RESUMO
BACKGROUND: Patients with bloodstream infections need early adequate antimicrobial treatment to reduce mortality. This raises the question of timing and logistics. How important is the time of day when a culture is flagged positive to the processing of blood cultures and optimisation of antimicrobial therapy? METHODS: We performed a retrospective study assessing the time delay of a positive blood culture result during and after office hours and its impact on adequate antimicrobial therapy. Process duration from the moment of culture positivity to Gram stain completion was compared at different timepoints during the day in a medium-sized hospital with an offsite microbiological laboratory. RESULTS: Ninety-four patients with positive, noncontaminated blood cultures were included. Sixty-six patients (70%) received adequate empirical therapy; this increased to 76 cases (82%) and to 88 cases (95%) after analysis of Gram stain results and complete determination, respectively (p < 0.05 for all comparisons). Median duration from culture positivity to Gram stain completion (including offsite culture transport) increased from a median of four to 12 hours if time of cultures turned positive after office hours (p < 0.05), irrespective of the adequacy of empirical coverage. This also resulted in a median 12-hour delay for the complete process from time of culture positivity to administration of the antimicrobial drug (p < 0.05). CONCLUSION: Processing blood cultures after office hours is often deferred, which can lead to a delay in adequate antimicrobial therapy for patients with bloodstream infections.
Assuntos
Bacteriemia/diagnóstico , Diagnóstico Tardio/estatística & dados numéricos , Laboratórios Hospitalares/organização & administração , Fatores de Tempo , Tempo para o Tratamento/estatística & dados numéricos , Idoso , Agendamento de Consultas , Feminino , Humanos , Masculino , Países Baixos , Estudos RetrospectivosRESUMO
The usefulness of restriction endonuclease analysis of chromosomal DNA as a typing method for Clostridium difficile was tested. Over four months all faecal samples were routinely cultured for C difficile. DNA of all isolated strains was isolated and tested with the restriction endonuclease Hind III. The patterns obtained after electrophoresis in agarose gels seemed to be strain specific. Antibiotic susceptibility profiles agreed with the results of the restriction endonuclease analysis, though they were much less discriminating. Analysis of the results indicated that restriction endonuclease analysis is a suitable typing method for C difficile, which may be very valuable in epidemiological studies where a highly discriminating typing method is needed.
Assuntos
Cromossomos Bacterianos , Clostridium/classificação , Enzimas de Restrição do DNA , DNA Bacteriano/análise , Antibacterianos/farmacologia , Criança , Clostridium/efeitos dos fármacos , Eletroforese em Gel de Ágar , Fezes/microbiologia , Humanos , Lactente , Testes de Sensibilidade Microbiana , Sorbitol/metabolismoRESUMO
A group of faecal isolates of Proteus vulgaris and P. mirabilis was studied for the presence of possible virulence factors such as growth rates in urine and broth, haemolysin production, hydrophobicity, sensitivity to the bactericidal activity of human serum and cell invasiveness. Differences were found in haemolysin production, cell invasiveness and experimental virulence in a mouse model. These differences might explain why P. mirabilis is much more common in human urinary-tract infections than P. vulgaris.
Assuntos
Proteus mirabilis/patogenicidade , Proteus vulgaris/patogenicidade , Urina/microbiologia , Animais , Fezes/microbiologia , Humanos , Masculino , Camundongos , Infecções Urinárias/microbiologiaRESUMO
The importance of K antigens from six strains of Escherichia coli for the interaction with polymorphonuclear leukocytes (PMNL) was studied. The major factor influencing this interaction was the ability of strains to activate complement by the classical route during opsonisation, this process being reduced for most K-positive strains. Interference of K antigens with the functioning of common pili as adhesions of eukaryotic cells was not observed nor a toxic effect of K antigens on PMNL.
