Multicenter evaluation of the Cepheid Xpert methicillin-resistant Staphylococcus aureus (MRSA) test as a rapid screening method for detection of MRSA in nares.

The first U.S. multicenter clinical trial to assess the performance of the Cepheid Xpert MRSA assay (Xpert MRSA) was conducted. The assay is a qualitative test designed for the rapid detection of methicillin-resistant Staphylococcus aureus (MRSA) directly from nares swabs. This novel test combines integrated nucleic acid extraction and automated real-time PCR for the detection of a MRSA-specific signature sequence. A total of 1,077 nares specimens were collected from seven geographically distinct health care sites across the United States with prevalence rates ranging from 5.2% to 44%. Nares specimens were tested by (i) the Xpert MRSA assay, (ii) direct culture on CHROMagar MRSA medium (direct CM culture), and (iii) broth-enriched culture (Trypticase soy broth with 6.5% sodium chloride) followed by plating onto CHROMagar MRSA medium (broth-enriched CM culture). When direct CM culture was designated the reference method, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the Xpert MRSA assay were 94.3%, 93.2%, 73.0%, and 98.8%, respectively. When broth-enriched CM culture was used as the reference method, the clinical sensitivity, specificity, PPV, and NPV of the Xpert MRSA assay were 86.3%, 94.9%, 80.5%, and 96.6%, respectively. The BD GeneOhm MRSA (BDGO) assay was performed as a comparative molecular method. No statistical performance differences were observed between the Xpert MRSA and BDGO assays when they were compared to culture methods. From this large-scale, multicenter clinical comparison, we conclude that the Xpert MRSA assay is a simple, rapid, and accurate method for performing active surveillance for MRSA in a variety of health care populations.

Phaeohyphomycosis of the paranasal sinuses masquerading as a neoplasm: a case report.

A case of fungal infection of the paranasal sinuses simulating a neoplasm is reported. Fonsecaea pedrosoi, a dematiacious fungus, which has not been previously reported, was responsible for this unusual infection. Fungal infection may mimic malignant lesions of the paranasal sinuses; however, coexisting malignancy must be ruled out.

Complications following surgery for cancer of the larynx and pyriform fossa.

The hospital records of patients undergoing major surgery for cancer of the larynx and hypopharynx at the Tata Memorial Hospital, Bombay, from 1981 to 1985 were reviewed. Different variables were correlated with the incidence of major complications and were analysed to find out significant factors contributing to increased complication rates. Complications included wound infection, pharyngocutaneous fistulae, flap necrosis, carotid blowout, and neo-esophageal stenosis. Postoperative deaths and delayed fatalities were also recorded. The overall fistulae rate was 34.7%, and wound infection occurred in 28% of patients. Prior radiotherapy and the need for pharyngeal reconstruction were found to be significant in determining postsurgical complications. Age, sex, site, stage, cartilage and soft tissue infiltration, preoperative tracheostomy, involvement of resection margins by tumor, and the dose of radiotherapy were not found to influence the complication rates.

Mortality and morbidity of primary pharyngogastric anastomosis following circumferential excision for hypopharyngeal malignancies.

Seventy-five patients underwent gastric transposition for replacement of the pharyngoesophagus. These patients had primary or recurrent malignant tumors of the hypopharynx, postcricoid region, and cervical esophagus. The operative procedure consisted of a transhiatal esophagectomy and gastric pull-up to establish gastrointestinal continuity, with a unilateral or bilateral neck dissection where indicated. Seven patients died, a mortality rate of 9.33%. The average hospital stay of uncomplicated cases was 18 days and for complicated cases was 40 days. Immediate restoration of oral intake was achieved in 70.6% of patients. We conclude that gastric transposition after circumferential laryngopharyngeal excision is a procedure with low mortality and acceptable morbidity leading to early relief of dysphagia.