Rady Faculty of Health Sciences Scholarly Works

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Open Access
Comparison of Norfloxacin Versus Nalidixic Acid in Therapy of Acute Urinary Tract Infections
(1990-1-1) Selin, Liisa K; Harding, Godfrey KM; Thomson, Margaret J; Kennedy, James K; Urias, Barbara A; Ronald, Allan R
Thirty-seven adult patients with acute urinary tract infections (UTI) were randomized to receive either a seven day (lower UTI) or a 14 day (upper UTI) course of norfloxacin 400 mg orally twice daily, or nalidixic acid 1 g orally four times per day. Mean age, underlying disease and infecting organisms were similar in the two groups. Nine patients in the norfloxacin group and seven in the nalidixic acid group had presumptive evidence of upper UTI. Overall, 12 patients had antibody-coated bacteria-positive infections. The infecting organisms were: Escherichia coli (27), coagulase-negative staphylococci (four), Citrobacter freundii (three), Klebsiella pneumoniae (three), and Proteus mirabilis, Proteus vulgaris, Pseudomonas aeruginosa, Enterobacter agglomerans, Streptococcus agalactiae, Enterococcus faecalis (one of each). All of the organisms were susceptible to norfloxacin, while 81% were susceptible to nalidixic acid. The effects on the periurethral and anal canal flora were similar in both groups. Five patients in each group experienced adverse clinical effects. The cure rates for norfloxacin and nalidixic acid were 79 and 83%, respectively. There were two failures, two relapses and four reinfections in the norfloxacin group. In the nalidixic acid group, there were two failures, one relapse and four reinfections. One of the failure patients in the nalidixic acid group developed resistance to the drug, and two of the four reinfections were due to organisms resistant to nalidixic acid. In this patient population it was concluded that nalidixic acid may be as effective as norfloxacin in the treatment of acute, symptomatic UTI.
Open Access
Erythromycin-Resistant Group G Streptococci in an Isolated Northern Canadian Community
(1990-1-1) Nicolle, Lindsay; Postl, Brian; Urias, Barbara; Law, Barbara; Ling, Norma; Efstratiou, Androulla
The susceptibility of groups A, C, and G streptococci isolated from pharynx or skin in two northern Canadian native communities during a one year study of the epidemiology of streptococcal infection was determined for penicillin, erythromycin and clindamycin using an agar dilution method. Organisms studied included 725 group A, 82 group C, and 184 group G streptococci. All organisms were susceptible to penicillin (minimum inhibitory concentration [MIC] range less than 0.004 to 0.015 μg/mL; MIC90 0.015 μg/mL) and clindamycin (range 0.007 to 0.06 μg/mL; MIC90 0.06 μg/mL) with no differences observed between streptococcal groups. For erythromycin, groups A and C were generally susceptible (range less than 0.007 to 0.030 μg/mL; MIC90 0.03 μg/mL; and range 0.007 to 1.0 μg/mL; MIC90 0.06 μg/mL, respectively). Group G was less susceptible (range 0.007 to greater than 2.0 μg/mL; MIC90 greater than 2.0 μg/mL) with 38% of all isolates having an MIC greater than or equal to 1 μg/mL. On review of group G isolates, 100 of 100 from one community were susceptible (MIC less than 0.007 to 0.03 μg/mL) and 73 (87%) of 84 from the second community were resistant. All resistant strains tested were type T16. These data suggest that erythromycin-resistant group G streptococci may occur with high prevalence in certain populations and that patterns of antimicrobial susceptibility in isolated communities may be highly community-specific.
Open Access
Epiglottitis in Canada: A Multiregional Review
(1990-1-1) Law, Barbara J; Draper, David; Mills, Elaine L; Allard, Manon; Nijssen-Jordan, Cheri; Bortolossi, Robert; MacDonald, Noni E; Al-Twaim, Abdulaziz A; Albritton, William; Kasian, Gordon; Rea, Lottie; Cronk, Sharon; Morris, Robert
Epiglottitis is an acute, life threatening infection usually caused by Haemophilus influenzae type b. Although antibiotic therapy is an important part of management, the optimal route and duration is unknown. A multicentre retrospective review of 305 children with epiglottitis was carried out in order to relate antibiotic therapy to hospital course and outcome, as well as to examine regional variation in patient demographics, clinical presentation and course of disease. A standardized form was used to extract data from hospital records. Although management varied significantly among the six centres in terms of mean duration of intubation (46 to 81 h), intravenous antibiotic therapy (3.8 to 5.7 days) and hospital stay (5.3 to 8.4 days), there were no significant centre-related differences in epidemiology, clinical course or outcome of epiglottitis. An extraepiglottic focus of infection was present in 15% of patients and included three with septic arthritis and one with meningitis. The duration of fever in hospital and maximum recorded temperature in hospital were significantly greater for children with extraepiglottic infection compared to those with epiglottitis alone. The data presented in this review suggest that most children with epiglottitis have an uncomplicated course and respond rapidly to antimicrobial therapy following airway securement. A short period of intravenous and oral antibiotic therapy is likely adequate for most children with epiglottitis. A well designed multicentre prospective trial is still needed to determine the optimal duration of antibiotic therapy.
