An outbreak of campylobacter food poisoning in a health care setting.

An outbreak of campylobacter food poisoning in a group of health care workers is reported. The outbreak involved 12 of 31 staff members attending a departmental party. Investigations revealed that a chicken dish was the most likely vehicle of infection. The relative risk of developing symptoms after eating this dish was 6.15 (P < 0.002). Further investigation established that not only had the cooking instructions been misunderstood but storage of the the food the morning of the party did not comply with Department of Health guidelines. The outbreak was associated with considerable morbidity and cost. It is important that health care workers other than professional catering staff are aware of the guidelines available to ensure the correct preparation and storage of food if such events are to be held in hospital departments. It is also important that manufacturers of chicken products ensure that labelling regarding further cooking is clear and in large print.

Bacteriuria of pregnancy--an update on significance, diagnosis and management.

Bacteriuria of pregnancy is a common condition which is thought to be associated with serious sequelae in mother and fetus. A programme of screening, treatment and follow-up is likely to be cost-effective, but will depend on local prevalences of bacteriuria and pyelonephritis. If treatment is undertaken, nitrofurantoin and cephalexin are both safe and effective and have resistance rates of below 10%. Amoxycillin is also safe, but resistance rates in Escherichia coli are about 40%. A 7 day course of treatment remains advisable.

Anti-Proteus antibodies and Proteus organisms in rheumatoid arthritis: a clinical study.

We have studied anti-Proteus antibodies (APA), isolation of Proteus, and their relation to various measures of RA disease activity. Seventy RA patients with a CRP > 10 mg/l had higher APA titres than 17 RA patients with CRP < or = 10 mg/l (P = 0.006), and 36 non-RA controls (P = 0.003). However, in a cross-sectional study of the RA group, there was no correlation between APA and a number of clinical and laboratory measures of disease activity, including the CRP and Stoke RA activity index. A longitudinal study showed no correlation between changes in these measures of disease activity and change in APA titre. We were unable to isolate Proteus in the urine or faeces of RA patients more frequently than controls, and the isolation of Proteus did not correlate with serum APA titres. Urinary APA was present in equal frequencies in RA and non-RA patients. NSAIDs, DMARDs and steroids did not appear to influence APA titres in the RA group. These results suggest that APA may act as an acute phase protein, distinct from CRP, but not correlating with RA disease activity in its broadest context. The fact that the antibody we are measuring binds to Proteus may be irrelevant, and the study does not support a role for Proteus in RA.

A comparative study of imipenem versus piperacillin plus gentamicin in the initial management of febrile neutropenic patients with haematological malignancies.

Three-hundred and twelve episodes of fever in 234 neutropenic patients with haematological malignancies were treated empirically with either imipenem or a combination of piperacillin and gentamicin. There were no significant differences in the percentages of patients responding to therapy at either 72 h (59% and 56% of assessable episodes in the imipenem and combination groups respectively) or at the end of treatment (55% and 53% of assessable episodes in the imipenem and combination groups respectively). Patients in the piperacillin plus gentamicin group experienced significantly more renal tubular damage whereas those who received imipenem suffered more nausea or vomiting. We conclude that imipenem monotherapy represents an acceptable alternative to piperacillin plus gentamicin as empirical therapy of the febrile neutropenic patient.

Specificity of the proteus antibody response in rheumatoid arthritis.

Antibodies to proteus were determined by indirect immunofluorescence in 146 serum samples from patients with rheumatoid arthritis (RA). An autoantibody screen was performed in the same samples and in 52 of these antibody titres to the viruses influenza A, adenovirus, rubella, and parvovirus were determined. There was no significant correlation between proteus antibodies and any of the other antibodies tested. Dividing the samples into those from patients with active (C reactive protein > 10 mg/l) and inactive RA showed that the only antibodies to be significantly increased in active RA were the proteus antibodies. These observations suggest that the proteus antibody response in RA is specific.

P blood group phenotype, proteus antibody titres, and rheumatoid arthritis.

The interrelationships between P blood group phenotype, proteus antibodies and rheumatoid arthritis (RA) were investigated in 140 patients with RA and 114 of their siblings who did not have RA. In the group with RA P2 subjects had significantly higher titres of proteus antibodies than P1 patients. This was not observed in the group without RA, or for antibodies to Escherichia coli. Although C reactive protein was the best predictor of proteus antibodies in the group with RA, the P blood group had an independent and significant influence. These observations suggest a testable model in which asymptomatic carriage of proteus in the urinary tract may lead to antibody production, which in turn may be important in the pathogenesis of RA.

Sampling time for serum gentamicin levels.

A survey in 53 UK hospitals showed that 44% of clinical microbiologists recommended post-dose serum gentamicin concentrations to be measured at less than 40 min after an iv bolus dose. Serum gentamicin concentrations were measured in ten patients following bolus iv and im injections. Distribution of the drug occurred for up to 45 min following iv doses and maximum serum concentrations occurred at 45 to 60 min after im injection. The data validate current guidelines to sample at 60 min post bolus iv and im doses. Earlier sampling after iv bolus injections may result in significantly higher gentamicin concentrations, leading to potential interpretive errors of clinical significance.

