The sensitivity ofEscherichia coli strains with K1 surface antigen and rods without this antigen to the bactericidal effect of serum

The susceptibility of Escherichia coli strains with K1 surface antigen (K1+) and rods without this antigen (K1-) to the bactericidal action of normal bovine serum and human normal cord serum was determined. Seventy E. coli strains (35 K1+ and 35 K1-) were isolated from urine obtained from children with urinary tract infections. The strains investigated showed variable sensitivity to the bactericidal action of the sera. E. coli K1+ strains were characterized by lower sensitivity to bactericidal effect of the sera in comparison with K1- rods. The role of the particular mechanisms of complement activation in the process of killing of the E. coli strains was also determined.

The mechanisms of activation of normal human serum complement byEscherichia coli strains with K1 surface antigen

Ten E. coli K1 strains isolated from the urine of children with urinary tract infections were sensitive to the bactericidal action of normal human serum (NHS). The role of the particular mechanisms of complement activation was determined in the process of killing these strains, showing variable sensitivity to the bactericidal action of NHS; three mechanisms of activation of human complement were observed. Important role of alternative pathway activation in the bactericidal action of NHS against E. coli K1 strains independent of the classical and lectin pathways was not established.

[Etiological factors of urinary tract infections in children]

Etiological factors of urinary tract infection in children have been studied. The Escherichia coli, Klebsiella sp., Enterococcus sp. and Enterobacter sp. were the most often isolated bacteria from infant and baby urine. In this age group of patients uromycoses were also affirmed. From the urine of older children (1-18 years old) mainly Escherichia coli, Enterococcus sp., Proteus sp. and Morganella morganii have been raised. Uropathogens' occurrence was analysed by a statistical method in the relation to age and sex of the children. The girls in the age of 1 to 18 years were more open than boys to urinary tract infections caused by Escherichia coli and less open to infections caused by Morganella morganii and Enterococcus sp.

[Nonspecific adhesion of Staphylococcus aureus strains to solid surfaces]

Autoagregating strains of bacteria are characterised by high surface hydrophobicity, which determines their ability to adhesion. An assessment was done of non-specific adhesion to solid surfaces of S. aureus strains isolated from blood, pus and nasopharynx of hospitalised people. The method used made possible differentiation of strains, which were studied, on the basis of their surface characteristics. Their properties decide about the abilities of strains to the colonisation of host tissues and at the same time they influence their potential virulence. In the study attention was also paid to the participation of surface proteins in the processes of adhesion cells to glass surfaces.

[Infectivity and resistance to antibiotics of uropathogenic gram-negative rods]

The nature of bacterial isolates from children with clinically suspected urinary tract infections (UTI) was studied. The susceptibility of urinary pathogens to selected antibiotics was determined. The results clearly show that E. coli was identified as the main causative agent of UTI children (67% of isolates). The second commonest pathogen was P. mirabilis (10%). Over half E. coli isolates were resistant to amino-penicilins but almost all isolates (over 80%) were sensitive to antimicrobial agents combined with beta-lactamase inhibitors. We found significantly high percentage (32.5%) of ESBL strains among K. pneumoniae isolates.

Synergistic bactericidal effect of cephalexin and normal cord serum (NCS) against Escherichia coli K1 strains isolated from children with urinary tract infections (UTI)

Investigations were performed on the bactericidal activity of cephalexin (keflex) and normal cord serum (NCS) against Escherichia coli K1 strains isolated from UTI. A synergistic interaction of the antibiotic and NCS was found against the strains resistant and sensitive to the serum.