Open Access
The Rapid Emergence of High Level Gentamicin Resistance in Enterococci
(1990-1-1) Forward, Kevin R; Kennedy, James K; Degagne, Patricia A; Bartlett, Kathy R; Harding, Godfrey KM
The proportion of enterococci isolated from blood and urine cultures that were highly resistant to gentamicin and streptomycin were determined. No blood or urine isolates highly resistant to gentamicin were seen in 1983, whereas by 1986–87 25% of blood and 17% of urine isolates were highly resistant. The rapid emergence of gentamicin resistance has serious implications for patients with life threatening enterococcal disease.
Open Access
Heterosexual Transmission of Human Immunodeficiency Virus Infection – Strategies for Prevention
(1991-1-1) Conway, Brian; Cameron, D William; Plummer, Francis A; Ronald, Allan R
In Canada, over 90% of the acquired immune deficiency syndrome cases diagnosed so far have been acquired sexually, with an increasing proportion made up of heterosexual contacts of high risk individuals. In multiple studies, the transmission rate among steady heterosexual partners of infected individuals has been variable. It is likely that complex biological and epidemiological interactions exist between human immunodeficiency virus (HIV) and sexually transmitted diseases with respect to transmission and disease. Other important determinants in transmission of infection may relate to the virus itself. The importance of sexual practices other than vaginal intercourse (such as anal intercourse) in the heterosexual transmission of HIV has not been well studied. The major approach to the control of HIV-associated disease remains the control of primary infection. Sexual practices which are the major epidemiological determinants of HIV transmission can be successfully modified by appropriate educational interventions. The promotion of condom use must form a special part of these interventions. Results of ongoing trials should be available prior to the formulation of recommendations for the use of spermicides. Targeted education programs may allow us to make better use of our resources in a more efficient way. In Canada, groups that could be reached by such programs include: prostitutes and their clients; men and women attending sexually transmitted disease clinics; sexually active women attending family planning clinics; and children and adolescents who are becoming sexually active.
Open Access
Effectiveness and Cost-Benefit of an Influenza Vaccination Program for Health Care Workers
(1991-1-1) Yassi, Annalee; Kettner, Joel; Hammond, Greg; Cheang, Mary; McGill, Myrna
This study retrospectively reviewed the effectiveness of a vaccination program for hospital workers in a large tertiary care hospital, quantified influenza-induced absenteeism, and examined the factors determining the costs and benefits of this program. Absenteeism among high risk hospital workers was increased by 35% (P=0.001) during the virulent influenza epidemic of 1987–88. Benefits, measured as the value of sick time avoided, compared with costs, including materials, occupational nursing staff time, employee time during vaccination, and time lost due to adverse reactions, revealed a net benefit of $39.23 per vaccinated employee. Sensitivity analyses highlighted vaccine efficacy and absenteeism due to influenza and adverse reactions to vaccination as the most important factors; with time lost due to adverse reactions as much as 0.013 days per vaccinated employee and a vaccine efficacy of 70%, net positive benefits could be achieved if influenza-induced absenteeism is 0.5% or greater of paid employee time during the epidemic season. The results suggested that the net cost-benefit of a hospital employee vaccination program to decrease both employee morbidity and nosocomial influenza among patients, would be increased by active promotion of the vaccination program, especially for employees in high risk areas.
Open Access
Prevalence of Antibody to Hepatitis C Virus in an Isolated Canadian Inuit Settlement
(1991-1-1) Minuk, GY; Nicolle, LE; Gauthier, T; Brunka, J
Sera from 720 inhabitants of Baker Lake, Northwest Territories, a community with high rates of hepatitis A and B infection, were tested for antibody to hepatitis C virus by commercial enzyme-linked immunosorbent assay. Only two individuals (0.3%) were positive, a 63-year-old female and an unrelated 10-year-old male. Neither individual was at increased risk of hepatitis C virus exposure. The results of this study indicate that hepatitis C virus infection is no more common in this northern Canadian Inuit settlement than it is in the blood donor population of southern Canada.