Assuntos
Antígenos de Bactérias/imunologia , Antígenos de Superfície , Antígenos/imunologia , Escherichia coli/imunologia , Neutrófilos/imunologia , Fagocitose , Anticorpos Antibacterianos/imunologia , Ativação do Complemento , Via Alternativa do Complemento , Via Clássica do Complemento , Proteínas do Sistema Complemento/imunologia , Ácido Egtázico , Fímbrias Bacterianas/imunologia , Testes de Hemaglutinação , Temperatura Alta , Medições Luminescentes , Magnésio , Proteínas Opsonizantes/imunologia , ZimosanRESUMO
We report the relative frequencies of members of the Bacteroides fragilis group in the faeces, in colon lavage fluid obtained pre-operatively, and in colonic tissue specimens obtained at operation from 10 patients with colonic cancer. B. vulgatus was the most and B. fragilis and B. ovatus were the least frequently isolated Bacteroides spp. in the faeces of the 10 subjects. B. uniformis and B. thetaiotaomicron ranked second and third in the faeces. The relative frequencies of all species except B. fragilis were lower in the lavage fluid and in cultures of mucosa. The relative frequency of B. fragilis increased from 4% in faeces to 39% in the final lavage fluid and to 42% in the colonic mucosa culture. Our results suggest that B. fragilis has a more intimate association with the gut mucosa than other members of the B. fragilis group, which might be one explanation for the high incidence of this species in gut-associated intra-abdominal infections.
Assuntos
Infecções por Bacteroides/epidemiologia , Bacteroides fragilis/crescimento & desenvolvimento , Bacteroides/crescimento & desenvolvimento , Colo/microbiologia , Neoplasias do Colo/microbiologia , Adulto , Idoso , Infecções por Bacteroides/complicações , Infecções por Bacteroides/microbiologia , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Neoplasias do Colo/complicações , Meios de Cultura , Epitélio/microbiologia , Fezes/microbiologia , Feminino , Humanos , Mucosa Intestinal/microbiologia , Masculino , Pessoa de Meia-IdadeRESUMO
A bacteriological study of the middle-ear effusions and the ear canals in children with chronic serous otitis media (S.O.M.) was performed. Sixty-eight children (127 ears) were investigated. From this study it appeared that cleansing of the ear canal with 0.5% chlorhexidine in 70% ethanol for 30 s is partially effective; micro-organisms (diptheroids, Staphylococcus epidermidis) could still be isolated in 29%. Cleansing of the ear canal decreases the incidence of middle-ear fluid contamination by non-pathogenic ear canal organisms (diptheroids, Staphylococcus epidermidis, Aerococcus), but after cleansing, 'non-pathogenic' micro-organisms could still be isolated in 33% of the effusions (diptheroids, Staphylococcus epidermidis). From 12% of the middle-ear effusions pathogenic micro-organisms (Hemophilus influenzae, Staphylococcus pneumoniae) were isolated; cleansing of the ear canal did not influence this percentage. Anaerobics were not isolated from the middle-ear effusions.
Assuntos
Bactérias/isolamento & purificação , Meato Acústico Externo/microbiologia , Orelha Média/microbiologia , Otite Média com Derrame/microbiologia , Adolescente , Antibacterianos/uso terapêutico , Cetrimônio , Compostos de Cetrimônio/uso terapêutico , Criança , Pré-Escolar , Clorexidina/uso terapêutico , Corynebacterium/isolamento & purificação , Detergentes/uso terapêutico , Feminino , Humanos , Lactente , Masculino , Streptococcus/isolamento & purificaçãoRESUMO
Urinary tract infections occur frequently in nursing homes. Treatment is usually empiric without microbiological investigation. Because there is widespread resistance to the most frequently used antibiotics, we tested a relatively simple method (direct sensitivity testing for 7 antibiotics) to get information about the antibiotic resistance. The results, with 49 urine samples in the evaluation, showed a concordance of our direct sensitivity test with conventional culture (the golden standard) of 89.8% (35/342 evaluations were not in concordance). The concordance for the result 'sensitive' was 98.8% (3/240 results showed 'false-sensitive'), and the the result 'resistant' 68.6% (32/342 results showed 'false-resistant'). Urinary tract infections in the nursing home can be treated more quickly and more adequately with antibiotics with the information obtained by direct sensitivity testing. This method can be recommended as an alternative to empiric treatment.
