Vaginal disinfection with chlorhexidine during childbirth

The purpose of this study was to determine whether chlorhexidine vaginal douching, applied by a squeeze bottle intra partum, reduced mother-to-child transmission of vaginal microorganisms including Streptococcus agalactiae (streptococcus serogroup B = GBS) and hence infectious morbidity in both mother and child. A prospective controlled study was conducted on pairs of mothers and their offspring. During the first 4 months (reference phase), the vaginal flora of women in labour was recorded and the newborns monitored. During the next 5 months (intervention phase), a trial of randomized, blinded placebo controlled douching with either 0.2% chlorhexidine or sterile saline was performed on 1130 women in vaginal labour. During childbirth, bacteria were isolated from 78% of the women. Vertical transmission of microbes occurred in 43% of the reference deliveries. In the double blind study, vaginal douching with chlorhexidine significantly reduced the vertical transmission rate from 35% (saline) to 18% (chlorhexidine), (P < 0.000 1, 95% confidence interval 0.12-0.22). The lower rate of bacteria isolated from the latter group was accompanied by a significantly reduced early infectious morbidity in the neonates (P < 0.05, 95% confidence interval 0.00-0.06). This finding was particularly pronounced in Str. agalactiae infections (P < 0.0 1). In the early postpartum period, fever in the mothers was significantly lower in the patients offered vaginal disinfection, a reduction from 7.2% in those douched using saline compared with 3.3% in those disinfected using chlorhexidine (P < 0.05, 95% confidence interval 0.01-0.06). A parallel lower occurrence of urinary tract infections was also observed, 6.2% in the saline group as compared with 3.4% in the chlorhexidine group (P < 0.01, 95% confidence p interval 0.00-0.05). This prospective controlled trial demonstrated that vaginal douching with 0.2% chlorhexidine during labour can significantly reduce both maternal and early neonatal infectious morbidity. The squeeze bottle procedure was simple, quick, and well tolerated. The beneficial effect may be ascribed both to mechanical cleansing by liquid flow and to the disinfective action of chlorhexidine.

In vitro activity of antifungal agents against yeast species

The antimicrobial activity of 8 antifungal agents have been compared in vitro against 151 strains of yeast fungi and 2 of Geotrichum candidum. The drugs were the classical nystatin and amphotericin-B, 5-flucytosine, and 5 imidazoles, clotrimazole, econazole, ketoconazole, miconazole, and tioconazole. An agar dilution technique with incubation at 37 degrees C was used. By this procedure, econazole was the most active agent per weight basis among those suitable for topical therapy. Tioconazole had a wide spectrum and high activity. Ketoconazole had an antimicrobial activity which makes it an interesting agent considering its applicability in systemic therapy. The activity of 5-flucytosine surpasses that of other systemically applicable agents.

Evaluation of four commercial biochemical test systems for identification of yeasts

The performance of four miniaturized biochemical test systems (API 20C Auxanogram, Mycotube, Oricult, and Uni-Yeast-Tek) for the identification of yeasts was evaluated using standard biochemical tests as reference. One hundred and twenty-six strains were used for the study. Mycotube identified 93% of the strains correctly, and Uni-Yeast-Tek 89%. API 20C Auxanogram and Oricult identified 77% and 82% of the strains respectively if the germ tube test was also included. Mycotube and Uni-Yeast-Tek in particular facilitate identification of yeasts in the routine clinical laboratory but recourse to microscopic examination of morphology and other supplementary tests may also be necessary.

Radioimmunoassay of tobramycin compared to microbial methods

A commercial radioimmunoassay (RIA) for tobramycin was compared with microbial methods by determining the concentrations of known standards prepared with pooled human serum. The correlation coefficients were r=0.94 for the RIA method and an agar diffusion procedure using commercial paper disk standard, and r=o.95 for a standard agar well diffusion procedure. The agar well method tended to overestimate the real concentrations.