No need to change the skin knife in modern arthroplasty surgery

Earlier studies have found varying contamination rates using separate skin and deep knives in total hip (THA) and total knee (TKA) arthroplasty surgery. Previous studies were primarily conducted in the setting of concomitant use of laminar airflow and/or plastic adhesive draping. This has lead to conflicting conclusions regarding discarding the skin knife or not. This study evaluates the prevalence of contamination of a separate skin knife using modern antiseptic technique in primary THA and TKA without laminar airflow. Three knives from each primary THA and TKA surgery in non-laminar airflow operating rooms were collected: one used for the skin, one used for deeper tissues and one control knife. A total of 831 knife blades from 277 patients were cultured 12 days. Contamination of the skin knife was found in eight patients (2.8 %), contamination of the "deep" knife in five patients (1.8 %) and contamination of the control knife in five patients (1.8 %). No patient developed an infection with 1-year follow-up. Our findings suggest a very low rate of contamination of the skin knife using modern antiseptic technique without laminar airflow and/or plastic adhesive draping and do not support the use of a separate skin knife in arthroplasty surgery.

Human group A rotavirus infections in children in Denmark: detection of reassortant G9 strains and zoonotic P[14] strains

One of the leading causes of severe childhood gastroenteritis are group A rotaviruses, and they have been found to be associated with ∼40% of the annual gastroenteritis-associated hospitalizations in young Danish children <5years of age (Fischer et al., 2011). In this study, we investigated the diversity of rotavirus strains circulating among young children <5years of age, presenting with gastroenteritis disease either at the general practitioner or in the hospital, during the period 2009-2013. A total of 831 rotavirus positive stool samples were genotyped in the study period, and the majority of samples (74%) were from hospitalized children. G and P genotypes were successfully determined for 826 of samples, with G1P[8] being the most commonly detected genotype. Detection of G1 showed a decreasing trend over time, and an inverse trend was seen for the emerging G9P. The common human genotypes (G1/G3/G4/G9P[8] and G2P[4]) were detected in the majority of samples (n=733, 88.2%). Rare genotype combinations such as G6P[14] were detected in <1% of samples. Rare genotype strains and strains which failed to amplify in genotyping RT-PCR were subjected to genetic characterization by sequencing one or all of the following genes; VP7, VP4, VP6 and NSP4. Sequences of sufficient length and quality were available for all 4 genes for 28 strains. Phylogenetic analysis revealed that reassortant G9P[4] strains circulated with 3 different genotype combinations. As rotavirus vaccines are not widely used in Denmark or its neighboring countries, the diversity of rotavirus strains identified in this study most likely reflects naturally occurring selection pressures and viral evolution.

Pancreatic panniculitis complicated by infection with Corynebacterium tuberculostearicum: A case report

We present a case of pancreatic panniculitis in a patient with alcohol abuse where Corynebacterium tuberculostearicum was isolated from a pannicular nodule on the crus. The patient was started on linezolid treatment leading to regression of the patient's symptoms. Upon discontinuation of linezolid treatment progression of the skin symptoms progressed.

Elevation of Francisella philomiragia subsp. noatunensis Mikalsen et al. (2007) to Francisella noatunensis comb. nov. [syn. Francisella piscicida Ottem et al. (2008) syn. nov.] and characterization of Francisella noatunensis subsp. orientalis subsp. nov., two important fish pathogens

AIMS

This study was conducted to clarify the taxonomic status of Francisella sp. strain Ehime-1, a fish pathogen, in relation to the fish pathogens F. piscicida and F. philomiragia subsp. noatunensis and to F. philomiragia subsp. philomiragia.

