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Purpose: To compare recovery experienced during inpatient rehabilitation among individuals with traumatic brain injury (TBI) based on whether their acute care included the Clinical Institute Withdrawal Assessment for Alcohol (CIWA) protocol., Design: Participants included 234 individuals with TBI who completed inpatient rehabilitation at a TBI Model Systems site. Of these, 67 patients were treated using the CIWA protocol (TBI + CIWA); 167 patients were treated for TBI alone (TBI only). Demographic, injury, and treatment variables between the 2 groups were compared. A repeated-measures analysis of variance (ANOVA) compared Disability Rating Scale (DRS) scores between the groups at admission and discharge from inpatient rehabilitation., Results: The 2 groups did not significantly differ on DRS scores at admission to inpatient rehabilitation: TBI + CIWA, M = 9.6 (SD = 3.5) vs. TBI only, M = 10.1 (SD = 4.2). There was a significant difference in DRS scores at discharge, with the TBI + CIWA group having lower scores: TBI + CIWA, M = 6.4 ( SD = 1.9) vs. TBI only, M = 7.0 (SD = 2.2). A repeated-measures ANOVA of DRS scores from admission to discharge revealed a significant between-subjects effect based on patients' Mississippi categorization of posttraumatic amnesia (PTA) duration ( p < .001) and age ( p = .016) but not based on their CIWA status ( p = .068). A post hoc comparison including age as a covariate revealed a significant difference based on CIWA status ( p = .013) within the "moderate" injury group at discharge, with the TBI + CIWA group having lower discharge DRS scores., Conclusions: Given the significant symptom overlap between alcohol withdrawal and PTA, it is likely that these 2 delirium presentations are confounded during the initial recovery from TBI, leading to "overestimation" of injury severity-particularly among individuals with moderate TBI. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

A study was carried out using high performance liquid chromatography (HPLC) to determine the chemical stability of amoxycillin and potassium clavulanate in 250/62 co-amoxyclav oral suspension (Augmentin), stored at room temperature (RT, 20 degrees C) and 8 degrees C over a period of 11 days. The suspension was judged to be acceptable if its components maintained at least 90% of their label concentrations. During the test period, the amoxycillin component was found to be more stable than the clavulanate. Amoxycillin was stable for 7 days at both temperatures. Potassium clavulanate maintained at least 90% of its initial concentration for 7 days at 8 degrees C but showed more than 40% degradation in the same time period at RT. For potassium clavulate the shelf-life, or time taken for the original concentration to drop to 90% of its value (t90) at RT was found to be 2 days.

The API Coryne system, a commercially available system for the identification of coryneform bacteria, was used to identify 103 strains of Listeria spp. from clinical and environmental sources. All isolates were identified correctly to the genus or species level, although complete characterization also required tests for beta-hemolysis and CAMP reaction.

Forty clinical isolates of methicillin-resistant and methicillin-sensitive Staphylococcus aureus were studied for their susceptibility to povidone-iodine (available iodine 11%) under a variety of conditions. The cultures varied in properties, notably in their sensitivity to other therapeutic agents. No differences were observed between the resistant and sensitive cultures in destruction by povidone-iodine. When bactericidal activity occurred, > 99% of the bacterial cells were lethally damaged within 10 seconds of exposure to povidone-iodine. The bacterial cells that had been washed and resuspended thrice in distilled water were most susceptible, with as little as 1 x 10(-16) G (2.36 x 10(5) atoms) of iodine being required to destroy one bacterial cell. Attempts were made to select variants resistant to iodine from the surviving minority population in such experiments. These experiments failed to select resistance, and it is concluded that any apparent variation in vulnerability to povidone-iodine results from aggregation of the bacteria and differences in penetration of povidone-iodine. Substances were studied for their ability to inactivate povidone-iodine. The most potent agents were the free sulphur-containing amino acids, cysteine and methionine. These are present in high concentrations in nutrient broth and most other culture media. This explains the reports of 'pseudo-resistance' to povidone-iodine in certain laboratory experiments. Suggestions are made for the optimum use and formulation of povidone-iodine.

