Acinetobacter baumannii outbreak isolates characterized by three typing methodsAubert, G.; Grimont, F.; Zéni, F.; Pain, P.; Michel, V.; Vautrin, A.; Vedel, G.; Bouvet, P.
doi: 10.1007/BF01590947pmid: 8681988
Forty-two strains ofAcinetobacter baumannii were isolated from 15 patients hospitalized in a French intensive care unit. An epidemiological study based on the typing of these isolates was carried out using biotyping, antibiotyping, and ribotyping to recognize the transmission of multiresistant strains by transfer of a patient from one hospital to another. Fifteen strains from the outbreak (1 strain for each patient), fiveAcinetobacter baumannii strains isolated before the outbreak in Bellevue Hospital (St. Etienne), and five strains isolated in Cochin Hospital (Paris) were included. The three methods gave a good correlation: the epidemic strains had the same antibiotic resistance pattern, the same biotype, and the same ribotypes obtained with three different endonucleases.
Plasma endotoxin and cytokine levels in neutropenic and non-neutropenic bacteremic patientsHynninen, M.; Valtonen, M.; Vaara, M.; Markkanen, H.; Kuusela, P.; Saxen, H.; Takkunen, O.
doi: 10.1007/BF01590936pmid: 8681977
Plasma endotoxin, tumor necrosis factor-α (TNF-α), interleukin 1β (IL-1β), interleukin 1 receptor antagonist (IL-1ra), and interleukin 6 (IL-6) concentrations in 69 bacteremic patients were compared with those in 54 nonbacteremic patients suffering from suspected bacterial infections. Only three (11%) of the 27 patients with gram-negative bacteremia showed detectable levels of endotoxin. TNF-α was detected in 6% of the bacteremic patients and in none of the nonbacteremic patients. Median IL-6 levels were significantly higher in bacteremic than in nonbacteremic patients (55 vs. 0 pg/ml, p=0.0008). IL-6 concentrations were similar in neutropenic and non-neutropenic bacteremic patients (median 55 vs. 74 pg/ml). In contrast, neutropenic bacteremic patients had significantly lower concentrations of tIL-1ra than non-neutropenic bacteremic patients (250 vs. 1,950 pg/ml, p<0.0001). Patients with fatal bacteremia had significantly higher concentrations of IL-6 and IL-1ra than the survivors (median, 450 vs. 40, p=0.012 and 7,600 vs. 420 pg/ml, p=0.0075, respectively). Determinations of endotoxin or TNF-α in patients with suspected bacteremia failed to offer clinically relevant data on the prognosis of these patients. IL-6 levels correlated with both the presence of bacteremia and the risk of death. Granulocytopenic patients with bacteremia had lower levels of circulating IL-1ra than patients with normal granulocyte counts, and these levels correlated with poor outcome.
Immune response toChlamydia trachomatis heat-shock protein in infertile female patients and influence ofChlamydia pneumoniae antibodiesFreidank, H.; Clad, A.; Herr, A.; Wiedmann-Al-Ahmad, M.; Jung, B.
doi: 10.1007/BF01590940pmid: 8681981
A total of 446 sera from 245 patients with primary or secondary infertility, all of whom were examined laparoscopically, 117 patients withChlamydia trachomatis-positive cervical swabs, and 84 control persons (50 obstetric patients and 34 female blood donors) were tested for antibodies toChlamydia trachomatis and toChlamydia pneumoniae with the microimmunofluorescence (MIF) test. MIF test antibody rates were highest in patients with complete tubal occlusion (73%) and in patients with provenChlamydia trachomatis infection (74%), whereas only 9 to 10% of the control group showedChlamydia trachomatis antibodies. Reaction to the 60 kDa antigen ofChlamydia trachomatis, a heat-shock protein (hsp) analogue, has been suggested as a possible marker for the development of chronic sequelae afterChlamydia trachomatis infection. Immunoblot analysis of 222 sera (169 infertility patients, 20 antigen-positive patients, and 33 mothers) showed a significantly higher anti-hsp antibody rate in patients with complete tubal occlusion than in infertility patients with normal fallopian tubes (76% vs. 19%, p<0.001). The presence of antibodies not only toChlamydia trachomatis but also toChlamydia pneumoniae in the MIF test was associated with a significantly higher rate of anti-hsp antibodies and with complete tubal occlusion. This association did not appear to be due to cross-reactivity betweenChlamydia pneumoniae and Chlamydia trachomatis antibodies in the MIF test.
