[Medical graduates from the Odense University 1972-1998. Recruitment and employment]. / Laegevidenskabelige kandidater fra Odense Universitet 1972-1998. Rekruttering og beskaeftigelse.

The aim was to create and maintain a registration of all medical graduates from Odense University from the first graduates in 1972 and to describe the graduates' background and subsequent professional employment. All graduates from 1972 to 1998 are included. About 55% of the graduates came from secondary schools in the country og Funen, 20% from southern Jutland and 15% from Copenhagen and Jutland north of Vejle. About 45% became general practitioners after 5-22 years (median 11 years), a third of them in the county of Funen. Twenty-five percent became consultants after 11-17 years (median 14 years), twenty-five percent of these in the county of Funen. The cumulated death rate was 5% for the ages 30-55 years. At 17 years after graduation 83% had become specialists, at ten years the number was 55%. In conclusion, Odense University recruits 75% of its medical students from southern Denmark. Of the graduates that become general practitioners, about two-thirds are employed in southern Denmark, for consultants the corresponding figure is 50%.

Resistance problems in two university hospitals in Denmark.

In 1997, 80 and 89% of Staphylococcus aureus isolated from university hospitals in Odense and Hvidovre respectively were resistant to penicillin and 32.0 and 41% of Escherichia coli were resistant to ampicillin. There were low incidences of methicillin resistance in S. aureus (<1%), penicillin resistance in Streptococcus pneumoniae (3%),and gentamicin in E. coli (2%). These figures might reflect the low use of antibiotics in Denmark.

[Infections in connection with epidural catheterization]. / Infektioner i forbindelse med epidural kateterisation.

Seventy-eight patients with culture-positive epidural catheters were studied. Fifty-nine had symptoms of exit site infection and 11 patients had clinical meningitis, two of whom also had en epidural abscess. This corresponds to a local infection incidence of at least 4.3% and an incidence of central nervous system infection of at least 0.7% at Odense University Hospital. The patients with generalized symptoms of infection had been catheterized for a longer time, and were older than patients with only local symptoms of infection. The microorganisms isolated from the epidural catheters were coagulase- negative staphylococci (41%), Staphylococcus aureus (35%), Gram-negative bacilli (14%) and other bacteria (10%). The Gram-negative bacilli and S. aureus caused serious infections more frequently than the others. We discuss the symptoms and diagnosis of spinal epidural abscess and propose prophylactic and diagnostic guidelines for epidural catheter-related infections.

Infections following epidural catheterization.

Seventy-eight patients with culture-positive epidural catheters, were studied. Fifty-nine had symptoms of exit site infection and 11 patients had clinical meningitis, two of whom also had an epidural abscess. This corresponds to a local infection incidence of at least 4.3% and an incidence of central nervous system infection of at least 0.7% at Odense University Hospital. This degree of infection is of the same magnitude as that reported for intravascular devices. We found that the patients with generalized symptoms of infection had been catheterized for a longer time, and were older than patients with only local symptoms of infection. The microorganisms isolated from the tips of the epidural catheters were coagulase-negative staphylococci (41%), Staphylococcus aureus (35%), Gram-negative bacilli (14%) and others (10%). The Gram-negative bacilli and S. aureus caused serious infections more frequently than the others. We discuss the symptoms and diagnosis of spinal epidural abscess and suggest a proposal for prophylactic and diagnostic guidelines for epidural catheter-related infections.

Nosocomial respiratory syncytial virus infections in a paediatric department.

The seasonal problem of respiratory infections in children caused by respiratory syncytial virus (RSV) is worldwide. A number of these infections are known to occur by nosocomial acquisition. In order to reduce the risk, measures, such as cohort nursing and handwashing, have been used in the paediatric department of Odense University Hospital for three years. In a retrospective evaluation of this routine practice the incidence of nosocomial RSV infections was recorded. The overall rate of nosocomial infection was low, but was proportionally highest in the unit for children aged under 6 months; no change in incidence was seen over the three-year period. In the infectious disease unit, where the majority of RSV infected children were admitted, the rate of nosocomial infection decreased despite an unchanged routine. This difference cannot be explained simply on the basis of longer hospital admission of the children under 6 months of age, but might relate to acquired immunity in children of all ages in the infectious diseases unit or better facilities for segregation within that unit.

Intracranial abscesses in Odense Hospital. Survey of bacteriology, epidemiology, and treatment with antibiotics, 1963-1989.

Fifty-nine patients were operated or punctured in 60 incidents of brain abscess from 1963-1989, twice as many in men as in women. The number of cases tripled in 1980 to an incidence of 3.6 per million inhabitants per year, supposedly due to the advent of computerized tomography. Simultaneously, the aetiology changed from staphylococci and Gram negative rods to dominance of streptococci and Haemophilus aphrophilus. Apart from temporal abscesses, there was no correlation between localisation in the brain and the bacterial species isolated. Ninety-five per cent of the specimens from untreated patients gave growth, but so did specimens from six of 18 patients treated with relevant antibiotics up to 11 days before puncture. Therefore, we recommend removal of pus by excision or puncture.

