Gut-derived bone infection in the neonatal rat.

The risk of osteomyelitis is increased in the premature and critically ill neonate. Although potential sites of bacterial entry are present in many of these infants, the source of infection frequently cannot be established. This study was performed to assess the possible role of bacterial translocation from the intestine in the origin of bone infection using models of breast-fed and formula-fed rat pups. Newborn Sprague-Dawley rats suckled either ad libitum by the dam (n = 30), or were fed a rat milk-simulated formula (n = 30). After 3 d, the animals were killed, and the left femur, heart blood, mesenteric lymph nodes, liver, spleen, and terminal ileum were excised. Organs were analyzed for bacteria by standard microbiologic procedures. Bacterial translocation occurred in 23% of breast-fed rats; the bone was not infected in any of these animals. After feeding of formula diet, bacterial counts of the ileum were markedly elevated (p < 0.001), and the composition of the gut flora was disrupted. Bacterial translocation was noted in all formula-fed rats. Bone cultures were positive in 23 of 30 (77%) rats after formula-feeding (p < 0.001 versus breast-feeding). Organisms translocated to the bone included Enterococci, Proteus, Enterobacter, and Escherichia coli. Bacterial species cultured from the bone correlated with the individual colonization pattern of other extraintestinal organs and with the composition of the ileal flora. Members of the gut flora can escape the intestine and colonize the bone in formula-fed rats. The gut should be considered as a potential source for osteomyelitis in the neonate.

[Ureaplasma urealyticum pneumonia and isolation of U. urealyticum from endotracheal tube aspirates of preterm and full-term infants]. / Ureaplasmapneumonien und Nachweis von Ureaplasma urealyticum im Tubussekret bei Früh- und Neugeborenen.

OBJECTIVE: Our purpose was to investigate how many preterm infants with a birth weight 1,250 g with clinical symptoms had Ureaplasma urealyticum in their endotracheal tube aspirates, and how many of them had pneumonia. METHODS: The patients were divided into two groups (group 1: birth weight 1,250 g, n = 45), and these two groups were subdivided into two subgroups (subgroup a: U. urealyticum in aspirate without pneumonia; subgroup b: U. urealyticum in aspirate with pneumonia). RESULTS: In group 1, there were 25 patients. Nine patients (36%) had U. urealyticum in their aspirates, 5 patients (20%) had pneumonia (group 1b), and 4 patients (16%) did not (group 1a). Infants with pneumonia showed a significant increase in parameters of mechanical ventilation, in the duration of mechanical ventilation, and in the duration of oxygen dependence as compared with subgroup 1a. In group 2, there were 45 patients. Six patients of group 2 (13%) had U. urealyticum in their aspirates, 2 patients (4.4%) had a pneumonia (group 2b), and 4 patients (8.8%) did not (group 2b). CONCLUSIONS: In preterm infants as well as in term newborns one should consider U. urealyticum as a potential cause of neonatal pneumonia.

Effect of early nutritional deprivation and diet on translocation of bacteria from the gastrointestinal tract in the newborn rat.

The gastrointestinal (GI) barrier function is immature in the preterm neonate and might thus facilitate translocation of enteric bacteria and gut-derived septicemia. Circumstantial evidence suggests that bacterial uptake from the intestine may be further enhanced by an alteration of the host nutritional status. To test this hypothesis, neonatal rats were fed normal or restricted amounts of either breast milk or of a rat milk-simulated formula for 3-5 d. At the end of the study, various sections of the GI tract, mesenteric lymph nodes, liver, spleen, and blood were analyzed for bacteria using standard microbiologic procedures. Normal breast feeding was associated with bacterial translocation to mesenteric lymph nodes and in some cases to liver or spleen in 27% of rats, whereas all bacterial cultures were negative in a control group killed immediately after birth. Restricted breast feeding did not increase translocation compared with normal breast feeding. By contrast, feeding normal or restricted amounts of formula increased the numbers of gut bacteria by 2-3 logs, altered the morphology of the small intestinal mucosa, and resulted in ample bacterial translocation to the mesenteric lymph nodes and to systemic organs including the blood. Bacterial translocation may normally occur in suckling neonatal rats and is not increased by food restriction. Artificial feeding dramatically enhances translocation of gut bacteria.

Increase of ciprofloxacin resistance in Campylobacter species in Styria, Austria.

Salmonella spp. and thermophilic Campylobacter spp. are the most important diarrhea-causing pathogens in the area investigated in Styria, Austria. The isolation rate of Campylobacter in the more than 62,000 stool specimens investigated in the six-year period between 1988 and 1993 ranged between 1.90% in 1988 and 3.58% in 1991. The testing of susceptibility to nalidixic acid has been an usual characteristic for species identification. Nalidixic acid-resistant strains were rare in 1988-1990, but in the summer of 1991, we found an increasing number of these isolates. At the same time, we learnt about the increasing use of enrofloxacin in veterinary medicine, especially in the poultry industry, and therefore we started routine testing of Campylobacter spp. susceptibility to ciprofloxacin in 1992. In 1992, the resistance rate to ciprofloxacin was already 16.9%, rising to 22.1% in 1993.

[Whipple's disease: abdominal lymphoma, intermittent fever and recurrent arthralgias]. / Morbus Whipple: abdominale Lymphome, Fieberschübe und rezidivierende Arthralgien.

A diagnostic laparotomy was performed on a 41-year old woman who, having suffered from recurrent arthralgias for several years and intermittent fever for many months, was found to have extensive enlargement of abdominal lymph-nodes, raising the suspicion of malignant lymphoma. Frozen-tissue biopsy was highly suspicious of Hodgkin's lymphoma, but light- and electron-microscopy revealed Whipple's disease, confirmed in an endoscopically obtained duodenal mucosal biopsy. The arthralgia quickly responded to antibiotic treatment. This case demonstrates the potential difficulties and errors in the diagnosis of Whipple's disease.

The germ-spectrum problem and antibiotic-resistance in Bida and Minna hospitals--Nigeria.

In the present paper the occurrence of different species of Pseudomonas, of Acinetobacter calcoaceticum var. anitratum and Aeromonas hydrophila in hospitals is described. The possible human pathogenic significance is discussed.