[Can ingestion of cranberry juice reduce the incidence of urinary tract infections in a department of geriatric medicine?]. / Reducerer brug af tranebaersaft hyppigheden af urinvejsinfektioner i en geriatrisk afdeling?

INTRODUCTION: The incidence of urinary tract infections was compared in two geriatric units, where patients were offered cranberry juice and the usual mixed berry juice, respectively. METHODS: In all cases where urinary tract infection was suspected, the doctors noted symptoms and signs used as indication for urinary culture. The urine collected from men was the usual mid-flow specimen, whereas the specimens from women were taken from a bedpan and by catheter. End points were the prevalence of symptoms leading to urine culture, specimens with significant growth of bacteria, and the use of antibiotics. RESULTS: Urine specimens were cultured in 140/338 cases. The reason for culture in 23% was general symptoms and in 62% urinary tract symptoms. A significant growth of bacteria was found in 54% and this information led to antibiotic treatment in 44%. In all cases (n = 55) where bedpan and catheter specimens were taken, the results were identical. CONCLUSION: Cranberry juice in a geriatric department, where the mean stay was 4 weeks, did not influence the incidence of urinary tract infections.

Direct or referral microscopy of vaginal wet smear for bacterial vaginosis: experience from an STD clinic.

A new wet smear diagnostic criterion for bacterial vaginosis was applied to 124 consecutive female patients attending an STD clinic located in the centre of Copenhagen. Bacterial vaginosis was detected in 54 (44%) women, making bacterial vaginosis the most prevalent pathological condition encountered. A total of 47 (87%) of the women were symptomatic. Concomitant genital infections were found in 13 (24%) of these women, most often as vulvo-vaginal candidiasis. A correct microscopic diagnosis could also be obtained by sending the vaginal smear to the local microbiologist for rehydration and phase contrast microscopy. It is suggested that the previously described vaginal wet smear criteria are used in place of Amsel's criteria for routine diagnosis of bacterial vaginosis.

Molecular cloning and expression of a novel Staphylococcus aureus antigen.

A novel gene encoding an antigen from Staphylococcus aureus was isolated from an expression library by screening with antisera from patients with deep Staphylococcus aureus infections. In one positive clone an open reading frame, named ORF-2, was identified. Recombinant ORF-2 protein reacted with human immune serum. ORF-2 was shown to be present in other Staphylococcus aureus strains, but not in related species.

Antimicrobial susceptibility of 278 streptococcal blood isolates to seven antimicrobial agents.

A total of 278 streptococci isolated from blood (including 66 strains of Streptococcus pneumoniae) were tested for their MIC to penicillin G, gentamicin, rifampicin, clindamycin, erythromycin, vancomycin and teicoplanin to determine the current state of resistance among streptococci isolated from blood at a University Hospital in Copenhagen, Denmark, and thereby to assess alternative treatment for patients who are infected with a penicillin-resistant streptococcal strain or allergic to penicillin. Danish Blood Sensitivity Agar and the Etest were used. Overall, resistance to penicillin among Streptococcus mitis strains was 44.4% (37% intermediately susceptible and 7.4% resistant). As penicillin resistance in S. mitis may be an early indication of emerging penicillin resistance among other streptococcal species, this finding is a matter of concern. Except for this observation, penicillin remains the best and a safe choice for treatment of streptococcal infection. For alternative treatment when the patient is allergic to penicillin and for prophylaxis, the usual recommendation is macrolide antibiotics or clindamycin. The majority of non-enterococcal groups of streptococci remain sensitive to erthromycin and clindamycin, but the antibiotic susceptibility pattern is unpredictable without testing the isolates, so empirical therapy or prophylaxis may fail.

Experimental implant-related osteomyelitis induced withStaphylococcus aureus.

Experimental knee-implant infection was induced in the rabbit knee with a strain (1369,phage type 85,a laboratory strain) of Staphyloccus aureus. The experimental model was adapted from an experimental study in rabbits by Gudmund Blomgren, 1981. In these experiment's osteomyelitis was induced with an noculum of 100,000 bacteria in the tibia and femur. In one series we used gentamicin impregnated bone cement and in the other series dicloxacillin was given intravenously. The controlgroup, four rabbits had no supplemental antibiotics. The animals were monitored by clinical observation, microbiological, histological and antibody methods. Only in the controlgroup without supplemental antibiotics we would see manifest inflammation around the prosthesis with increased antibody titre. With supplemental antibiotics no bacteria was found around the prosthesis.The gentamicin concentration was measured in bone from femur, tibia and from the jointfluid. A high level of gentamicin was found in the bone but not in the joint fluid. The animal model was excellent to create a model for human total joint replacement to study the dissemination of localy and intravenously injected bacteria to the artificial joint. The use of either systemic or locally administered antibiotics as prophylaxis avoided development of infection.