Open Access
Pyuria in Institutionalized Elderly Subjects
(1991-1-1) Rodgers, K; Nicolle, LE; McIntyre, M; Harding, GKM; Hoban, D; Murray, D
Two hundred and forty-three urine specimens from 76 elderly institutionalized residents were obtained for urine culture, quantitative leukocyte count and urinalysis. Significant bacteriuria was present in 153 specimens (63%), including 33 (22%) with more than one organism. Pyuria (greater than or equal to 10 leukocytes/mm3) was present in 214 specimens (88%), including 116 (97%) with single organism bacteriuria, 27 (82%) with multiple organism bacteriuria, and 71 (80%) without significant bacteriuria. The leukocyte esterase test had a positive predictive value of 99% for pyuria but a negative predictive value of only 30%. The quantitative level of pyuria was associated with the level of proteinuria and inversely with pH. A relatively constant level of pyuria tended to persist over months to years in a given individual if bacteriuria persisted. Pyuria is significantly associated with bacteriuria in the institutionalized elderly, but is also common in the nonbacteriuric. The clinical significance of pyuria requires further assessment.
Open Access
Overview of Pyrexia
(1992-1-1) MacDonald, Kelly S
Open Access
Differences between Infected and Noninfected Patients with Acute Alcoholic Hepatitis
(1992-1-1) Minuk, GY; Cohen, A; Thompson, V
The medical records of 97 patients with alcoholic hepatitis, including 20 with coexisting bacterial infections and 77 with no evidence of bacterial infection, were reviewed to determine whether commonly employed tests would be useful in distinguishing between the two groups. The results of the study revealed that patients with alcoholic hepatitis and bacterial infections had higher temperatures (38.4±0.9°C versus 37.9±0.7°C, Pud_less_than0.05) and white blood cell counts (16.4±7.9 versus 11.2±6.4×109/L, Pud_less_than0.005), but lower serum bilirubin levels (39±42 versus 115±152, Pud_less_than0.05), than patients with alcoholic hepatitis alone. Patients with alcoholic hepatitis and bacterial infections also tended to reach maximum temperatures and white blood cell counts later in their hospital stay than patients with alcoholic hepatitis alone (5.1±5.3 versus 2.5±1.8 days, and 7.7±11.8 versus 4.4±5.7 days, respectively, Pud_less_than0.05 and Pud_less_than0.005). These results suggest that the extent and timing of peak abnormalities in body temperature, white blood cell count and serum bilirubin level may be of value in distinguishing patients with alcoholic hepatitis with bacterial infections from patients with alcoholic hepatitis alone.
Open Access
Sexually Transmitted Diseases: A Significant Complication of Childhood Sexual Abuse
(1992-1-1) Lindsay, Deborah; Embree, Joanne
The acquisition of one or more sexually transmitted diseases (STD) is a significant complication of sexual assault of children. The risk of infection by pathogens varies from less than 1 to 50% depending on the nature of the assault, the organism studied and the background prevalence of STD in the general community. The correct diagnosis of STD in children depends upon optimal collection and appropriate laboratory testing of clinical specimens. Diagnosing STD will allow for treatment and follow-up to ensure cure of these infections as well as to monitor for re-infection. It will also help confirm that sexual activity involving the child has occurred. This can be exi.remely important, particularly when there are minimal other physical findings of abuse or if the child has limited verbal skills and thus cannot provide a complete disclosure. All physicians who care for children should be knowledgeable about the methods of STD diagnosis and the currently recommended treatment regimens.
Open Access
Risk of Acquiring Cytomegalovirus Infection while Working in Out-of-Home Child Care Centres
(1992-1-1) Law, Barbara
Open Access
Subinhibitory Antimicrobial Concentrations: A Review of In Vitro and In Vivo Data
(1992-1-1) Zhanel, George G; Hoban, Daryl J; Harding, Godfrey KM
Antimicrobial activity is not an ‘all or none’ effect. An increase in the rate and extent of antimicrobial action is usually observed over a wide range of antimicrobial concentrations. Subinhibitory antimicrobial concentrations are well known to produce significant antibacterial effects, and various antimicrobials at subinhibitory concentrations have been reported to inhibit the rate of bacterial growth. Bacterial virulence may be increased or decreased by subinhibitory antimicrobial concentrations by changes in the ability of bacteria to adhere to epithelial cells or by alterations in bacterial susceptibility to host immune defences. Animal studies performed in rats, hamsters and rabbits demonstrate decreased bacterial adherence, reduced infectivity and increased survival of animals treated with subinhibitory antimicrobial concentrations compared to untreated controls. The major future role of investigation of subinhibitory antimicrobial concentrations will be to define more fully, at a molecular level, how antimicrobials exert their antibacterial effects.
