[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.

16S rRNA gene sequencing in routine identification of anaerobic bacteria isolated from blood cultures.

A comparison between conventional identification and 16S rRNA gene sequencing of anaerobic bacteria isolated from blood cultures in a routine setting was performed (n = 127). With sequencing, 89% were identified to the species level, versus 52% with conventional identification. The times for identification were 1.5 days and 2.8 days, respectively.

[Blood cultures--indication and antibiotic therapy]. / Bloddyrkning--indikation og antibiotisk behandling.

INTRODUCTION: The purpose of this study was 1) to record the indication for obtaining blood cultures by registration of rectal temperature and presumed focus or symptoms 2) to register the choice of antibiotic therapy immediately after obtaining the blood culture and to relate it to the indication and 3) to evaluate the indication and choice of antibiotic therapy on the basis of the blood culture result. MATERIAL AND METHODS: The study is a retrospective study of all blood cultures obtained at a department of internal medicine. In all 432 defined episodes, where blood cultures were obtained, the rectal temperature and the presumed focus or symptoms were registered. RESULTS: In 46.1% of the episodes the rectal temperature was below 38.5 degrees C. The most frequently presumed focus was the respiratory tract, accounting for 38.2%. Significant microorganisms were found in 50 episodes (11.6%) and in 14 (28%) of these the rectal temperature was below 38.5 degrees C. In 18 episodes (36%), the antibiotics used were inappropriate. DISCUSSION: It is difficult to define clearly the indication for obtaining blood cultures. There are many parameters to be considered, the rectal temperature being one of the most important, though not necessarily the decisive guideline. In many cases the presumed focus at the time of blood culture does not correspond well with the microorganism isolated later. It is therefore imperative to collect other relevant specimens in addition to blood and to make sure that the antibiotic therapy covers the most frequent types of infections and most serious aetiologies.

[Can we rely on the results of urine microscopy and culture when tests are performed in general practice?]. / Kan man stole på urinmikroskopi og dyrkning, der er udført i almen praksis?

INTRODUCTION: Urinary tract infections (UTI) account for 2-5% of consultations in general practice, but only about half the patients with dysuria have significant bacteriuria (> 100,000 bacteria per ml). A microbiological diagnosis can be made by examination of a urine sample, and in Danish family practice the diagnosis of UTI is often reached by a microscopic analysis or a dip-slide culture test. These methods have a high validity when performed in hospital, but we need knowledge about the validity of microbiological urine examinations when performed in general practice. The aim of this study was to validate detection of bacteriuria by urine microscopy and dip-slide culture in general practice. MATERIAL AND METHODS: Urine specimens artificially produced by adding a known quantity of bacteria (Escherichia coli, Proteus mirabilis, Enterobacter cloacae, Staphylococcus epidermidis and Enterococcus faecalis) to sterile urine were sent to 25 general practices for microscopic examination and dip-slide culture. No prior instruction in testing procedure was given. As the gold standard, the results of a standardised culture method performed by skilled laboratory technicians at the Department of Microbiology, University of Southern Denmark, were used. RESULTS: Significant bacteriuria was identified by microscopy with a sensitivity of 95% and a specificity of 83%. The corresponding figures for urine culture were 95% and 96%. The morphology of bacteria was interpreted correctly in 80% of microscopic examinations, and 60% of the bacteria strains were classified correctly in terms of their motility. DISCUSSION: The results of urine microscopy and culture performed in general practice are to be relied on.

[Resistance tests in general practice. Validity can be improved by standardized procedures]. / Resistensbestemmelse i almen praksis. Validiteten kan forbedres ved standardiserede procedurer.

INTRODUCTION: Susceptibility testing of bacteria in urine is one of the commonest laboratory tests in general practice in Denmark. It is quick and easy to perform, but recent studies have shown low validity when the test is performed in general practice. If it is to continue as a diagnostic tool in general practice, its quality should be improved. The aim of this study was to investigate the effect of an intervention to improve the quality of susceptibility testing in general practice. MATERIAL AND METHODS: Twenty-three randomly selected general practices took part in the study. The intervention consisted of visits by laboratory technicians who instructed the practitioners in standardised procedures for susceptibility testing. Before and after the intervention, urine specimens containing monocultures of typical uropathogenic bacteria were sent to the practices. The practitioners performed susceptibility testing by the Sensicult and the Iso-Resagar methods, and the validity of the results before and after the intervention was compared. Results from susceptibility testing at the bacteriological laboratory, Odense University Hospital, were used as the gold standard. RESULTS: The median frequency of correct results increased from 82% to 98% for susceptibility testing by the Sensicult method (p = 0.001) and from 90% to 96% by the Iso-Resagar method (p = 0.05). DISCUSSION: The validity of susceptibility testing in general practice improves when preceded by instruction in standardised procedures.

Ear infections with Shewanella alga: a bacteriologic, clinical and epidemiologic study of 67 cases.

OBJECTIVE: To present bacteriologic and clinical data on 67 patients from the island of Funen, Denmark, with Shewanella alga, a bacterium rarely seen in Scandinavia, isolated from ear swabs. Included in the study is an examination of the occurrence of S. alga in sea water around the island. METHODS: Bacteriologic examination and antibiotic susceptibility testing of 67 clinical isolates, 11 sea-water isolates and two reference strains were conducted. Clinical information was obtained from the referring physicians. RESULTS: During 6 months S. alga was isolated from 67 patients, in 33 cases in pure culture. Seventy per cent of the patients were children between 3 and 15 years old who had clinical symptoms of acute or chronic otitis media. Previous ear disease was common (76%). Most of the cases (85%) occurred in August or September, and 47 of 55 patients reported contact with sea water shortly before symptoms developed. From seven of the patients, S. alga was isolated more than once. The species was also isolated from five of 10 bathing areas around the island of Funen. CONCLUSIONS: The patients were probably infected with S. alga during sea-water bathing in the unusually warm summer of 1994. Infections with marine bacteria are possible in countries with a temperate climate; patients with previous ear disease are at special risk.