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1.  Drug Use and Other Risk Factors Related to Lower Body Mass Index among HIV-Infected Individuals 
Drug and alcohol dependence  2008;95(0):10.1016/j.drugalcdep.2007.12.004.
Malnutrition is associated with morbidity and mortality in HIV infected individuals. Little research has been conducted to identify the roles that clinical, illicit drug use and socioeconomic characteristics play in the nutritional status of HIV-infected patients. This cross-sectional analysis included 562 HIV-infected participants enrolled in the Nutrition for Healthy Living study conducted in Boston, MA and Providence, RI. The relationship between body mass index (BMI) and several covariates (type of drug use, demographic, and clinical characteristics) were examined using linear regression.
Overall, drug users had a lower BMI than non-drug users. The BMI of cocaine users was 1.4 kg/m2 less than that of patients who did not use any drugs, after adjusting for other covariates (p= 0.02). The BMI of participants who were over the age of 55 years was 2.0 kg/m2 less than that of patients under the age of 35, and BMI increased by 0.3 kg/m2 with each 100 cells/mm3 increase in CD4 count. HAART use, adherence to HAART, energy intake, AIDS status, hepatitis B and hepatitis C co-infections, cigarette smoking and depression were not associated with BMI in the final model.
In conclusion, BMI was lower in drug users than non-drug users, and was lowest in cocaine users. BMI was also directly associated with CD4 count and inversely related to age more than 55 years old. HIV infected cocaine users may be at higher risk of developing malnutrition, suggesting the need for anticipatory nutritional support.
doi:10.1016/j.drugalcdep.2007.12.004
PMCID: PMC3837518  PMID: 18243579
drug users; cocaine users; BMI; HIV; CD4 count
2.  Whole-Genome Sequencing Demonstrates That Fidaxomicin Is Superior to Vancomycin for Preventing Reinfection and Relapse of Infection With Clostridium difficile 
The Journal of Infectious Diseases  2013;209(9):1446-1451.
Whole-genome sequencing was used to determine whether the reductions in recurrence of Clostridium difficile infection observed with fidaxomicin in pivotal phase 3 trials occurred by preventing relapse of the same infection, by preventing reinfection with a new strain, or by preventing both outcomes. Paired isolates of C. difficile were available from 93 of 199 participants with recurrences (28 were treated with fidaxomicin, and 65 were treated with vancomycin). Given C. difficile evolutionary rates, paired samples ≤2 single-nucleotide variants (SNVs) apart were considered relapses, paired samples >10 SNVs apart were considered reinfection, and those 3–10 SNVs apart (or without whole-genome sequences) were considered indeterminate in a competing risks survival analysis. Fidaxomicin reduced the risk of both relapse (competing risks hazard ratio [HR], 0.40 [95% confidence interval {CI}, .25–.66]; P = .0003) and reinfection (competing risks HR, 0.33 [95% CI, 0.11–1.01]; P = .05).
doi:10.1093/infdis/jit598
PMCID: PMC3982846  PMID: 24218500
Clostridium difficile; recurrence; fidaxomicin; whole genome sequencing
3.  Renal Failure and Leukocytosis Are Predictors of a Complicated Course of Clostridium difficile Infection if Measured on Day of Diagnosis 
Nonsevere Clostridium difficile infection (CDI) and severe CDI, which carries a higher risk than nonsevere CDI for treatment failure and CDI recurrence, are difficult to distinguish at the time of diagnosis. To investigate the prognostic value of 3 markers of severe CDI suggested by recent guidelines (fever, leukocytosis, and renal failure), we used the database of 2 randomized controlled trials, which contained information for 1105 patients with CDI. Leukocytosis (risk ratio [RR], 2.29; 95% confidence interval [CI], 1.63–3.21) and renal failure (RR, 2.52; 95% CI, 1.82–3.50) were associated with treatment failure. Fever, although associated with treatment failure (RR, 2.45; 95% CI, 1.07–5.61), was rare. Renal failure was the only significant predictor of recurrence (RR, 1.45; 95% CI, 1.05–2.02). Different timing of measurements of leukocyte count and serum creatinine level around the CDI diagnosis led to a different severity classification in many cases. In conclusion, both leukocytosis and renal failure are useful predictors, although timing of measurement is important.