Recurrent bacteremia due toBrevibacterium casei in an immunocompromised patientReinert, R.; Schnitzler, N.; Haase, G.; Lütticken, R.; Fabry, U.; Schaal, K.; Funke, G.
doi: 10.1007/BF01590943pmid: 8681984
A case of an immunocompromised patient who experienced two episodes of septicemia caused by a coryneform bacterium is reported. Biochemical characteristics and analysis of cellular fatty acids and of cell wall components showed two identical strains ofBrevibacterium casei to be responsible for these infections. The lack of easy-to-perform methods for identification may have led, in the past, to an underestimation of the role of this bacterium, especially in immunocompromised patients.
Once-daily dosing of aminoglycosidesBlaser, J.; König, C.
doi: 10.1007/BF01590935pmid: 8681976
Since their introduction one or more decades ago, aminoglycosides have generally been administered in multiple daily (i.e. twiceor thrice-daily) dosing regimens. However, nephrotoxicity can be reduced in animal models by administering the same total daily dose as one large dose instead of as multiple small doses. In addition, in vitro and in vivo studies that considered the impact of dosing regimens on efficacy suggest that once-daily dosing is equally or more effective compared to multiple daily dosing. Once-daily versus multiple daily dosing regimens have been compared for amikacin, netilmicin, and gentamicin in 24 randomized, clinical trials including a total of 3,181 patients. An analysis of these studies revealed superior results for once-daily regimens with respect to clinical efficacy (89.5 % vs. 84.7%, p<0.001) as well as bacteriological efficacy (88.6% vs. 83.4%, p<0.01). No statistically significant differences were noted for toxicity. Nevertheless, both nephrotoxicity and ototoxicity occurred less frequently during once-daily dosing (4.5% vs. 5.5% and 4.2% vs. 5.8%, respectively). Finally, once-daily dosing is more economical, since less nursing time and infusion material are required and the efforts for drug monitoring can be reduced. In conclusion, amikacin, netilmicin, and gentamicin can be administered once a day.
Comparison of fresh versus sodium acetate acetic acid formalin preserved stool specimens for diagnosis of intestinal protozoal infectionsMank, T.; Zaat, J.; Blotkamp, J.; Polderman, A.
doi: 10.1007/BF01590942pmid: 8681983
The use of sodium acetate acetic acid formalin (SAF)-preserved stool specimens was compared with that of nonpreserved specimens for the recovery of intestinal protozoa. A total of 247 patients, 170 with diarrhea of more than one week's duration and 77 refugees, were asked to collect a stool specimen. Each specimen was placed into two vials, one empty, the other containing SAF fixative. Laboratory investigations included microscopic examination of the concentrated sediment and direct wet smears from both types of stool specimens and the microscopic examination of a permanent stained smear from the unsedimented, SAF-preserved stool specimens. Examination of SAF-preserved stool specimens revealed intestinal protozoa in 149 of the 247 patients. With the conventional procedure using unpreserved stool specimens, intestinal protozoa were found in 89 of the 247 patients. The results show that the examination of SAF-preserved stool specimens, consisting of the microscopic examination of both the concentrated sediment and the permanent stained smear from the unsedimented material, increases the chance of recovering intestinal protozoa as compared to the conventional procedure.
Detection ofMycobacterium tuberculosis complex in clinical specimens by a commercial polymerase chain reaction kitStauffer, F.; Mutschlechner, R.; Hasenberger, P.; Stadlbauer, S.; Schinko, H.
doi: 10.1007/BF01590937pmid: 8681978
A total of 722 respiratory and 86 nonrespiratory specimens obtained from 456 patients were tested for detection ofMycobacterium tuberculosis complex by a commercial polymerase chain reaction (PCR) kit (Amplicor, Roche Diagnostic Systems) and the results compared with those of microscopy and culture (solid and radiometric media). Respiratory and nonrespiratory specimens were analysed separately. Of the respiratory specimens, 54 were positive forMycobacterium tuberculosis complex both in the PCR and in culture, five were positive in the PCR but negative in culture, and eight were positive in culture but negative in the PCR. Four cultures were positive for mycobacteria other thanMycobacterium tuberculosis; none of these gave a positive result in the commercial test. Resolution of discrepant results was performed by analysis of patients' clinical data. For respiratory specimens the sensitivity of the commercial test was 87.6%, the specificity 99.6%, the positive predictive value 96.6%, and the negative predictive value 98.7%. For nonrespiratory specimens the sensitivity was 60%, whereas the specificity ranged as high as 98.6%. For this group the positive predictive value was 85.7% and the negative predictive value 94.9%. When respiratory specimens are used, the commercial PCR test for detection ofMycobacterium tuberculosis complex, with its high sensitivity and specificity, is a good complementary diagnostic tool for rapid diagnosis of bronchopulmonary tuberculosis in a routine mycobacterial laboratory.