METHODS AND RESULTS

Francisella sp. Ehime-1 was compared to F. piscicida, F. philomiragia subsp. noatunensis and several F. philomiragia subsp. philomiragia isolates through sequencing of the 16S rRNA-gene and several house-keeping genes and determination of biochemical and phenotypic properties. Results show that F. piscicida is indistinguishable from F. philomiragia subsp. noatunensis by sequence and phenotypic traits. Francisella sp. Ehime-1 and F. philomiragia subsp. noatunensis are clearly separated from F. philomiragia. Francisella sp. Ehime-1 is biochemically, phenotypically and genetically different from F. philomiragia subsp. noatunensis (=F. piscicida), but DNA-DNA hybridization does not clearly support establishment as a separate species (level of relatedness 64% and 73.4%, mean 68.7%).

CONCLUSIONS

We propose to elevate F. philomiragia subsp. noatunensis to species rank as F. noatunensis comb. nov., while F. piscicida is considered a heterotypic synonym of F. noatunensis comb. nov. Evidence suggests that Francisella sp. Ehime-1 represents a novel subspecies of F. noatunensis, for which the name F. noatunensis subsp. orientalis subsp. nov. is proposed (=DSM21254(T), = LMG24544(T)).

SIGNIFICANCE AND IMPACT OF THE STUDY

This study contributes to the taxonomy and characteristics of fish-pathogenic Francisella spp.

Phenotypic and genotypic characterization of prolyliminopeptidase-negative Neisseria gonorrhoeae isolates in Denmark

In the study presented here 26 recent Danish clinical isolates of prolyliminopeptidase (PIP)-negative Neisseria gonorrhoeae were phenotypically and genotypically characterized to investigate whether one or more PIP-negative strains are circulating in the Danish community. The profiles of these isolates were compared with those of three isolates from a recent outbreak of PIP-negative N. gonorrhoeae infection in the UK. Twenty-five of the Danish isolates and all three UK isolates had similar antibiograms and were designated serovar IB-4. Genotypic characterization by pulsed-field gel electrophoresis, porB1b gene sequencing, and opa-typing revealed that these isolates were indistinguishable or closely related. The results indicate that at least one PIP-negative N. gonorrhoeae strain is currently circulating in the Danish community, and this strain is indistinguishable from the one that caused an outbreak in the UK.

Problems in identification of Francisella philomiragia associated with fatal bacteremia in a patient with chronic granulomatous disease

Francisella philomiragia is a rare gram-negative, halophilic coccobacillus with bizarre spherical forms on primary isolation. A case of F. philomiragia bacteremia in a 24-year-old patient with chronic granulomatous disease is reported. Identification of F. philomiragia was problematic with conventional tests but was done correctly and rapidly by kit 16S ribosomal DNA sequencing.

Clinical significance and taxonomy of Actinobacillus hominis

Clinical findings in 36 immunosuppressed patients with lower respiratory tract infection or bacteremia with Actinobacillus hominis are described. Animal contact was only recorded for three patients; nine patients died despite appropriate antimicrobial treatment. Although infections with this microorganism seem to be rare, the fact that 37 of 46 strains characterized in this study have been found in Copenhagen indicates that under-reporting may occur. A. hominis is phenotypically relatively homogeneous but can be difficult to differentiate from other Actinobacillus species unless extensive biochemical testing is performed. Mannose-positive strains of A. hominis are especially difficult to differentiate from A. equuli. Attempts to identify A. hominis by automatic identification systems may lead to misidentifications. Ribotyping and DNA-DNA hybridization data show that A. hominis is a homogeneous species clearly separated from other species within the genus Actinobacillus.

[Fatal outcome of Strongyloides stercoralis infection in a patient with no previously known immunosuppression]

A case of fatal infection with Strongyloides stercoralis in a previously healthy young African with no known immunosuppression is reported. The patient suffered severe gastrointestinal bleeding and despite intensive treatment died of multiorgan failure. Postmortem, signs of ulcerating T-cell lymphoma were found in a jejunal specimen, and the patient was found to be infected with HTLV-1. Gastrointestinal bleeding in relation to infection with Strongyloides stercoralis is discussed as well as possible relations between the severity of infection, lymphoma and HTLV-1.