doi:10.1093/cid/cis340
PMCID: PMC3388022  PMID: 22752864
4.  Treatment of First Recurrence of Clostridium difficile Infection: Fidaxomicin Versus Vancomycin 
Recurrence of Clostridium difficile infection (CDI) occurs in approximately 25% of successfully treated patients. Two phase 3 randomized, double-blind trials were conducted at 154 sites in the United States, Canada, and Europe to compare fidaxomicin vs vancomycin in treating CDI. Patients with CDI received fidaxomicin 200 mg twice daily or vancomycin 125 mg 4 times daily for 10 days. The primary end point was clinical cure of CDI at end of treatment, and a secondary end point was recurrence during the 28 days following clinical cure. In all, 1164 subjects were enrolled, of which a subgroup of 128 in the per-protocol population had another recent episode of CDI prior to the CDI diagnosis at study enrollment. In the analysis of this subgroup, initial response to therapy was similar for both drugs (>90% cure). However, recurrence within 28 days occurred in 35.5% of patients treated with vancomycin and 19.7% of patients treated with fidaxomicin (−15.8% difference; 95% confidence interval, −30.4% to −0.3%; P = .045). Early recurrence (within 14 days) was reported in 27% of patients treated with vancomycin and 8% of patients treated with fidaxomicin (P = .003). In patients with a first recurrence of CDI, fidaxomicin was similar to vancomycin in achieving a clinical response at end of therapy but superior in preventing a second recurrence within 28 days.
Clinical Trials Registration. NCT00314951 and NCT00468728.
doi:10.1093/cid/cis462
PMCID: PMC3388030  PMID: 22752865
5.  Fidaxomicin Versus Vancomycin for Clostridium difficile Infection: Meta-analysis of Pivotal Randomized Controlled Trials 
Two recently completed phase 3 trials (003 and 004) showed fidaxomicin to be noninferior to vancomycin for curing Clostridium difficile infection (CDI) and superior for reducing CDI recurrences. In both studies, adults with active CDI were randomized to receive blinded fidaxomicin 200 mg twice daily or vancomycin 125 mg 4 times a day for 10 days. Post hoc exploratory intent-to-treat (ITT) time-to-event analyses were undertaken on the combined study 003 and 004 data, using fixed-effects meta-analysis and Cox regression models. ITT analysis of the combined 003/004 data for 1164 patients showed that fidaxomicin reduced persistent diarrhea, recurrence, or death by 40% (95% confidence interval [CI], 26%–51%; P < .0001) compared with vancomycin through day 40. A 37% (95% CI, 2%–60%; P = .037) reduction in persistent diarrhea or death was evident through day 12 (heterogeneity P = .50 vs 13–40 days), driven by 7 (1.2%) fidaxomicin versus 17 (2.9%) vancomycin deaths at <12 days. Low albumin level, low eosinophil count, and CDI treatment preenrollment were risk factors for persistent diarrhea or death at 12 days, and CDI in the previous 3 months was a risk factor for recurrence (all P < .01). Fidaxomicin has the potential to substantially improve outcomes from CDI.
doi:10.1093/cid/cis499
PMCID: PMC3388031  PMID: 22752871
7.  Efficacy of Fidaxomicin Versus Vancomycin as Therapy for Clostridium difficile Infection in Individuals Taking Concomitant Antibiotics for Other Concurrent Infections 
Concomitant antibiotic (CA) use compromised initial response to Clostridium difficile infection therapy and durability of that response. Fidaxomicin was significantly more effective than vancomycin in achieving clinical cure in the presence of CAs and preventing recurrence regardless of CA use.
Background. Treatment guidelines recommend stopping all implicated antibiotics at the onset of Clostridium difficile infection (CDI), but many individuals have persistent or new infections necessitating the use of concomitant antibiotics (CAs). We used data from 2 phase 3 trials to study effects of CAs on response to fidaxomicin or vancomycin.
