Predicting postoperative fever and bacterial colonization on packing material following endoscopic endonasal surgery.

Postoperative fever following endoscopic endonasal surgery is a rare occurrence of concern to surgeons. To elucidate preoperative and operative predictors of postoperative fever, we analyzed the characteristics of patients and their perioperative background in association with postoperative fever. A retrospective review of 371 patients who had undergone endoscopic endonasal surgery was conducted. Predictors, including intake of antibiotics, steroids, history of asthma, preoperative nasal bacterial culture, duration of operation, duration of packing and intraoperative intravenous antibiotics on the occurrence of postoperative fever, and bacterial colonization on the packing material, were analyzed retrospectively. Fever (≥38 °C) occurred in 63 (17 %) patients. Most incidences of fever occurred on postoperative day one. In majority of these cases, the fever subsided after removal of the packing material without further antibiotic administration. However, one patient who experienced persistent fever after the removal of packing material developed meningitis. History of asthma, prolonged operation time (≥108 min), and intravenous cefazolin administration instead of cefmetazole were associated with postoperative fever. Odds ratios (ORs) for each were 2.3, 4.6, and 2.0, respectively. Positive preoperative bacterial colonization was associated with postoperative bacterial colonization on the packing material (OR 2.3). Postoperative fever subsided in most patients after removal of the packing material. When this postoperative fever persists, its underlying cause should be examined.

Antibodies directed against integration host factor mediate biofilm clearance from Nasopore.

OBJECTIVES/HYPOTHESIS: Intranasal resorbable packing, such as Nasopore, is commonly used during sinus surgery despite a paucity of evidence that demonstrates clinical benefit. We theorized that Nasopore supports bacterial growth and biofilm formation. The DNABII family of bacterial nucleic acid binding proteins stabilizes the extracellular polymeric substance of the biofilm, thus protecting bacteria from host defenses and traditional antibiotics. We tested the hypothesis that use of anti-IHF antibodies in conjunction with antibiotics would enhance biofilm eradication from Nasopore. STUDY DESIGN: In vitro experiments. METHODS: Nontypeable Haemophilus influenzae (NTHI) biofilms were grown on Nasopore. Following 24-hour incubation, biofilms were incubated for an additional 16 hours with either medium alone, naïve rabbit serum, rabbit anti-IHF serum, amoxicillin/clavulanate, or anti-IHF serum + amoxicillin/clavulanate. Computer statistics (COMSTAT) analysis was performed on images of biofilms obtained via confocal microscopy. RESULTS: NTHI readily formed a biofilm on Nasopore. Treatment with amoxicillin/clavulanate alone mediated an increase in biomass by 92% to 6.63 µ(2) /µ(3) compared to incubation in sterile medium alone (3.46 µ(2) /µ(3)). Treatment with anti-IHF alone reduced the biomass by 77% to 1.29 µ(2) /µ(3) compared to incubation with naïve rabbit serum (5.53 µ(2) /µ(3)). Anti-IHF + amoxicillin/clavulanate reduced biomass by 88% to 0.66 µ(2) /µ(3) (P <0.02) compared to incubation with naïve rabbit serum. CONCLUSION: Antibiotics alone were ineffective in eradicating NTHI biofilms that had formed on Nasopore in vitro. Anti-IHF antibodies plus amoxicillin/clavulanate therapy synergistically reduced biofilm biomass by 88%. These data support clinical studies for the use of anti-IHF combined with antibiotics to reduce biofilm formation on intranasal packing.

Development and validation of a drag swab method using tampons and different diluents for the detection of members of Salmonella in broiler houses.

