Mycobacterium chelonae lumbar spinal infection.

A case report of a previously healthy adult patient with a lumbar spinal extradural abscess due to Mycobacterium chelonae is presented. His course of treatment was complicated by recurrent psoas abscesses, as well as multiantibiotic resistance, requiring multiple surgical drainage procedures and antibiotic changes over a 33-month period. Cure was achieved only after aggressive surgical debridement of the abscess.

Methicillin-resistant Staphylococcus aureus: a questionnaire and microbiological survey of nursing and residential homes in Barking, Havering and Brentwood.

The study determined the policies and procedures for the control and prevention of methicillin-resistant Staphylococcus aureus (MRSA) and its prevalence among nursing and residential homes, and evaluated whether certain home characteristics such as bed size, staffing level, and type of home are related to the prevalence of MRSA. A 21-questionnaire survey, with primarily categorical responses, was mailed to the home managers of all the 121 nursing and residential homes in the district, following which a simple, stratified random sample of 28 (23.14%) homes was taken and all agreeing residents screened from multiple sites for MRSA. Seventy-seven (63.6%) homes returned a completed questionnaire, 13 (46.4%) of whom agreed to participate in the microbiological study. The response rates for returning questionnaires and agreeing to participate in the microbiological study were similar for nursing and residential homes (65% vs. 60%; 67% vs. 40%; P = 0.12; P = 0.62), respectively. Nursing homes had a mean bed size of 30 (95% Confidence Interval (CI) 17-43), not significantly different from residential homes of 23 (95% CI 18-27; P = 0.26). The nursing homes employed a mean of 8.6 (95% CI 4.7-12.5) staff nurses per home; significantly higher than residential homes with a mean of 1.6 (95% CI 0.3-2.8; P = 0.006). No significant differences in mean number of home care assistants employed per home (22.8; 95% CI 12.4-33.13; and 14.4; 95% CI 11.83-16.90; P = 0.098, for nursing and residential homes, respectively) were observed. None of the homes had employed infection control practitioners. Only four (6.8%) of the responding homes stated that MRSA was a problem. Nursing homes were not significantly more likely to have admission policies for colonized person than residential homes (10/13 vs. 40/55, P = 1.00). Of the fifty-five (71.4%) homes who had admission policies, 40 (72.7%) stated that persons colonized/infected with MRSA would not be accepted, while 12 (21.8%) would accept such persons in single-room isolation and/or barrier nursing. Greater proportions of residential homes than nursing homes would not accept admission of persons with documented MRSA colonization (30/35 vs. 4/10, P = 0.007). Four (9.1%) homes (three nursing) had identified a total of five residents colonized/infected with MRSA in 5 years prior to the survey. Two hundred and forty-six residents were screened (552 sites), two (0.81%) of whom were found to be colonized in the nose (one resident) and in the groin (two residents) with MRSA, giving a 2-month weighted point prevalence rate of 0.14% (95% CI 0.01-0.26%). We conclude that in our district the nursing staffing levels and control measures vary widely within these homes, while the prevalence of residents who are colonized/infected with MRSA is lower than in other areas. We suggest that the exclusion admission policy for MRSA positive patients should be abandoned and targeted infection control programmes be instituted.

Streptococcal vulvovaginitis in girls.

Group A beta-hemolytic Streptococcus (GAHS) was isolated from 18% of swabs submitted to a district microbiology laboratory from girls with vulvovaginitis, a figure similar to that from a contemporary British study. This suggests that vulvovaginitis is more commonly associated with GAHS than reported previously. This could represent either an increase in frequency of the condition or better recognition of it.

The pharmacokinetics and tissue penetration of enoxacin and norfloxacin.

Two new quinoline compounds, enoxacin (600 mg) and norfloxacin (400 mg) were administered consecutively to six healthy male volunteers. The levels of the two agents were measured in serum, urine and blister fluid. The mean peak serum level of enoxacin was 3.7 mg/l and attained at a mean time of 1.9 h after administration; the mean peak serum level of norfloxacin was 1.45 mg/l at a mean time of 1.5 h. The mean serum half-lives were 6.2 h for enoxacin and 3.25 h for norfloxacin. Both agents penetrated blister fluid well and reached maximum levels of 2.9 mg/l (for enoxacin) and 1.0 mg/l (for norfloxacin). The 24 h urinary recovery of enoxacin of 61% was about twice that of norfloxacin. No adverse effects of either agent were observed. The data suggest that enoxacin might be used as a once daily dose for the treatment of urinary tract infections, but twice daily for the treatment of susceptible pathogens causing systemic (as against urinary) infections.

The pharmacokinetics and tissue penetration of norfloxacin.

The pharmacokinetics and cantharides-induced blister fluid levels of norfloxacin were studied after a single 400 mg oral dose. The mean maximum serum level was 1.45 mg/l and occurred 1.5 h after administration. The serum half-life of norfloxacin was found to be 3.5 h. After 24 h 27% of the administered dose was recovered in the urine as microbiologically active compound. High urine levels were found. Rapid blister fluid penetration occurred, the maximum level (occurring between 2-3 h) was about 1 mg/l. Thereafter the blister fluid level exceeded the serum level, both declining in parallel.