The number of episodes of diseases caused by bacterial contamination of food has shown a real increase by about threefold in the last decade in the U.K. The numbers for 1992 are estimated to be 2 million. The causes are multifactorial and complex, and 4 representative pathogens are reviewed. The main increase in diseases due to salmonella has been caused by Salmonella enteritidis, especially from eggs. The commonest bacterial food pathogen is campylobacter, which causes an illness with specific season peaks in May and June. This may be related to the activities of birds and mammals. Both these bacteria cause common diseases that are rarely fatal. In contrast, Listeria and E. coli are ubiquitous but rarely produce disease; however, the consequences of any such illness are often dire. Procedures and techniques are available for the control of most of these diseases, but society does not seem determined to implement them.

The Rosco system was used to identify previously confirmed isolates of the seven currently recognised species of Listeria. These included reference cultures and recent isolates from clinical material, food products and environmental sources. The system identified all correctly. Results were obtained after 4 h if heavy inocula, as suggested by the manufacturers, were used. The method may be used to aid identification of isolates of Listeria from clinical and non-clinical specimens and would be of particular value in laboratories examining small numbers of isolates relatively infrequently. Essential tests not included in the system are beta-haemolysis on sheep-blood agar and the CAMP test.

One hundred and two samples of ready-to-eat, pre-cooked, chilled chicken were examined for Listeria spp. using culture and a commercially available enzyme linked immunoassay (ELISA). Overall, 29 (28%) samples contained Listeria spp. as determined by culture, Listeria monocytogenes being present in 27 (26.5%) samples. In comparison with culture, the ELISA yielded no false positives. However, the technique detected Listeria spp. in only 24 of 29 culture-positive samples.

This paper reports a double-blind placebo-controlled trial of oral tobramycin in acute ulcerative colitis. Eighty-four patients with an acute relapse of ulcerative colitis were randomized to receive oral tobramycin or placebo for 1 week as an adjunct to steroid therapy. At endpoint, 31 of 42 (74%) in the tobramycin group achieved complete symptomatic remission compared with 18 of 42 (43%) in the placebo group (P = 0.008). The tobramycin group achieved better histological scores (P less than 0.05) at endpoint. These findings show that treatment with oral tobramycin improves the short-term outcome of patients with ulcerative colitis in relapse.

A multipoint inoculation technique (Mast ID) for the identification and species determination of Listeria monocytogenes (sensu strictu) and six other species of the genus Listeria was evaluated. This was compared with the commercially available API 50CH system. Both methods successfully identified all 123 strains tested. The Mast ID system is inexpensive and utilizing a multipoint inoculation technique permits the screening of up to 21 isolates per 9-cm petri dish. The API 50CH system was more expensive and time consuming and is therefore suitable only for the examination of smaller numbers of strains.

Ninety-six elderly patients (mean age 80 years) with acute urinary infections were treated in a single-blind trial, with either one 200 mg dose of trimethoprim or 200 mg b.d. for five days. After one week the initial pathogen was eliminated in 67% of patients who had received the single dose and in 94% who received the drug for five days. These differences were highly significant (P less than 0.01). After two weeks, the patients who had received trimethoprim for five days were significantly freer from infection than those who had received the single dose. The level of acquired resistance following trimethoprim was small. The single dose of trimethoprim was associated with less suppression of the faecal Enterobacteriaceae and the selection of less resistance in these organisms than the five-day course. Interrupted antibiotic courses may not be particularly prone to select resistance. Trimethoprim was well tolerated in the great majority of patients; only three patients suffered possible side-effects.

