Tove Højbjerg

Symptoms and signs in culture‐proven acute maxillary sinusitis in a general practice population

The objective of this study was to assess symptoms and signs in patients with maxillary sinusitis and a bacteriological diagnosis obtained by sinus aspiration or lavage. Designed as a prospective cohort study in general practice, the study included 174 patients, aged 18–65 years, suspected of having acute maxillary sinusitis by their general practitioner. The main outcome measures were the independent association of symptoms, signs, erythrocyte sedimentation rate (ESR), and C‐reactive protein (CRP) concentration and confirmed infection with the predominant bacterial pathogens Streptococcus pneumoniae and Haemophilus influenzae. The predominant organisms found in patients with acute maxillary sinusitis were S. pneumoniae and H. influenzae. Body temperature >38 °C and maxillary toothache were significantly associated with the presence of S. pneumoniae and H. influenzae. Positive bacteriological culture results were significantly associated with increasing ESR and CRP values. None of the symptoms and signs, with the exception of body temperature >38 °C and maxillary toothache, were particularly sensitive indicators of the specific aetiology in patients with acute maxillary sinusitis. Elevated ESR and CRP values were significantly associated with positive bacteriological culture results. On the other hand, absence of these symptoms and signs did not exclude the presence of acute maxillary sinusitis.

Aminoglycoside resistance mechanisms in Enterobacteriaceae and Pseudomonas spp. from two Danish hospitals: correlation with type of aminoglycoside used

Sixty‐two aminoglycoside‐resistant Gram‐negative enteric bacteria were isolated over a 3‐year period from two hospitals (Bispebjerg and Esbjerg) among a total of almost 270,000 isolates. These hospitals were selected because of their different aminoglycoside policies during the years investigated. At Bispebjerg Hospital the principal aminoglycoside used was tobramycin, while gentamicin was the first choice at Esbjerg Hospital. Escherichia coli was the most frequently found aminoglycoside‐resistant species. Among the 61 aminoglycoside‐resistant strains studied, resistance was due to aminoglycoside‐modifying enzymes in all except two Xanthomonas maltophilia strains. The ANT(2“) enzyme occurred significantly more often at Esbjerg Hospital (p=0.001), while enzymes of the AAC(3) or AAC(6‘) moieties were more common, but not significantly so, at Bispebjerg Hospital. The phenotypic pattern of aminoglycoside resistance, as determined by disc diffusion, correlated 100% with the ANT(2”) and AAC(3)‐V (the two most common enzymes among the isolates) genotype of the organisms as established using DNA probes. Median minimum inhibitory concentrations (MICs) (mg/1) for clinically utilized aminoglycosides were: amikacin (1.6), gentamicin (25.0), kanamycin (50.0), netilmicin (1.6–25.0) and tobramycin (12.5–50.0). Isolates from Bispebjerg Hospital revealed significantly higher MICs for netilmicin and tobramycin (p<0.01) as compared to isolates from Esbjerg Hospital.

The Clinical Significance Of The Genital Microbiologic Flora At Vacuum Aspiration Following Miscarriage

85 women undergoing vacuum aspiration following miscarriage were studied. At the time of vacuum aspiration, immunofluorescent stainings for detection of C. trachomatis proved positive in 5.9% of the patients. Group 8 streptococci were isolated in 7.5%, coliforms in 3.5%, and Gardnerella vaginalis in 51% of the patients. The overall frequency of postabortal pelvic inflammatory disease (PID) was 3.5%. whereas 40% of chlamydia‐positive women contracted postabortal PID (p < 0.05). No significant relation between other microorganisms and postabortal PID was observed. The duration of postabortal bleeding was unrelated to the genital microbiologic flora. Based on anamnestic information about previous pregnancies and duration of preoperative bleeding it was possible to define subgroups at risk of harboring C. trachomaris and coliforms. The clinical significance of this is unknown.