The isolation of anaerobic bacteria from wound swabs.

The isolation of anaerobic bacteria from routine wound swabs by three procedures was evaluated. Recovery of anaerobic organisms was doubled by immediate incubation of seeded plates, and the recovery could be further dramatically improved by the use of prereduced media, in conjunction with an anaerobic chamber. Recommendations for the treatment of swabs and cultures for anaerobic investigation are made.

An evaluation of the Modified R/B Enteric Differential System for the identification of the Enterobacteriaceae.

Two hundred and twenty-two organisms were identified by conventional methods and by the Modified R/B Enteric Differential System. Two hundred and eighteeen (98-2%) of these organisms were correctly identified by the R/B system. The results of individual tests were also compared. The convenience and general ease of handling of the R/B system are discussed.

A comparison of two commerical methods for the identification of the Enterobacteriaceae--API 20E and the Enterotube--with conventional methods.

The API 20E, the Enterotube, and routine methods of Cowan and Steel were used in parallel to identify 245 members of the Enterobacteriaceae. The API 20E and conventional methods gave the same identification in all but 2 (0-8%) of the 245 organisms tested. The Enterotube correctly identified 85% of these organisms on the first testing. On re-testing those organisms incorrectly identified the Enterotube results agreed with the conventional ones in a further 20 (8%). There was no change in the identification obtained by the API or conventional methods. Further conventional sugar tests were necessary before final identification was available by the API system in 7 (3%) against 106 (47%) of the 226 organisms correctly identified by the Enterotube. The Enterotube relied on serological testing alone to distinguish between alternatives in 17 (7%) isolates. Other advantages and disadvantages of these systems are discussed.

Identification of the Enterobacteriaceae: a comparison of the Enterotube II with the API 20E.

Two commercial methods for the identification of the Enterobacteriaceae, API 20E and Enterotube II, were compared using the results obtained with 235 cultures of fresh clinical isolates. Enterotube II was an improvement on the original Enterotube, but the availability of two differing indices, one using the Voges-Proskauer (VP) test result and one without, is criticised.

Preoperative whole body disinfection--a controlled clinical study.

Preoperative whole body washing with chlorhexidine scrub was compared with soap for its effect on prevention of wound infection in clean surgery. Two thousand and fifteen patients were studied using chlorhexidine scrub, placebo or plain soap. The overall infection rate in the control and placebo groups was 12.8% (p less than 0.05) and 11.7% as opposed to 9% (p less than 0.05) in the treated group. Three per cent fewer infections were found in treated 'clean surgery' patients, and the incidence of Staphylococcus aureus infections was reduced from 6% (bar soap) to 3% (chlorhexidine). The saving in bed occupancy from prevention of infection is a significant cost-saving.

A placebo-controlled trial of the effect of two preoperative baths or showers with chlorhexidine detergent on postoperative wound infection rates.

The effect of preoperative whole-body washing with chlorhexidine detergent on the incidence of postoperative wound infection was assessed in a placebo-controlled trial of 1989 patients. Patients bathed or showered with chlorhexidine, placebo, or conventional bar soap, on two occasions in the 24 h before operation. The overall infection rate for patients treated with chlorhexidine was 9%, against 12.8% in the bar soap and 11.7% in the placebo groups; in the 'clean' surgery group infections were 7.2% against 10.2% and 10%, respectively. The Staphylococcus aureus infection rate in the 'clean' group was 3% for chlorhexidine against 6% for bar soap.

Endocarditis caused by Kingella denitrificans.

We report the case of a 48-year-old man with native valve endocarditis caused by Kingella denitrificans. He was successfully treated with a combination of beta-lactam antibiotics and aminoglycosides, after which he underwent valve replacement surgery. This case represents the first report in the literature of elective native valve replacement. Previously reported cases are discussed together with management options, including suggestions for the treatment of patients with beta-lactam allergy and those infected with beta-lactamase producing strains.

Sexing North American Eskimo and Indian innominate bones with the acetabulum/pubis index.

The acetabulum/pubis index was tested on American Eskimo and Indian samples of innominate bones to which sex had been assigned by visual inspection. The index alone sexed 91 and 89% of the Eskimo and Indian samples, respectively. Subsequent sorting of misclassified specimens with femur head diameter resulted in 96 and 99% rates of classification. The index and a measurement of ischial height were used in a discriminant function model which correctly identified the sex of 93% of the Eskimo and 92% of the Indian bones. Using femur head diameter to sort those specimens which were misclassified by their discriminant function score yielded classification rates of 96 and 98%. These results are compared to a range of 92 to 100% obtained with the index in earlier studies of American black and white pelvic bone samples.

Comparison of macroscopic cranial methods of age estimation applied to skeletons from the Terry Collection.