Thymidine at levels as low as 0.05 mg/1 reduces the activities of sulphamethoxazole and trimethoprim and their combination in vitro. Using a biological assay procedure, levels of thymidine greater than this were interpreted as being present in urine. The addition of sulphamethoxazole and trimethoprim, singly or in combination, to urine obtained from patients with urinary tract infections showed that all the antibacterial effect towards sensitive organisms was due to the trimethoprim component. It is suggested that trimethoprim should replace the combination co-trimoxazole for the treatment of some lower urinary tract infections, and that laboratory media, if they are to resemble the clinical environment, should contain thymidine.

Non-lysogenic Staphylococcus aureus strain 1030 was lysogenized with 12 different bacteriophages. Lysogeny was associated with acquisition of phase inducibility to mitomycin C treatment or ultraviolet irradiation, with the presence of plaque-forming phage in culture supernatants and with considerable narrowing in susceptibility to the typing bacteriophages and also with increased sensitivity to trimethoprim and sulphadiazine. The presence of prophages in the donor and/or the recipient could either promote or inhibit transfer of plasmids between mixed cultured. Transfer frequencies in mixed culture after 18 h incubation could be as high as 7 . 0 x 10(-1) resistant recipients/final donor, and evidence was adduced for a mechanism distinct from transfer by spontaneous transduction. It is suggested that this method of gene transfer be described as 'phage-mediated conjugation'. Chromosomal genes were not transferred by this method. Two similar plasmids cp-2 and cp-3 were able to promote their own transfer through clones of 1030; plasmids coding for resistance to either neomycin or tetracycline could be transferred to a recipient by the presence of cp-2 or cp-3 simultaneously in the donor. The presence of plasmids in 1030 was associated with a small increase in sensitivity to trimethoprim or sulphadiazine.

The inhibition of coagulase-negative staphylococci and Staphylococcus aureus of human or animal origin by most free fatty acids was similar, but coagulase-positive staphylococci were sensitive and coagulase-negative cultures were resistant to linolenic acid. Animal strains of S. aureus were more sensitive to linolenic acid than were human strains. These differences were reflected in the relative abilities of the three categories of strains to survive on human skin. The antibacterial effects of 20 mg of linolenic acid were inactivated by 1 ml of serum in vitro. A test organism seeded on to skin also survived better if first suspended in serum. The mechanism of the interaction between serum and linolenic acid may be due to a detergent effect of the serum and could account for colonisation of diseased skin with S. aureus. Cultures of S. aureus seeded on to human skin were rapidly killed after the skin has been covered with linolenic acid. The possibility of therapeutic use of linolenic acid as an antibacterial agent should be explored.

One hundred and fifty-three isolates of coagulase-negative staphylococci obtained from human skin failed to transfer resistance to either cadmium ions (46 isolates), trimethoprim (37 isolates), erythromycin (25 isolates) or tetracycline (45 isolates) to Staphylococcus aureus strain 1030 or to each of 10 of its lysogenic derivatives in mixed cultures. Thirty-three trimethoprim-resistant coagulase-negative staphylococcal isolates obtained from the human intestine also failed to transfer this resistance to the recipients in mixed cultures.

Patients with uncomplicated gonorrhoea were treated with a single dose of either ampicillin 3 g orally or procaine penicillin 2.4 MIU by injection, both with probenecid 1 g orally. The proportion of faecal Escherichia coli resistant to ampicillin before and a week after treatment was assessed. Of 55 patients treated with ampicillin who initially possessed sensitive flora, 25 (45.5%) became colonised subsequently by resistant E coli. Resistance to ampicillin, together with resistance to some other antimicrobials, was transferable in vitro. Penicillin, however, selected resistant E coli in only four (14.3%) out of 28 patients with initially sensitive flora. There was no difference in therapeutic response between the two agents. Intramuscular penicillin appeared to offer appreciably greater microbiological benefits than oral ampicillin in treating gonorrhoea.

