A South African national database in cardiothoracic surgery.

This article aims to update South African cardiothoracic surgeons on the developmental progress of the national database in cardiac and thoracic surgery and to encourage participation in this most important endeavour.

[Early neonatal bacterial infections: could superficial bacteriologic samples at birth be limited?]. / Infections bactériennes néonatales précoces en maternité: peut-on limiter les prélèvements bactériologiques périphériques en salle de naissance ?

INTRODUCTION: Without promptly started antibiotic therapy, early neonatal bacterial infections incur a significant mortality. Superficial bacteriologic samples at birth have in France a real place for the diagnosis and the decision to treat a neonate. OBJECTIVES: In order to limit their indication and their choice, the aim of this article was to describe the proportion of neonates with samples and to determine the diagnostic value of the gastric aspirate, the ear swab and the placental sample. METHODS: Neonates born in the CHRU of Lille in 2005 and staying in the maternity ward were prospectively included. Criteria for samples, type of samples and diagnosis taken were noted. Sensibility, specificity, positive and negative predictive values and likelihood ratios for a positive test and a negative test were calculated. RESULTS AND CONCLUSION: This study included 3918 neonates; 1.7% (65 children) were infected according to our criteria; 42.3% received bacteriologic samples. In accordance with the Anaes guidelines (2002), if mothers were Group B Streptococci positive and received intrapartum antibiotics (up to 2 injections) or did not have any screening test without any other indication of samples, the neonate did not have to receive bacteriologic samples. The gastric aspirate was the best exam thanks to the excellent negative predictive value of its direct examination: 99.4% (IC 95%: 98.8-99.7), its high likelihood ratio for a positive test: 10.04 (IC 95%: 8.29-12.15) and its low likelihood ratio for a negative test: 0.16 (IC 95%: 0.09-0.29); this sample could restrict the antibiotics' ratio given to the neonate. Placental sample could be taken only in certain indications.

Comparison of eight methods to detect vancomycin resistance in enterococci.

A collection of genetically unrelated vancomycin-resistant enterococci (VRE) including 50 vanA, 15 vanB, 50 vanC1, and 30 vanC2 VRE were used to evaluate the accuracy of eight currently available susceptibility test methods (agar dilution, disk diffusion, E-test, agar screen plate, Vitek GPS-TA and GPS-101, and MicroScan overnight and rapid panels). vanA VRE were detected by all methods. vanB VRE were often not detected by Vitek GPS-TA and MicroScan rapid (sensitivities, 47 and 53%, respectively), though the new Vitek GPS-101 was found to be a significant improvement. E-test and the agar screen were the only two methods detecting all VRE, including the vanC1/C2 VRE.

Diagnostic problems with imported cases of mycetoma in The Netherlands.

Eight cases of imported mycetomata in The Netherlands are reviewed. Seven of these were cultured; only one isolate, Actinomadura madurae, belonged to a species commonly known as an agent of mycetoma. The remaining strains either belonged to very rare species, such as Phialophora cyanescens, or could not be identified at all. The list of possible agents of mycetoma apparently needs to be expanded. In addition, the concept of endemic occurrence of aetiological agents of eumycetoma needs revision. Divergent saprophytes may be involved which are able to survive in human tissue.

Mycobacterium marinum infection of the hand involving deep structures.

Five patients with Mycobacterium marinum infection of the hand involving deep structures were seen recently. Four of them were fishermen. Hydrocortisone injection or simple incision and drainage led to worsening of the infection. The clinical presentation, operative finding, and histopathologic and microbiologic features were quite similar in all five patients. Extensive debridement and therapy with ethambutol and rifampin led to satisfactory results in four patients while biopsy and therapy in the fifth patient seemed to offer another form of acceptable treatment.

Mycobacterial infection of the hand: clinical features and functional results.

The clinical and laboratory features of twenty-eight patients with mycobacterial infection of hand are presented and discussed. Hand function assessment in fourteen patients showed that the majority had satisfactory results. The possibility of atypical mycobacterial infection is emphasised.

A longitudinal study of antibody titres to Antigen 6 in patients with bone and joint tuberculosis.

Thirteen patients with active bone and joint tuberculosis were investigated to determine their antibody response to Antigen 6 of Mycobacterium tuberculosis during and after treatment. The antibody titre was found to be most helpful in diagnosis and in assessing the activity of the disease after treatment was completed. There is great individual variation of the antibody level, so the use of this serological test for monitoring the response to treatment requires further investigation in a larger group of patients.

Hemorrhagic tendency as a complication of Moxalactam therapy in bacterial meningitis.

Moxalactam penetrates cerebral spinal fluid (CSF) and subdural fluid well enough to be a promising antimicrobial for enteric bacterial meningitis in neonates and infants. Clinical trials in adults and children have found few adverse effects. Prolongation of prothrombin time (PT) and partial thromboplastin time (PTT) with or without bleeding was reported in adults. This paper reports this complication in two infants occurring at a time of clinical improvement following addition of Moxalactam to other antibiotics to which the meningitis had failed to respond. It is not certain if this complication was related to the underlying meningitis, the use of Moxalactam together with other antibiotics, or a combination of many factors. Further observation, close hemostatic monitoring, and timely vitamin K administration during its use are warranted.

Caseating regional lymphadenitis complicating BCG vaccination: a report of 6 cases.

Six infants had caseating regional lymphadenitis complicating BCG vaccination. There was a delayed onset and a lack of immediate vaccination complications. Three infants had frank abscesses. Additional affected nodes undetected clinically were found at operation in all cases. All lymph nodes contained tubercles, 3 showing acid-fast bacilli, 2 of which grew Mycobacterium bovis. Complete excision followed by antiuberculous chemotherapy produced satisfactory results.

Serologic diagnosis of bone and joint tuberculosis by an enzyme-linked immunosorbent assay.

Sera from patients receiving treatment for active bone and joint tuberculosis and sera from patients with inactive bone and joint tuberculosis were examined by an enzyme-linked immunosorbent assay for antibody to antigen 6, a homogeneous protein prepared from Mycobacterium tuberculosis strain H37Ra by immunosorbent affinity chromatography. Sera from 21 control subjects had a geometric mean titer of 1:6 with no difference between tuberculin purified protein derivative-positive and -negative patients. Sera from 20 patients with inactive disease had a geometric mean titer of 1:19. Fifteen patients receiving treatment for M. tuberculosis infection had a geometric mean titer of 1:179, which is significantly different from the geometric mean titers of both of the patients with inactive tuberculosis (P less than 0.001) and the control subjects (P less than 0.001). At a cut-off titer of 1:32, the sensitivity of the assay is 94% and the specificity for the control subjects and patients with inactive disease was 100%.