A total of 963 skeletons (408 Whites and 555 Blacks) from the Terry Collection were studied to examine macroscopic cranial methods of age estimation. The methods of Acsádi and Nemeskéri, Masset, Baker and Meindl and Lovejoy were applied to every skull. The results indicate that the most accurate techniques in this application were those that consider endocranial suture closure. The methods of Acsádi and Nemeskéri and Masset were the most accurate in all the subsamples (by population, sex, sex within population and in total), although the relative accuracy could vary in application to other populations.

Determination of sex with a discriminant analysis of new pelvic bone measurements: Part II.

The pelves of 100 white skeletons were measured on both sides for the following: (1) length from the superiormost aspect of the pubic symphysis to the nearest rim of the acetabulum (PS-A), (2) length from the highest point of the pubic tubercle to the nearest rim of the acetabulum (PT-A), (3) acetabular diameter (AD), (4) the vertical distance from the anterior aspect of the ischial tuberosity to the farthest rim of the acetabulum (IT-A), and (5) greatest femur head diameter. From these, three indices were derived: AD/PS-A (acetabulum/pubis index), AD/PT-A (acetabular diameter/pubic tubercle-acetabular rim index), and IT-A/PS-A (ischium-acetabulum height/pubic symphysis-acetabular rim index). The left AD/PS-A ratio and left IT-A height proved statistically to be of greatest discriminating value. Using these two variables, a discriminant function was derived which correctly separated 98% of our sample. The acetabulum/pubis ratio alone correctly assigned 95%. With either the discriminant function analysis of two variables or the acetabulum/pubis index as a single predictor, 97% of our sample of known sex was correctly identified if all specimens that fell within a doubtful or overlapping range of values were sorted by femur head diameter.

Evaluation of seven methods of estimating age at death from mature human skeletal remains.

Different approaches to the estimation of age at death in mature human skeletal remains were evaluated utilizing samples from 19 recent French autopsy individuals of known age at death. Methods of estimating age at death from single-rooted teeth, the sternal ends of the fourth ribs, the symphyseal face of the pubis and femoral cortical remodeling were evaluated by two independent observers (three observers for the teeth). Comparison included ages estimated from three more comprehensive approaches utilizing data from the application of two or more of the individual methods. The results indicate that the comprehensive approaches are superior to the individual ones and the success of the latter reflects not only the morphological expression of the aging process, but also the technique complexity and the experience of the investigator. Of the individual techniques, the "Lamendin" dental technique was most effective for individuals of ages greater than 25 years.

Determination of sex with a discriminant analysis of new pelvic bone measurements: Part I.

The pelves of 100 black skeletons were measured on both sides for the following: (1) length from the superiormost aspect of the pubic symphysis to the nearest rim of the acetabulum (PS-A), (2) length from the highest point of the pubic tubercle to the nearest rim of the acetabulum (PT-A), (3) acetabular diameter (AD), (4) the vertical distance from the anterior aspect of the ischial tuberosity to the farthest rim of the acetabulum (IT-A), and (5) greatest femur head diameter. From these, three indices were derived: AD/PS-A (acetabulum/pubis index), AD/PT-A (acetabular diameter/pubic tubercle-acetabular rim index), and IT-A/PS-A (ischium-acetabulum height/pubic symphysis-acetabular rim index). The left AD/PS-A ratio and left IT-A height proved statistically to be of greatest discriminating value. Using these two variables, a discriminant function was derived which, followed by sorting with femur head diameter, accurately classified 97% of our sample. The acetabulum/pubis index alone with subsequent sorting by femur head diameter correctly assigned 96% of our sample. While this does not represent an improvement of predicatability over similar methods using the ischium/pubis index, measurements required for the acetabulum/pubis index are more easily defined and should, therefore, reduce the chance of observer error.

Managing a large outbreak of cryptosporidiosis: how to investigate and when to decide to lift a 'boil water' notice.

The largest outbreak of cryptosporidiosis reported in the United Kingdom, involving 575 confirmed cases (of which 474 met an agreed case definition), occurred in the county of Devon during August and September of 1995. The descriptive epidemiology supports the hypothesis that the outbreak was associated with the consumption of cold tap water in the area served by a particular water treatment works. Cryptosporidium oocysts were detected in treated water samples at the time of the outbreak. Although the epidemiological analysis provided strong circumstantial evidence of a waterborne outbreak, the data were not recorded in a manner that made them admissible in criminal proceedings taken by the Drinking Water Inspectorate against the water company involved. The need to carry out an analytical study in conjunction with the identification and characterisation of the pathogen in the drinking water and the practicalities of agreeing criteria for lifting a 'boil water' notice are discussed.