Open Access
Comparative Antifungal Activity of Cilofungin (LY121019) against Candida Species, Including Evaluation of Susceptibility Testing Method
(1992-1-1) Chagla, Abdul H; Hii, John H; Hoban, Daryl J; Simor, Andrew E; Ferro, Santiago; Witwicki, Evelyn; Poon, Ruby; Low, Donald E
The in vitro activity of cilofungin against 100 Candida species was compared with 5-flucytosine. amphotericin B and ketoconazole by two laboratories independently and in a blinded fashion using a macrotitre dilution broth method in saam-f medium. Cilofungin showed good in vitro activity against Candida albicans. Candida tropicalis and Candida glabrata (90% minimal inhibitory concentration [MIC] 3.2 μg/mL) but was inactive against other Candida species. When testing the susceptibility of cilofungin, 5-flucytosine and amphotericin B at the two centres, approximately 90% of the Candida strains had MICs differing by fourfold or less. However, when testing susceptibility of ketoconazole, only 51% of the Candida strains had MIC differences fourfold or less. MIC susceptibility testing with cilofungin, 5-flucytosine and amphotericin B in saam-f medium is reproducible.
Open Access
Improving Surveillance of the Impact of Influenza and Its Prevention in Canada
(1993-1-1) Fedson, David S
The organization of Canada’s provincial health care systems and the administrative databases that sustain them provide physicians, epidemiologists and public health officials with unique opportunities to improve surveillance of influenza and its prevention. These databases can be used to measure the impact of influenza on excess mortality, hospitalization and costs to the health care system. They can also be used to study the epidemiology of influenza vaccination practices. Studies using the administrative database for the province of Manitoba have established the epidemiological rationale for hospital-based vaccination and have evaluated the clinical effectiveness of influenza vaccination. As pneumococcal vaccination becomes widespread in Canada, provincial databases should also prove useful in assessing the impact of the pneumococcal infections and their prevention with pneumococcal vaccine.
Open Access
Streptococcus pneumoniae: A Cause of Primary Lung Abscess in a Child
(1993-1-1) MacDonald, Kelly S; de Carvalho, Volia M; Liebert, Lawrence; Embree, Joanne E
A case of primary pneumococcal lung abscess in a five-year-old child is described. Secondary anaerobic infection as a cause of cavitation was excluded by bronchoscopic culture of the cavity. Streptococcus pneumoniae is a rare but recognized cause of lung abscess in healthy children.
Open Access
A Case of Group A Streptococcal Meningitis in an Adult
(1993-1-1) Pattullo, Andrew LS; Bow, Eric J
Group A streptococci are an important cause of soft tissue infections but have rarely been reported as the cause of pyogenic meningitis since the advent of antibiotics. A case of group A streptococcal meningitis in an adult is presented along with a review of similar cases reported in the literature. This case serves to illustrate the virulent nature of this pathogen in infections of the meninges, the potential for associated complications, and the need for rapid diagnosis and appropriate treatment. The source of infection in this and many other cases in the literature is the upper respiratory tract. The case presented responded well to antibiotics but resulted in permanent auditory-vestibular dysfunction.
Open Access
Etiology of Cervicitis and Treatment with Minocycline
(1993-1-1) Bowie, William R; Willetts, Val; Binns, Bernard A; Brunham, Robert C
Objective: To evaluate the etiology of cervicitis using the recommended Canadian definition, and to evaluate the efficacy and tolerability of seven days of minocycline treatment, 100 versus 200 mg at bedtime.Design: Randomized double-blind study with initial microbiological evaluation, and intended follow-up through 12 weeks.Setting: Women attending the major sexually transmitted disease clinic in Vancouver and the major teaching hospital in Winnipeg.Population Studied: Women with cervicitis (inclusion criteria were an off-white or yellow colour of cervical mucus when viewed on a white-tipped swab, and a mean of 10 or more polymorphonuclear leukocytes per oil immersion [× 1000] field on Gram stain of cervical mucus). Fourty-four women were enrolled but two were excluded because of contaminated cultures.Interventions: Treatment with two identical appearing capsules of 50 mg (100 mg dose) or 100 mg (200 mg dose) of minocycline taken at bedtime with water for seven days.Main Results: Of the 42 evaluable women, Chlamydia trachomatis was initially isolated from 19 (45%) and Neisseria gonorrhoeae from four (10%). The study was prematurely terminated because of an unacceptable and significantly higher frequency of adverse reactions on the higher dose regimen of minocycline – severe reactions in one (4%) on 100 mg compared with six (30%) on 200 mg (P=0.05). Major reactions were dizziness, mood alterations and nausea. Clinical parameters, but not numbers of polymorphonuclear leukocytes, improved significantly irrespective of initial microbiology or the regimen received. Cultures became and stayed negative for C trachomatis in seven of eight on minocycline 100 mg and five of six on minocycline 200 mg. Both ‘failures’ had an intervening negative culture and were re-exposed to untreated sexual partners.Conclusions: Although not a definitive study in terms of proving efficacy of lower dose regimens, the results are consistent with efficacy and demonstrate the significant advantage of the lower dose regimen in terms of adverse reactions.