Catechol-O-methyltransferase inhibition attenuates levodopa toxicity in mesencephalic dopamine neurons

Inhibition of catechol-O-methyltransferase (COMT; EC 2.1.1.6) is a new therapeutic strategy in the treatment of Parkinson's disease. However, nothing is known about the effects of COMT inhibition on levodopa (L-dopa)-induced toxicity in dopamine (DA) neurons. Therefore we evaluated the effects of the selective COMT inhibitors Ro 41-0960, OR-486, and tolcapone alone and in combination with L-dopa in primary mesencephalic cultures from rat. Neither COMT inhibitor affected the growth of tyrosine hydroxylase immunoreactive (THir) cells with concentrations up to 10 microM when studied alone. However, Ro 41-0960 reduced the L-dopa-induced THir cell loss after 24 h in a dose-dependent manner, shifting the TD(50) value from 21 microM in the absence to 71 microM in the presence of 1 microM Ro 41-0960 (P <.01) without affecting survival of non-DA neurons. OR-486 and the clinically used COMT inhibitor tolcapone showed similar effects. In contrast, toxicity induced by D-dopa was not altered by COMT inhibitors. Furthermore, the primary metabolite of L-dopa formed by COMT, 3-O-methyldopa, and the methyl group donor S-adenosyl-L-methionine used by COMT did not alter THir neuron survival and L-dopa-induced toxicity, respectively, with concentrations up to 100 microM. These data demonstrate that COMT inhibition attenuates L-dopa toxicity toward DA neurons in vitro, but probably not by preventing 3-O-methyldopa production or cellular S-adenosyl-L-methionine depletion.

The susceptibility of gram-negative rods and their adaptive forms resistant to colistine to the bactericidal action of sera

The susceptibility of Escherichia coli K1, Salmonella enteritidis, Salmonella typhimurium strains and their adaptative forms resistant to colistine (Colr forms) was compared with respect to their sensitivity to the bactericidal action of normal cord serum and normal bovine serum. It has been shown that the Colr forms are more susceptible to sera as compared to initial strains. The increase of sensitivity of the Colr forms is connected with structural changes within bacterial cell wall which is the target for complement as well as for colistine.

Changes in ionized calcium concentrations and acid-base status during abdominal aortic vascular surgery

Abdominal aortic surgery may produce significant haemodynamic instability (from a combination of factors: hypovolaemia, acid-base disturbances, vasoactive metabolite release from ischaemic tissues and hypocalcaemia). Calcium is often given after aortic unclamping to attenuate this instability. We studied 20 patients undergoing elective abdominal aortic surgery and observed a triphasic change in ionized calcium concentrations and acid-base status. Initially, during the cross-clamp period (when patients were cardiovascularly stable), ionized calcium concentrations decreased significantly (mean 1.06 (SD 0.08) to 0.91 (0.13) mmol litre-1; P < 0.01), while a significant metabolic acidosis developed (pH 7.38 (0.05) to 7.30 (0.05); P < 0.05). Second, release of the aortic cross-clamp resulted in further acidosis (pH 7.27 (0.05) (P < 0.05) mixed respiratory and metabolic) with a decrease in mean arterial pressure, with no change in ionized calcium concentrations. The third phase was associated with spontaneous restoration of acid-base status and ionized calcium concentrations to normal over 2 h. There was no correlation between units of blood given, volume of blood lost, fluid volume given or duration of aortic cross-clamping and degree of ionized hypocalcaemia. We conclude that ionized hypocalcaemia occurred during the cross-clamp period of aortic surgery, was unrelated to the volume of blood given and did not appear to be responsible for the changes in arterial pressure during surgery.

[Hydrophobic properties of Pseudomonas aeruginosa strains]

Hydrophobic properties are considered as a factor enhancing the adhesion of bacteria to tissue cells. The strains of P. aeruginosa isolated from patients with urinary tract infections (UTI), from feces and soil were investigated. It shows that over 50% strains isolated from UTI had hydrophobic cell surface. Most of all strain investigated (67.9%) is characterized by hydrophobicity what probably favours their pathogenicity.

Blood interleukin 10 levels parallel the severity of septic shock

PURPOSE

The aim of this study was to investigate the relation between interleukin (IL) 10, tumor necrosis factor alpha (TNF alpha), IL-1, and IL-6 levels in patients with septic shock and relate these cytokine levels to the development of organ failure.

PATIENTS AND METHODS

In 11 patients with septic shock of recent onset, blood was sampled for determinations of TNF, IL-1, IL-6, and IL-10. The degree of organ failure was scored for four organ systems (respiratory, hepatic, renal, hematologic) in the first 48 hours of the study.

