Evaluation of a syndromic panel polymerase chain reaction (spPCR) assay for the diagnosis of device-associated bone and joint infections (BJI).

OBJECTIVE: Pathogen detection is crucial for diagnosis and targeted therapy in implant-associated bone and joint infections (BJI). Culture-based microbiology regularly fails to identify causative pathogens. This study evaluated the diagnostic accuracy and clinical usefulness of a syndromic panel polymerase chain reaction (spPCR) assay targeting common BJI pathogens in tissue specimens from patients with implant-associated BJI. METHODS: Results obtained by spPCR assay and a 16S rDNA PCR were compared with results obtained from a standard of care (SOC) culture-based diagnostics, serving as a gold standard. In total, 126 specimens obtained from 73 patients were analyzed. RESULTS: The spPCR assay correctly identified 33/40 culture-positive samples (82.5 %) and was positive in 9/86 (10.5 %) culture-negative samples, resulting in an overall sensitivity of 84.6 % (95% confidence interval [CI] 68.79-93.59%) and specificity of 89.35% (95% CI 80.6-94.81%). The spPCR was more sensitive compared with the 16S rDNA PCR (37.5%). The spPCR identified pathogens in 7/51 (13.7%) SOC-negative patients. Re-evaluation of spPCR results in clinical context suggested their clinical significance. CONCLUSION: An spPCR assay targeting common pathogens causing implant-associated BJI may help to identify causative agents in culture-negative cases. As false-negative results are possible, spPCR assays appear as an add-on approach for pathogen detection in implant-associated BJI.

A novel method to evaluate quality of care from the perspective of cataract patients.

PURPOSE: To evaluate quality of care from patient's perspective following cataract surgery using a novel questionnaire and to assess validity of the survey in context with the identification of lacks in quality of care. METHODS: Assessment of quality of care in 150 patients (150 eyes) who underwent cataract surgery in an Austrian clinical setting based on a novel "Quality of Care from Patient's perspective following Cataract Surgery" (QCPCS)-questionnaire including 10 subjective, 10 objective and 7 general health care criteria. Quality of care was graded according to importance (range: 1 = not important to 4 = extremely important) and frequency of occurrence (range: 1 = never to 4 = often, 0 = not applicable). Quality-impact indices (QI-respective grading by patient/4) were assessed. RESULTS: Mean performance score was 3.84 (SD = 0.42, range: 1-4). Mean QI was 0.89 for subjective, 0.90 for objective and 0.96 for general health care criteria (p = 0.29). All-over skewness and coefficient of variation were -2.65 and 5.85 respectively. Internal consistency was high (Cronbach's α = 0.75) confirming causal taxonomy of disease-specific and generic items. CONCLUSION: A valid new method to reliably and holistically evaluate patient's satisfaction related to cataract surgery including a broad range of patient needs is presented, suitable to assess potential lacks in quality of health care in daily ophthalmological clinical practice.

Clinical risk management - a 3-year experience of team timeout in 18 081 ophthalmic patients.

PURPOSE: Clinical risk management aims to identify, analyse and avoid errors and risks systematically to improve patient's safety. Preoperative checklists to prevent mistakes have gained importance in the last few years. A so-called team timeout checklist was introduced in October 2011 at the Department of Ophthalmology, Hietzing Hospital, Vienna. The purpose of the study is to evaluate the benefits and demonstrate the value of team timeout. METHODS: After the team timeout had been in use for 6 months, all near misses that occurred over a period of 34 months were assigned to the following groups: wrong side, wrong lens, wrong patient and miscellaneous. RESULTS: Eighteen thousand and eighty-one surgeries were performed in the specified period; 53 cases of 'wrong side' and 52 cases of 'wrong intraocular lens' were noted. Ninety-six near misses concerned the patients' data and 38 concerned documentation. A reduction of near misses was noted after an adaptation phase of 3 months. CONCLUSIONS: Team timeout proved valuable, as it improved the patients' safety with minimum effort. Errors may occur despite several preoperative controls and can be detected by performing team timeout.

Detection of resistance to macrolides in thermotolerant campylobacter species by fluorescence in situ hybridization.

The resistance of enteritis-causing Campylobacter strains to erythromycin is an emerging problem. We therefore evaluated fluorescence in situ hybridization (FISH) for the rapid detection of resistance using 74 campylobacter isolates. FISH showed specificity and sensitivity of 100% for the detection of high-level resistance.

Identification of thermotolerant campylobacter species by fluorescence in situ hybridization.

Thermotolerant Campylobacter spp. (Campylobacter jejuni, C. coli, C. lari, and C. upsaliensis) are leading causes of food-borne diarrhea in humans. In this study, the usefulness of fluorescence in situ hybridization (FISH) for the identification of Campylobacter isolates was investigated. A hierarchical FISH probe set that included six group-, genus-, and species-specific probes was developed and evaluated with 12 reference strains and 94 clinical isolates of Campylobacter, Arcobacter, and Helicobacter. FISH correctly identified all isolates to the genus level and detected all thermotolerant Campylobacter isolates. The assay showed high degrees of sensitivity for the identification of C. jejuni (90%), C. coli (97%), C. lari (81%), and C. upsaliensis (100%) to the species level.