Methods. Subjects with CDI were treated for 10 days with fidaxomicin 200 mg every 12 hours or vancomycin 125 mg every 6 hours, assessed for resolution of symptoms, and followed up for an additional 4 weeks for evidence of recurrence. Rates of cure, recurrence, and global cure (cure without recurrence) were determined for subgroups of subjects defined by CA use and treatment group.
Results. CAs were prescribed for 27.5% of subjects during study participation. The use of CAs concurrent with CDI treatment was associated with a lower cure rate (84.4% vs 92.6%; P < .001) and an extended time to resolution of diarrhea (97 vs 54 hours; P < .001). CA use during the follow-up was associated with more recurrences (24.8% vs 17.7%; not significant), and CA administration at any time was associated with a lower global cure rate (65.8% vs 74.7%; P = .005). When subjects received CAs concurrent with CDI treatment, the cure rate was 90.0% for fidaxomicin and 79.4% for vancomycin (P = .04). In subjects receiving CAs during treatment and/or follow-up, treatment with fidaxomicin compared with vancomycin was associated with 12.3% fewer recurrences (16.9% vs 29.2%; P = .048).
Conclusions. Treatment with CAs compromised initial response to CDI therapy and durability of response. Fidaxomicin was significantly more effective than vancomycin in achieving clinical cure in the presence of CA therapy and in preventing recurrence regardless of CA use.
doi:10.1093/cid/cir404
PMCID: PMC3156139  PMID: 21844027
8.  Fat/Fiber intakes and sex hormones in healthy premenopausal women in USA 
The mechanisms by which diet affects breast cancer (BC) risk are poorly understood but a positive relationship between fat and a negative association with fiber intake and BC risk have been demonstrated. Here we study the association between dietary fat/fiber ratio and estrogen metabolism. Fifty women were recruited, 22 were included in the low fat/high fiber and 22 were in the high fat/low fiber and 6 did not meet our criteria. Estrogens (determined in plasma, urine and feces) and dietary records were collected during 3 following days. All data were collected in winter and in summer. The high fat/low fiber group had significantly higher urinary total estrogens, estriol-3-glucuronide, 2-hydroxyestradiol, 16α-hydroxyestrone, and a higher 2-hydroxyestrone/4-hydroxyestrone ratio. Total fat intake correlated significantly with plasma estrone, estradiol, urinary 2-hydroxyestrone, 2-hydroxyestradiol, 2-hydroxyestrone/4-hydroxyestrone ratio, and total urinary estrogens, even after adjustment for total fiber intake. The high fat/low fiber diet was associated with high values both for catechol and 16α-hydroxylated estrogens and a high 2-hydroxyestrone/4-hydroxyestrone ratio, but 2-hydroxyestrone/16α-hydroxyestrone ratio was not different between the groups. Our results suggest that fat affects estrogen metabolism more than does fiber and that one mechanism resulting in high estrogen values is an increased reabsorption of biliary estrogens.
doi:10.1016/j.jsbmb.2008.08.002
PMCID: PMC2656650  PMID: 18761407
Diet; Estrogens; Breast cancer risk; Women
9.  Risk Factors for Cardiovascular Disease in Human Immunodeficiency Virus-1 Infected Children 
The Journal of pediatrics  2008;153(4):491-497.
Objective
To determine risk factors for cardiovascular disease (CVD) in HIV-infected children compared with nationally representative controls from 2003–2004 NHANES data.
Study design
Prospective, longitudinal analysis of CVD risk factors in 42 HIV-infected children compared with NHANES controls with multivariable modeling of demographic, disease-specific, and treatment-related factors contributing to cardiac risk in the HIV cohort.