Members of the genus Salmonella represent a significant public health concern and also a colonizer of commercial poultry. Therefore, the early detection and management of colonized broiler breeders and their progeny is essential. There have been numerous methods for farm-based detection, with gauze-based drag swabs being the most commonly used. In the present study, the wet (boiled water, buffered peptone water and double-strength skin milk) tampon was compared with the gauze to determine the recovery rate (10(2) colony-forming units/swab) of five common poultry serovars of Salmonella and after cold (4°C/48 h) storage. The recovery was found to be equivalent when tested using the ISO6572:2002 method, for all diluents (Cohen's κ =1.0; sensitivity = 1.0; specificity = 1.0). The subsequent field trial (n = 15 farms) compared the tampon drag swab (TDS) with a statistically appropriate (90% confidence, detect 10% prevalence) number of faecal swabs (n = 22), which also showed high agreement between the TDS and faecal sampling (κ = 0.86; McNemar's χ(2) = 1.0; sensitivity = 0.9; specificity = 1.0). However, direct faecal sampling showed a wider diversity of serovars of Salmonella than the corresponding TDS. The TDS is a very sensitive, readily available and cost-effective screening method for salmonellas in broiler breeder houses. This TDS technique may be used for routinely screening of broiler houses, and faecal sampling would only be used to confirm colonization or contamination, and to measure flock serovar variance.

A toroid model for in vitro investigations of toxic shock syndrome toxin-1 production.

Human behaviours and consumer products may affect vaginal microbial ecology, thereby influencing women's health. Relevant experimentation systems are needed to understand such possible links. Here, we describe the development of a practical semi-solid in vitro model to assess the effects of interactions between vaginal environment and the presence of tampons, on bacterial communities, including the production of toxic shock syndrome toxin-1 (TSST-1) by Staphylococcus aureus.

Diagnosis of sexually transmitted infections (STI) using self-collected non-invasive specimens.

Paramount in control of transmission of sexually transmitted infections (STIs) is their prompt recognition and appropriate treatment. In countries where definitive diagnoses are difficult, a 'syndromic approach' to management of STIs is recommended and practiced, yet many STIs have common symptoms or are asymptomatic and therefore go undetected and untreated. This is of particular concern with the recognition that HIV transmission is increased with co-existent STIs: the attributable risk for each STI varying with the prevalence within a particular population. Hence, HIV public health prevention approaches must include STI preventative strategies to be effective. Even then, microbiological screening is incorporated into STI control strategies; lack of access to appropriate services (especially in rural and remote areas), reluctance of at-risk populations to attend for treatment, fear of invasive genital examinations, and lower sensitivities of conventional diagnostic assays reduces the effectiveness of such programmes. Therefore, accurate, cost-effective, reliable diagnostic assays (preferably those which can be used in the field) are needed to impact on the incidence of the various STIs, as well as HIV. With the advent of molecular technologies, including target and signal amplification methods, diagnoses of STIs have been revolutionised and allow the use of non or minimally invasive sampling techniques, some of which are self-collected by the patient, e.g. first-void urine, cervico-vaginal lavage, low vaginal swabs, and tampons. Most studies evaluating such self-sampling with molecular diagnostic techniques have demonstrated an equivalent or superior detection of STIs as compared to conventional sampling and detection methods. These sampling methods can also be used to determine prevalence of STIs in various populations, but particularly those with difficult access to medical care. In this article, the utility of self-sampling collection devices for detection of various STIs, particularly in women, is reviewed as one step towards formulating appropriate strategies in control of STIs, and which are especially suited for remote areas.

Bacteriemia in septoplasty and septorhinoplasty surgery.

This study was conducted in an attempt to investigate whether bacteriemia developed in patients with septoplasty and septorhinoplasty in the postoperative period during which an anterior nasal pack was in their nose. Fifty-three patients who went through septoplasty or septorhinoplasty operations were followed in this study. Nasal smear cultures were obtained from all the subjects before the operation. After the packs were retrieved, smears were also obtained from the pack material. Venous blood samples were obtained from the patients immediately before the operation, after the operation and immediately following the retrieval of the pack. When preoperative nasal smear cultures and postoperative pack material cultures of the patients that were obtained at 48 hours were compared, it was seen that different microorganisms were present in 66% of the patients. Bacterial growth was not observed in any of the preoperative blood cultures; whereas 8 patients (15.0%) had bacteriemia in the blood samples obtained immediately after the operation and 9 (16.9%) had growth in the blood samples obtained following the retrieval of the pack. With these results we have seen that bacteriemia can develop in patients with septoplasty and septorhinoplasty. It did not cause serious clinical problems. However, in patients with cardiovascular problems, this possibility should be taken into consideration and relevant preoperative precautions should be implemented.

Tampon samplings with longer cervicovaginal cell exposures are equivalent to two consecutive swabs for the detection of high-risk human papillomavirus.