[The clinical consequence of blood culture results]

The effect of blood culture results on patient management in a department of internal medicine was analyzed retrospectively. In a series of 300 patients 538 blood cultures were taken. Fifty-four (10%) of blood cultures from 44 of the 300 patients were positive, but in 16 patients cultures yielded organisms considered to be contaminants. Only 28 (9.3%) patients' cultures showed growth of clinically significant pathogenic bacteria. Antimicrobial chemotherapy was instituted in 234 (78%) patients before culture results were available. For only 21 (7%) patients did the result of the blood culture have any therapeutic consequences. The high frequency and lack of impact of negative blood cultures demands a more appropriate protocol for blood culturing, and guidelines are suggested.

Infections related to the menstrual cycle. A study of five otherwise healthy women with recurrent abscesses and a review of the literature

The purpose of the study was to investigate the in vitro bactericidal function of blood polymorphonuclear leucocytes (PMN) in various phases of the menstrual cycle from otherwise healthy women with recurrent cutaneous abscesses related to the premenstrual phase of the menstrual cycle compared with the bactericidal activity of PMN from healthy women with no inconveniences related to the menstrual cycle. The bactericidal activity against Staphylococcus aureus 502A was investigated and when possible against the patients' own strain. No variation in bactericidal activity was observed during the different phases of the menstrual cycle. PMN from five women with recurrent abscesses related to the premenstrual phase tended to kill fewer S. aureus 502A than PMN from three women in the control group. The literature of immunological defence mechanisms and the occurrence of infections related to the menstrual cycle is reviewed.

[Multimicrobial pulmonary infection in an AIDS patient]

A case of a 44 year old male AIDS patient with multimicrobial lung infection is presented. Six possible pathogens were found and the relative importance of these is discussed. An active diagnostic and therapeutic approach is recommended when treating AIDS patients with pneumonia.

[Measurement of basal temperature with the Tempadot disposable thermometer for oral use]

Twenty-two healthy women of fertile age who participated in an immunological investigation recorded basal temperature curves (BTC) with the object of illustrating the course of the menstrual cycle by means of daily measurements of the morning temperature with the Tempadot disposable thermometer for oral use. The total of 63 BTC's were assessed on the basis of the requirement of normal diphasic curves. The number of diphasic BTC was less than anticipated. In addition, four other healthy women measured the morning temperature daily with the Tempadot disposable thermometer orally and with a mercury thermometer rectally for a calendar month. It is concluded that employment of the Thermadot disposable thermometer orally is associated with great unreliability even in this material where the measurements were carried out on repeated occasions by young healthy persons.

Non-typhoid Salmonella bacteraemia in Greater Copenhagen 1984 to 1988

A retrospective survey of non-typhoid Salmonella bacteraemia in the period 1984 to 1988 was carried out by the five departments of clinical microbiology in Greater Copenhagen. A total of 168 patients were identified. A gradual increase was observed from 11 cases in 1984 to 58 cases in 1988. The corresponding incidence per 100,000 inhabitants in Copenhagen rose from 0.9 in 1984 to 5.0 in 1988. During the same period the total registered incidence of human Salmonella infections in Denmark increased from 17.6 to 67.4 per 100,000 inhabitants. The serotype most often isolated from bacteraemic patients was Salmonella dublin followed by Salmonella enteritidis and Salmonella typhimurium. Salmonella dublin demonstrated enhanced invasive and pathogenic properties. Predisposing factors were present in 56% of the patients; the most common was malignant disease. A fatal or complicated course of the bacteraemia was observed more frequently in patients with underlying diseases than in persons who had previously been healthy. A total of 17% of the patients died; one-fifth of these had a ruptured aortic aneurysm. It is concluded that the substantial increase in the number of cases and the often serious course taken by the infection demonstrate a need for increased efforts at prophylaxis.