Results
The 42 HIV-infected children were initially an average of 10.1 years old, 68% CDC class B or C, and 76% were on HAART. Compared with age- and sex-adjusted NHANES controls, HIV-infected children had lower weights (−.46 SD vs +.54 SD; P<.001), heights (−.62 SD vs +.26 SD; P<.001), and body mass index (−.09 SD vs +.51 SD; P<.001). HIV-infected children had higher triglycerides (136 mg/dL vs 90 mg/dL; P < 0.001) and lower HDL-cholesterol levels (47 mg/dL vs 54 mg/dL; P < 0.001). Protease inhibitor (PI) therapy was independently associated with higher triglycerides (P = 0.02) and LDL-cholesterol (P = 0.04) and lower HDL-cholesterol (P=0.02); NNRTI therapy was associated with lower visceral fat (P=0.01) and higher HDL-cholesterol (P = 0.005).
Conclusions
HIV-infected children, compared with NHANES controls, have adverse cardiac risk profiles. Antiretroviral therapy has significant effects on these factors.
doi:10.1016/j.jpeds.2008.04.016
PMCID: PMC2603524  PMID: 18538789
Child; HIV - AIDS; Cardiovascular Risk Factors; Lipids; Abdominal fat
10.  Metabolic Syndrome and Subclinical Atherosclerosis in Patients Infected with HIV 
Background
The present study examines the association between carotid and coronary atherosclerosis and metabolic syndrome in human immunodeficiency virus (HIV)–infected adults.
Methods
We measured the common and internal carotid intima-media thickness (c-IMT) using B-mode ultrasonography, and we measured coronary artery calcium (CAC) using high-resolution, electrocardiographic, synchronized, computed tomography, for 314 HIV-infected men and women. Metabolic syndrome was defined by National Cholesterol Education Program/Adult Treatment Panel III criteria. We compared the c-IMT measurements and CAC scores of patients with metabolic syndrome with the scores of those without metabolic syndrome using a Wilcoxon test for continuous variables and a χ2 test for categorical variables. To examine the association between surrogate markers and metabolic syndrome, we used logistic regression analysis.
Results
Participants with metabolic syndrome were more likely to have a common c-IMT measurement >0.8 mm than were those without metabolic syndrome (17% vs.7%; P=.009), but both groups were equally likely to have an internal c-IMT measurement >1.0 mm (20% vs. 13%; P=.15). Any positive CAC score was more likely to occur for participants with metabolic syndrome (80.3% vs. 46.7%; P < .0001). In a multivariate model adjusted for sex, age, ethnicity, and smoking status, participants with metabolic syndrome were more likely than those without metabolic syndrome to have an abnormal common c-IMT measurement (odds ratio [OR], 2.9; P= .020) and detectable CAC scores (OR, 4.9; P < .0001) but not a higher internal c-IMT measurement (OR, 1.6; P=.255).
Conclusion
Our study demonstrates that HIV-infected individuals with metabolic syndrome may be at increased risk for subclinical atherosclerosis and supports screening for metabolic syndrome among HIV-infected patients at risk for cardiovascular disease.
doi:10.1086/516616
PMCID: PMC2745593  PMID: 17443477
11.  Changes in macronutrient intake among HIV-infected children between 1995 and 20041–3 
Background
Nutritional concerns in HIV-infected children have evolved, from wasting to obesity and insulin resistance. However, little is known about the diet of these children during this evolution.
Objective
We analyzed dietary macronutrient intake in HIV-infected children over nearly 10 y.
Design
HIV-infected children underwent periodic longitudinal nutritional assessments between 1995 and 2004. Sex-specific initial and final means or proportions and time trends in macronutrient intakes were estimated with regression analyses.
Results
Three hundred thirty nutritional records from 49 males and 411 from 67 females were analyzed. Caloric intake exceeded the estimated energy requirement (EER) for ideal body weight in 1995 by 62% for males and 39% for females and decreased by 3% of the EER per year in males (P = 0.02) and by 2% in females (P = 0.004). In 2004, caloric intake still remained >19% above the EER in both groups. Protein intake was nearly 400% of the recommended dietary allowance (RDA) for ideal body weight in 1995 among both males and females and decreased by 13% of the RDA per year for males (P = 0.001) and by 21% per year for females (P < 0.001). However, daily protein intake still exceeded the RDA by >60% in both groups in 2004. Females consumed more energy from carbohydrates (P = 0.05) and sugar (P = 0.10) and less from monounsaturated (P = 0.04), polyunsaturated (P = 0.05), saturated (P = 0.03), and total (P = 0.10) fat in 2004 than in 1995.