The selection of aminoglycoside-resistant bowel flora, following the administration of either gentamicin or netilmicin in combination with metronidazole for prophylaxis, during colo-rectal surgery in 88 patients has been examined. Both antibiotic regimens resulted in the selection of an aminoglycoside-resistant flora in a total of 57 (65%) of patients: in half of the patients there was a net gain in the aminoglycoside-resistant flora, and in 13 (15%) one aminoglycoside-resistant strain present prior to prophylaxis was displaced by another following operation. Three patients (3%) lost aminoglycoside-resistant strains after prophylaxis. Most of the resistant organisms selected were considered to be of little importance as potential pathogens, at least in the short term. In only a small minority (5%) of patients were aminoglycoside-resistant enterobacteria isolated. Aminoglycoside-resistant Staphylococcus aureus was not isolated. Of the resistant enterobacteria, only one strain, an isolate of Enterobacter cloacae selected in a patient receiving gentamicin, carried a resistance determinant which was self-transmissible to Escherichia coli.

In a prospective, randomised, double-blind study, 179 patients undergoing retropubic or transurethral prostatectomy were given pre-operatively either 1 g aztreonam or a placebo. In patients treated with aztreonam there was a significant reduction in the number with post-operative bacteriuria and in the number requiring treatment of post-operative bacteriuria. Other differences were not significant. The mean duration of post-operative hospital stay for patients receiving aztreonam was 7.1 days compared with 6.9 days for those receiving placebo. In patients treated with aztreonam there was no increase in the frequency of infections due to Gram-positive bacterial species.

This article reviews the current place of erythromycin in antibiotic therapy. Overall, erythromycin is thought to be underused because: (1) the fear of resistance has been exaggerated; (2) significant toxicity has been associated with only one derivative (the estolate); (3) newer antibiotics have very rarely been demonstrated to be superior to erythromycin. Erythromycin has an important place in treating acute upper and lower respiratory tract infections, acute otitis media, sinusitis, skin and soft tissue, osteomyelitis, prostatitis, infections due to Mycoplasma spp. and Chlamydia organisms, and infections due to anaerobes.

Antibiotics were added at final concentrations of 0.5 to 10 mg/l to either human blood, serum, urine, bile or ascitic fluid inoculated with sensitive cultures. Bactericidal effects were monitored by estimation of viable counts over 24 h at 37 degrees C. Cefotetan was reliably bactericidal to bacteria suspended in human urine over a wide range of conditions. Gentamicin, cefotaxime, cefotetan and azthreonam were predominantly bactericidal against Enterobacteriaceae in serum and blood; gentamicin, cefotetan and cefotaxime were bactericidal in bile, and cefotetan bactericidal in ascitic fluid. The above antibiotics all also produced a bactericidal effect against Haemophilus influenzae in serum, and the macrolides erythromycin and rosaramicin destroyed haemophilus in serum more rapidly than did ampicillin or amoxycillin. In most of these fluids, destruction (reduction in viable counts by greater than 10-fold) of the inoculum occurred within 2 to 4 h for gentamicin and 4 to 6 h for similar concentrations of beta-lactam agents.

Magnesium/phosphotungstic acid was confirmed as specific for precipitation of chylomicrons, low-density and very low density lipoprotein particles in serum from healthy volunteers who were either fasting or who had eaten egg yolks or a salmon sandwich containing Flora margarine 2 hours previously. In eight subjects who ate salmon sandwiches that contained butter or Flora margarine, neither the total cholesterol nor the high-density lipoprotein (HDL) cholesterol differed significantly from the fasting level over 7 hours. In eight subjects, egg yolks also did not alter significantly either the total serum cholesterol or the HDL cholesterol at 1/2, 1, 1 1/2, 2, 5, and 7 hours after eating. Patients may be screened for HDL cholesterol and total cholesterol estimation when not fasting. However, individual subjects showed variation in their total cholesterol and, particularly, HDL cholesterol over a three-month period. Replicate analysis of HDL cholesterol may be required for its complete assessment.

