A fatal case of disseminated zygomycosis associated with the use of blood glucose self-monitoring equipment.

We report a fatal case of disseminated zygomycosis due to Cunninghamella bertholletiae in a 68-year-old man with myelodysplasia and type II diabetes mellitus, receiving desferrioxamine therapy for iron overload secondary to multiple transfusions. It is thought that he acquired the infection through the use of blood glucose self-monitoring equipment.

Evaluation of the mastascanelite image analysis system for measuring zones of inhibition in disc diffusion susceptibility tests.

In this evaluation a mastascanelite image analysis system is compared with manual measurement of disc diffusion inhibition zones. Data for 213 diverse organisms and a total of 1679 organism/antibiotic combinations gave an overall correlation coefficient of 0.988. The mean difference between readings was +0.425 mm, with 95% confidence limits of +/-2.94 mm, and the majority of scanned zones (97.51%) fell within +/-3 mm of the manual measurement. The mastascanelite system forms part of a laboratory suite and was found to be objective, accurate and rapid, reading and interpreting each plate in less than a second. Interfacing to the laboratory computer system facilitated data handling and performance control.

Capsular serotypes and antibiotic sensitivity of Streptococcus pneumoniae isolated from primary-school children.

A total of 1049 primary-school children in 18 schools were screened for carriage of Streptococcus pneumoniae. Data on family size, antibiotic use, travel and hospital admissions were collected. Pneumococcal serotyping and sensitivity tests were performed. One third of children were found to be pneumococcal carriers. Ten of 344 isolates were penicillin-resistant (2.9%). Apart from resistance to trimethoprim and ciprofloxacin, resistance rates in penicillin-sensitive strains were low. Among penicillin-resistant strains (PRP), co-resistance to trimethoprim, chloramphenicol and tetracycline was common. Cefotaxime-resistance was seen in 90% of PRP. Although 24 serotypes were represented, groups 6, 19 and 23 accounted for 55% of strains. Serogroup 23 strains were significantly more likely to be penicillin-resistant than other groups/types. Clustering of strains by serotype and antibiotic resistance was seen in several schools. No association with foreign travel, family size or age of siblings was seen and penicillin resistance was not associated with prior antibiotic use. However, hospital admission was significantly associated with carriage of PRP. The implications of detecting PRP in the community are discussed.

'Grippers' shoes: can they be reused?

'Grippers' footwear has been recommended for patients with painful or bandaged feet. In order to reduce costs, reuse between patients may be considered. The manufacturer's proposed washing instructions were evaluated. Thermal disinfection was not achieved with the 40 degrees C wash cycle recommended. Higher temperatures resulted in shrinkage and deformation of the shoes. We recommend that these shoes are not reused or that alternative methods of disinfection are employed.

Hexachlorophane powder and neonatal staphylococcal infection.

An outbreak of Staphylococcus aureus infections occurred following discontinuation of antiseptic cord care on a neonatal unit. Multiple phage types were involved. The most common site of infection was the umbilicus. In addition, there were two clusters of methicillin-resistant S. aureus (MRSA) infection and one due to Streptococcus pyogenes. The outbreak was rapidly controlled by the reintroduction of hexachlorophane powder for cord care.

Clustering of group A streptococcal infections on a burns unit: important lessons in outbreak management.

In a 12-month period 37 patients and four members of staff on a burns unit were infected or colonized by Streptococcus pyogenes (Group A streptococcus). One patient became septicaemic and died. Serotyping revealed five distinct clusters against a low background level of infection. Infection control measures included isolation, screening of patients, staff and environment and the use of prophylactic antibiotics for uninfected patients. We discuss the role of staff and patient carriers and the environment as a continuing source of infection, and the importance of serotyping in outbreak epidemiology.

Clostridial endocarditis: report of a case caused by Clostridium septicum and review of the literature.

We describe a case of fatal infective endocarditis due to Clostridium septicum in a patient with underlying colonic carcinoma. This is believed to be the first reported case of C. septicum endocarditis. The literature on the subject is reviewed.

In-vitro activity of ten antimicrobial agents against penicillin-resistant Streptococcus pneumoniae.

The minimum inhibitory concentrations (MICs) of ten antibiotics were determined by the agar dilution method for 40 strains of penicillin-resistant Streptococcus pneumoniae, all of which were clinical isolates from this laboratory. The antibiotics tested were clarithromycin, erythromycin, teicoplanin, vancomycin, ceftriaxone, cefodizime, azithromycin, ramoplanin, ciprofloxacin and MDL 62873. Of these agents, clarithromycin, vancomycin, teicoplanin, ceftriaxone, ramoplanin and MDL 62873 were the most active. The role of these antibiotics as alternatives to penicillin for the treatment of infections caused by penicillin-resistant S. pneumoniae is discussed.

Evaluation of the Microring YT system for identifying clinical yeast isolates.

The Microring YT is a commercial system for identifying clinical yeast isolates. The system uses a series of discs impregnated with inhibitory agents mounted on a ring. The pattern of growth and inhibition produced provides a six digit code which can be compared with a table provided by the manufacturer. The performance of this system was compared with the API 32C in the identification of 606 yeast isolates (355 clinical and 251 environmental strains). The Microring YT system was in 72.6% agreement with the API 32C system. The sensitivity of identification of different species varied from 38% to 100%. The API 32C system has a more extensive database than the Microring YT and is thus more reliable for use, but it is considerably more expensive. It is concluded that although the Microring YT is cheap, easy, and convenient to use, it is inadequate for many common Candida species.