Bacterial colonization of the larynx and trachea in healthy children.

Fifty healthy children were included in the study; tracheal and laryngeal aspirations were performed after oral endotracheal intubation during minor surgery. The aspirates were evaluated and examined in the same way as aspirates from children suspected of pneumonia; 31 samples were accepted for the final analysis. After culturing, specimens from 30 children exhibited growth of potential pathogenic bacteria either from the larynx, the trachea or both. Prior to culture, bacteria were seen by microscopy in 24 samples from 30 children. These results indicate that the majority of healthy children carry potential pathogenic bacteria, not only in the larynx but also to a certain extent in the trachea. We conclude that aspirates from the larynx and the trachea are of limited value in the diagnosis of bacterial pneumonia in children.

Evaluation of Staph ID 32 system and Staph-Zym system for identification of coagulase-negative staphylococci.

The purpose of the investigation was to evaluate two commercially available identification systems: a new modification of the Staph-Zym system (Rosco, Tåstrup, Denmark) and the Staph ID 32 API system (API System, BioMérieux, Paris, France). A local standard method to be used in routine laboratories was also evaluated. A total of 200 staphylococcal isolates, including strains from both the American Type Culture Collection and the Czechoslovak Collection of Microorganisms as well as 89 clinical isolates, were used in tests of all three identification systems. The Staph ID 32 API system identified from 50 to 100% of the reference strains and 82.1% of the clinical isolates correctly. The Staph-Zym system identified from 90 to 100% of the reference strains and 82.1% of the clinical isolates correctly. Most misidentifications were of minor importance, but in both systems major failures appeared (Staphylococcus aureus was identified as a coagulase-negative staphylococcus). Both systems needed backup from a reference laboratory to determine if two isolates were of the same strain.

Serum antibody response to proteins of Moraxella (Branhamella) catarrhalis in patients with lower respiratory tract infection.

We searched for antibodies against Moraxella (Branhamella) catarrhalis proteins in the sera of patients with lower respiratory tract infection. Sera from 48 patients with M. catarrhalis and 39 patients without M. catarrhalis in their lower respiratory tract specimens were studied by a gel electrophoresis-immunoperoxidase technique; sera from 23 healthy adult blood donors were also included. Immunoglobulin G (IgG) antibodies against a 28-kDa protein were found significantly more frequently in patients with M. catarrhalis in lower respiratory tract specimens (71%) than in patients without M. catarrhalis in lower respiratory tract specimens (28%) or healthy adult blood donors (22%). Seroconversion, from the acute to the convalescent stages, occurred in at least eight patients with M. catarrhalis and in one patient without detectable M. catarrhalis. IgG antibodies against other M. catarrhalis proteins were found in most sera, including those obtained from blood donors. By adsorption experiments the 28-kDa protein was demonstrated to be surface exposed. IgM antibodies against an 85-kDa protein were found in serum from one patient from whom M. catarrhalis and Streptococcus pneumoniae were isolated from the lower respiratory tract, while IgA antibodies against M. catarrhalis proteins could not be detected in any serum specimen.

Bacteremia at a Danish university hospital during a twenty-five-year period (1968-1992).

In the 25-year period 1968-92, 3,317 out of 477,420 patients admitted to Frederiksberg Hospital experienced 3,491 episodes of bacteremia. Enterobacteriaceae dominated as causative agents (57%), following by Gram-positive cocci (31%) and anaerobes (7%). Polymicrobial bacteremia was found in 8% of the episodes. The incidence of Enterobacteriaceae bacteremia culminated in the middle (1978-82) of the period (4.7/1,000 admissions) and decreased during the last decade. Gram-positive bacteremia increased throughout the period (from 1.8 to 2.9; p < 0.001), due mainly to increasing incidences of bacteremia caused by non-hemolytic streptococci, Streptococcus pneumoniae and coagulase-negative staphylococci. Bacteroides fragilis accounted for a rising incidence of anaerobic bacteremia (from 0.3 to 0.7; p < 0.05). Clinical data were available for the 2,599 bacteremic episodes in the 20-year period 1968-87. 59% of these were hospital acquired. Of those, 38% were associated with indwelling catheters, mainly bladder catheters (28%) and i.v. lines (7%). The urinary tract dominated as source of bacteremia (46%), followed by the respiratory (11%) and the gastrointestinal tract (9%). Half of the patients had predisposing underlying diseases, most frequently malignancies (20%) and diabetes mellitus (7%). The mortality rate related to bacteremia decreased from 25% to 11% (p < 0.001). More than half (55%) of the fatal cases related to bacteremia occurred within the first 2 days after the first positive blood culture was obtained. Logistic regression analysis defined 7 variables that independently influenced the outcome related to bacteremia: age, source, culture verification of source, shock, body temperature, leukocyte count and empiric antibiotic treatment.(ABSTRACT TRUNCATED AT 250 WORDS)

Maternal antibodies and acquired serological response to Moraxella catarrhalis in children determined by an enzyme-linked immunosorbent assay.

