Two cases of severe sepsis due to Vibrio vulnificus wound infection acquired in the Baltic Sea.

Two severe cases of Vibrio vulnificus wound infection with secondary septicemia occurred during 1 week in August 2003 on the German island of Usedom in the southwestern Baltic Sea. In both cases, pre-existing wounds were inoculated by wading in contaminated sea water. One of the patients died from septic multiorgan failure. To the best of our knowledge, this is the first fatality due to a V. vulnificus infection to have occurred in Germany. Microbiological analysis revealed high concentrations of V. vulnificus in sea water along the coastline, following a period when water temperature exceeded 20 degrees C for more than 2 weeks.

Transmission of a multiresistant Pseudomonas aeruginosa strain at a German University Hospital.

Over 15 months, 60 patients at a German University Hospital became infected or colonized by a multiresistant Pseudomonas aeruginosa strain, which was isolated from tracheal secretions, blood, urine, venous catheters, ascites and several wounds. Most patients had undergone invasive treatment (surgery, cancer therapy). The genetic relationship of the isolates was investigated by pulsed field gel electrophoresis. The isolates were resistant to beta-lactam antibiotics, including carbapenems and aztreonam, to aminoglycosides and quinolones. The only in vitro susceptibility was to polymyxin B. Extensive sampling was carried out to identify contaminated medical devices, surfaces or media (water, food). Samples were taken from doctors and nursing staff and various treatment procedures were observed for several weeks. The handling of respirators, resuscitation tubes, urine bottles, and bedpans resulted in the contamination of the patients' environment, although most devices were cleaned and disinfected with automatic washer/disinfectors. Several wash basins on the intensive care unit were contaminated, but none of the drinking water samples showed any growth of P. aeruginosa. We recommend the strict use of gloves and strict application of alcoholic hand disinfectants immediately after discarding the gloves. The chain of infection ceased after strict cohort isolation and the subsequent introduction of the specific hygiene regime.

Characterization of epidemic and nonepidemic methicillin-resistant Staphylococcus aureus strains in a university hospital in northeast Germany.

The aim of this study was to analyze methicillin-resistant Staphylococcus aureus strains isolated during a 1-year period by means of pulsed-field gel electrophoresis, resistance phenotyping and determination of biochemical features. Eight different resistance phenotypes with the predominant resistance type Pen Oxa Cip (penicillin, oxacillin, ciprofloxacin) were observed. None of the strains tested exhibited decreased susceptibility to vancomycin, but two strains were resistant to mupirocin. Genetic relatedness of methicillin-resistant Staphylococcus aureus isolates could be shown for two outbreaks, one of which was caused by a clone with an epidemic potential concerning duration of colonization/infection of patients and dissemination of the strains in the hospital.

A large outbreak of multiresistant Pseudomonas aeruginosa strains in north-eastern Germany.

Multiply-resistant Pseudomonas aeruginosa were first detected in north-eastern Germany at the end of 1996; since then they have been isolated predominantly from patients in intensive care units. Colonization/infection, especially of the respiratory tract, has been demonstrated in 80 patients, with strains resistant to beta-lactams, carbapenems, aminoglycosides and quinolones. Amikacin showed in-vitro synergy with cefepime, ceftazidime or piperacillin/tazobactam. Horizontal transfer of strains was followed by PFGE and identical strains were detected in the environment, but the source of infection was not established. Rigorous infection control and restricted clinical use of carbapenems limited further dissemination of this outbreak.

The diagnostic importance of eosinophil granulocytes in the CSF of children with ventricular-peritoneal shunt systems.

We investigated the occurrence of cerebrospinal fluid (CSF) eosinophilia in patients with ventriculo-abdominal shunt systems with regard to possible infection. For this purpose, we examined the CSF of 83 children at the time of shunt obstruction or malfunction. In 32 children (38.6%) we found more than 4% of eosinophil granulocytes in the CSF with a maximum of 76%. In 15 of these 32 children the CSF was sterile, whereas in 17 patients bacterial infection was present. In the CSF of 16 of those 17 children, Staph. epidermidis was cultivated. There was statistically significant correlation between positive Staph. epidermidis culture and the occurrence of CSF eosinophilia (P<0.05). The occurrence of CSF eosinophilia in patients with ventriculo-peritoneal shunts is well known and was mostly attributed to an allergic reaction. Our findings support the theory of an infectious etiology of the eosinophilia and are thus in line with new American and French studies. We believe that CSF eosinophilia indicates a persistent infection of the central nervous system by the contaminated shunt system. As the organism which is the most common cause we cultured Staph. epidermidis.

