An audit of microbiology laboratory utilization: the diagnosis of infection in orthopedic surgery.

OBJECTIVE: To analyse the quality of ordering, collection and transport of specimens for microbiological analysis by a department of orthopedic surgery. METHODS: The analysis consisted of a prospective formal evaluation performed by two consultant microbiologists. RESULTS: One hundred and seventeen consecutive requests were audited. These requests belonged to 55 clinical episodes, 39 of which were of (presumed) infection and 16 of surveillance. The main sites sampled were: joint 28 (51%), and extra-articular bone or tissue 6 (11%). Of 98 surgical specimens, 20 (20%) yielded a relevant microorganism. The requests were classified as definitely appropriate in 67% and 85% of episodes, by the two consultants respectively. No request was considered unjustified. Collection, handling and transport were categorized as definitely appropriate in 56% and 73% of requests. Analysis of compliance with an existing protocol for prosthetic joint revision revealed similar errors. CONCLUSION: Audits of this type can give invaluable information about the area of uncertainty between the clinician and the laboratory and can identify appropriate measures for corrective action.

Diagnosis and treatment of 409 patients with prostatitis syndromes.

We reviewed 409 patients who had prostatitis syndromes during the period 1985-1991. Urine analysis, x-ray film of abdomen, and sonograms of the kidneys did not contribute to the diagnosis of prostatitis. In 22 percent of the urine samples, slight-to-moderate atypia was seen in urine cytology but no malignancy was found. Uroflowmetry data were abnormal for 30 percent of the patients, and thus uroflowmetry may contribute to treatment selection of patients who may gain from specific drugs such as the newly developed alpha-1 receptor blocking agents. Positive bacteria cultures were found in 10.4 percent of the prostatic fluid cultures and in 14.3 percent of cultures of the urethra. Ureaplasma urealyticum was seen in 19.6 percent of the prostatic fluid cultures and in 32 percent of cultures of the urethra. Prostatic fluid cultures did not give additional information, and the outcome of semen cultures showed a poor correlation with urethra or prostatic fluid cultures. In this series, the most advocated treatment remains the antibiotic treatment (75% of patients) bringing relief of complaints in 35.6 percent of the patients and cure in 23.8 percent. However, similar results were found if no antibiotics were administered (relief of complaints in 31.6% and cure in 30.5%) and more than one course of antibiotics did not improve these results. Consequently, we advocate the use of specific antibiotics only when the causative bacterial agent has been identified.

[Is Chlamydia TWAR of significance in The Netherlands?]. / Heeft Chlamydia TWAR betekenis in Nederland?

Chlamydia TWAR is as a newly recognised organism that causes respiratory tract infection with human-to-human transmission. Our sero-epidemiological study showed that in The Netherlands prevalence of TWAR antibodies is very low in children under the age of five years, increases after beginning of school age until adolescence, and remains high (80%) during adulthood. It is known that Chlamydia TWAR can cause acute lower respiratory tract infection. However, the exact clinical spectrum within the various groups of patients still needs to be defined.