Letter to the Editor: The Bacterial Etiology of Otitis Media and Specimen Collection

No abstract available.

An Outbreak of Oropharyngeal Tularemia with Cervical Adenopathy Predominantly in the Left Side

PURPOSE: We describe the epidemiological and clinical characteristics and the efficacy of a delayed initiation to therapy in an oropharyngeal tularemia outbreak in Duzce, Turkey. MATERIALS AND METHODS: Between March and June 2000, 22 patients with tularemia were diagnosed by microagglutination tests. RESULTS: Oropharyngeal and ulceroglandular forms of the disease were discovered. Most of the cases were oropharyngeal (19 cases). The most common symptoms were sore throat (95.4%) and fever (90.9%). Lymphadenopathy (95.4%) and pharyngeal hyperemia (81.8%) were usually observed signs. The lymphadenopathies were localized especially in the left cervical region (66.7%), a finding that has not been previously reported in the literature. The time between the onset of the symptoms and diagnosis was 40.7 +/- 22.8 (10 - 90) days. The patients were treated with streptomycin plus doxycycline and ciprofloxacin. The patients' recoveries took up to 120 days. CONCLUSION: This report describes the first outbreak of tularemia in northwest Turkey. Tularemia may occur in any region where appropriate epidemiological conditions are found and should be kept in mind for differential diagnosis in oropharyngeal symptoms. Late initiation of therapy may delay complete recovery. In this outbreak, cervical lymph nodes predominantly localized on the 1eft side were found, which had not been previously reported.

Compliance and efficacy of hand rubbing during in hospital practice

To compare alcohol-based hand rubbing with hand washing using antimicrobial soap regarding antimicrobial efficacy and compliance with routine practice in hospital and intensive care units. From February to June 2003, 35 nurses were randomly selected from a nursing staff of 141 and divided into two groups: hand rubbing and hand washing groups. Hand cultures were obtained before and after health care procedures. The nurses were observed on days 1, 7 and 14 of the study, in order to determine compliance and efficacy of the hand hygiene methods. A total of 368 routine patient care activities were observed during the study period. Hand rubbing with alcohol-based solutions significantly reduced the bacterial contamination of the hands of the nurses more than hand washing with an antimicrobial soap [54 and 27%, respectively; p < 0.01]. Compliance was also better in the hand rubbing group than in the hand washing group [72.5 and 15.4%, respectively; p < 0.001]. Compliance with hand rubbing was markedly lower among the nurses who had experience of more than 3 years in hospital practice. Both hand rubbing and hand washing compliance were poorer among nurses working inintensive care units than among nurses working in the other hospital wards. Generally, after taking off gloves, nurses preferred hand washing to hand rubbing. These data indicate that alcohol-based hand rubbing reduces mean bacterial counts on the hands of nurses more effectively than hand washing with antimicrobial soaps, and compliance rates with hand rubbing were also higher than with hand washing. Nevertheless, the compliance with hand rubbing was markedly lower in more experienced nurses