Assuntos
Antibacterianos/uso terapêutico , Testes de Sensibilidade Microbiana , Infecções Urinárias/microbiologia , Idoso , Bactérias/crescimento & desenvolvimento , Resistência Microbiana a Medicamentos , Humanos , Casas de Saúde , Infecções Urinárias/tratamento farmacológicoRESUMO
A study of the registered number of Shigella infections in Amsterdam for the period 1997-2001 revealed that in 2001, there was an increase in the number of homosexual patients with oral-anal contacts as source for their infections. All of these infections were caused by subtype Shigella sonnei. The infections were not associated with a specific meeting place for homosexual men. A relationship with an underlying HIV-infection is likely.
Assuntos
Disenteria Bacilar/transmissão , Doenças Bacterianas Sexualmente Transmissíveis/transmissão , Shigella sonnei , Adolescente , Adulto , Disenteria Bacilar/complicações , Disenteria Bacilar/epidemiologia , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Homossexualidade Masculina , Humanos , Masculino , Países Baixos/epidemiologia , Sexo Seguro , Doenças Bacterianas Sexualmente Transmissíveis/complicações , Doenças Bacterianas Sexualmente Transmissíveis/epidemiologiaRESUMO
The introduction of methicillin-resistant Staphylococcus aureus (MRSA) in an Amsterdam nursing home (312 beds) by a patient discharged from a local hospital, the spread of this strain to other residents and staff of the nursing home and the actions taken to prevent this spread are described. During the period when this MRSA strain was circulating residents and staff members were checked periodically for presence of MRSA. In spite of all preventive measures as implemented in Dutch hospitals (including isolation of infected residents) additional residents (in a total of 8) and staff members acquired the MRSA strain. Relaxation of the precautions (no more isolation) and continued instruction of the members of the staff was attended by a decrease of further contamination. Four of 8 residents died while being colonised or infected. The course of this epidemic illustrates that limited precautions and proper training of staff in hygiene can restrict spread of MRSA in nursing homes.
Assuntos
Resistência a Meticilina , Casas de Saúde , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/metabolismo , Idoso , Idoso de 80 Anos ou mais , Surtos de Doenças , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Isolamento de Pacientes/organização & administraçãoRESUMO
In addition to a rise in the number of cases of gonorrhoea, the susceptibility of Neisseria gonorrhoeae to antibiotics is also a cause for concern. After a period of high resistance rates to penicillin and tetracycline between 1985 and 1995, resistance rates have dropped considerably in recent years, probably due to changes in treatment regimens. However, recently we have seen an increasing number of quinolone-resistant N. gonorrhoeae isolates in Amsterdam, the Netherlands, a development that has previously been reported in other parts of the world. Some form of national resistance monitoring for gonococci is therefore urgently required to allow timely detection of changes in N. gonorrhoeae resistance.
Assuntos
Anti-Infecciosos/uso terapêutico , Gonorreia/tratamento farmacológico , Neisseria gonorrhoeae/efeitos dos fármacos , 4-Quinolonas , Animais , Anti-Infecciosos/farmacologia , Resistência Microbiana a Medicamentos , Gonorreia/epidemiologia , Humanos , Neisseria gonorrhoeae/isolamento & purificação , Países Baixos/epidemiologia , PrevalênciaRESUMO
OBJECTIVE: To establish prevalence and aetiology of tinea capitis in children attending primary school in Amsterdam South-East. DESIGN: Prevalence survey. METHODS: The Municipal Health Service Amsterdam, the Netherlands, selected classes of four primary schools in a survey with children clinically suspected of having tinea capitis as well as classes without clinical cases. Per school at least one class with a notified case was included. Written information was provided to all parents; the parents of three children refused participation. After clinical examination by a team of physicians and nursing staff scalp cultures were taken using the brush method from 315 children (aged 4-12 years) in 16 classes. RESULTS: The clinical diagnosis 'tinea capitis' was established in 25 children, significantly more in boys than in girls (relative risk (RR) = 2.92: 95% confidence interval (95% CI) 1.20-7.11). Of all children 7% had positive cultures, more boys than girls (RR = 3.13: 95% CI: 1.18-8.28). Symptomatic cases (confirmed by culture) amounted to 3.2% of all children. The carrier rate was 3.8%. Trichophyton tonsurans was the most frequently isolated dermatophyte both in symptomatic children and in carriers. CONCLUSION: In 7% of all children (3.2% with symptoms of tinea capitis, 3.8% without) dermatophytes were cultured from scalp samples, the main aetiologic agent being T. tonsurans.