Urosepticemia and fatal endocarditis caused by aerococcus-like organisms

Two cases of invasive infections with aerococcus-like organisms (ALO) are presented: an 81-year-old man with fatal endocarditis and a 63-year-old man with urosepticemia. No antigenic relationship was found between ALO and Aerococcus viridans (NCTC 8251) in crossed immunoelectrophoretic assay.

Legionellosis in patients with HIV infection

During the five-year period 1984-1988 we received 192 specimens from 180 patients infected with the human immunodeficiency virus (HIV) for investigation of Legionella infection. The majority of specimens were bronchoalveolar lavage (BAL) fluids (84%), but tracheal suctions and lung tissue from autopsies were also examined. The diagnostic methods used were a direct immunofluorescence assay (DFA) for the detection of Legionella antigen, and culture on buffered charcoal yeast extract (BCYE-alpha) media. All specimens were also examined for the presence of other bacterial lung pathogens, and all BAL specimens additionally for Pneumocystis carinii and mycobacteria. Legionellosis was not found to be common among HIV-infected patients, as only six specimens (3%) from six patients were found positive by DFA, and no specimens were culture-positive for Legionella species. Dual infection with Legionella and P. carinii occurred in two patients. Clinical data of the six patients are presented, and currently used methods for diagnosing legionellosis are discussed.

[Bacteremia caused by zoonotic Salmonella types in greater Copenhagen in 1984-1988]

The five departments of clinical microbiology in Greater Copenhagen have together carried out a retrospective review of bacteraemia caused by the zoonotic Salmonella serotypes in the period 1984-1988 in the municipalities of Copenhagen and Frederiksberg and in the County of Copenhagen. A gradual increase in frequency was observed from 11 cases in 1984 to 58 cases in 1988. The serotype most commonly isolated was Salmonella dublin followed by Salmonella enteritidis and Salmonella typhimurium. S. dublin was found to be more invasive and more virulent than the other serotypes. Predisposing factors were present in 56% of the patients; the commonest of these was malignant disease. Fatal or complicated course of the disease were observed more frequently in predisposed patients than in persons who had previously been healthy. A total of 17% of the patients died and one fourth of these had ruptured aortic aneurysm probably on account of Salmonella arteritis. 20% developed recurrence of bacteraemia while in the remaining patients the disease ran an uncomplicated course. It is concluded that the marked increase in the number of cases and the serious course taken by the infection demonstrate a definite need for increased prophylactic efforts in the food industry.

Prevalence of IgM antibodies to nine Legionella species in Icelandic children

In order to evaluate the prevalence of antibodies to Legionella species among children in Iceland, a prospective study was conducted in 424 children aged 1 month to 12 years, 28 of whom had an acute respiratory tract infection. Antibody titers to L. pneumophila serogroup 1-6, L. bozemanii, L. dumoffii, and L. micdadei were measured by microagglutination technique. Seroreactivity to Legionella spp. was found in 30% of the children greater than 3 years of age and in 22% of all children. The majority of the children with legionella antibodies had no history of previous or present respiratory tract infection. The children with previous pneumonia or bronchial asthma did not show a higher seroreactivity to legionella than children without such a history. Our observations suggests that Icelandic children are frequently exposed to Legionella species or closely related bacteria.

Neutrophil response, serum opsonic activity, and precipitating antibodies in human infection with Actinobacillus hominis

Actinobacillus species are usually not considered as being human pathogens apart from A. actinomycetemcomitans. However, single cases of human meningitis, septicemia, and empyema caused by Actinobacillus lignieresii have been reported in the literature. This is the first reported case of Actinobacillus hominis giving rise to pleural-empyema in a patient with carcinoma of the lung. The function of peripheral blood neutrophils, serum opsonic activity and specific precipitating antibodies were investigated. Neutrophils from the patient exhibited an enhanced oxidative burst response measured by chemiluminescence assay. Furthermore, the opsonic activity of the serum from the patient was higher than that of a healthy control person. Several precipitating antibodies to various antigens of Actinobacillus hominis were demonstrated in the serum of the patient by crossed immunoelectrophoresis.