Conclusion
Excessive caloric intake and a shift in dietary composition toward carbohydrates in females suggest that continued monitoring of diet in HIV-infected children is important to avoid increased nutritional risk.
PMCID: PMC2562173  PMID: 18689374
12.  Nutrition Issues in Chronic Drug Users Living With HIV Infection 
Human immunodeficiency virus (HIV) infection and chronic drug abuse both compromise nutritional status. For individuals with both disorders, the combined effects on wasting, the nutritional consequence that is most closely linked to mortality, appear to be synergistic. Substance abuse clinicians can improve and extend patients’ lives by recommending healthy diets; observing and assessing for food insecurity, nutritional deficits, signs of weight loss and wasting, body composition changes, and metabolic abnormalities; and providing referrals to food programs and nutritionists. More studies are needed on the nutritional consequences of using specific illicit drugs, the impact on health of specific micronutrient and metabolic deficiencies seen in people with HIV, and the causes and clinical implications of body fat changes associated with HIV.
PMCID: PMC2797116  PMID: 19369915
13.  Typhoid Fever—`Recherches du Temps Perdu' 
Western Journal of Medicine  1986;144(5):606-607.
PMCID: PMC1306723  PMID: 18749987
14.  Inactivation of Cephalosporins by Bacteroides 
We investigated the relationship between β-lactamases of Bacteroides fragilis organisms and their resistance to cephalosporins. Timed killing curves were used to study the in vitro activity of three cephalosporins, cephalothin, cefazolin, and cefamandole, and a semisynthetic cephamycin, cefoxitin. Measurements of residual antibiotic concentrations in culture supernatants were made, and they were compared with the β-lactamase activity of the microorganism. A cephalosporin-susceptible strain was rapidly killed by cephalothin, cefazolin, cefamandole, and cefoxitin. Four cephalosporin-resistant strains were not killed by cephalothin, cefazolin, or cefamandole but were killed by cefoxitin. An inoculum effect was noted with cefazolin and not with cefoxitin. The resistant strains of Bacteroides inactivated the three cephalosporins, but there was no inactivation of cefoxitin. A constitutive β-lactamase was detected in all the isolates of the B. fragilis group that were resistant to the cephalosporins. There was no distinction of the species based on isoelectric focusing of the enzyme. These data suggest that inactivation by β-lactamase may be the mechanism for resistance of B. fragilis to the cephalosporins and would explain the enhanced in vitro activity of cefoxitin.
PMCID: PMC352906  PMID: 525995
15.  Netilmicin in Gram-Negative Bacterial Infections 
Netilmicin, a new semisynthetic aminoglycoside, was used in the treatment of 42 patients with serious gram-negative bacterial infections. Of the 40 evaluable patients, 24 (60%) were cured, and 8 (20%) had a favorable clinical response, for a total clinical response rate of 80%. Eight patients failed to respond; of these, three had undrained abscesses and two had severe granulocytopenia. Three of the patients who failed had organisms in which resistance to netilmicin developed during therapy, and in two of these three netilmicin was the only aminoglycoside to which resistance developed. Of the 37 patients evaluable for toxicity, 8 (22%) developed renal insufficiency. Two patients had mild but persistant elevation in serum creatinine. Three patients had nephrotoxicity while on gentamicin in the past. Pre- and posttherapy audiograms were done on 26 patients; none had hearing loss. Four patients had mild, transient asymptomatic elevations in alkaline phosphatase. The pretreatment clinical isolates were tested for in vitro susceptibility. The median minimal inhibitory concentration of netilmicin, gentamicin, and tobramycin ranged between 0.5 and 2 μg/ml. The median minimal inhibitory concentration of amikacin was approximately twofold higher. No clear in vitro superiority of one aminoglycoside over another was observed.
