Showing papers by "Itzhak Brook published in 1987"

Microbiology of human and animal bite wounds in children.

Abstract: Aspirates from bite wounds in 39 children (21 with animal bites and 18 with human bites) were cultured for aerobic and anaerobic bacteria. Aerobic bacteria only were recovered in 7 (18%) wounds, anaerobic bacteria only in 3 (8%) and mixed aerobic and anaerobic bacteria in 29 (74%). A total of 59 isolates was recovered from animal bites (2.8/specimen): 37 aerobes (1.8/specimen); and 22 anaerobes (1.0/specimen). A total of 97 isolates were recovered from human bites (5.4/specimen): 44 aerobes (2.4/specimen); and 53 anaerobes (3.0/specimen). The most frequent isolates in both types of wounds were Staphylococcus aureus, anaerobic cocci and Bacteroides spp. Present only in animal bites were Pasteurella multocida, Pseudomonas fluorescens and M-5. Present only in human bites were Group A streptococci. Eighteen beta-lactamase-producing organisms were isolated in 16 wounds. This study demonstrates the polymicrobial aerobic-anaerobic nature of human and animal bite wounds.

Microbiology of abscesses of the head and neck in children.

Abstract: Specimens from 36 children with abscesses of the neck and 31 children with abscesses of the head were cultured for aerobic and anaerobic bacteria. Antimicrobial therapy was administered to 51 of the 67 patients (76%) prior to sample collection. In specimens obtained from neck infections, aerobic bacteria only were recovered in 24 (67%), anaerobic bacteria only in seven (19%), and mixed aerobic and anaerobic bacteria in five (14%). In abscesses of the head, aerobic bacteria only were recovered in 11 (35%), anaerobic bacteria only in eight (26%), and mixed aerobic and anaerobic bacteria in 12 (39%). Of a total of 52 isolates recovered from neck abscesses (1.4 per specimen), 34 were aerobes (0.9 per specimen), and 18 were anaerobes (0.5 per specimen). Of a total of 62 isolates recovered from head abscesses (2.0 per specimen), 20 were aerobes (0.6 per specimen), and 42 were anaerobes (1.4 per specimen). The most frequently recovered organism in neck infection was Staphylococcus aureus (20 isolates), and the most frequently recovered organism in head infection was Bacteroides sp (19 isolates). beta-Lactamase activity was detected in 36 isolates recovered in 21 abscesses (46%). Correlation between the predisposing conditions and the bacteria recovered showed a higher recovery of anaerobes in patients with dental infection or manipulation, tonsillitis, and fetal monitoring. Staphylococcus aureus was associated with trauma. This study demonstrated the importance of anaerobic bacteria in abscesses in the head and neck, especially in infections originating from sites where these organisms are the predominant flora.

Microbiology of retropharyngeal abscesses in children.

Abstract: • Aspiration of retropharyngeal abscesses was performed in 14 children. Cultures were taken from aspirates for aerobic and anaerobic bacteria, and all yielded bacterial growth. Anaerobes were isolated in all patients; they were the only organisms isolated in two patients (14%) and were mixed with aerobes in 12 patients (86%). There were 78 anaerobic isolates (5.6 per specimen). The predominant anaerobes were Bacteroides species, Peptostreptococcus species, and Fusobacterium species. There were 26 aerobic isolates (1.9 per specimen). The predominant aerobes were α- and γ-hemolytic streptococci, Staphylococcus aureus, Haemophilus species, and group A β-hemolytic streptococci. β-Lactamase production was noted in 16 isolates recovered from ten patients (71%). These included all isolates of S aureus, six of 18 Bacteroides melaninogenicus group (33%), and two of three Bacteroides oralis (67%). These findings demonstrate the major role of anaerobic organisms in retropharyngeal abscesses and the presence of β-lactamase–producing organisms in two thirds of the patients. ( AJDC 1987;141:202-204)

Approval of zidovudine (AZT) for acquired immunodeficiency syndrome. A challenge to the medical and pharmaceutical communities.

Abstract: THE ANTI-INFECTIVE Advisory Committee to the Food and Drug Administration (FDA) recently recommended the approval of zidovudine (azidothymidine [AZT]) for use as a treatment of selected patients with acquired immunodeficiency syndrome (AIDS), but only for those with advanced illness characterized by Pneumocystis carinii pneumonia and depressed immunity and for symptomatic cases of AIDS-related complex (ARC). It did not, however, recommend approval of zidovudine for treatment of pre-AIDS or nonadvanced AIDS cases with other opportunistic infections. Within two months of that recommendation, the FDA released the drug for use for the above indications. The committee, which I chaired, was made up of 11 medical experts in infectious diseases and other disciplines; it was asked to review data from one placebo-controlled clinical trial of patients with AIDS who had recovered from their first episode of P carinii pneumonia before enrollment and patients with ARC who had multiple clinical symptoms, such as oral

Role of anaerobic beta-lactamase-producing bacteria in upper respiratory tract infections.

Abstract: Bacteroides sp (Bacteroides melaninogenicus, Bacteroides oralis and Bacteroides fragilis), peptostreptococci and Fusobacterium sp are important pathogens in upper respiratory tract infections A recent increase in numbers of beta-lactamase-producing strains of anaerobic Gram-negative bacteria in upper respiratory tract infections has been associated with increased failure rates of penicillins in eradication of these infections These infections include chronic otitis media, chronic sinusitis and mastoiditis, chronic recurrent tonsillitis and lung abscesses The indirect pathogenicity of these organisms is apparent through their ability not only to survive penicillin therapy but also to protect penicillin-susceptible pathogens from the drug These direct and indirect virulence characteristics of anaerobic bacteria require the administration of appropriate antimicrobial therapy directed against all pathogens in mixed infections

Synergistic combinations of antimicrobial agents against anaerobic bacteria.

Abstract: Studies evaluating the in vitro and in vivo synergistic potential of combined antimicrobial agents against anaerobic bacteria are reviewed. Most studies evaluated therapy against Bacteroides sp. (mostly Bacteroides fragilis group). The combinations found to be most effective against B. fragilis were between metronidazole and clindamycin, spiramycin or gentamicin and between clindamycin and aminoglycosides. Against Bacteroides melaninogenicus the effective combinations were penicillin or clindamycin plus gentamicin and metronidazole and spiramycin or gentamicin. Occasional synergy was observed against Clostridium sp. and anaerobic cocci with clindamycin and gentamicin. Synergistic combinations have the potential of clinical use in serious anaerobic infections.