Outbreak of infection with Achromobacter xylosoxidans from contaminated intravascular pressure transducers.

Achromobacter xylosoxidans contaminating transducers caused 15 cases of hospital infection. In the eight patients with bacteraemia the interval from inoculation to fever was an average of 6.6 days. All the infected patients recovered. Computerization of laboratory records allowed retrieval of previous isolates, and review of clinical records focused the problem on patients with cardiac and aortic diseases. The problem arose from the re-use of disposable equipment after disinfection with a benzalcone.

Studies on clinical isolates of coagulase-negative staphylococci resistant to methicillin. Evidence of cross-resistance between methicillin and cephalothin.

The in vitro susceptibility to cephalothin and cefuroxime of 195 isolates of methicillin-resistant coagulase-negative staphylococci was determined by the agar-diffusion test, using 7.5% NaCl-supplemented agar. The distribution of the inhibition zone diameters for isolates of S. epidermidis (S. biotype 1) as well as for S. haemolyticus (S. biotype 4) was trimodal. While 4% of the isolates were found susceptible to cefuroxime, 39% of the S. epidermidis/S. hominis (S. biotype 1) isolates and 34% of the S. haemolyticus (S. biotype 4) isolates were found susceptible to cephalothin by this method. Eight of these isolates (six S. epidermidis, two S. haemolyticus) were selected for susceptibility testing by the tube-dilution method, together with four isolates (three S. haemolyticus, one S. epidermidis) found resistant to cephalothin by the agar-diffusion test. The first-mentioned isolates were all found susceptible to cephalothin with MICs less than or equal to 2 micrograms/l, while the last-named all were resistant with MICs greater than or equal to 16 micrograms/ml. Population analyses revealed sub-populations of highly resistant bacteria in all methicillin-resistant isolates of S. epidermidis (S. biotype 1), as well as in all isolates of S. haemolyticus (S. biotype 4). We thus concluded that methicillin-resistance in isolates of coagulase-negative staphylococci implies resistance to cephalosporins and that the difference between S. epidermidis and S. haemolyticus as regards cephalosporin-susceptibility is quantitative and not qualitative. Eighty-nine per cent of the 195 methicillin-resistant isolates in this study were resistant to penicillin and at least one more antibiotic. We therefore think that resistance to penicillin and one or more non-beta-lactam antibiotics strongly suggests methicillin-resistance and that such isolates should be further tested on hypertonic media.

Studies on ampicillin resistance in Achromobacter xylosoxidans. Brief report.

Population analyses of susceptibility to ampicillin in ampicillin-susceptible and ampicillin-resistant strains of Achromobacter xylosoxidans revealed the existence of ampicillin-resistant subpopulations in ampicillin-susceptible isolates. Bacteria resistant to a concentration four times the one that inhibited the majority population had a frequency of 10(-3) to 10(-4). Strains isolated from aqueous environments are often found susceptible to ampicillin, while sporadic cases of infections with A. xylosoxidans are often caused by ampicillin-resistant strains. We suggest that the isolation from clinical specimens of ampicillin-susceptible strains, therefore, may be an indication of nosocomial infections due to recently contaminated aqueous solutions or medical equipment.

Epidemic spread of Acinetobacter calcoaceticus in a neurosurgical department analyzed by electronic data processing.

An epidemic spread of Acinetobacter calcoaceticus var. anitratus in two neurosurgical wards is described retrospectively and prospectively using electronic data processing. Isolation of the species from sputum preceded the isolation from CSF by 1/2-1 year. Control measures directed against spread by air and indirect contact controlled the epidemic. Reexamination of 20 selected strains from the epidemic revealed two distinct resistance patterns.

The occurrence of the trehalose fermenting, tetracycline and polymyxin resistant phenotype among the Enterobacteriaceae.

In Proteus morganii, P. mirabilis, and Providencia stuartii the ability to ferment trehalose and resistance to tetracycline were associated in 90%-97% of the strains. The same was true of at least 78% of the strains of Serratia marcescens. Proteus vulgaris showed a more quantitative association of the two traits. As the characters occur independently in 3-10% of the strains, the association is considered to be due to simultaneous selection in some natural niche. The trehalose fermenting, tetracycline and polymyxin resistant species ferment few other carbohydrates, fewer than the remainder of the Serratia species.

Sensitivity of Serratia to tetracycline.

S. marcescens had two levels of resistance to tetracycline, bacteriostatic end-points 32 and 180 microgram/ml; the latter group consisted of strains resistant to carbenicillin and to streptomycinl S. plymouthica, S.l liquefaciens, and S. marinorubra were sensitive to tetracycline with the last-named as the least sensitive species. Less difference was found between the bactericidal end-points of the four species, but there was still 1-2 two-fold steps between S. marcescens and the remaining three species.