Frequency of occurence and antimicrobial resistance in isolates of bacterial conjunctivitis in patients at the University Hospital of the West Indies [abstract]

OBJECTIVE: There is paucity of published data on bacterial conjunctivitis in patients at the University Hospital of the West Indies and the wider community in Jamaica. This report analyses 208 bacterial isolates from 198 eye swab cultures of patients with clinical diagnosis of conjunctivitis in this hospital. METHODS: Culture of eye swabs was done by routine methodology, and anti-microbial susceptibility tests were performed by the standard disc-diffusion technique. RESULTS: Two hundred and eight bacterial isolates were encountered in the 198 ocular cultures. Eighty of these (32.9 percent) were likely contaminants (normal commensal from skin of the eyelid). The common isolates in order of frequency in the remaining 128 were: Haemophilus influenzae pneumoniae 12 (9.4 percent) and Pseudomonas aeruginosa 5 (3.9 percent). These four organisms together accounted for over two-thirds (69.5 percent) of the 128 isolates. More than 90 percent of these strains were susceptible to chloraphenicol and gentamicin. CONCLUSIONS: The contamination rate in eye swab cultures is very high and there is need for improvement of the collection procedures. Haemophilus influenzae remains the most common pathogen of bacterial conjunctivitis as in many other parts of the world. The common eye preparations such as chloramphenicol and gentamicin (alternatively, tobramycin) continue to be highly effective against pathogens from conjunctivitis at the University Hospital of the West Indies. (AU)

Antimicrobial sensitivity of Haemophilus influenzae isolates from bacterial conjunctivitis

Haemophilus influenzae is one of the common bacterial pathogens which affect children. Resistance to frequently use antibiotics is becoming a significant problem in community isolates of common pathogens. A retrospective review was conducted of the serotypes and antimicrobial sensitivity of H influenzae isolates from bacterial conjunctivitis, over an 18-month period. Data on antimicrobial sensitivity (obtained by the National Committee for Clinical Laboratory Standards disk diffusion method) and B-lactamase production, and typing results, were analysed. Ninety-nine islolates were recovered, of which 87 were typed. Most isolates were recovered from children under one year of age. Ninety-three percent were unencapsulated and biotypes I and IV were most common. H influenzae type b was recovered only twice. B-lactamase was produced by 41 percent isolates while four isolates were ampicillin-resistant but did not produce B-lactamase. All isolates were sensitive to chloramphenicol and 45 percent were co-trimoxazole sensitive. H influenzae is commonly isolated from bacterial conjunctivitis in Barbados and, as elsewhere, the majority of isolates are from small children and are non-encapsulated. However, there is a high prevalence of B-lactamase production, which may serve as a reservoir for transfer to more invasive encapsulated strains of H influenzae within the oropharyngeal flora.(Au)

Acute aphasia complicating typhoid fever in an adult

Motor aphasia complicating bacteriologically confirmed typhoid fever in a 20-year old adult female is presented. Neither the cause of death nor the aetiology of this isolated neurological deficit could be determined from detailed post-mortem examination. An immune related mechanism is suggested based on the temporal characteristics of this complication and CSF abnormalities.(AU)

Considerations for implementing an antibiotic policy in hospital practice

An antibiotic policy should aim for the safe, effective and economical use of antimicrobial drugs, and to prevent their indiscriminate use and development of resistant bacterial strains. The term 'antibiotic' is used as a general term for all antimicrobial drugs. Antibiotics prescriptions should be based on clinical evidence of bacterial infection, preferably substantiated by appropriate laboratory culture and sensitivity tests. Viral infections are not an indication for antibiotic prescriptions. Patient factors to be considered for choice and dose of an antibiotic are age, pregnancy, lactation, renal and hepatic impairment. Immunodeficient patients should receive only bactericidal drugs. Severity of infection determines the route of administration. Duration of therapy should not exceed five days, unless specifically prescribed by the physician. An antibiotic should, if started as an empirical therapy not be changed before a minimum of three days trial. Prescriptions of drugs such as aztreonam, imipenem, vancomycin, piperacillin and amphotericin are to be restricted due to cost and toxicity and should be reviewed by the microbiologist (AU)

Bacterial meningitis in children in Barbados: a decade later - abstract

Forty-eight paediatric patients admitted with bacterial meningitis during a 10-year period, comprising 22 males (46 percent) and 26 females (54 percent), were reviewed. Ages ranged between 7 weeks and 12 years (mean 2.7 years). The mean 10-year incidence was 29/10,000 ward admissions, with a peak incidence of 69/10,000 admissions in 1989. The highest seasonal prevalence occurred during the dry months. Twenty-five patients (52 percent) were less than 2 years of age. Predominant symptoms were fever (85 percent), gastrointestinal (65 percent), and lethargy (40 percent). Frequently associated illnesses included upper respiratory infections in 21 (44 percent), and otitis media in 5(10 percent) of cases. H. influenzae was cultured from the cerebrospinal fluid in 34 cases (71 percent), S. pneumoniae in 4 cases (8 percent), and no organism in 10 cases (21 percent). Thirteen patients (27 percent) had received antibiotic therapy within a week of admission. Initial therapy consisted of parenteral ampicillin and chloramphenicol in 37 cases (77 percent), penicillin and chloramphenicol in 9 cases (19 percent) chlodramphenicol in 1 (2 percent), and trimethoprin/sulfamethoxazole in 1 case (2 percent). These data support a case for routine administration of H. influenzae B vaccine which will lead to the eradication of, or reduction of the overall incidence of bacterial meningitis in childhood (AU)