RESULTS

The APACHE II score was 21 +/- 4. Three patients died. IL-10 levels were directly correlated with TNF levels (r = 0.73, P < .05) and IL-6 levels (r = 0.67, P < .05); and inversely correlated with total C3 (r = -0.73, P < .05) and CH50 (r = -0.68, P < .05). Both IL-10 and TNF levels were correlated to the organ failure score (r = 0.75 and r = 0.68, both P < .01). Six patients with high IL-10 levels (> 60 pg/mL) had lower C3 (37 +/- 11 v 62 +/- 10 mg/dL) and CH50 (32 +/- 7 v 68 +/- 19%), and higher organ failure scores (5.7 +/- 0.8 v 3.8 +/- 1.3) than those with low IL-10 levels (all P < .05).

CONCLUSION

Although IL-10 has an inhibitory effect on the production of cytokines, it is released together with TNF and IL-6 in patients with septic shock. IL-10 blood levels are directly related to the severity of inflammation and the development of organ failure in septic shock.

Social support networks of confidants to people with AIDS

AIDS has a devastating impact on the social support networks of those most closely involved with the person with AIDS (PWA). This qualitative study of the social support networks of confidants to PWAs reports the findings of intensive, semistructured interviews with 11 confidants. Numerous changes were observed in the confidants' supportive resources, network structure, and functioning. Implications for social work practice are discussed.

Administration of an antibody to E-selectin in patients with septic shock

OBJECTIVES

To determine the safety and pharmacokinetics of a murine monoclonal antibody to E-selectin in patients with newly developed septic shock.

DESIGN

Open-label, prospective, phase II pilot study with escalating doses of the antibody.

SETTING

Intensive care unit of a 900-bed university hospital.

PATIENTS

Nine patients who survived the first 24 hrs of septic shock.

INTERVENTIONS

In addition to standard therapy, an intravenous bolus of a murine monoclonal antibody to E-selectin, CY1787, was given at doses of 0.1 mg/kg (n = 3), 0.33 mg/kg (n = 3), and 1.0 mg/kg (n = 3).

MEASUREMENTS AND MAIN RESULTS

CY1787 was well tolerated in all patients. Signs of shock resolved in all patients, and organ failure entirely reversed in eight patients. All patients survived the 28-day follow-up. Administration of CY1787 was associated with an early and brisk increase in PaO2/FIO2 ratio (p < .001), from 146 +/- 38 mm Hg (19.5 +/- 5.1 kPa) to 205 +/- 45 mm Hg (27.3 +/- 6.0 kPa) after 2 hrs, and 250 +/- 58 mm Hg (33.3 +/- 7.7 kPa) after 12 hrs. A dose-related effect of CY1787 was suggested by an earlier weaning from catecholamine therapy and a faster resolution of organ failure in the high-dose group. Development of antimouse antibodies was documented in eight patients.

CONCLUSIONS

This pilot study indicates that this antibody to E-selectin appears to be safe and may represent a promising form of therapy in septic shock.

Influence of ozone on the susceptibility of Escherichia coli K1 to the bactericidal action of serum

The susceptibility to the bactericidal action of normal bovine serum of twenty two Escherichia coli K1 strains, isolated from the urine of patients with urinary tract infections, was determined. Only four strains were resistant. Ozonization of bacterial suspensions enhanced the sensitivity of the strains to the action of both normal serum and a serum in which the alternative pathway of complement activation was thermally blocked.

The sensitivity of Hafnia alvei strains to the bactericidal effect of serum

Most Hafnia alvei strains are sensitive to the bactericidal action of normal bovine serum (NBS) as well as to a serum in which the alternative pathway of complement activation has been thermally blocked. Introduction of polysaccharides (PS) to NBS lowers the bactericidal effect. In a serum in which the alternative pathway of complement activation is blocked, PS completely cancels the bacterial effect.

