Better environmental survival of outbreak vs. sporadic MRSA isolates

Environmental sources have been associated with prolonged epidemics of methicillin-resistant Staphylococcus aureus (MRSA). Our objective was to evaluate whether outbreak MRSA strains differ in their environmental survival from sporadic MRSA strains. The strains were detected in five adult patients unknowingly colonized by MRSA. The MRSA strains from patients No. 1 (phage pattern; III-29) and No. 2 (III-215) caused extensive outbreaks in our hospital. Contact tracing after detection of the different MRSA strains in the three other patients did not reveal further spread.Suspensions of MRSA with and without added hospital dust were made in sterile PBS. Surviving counts of MRSA were made by culture at two-weekly or longer intervals up to approximately one year. For each MRSA strain the ultimate day of viability was ascertained. The environmental survival patterns of the five MRSA strains showed qualitative and quantitative differences between the two outbreak and three sporadic strains. A gradual decline was noted for all strains. All survived longer than 6 months, but the two outbreak strains survived significantly better (P<0.01), i.e. in higher quantities (circa 1000-fold) and for a 1-3 months longer period. The survival patterns of the MRSA strains with and without added dust were similar.     

Pulmonary veno-occlusive disease. Entity or syndrome?

Pulmonary veno-occlusive disease is a rare and usually fatal condition in which there is gradual obliteration of the pulmonary veins and venules. Without a lung biopsy the clinical diagnosis of this disease is difficult. If there is pulmonary hypertension with roentgenographic signs of pulmonary edema and of congestion in the absence of signs of increased left atrial pressure, the diagnosis must be considered. The morphologic picture of the lungs is characteristic. The small veins, and sometimes also the major veins, are narrowed or occluded by fibrous tissue, almost certainly on the basis of organized thrombi. Nodular areas of congestion, interstitial fibrosis, and pneumonitis are regularly present. A viral etiology has been suggested in a number of cases. If we may assume, however, that thrombosis of pulmonary veins is the initial event, the possibility has to be considered that this may be elicited by a virus in some patients and by toxic factors or by clotting disorders in others. Pulmonary veno-occlusive disease might then well be a syndrome rather than an etiologic entity.     

Ultrafast scan magnetic resonance in prenatal diagnosis

OBJECTIVE: To determine whether magnetic resonance (MR) can give additional information in prenatal diagnosis of congenital anomalies, when the ultrasound (US) analysis is not conclusive. METHODS: Ultrafast MR scanning examined 39 pregnant women with 41 fetuses in whom US was suspicious of fetal congenital abnormalities. Two techniques were used namely (1) HASTE inversion recovery sequence and (2) FISP 2D. RESULTS: Thirty-nine patients with 41 fetuses were referred for MR because of an equivocal US with regard to brain, spine, skeletal and miscellaneous anomalies. In 1 twin pregnancy, 1 co-twin has not been examined with MRI because of its demise. In 22 of them, additional information was obtained by MR. In 9 the MR was confirmative with the US examination. Four were false negative, comparing with the postnatal diagnosis. Three failed because of maternal claustrophobia and in 2 a diagnosis could not be made. From the 40 fetuses in this study, 38 were examined postnatally by MR, US, plain X-ray or autopsy was performed to confirm the prenatal diagnosis. CONCLUSION: The use of MRI in obstetrics has been limited, until recently. With fast MRI sequences it is not necessary to sedate the fetus. It is advisable in cases where US is equivocal concerning congenital anomalies of the fetus to use MR with fast or ultrafast scan technique, especially when the central nervous system is concerned.     

Randomized comparative study of 0.5 and 1 g of cefodizime (HR 221) versus 1 g of cefotaxime for acute uncomplicated urogenital gonorrhea.

Uncomplicated urogenital and concomitant oropharyngeal gonorrhea in 424 male and female patients was treated in a randomized comparative study with 0.5 g of cefodizime (89 men and 54 women), 1 g of cefodizime (87 men and 52 women), or 1 g of cefotaxime (86 men and 56 women). The cure rates were 100% for men and women in the group given 0.5 g of cefodizime, 100% for men and women in the group given 1 g of cefodizime, and 99% for men and 100% for women in the group given 1 g of cefotaxime. The MICs of cefodizime and cefotaxime for the isolate of Neisseria gonorrhoeae ranged from 0.004 to 0.06 micrograms/ml. Chlamydia trachomatis was isolated before treatment in 15% and after treatment in 13% of all patients. Side effects, such as nausea, diarrhea, abdominal pain, genital candidiasis, and pain at the site of injection, developed in 4% of the patients given cefodizime. Side effects, such as vertigo, genital candidiasis, fatigability, and diarrhea, developed in 4% of the patients treated with cefotaxime. In both groups of patients, the side effects were mild and transient. Cefodizime and cefotaxime are safe and effective agents in the treatment of uncomplicated urogenital gonorrhea.     