PMCID: PMC352599  PMID: 426506
16.  Assay of Gentamicin and Tobramycin in Sera of Patients by Gas-Liquid Chromatography 
Therapeutic levels of gentamicin and tobramycin in the sera of patients were measured by gas-liquid chromatography. Concentration-response curves for both drugs were linear over an expected therapeutic range of 1.3 to 12.5 μg/ml (coefficient of determination was >0.97). Coefficients of variation for chromatographic response to gentamicin varied from 6.3 to 9.6%, and to tobramycin from 3.8 to 13.5%. Paired gas-liquid chromatography and microbiological assays for patient serum aminoglycoside levels were performed on 106 gentamicin and 40 tobramycin sera. At levels <2.0 μg/ml, the average difference of estimates between the two assay techniques for gentamicin and tobramycin were, respectively, 38 and 29%. At drug concentrations >2.0 μg/ml, the mean difference between paired estimates was near 20% for both aminoglycosides. The speed, precision, and accuracy of the gas-liquid chromatography assay indicate that it can be a useful alternative to the microbiological procedure for the determination of gentamicin and tobramycin levels in human serum.
PMCID: PMC352569  PMID: 369455
17.  In Vitro Activity of Thienamycin 
The in vitro activity of thienamycin was tested against 135 aerobic and anaerobic bacteria. The compound was highly active against resistant gram-negative bacilli and penicillin-resistant Straphylococcus aureus. The antianaerobic spectrum of the drug seemed to be comparable to that of metronidazole.
PMCID: PMC352476  PMID: 708019
18.  Rapid Microbiological Assay for Chloramphenicol and Tetracyclines 
An agar diffusion assay for chloramphenicol and tetracyclines is described, using inhibition of hemolysis by Clostridium perfringens as a biological indicator of antimicrobial activity. Well-defined zones formed after a 1.5- to 2-h incubation in an anaerobic chamber or after 3 h using a GasPak system. Serum levels of chloramphenicol as low as 2.0 μg/ml could be reproducibly determined with this method. Concurrent presence of gentamicin did not influence the assay. Levels of penicillin G were also reproducibly determined with this method, although use of stable zones of growth inhibition which would form after overnight incubation were a more convenient end point for this bactericidal drug. The hemolytic assay with C. perfringens is a reproducible, accurate, and rapid method for determination of levels for chloramphenicol and tetracyclines.
Images
PMCID: PMC429642  PMID: 180881
19.  Effects of Time and Growth Media on Short-Chain Fatty Acid Production by Bacteroides fragilis 
Applied Microbiology  1975;29(4):472-475.
Gas-liquid chromatography was used to monitor the evolution of short chain fatty acids by Bacteroides fragilis in five media. Acetic and succinic acids, the prominent end products encountered, were readily detected within 24 h. Propionic, isobutyric, butyric, isovaleric, and lactic acids were usually recorded in more limited quantities. Maximum rates of bacterial multiplication, glucose catabolism, and end-product production coincided with the first 24 h in carbohydrate-supplemented media. Extended incubation (672 h) favored substantial succinate increases in three of five media. These observations suggest that incubation time and composition of the medium are important determinants in short chain fatty acid production by B. fragilis.
PMCID: PMC187008  PMID: 1124920
20.  In Vitro Activity of Penicillins Against Anaerobes 
The in vitro susceptibility of 162 anaerobic isolates from clinical material were tested to pencillin G, BL-P1654, and carbenicillin. Penicillin G and BL-P1654 showed good activity against Bacteroides fragilis, but only 60% of strains were susceptible to carbenicillin at achievable blood levels (128 μg/ml).
PMCID: PMC429153  PMID: 1041215
21.  Rapid Gas Chromatographic Technique for Presumptive Detection of Clostridium botulinum in Contaminated Food 
Applied Microbiology  1975;29(2):297-299.