Correlation of serial blood lactate levels to organ failure and mortality after trauma

To define the value of serial measurements of blood lactate levels after trauma, the present study investigated the correlation between blood lactate, mortality, and organ failure in 129 trauma patients, including 100 intensive care unit (ICU) survivors and 29 ICU fatalities. On admission, injury severity score (ISS) was higher and Glasgow coma score (GCS), revised trauma score (RTS), and trauma revised ISS (TRISS) were lower in the nonsurvivors than in the survivors. Serial arterial blood lactate levels were measured on admission and at least three times a day until normalization. Both initial lactate and highest lactate levels were higher in the nonsurvivors than in the survivors. Organ failure developed in 84 (65%) of the 129 patients. Patients with organ failure had significantly lower RTS and TRISS. Initial lactate and highest lactate levels were significantly higher in patients with organ failure than without organ failure (3.4 [0.7 to 12.7] versus 2.4 [0.4 to 7.6] mEq/L and 4.1 [0.7 to 12.7] versus 2.8 [0.4 to 8.9] mEq/L, respectively, both P < .01). The duration of hyperlactatemia averaged 2.2 days in the former but 1.0 day in the latter patients (P < .01). The data therefore indicate that not only the initial or the highest lactate value but also the duration of hyperlactatemia can be correlated with the development of organ failure. These observations stress the importance of the initial resuscitation in the prevention of organ failure. Serial blood lactate measurements are reliable indicators of morbidity and mortality after trauma.

Correction of hypocalcaemia in the critically ill: what is the haemodynamic benefit?

OBJECTIVE

The prevalence of hypocalcaemia is known to be elevated in critically ill patients, but the expected benefit from calcium repletion in hypocalcaemic patients has not been well defined. The objective of the present study was therefore prospective determination of the cardiovascular response to calcium administration in critically ill patients with hypocalcaemia.

PATIENTS

A total of 17 patients found to have ionized hypocalcaemia (Ca2+ < 1.05 mmol/l) from a group of 32 patients who were invasively monitored as part of their ICU management.

INTERVENTION

Slow intravenous injection of 1 g of calcium chloride.

MEASUREMENTS AND RESULTS

Calcium administration was followed by an increase in mean arterial pressure from 77 +/- 8 to 90 +/- 12 mmHg (P < 0.01). There was no significant change in cardiac filling pressures or heart rate. Cardiac index and systemic vascular resistance increased slightly but not significantly (from 2.67 +/- 0.92 to 2.81 +/- 1.25 1/min.m2 and from 2133 +/- 647 to 2378 +/- 817 dynes.s.cm-5 m-2, respectively). Left ventricular stroke work index increased from 23 +/- 8 to 32 +/- 13 g.m/m2 (P < 0.01). These changes were maintained for 60 min.

CONCLUSIONS

The correction of hypocalcaemia can result in a significant increase in arterial pressure that can persist for at least 1 h. Despite an associated improvement in left ventricular function, cardiac index and oxygen delivery do not increase significantly.

Calcium administration for cardiovascular support in critically ill patients: when is it indicated?

Calcium has a fundamental role in the maintenance of myocardial function and vascular tone. The ionized form of calcium is the most important physiologically, and this form needs to be measured to assess physiologically active calcium levels. Ionized hypocalcemia can occur as a result of various pathophysiological disturbances, and it is seen frequently in critically ill patients. Several investigators have observed a poorer prognosis in those patients with ionized hypocalcemia. It is unclear whether calcium supplementation is beneficial in these patients. It may improve cardiovascular performance, but, in contrast, it may contribute to cellular damage (especially during hypoxia following cardiopulmonary resuscitation). In sepsis, there may be an increased cellular influx of calcium, which may be deleterious to cellular function; indeed, calcium entry blockers in this situation may be protective. We review the role of calcium as an inotropic agent, its interaction with other inotropic agents, and its use during blood transfusion and during cardiopulmonary resuscitation.

Studies on the influence of ozone on complement-mediated killing of bacteria

The role of ozone in the susceptibility of clinical isolates of Acinetobacter anitratus and Pseudomonas aeruginosa to serum was investigated. It was found that ozone-treated cells were more susceptible to complement-mediated killing serum. These results suggest that ozone damage or change of cell membrane leads to a more rapid penetration of the membrane attack complex of complement.