Different clonal complexes of methicillin-resistant Staphylococcus aureus are disseminated in the Euregio Meuse-Rhine region

The Euregio Meuse-Rhine (EMR) is formed by the border regions of Belgium, Germany, and The Netherlands. Cross-border health care requires infection control measures, in particular since the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) differs among the three countries. To investigate the dissemination of MRSA in the EMR, 152 MRSA isolates were characterized by pulsed-field gel electrophoresis (PFGE), SCCmec typing, and multilocus sequence typing. PFGE revealed major clonal groups A, G, L, and Q, suggesting dissemination of MRSA in the EMR. Group A harbored mainly SCCmec type III and sequence types (STs) 239 and 241. The majority of the strains from group G harbored SCCmec type I and ST8 and ST247, whereas most strains from group L carried either SCCmec type IV or type I. Within group L, ST8 and ST228 were found, belonging to clonal complexes 8 and 5, respectively. Most strains from group Q included SCCmec type II and were sequence typed as ST225. Both ST225-MRSA-II and ST241-MRSA-III were novel findings in Germany. In addition, the SCCmec type of two isolates has not been described previously. One strain was classified as SCCmec type III but harbored the pls gene and the dcs region. Another strain was characterized as SCCmec type IV but lacked the dcs region. In addition, one isolate harbored both SCCmec type V and Panton-Valentine leukocidin. Finally, the SCCmec type of the strains was found to be correlated with the antibiotic susceptibility pattern.     

Different doses of cefetamet pivoxil (Ro 15-8075) in the treatment of acute uncomplicated gonococcal urethritis in men.

In an open, dose-finding study, a 100% cure rate was observed in patients suffering from uncomplicated gonococcal urethritis who were treated with a single oral dose of either 1.2 g (n = 10), 0.8 g (n = 11), or 0.4 g (n = 10) of cefetamet pivoxil. The MICs of cefetamet for all gonococcal strains ranged from 0.001 to 0.12 micrograms/ml, and the MIC for 90% of the strains tested was 0.008 micrograms/ml. Cefetamet pivoxil was ineffective against Chlamydia trachomatis in 3 of 31 patients. Side effects were minor.     

Comparison of an enrichment broth-enhanced commercial PCR procedure versus bacteriological culture for separating non-colonized from suspected or colonized MRSA individuals

The aim of the study presented here was to evaluate an enrichment broth-enhanced commercial PCR procedure for excluding the presence of meticillin-resistant Staphylococcus aureus (MRSA) in patient samples in less than 36 h. In The Netherlands to date, all MRSA epidemics have been successfully controlled with the Dutch search-and-destroy policy. However, PCR facilitates more rapid screening for MRSA than traditional culture. One commercial PCR option is the hyplex StaphyloResist® PCR assay (Biologische Analysensystem GmbH, Lich, Germany), which detects Staphylococcus aureus and the mecA gene in MRSA as well as in coagulase-negative staphylococci (CoNS). This assay was used to test a total of 939 specimens obtained from 346 individuals. Following resolution of all discrepancies, the prevalence, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for all separate specimens were 9.0, 97.6, 83.7, 37.4 and 99.7%, respectively, and for specimens grouped according to daily episode submitted per individual, they were 7.5, 97.4, 77.2, 26.2 and 99.7%, respectively. These results led to the introduction of this PCR into the hospital laboratory’s routine for the purpose outlined above.     

Screening for cervical Chlamydia trachomatis infections in two Dutch populations.

Endocervical cultures for Chlamydia trachomatis and Neisseria gonorrhoeae were taken from 492 women attending an outpatient clinic for sexually transmitted diseases (group I) and 560 women seeking legal abortion (group II). Possible risk factors for C trachomatis infection were evaluated by multivariate analysis. The prevalence rates for C trachomatis and N gonorrhoeae were 7.3% and 2.5% in group I and 9.4% and 0.4% in group II. From multivariate analysis it was found that age (p less than 0.01), number of sexual partners (p less than 0.01), abnormal vaginal discharge (p less than 0.01), and endocervical mucopus (p = 0.02) were independently associated with chlamydial infection in group I. In the abortion clinic age (p = 0.03) and endocervical mucopus (p = 0.03) were the only significant independent predictors of C trachomatis. In all women vaginal discharge was collected for Gram staining. A significant higher number of polymorphonuclear cells was seen in the smears of C trachomatis positive women (group I: p = 0.04; group II: p = 0.03). In group II there was also a significant association between C trachomatis and Gardnerella type bacterial flora (p = 0.02) and the presence of comma-shaped rods (p = 0.04). Screening for C trachomatis infection may help to decrease the incidence of (post-abortal) pelvic inflammatory disease. Because screening in abortion clinics is not always possible, decreasing the incidence of postabortal pelvic inflammatory disease could be achieved by using prophylactic antibiotics. Selective use of prophylaxis in high risk patients can minimise costs and the incidence of side effects.