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Biomedical subjects

B D Cookson

Publications and source records attributed to B D Cookson.

At least 55 records · Page 3Linked to original sources

Progress with establishing and implementing standards for infection control in the UK.

The process of agreeing standards for infection control in England and Wales is described. To ensure ownership of these standards an extensive consultation exercise was undertaken. Further development has been left to Infection Control Teams (ICTs) and the relevant health care workers. Management and Consultants in Communicable Disease Control were also sent the standards to further encourage support for their implementation. The results of a questionnaire of ICT resources and activities is alluded to and these data will be a valuable point of reference to monitor changes in the status quo of a rapidly changing health service.

Communicable Disease Control↗

Inactivation of HIV-1 by chemical disinfectants: sodium hypochlorite.

The efficacy of sodium hypochlorite was assessed against human immunodeficiency virus type 1 suspended in low (8% v/v) or high (80% v/v) concentrations of serum or in a high (80%) concentration of blood. In the presence of 8% serum, 100 p.p.m. available chlorine in the disinfectant test mixture inactivated 3.75 log TCID50 HIV/ml within 30 s. When the test mixture contained 80% serum, 500 p.p.m. available chlorine inactivated more than 4 log TCID50 HIV/ml in 1-2 min. Lower concentrations of available chlorine were unable to inactivate the virus completely. In the presence of 80% blood, 1000 p.p.m. available chlorine in the disinfectant test mixture was unable to inactivate 3.75 log TCID50 HIV/ml, although 2500 p.p.m. available chlorine was able to inactivate at least 1.5 log TCID50 HIV/ml. In all test mixtures, the chlorine rapidly became combined and thus less active. Our results emphasise the importance of cleaning prior to disinfection with sodium hypochlorite since it may prove to be ineffective in the presence of high levels of organic matter. In cases where prior cleaning is impossible, care must be taken to use the higher recommended concentration (a minimum of 10,000 p.p.m. available chlorine).

Cell Survival↗

Susceptibility of methicillin-resistant Staphylococcus aureus to the essential oil of Melaleuca alternifolia.

All 66 isolates of Staphylococcus aureus tested were susceptible to the essential oil of Melaleuca alternifolia, or tea tree oil, in disc diffusion and modified broth microdilution methods. Of the isolates tested, 64 were methicillin-resistant S. aureus (MRSA) and 33 were mupirocin-resistant. The MIC and MBC for 60 Australian isolates were 0.25% and 0.50%, respectively. Comparable results were obtained by co-workers in Britain using similar methods. These in-vitro results suggest tea tree oil may be useful in the treatment of MRSA carriage.

Methicillin Resistance↗

Distribution of serovariants of group B streptococci in isolates from England and Norway.

The distribution of capsular polysaccharide antigen (CHO) types, surface-exposed c proteins alpha (c alpha) and beta (c beta) and an R-protein antigen was examined in 334 group B streptococci (GBS) isolates from three groups of patients hospitalised in England and Wales or Norway. The isolates were from 108 carriers, 67 cases of neonatal infection and 154 cases of adult infection. Each group contained all CHO types (Ia, Ib, II, III, IV, V and NT); type III strains predominated except in the adult infected group. Strains within each CHO type could be further subdivided by the protein markers into five subtypes by a combined typing system. The proportion of type Ib and type III strains in the neonatal infection cases and of type Ib strains in the adult infection cases significantly outnumbered isolates of these serotypes among the carrier strains. Twenty-nine different serovariants were identified; 24, 13 and 23 serovariants among the carrier, neonatal infection and adult infection isolates, respectively. Certain CHO antigen-protein associations were identified, notably those between Ia/c alpha, Ib/c alpha beta and III/R. The proportion of invasive isolates that expressed protein was not higher than in the carrier isolates. All CHO-type Ib isolates contained a c protein, but 7% of the Ib isolates did not contain any of these proteins. These findings indicate that this combined typing approach may be useful in examining epidemiological problems associated with GBS.

Adult↗

Ribotyping of Staphylococcus aureus: an assessment using well-defined strains.

Ribotyping, with homologous or heterologous (Escherichia coli) r-RNA, of the propagating strains for phages of the international set for strains of Staphylococcus aureus of human origin was undertaken to determine the discrimination of this typing method. Ribotyping could distinguish between strains of different phage groups, but could not distinguish between seven phage group III strains of different phage type. Ribotying may be a useful adjunct to phage typing in S. aureus but is unlikely to replace it as the primary method of epidemiological typing.

Bacterial Typing Techniques↗

Rapid characterisation of Candida albicans by pyrolysis mass spectrometry.

Clinical isolates (41) of Candida spp. from three possible outbreaks of nosocomially-acquired infection were compared by pyrolysis mass spectrometry (PMS) and by a combined morphotyping and resistotyping (M-R typing) method. Both systems characterised all the isolates and distinguished one isolate of C. tropicalis and another of C. glabrata from the 39 isolates of C. albicans. Results from both systems suggested that cross-infection with a single strain contributed to two of the outbreaks. In several instances, more than one strain of C. albicans was found amongst multiple isolates from the same patient. PMS is a simple, rapid and objective technique capable of characterising C. albicans isolates; discrimination was similar to M-R typing.

Candida albicans↗

Survival of human immunodeficiency virus in suspension and dried onto surfaces.

Cell-free and cell-associated human immunodeficiency virus cultures suspended in 10% serum remained infectious for several weeks at room temperature. The stability was further increased when cell-associated virus was suspended in neat serum. When dried onto a glass coverslip, virus remained infectious for several days, although cell-associated virus lost infectivity more rapidly than cell-free virus.

Cell Line↗

Endemic cross-infection in an acute medical ward.

