Bacteriologic laboratory reports. A critical evaluation.
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Bacteria↗
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Kingella kingae infections of the skeletal system in children: diagnosis and therapy.
As the result of improved bacteriological techniques, Kingella kingae is emerging as an important cause of infections of the skeletal system in children younger than 2 years of age. This review details the bacteriological features and detection methods of this pathogen, as well as the epidemiology, clinical presentation, treatment and prognosis of septic arthritis, osteomyelitis and diskitis caused by the organism.
Anti-Bacterial Agents↗
[The advantages of agglutination and precipitation tests used in the serological diagnosis of meningitis due to H. influenza type B].
During the period January 1985-July 1988, 532 purulent CSF taken from patients with meningitis, aged between 3 weeks and 91 years, were studied by microscopic examination, cultivation and for H. influenzae type B (HITB) also by coagglutination (COA), counterimmunoelectrophoresis (CIE) and double immunodiffusion (DID) in agarose gel. Positive CSFs were taken from the patients aged 1 month-24 years old, of which 76% from children under 5 years old, and 42% from children under one year. 65.9% of the patients were males; the disease was more frequent in the first and last 4 months of the year, with the highest incidence in April. 12 bacterial spectra were found: N. meningitidis--62.97%, Str. pneumoniae--9.77%, H. influenzae type B--8.27%, and also Salmonella, E. coli, Staphylococcus, Klebsiella, Acinetobacter, beta-hemolytic Streptococcus, Alcaligenes, Proteus and Enterobacter in 4.70; the rest of 14.28% had indefinite etiology. H. influenzae was evidenced in CSF by microscopic examination in 3.38%, by cultivation in 3.94%, and the soluble antigen of HITB by COA in 8.27%, by CIE in 8.08% and by DID in 7.33%. The sensibility order of the tests was: COA, CIE, DID, cultivation and microscopic examination. The COA and CIE techniques are recommended for the current use in examination of the purulent CSF due to their simplicity, rapidity, sensibility, specificity and possibility of establishing the diagnosis when the bacteriologic techniques are negative.
Agglutination Tests↗
PORTACAVAL SHUNT OPERATION IN A SURGICAL ISOLATOR: A STUDY OF CULTURES DURING OPERATION AND WOUND HEALING THEREAFTER.
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Animals↗
SOME RECENT ADVANCES IN DIAGNOSTIC MEDICAL BACTERIOLOGY.
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Anti-Bacterial Agents↗
A Streptococcus pyogenes outbreak caused by an unusual serotype of low virulence: the value of typing techniques in outbreak investigations.
OBJECTIVES: To investigate and stop the spread of an outbreak of Streptococcus pyogenes infection in a district general hospital, involving 19 patients and two nurses over a 20-day period. METHODS: All suspected persons were investigated using conventional bacteriological techniques, followed by M, T and exotoxin gene-typing of the isolates in a national reference laboratory. RESULTS: 11 patients and both nurses were associated with the acute surgical ward on one floor of the hospital. They were infected with serotype M 9/T B3264, a strain with apparently low virulence, which has not been previously associated with outbreaks. Two other patients on the same floor each had different types and there were two clusters of another S. pyogenes serotype on other floors, each involving two patients. Two (unrelated) patients yielded other types of S. pyogenes. The patients were not seriously ill but had some delay in wound healing. CONCLUSIONS: The value of typing the isolates of S. pyogenes in this outbreak was in defining which patients were involved. No added value could be ascribed to the exotoxin gene-typing results.
Adult↗
Use of a serological approach for prediction of Salmonella status in an integrated pig production system.
