Alteration of Superficial Bacterial Flora in Severely Ill Patients

Stratford, Bryan C.; Gallus, Alexander; Matthiesson, Anthony M; Dixson, Shirley

doi:10.1016/s0140-6736(68)90068-8

Cited by 47 publications

(16 citation statements)

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“…Furthermore, of the 81 coliforms isolated from patients in all groups who had received previous therapy 76 were resistant to the agents already employed. This is consistent with previous reports that prophylactic antimicrobial therapy predisposes to the emergence of resistant coliforms in the respiratory tract (Lipman et al, 1946;Stratford et al, 1968;Johanson et al, 1969). In many patients these organisms colonize the respiratory tract without obvious associated disease.…”

Section: Discussionsupporting

confidence: 93%

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Secondary Respiratory Infection in Hospital Patients: Effect of Antimicrobial Agents and Environment

Philp¹,

Spencer²

1974

BMJ

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359were "failures" and more rthan one-third actually regained all the weight lost. Moreover, though most of the "successes" or "modified successes" continued to maintain a steady weight the incidence of failure increased with the length of followup. This was especially true during the first 12 months, and follow-up reports for such short periods are of limited value.The results for the male and female patients appeared to be similar and suggest that those most overweight are least likely to succeed; however, the initial percentage excess weight was of no clear predictive value. We failed to substantiate the previous impression that the ability to reduce to within 25% in excess of the ideal weight is associated with increased prospects of long-,term sucoess. Long-term success, however, is closely correlated with regular attendance at the follow-up clinic, and only two patients were known to have kept their weight down despite a lengthy lapse of follow-up. Some of the patients who regained weight rapidly admitted that though superficially their eating habits had been reformed they continued to eat excessively but in secret.All the patien;ts were "failures" before admission and the primary reason for selection was their inability to respond satisfactorily ito conventional treatment despite regular supervision at an obesity clinic for at least a year. All were suffering either physically or psychologically from their morbid obesity. Thus for the small proporton of successes a mean weight loss of 27 kg at a mean follow-up of 27 months represents a worthwhile achievement. Success, however, cannot be gauged solely in terms of weight reduction. Ten patients had 12 elective operations, including hiatus hernia repair, cholecystectomy, and total hip replacement. Nine married, and among the women there were six pregnancies, including one full-term delivery in a previous habitual aborter. Eleven patients held jobs which pTeviously they could not have obtained. It follows that the distinction between success and failure is necessarily arbitrary, and many who regained weight did not regret the time spent in hospital.Therapeu-tic starvation could be better justified if patient selection were improved, but at present the long-term sequelae of the other form of radical therapy, bypass surgery, are uncertain. The current policy is to offer surgery only to selected patients who have regained weight after starvation.We wish to thank the many doctors, the nursing staff, and the other staff who were concerned in the care of these patients, and are grateful to Servier Laboratories for their very generous financial support. Rooth, G., and Carlstr6m, S. (1970

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Section: Discussionsupporting

confidence: 93%

“…Another possible cause of the acquisition of coliforms is underlying disease (Stratford et al, 1968;Johanson et al, 1969). Unfortunately we were unable to dissociate this factor from the effects of antimicrobial therapy and, quite apart from ethical considerations, it is difficult to see how a definitive trial could be designed.…”

Section: Discussionmentioning

confidence: 99%

Secondary Respiratory Infection in Hospital Patients: Effect of Antimicrobial Agents and Environment

Philp¹,

Spencer²

1974

BMJ

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“…Skin carriage of gram-negative bacteria and subsequent infection has been assigned to rather specialized conditions e.g. nialigtiancies (McBride et al 1976), and tertninal illnesses (Stratford et al 1968).…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Microflora of Patients with Repeated Skin Infections

1977

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The microflora of normal skin in 16 patients with repeated staphylococcal and streptococcal skin infections was examined to determine whether abnormalities existed which would indicate a protective role for the indigenous flora against colonization by pathogens. Five sites-hands, feet, axilla, groin and back-were examined quantitatively and qualitatively and compared with a control group. Total populations of indigenous flora were significantly higher from patients with repeated skin infections of the back, axillae and feet. The frequency of isolation of different species from normal skin was comparable between the control and experimental groups, with the exception of the incidence of Staphylococcus aureus and Proteus species which were isolated only from patients with repeated skin infections. Gram-negative bacteria were isolated with comparable frequency between the two groups, but patients with repeated skin infections tended to carry gram-negative bacteria on multiple sites. It was concluded from the high population of indigenous flora and the types of microogranisms present that the microflora of normal skin did not appear to protect patients with repeated skin infections against colonization by pathogens. The presence of high populations of Staphylococcus aureus on the normal skin of patients with repeated skin infections would appear to be the most important contributing factor.

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“…Stratford and coworkers noted, however, already in 1968 (Stratford et al, 1968), that the prevalence of colonization increased as the severity of illness increased. Similar results have been reported by Johanson and co-workers (1969).…”

Section: Colonization Resistance In the Oropharynxmentioning

confidence: 99%

The digestive tract in immunocompromised patients: importance of maintaining its resistance to colonization, especially in hospital in-patients and those taking antibiotics

Waaij

1984

Antonie van Leeuwenhoek

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The colonization resistance (CR) of the gastrointestinal tract to potential pathogens depends partly on factors within the host but to a greater extent on the normal (anaerobic) gut flora. Its strength varies between individuals. These individual differences in resistance to colonization by pathogenic microorganisms may explain differences in susceptibility to infection. CR is lowered by remission-inducing treatment (radiation and/or chemotherapy) in leukaemia, but more severely by certain antibiotics. Development (by selection or transfer) of resistance to these antibiotics may lead to overgrowth and penetration of the mucosal lining by the overgrowing (potentially) pathogenic bacteria. Other antibiotics however, if sufficiently dosed, have been found to eliminate (potential) pathogens selectively without decreasing CR. This selective decontamination of the gastrointestinal tract has been successfully used prophylactically in neutropenic patients but needs to be monitored bacteriologically. It should perhaps be used more widely in the hospital to control development and spread of antibiotic-resistant strains.

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Alteration of Superficial Bacterial Flora in Severely Ill Patients

Cited by 47 publications

References 1 publication

Secondary Respiratory Infection in Hospital Patients: Effect of Antimicrobial Agents and Environment

Secondary Respiratory Infection in Hospital Patients: Effect of Antimicrobial Agents and Environment

Cutaneous Microflora of Patients with Repeated Skin Infections

The digestive tract in immunocompromised patients: importance of maintaining its resistance to colonization, especially in hospital in-patients and those taking antibiotics

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