Urine samples from patients on an acute medical ward were examined each week over a three-month period in order to detect endemic cross colonization or infection. The bed positions for each patient in the ward were recorded continuously and the patients cared for by each different nurse team noted. We found an outbreak of urinary colonization/infection with a strain of Klebsiella K8 in nine patients. Two groups of two patients probably suffered cross colonization/infection with different strains of Escherichia coli. These episodes were not detected by our routine laboratory ward liaison surveillance, but by the weekly samples and molecular typing methods applied to these relatively common strains. This survey demonstrates that cross colonization/infection may occur more widely than is normally detected. The implications of these findings to surveillance audit programmes are discussed.

Acute Disease↗

Crystal violet reactions of Staphylococcus aureus strains colonizing infants in the first six weeks.

Nasal colonization with Staphylococcus aureus occurred in 18% of babies leaving a maternity unit and had risen to 40% by 6 weeks after birth. S. aureus was first acquired by 34.5% of babies after discharge. Female infants were more likely to be colonized than males. Colonization was not significantly different between babies receiving standard postnatal care and those nursed on the Special Care Baby Unit. Crystal violet (CV) tests showed that purple-reacting isolates accounted for approximately 60% of strains, whether first detected at hospital discharge or subsequently acquired. Purple-reacting strains, once acquired, were significantly better able to persist than non purple-reacting strains and formed a cumulatively higher proportion of the strains isolated at 6 weeks after birth than at hospital discharge. CV purple-reactions were significantly associated with lysis by phages of groups III and I and non-purple-reactions were significantly associated with lysis by phages of group II and/or 94/96. Maternity units remain a significant route whereby strains of S. aureus with some characteristics associated with a hospital origin gain access to the community.

Bacterial Typing Techniques↗

Comparison of serotype, biotype and bacteriocin type with rDNA RFLP patterns for the type identification of Serratia marcescens.

Variations in rDNA gene loci in DNA digests of 209 clinical isolates of Serratia marcescens were determined with an Escherichia coli rRNA probe. Forty-one restriction fragment length polymorphism patterns (ribotypes) were identified, based on the size of 4-14 (mean 7.5) hybridization bands. The patterns differed by more than a single band in 98% of pair-wise comparisons. On a subset of 76 isolates, ribotyping proved to be marginally more discriminating than biotyping (discrimination index 0.92 v. 0.89) followed by serotyping (0.87) and bacteriocin typing (0.74). About one-third of isolates belonged to unique ribotypes and only two ribotypes exceeded 5% in frequency (23.0 and 6.4% respectively). A combination of serotype or biotype with ribotyping defined a similar number of strains, although none of the methods alone was sufficiently discriminatory to identify strains. We conclude that due to the accessibility of biotyping and the lack of commercially available antisera for S. marcescens, the biotype and ribotype together provide reliable markers of strain identity.

Bacterial Typing Techniques↗

Phenotypic and phylogenetic characterization of some Gemella-like organisms from human infections: description of Dolosigranulum pigrum gen. nov., sp. nov.

A phylogenetic analysis was performed on two previously uncharacterized Gram-positive, catalase-negative bacteria from clinical sources. 16S rRNA sequencing studies revealed the isolates represent a new line of descent within the lactic acid group of bacteria. On the basis of the phylogenetic findings and phenotypic distinctiveness of the organisms, it is proposed that they be classified in a new genus Dolosigranulum, as Dolosigranulum pigrum sp. nov. The type strain of Dolosigranulum pigrum is NCFB 2975.

Base Sequence↗

An epidemic methicillin-resistant strain of Staphylococcus aureus in Spain.

During 1990, a strain of methicillin-resistant Staphylococcus aureus became epidemic in Spain and spread in a manner analogous to that of EMRSA-1 in England. Isolates of this strain produced little protein A and were resistant to a number of antibiotics including ciprofloxacin. Beta-lactamase production was encoded by a c. 39 kb plasmid, which also conferred resistance to mercury, cadmium, ethidium bromide and propamidine isethionate. Investigation showed that two variants, separable by supplementary and Fisk phage typing, were circulating. The B variant appeared to spread more readily than the A variant. The opportunity was taken to compare the discriminatory power of traditional typing methods with molecular techniques. The discriminatory power of the molecular techniques used only reached the same level as the traditional methods when double enzyme digestion of total cellular DNA by EcoR I and Cla I was performed.

Bacterial Typing Techniques↗

Ribotyping of coagulase-negative staphylococci.

The discriminative capacity of ribotyping was initially assessed without knowledge of results obtained for the same isolates by use of more established typing methods. Forty-eight isolates of coagulase-negative staphylococci (CNS) from peritoneal fluids were studied. They were collected prospectively during 31 consecutive episodes of infection associated with peritoneal dialysis in 17 patients. DNA was digested by the restriction endonucleases EcoRI or HindIII and ribotyped by means of a biotinylated cDNA probe to 16S + 23S staphylococcal ribosomal RNA gene sequences. These methods in combination produced a total of 27 types which compared well with numbers of groups distinguished by other typing methods: limited biotype-antibiotic resistogram (ARB; 28), antibiotic resistogram alone (25), API-Staph (12), phage typing (9) and plasmid analysis (22). Ribotyping was highly reproducible and typed all isolates, including those that were not phage-typable (35) or did not contain plasmids (4). When used in a hierarchical manner with ARB, ribotyping results produced 13 additional types in comparison with the other three methods. When used hierarchically with all other typing systems, a further five types were found among isolates from two patients. However, some of the differences observed as a result of ribotyping could have been due to subtle changes produced by mutation, lysogenisation or gene transposition. Since the method requires additional time, expense and technical expertise, it is likely to be useful only when answers to specific epidemiological problems are required or as an initial screen before using other methods of genetic analysis.

Base Sequence↗