Relevance of a Salmonella serological detection technique was studied from complete results obtained from 9 pigs fattening units. Feces and overshoes were sampled at different periods after starting fattening (2, 3 and 4 months) while caecal contents were taken on the slaughter line. The bacteriological technique used was based on a Diasalm enrichment and a commercial test was used for serology on an average of ten animals per batch. The aim of this work was to establish a correlation between serological results obtained at slaughter (10 samples/batch) and bacteriological results. In this context, two types of logistic regression models were tested by considering alternatively serology and Salmonella detection in caecal contents as the dependent variables. Firstly, beside the fact that all logistic regression models show weak correlations, the first finding was that positive results in overshoes taken at 2 and 3 months are slightly correlated with serological status of herds (odds-ratios of 4.96 and 2.55). Secondly, when batches were characterized as positive on the basis of serological results, the probability of Salmonella recovery in caecal contents was higher than when the batches were considered as negative (odds-ratios comprised between 4.36 and 5.81). A major conclusion is that serology can be used to follow the improvement of an integrated pig production system, but is not the unique solution for assessing risk of Salmonella shedding from specific herds.
Abattoirs↗
The conventionally ventilated operating theatre and air contamination control during cardiac surgery--bacteriological and particulate matter control garment options for low level contamination.
OBJECTIVE: The purpose of the study was to compare the usefulness of a conventional bacteriological technique with that of particle counting under lower air contamination and better aseptic conditions achieved with special staff garments and covering for the patient. Contamination levels were estimated with continuous on line air particle counting measurement, volumetric intermittent short period aerobic bacteriological cultures and wound surface contact cultures. METHODS: In a series of 66 consecutive coronary artery bypass operations performed by the same team and in the same theatre using different types of patient and staff clothing, the impact of a reduced bacteriological and particulate contamination were assessed. The volumetric air contamination of particles > or =5 microm and bacteria-carrying particles were monitored 30 cm above the sternal wound. The bacterial contamination and bacterial wound infections in the sternal and leg wounds were assessed as well. RESULTS: With the alternative garment and textile system, the air counts fell from 25 colony-forming units (CFU)/m3 to 7 CFU/m3 (P < 0.0038). The contamination of the sternal wound was reduced by 46% and that of the leg wound by >90%. In order to give continuous contamination feedback during the whole operation to the theatre staff, particle counts > or =5 microm were monitored and visualized. Air particle counts decreased rapidly from 850 particles/m3 and stabilized to approximately 50 particles/m3 when the alternative clothing system was used (P < 0.001). Low particle counts > or =5 microm should offer the possibility to indirectly estimate air bacteria carrying particle counts during the entire operation. Less than 20% of the total count in this size group carries bacteria. The low air contamination was achieved even in an ordinary ventilated theatre when individual team members used clean air suits in combination with impermeable patient drapes. When air particle level < or =50 particles/m3 is reached, the bacterial air contamination is in the order of that of orthopaedic hip operations. The staff must during the entire operation adjust their activity to air asepsis. CONCLUSIONS: The use of clean air suits and impermeable patient clothing results in a low exogenous contamination of air and wound. Continuous air particle monitoring is a good intraoperative method to monitor the air contamination longitudinally in an operating theatre.
Air Microbiology↗
[The prevention of suppuration of postoperative wounds].
A method to prevent operative wound suppuration is offered. An experimental animal model of operative wound suppuration was elaborated to specify rational antibiotic-antiseptic prophylaxis and adequate wound drainage. This yielded a complex of measures to prevent purulent complications on the part of the operative wound. In addition, an original turbidimetric technique to assess the resistance of the biological fluid microflora to antisepsis was elaborated. The complex prophylaxis against suppuration of infected wounds was clinically tested on 124 patients operated on for different acute surgical conditions of abdominal organs. The wound process was controlled by means of an original endoscopic-bacteriologic technique. The postoperative period was complicated by the wound suppuration in two of the 124 patients (1.6 per cent). The postoperative hospital stay in most cases lasted 5-7 days.
Adult↗
[Acute primary infection due to slow-growing anaerobes after total hip arthroplasty (author's transl)].