[Antibiotic sensitivity of important pathogens of bacterial respiratory tract infections in Northeast Germany]. / Antibiotikaempfindlichkeit wichtiger Erreger bakterieller Atemwegsinfektionen im Nordosten Deutschlands.

BACKGROUND: There is still a lack of comprehensive study results about resistance of bacterial respiratory pathogens from the east of the Federal Republic of Germany. METHODS: In Greifswald we isolated in 1995 and 1996 320 strains of typical pathogens and tested their susceptibility to 14 antibiotics, using the microbouillon dilution method. RESULTS: Pneumococci and beta-haemolytic streptococci were completely susceptible to penicillin and all other beta-lactam-antibiotics, clindamycin and vancomycin. 4.8% of pneumococci and 10.0% of Streptococcus pyogenes isolates were resistant to erythromycin. This should lead to a more differentiated use of macrolides as concerns these pathogens, especially as penicillin still has high efficacy in these cases. Pneumococci had resistance rates of 4.8%, 9.5% and 6.7% to cotrimoxazole, tetracycline and ofloxacin, respectively. No strain of Haemophilus influenzae produced a beta-lactamase, 2.6% of strains were relatively resistant to ampicillin, even in combination with sulbactam. Cefaclor, erythromycin and tetracycline had restricted efficacy of 16.7%, 14.1% and 53.8%, respectively. Cefuroxime, cefixime, cefepime, imipenem and ofloxacin all had complete efficacy. 77.8% of Moraxella catarrhalis isolates were beta-lactamase positive. Strains were susceptible to erythromycin, ofloxacin and all tested beta-lactam-antibiotics except ampicillin and cefaclor. There was a relative resistance to clindamycin and tetracyclin of 22.2% and 2.2%, respectively. DISCUSSION: We present our results in national and international comparison, describe tendencies of resistance, give reasons for the low incidence of penicillin resistance in pneumococci in Germany and draw conclusions for empirical chemotherapy.

[Selective gut decontamination in ventilated intensive therapy patients]. / Selektive Darmdekontamination bei beatmeten Intensivtherapiepatienten.

Treatment of long-term artificially ventilated patients is often complicated by nosocomial infections. The infection that occurs with the highest frequency during intensive care treatment is pneumonia (22-63%). Ninety per cent of nosocomial infections of intensive care patients are endogenous infections caused by mainly gram-negative aerobic microorganisms that have colonized in the gastrointestinal tract. Selective decontamination of the intestine provides a method that prevents nosocomial infections. In a prospective study 13 patients whose oropharynx and gastrointestinal tract had been decontaminated (SDD) were compared to 17 patients in a control group. In a third group twelve patients were decontaminated in the gastrointestinal tract (SGD) only, and in a fourth group 16 patients were decontaminated in the oropharynx (SMD) only. Trachea, oropharynx and faeces of the patients belonging to the control group (KG) were colonized to almost 100% with gram-negative bacteria. Only 10% of the patients of the SDD and SMD groups showed gram-negative bacteria located in the trachea and oropharynx after one week of decontamination. No gram-negative aerobic bacteria were present after seven days in the faeces of the patients of the SDD and SGD groups. There was no difference with regard to the trachea and oropharynx between the control group and the SGD group. The gram-negative aerobic intestinal flora was not affected by the selective mouth decontamination. The average rate of pneumonia occurrence within the 15-day observation period was 28.2% for the control group, 14% for the SGD group, and 9.6% for the SDD group, and 4.1% for the SMD group. Decontamination of the oropharynx of patients is essential in order to successfully prevent pneumonia.(ABSTRACT TRUNCATED AT 250 WORDS)

Further studies on cold adapted variants of human influenza virus A/Krasnodar/101/59 (H2N2) with special reference to genetic stability of attenuation markers.

A previously described cold adapted (ca) attenuated virus, K/25, derived from parent strain A/Krasnodar/101/59 (H2N2), was further modified by 35 additional passages in chick embryos at suboptimal temperature. The virus obtained had retained a distinct ts and ca phenotype and some other markers of attenuation but differed from formerly isolated ca variants by its higher genetic stability connected with an increased growth capacity in chick embryos.

Ts mutations in the genome of cold-adapted variants of human influenza virus A/Krasnodar/101/59 (H2N2) at different passage levels and their reproduction in lungs of hamsters.