Assuntos
Tinha do Couro Cabeludo/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Países Baixos/epidemiologia , Prevalência , Instituições Acadêmicas/estatística & dados numéricos , Tinha do Couro Cabeludo/etiologia , Trichophyton/isolamento & purificaçãoRESUMO
OBJECTIVE: To determine the incidence of patients reported with typhoid fever in Amsterdam (1991-2000) and to evaluate the contact tracing for those patients with the specific objective of examining whether contact tracing can be simplified. DESIGN: Retrospective. METHOD: From an automated database, data were collected on all reported typhoid fever patients in Amsterdam during the period 1991-2000 and on their contact persons. RESULTS: One hundred and one patients with typhoid fever were reported during the study period, and Salmonella typhi infection was diagnosed in 12 of the 281 household contacts. For 96 of the 101 index patients, travelling abroad was the most likely source of infection. In 8 of the 12 contact persons with an S. typhi infection, the index person was the most likely source of infection, which is equivalent to a secondary transmission rate of 2.8% (8/277). Seven of the 8 secondary infected persons had symptoms indicative of typhoid fever infection and S. typhi was found in all their first stool samples. CONCLUSION: Supported by these results, the national guidelines for source and contact tracing in the case of typhoid fever have been amended. In the case of index patients with bad toilet hygiene or who are responsible for food preparation, the faeces of all household contacts must be examined once. If the contact persons have symptoms indicative of an S. typhi infection and/or if their work involves food preparation, their faeces should also be tested once. The changes to the national protocol will markedly reduce the labour-intensity of tracing and testing the contacts of patients with typhoid fever, thereby maintaining the quality of the process. Tracing the source of infection in the case of patients with typhoid fever will also remain important in the future in order to detect potential transmission within the Netherlands at an early stage.
Assuntos
Busca de Comunicante , Febre Tifoide/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Transmissão de Doença Infecciosa , Fezes/microbiologia , Feminino , Microbiologia de Alimentos , Humanos , Incidência , Masculino , Países Baixos/epidemiologia , Estudos Retrospectivos , Salmonella typhi/patogenicidade , Viagem , Febre Tifoide/transmissãoRESUMO
OBJECTIVE: To determine the incidence of reported shigellosis in Amsterdam (1991-1998) and the factors related to the secondary attack rate of shigellosis. DESIGN: Retrospective. METHODS: From an automated data bank data were collected on all registered shigellosis patients in Amsterdam in the period 1991-1998, and their contacts found by contact tracing. RESULTS: 567 Patients with shigellosis had been reported and a Shigella infection has been diagnosed in 96 of the 983 contacts. The annual incidence decreased statistically significantly from 13 to 8/100.000. 329 males and 334 females were infected. The highest number of cases was found in children from 0-4 years and among adults from 20-34 years. Of the 663 patients 106 (16%) required hospitalization; for children under 7 this proportion was 30% (32/108). Among the contacts (excluding the 14 contacts with the same foreign source and the same first sickness day as the index patient) the secondary attack rate was 8%. Young age, of both the patient and the contact was independently related to a higher secondary attack rate. CONCLUSION: With contact tracing for shigellosis a large number of secondary infections were found. Given the high infection rate and large number of hospitalisations among children, contact tracing should focus at this young age group.