Intermittent thiopentone for teaching fibreoptic nasotracheal intubation

A technique for teaching fibreoptic nasotracheal intubation is described. Fifty patients presenting for elective dental surgery received thiopentone by intermittent injection for induction and maintenance of anaesthesia whilst a trainee anaesthetist attempted to visualise the vocal cords using an intubating fibrescope. During endoscopy patients spontaneously breathed oxygen-enriched air and passage of the tracheal tube was facilitated by suxamethonium. Arterial blood pressure, heart rate and arterial oxygen saturation were monitored continuously. Time from loss of eyelash reflex to successful intubation was 113 (90) (35-480) s (mean (SD) (range)). Changes in arterial blood pressure and heart rate were similar to those described in previous studies of tracheal intubation. Haemoglobin oxygen saturation remained above 95% in 43 patients, and above 93% in 46 patients; the lowest saturation recorded was 91%. Intermittent thiopentone provides good conditions for teaching fibreoptic nasotracheal intubation whilst maintaining arterial blood pressure and oxygen saturation.

Acute dystonia in labour: side-effect of concealed self-medication attributed to epidural analgesia

Any convulsion during labour requires immediate action, but before this can occur a correct diagnosis must be made. Here we describe a case where a 'fit' was wrongly attributed to epidural analgesia. This was in fact a dystonic reaction secondary to undeclared self-medication with metoclopramide. It is therefore important to ensure that a full drug history is obtained from all patients to exclude a drug interaction or side-effect when faced with unusual and potentially serious complications of drug therapy.

[Susceptibility in vitro to certain quinolines of gram-negative bacteria and gram-positive cocci causing urinary tract infections]

Susceptibility to norfloxacin, ofloxacin, pipemidic acid and nalidixic acid of 848 bacterial strains isolated from urine of patients treated in 1989-1992 in Wrocław hospitals was investigated. The study, performed by the disc diffusion methods, concerned 568 Enterobacteriaceae strains, 147 Gram-negative non-fermenting bacteria and 133 strains of staphylococci. Highest percentage (90-100%) of susceptibility to all used antimicrobial agents was detected among Escherichia, Proteus, Morganella and Citrobacter. Less frequent susceptibility (30-70%) was observed among Klebsiella, Enterobacter and Serratia. Among strains of P. aeruginosa susceptible to norfloxacin and ofloxacin were, respectively, 61.4 and 22.2% isolates. Over 95% of strains of P. aeruginosa were resistant to nalidixic acid. Among other non-fermenting Gram-negative bacteria, over 50% were resistant to norfloxacin and ofloxacin. Both S. aureus and S. epidermidis were susceptible to ofloxacin and norfloxacin in 81-93% of tested strains. They were 2-3 times less frequently susceptible to pipemidic and nalidixic acid.

Susceptibility of isolates of Acinetobacter anitratus and Acinetobacter lwoffii to the bactericidal activity of normal human serum

The bactericidal activity of normal human serum against the Gram-negative coccobacilli Acinetobacter anitratus and Acinetobacter lwoffii was studied; 12% and 84%, respectively, of the tested strains appeared to be sensitive. Thus, serum resistance may be an important factor contributing to the pathogenic potential of A. anitratus strains. Three types of bactericidal action were shown. In the first, the strains were killed when the alternative complement pathway was activated. In the second, some strains required both the classical and alternative pathways. In the third variant, the strains needed either the alternative or classical activation pathway.

Preliminary studies of the effect of ozone on the bactericidal properties of complement

The study analyzes the bactericidal influence of an ozonized blood serum on gram-negative bacilli. Considerable differences were observed concerning the effect which ozonized normal human serum has upon Klebsiella, Pseudomonas and Salmonella strains. It was found that the impact may vary depending not only on the time of the exposure of serum to ozone, but also on the type of strain and the structure of the outer membrane of the bacteria. The Salmonella typhimurium strain of the Ra chemotype treated with the serum which was exposed to ozone showed higher susceptibility to the action of complement than the S. typhimurium strain of the S chemotype.