Most early post-operative infections in total hip arthroplasty are due to aerobic bacteria. Anaerobes infections are less common and less easy to diagnose since the organisms are growing slowly. In the three patients reported the responsible organisms were detected by a strict bacteriological technique including cultures lasting more than 48 hours. Treatment consisted of re-operation and appropriate antibiotic therapy. The slow development of anaerobic bacteria makes antibiotic sensitivity tests particularly difficult to read. The need for cultures prolonged beyond 48 hours partly explains the frequency of overt suppuration in cases where standard bacteriological methods had given negative results.
Acute Disease↗
[Mutual relations between plastic materials and bacteria (author's transl)].
The complex problems of microbiological degradation of synthetic plastics and a fairly wide variety of 62 testing materials, belonging to 14 major groups of plastics, are described. Adaequate and reliable testing techniques had to be devised. Drawing on the experiences of H. Braun, 1930, and of Bushnell and Haas, 1941, as to the metabolism of bacteria and the utilization of certain hydrocarbons by microorganisms, and previous research work by A. Schwartz in Berlin, 1959-60, on microbial corrosion of plastics, methods of laboratory testing were developed. The bacteriological technique was based on selection of aerobic microorganisms, which were, by starvation, adapted to use the plastic materials as their only carbon source; foreign carbon sources had to be strictly eliminated; emphasis was laid on proper, double control cultures. The test organisms involved included P. aeruginosa and fluorescens strains, also a certain species of Candida, and mixtures of soil, sewage and garbage organisms grown on exposed plastic surfaces. By means of series of passages the selective adaptation and conservation of these organisms was continued up to 4 1/2 years. An anaerobic adaptation method for Desulfovibrio desulfuricans was developed and used successfully. After preliminary experimentation (Soil burial, sewage and garbage exposure tests) in the laboratory as well as in the open, a large scale Field testing programme under realistic and to some extent extreme conditions was implemented: Nine different plastic materials comprising eight plain high polymer plastics and for comparison one synthetic Cellulose derivate, together with glass control samples, were exposed in twelve different sewage, garbage, and soil media over a period of 3 months to 2 years, and subsequently examined. On the basis of the bacteriological results obtained from the adaptation series the test materials were classified into three categories, corresponding to the stimulation of bacterial growth: Group one, which allowed strong proliferation, included certain types of plasticized P.V.C. and Cellulose esters, as expected, and, as a new result, Polyurethane rubber; the latter showed clear signs of surface corrosion. Group two, which induced a clear but moderate growth, comprised a nylon trade type of Polyamide. Gruop three, allowing weak but still recognisable growth, included Formaldehyde pressure resing (Bakelite). This was surprising as it was thought that the formaldehyde and phenol components would exert a bacteriocidic or at least bacteriostatic effect. The results of the long and time consuming adaptation series with Pseudomonas aeruginosa were confirmed by the manometric dissimilation method of O. Warburg by means of the Braun/Melsungen apparatus. With this subtle but elegant procedure results and graphical recordings were obtained within hours and days...
Candida↗
Urine samples from disposable diapers: an accurate method for urine cultures.
BACKGROUND: The method of collection of the urine sample is of paramount importance in making a diagnosis of urinary tract infection in infants and children. Squeezing urine out of disposable diapers can provide a urine sample that can be used to detect chemical abnormalities as well as a specimen suitable for microscopic examination. To date there have been no reported studies on the use of this technique for urine culture as compared with samples collected by suprapubic aspiration and catheterization. METHODS: Urine was obtained from 38 infants aged under 2 years who presented with fever with no obvious cause. All infants had urine collected either by catheterization or suprapubic aspiration and by extraction from a disposable diaper. The urine samples were cultured using standard bacteriologic techniques. RESULTS: Five infants had a urinary tract infection, as shown by a pure growth of more than 10(5) colonies/mL of a single species of bacterium. In all the cases the same result was obtained from both the diaper urine sample and the sample obtained by suprapubic aspiration or catheter. In 31 infants the urine samples collected by both techniques (diaper and catheter or suprapubic aspiration) were negative, and in only 2 infants did the diaper specimen yield a positive result, while the urine obtained by suprapubic aspiration or catheter was sterile. CONCLUSIONS: Urine obtained from a disposable diaper can provide a valid sample for diagnosing urinary tract infection. The technique is simple, and can be carried out readily in ambulatory settings with minimal equipment and expense.