Assuntos
Busca de Comunicante/estatística & dados numéricos , Transmissão de Doença Infecciosa/estatística & dados numéricos , Disenteria Bacilar/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Pré-Escolar , Busca de Comunicante/métodos , Disenteria Bacilar/prevenção & controle , Disenteria Bacilar/transmissão , Feminino , Hospitalização/tendências , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Sorotipagem , Shigella/isolamento & purificaçãoRESUMO
The results of the serological syphilis screening programme for pregnant women in the region of Amsterdam in the period 1985-1989 are described. In addition, a cost-benefit analysis was done to determine useful effects of the programme. Every GP and obstetrician routinely takes blood samples from pregnant women to determine the blood group, rhesus factor and syphilis serology. In the period 1985-1989, a total of 37,520 serum samples were screened for syphilis in the Amsterdam region by the Central Laboratory of the Blood Transfusion Service (until mid-1986) and by the Regional Public Health Laboratory of the Municipal Health Service (from mid-1986). In 55 women (0.15%) both the Treponema pallidum haemagglutination assay (TPHA) and the venereal disease research laboratory (VDRL) tests were positive. Further evaluation of these 55 women ultimately brought to light 10 women with positive syphilis serology who had not been treated and consequently might infect their child with Treponema pallidum. Considering the various transmission percentages of the bacterium from mother to foetus, which depend on the stage of the maternal infection, the screening programme has prevented two cases of congenital syphilis. This brings the cost-benefit ratio of the syphilis screening programme for the region of Amsterdam to 1:6.2. In view of these findings there is no reason to reconsider the current screening practice in Amsterdam.
Assuntos
Programas de Rastreamento , Complicações Infecciosas na Gravidez/epidemiologia , Sorodiagnóstico da Sífilis , Sífilis/epidemiologia , Adulto , Análise Custo-Benefício , Feminino , Humanos , Recém-Nascido , Programas de Rastreamento/economia , Países Baixos/epidemiologia , Gravidez , Sífilis/diagnóstico , Sífilis Congênita/prevenção & controleRESUMO
OBJECTIVE: To report the incidence of gonorrhoea and the development of resistance to Neisseria gonorrhoeae among attendees at the Municipal Health Service's STD-clinic in Amsterdam, The Netherlands, 2000-2003. DESIGN: Descriptive. METHOD: Urethral or cervical swabs for culture for N. gonorrhoea were taken from attendees at the STD-clinic. Depending on reported sexual techniques throat and rectal swabs were also taken. The disk diffusion technique in combination with a beta-lactamase test were used for sensitivity testing. RESULTS. The number of Neisseria gonorrhoeae (NG) isolates collected at the Amsterdam Municipal Health Service's STD-clinic decreased from 1047 in 2002 to 772 in 2003. The number of fluoroquinolone-resistant NG (FRNG) isolates rose from 3 in 2000 to 56 in 2003 (p < 0.001). FRNG isolates amongst men who have sex with men increased from 1 in 568 isolates (0.2%) in 2000 to 50 in 478 isolates (10.5%) in 2003 (p < 0.001). Amongst heterosexual men, FRNG rose from 2 per 275 (0.7%) in 2000 to 16 per 297 (5.4%) in 2002 and dropped to 6 per 190 (3.4%) in 2003 (p = 0.146). No FRNG isolates were found in women in 2003 (2000: 0/180 (0.0%); 2001: 2/160 (1.3%); 2002: 4/183 (2.2%). CONCLUSION: The recent incidence of FRNG among men who have sex with men to over 5% makes ciprofloxacin and other fluoroquinolones obsolete as the first-choice treatment option for uncomplicated gonorrhoea if no antibiogram is available. It is advised to use cefotaxim when an antibiogram is not available (yet).
Assuntos
Antibacterianos/uso terapêutico , Cefotaxima/uso terapêutico , Fluoroquinolonas/farmacologia , Gonorreia/tratamento farmacológico , Neisseria gonorrhoeae/efeitos dos fármacos , Antibacterianos/farmacologia , Farmacorresistência Bacteriana , Feminino , Gonorreia/epidemiologia , Gonorreia/microbiologia , Homossexualidade Masculina , Humanos , Masculino , Testes de Sensibilidade Microbiana , Países Baixos/epidemiologia , Fatores de Risco , Comportamento SexualRESUMO
Five antimicrobial agents, ciprofloxacin, ticarcillin, piperacillin, aztreonam and gentamicin, were compared both in vitro (MIC's, time-kill studies) and in vivo, in the treatment of experimental Proteus mirabilis pyelonephritis in mice. In the treatment of the pyelonephritis, ciprofloxacin was clearly superior to the other agents, both with respect to the percentage of sterile kidneys after treatment as with respect to the mean numbers of bacteria per kidney. The results can only be partially explained by the in vitro activities of the different antibiotics.