Seventy-eight cultures of multiresistant Staphylococcus aureus (MRSA), obtained from Australian hospitals in 1981, were studied to see whether they possessed novel properties responsible for their epidemic spread. In general, these strains resembled MRSA from other countries and were probably derived from them; in particular, they did not survive desiccation better than other staphylococci. The majority of MRSA produced lipases, which might be responsible for their invasiveness, and all produced high amounts of beta-lactamase which hydrolysed each of the isoxazolyl penicillins. This may account for therapeutic failure with cloxacillin of flucloxacillin. Control of this epidemic should rely principally on general measures against the hospital staphylococcus.

The genetic equipment of Staphylococcus aureus is at least as comprehensive as other organisms. Transposons provide the potential for reassortment of genes between plasmids and the chromosome. At least six different mechanisms of gene transfer between cells are documented in vitro. Phage-mediated conjugation is the transfer mechanism most likely to occur between staphylococci in nature. MRSA have evolved from a single clone and are now heterogeneous in properties. Some may show decreased virulence. The origin of new resistant determinants is likely to be other human cultures of Staph. aureus rather than an animal staphylococcal reservoir.

Of 19 recently isolated cultures of methicillin-resistant Staphylococcus aureus, 18 showed inducible low-level resistance to minocycline, 15 showed high-level resistance to streptomycin, and 4 showed resistance to low levels of streptomycin. Two cultures produced yellow pigment and may have been derived in vivo by loss of a gene(s) determining orange pigment. Treatment of three cultures with serial exposures to N-methyl-N'-nitro-N-nitrosoguanidine resulted in a widening of phage typing pattern that included all reactions in group I, the great majority in group III, but none in group II. The widening in phage lysis was possibly due to the elimination of defective prophages. Transfer of tetracycline resistance occurred from 12 out of the 19 cultures to a recipient in mixed culture; this transfer required either Ca2+ or Mg2+, was abolished by citrate, and enhanced by high cell density. It was probably mediated by defective bacteriophages. No evidence was obtained for the occurrence of recombination within the methicillin-resistant clone in nature. Eleven methicillin-resistant cultures stored for at least 5 years on agar slopes at 20 degrees C had all lost this resistance at high frequency.

Elderly patients with acute urinary infections were treated in a double-blind study with either amoxycillin or cephradine. In 52 patients who had received amoxycillin for one week about a third of all intestinal Escherichia coli were highly resistant to amoxycillin, and many were resistant to tetracycline, trimethoprim, or chloramphenicol. Cephradine selected less resistance. At a week after completion of chemotherapy, cephradine-resistant E coli were replaced by sensitive cultures at a greater frequency than were amoxycillin-resistant E coli. Neither antibiotic altered the skin flora. Amoxycillin, but not cephradine, selected for Enterobacteriaceae in the saliva. The propensity of amoxycillin to select resistance in E coli will limit its usefulness in treating urinary infections.

Both the genetic and biochemical basis of tetracycline resistance in a number of staphylococcal strains was investigated. The strains examined could be classified into three groups: (i) those possessing a high basal level of resistance and in which resistance could be induced to higher levels (macro-inducible); (ii) those which had a high uninduced level of resistance, but which were virtually uninducible (macro-constitutive); (iii) one derivative which had a low basal level of resistance and was also uninducible (micro-constitutive). Resistance in macro-constitutive strains was plasmid mediated and typical of organisms possessing wild-type plasmids. The macro-constitutive pattern of resistance appeared to be correlated with a chromosomal location for the resistance genes, whereas the micro-constitutive pattern was correlated with loss of a region from the wild-type plasmid. Analysis of membrane proteins by sodium dodecyl sulfate polyacrylamide gel electrophoresis suggested that a number of membrane polypeptides became unstable in staphylococci possessing high-level tetracycline resistance. In particular, the absence of a polypeptide of 22,000 daltons was always associated with high-level resistance. There was no evidence that multiple gene copies are required for expression of tetracycline resistance in Staphylococcus aureus.