Disposable Equipment↗
Chorioamnionitis: a comparative histologic, bacteriologic, and clinical study.
Using morphologic and bacteriologic techniques, we examined placentas from 224 deliveries considered potentially complicated by infection. The severity of the chorioamnionitis was graded histologically according to the intensity of the inflammatory infiltrate. Chorioamnionitis or funisitis occurred in 111 placentas. Neonatal morbidity in this group was 48 (43%) as compared with 14 (12%) in those without chorioamnionitis. Pathogens were cultured from 49 of the 111 placentas with chorioamnionitis. Neonatal morbidity or mortality occurred in 28 (58%) of the group with positive cultures but occurred also in 20 (32%) of the 63 with chorioamnionitis from which no pathogens were cultured. Perinatal mortality was especially high (64%) among premature infants (less than 30 weeks) with infection. A comparison of culture techniques (surface swab versus swab of subchorionic fibrin after searing amnionic surface) showed similar rates of recovery but less contamination using the deep culture technique. Neonatal morbidity and mortality with severe chorioamnionitis (grades II and III; 62% and 82%) were significantly greater than with little or no chorioamnionitis (grades I and 0; 43% and 36%). Higher grades of histologically demonstrable chorioamnionitis are associated significantly with the highest rates of neonatal morbidity or mortality. In many instances, pathogens are not recovered by conventional aerobic and anaerobic bacteriologic study. A search for other infectious agents (viruses, mycoplasmas, chlamydiae) deserves attention.
Acute Disease↗
[Imipenem in the treatment of patients with severe surgical infection].
The clinical efficacy and safety of intravenously administered imipenem/cilastatin in the treatment of 45 patients with severe bacterial septicemia due to intra-abdominal abscesses, respiratory and urinary tract as well as skin, soft tissue and bone infections was studied in the prospective and open trial. The in vitro antimicrobial activity of imipenem has been assessed on the basis of 909 bacterial strains isolated from patients treated and non-treated with imipenem/cilastatin. Among them were 526 Gram-negative, 370 Gram-positive aerobic bacteria and 13 Gram-negative anaerobic bacteria (Bacteroides sp.). Pathogen susceptibility to imipenem was determined with a disc-diffusion technique using Merck, Sharp Dohme sensitive discs containing 10 mcg of imipenem. Highly sensitive to imipenem were 96.8% of Gram-negative 82.7% of Gram-positive aerobic bacteria and 100% of Bacteroides sp. All patients, in whom evident foci of infection e.g. intra-abdominal abscesses were discovered, were operated on. The dosage of imipenem/cilastatin ranged from 1.5 to 2.0 g/24 h. Clinical cure and bacteriological elimination was achieved in 39 (86.7%) of patients while 6 (13.3%) showed marked clinical improvement. Before and during therapy, aerobic and anaerobic cultures were taken from accessible sites. All specimens were worked up using conventional bacteriological techniques. Before during and after therapy, samples for hematology, biochemistry and urinanalysis were obtained. Adverse clinical effects were noted in 2 (4.4%) patients. One had nausea and vomiting which were probably related to rapid infusion and disappeared after increasing the administration time, and one had transient diarrhea. In conclusion, imipenem/cilastatin was a well tolerated and effective drug in the treatment of life-threatening surgical infections.
Adolescent↗
Aerobic and anaerobic bacteria in chronic suppurative otitis media. A quantitative study.