Sexually transmitted diseases in hetero-, homo- and bisexual males in Copenhagen

This study is a mapping of intestinal protozoal and pathogenic bacterial infections, and sexually transmitted urethral and anorectal infections among 365 consecutive male patients attending a veneric disease (VD) clinic in Copenhagen. The profile of diseases was strongly correlated to sexual life-style. Amoebiasis and giardiasis were found respectively in 31.9% and 13.8% of homosexuals. None of the heterosexuals had pathogenic protozoa. Protozoal infections were correlated to anilingus. Forty-five percent of the patients were infected in Denmark. Travelling to endemic areas was of no obvious importance. Among males with homosexual partners, 14% had rectal infections. Gonococcal and chlamydial infections were equally frequent. Three percent had symptomatic anorectal herpes simplex infection and 11% anal warts. Gastrointestinal symptoms were not reliable indicators of gastrointestinal infection; symptoms were claimed frequently among homosexuals without infections compared to heterosexuals. Urethral gonorrhoea and/or chlamydia infections were diagnosed in 39% of the heterosexuals compared to only 10% of the homo-bisexuals. Twelve percent of the homosexuals had untreated early syphilis, whereas syphilis was exceptional among heterosexuals. The total burden of infections expressed as the actual number of infections was largest among homosexuals, 40.4%, 22.4%, and 5.3% having one, two, and three infections respectively.

The E. coli immunosorbent as used in serodiagnosis of Legionella infections studied by crossed immunoelectrophoresis

In this study we investigated an immunosorbent, E. coli blocking fluid (BF), proposed for use in the Legionella Indirect Fluorescent Antibody Test (IFA). With crossed immunoelectrophoresis (CIE) of clinically relevant Legionella species, only one heat-stable antigen (no. 1) cross-reacted with the BF preparation. Patients' sera with elevated Legionella IFA titres did not react with this antigen in CIE. Out of 23 IFA positive patients' sera, six had titres lowered significantly to negative, when BF was applied as serum diluent for the titration (IFA BF negative sera). All six sera were negative in the micro agglutination test (MA). None of the IFA BF negative sera contained any Legionella precipitins in CIE, whereas nine out of the remaining 17 IFA BF positive sera unchanged by BF contained one or more precipitins. CIE results could not explain the effect of BF in Legionella IFA, and further studies are needed to sufficiently define the use of immunosorbents in diagnostic Legionella serology.

Trichomonas species in a subhepatic abscess

A rare case of Trichomonas tenax/Trichomonas hominis and mixed oral bacterial flora in pus from a subhepatic abscess in a patient with a perforated penetrating ventricular ulcer is reported and the possible pathogenicity of the flagellate is discussed.

Comparison of a fluorescent monoclonal antibody assay and a tissue culture assay for routine detection of infections caused by Chlamydia trachomatis

The applicability of a commercial direct immunofluorescent monoclonal antibody assay for detection of Chlamydia trachomatis elementary bodies was studied on endocervical smears from 506 women attending a venereal disease clinic. The aim of this prospective examination was to simulate a daily routine. The results were compared to those of a well-functioning tissue culture assay. The overall positivity was 22.7%. Based on a positivity criterion of greater than or equal to 1 elementary body in the fluorescent antibody assay, the two assays agreed in 84.8% of the cases. In 50 specimens the antibody assay was positive and the culture assay negative, whereas in 23 the culture assay was positive and the antibody assay negative. The positive predictive value was 63.8%. Most of the discrepancies were found in specimens containing few elementary bodies or inclusions. Based on a criterion of greater than or equal to 10 elementary bodies, the positive predictive value was 70.9%, but the sensitivity fell to 67.5%.