A simple gas-liquid chromatography end-product assay is reported for butyric and other short-chain fatty acids as presumptive indicators of Clostridium botulinum contamination in food.
PMCID: PMC186962  PMID: 1090253
22.  Susceptibility of Anaerobes to Cefoxitin and Other Cephalosporins 
The in vitro susceptibility of 155 strains of anaerobic bacteria to five cephalosporin antibiotics was tested. Cefoxitin was the most active against 33 isolates of Bacteroides fragilis; 82% of the strains were sensitive at 16 μg/ml. At 64 μg/ml cefazolin and cephaloridine were also generally effective. Cephalothin and cephalexin were relatively inactive versus B. fragilis. Cefoxitin, cephaloridine, cefazolin, and cephalothin showed comparable activity against 122 strains of anaerobes other than B. fragilis. More than 90% of the strains were sensitive to each of these antimicrobials at 16 μg/ml. Cephalexin was the least effective cephalosporin against all species tested.
PMCID: PMC429091  PMID: 1137364
23.  Comparative Effect of Tetracycline and Doxycycline on the Occurrence of Resistant Escherichia coli in the Fecal Flora 
Antibiotic-induced changes in the fecal microflora after oral administration of tetracycline hydrochloride and doxycycline for 8 to 10 days were compared. A significant difference was noted in the concentrations of Escherichia coli resistant to tetracyclines. With tetracycline hydrochloride, there was a mean increase of approximately 104 resistant strains per g compared to only 101/g for doxycycline. This difference is ascribed to reduced intestinal concentrations of bioactive drug with recommended oral dosage for doxycycline.
PMCID: PMC429072  PMID: 1094945
24.  Experimental Intra-Abdominal Abscesses in Rats: Quantitative Bacteriology of Infected Animals 
Infection and Immunity  1974;10(6):1256-1259.
An animal model simulating intra-abdominal sepsis was produced by implanting large bowel contents into the pelvic region of rats. Bacteriological analysis of infected sites showed quantitative differences according to the stage of disease. During the initial, often lethal, peritonitis stage, Escherichia coli (mean concentration, 106/ml), enterococci (105) and Bacterioides fragilis (106) were always present. Blood cultures obtained during this phase were uniformly positive, with E. coli being the principal isolate. Animals that survived this early acute peritonitis stage developed indolent intra-abdominal abscesses. The major isolates in abscess contents were B. fragilis (108.7) and Fusobacterium (108.6); E. coli (107.8) and enterococci (105.7) were also present but in lesser concentrations. Rank order analysis of these four species in peritoneal exudates and abscess pus showed that the two aerobes outranked the two anaerobes during the early stage of the disease, whereas the reverse was true in abscesses. These experiments also illustrated that a major simplification of the original fecal inoculum occurred, even though the subsequent infection remained bacteriologically complex.
PMCID: PMC423096  PMID: 4611923
25.  Experimental Intra-Abdominal Abscesses in Rats: Development of an Experimental Model 
Infection and Immunity  1974;10(6):1250-1255.
An animal model has been developed to study the evolution of intra-abdominal abscesses. Gelatin capsules containing pooled colonic contents and barium sulfate were prepared in an anaerobic chamber and implanted into the pelvic region of Wistar rats. The natural course of the ensuing disease was studied in various groups according to the source of the inoculum and sex of the recipient. Colonic contents derived from rats fed a grain diet produced a highly lethal disease with an 80% mortality rate for males and 100% for females. Most deaths occurred within 3 days of implantation, and autopsies showed generalized peritonitis. The addition of blood to the inoculum caused a rapidly fatal peritonitis in all animals. With an inoculum derived from meat-fed rats implanted in male recipients, there was a biphasic disease. Initially, there was peritonitis associated with 43% mortality. All animals that survived this acute period developed discrete intra-abdominal abscesses by the seventh postoperative day. The latter stage was characterized by an indolent course and progressive enlargement of abscesses.
PMCID: PMC423095  PMID: 4611922

Results 1-25 (33)