Local outbreak of quinolone-resistant but ceftriaxone-susceptible gonorrhoea in a region of Denmark.

INTRODUCTION: During the past decade, gonorrhoea has been on the rise in several European countries, and along with a decreasing susceptibility to currently used antimicrobial agents, there are worldwide concerns about future case management. The objective of the present study was to describe the antibiotic resistance of gonococci and physicians' adherence to national Danish guidelines in the Region of Northern Jutland (RNJ) from 2000 to 2010. MATERIAL AND METHODS: All incident episodes of microbiologically confirmed Neisseria gonorrhoeae infections from 2000 to 2010 were included. Data were retrieved from the Laboratory Information System at the Department of Clinical Microbiology, Aalborg University Hospital. Clinical data on hospital-treated patients were retrieved from medical records. General practitioners and patients were not contacted. RESULTS: A total of 296 incident episodes in 285 patients were included. The majority of infections were observed in men (71%). The annual incidence increased five-fold during the study period and peaked in 2009. Most infections were acquired in Denmark. 13 per cent had swabs performed according to guidelines from the Danish National Board of Health. Quinolone-resistance fluctuated between 13% and 93%. The highest level was observed in 2009. No isolates were resistant to ceftriaxone and we observed no treatment failure. CONCLUSION: We have described a local outbreak of quinolone-resistant but ceftriaxone-susceptible gonorrhoea in the RNJ. Our study highlights the importance of microbiological confirmation, treatment and follow-up of gonorrhoea in accordance with national guidelines. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.

[The quality of susceptibility examinations of urine in general practice is generally good]. / Kvaliteten af resistensbestemmelser på urin i almen praksis er generelt god.

In Denmark, many microbiological tests (microscopy, culture and susceptibility examinations) are done in general practice for the diagnosis of urinary tract infections (UTI). In 2006, the costs of susceptibility examinations were 28 million DKK. Some regional health authorities have established a program for quality assessment. National quality requirements for susceptibility examinations have already been established. The clinical microbiological departments send simulated urines with bacteria of common UTI strains. The specimens are examined in general practice with routine methods. The results for a two-year period of susceptibility examinations are reported. Generally, the quality criteria were met.

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 degrees 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 degrees 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.

[Gastrointestinal symptoms predominant in refugee children with malaria]. / Primaert gastrointestinale symptomer ved malaria hos flygtningebørn.

We present three cases of malaria in refugee children newly arrived from Sub-saharan Africa. Only one of the three children had fever and all had high parasite loads (2,5-14% parasitemia). Malaria is an important differential diagnosis in refugees from endemic areas, regardless of whether they present with fever.

Bedside diagnosis of imported malaria using the Binax Now malaria antigen detection test.

Malaria may be misdiagnosed in non-endemic countries when the necessary experience for rapid expert microscopy is lacking. Rapid diagnostic tests may improve the diagnosis and may play a role as a bedside diagnostic tool. In a multicentre study we recruited patients suspected of malaria over a period of 14 months. The Binax Now Malaria rapid test was used at the bedside and in the clinical microbiology laboratory. The training of clinical staff was monitored and their experience with the use of the test was recorded. 542 patients were included, 80 of whom had malaria diagnosed by microscopy. The rapid test used at the bedside had a sensitivity of 88% for the detection of P. falciparum compared to 95% when the test was performed in the microbiology laboratory. The risk of technical problems and invalid tests was highest when the test was used at the bedside. The rapid diagnostic test may be useful for the diagnosis of P. falciparum malaria when used by routine laboratory staff, but could lead to misdiagnoses when used at the bedside. Microscopy is still essential in order to identify the few missed diagnoses, to determine the degree of parasitaemia, and to ensure species diagnosis, including mixed infections.

Culture of multiple peroperative biopsies and diagnosis of infected knee arthroplasties.

Prosthetic joint infections remain difficult to diagnose. In 1981, Kamme & Lindberg described a diagnostic procedure with five peroperative biopsies in patients with total hip arthroplasty (Clin Orthop Relat Res 1981;154:201-7). Its usefulness, however, has not been ascertained for other prosthetic joints undergoing surgical revision. Therefore, we undertook a retrospective study of 120 surgical revisions in 118 patients with knee arthropasties where such biopsies had been obtained. Cases were categorized into three groups based on information available prior to revision and peroperative inspection: prosthetic joint infection (n = 26), aseptic loosening (n = 58), and mechanical problems (n = 36). Fifteen sets were positive, 13 had significant growth (i.e. > or =3 biopsies with the same microbe/s), and 2 had insignificant growth (< or =2 positive biopsies). Excluding the group with a mechanical problem, the sensitivity for infection was 12/26 (46%), the specificity 58/58 (100%), the positive predictive value 12/12 (100%), and the negative predictive value 58/72 (81%). In the group with infection there was a trend towards less exposure to antibiotics in cases with positive cultures than cases with negative cultures. The Kamme & Lindberg procedure is applicable also to knee arthroplasties, but the low sensitivity and negative predictive value underline the need for new diagnostic methods.

Detection of candidaemia in high risk patients: can yield of blood cultures be improved by blind subculture?

Rapid detection of candidaemia is crucial for timely antifungal chemotherapy. However, the sensitivity of automated blood culture (BC) systems has been questioned. Blind subculture might increase detection rate and possibly also reduce time to detection of candidaemia. This retrospective study aimed to evaluate the efficacy of blind subcultures in patients deemed at high risk of candidaemia. BCs were processed by the BacT/Alert BC system, and during a 5-y period (1998-2003) subculture on the third d of incubation was performed for patients selected by clinical and microbiological assessment. A total of 79,165 BCs were drawn during the study period. 2154 BCs from 285 patients were selected for subculture. 103 (4.8%) BCs from 52 patients were yeast positive; 71 were detected positive prior to the planned subculture, 25 were positive on subculture, and 7 were negative on subculture, but became positive during further incubation. The 25 BCs positive on subculture originated from 14 patients, 11 of whom had already been diagnosed with candidaemia during the previous 14 d. Thus, a primary diagnosis of candidaemia was obtained by subculture in only 3 (1.1%) of the 285 patients selected. In conclusion, in our clinical setting blind subculture did not materially increase the detection of candidaemia, but helped to document persistent infection in a subset of cases.