An enzyme-linked immunosorbent assay (ELISA) for determination of serum immunoglobulin G (IgG) antibodies to Moraxella catarrhalis was developed, with an ultrasonic extract of M. catarrhalis immobilized on polystyrene microtiter plates serving as the antigen. The specificity was determined by adsorption tests. All of the 541 women tested showed a high level of maternal IgG antibodies to M. catarrhalis in umbilical cord blood specimens. One hundred eighty-nine children aged 0 to 15 years were examined. A low level of IgG antibodies to M. catarrhalis in serum was found in children aged up to 1 year; in older children, the levels increased with age. Levels in the same range as maternal IgG antibody levels were reached at the age of 10 years. The level of antibodies in children did not correlate with the state of colonization with M. catarrhalis or with the state of acute lower respiratory tract infection. Pairs of acute-phase and convalescent-phase serum samples did not discriminate between the children with M. catarrhalis in pure culture and those with mixed cultures of M. catarrhalis, Haemophilus influenzae, and Streptococcus pneumoniae. In adult women, high IgG antibody levels and low colonization rates with M. catarrhalis were found, whereas in small children, low IgG antibody levels and high colonization rates were found.

Branhamella catarrhalis in children and adults. A study of prevalence, time of colonisation, and association with upper and lower respiratory tract infections.

The colonisation rate of Branhamella catarrhalis in patients from 0 to 45 years of age was examined. Of 561 women admitted to hospital in labour, 6 (1%) carried B. catarrhalis in their throats but none carried the organism in their vaginas. None of 534 newborn babies became colonised at birth or during their 5 days' stay in hospital. Neither were 102 neonates < 1 month of age in hospital colonised. The maximum colonisation rate during childhood was observed in children 1-48 months of age with 143 of 266 (54%) children colonised. Among children 4-15 years of age, four of 57 (7%) children with healthy respiratory tracts were colonised. Significantly more children with upper or lower respiratory tract infections (RTI) were colonised (68%) than were children without such infections (36%), (P < 0.001). After recovery from RTI, the isolation rate in the RTI group fell to that of the non-RTI group. A seasonal variation in prevalence was not observed. Of all the strains of B. catarrhalis isolated, 84% produced beta-lactamase.

Definitions of antibacterial interactions in animal infection models.

Combination of antibiotics in order to achieve antimicrobial synergy is often necessary in the treatment of infections due to resistant bacterial strains. Therefore, several in-vitro test systems have been developed with the purpose of predicting in-vivo action of antibiotics, and the fractional inhibitory concentration (FIC) index has been used to interpret results obtained in different test systems. Using these systems it seems that only antibiotic synergy in vitro is predictive of the results of treatment. It is therefore of interest to have an in-vivo test system that makes it possible to describe antibiotic interaction in detail. Animal infection models such as the foreign body model system enable the measurement of many parameters at the site of infection, such as bactericidal effect (BE) and antibiotic concentrations. A new calculation of drug interaction is suggested in which the measurements used are the BE and the time during which the MIC is exceeded, for the individual drugs and the combination. This calculation enables us to penetrate into observed antibiotic efficacy in vivo to find out whether an observed high BE is due to real synergy or simply to optimal pharmacokinetics of antibiotics at the site of infection.

Interactions of drugs acting against Staphylococcus aureus in vitro and in a mouse model.

Two combinations of antibiotics, clindamycin with rifampicin and cloxacillin with netilmicin, were investigated for their activity against two strains of Staphylococcus aureus (a sensitive reference strain and a methicillin-resistant clinical isolate) by means of the in vitro checkerboard technique and an in vivo infected mouse model. The mouse model allowed drug interactions to be evaluated both from the changes in the number of bacteria surviving treatment and from the measured exposure to antibiotics at the site of infection. Specimens from the latter were evaluated twice (day 0 and day 2) in each experiment. The combination of cloxacillin and netilmicin exhibited a synergistic effect against the reference strain both in vitro and in vivo, whereas synergism was obtained under in vitro conditions only against the methicillin-resistant strain. The clindamycin and rifampicin combination acted synergistically or indifferently against both strains in vitro and at day 0 of the in vivo experiments. In contrast, on day 2 of infection, this combination had significantly greater bactericidal effect (synergism) compared to the combination of cloxacillin and netilmicin. These results illustrate the difficulties of interpreting in vitro results for clinical use.