Anti-Proteus antibodies in rheumatoid arthritis same-sexed sibships.

One hundred and forty-two RA patients and 121 of their healthy same-sexed siblings were tested for antibodies (Abs) to Proteus mirabilis and Escherichia coli by indirect immunofluorescence. Eighty-five individuals had active RA (CRP greater than 10 mg/l) and 57 inactive RA. The anti-Proteus Ab titre in the active RA group was significantly higher than in the inactive RA and non-RA group (P less than 0.0001 in both cases). Anti-Proteus Abs were significantly elevated in 30 individuals with active RA compared with their healthy HLA-identical same-sexed siblings (P less than 0.001). In 42 HLA-DR4 positive and 15 HLA-DR4 negative active RA patients, the Ab titre was non-significantly higher in the former group. Anti-E. coli Abs were not significantly elevated in any of the groups. Longitudinal data on 36 RA patients demonstrated a significant positive correlation between changes in CRP and changes in anti-Proteus antibody titres (r = 0.52, P less than 0.001). These observations require an explanation.

A comparison between oral ciprofloxacin and intraperitoneal vancomycin and netilmicin in CAPD peritonitis.

This report describes a prospective, randomized comparison of oral ciprofloxacin and intraperitoneal vancomycin/netilmicin in the treatment of 50 consecutive episodes of CAPD peritonitis in 35 patients. Successful cure of peritonitis was achieved in 76% of subjects taking oral ciprofloxacin and 72% of those given intraperitoneal antibiotics. Satisfactory concentrations of ciprofloxacin in dialysate were achieved in all patients. Failure of ciprofloxacin was due to persistence of an isolate of intermediate sensitivity (1), to persistence with acquisition of resistance (1), and to relapse/reinfection in the remaining four cases (with resistant or moderately sensitive strains in three cases). Ciprofloxacin was well tolerated in the majority of cases. A significant rise in serum creatinine was noted in almost all patients taking oral ciprofloxacin. The advantages of oral drug administration indicate that oral ciprofloxacin is the preferred first-line treatment of CAPD-associated peritonitis.

A randomised, prospective, single-blind comparison of cefadroxil and amoxycillin in the treatment of acute exacerbations of chronic bronchitis.

Cefadroxil 1 g twice daily and amoxycillin 500 mg three times a day were compared in 111 patients suffering from acute exacerbations of chronic bronchitis. Treatment was for seven days. Excellent or good clinical responses were found in 85 per cent of cases receiving cefadroxil and 81 per cent of patients taking amoxycillin. However, residual symptoms of cough and rhonchi were present to a statistically significantly greater extent in the amoxycillin group. Tolerance of both drugs was good with mild to moderate side effects reported in seven of 54 patients in the cefadroxil group and six of 56 patients taking amoxycillin. Severe nausea and vomiting in two cases in the amoxycillin group resulted in discontinuation of therapy. Microbiological examination of sputum samples showed pathogenic bacteria in 16 per cent, principally Haemophilus influenzae. Amoxycillin 500 mg tds and cefadroxil 1 g bd were equally effective in the treatment of acute exacerbations of chronic bronchitis.

Management of bacteriuria in pregnancy.

Bacteriuria of pregnancy is a common condition which, although usually asymptomatic, may give rise to potentially serious sequelae. All pregnant women should therefore be screened for the presence of bacteriuria, which if detected should be treated with an antimicrobial agent believed to be safe for use in pregnancy. Appropriate antimicrobial drugs include penicillins, cephalosporins and nitrofurantoin. Nalidixic acid, aminoglycosides and sulphonamides may be used under certain circumstances and with some precautions. Tetracyclines, trimethoprim and co-trimoxazole (trimethoprim-sulphamethoxazole) should be avoided. There is some evidence that short-course therapy in pregnant women is less effective than longer courses, and we continue to recommend a 7-day course. Follow-up after completing a treatment course is an essential part of managing bacteriuria of pregnancy.

Cryptosporidiosis in patients at a large teaching hospital.

In 1984, all stool samples submitted to a microbiology laboratory (n = 2,197) from a predominantly hospital-based population were examined for Cryptosporidium oocysts after Ziehl-Neelsen staining, but only 0.5% were positive. We suggest that in low-incidence areas, individual laboratories examine stool samples for this organism only in immunosuppressed patients and those in whom symptoms persist.

The isolation of Moellerella wisconsensis from stool samples in the U.K.

Three strains of Moellerella wisconsensis were isolated from a total of 400 stool specimens screened for this organism by means of a new selective medium developed in this laboratory. This is the first report of the isolation of this organism in the U.K. The exact role of M. wisconsensis in causing diarrhoea remains to be elucidated.