Joseph L. Staneck

Staphylococcus aureus Associated with Toxic Shock Syndrome: Phage Typing and Toxin Capability Testing

Phage type 29 Staphylococcus aureus was identified singly or with type 52 in 64.1% of 248 coded isolates from patients with toxic shock syndrome. These phage types also have a high capability of producing pyrogenic exotoxin C and enterotoxin F. The origin and development of these toxigenic strains were explored by studying 25,220 isolates of S. aureus stored in a staphylococcal bank between 1960 and 1979. A small percentage of phage types 29, 52 were found in 1960, but their prevalence increased between 1961 and 1970, and continued at elevated levels through 1979. The toxigenic capabilities of these phage types were apparently acquired about 1971 and increased up to 1975. High levels of prevalence persisted during the following 4 years, and receded in 1980 and 1981. Other evidence during 1980 and 1981 indicates that these strains of S. aureus have become an important pathogen in surgical wounds, burns, and other infections.

Established hand infections: A controlled, prospective study

A randomized, prospective study of 200 consecutive established hand infections was designed to compare the efficacy of two antibiotics, cefamandole and nafcillin. Bacteriologic data revealed 63.5% of the patients grew multiple organisms (2.3 organisms per culture) and 26% of the patients had anaerobic infections. Complications were noted in 13% of all patients--26% in patients who grew aerobes and anaerobes and 9.8% in patients who grew aerobes alone (p less than 0.05). Despite the fact that 95% of all organisms were sensitive in vitro to cefamandole whereas only 67% of organisms were sensitive to nafcillin (p less than 0.01), complications occurred more frequently in patients treated with cefamandole. We conclude that the empirical selection of a broad-spectrum antibiotic is reasonable based on in vitro sensitivity studies; however, other factors such as treatment delay, initial extent of infection, anatomic location of infection, cause of infection, and extent of surgical debridement are important in the development of complications.

Prolonged Hospital Epidemic of Salmonellosis: Use of Trimethoprim-Sulfamethoxazole for Control

The occurrence of a foodborne outbreak of Salmonella drypool, an uncommon serotype, led to the recognition of hospital-acquired cases occurring over a 5-year period. In late 1981, a catered luncheon resulted in an epidemic of S. drypool, and in retrospect, cases were found to have been occurring in hospital patients from 1977 until 1981. Over the next 4 months, patients, employees, and 50% of the kitchen workers became infected, despite repeated culture surveys of the staff and removal of all infected workers. Food and environmental cultures failed to reveal the source of infection, but infected workers were observed to have multiple negative cultures over several months and then to become positive again. Closing of the kitchen for 2 weeks failed to stop the epidemic. Finally, all kitchen employees, both infected and uninfected, were treated with trimethoprim-sulfamethoxazole for 2 weeks. After treatment, no new kitchen workers became infected, although two workers who had had positive cultures earlier in the epidemic began to excrete S. drypool again, and the epidemic ended.

Cutaneous abscesses: natural history and management in an outpatient facility.

This study investigated the natural history and treatment of cutaneous abscesses in an outpatient setting. Incision, drainage, aerobic and anaerobic cultures were done on all 78 patients entered in the study. Tenderness and fluctuance were noted in more than 80% of the patients; erythema and induration in more than 60%. Forty-one percent of all abscesses were in the anogenital region. Forty-two percent of cultured abscesses grew aerobes exclusively, 28% grew anaerobes exclusively, and 27% grew a mixture of aerobes and anaerobes. The predominant aerobic organisms were Staphylococcus and Streptococcus, which were mostly isolated from the head/neck, extremities, and axillary regions. The predominant anaerobic organisms were Peptococcus and Bacteroides, which were primarily isolated from the anogenital regions. Nearly 60% of the patients returned for reevaluation. They were equally divided between those patients taking antibiotics and those not on antibiotics. However, all patients were clinically improved.