- Email: [email protected]
Pseudomonas aeruginosa bacteremia in a dialysis unit. II. Relationship to reuse of coils
2
%
Dialysis
Contamination of diaiysate
Infections commonly occur in patients undergoing dialysis and have been related to diminished host resistance of uremic patients, the arteriovenous fistulas and bacteriologic contamination of dialysis fluids. The occurrence of four cases of bacteremia due to Pseudomonas, three of which were type 7, and the presence of this serotype in the dialysis fluids suggested an important association between infection and growth of bacteria in the fluids. Attempts to reduce levels of bacteria in the dialysis fluid were unsuccessful using dialysate free of glucose in clinical trial, despite in vitro studies demonstrating poor growth of Pseudomonas in this medium. A filter placed with the recirculating system was only partially successful. The second paper of this series traces the portal of entry of bacteria from dialysate to the blood through reutilized coils.
Uman SJ, Johnson CE, Beirne GJ, Kunin CM: Pseudomonas aeruginosa bacteremia in a dialysis unit. I. Recognition of cases, epidemiologic studies and attempts at control. Am J Med 62: 667-671, 1977.
Ps. aeruginosa bacteremia Culture methods
In 56 cases of galactorrhea and/or hyperprolactinemia, a pituitary adenoma was diagnosed in 17 and myxedema in two. Etiologic factors included phenothiazine ingestion in six and breast manipulation in four. In 27 cases no etiologic factor was found. Aside from roentgenographic studies andvisual field perimeby, a serum prolactin level above 100 ng/ml was the only indicator of pituitary adenoma. Prolactin suppression tests were found to be of no value for differential diagnosis. Both pituitary tumor excision and irradiation were successful, but improvement following radiotherapy was slow. Induction of ovulation was more successful with 2a-Br-ergocryptine than with clomiphene. To discriminate between tumoral and dysfunctional conditions, prolonged observation of these patients remains essential.
Gomez F, Reyes FI, Faiman C: Nonpuerperal gaiactorrhea and hyperprolactinemia. Clinical findings, endocrine features and therapeutic responses in 56 cases. Am J Med 62: 646660, 1977.
Gaiactorrhea Hyperproiactinemia Pituitary adenoma Pituitary proiactin-ceil adenoma Lactation in United
Meningitis
Blood cultures
V, to
Blood for culture was obtained over a six week period from 17 patients undergoing long-term hemodialysis. Bacteremia was detected duriog 18 of 201 dialyses. Ten of the 17 patients had a Pseudomonas bacteremia some time during the study. Only one patient was symptomatic. The frequency of positive cultures was related to reuse of coils. No cultures were positive until after the fifth use, but by the 10th use, 41 per cent of the dialyses were associated with bacteremia. All coils used repeatedly, and 32 of 45 used only once, grew Ps. aeruginosa when filled with media and incubated. This suggests that the coils were inoculated during dialysis and that the sterilizing agent, benzalkonium chloride, was unable to eradicate this organism. With repeated uses, the number of residual bacteria in the coil became large enough lo cause detectable bacteremia during dialysis.
Wagnild JP, McDonald P, Craig WA, Johnson C, Hanley M, Uman SJ. Ramgopal Beirne GJ: Pseudomonas aeruginosa bacteremia in a dialysis unit. Il. Relationship reuse of coils. Am J Med 62: 672-676, 1977.
Hemodiaiysis Ps. aeruginosa bacteremia Diaiysate cultures Coil cultures
Between 1971 and 1974, group Y meningococcal disease developed in 88 Air Force recruits: 66 had primary bacterial pneumonia. None of the patients with primary pneumonia had the stigmata of meningococcemia or meningitis. Patients with pneumonia responded well to therapy with small doses of parenteral penicillin, Ten patients had meningococcemia, and six had meningitis. Pneumonia, therefore, predominated over meningococcemia and meningitis 4: 1. Skin lesions were rare in patients with meningococcemia but frequent in those with meningitis: otherwise, these clinical syndromes were similar to group B and C meningococcal disease. There was only one death, a patient with known preexisting leukopenia.
disease
Bacterial pneumonia
Koppes GM, Ellenbogen C. Gebhart RJ: Group Y meningococcal States Air Force recruits. Am J Med 62: 661-666, 1977.
