Jens Scheibel

Bacterial contamination of air and surgical wounds during joint replacement operations. Comparison of two different types of staff clothing

Compared with conventional surgical clothing, polypropylene coveralls reduced the bacterial contamination of the air of a conventionally ventilated operating room by 62%. The contamination of surgical wounds during joint replacement was also reduced, but not to a significant degree. Sixteen percent of the bacteria sampled from the wounds were resistant to the prophylactic antibiotic and the importance of a clean air system for performing joint replacement operations is stressed. The use of commercially available non-woven swabs for sampling bacteria from the surgical wound compared favourably with the use of specially prepared velvet pads.

Wound sepsis after elective cholecystectomy. Restriction of prophylactic antibiotics to risk groups.

This prospective study of elective cholecystectomy investigated the frequency and type of bacteria in gallbladder bile at operation, the factors predicting the presence of bacteria in bile, and the relationship between bacteria in bile and subsequent wound sepsis. In 148 consecutive cases 23% of bile cultures were positive. The overall wound infection rate was 15%, but 91% of all wound infections occurred in patients with positive bile cultures. Eighty-five per cent of all positive bile cultures and 86% of all wound infections occurred in 37% of the patients, characterized by age over 60 years and/or a history of previous attacks of acute cholecystitis. We suggest that in elective cholecystectomy prophylactic antibiotics should be restricted to this group of patients to limit the use of antibiotics.

The Role of Vaginal Secretory Immunoglobulin a, Gardnerella Vaginalis, Anaerobes, and Chlamydia Trachomatis in Post Abort al Pelvic Inflammatory Disease

In a prospective study of 129 women undergoing induced first‐trimester abortion, 14 (10.9%) contracted postabortal pelvic inflammatory disease (PID). Samples of vaginal secretion for quantitation of secretory immunoglo‐bulin A (slgA) as well as isolates from cervix/urethra for the culture of anaerobes and aerobes, including Bacteroides fragilis et melaninogenicus and Gardnerella vaginalis, were obtained at the preoperative visit. Two blood samples from each woman with postabortal PID were analysed for antibodies against G. vaginalis. Twenty‐five per cent of women with a history of PID developed postabortal PID, and 25% with vaginitis contracted postabortal infection (p< 0.001 and p<0.005).

Chlamydia Trachomatis in Acute Epididymitis

The etiology of acute epididymitis was studied in 52 patients. Infection with Chlamydia trachomatis was demonstrated by culture or serology in 13 patients. In men under the age of 25 C. trachomatis was associated with 7 out of 9 cases of epididymitis, in contrast to none of the 19 cases in men above 35. Culture from the urethra is probably sufficient in diagnosing infection with C. trachomatis in patients with acute epididymitis, since only one patient with a negative urethral culture had a chlamydia-positive aspirate from the epididymis. Half of the cases of epididymitis in men above the age of 35 years were associated with urinary tract infection. One patient was infected with N. gonorrhoeae and one had tuberculosis of the epididymis.

A 6-month Prospective Study of Hospital-acquired Bacteremia in Copenhagen County

During a 6-month period, 892 positive blood cultures were detected in the Copenhagen County hospitals. 302 (34%) were regarded as contaminations, and of the remaining cases 419 (71%) were community-acquired and 171 (29%) hospital-acquired, giving incidence rates of 6.8/1,000 admissions and 2.8/1,000 admissions, respectively. Both frequency and rate of hospital-acquired bacteremia were lower compared to most other studies. E. coli was more commonly found in community-acquired infections, while coagulase-negative staphylococci were the organisms most often considered as a contaminant. The main causative organisms in hospital-acquired infections were S. aureus (n = 37) and E. coli (n = 34). The proportion of polymicrobial bacteremias in this study was lower compared to most other studies (8%). E. coli from hospital-acquired infections were resistant to ampicillin in 42% of cases, but other Enterobacteriaceae showed higher percentage of resistance to beta-lactam antibiotics. S. aureus was penicillin-resistant in 92% of cases, but no methicillin-resistant strains were isolated. The frequency of antibiotic resistance was low compared to reports from other countries. A total of 136 hospital-acquired cases were followed prospectively. 61% of the patients were male and 46% were > or = 60 years of age. Most patients had predisposing diseases, 90% had foreign body and/or recent surgery performed, and 74 (54%) had an intraveneous catheter. The portal of entry was known in 132 (97%) of the cases, the most common being the urinary tract (42%), followed by an intravenous catheter (30%). The prevalence of urinary tract catheters gave an increased number of cases with E. coli bacteremia. The mortality was 16%.

Recurrent staphylococcal furunculosis in families.

Recurrent familial staphylococcal furunculosis causes severe physical and especially socio-psychological problems to the families involved. In the present study 6 families with 28 persons were not treated with antibiotics but with a combination of chlorhexidine bathing, nasal 1% chlorhexidine gel and improved cleaning and hygiene in the surroundings. The infecting Staphylococcus aureus strain was eradicated from the surroundings and the skin in all 6 families, but several of the family members still retained the strain in the nose. All family members were, however, cured and remained without infections during an observation period of 2 years.

Detection of Chlamydia trachomatis in individual and pooled endocervical and urethral scrapes by a commercially available polymerase chain reaction

The aim of this study was to compare a commercially available PCR kit (Amplicor, Roche) with our present routine analysis (SYVA EIA) for the detection of genital C. trachomatis infection in females. Furthermore, we wished to investigate the possibility of pooling samples for PCR analysis. Two hundred and sixty‐eight consecutive female patients attending two gynecology clinics in Copenhagen, Denmark were included in this study. Compared to the number of samples regarded as true positives, PCR had a sensitivity of 100% (18/18) and EIA a sensitivity of 83.3% (15/18). The specificity of the PCR analysis was 99.2% (248/250) compared to 100% (250/250) for the EIA. By pooling patient samples (five patient samples in each pooled sample), a 39% reduction in reagent costs was obtained without affecting the sensitivity. In conclusion, the implementation of a standardized commercially available C. trachomatis PCR kit leads to a marked increase in analytical sensitivity compared to EIA without affecting the specificity. When pooled samples were analyzed, the cost per patient sample was reduced, but further large‐scale studies are needed to rule out the possibility of a reduced sensitivity due to the dilution of individual patient samples.

Fatal Septicaemia Caused by DF-2 in a Previously Healthy Man

A case of fatal septicaemia caused by DF-2, a fastidious gram-negative rod is presented. Attention is drawn to the connection between DF-2 septicaemia and dog bites or contacts, not only in patients with impaired host defence but also in previously healthy individuals. As the organism is difficult to subculture, infections with DF-2 may easily be overlooked.

Wound infection rates following preoperative versus intraoperative commencement of antibiotic prophylaxis

The effect of antibiotic prophylaxis initiated one hour prior to contamination or at the time of contamination was evaluated in a randomized blind study using a guinea pig model of surgical wound infection. Wound infection, defined as accumulation of pus draining spontaneously or after opening of the wound, developed in 135 guinea pigs after intraincisional contamination before wound closure with 107Escherichia coli plus 108Bacteroides fragilis. Antibiotic prophylaxis with gentamicin plus clindamycin significantly reduced the wound sepsis rate from 82 % in the control group of 61 animals to 19 % in the two treated groups of 68 and 67 animals (p<0.001). However, the timing of antibiotic prophylaxis did not influence wound sepsis rates, rectal temperature during the postoperative period, or bacterial recovery from wound infections.