Group JK diphtheroid bacteremia. The successive isolation of an antibiotic-susceptible and an antigenically different multi-resistant strain

A 71-year-old man with a permanent, subcutaneously implanted, intra-cardial pacemaker suffered from prolonged bacteremia with an antibiotic-susceptible group JK diphtheroid rod. He died in spite of the formation of specific serum antibody and parenteral treatment with ampicillin, cephradine and gentamicin. A second multi-resistant, but otherwise similar group JK strain was isolated post-mortem from the aseptically removed pacemaker electrode tip. The susceptible and the multi-resistant strains differed antigenically in crossed immunoelectrophoresis assays, and fatty acid isomer patterns were dissimilar. The theory that a multi-resistant group JK clone emerged by simple mutation in susceptible, indigenous group JK skin flora is rejected. The concept of major structural differences among group JK bacteria, possibly affecting cell-wall permeability, is supported. Crossed immunoelectrophoresis is suggested as a means for strain comparison in epidemiological surveys. Vancomycin is regarded as the antibiotic of choice for the treatment of potentially fatal, deep-seated infections.

The infective dose of aerobic and anaerobic bacteria in postoperative wound sepsis

Surgery for perforated appendicitis was used to estimate the infective dose of aerobic and anaerobic bacteria in postoperative wound sepsis. The wound sepsis rates were 22.6% (7/31) after treatment with intravenous ampicillin sodium and metronidazole and 23.5% (8/34) after penicillin G sodium, streptomycin, and metronidazole, a nonsignificant difference. Intraoperative sampling by velvet pads demonstrated that the density of aerobes did not differ significantly from that of anaerobes, either on the surface of the appendix, in peritoneal exudate (aspirated), or in the wound before closure. The predominant pathogens were Escherichia coli and Bacteroides fragilis. In 15 patients who developed wound sepsis, the density of aerobes and anaerobes was significantly higher at all sampling sites than in 50 noninfected patients. The median infective dose of aerobes and anaerobes together was 4.6 X 10(5) colony forming units.cm-2 in the operative wound. There was a significantly high correlation between the densities of bacteria during operation and subsequent wound sepsis.

Immediate and prolonged clinical efficacy of ceftazidime versus ceftazidime plus tobramycin in chronic Pseudomonas aeruginosa infection in cystic fibrosis

20 patients with cystic fibrosis and chronic bronchopulmonary infection due to Pseudomonas aeruginosa entered a randomized cross-over study comparing ceftazidime (150 mg/kg body weight/24 h) plus tobramycin (10 mg/kg body weight/24 h) to ceftazidime alone (150 mg/kg body weight/24 h), both given intravenously for 2 weeks. 17 patients completed the study; both treatment regimens improved lung function and decreased the WBC count. No difference in clinical efficacy was found between the treatments. Pulmonary function returned to pre-treatment levels 3 months later with no difference between the treatments. No changes were seen in minimal inhibitory concentrations during treatment. None of the patients developed hypersensitivity or experienced serious adverse reactions to the drugs.

Prevalence of Legionnaires' disease in pneumonia patients admitted to a Danish department of infectious diseases

During a 14-month study period, 92 patients admitted to the University Clinic for Infectious Diseases with pneumonia were investigated to determine the prevalence and severity of Legionnaires' disease (LD). The diagnosis of LD was based on positive serology. Antibodies to 10 different legionella antigens--Legionella pneumophila serogroups 1-6, Fluoribacter (Legionella) bozemanae, F. dumoffii, F. gormanii, and Tatlockia (Legionella) micdadei--were measured by the microagglutination (MA) and indirect fluorescent antibody (IFA) techniques. LD was diagnosed in 22 patients showing a 4-fold or greater rise of MA titers. 10 patients showed a 4-fold or greater rise of IFA titer, 2 had standing high titer. One patient died. Legionella infection was the second most common cause of pneumonia. However, in half of the cases legionella infection occurred concomitantly with Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Chlamydia psittaci, or viral infections. All 22 LD cases were sporadic. LD had been contracted abroad by 6 patients. Two of the legionella pneumonias were hospital-acquired. Half of the LD patients were older than 60 years. The majority of cases occurred during the winter months. Neither clinical chemistry parameters nor clinical features could distinguish LD from other types of pneumonia.