Assuntos
Antibacterianos/uso terapêutico , Infecções por Proteus/tratamento farmacológico , Pielonefrite/tratamento farmacológico , Animais , Ciprofloxacina/uso terapêutico , Masculino , Camundongos , Testes de Sensibilidade Microbiana , Proteus mirabilis/efeitos dos fármacosRESUMO
Vero cell invasiveness was studied for a group of Proteus mirabilis strains isolated from the urinary tract and feces and for a limited group of urinary isolates of Escherichia coli. Experimental conditions affecting this invasiveness were studied. All of the P. mirabilis strains tested were capable of cell invasion, whereas none of the E. coli strains was. Correlation between the hemolytic activity of the P. mirabilis strains and their invasive ability suggested that the bacterial hemolysin may be involved in the invasion process. Other experimental evidence supporting this hypothesis is discussed. The differences in the invasive capacities of P. mirabilis and of E. coli may be important for the apparent differences in the pathogenesis of urinary tract infection by both species.
Assuntos
Infecções por Proteus/complicações , Infecções Urinárias/etiologia , Animais , Linhagem Celular , Chlorocebus aethiops , Proteínas Hemolisinas/fisiologia , Concentração de Íons de Hidrogênio , Infecções por Proteus/microbiologia , Proteus mirabilis/efeitos dos fármacos , Proteus mirabilis/crescimento & desenvolvimento , Proteus mirabilis/patogenicidade , Fatores de Tempo , Ureia/farmacologia , Infecções Urinárias/microbiologia , VirulênciaRESUMO
Young broth cultures of all P. mirabilis strains tested exhibited haemolytic activity. This activity seemed to be strongly cell-associated as only a very small fraction of this activity was found in the cell-free supernatant. The haemolysin was only produced by actively growing cells. Inhibition studies with trypsin and chloramphenicol suggested that the haemolysin is of protein nature. Lecithin and serum of several species had an inhibitory effect on the haemolysin. Besides erythrocytes of various species also VERO cells were affected by the haemolysin. A correlation was found between the haemolytic activity of a strain and its virulence in an experimental mouse model.
Assuntos
Proteínas Hemolisinas/biossíntese , Proteus mirabilis/metabolismo , 2,4-Dinitrofenol , Animais , Sangue , Linhagem Celular , Sobrevivência Celular , Cloranfenicol/farmacologia , Chlorocebus aethiops , Dinitrofenóis/farmacologia , Proteínas Hemolisinas/fisiologia , Hemólise/efeitos dos fármacos , Camundongos , Fosfatidilcolinas/farmacologia , Proteus mirabilis/patogenicidade , Especificidade da Espécie , Tripsina/farmacologia , VirulênciaRESUMO
OBJECTIVE: To determine the agreement of culture results of Candida albicans and Trichomonas vaginalis from the cervix versus posterior fornix in women with vaginal symptoms. DESIGN: Same patient comparison of culture results from two sample sites. SETTING: Twenty one general practices in Amsterdam and the east of the Netherlands. SUBJECTS: Six hundred and eighty two women aged 15 to 55 years with vaginal symptoms, seen between 1 October 1987 and 31 May 1990. MAIN OUTCOME MEASURES: For each site (cervix and posterior fornix) the proportion of detected C albicans and T vaginalis. The sensitivity of the cervical swab related to the vaginal one. The percentage of concordance for both microorganisms. RESULTS: In 248 (34%) women C albicans was diagnosed and in 38 (6%) T vaginalis. In 99% of the proven C albicans cases, the yeast was found in the vagina. In 94% C albicans was isolated from the cervix. Sensitivity of the cervical swab was 94%. In 98% of the patients a concordant observation was made regarding detection of yeast. In 97% of the proven T vaginalis cases the protozoon was found in the vagina. In 91% T vaginalis was detected from the cervical swab. Sensitivity of the cervical swab was 92%. The culture results were concordant in 99%. CONCLUSION: The yield from the vaginal source was slightly better than that from the cervix for culture of both microorganisms. For screening purposes, specimen-collection for culture of N gonorrhoeae, C albicans and T vaginalis can be combined in one swab taken from the cervix.