Transmission of infectious drug resistance from animals to man

The antibiotic resistance patterns of califorms in faecal specimens from pigs and their human contacts were studied. The ability of the resistant coliforms to transfer their resistance in vitro to antibiotic-sensitive recipients was examined. The results showed that pigs which had received antibiotics carried more multiply-resistant, R-factor bearing coliforms than pigs which had not been given antibiotics. Human contacts of the antibiotic-treated pigs had a higher incidence of antibiotic-resistant coliforms with R-factors than contacts of pigs which had not been given antibiotics. It is concluded that antibiotic treatment of farm animals may lead to acquisition of antibiotic resistance by gut coliforms of man.(AU)

The chemotherapy of viral infections

Only methisazone and amantadine of the synthetic antiviral agents are commercially available for general use, and they are used only prophylactically. Interferon inducers are promising but as yet untested in man. No doubt effective chemotherapeutic agents will in time become available but for the present and immediate future, vaccines will provide the first line of defence against disease. Methods of immunization are bound to improve and with an increasing awareness of public health measures the role of antiviral chemotherapeutic agents though important, will be minor. (Summary)

Osteomyelitis: A study of the aetiological agents responsible for acute osteomyelitis at the University Hospital of the West Indies, 1966-1968

It is shown from a review of 50 cases of acute osteomyelitis from 1966-68 that:- 1) Infecting organism is Staph. pyogenes (coag.+ve)-86 percent of cases. 2) They claim that no toxic effects have been observed with chlorophenicol when they use it. However, this is based on no scientific study and is in conflict with most other reports. 3) They argue that less than 5 percent of the organisms involved are sensitive to penicillin. This has shown to be a gross underestimate. 4) They argue that chloramphenicol is cheap. However, pencillin is also cheap and in any case cost of treatment must be balanced against quality of treatment. 5) Finally, they argue that chloramphentic is convenient to administer. However, convenience must also be balanced against quality of treatment and in many cases it is not known wether the chlorampheticol is taken as ordered. (Summary)

Typhoid fever

The clinical course of 121 cases of typhoid fever seen and treated at the University College Hospital of the West Indies is reviewed. Details of management are discussed and the question of relapse examined. (AU)

Typhoid in British Guiana (abstract only)

There has been a steady decline in fatality from typhoid since 1950 - partly due to the introduction of chloramphenicol and partly due to the introduction of a filtered and chlorinated water supply. The highest incidence is in school children (5 to 15 years of age) but the death rate is higher in adults. Little is known of the incidence of typhoid in the Amerindians in the interior but outbreaks still occur in rural areas which still obtain their water supply from untreated sources such as rivers or vats (AU)

A review of typhoid infection in Jamaica - abstract

During the period 1952-1959 there were two major epidemics of typhoid in Jamaica and 121 documented cases of typhoid infection were treated at the University College Hospital. Diagnosis was made mainly on culture of the organism and less reliance was placed on Widal agglutinations as T.A.B. inoculations are frequently given prophylactically in Jamaica. This disease was found to be mainly one of the young age groups. Although most cases responded to treatment, there was a relapse rate of 8 percent. Despite chloramphenicol, deaths continue to occur and a mortality rate of 5.8 percent found. The cost of treatment runs to thousands of pounds - a wasteful effort against a preventable disease (AU)

The prevention of relapse after chloramphenicol treatment of typhoid fever

In an attempt to reduce the rate of relapses after Chloramphenicol treatment of typhoid fever, two plans of treatment have been carried out. A group of thirty cases were treated with two courses of Chloramphenicol, each course lasting 5 days, separated by a rest period of 8 days. Another group of 14 cases were also given T.A.B. vaccine 0.5 ml on the 5th day after the temperature became normal. The percentage of cases who relapsed was 17 percent of the first group and 21 percent of the second. The difference is not statistically significant. (AU)

Chloromycetin in typhoid fever: a report on thirty cases

Thirty cases of typhoid have been treated with chloromycetin. Twenty-nine cases recovered and 1 died. Two cases developed melaena. One case developed oedema of lips, which was probably an allergic reaction to chloromycetin. Two cases developed symptoms suggestive of the burning feet syndrome and apparently attributable to chloromycetin. The average duration of the fever was 4.6 days after chloromycetin treatment was instituted. Forty-one percent of cases treated for less than 14 days, and 25 percent of cases treated for 14 days relapsed. (AU)