Human influenza virus A/Krasnodar/101/59 (H2N2) was passaged in chick fibroblast cultures in the presence of trypsin at suboptimal temperature. The virus which underwent 16 passages at 28 degrees C possessed cold-adapted (ca) and temperature sensitive (ts) phenotypes and formed larger plaques at the optimal temperature (33 degrees C). Its reproduction in the lungs of hamsters was decreased as evidenced by approximately 2.5 log10 lower titres; only one of 9 virus isolates from the lungs of hamsters acquired the ts +/- phenotype, although it had retained a ca phenotype. Recombination of this variant with ts mutants of fowl plague virus (FPV) revealed a ts mutation only in gene 4 of this variant coding for haemagglutinin (HA). The virus which had had 25 passages at 28 degrees C possessed the same properties as the previous variant, but all eight virus isolates from the lungs of hamsters retained the ts phenotype; the genome of this variant contained ts mutations in genes 1, 3, 4, 5 and 6. The mutation found in gene 8 was not a ts mutation. The virus, which underwent 25 passages at 28 degrees C and additional 15 passages at 27 degrees C, formed large plaques and alike to the previous variants it possessed the ca and ts phenotypes; however, its reproduction in the lungs of hamsters was decreased by 4.0 log10 and occurred in the lungs only of 4 out 16 infected animals. This variant contained ts mutations in genes 1, 3, 4, 5, 6 and 7 and a non-ts mutation in gene 8.

[On the antimicrobial activity of benzalkonium chloride in potential contact lens fluids]. / Zur antimikrobiellen Wirksamkeit von Benzalkoniumchlorid in potentiellen Kontaktlinsenflüssigkeiten.

To assess the suitability of benzalkonium chloride as a preserving agent for potential contact lens fluids, the authors tested its antimicrobial efficiency at various pH values, in the presence of viscosity modifiers (hydroxyethylcellulose, polyvinylpyrrolidone, polyacrylamide) and also in combination with other preserving agents. The diffusion test and the suspension test were used as test methods. The efficiency of benzalkonium chloride depends upon the pH value of the solution and upon the concentrations of the viscosity modifiers. No better results were achieved by combination with phenylethanol and chlorobutanol. Formulations for potential contact lens fluids were indicated, the appropiateness of which is viewed in microbiological perspective.

[Chronic osteomylitis in the standard animal model on the tibia head of rabbits]. / Die chronische Osteomyelitis im standardisierten Tiermodell am Tibiakopf des Kaninchens.

The making of a standardized model of a chronic osteomyelitis is represented. The standardized cavity in the tibia head of 7 x 12 x 5 mm is attainable by trepanation. A plastic body was inserted in the cavity. The cavity was inoculated with staphylococcus aureus after 4 weeks. The model is suitable for the assessment of different therapy methods and for the clarification of other questions, because of the control possibility of healing by exact methods.

[Simultaneous diagnostic studies of bacteriuria as related to method of urine collection]. / Simultanuntersuchungen zur bakteriologischen Urindiagnostik in Abhängigkeit von der Art der Harngewinnung.

In a direct comparative series were compared 204 functional, catheter, and mid-stream urines which were got simultaneously in patients with chronic pyelonephritis. In suprapubic vesical puncture 113 had a sterile urine, 91 showed a bacteriuria. After catheterisation 103 specimens were still sterile and 101 were bacterially infected. Of the mid-stream urines only 90 proved sterile, and 114 times pathogenic agents could be proved. While in males mid-stream urines achieved good results, in females a contamination was pretty frequent. Repeated investigations, estimation of the number of germs, and optimum taking essentially improve evidence. Though in females by means of catheterisation better bacteriological results may be achieved, in rare cases there is the danger of the invasion of germs. A clear judgment is possible, using the suprapubic vesical puncture.

[Demonstration of IgM antibodies in influenza virus infections]. / Nachweis von IgM-Antikörpern bei Influenzavirusinfektionen.

Forty-Four sera of patients with confirmed influenza-A infection were titrated in parallel with and without 2-mercaptoethanic treatment against influenza-A by means of passive haemagglutination. Reduction of titre by at least two levels was detectable in 21 cases. Gradient centrifugation was additionally undertaken of 23 patient sera and three serum samples obtained from intact probands who had produced a titre against influenza-A in passive haemagglutination. Antibody against influenza-A was present in both the IgM and IgG fractions of the patients' serum samples. Yet, in the three control sera of intact probands antibody against influenza-A was recordable only from the IgG fraction. IgM antibody could not be detected by 2-mercaptoethanoic treatment alone unless the 7s-antibody portion in a given serum sample was smaller than the 19s-antibody portion.