Toxicity of chlorhexidine irrigation in chronic postpneumonectomy empyema

Three patients with chronic Staphylococcus aureus empyema following pneumonectomy were treated with continuous chlorhexidine (0.02%) irrigation of the cavity. The empyema became sterile, but after a few days symptoms of cerebral intoxication appeared in all three patients. The symptoms resolved when the treatment was discontinued. Use of continuous chlorhexidine irrigation treatment of large wounds and cavities is therefore to be discouraged.

Meningitis and bacteremia caused by Pasteurella multocida. A case report

A case of pasteurella multocida meningitis in a 75-year old woman with chronic otitis media is reported. There were no unusual clinical features of meningitis in this case which distinguished it from meningitis due to other pyogenic bacteria. P. multocida is characterized by a distinctive biochemical pattern, and correct identification should not be difficult provided that the possibility of its occurrence in meningitis is kept in mind.

Cross-reactions between Legionella pneumophila (serogroup 1) and twenty-eight other bacterial species, including other members of the family Legionellaceae

Cross-reactions between Legionella pneumophila serogroup 1 and 28 other bacterial species were studied by various quantitative immunoelectrophoretic techniques. A sonicated L. pneumophila antigen and purified homologous rabbit antibody were used as a reference system. Few antigens (0 to 6) cross-reacted with non-Legionellaceae, but two were found in nearly all gram-negative bacteria tested (antigens no. 1 and 66). Antigen no. 66 of the L. pneumophila reference system was shown to be antigenically similar to the "common antigen" of Pseudomonas aeruginosa reported in many gram-negative bacteria. Greater than 85% of the antigens from L. pneumophila serogroup 1 cross-reacted with the other six serogroups of L. pneumophila. By contrast, Fluoribacter (Legionella) bozemanae, F. (L.) dumoffii, F. (L.) gormanii, and Tatlockia (Legionella) micdadei cross-reacted with only 45, 53, 39, and 43% of the reference system antigens, respectively. The antigenic relatedness of members of the Legionellaceae, expressed as a matching coefficient, is discussed in terms of its taxonomic significance. Serogroup-, genus-, and family-specific antigens are identified in the L. pneumophila reference system.

Cefotaxime for prevention of infectious complications in bacteriuric men undergoing transurethral prostatic resection. A controlled comparison with methenamine

Forty-two men with urinary tract infection and benign prostatic hyperplasia were randomized into two groups before transurethral resection. One group (22 patients) received Claforan (cefotaxime) peroperatively and thereafter daily for five days. In the other group (20 patients), Hiprex (methenamine hippurate) was given daily from the day before the operation, for a total of six days. All the bacterial isolates were sensitive to cefotaxime. The efficacy of the medication was clinically and bacteriologically evaluated. Postoperative temperature elevation (greater than 38 degrees C) occurred in one of the 22 patients in the cefotaxime group, and in nine of the 20 in the methenamine hippurate group (p less than 0.05). None of the former group, but two patients in the latter, had septicemia. The difference was not statistically significant. The response to treatment was satisfactory in 13 of the 22 patients in the cefotaxime group, but in only one of the 20 treated with methenamine hippurate (p less than 0.005). Antibiotic treatment is recommended for bacteriuric patients undergoing transurethral prostatic resection.

Velvet pad surface sampling of anaerobic and aerobic bacteria: an in vitro laboratory model

Velvet pads have been evaluated in an experimental, laboratory model, simulating intraoperative sampling of Staphylococcus epidermis, Escherichia coli and Bacteroides fragilis. After sampling, the pad was placed in a transport medium and kept in an anaerobic atmosphere, before being shaken and rinsed, followed by anaerobic and aerobic culture. This technique permitted quantitatively high recoveries of the test bacteria. Velvet pad sampling could be a measure to determine the density of aerobic and anaerobic bacteria during operation in an effort to predict the risk of postoperative wound sepsis.