BACKGROUND: Self-sampling for human papillomavirus (HPV) is useful for triage of ASCUS Papanicolaou (Pap) smears. Tampons with 10-second cervicovaginal cell exposure can detect HPV but appear to be less efficient than two consecutive swabs. GOAL: The purpose of this study was to evaluate increased vaginal tampon exposures for detecting high-risk HPV. STUDY DESIGN: This longitudinal cohort study followed women who self-sampled weekly with tampons for progressively longer periods of time. A tampon was inserted for 10 seconds at the office visit and 1 hour, 4 hours, and overnight for the three subsequent home samples. Two concurrent swabs were used with each tampon sampling for contemporaneous comparisons. The MY09/MY11 PCR primer system with reverse line blot detection strips was used to detect 18 distinct high-risk HPV types. RESULTS: Of the 309 tampons and 618 swabs used at home, 83% were returned. Among normal women, the 10-second tampon detected fewer with normal histology and high-risk HPV than did its swabs ( = 0.0412), but the 1-hour, 4-hour, and overnight tampons had high-risk-HPV detection rates equal to their swabs. In women with CIN, all tampons and swabs equally identified those with high-risk HPV. CONCLUSION: Self-sampling for HPV detection is acceptable, feasible, and technically accurate for both tampons with longer cervicovaginal exposures and swabs. The choice of technique is dependent on the woman, her culture, and her clinician.

[Staphylococcal toxic shock syndrome in young women]. / Stafilokokkovyi toksicheskii sindrom u zhenshchin molodogo vozrasta.

A literature review is presented on staphylococcal toxic shock syndrome. A case of this syndrome in a 39-year-old woman is reported. Clinical, pathology, treatment data on this condition are analysed.

Evaluation of patient-administered tampon specimens for Chlamydia trachomatis and Neisseria gonorrhoeae.

BACKGROUND: The patient-administered tampon specimen has proven to be an easy and sensitive method for the diagnosis of genital Chlamydia trachomatis and Neisseria gonorrhoeae infections in women by polymerase chain reaction (PCR). This method avoids the need for endocervical sampling and stringent criteria for transport. GOAL: To evaluate two commercial amplification systems for the detection of C trachomatis and N gonorrhoeae from tampon specimens. STUDY DESIGN: A group of 400 positive and negative tampon specimens tested by an in-house PCR method were selected from a pool of more than 2,000 previously collected tampons. Overall, 93 C trachomatis-positive and 77 N gonorrhoeae-positive specimens were evaluated. Each specimen was tested by Roche Cobas Amplicor and Abbott LCx (LCR), and results were compared to the in-house PCR method. RESULTS: Detection of C trachomatis by both assays was not significantly different from the in-house PCR assay. Fewer tampons were positive for N gonorrhoeae by LCR than either the in-house assay (P = 0.0001) or by Roche Amplicor (P = 0.01). However, tampon specimens tested by Roche Amplicor required DNA extraction to achieve comparative sensitivity. CONCLUSION: Both commercial assays can be applied to tampon-collected specimens for automated detection of sexually transmitted diseases. The detection of C trachomatis was similar to the in-house PCR test for both assays (P = 0.73, 0.68). Detection of N gonorrhoeae resulted in fewer positive tampon specimens when tested by ligase chain reaction than both Roche Amplicor and in-house PCR.

Comparison of tampon and urine as self-administered methods of specimen collection in the detection of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis in women.

Self-administered sampling techniques for the detection of sexually transmitted diseases (STDs) are particularly useful due to their ease of collection and better patient compliance. Urine specimens, and recently tampons, have been described as methods of specimen collection for the detection of some STDs in women. In this study, 660 women had both first-void urine (FVU) and tampon specimens analysed by polymerase chain reaction (PCR) for the detection of Chlamydia trachomatis, Neisseria gonorrhoeae and Trichomonas vaginalis. Overall 6.5%, 10.1% and 17.9% of urine samples were positive whereas 7%, 21.2% and 22% of tampon specimens were positive for C. trachomatis, N. gonorrhoeae and T. vaginalis respectively. Tampon-collected specimens tested by PCR were more sensitive than urine specimens for the detection of N. gonorrhoeae and T. vaginalis (P < 0.001) and equally sensitive for the detection of C. trachomatis (P=0.45).