Group Y meningococcai disease Meningococcemia
%
Dialysis
Contamination of diaiysate
Infections commonly occur in patients undergoing dialysis and have been related to diminished host resistance of uremic patients, the arteriovenous fistulas and bacteriologic contamination of dialysis fluids. The occurrence of four cases of bacteremia due to Pseudomonas, three of which were type 7, and the presence of this serotype in the dialysis fluids suggested an important association between infection and growth of bacteria in the fluids. Attempts to reduce levels of bacteria in the dialysis fluid were unsuccessful using dialysate free of glucose in clinical trial, despite in vitro studies demonstrating poor growth of Pseudomonas in this medium. A filter placed with the recirculating system was only partially successful. The second paper of this series traces the portal of entry of bacteria from dialysate to the blood through reutilized coils.
Uman SJ, Johnson CE, Beirne GJ, Kunin CM: Pseudomonas aeruginosa bacteremia in a dialysis unit. I. Recognition of cases, epidemiologic studies and attempts at control. Am J Med 62: 667-671, 1977.
Ps. aeruginosa bacteremia Culture methods
In 56 cases of galactorrhea and/or hyperprolactinemia, a pituitary adenoma was diagnosed in 17 and myxedema in two. Etiologic factors included phenothiazine ingestion in six and breast manipulation in four. In 27 cases no etiologic factor was found. Aside from roentgenographic studies andvisual field perimeby, a serum prolactin level above 100 ng/ml was the only indicator of pituitary adenoma. Prolactin suppression tests were found to be of no value for differential diagnosis. Both pituitary tumor excision and irradiation were successful, but improvement following radiotherapy was slow. Induction of ovulation was more successful with 2a-Br-ergocryptine than with clomiphene. To discriminate between tumoral and dysfunctional conditions, prolonged observation of these patients remains essential.
Gomez F, Reyes FI, Faiman C: Nonpuerperal gaiactorrhea and hyperprolactinemia. Clinical findings, endocrine features and therapeutic responses in 56 cases. Am J Med 62: 646660, 1977.
Gaiactorrhea Hyperproiactinemia Pituitary adenoma Pituitary proiactin-ceil adenoma Lactation in United
Meningitis
Blood cultures
V, to
Blood for culture was obtained over a six week period from 17 patients undergoing long-term hemodialysis. Bacteremia was detected duriog 18 of 201 dialyses. Ten of the 17 patients had a Pseudomonas bacteremia some time during the study. Only one patient was symptomatic. The frequency of positive cultures was related to reuse of coils. No cultures were positive until after the fifth use, but by the 10th use, 41 per cent of the dialyses were associated with bacteremia. All coils used repeatedly, and 32 of 45 used only once, grew Ps. aeruginosa when filled with media and incubated. This suggests that the coils were inoculated during dialysis and that the sterilizing agent, benzalkonium chloride, was unable to eradicate this organism. With repeated uses, the number of residual bacteria in the coil became large enough lo cause detectable bacteremia during dialysis.
Wagnild JP, McDonald P, Craig WA, Johnson C, Hanley M, Uman SJ. Ramgopal Beirne GJ: Pseudomonas aeruginosa bacteremia in a dialysis unit. Il. Relationship reuse of coils. Am J Med 62: 672-676, 1977.
Hemodiaiysis Ps. aeruginosa bacteremia Diaiysate cultures Coil cultures
Between 1971 and 1974, group Y meningococcal disease developed in 88 Air Force recruits: 66 had primary bacterial pneumonia. None of the patients with primary pneumonia had the stigmata of meningococcemia or meningitis. Patients with pneumonia responded well to therapy with small doses of parenteral penicillin, Ten patients had meningococcemia, and six had meningitis. Pneumonia, therefore, predominated over meningococcemia and meningitis 4: 1. Skin lesions were rare in patients with meningococcemia but frequent in those with meningitis: otherwise, these clinical syndromes were similar to group B and C meningococcal disease. There was only one death, a patient with known preexisting leukopenia.
disease
Bacterial pneumonia
Koppes GM, Ellenbogen C. Gebhart RJ: Group Y meningococcal States Air Force recruits. Am J Med 62: 661-666, 1977.
Group Y meningococcai disease Meningococcemia