 probe showed genetic rearrangement in the β-lactamase hyperproducer so that the TEM gene appeared to be present in larger amounts and was located on a smaller fragment than for the plasmid from the strain that produced normal amounts of β-lactamase.
32 citations
TL;DR: At St Thomas' Hospital for the past 20 years, medical microbiologists have documented all cases of septicaemia, as part of the routine service offered by the department, and the present system can be viewed as a prototype for other groups of patients.
Abstract: At St Thomas' Hospital for the past 20 years, medical microbiologists have documented all cases of septicaemia, as part of the routine service offered by the department. These records are used in the day-to-day management of patients and have provided much research and teaching material. When the number of paper records became so large that manual extraction of data was impossible we computerized the records. In 1986 information from the paper charts was transferred to a microcomputer, and since the beginning of 1988 the details of each new case have been added to this computer file at the end of the septicaemic episode. At present, collection of data during the course of a patient's illness continues on paper, but it is hoped that in future this process will also be computerized. Apart from our own data, little computerized information is to be found on patients or the treatment they receive, both within our hospital and nationally. The present system can be viewed as a prototype for other groups of patients.
12 citations
TL;DR: Humans can metabolize an extremely wide range of potentially harmful foreign hydrophobic compounds including many drugs, environmental pollutants and chemical carcinogens due to the action of cytochromes 1’-450.
Abstract: Humans can metabolize an extremely wide range of potentially harmful foreign hydrophobic compounds including many drugs, environmental pollutants and chemical carcinogens. This ability is mainly due to the action of cytochromes 1’-450. These proteins constitute a large superfamily that has been classified into several families, the largest of which (P45011) has been further divided into seven subfamilies
7 citations
TL;DR: Culturing hepatocytes in medium containing 0.5 mwmetyrapone prevented the loss of total 1’-450 content throughout the culture period, which suggests that metyrapone may be involved in the molecular action of haemoproteins.
Abstract: The primary culture of rat hepatocytes for 24 h in standard medium results in the loss of 50% o f their cytochrome 1’-450 (1’-450) content [ I ] . This loss can be prevented by culturing hcpatocytes with 0.5 mwmetyrapone which stimulates 1’450 synthesis 121. However, P 4 5 0 is a collective term for a superfamily of haemoproteins 131. In order to gain an insight into the molecular action of metyrapone we have compared its effects on the expression of the 1’-450IA and 1’-45011B subfamilies in hepatocyte culture with those of the classical inducers, phenobarbitone (PB) and P-naphthoflavone (BNF). Hepatocytes were prepared from 250-280 g male CD rats and cultured in Williams medium E as previously described [ 11. Total 1’-450 content was assayed [ 11 and total RNA isolated [4]. 1’-4501A2 and I’-45011B mRNAs were quantified after 24 and 72 h of culture by Northern blot hydridization to their respective cDNAs [ 5,6]. Rat hepatocytes cultured for 24 h contained 40 f 1 Soh of their initial 1’-450 content. Concomitant with this decrease, the abundance of the mRNAs encoding 1’-4501A2 and the P-4501IB subfamily declined to 37% and 33%, respectively. After 72 h of culture both total 1’-450 content and the levels of the mRNAs declined further (Table 1 ). Culturing hepatocytes in medium containing 0 . 5 mMmetyrapone prevented the loss of total 1’-450 content throughout the culture period. This was paralleled at 24 h by a higher abundance of both 1’-4501A2 and P-4501IB mRNAs compared with untreated cultures. However, at 72 h 1’-450IA2 mRNA had declined whereas P45011B mRNAs increased above the value found in freshly isolated hepatocytes. This observation suggests that metyrapone may
3 citations