Open Access
A Prospective Randomized Trial of Imipenem-Cilastatin Versus Clindamycin/Tobramycin in the Treatmentof Intra-Abdominal and Pelvic Infections
(1993-1-1) Mandell, Lionel A; Turgeon, Pierre L; Ronalds, Allan R; The Canadian Clinical Trials Group,
Objective: A Canadian multicentre clinical trial in the treatment of intra-abdominal and pelvic infections to compare the efficacy and safety of monotherapy using imipenem-cilastatin (imipenem) (500 mg intravenously every 6 h) versus combination therapy with clindamycin/tobramycin (clindamycin 600 mg intravenously every 6 h and tobramycin 1.7 mg/kg intravenously every 8 h).Methods: Two hundred and fifty patients were entered (88 definite and 162 possible infections) and all were evaluable for analysis of adverse events and intention to treat analysis of efficacy. Dichotomous outcomes used were: cured versus noncured (improved, failed, relapsed).Results: No statistically significant differences were found with the intention to treat analysis (P=0.88) or with definite infections (P=0.81). For overall bacteriological response, no significant differences were noted (P=0.1). Eleven and 15 patients on imipenem and clindamycin/tobramycin, respectively, were colonized with bacteria. Enterococci colonized four of 11 imipenem cases and five of 15 clindamycin/tobramycin cases while fungi colonized six patients on imipenem and four on clindamycin/tobramycin. Five patients on imipenem and seven on clindamycin/tobramycin developed superinfection. In the imipenem group, one case had a bacterial superinfection while four cases were due to Candida albicans. Seven of seven superinfections on clindamycin/tobramycin were bacterial. Three bacteria initially sensitive to the assigned study drug developed resistance. In two patients on imipenem, Enterococcus faecalis and Pseudomonas aeruginosa became resistant after 14 and 10 days of therapy, respectively. On clindamycin/tobramycin, one instance of Bacteroides fragilis resistance after eight days of therapy was seen. Eighty-three adverse events occurred; 47 in the imipenem group and 36 in the clindamycin/tobramycin group. This resulted in discontinuation of antibacterial therapy in 13 patients, seven of whom were on imipenem and six on clindamycin/tobramycin. Comparison of adverse effects showed statistically significant differences for nausea (P=0.02) and hepatotoxicity (P=0.05) occurring with greater frequency in the imipenem and clindamycin/tobramycin groups, respectively.Conclusions: These data support the conclusion that monotherapy with imipenem (500 mg intravenously every 6 h) is as efficacious as clindamycin/tobramycin for treatment of intra-abdominal and pelvic infections. Both regimens are well tolerated.
Open Access
Morbidity, Cost and Role of Health Care Worker Transmission in an Influenza Outbreak in a Tertiary Care Hospital
(1993-1-1) Yassi, Annalee; McGill, Myrna; Holton, Donna; Nicolle, Lindsay
An influenza A outbreak involving 17 health care workers (HCWs) and 16 chronic geriatric patients on a ward in a tertiary care hospital was reviewed. Thirty-seven per cent of all HCWs and 47% of patients on the affected wards became ill with influenza. Three patients died during the outbreak. The majority of health care workers became ill prior to detecting the first patient case of influenza, suggesting that nosocomial spread from HCWs to patients may have occurred. Only 13.7% of the staff and 5.9% of the patients had been vaccinated prior to the outbreak. Lost time due to HCW absenteeism, outbreak-related medication costs and additional staff time involved in outbreak control resulted in considerable cost to the hospital. It is suggested that much of this cost, as well as morbidity and possibly mortality, could have been avoided by increased immunization of HCWs and patients.