The aerobic and anaerobic bacterial flora of middle ear exudate (MEE) of 47 consecutive patients with chronic suppurative otitis media were studied using a quantitative bacteriological technique under strictly anaerobic conditions. Specimens from the external auditory canal (EAC) and the nasopharynx (NP) were obtained in order to correlate the bacterial findings with those of the MEE. Aerobic bacteria were invariably present in the MEE, the predominant aerobic species being Pseudomonas, found in 32%. Anaerobic bacteria were found in 45%: most anaerobes (55%) were cocci, 33% were of the Bacteroides species. The flora of the MEE correlated well with the bacteriological findings in the EAC cultures. In contrast, most organisms isolated from the NP represented the normal skin flora or were common respiratory pathogens.
Adolescent↗
Bacteriological evaluation of passive ultrasonic activation.
The purpose of this study was to evaluate the influence of passive ultrasonic activation on root canal disinfection. Sixty human teeth (group A: upper incisors, group B: upper canines, and group C: distobuccal root of first upper molars) were selected and sterilized in an autoclave. A standardized inoculum was placed into the canals, and they were incubated for 72 h at 37 degrees C. Then, they were divided into subgroup 1, which received sterile saline (SS) as an irrigant, and subgroup 2, which received sterile saline with passive ultrasonic activation (SU). The endodontic treatment was performed with a crown-down technique. Bacteriological identification of surviving colonies was carried out. Surviving colonies were higher when ultrasonics was not used (group A: SS: x 32.13, SU: x 13.53; group B: SS: x 53.70, SU: x 44.60; group C: SS: x 39.16, SU: x 29.40). The homogeneity proportion tests to compare the results of both subgroups showed that the surviving proportions were higher (p = 0.01) when the ultrasonic activation was not used.
Colony Count, Microbial↗
Correlation between the isolation of Mycobacterium tuberculosis and estimation of mycobacterial antigen in cisternal, ventricular and lumbar cerebrospinal fluids of patients with tuberculous meningitis.
In the study Mycobacterium tuberculosis was isolated in the cerebrospinal fluid (CSF) specimens of patients with tuberculous meningitis (TBM) by the conventional bacteriological technique. The isolation rate of M. tuberculosis was found to be 11.5% in lumbar, 75% in ventricular and 87.5% in cisternal CSFs. Low isolation rate of M. tuberculosis in lumbar CSF is due the low density of tubercle bacilli in lumbar CSF than in cisternal CSF. However M. tuberculosis antigen 5 is present in significant concentration in CSFs. The antigen concentration in CSF was estimated by an inhibition enzyme-linked immunosorbent assay (ELISA). Since CSF specimens can not be collected from ventricular or cisternal routes for the routine bacteriological investigations in patients with TBM, estimation of M. tuberculosis antigen 5 concentration in lumbar CSF by an inhibition ELISA may be considered as an adjunct in the laboratory diagnosis of TBM. This is particularly relevant in those patients in whom bacteriological methods fail to demonstrate M. tuberculosis in CSF specimens.
Antitubercular Agents↗
Anaerobic infections in children: a prospective study.
The prevalence and significance of anaerobic infections in patients at St. Louis Children's Hospital were studied prospectively for a one-year period. Blood, selected body fluids, and aspirates obtained from abscesses or areas of cellulitis were cultured using special anaerobic collection and processing techniques. Infected peritoneal fluid from patients with gastrointestinal disease yielded a large proportion of all anaerobic isolates. The types of organisms isolated were common inhabitants of the intestinal tract. Anaerobic organisms were recovered from only 0.75% of all blood cultures; anaerobic bacteremia accounted for 5.8% of all clinically significant bacteremic episodes (8.7% in the neonatal period and 4.8% in children over 1 month of age). Serious anaerobic infections occurred more frequently in the compromised host or in newborn infants than in otherwise healthy children. Since anaerobic organisms cause a small proportion of infectious diseases in a general pediatric population, the cost of refined bacteriologic techniques for the isolation and identification of these organisms is not warranted in most community hospitals. However, such a program should be available in selected tertiary care centers to aid in the management of certain high-risk patients.
Anti-Bacterial Agents↗