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.

A multiplex, internally controlled real-time PCR assay for detection of toxigenic Clostridium difficile and identification of hypervirulent strain 027/ST-1.

The purpose of this study was to validate a multiplex real-time PCR assay capable of detecting toxigenic Clostridium difficile and simultaneously identifying C. difficile ribotype 027/ST-1 by targeting the toxin genes tcdA, tcdB and cdtA in one reaction and in a separate reaction identifying the Δ117 deletion in tcdC associated with ribotype 027/ST-1. PCR was done prospectively on 704 samples routinely submitted to our department and results were compared to results of toxigenic culture. Sequencing of tcdC, multi locus sequence typing (MLST) and PCR ribotyping were done on cultured isolates to confirm the correct identification of the Δ117 deletion in tcdC and C. difficile ribotype 027/ST-1, respectively. The PCR assay displayed a sensitivity, specificity, PPV and NPV of 99.0%, 97.4%, 87.4% and 99.8%, respectively, compared to toxigenic culture on 665 samples evaluable both by PCR and culture. Sequencing of tcdC, ribotyping and MLST of cultured isolates validated the genotyping assay and confirmed the ability of the assay to correctly identify C. difficile ribotype 027/ST-1 in our current epidemiological setting. We describe the use of a combination of two separate PCR assays for sensitive and specific detection of toxigenic C. difficile and presumptive identification of C. difficile 027/ST-1.

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.

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.

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.

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.

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.

Influence of the cupric ion on the ampicillin concentration in cervical mucus.

PIP: It might be expected that the effect of antibiotics used in the treatment of lower genital tract infection in women using a copper-IUD for contraception would be reduced, and this hypothesis is the reason for the present investigation. Additionally, the correlation between the concentrations of ampicillin in serum and cervicul mucus is sought. 10 fertile healthy women, with no recent history of lower genital tract infection, participated. All of the women wanted an IUD for contraceptive reasons. No patients with known or suspected penicillin-allergy were asked. The Cu-T-200 was inserted in all the women in the proliferative phase (6-11 day), and the patients were studied with the IUD in situ in the next cycle on approximately the same day as the insertions were made. Blood and cervical mucus samples were taken before insertion of the IUD and again 1 month later, each woman serving as her own control. Prior to insertion of the IUD, the patients received 350 mg Pivampicillin and 500 mg Probenicid orally. Samples were taken approximately 1 hour afterwards for determination of the ampicillin concentration in serum and cervical mucus. After 1 month, new measurements were performed with the IUD in situ. There was no significant fall in the ampicillin concentration in cervical mucus after insertion of a copper-IUD. The correlation coefficient for the ampicillin concentration in serum and cervical mucus before insertion of IUD is 0.13 and after insertion of the IUD is 0.503. None of these figures is significant. Before insertion of the IUD, the mean ampicillin concentration in cervical mucus was 16.2% of the serum ampicillin concentration; it was 15.2% after insertion of the IUD. As the insertion of a copper IUD does not result in a fall of the ampicillin concentration in cervical mucus, it is not necessary to remove a copper IUD before treatment of a lower genital tract infection with ampicillin. There is also no reason to increase the dose of ampicillin given to women using the copper IUD.^ieng

[Multimicrobial pulmonary infection in an AIDS patient]. / Multimikrobiel lungeinfektion hos en 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]. / Basaltemperaturmåling med Tempadot-engangstermometer til oral brug.

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.

[Fatal outcome of Strongyloides stercoralis infection in a patient with no previously known immunosuppression]. / Fatalt forløbende Strongyloides stercoralis-infektion hos patient uden forudgående kendt immunsuppression.

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]. / Den kliniske konsekvens af bloddyrkningssvar.

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.

[Bacteremia caused by zoonotic Salmonella types in greater Copenhagen in 1984-1988]. / Bakteriaemi forårsaget af zoonotiske Salmonella-typer i Storkøbenhavn 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.

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.

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.