[HIV occupational risk of surgical specialists and operating room personnel in the Saint Lucas Hospital in Amsterdam]. / HIV-beroepsrisico van snijdende specialisten en operatiekamermedewerkers in het Sint Lucas Ziekenhuis te Amsterdam.

All instrument and needle accidents, and mucosal exposure to blood involving surgical specialists and operating room personnel were recorded for a seven-month period in a middle-sized Amsterdam hospital, the St. Lucas. Fifty-four accidents were reported, of which 42 were percutaneous wounds and 12, blood splatters in the eyes. The frequency of percutaneous wounds per operation per person ranged from 0 to 0.013. In the same period 3098 patients who had to be operated on were asked to participate in an anonymous study for HIV antibody. One hundred and twenty patients refused participation (3.9%). Of the 2978 participating patients seven were seropositive for anti-HIV (0.23%). The observed percutaneous accident frequency and HIV prevalence were used in combination with reports from the literature on the risk of infection after a single exposure to HIV infected material, to calculate the HIV professional risk for operating room personnel in this hospital. For general surgeons the risk of infection (based on 500 operations per year) was calculated as 0.0012 for an occupational lifespan of 30 years. For the other specialists and functions the risk was the same or less. Considering the low risk our conclusion is that screening of preoperative patients is not necessary in this hospital. The observance of general protective measures provides sufficient protection for the professional group examined.

Serovars, auxotypes, and plasmid profiles of PPNG strains with Asian type plasmid isolated in Amsterdam.

In 1982 an increase of penicillinase producing strains of Neisseria gonorrhoeae (PPNG), carrying the 4.5 megadalton Asian type plasmid and the 24 megadalton transfer plasmid (Asia+), was observed in Amsterdam. The main auxotypes were proline requiring (Pro-) and proline and hypoxanthine requiring (Pro-Hyx-). Using two monoclonal antibody systems, it was shown that the serovars of strains with these auxotypes isolated in 1981 were different from those isolated in 1982, which indicated the start and end of microepidemics. Different serovars were also observed in Pro- and non-requiring (NR) Asia- PPNG strains isolated in 1981-2 and 1985 respectively. Only one serovar (Aedih/Arst) was common in strains isolated in 1981-2 as well as in 1985.

Surveillance of the antibiotic susceptibility of non-penicillinase producing Neisseria gonorrhoeae in The Netherlands from 1983 to 1986.

From 1983 to 1986 more than 2000 non-penicillinase producing Neisseria gonorrhoeae from Amsterdam, The Hague and Rotterdam were auxotyped and screened for susceptibility to 10 antibiotics by MIC determination. By far the commonest auxotypes were N.R. (non-requiring; 40%) and Pro- (proline requiring; 30%). During that period there was a substantial shift in the ratio of both auxotypes-roughly from 1:2 to 2:1-in The Hague. Pro- isolates were generally less susceptible than N.R. isolates, and there was a strong positive correlation between the MICs of the different drugs. The prevalence of isolates with a penicillin MIC equal to or above 0.5 IU/ml amounted to 14%, while in only 1% was the MIC above 1 IU/ml. Comparing our results with an earlier study by Stolz, Zwarte & Michel (1975, British Journal of Venereal Diseases 51, 257-64), the level of resistance to penicillin among non-PPNG has not significantly increased in The Netherlands since 1972. The prevalence of isolates showing relative resistance towards tetracycline and thiamphenicol (MIC 2-4 mg/l) decreased from approximately 20% in 1983/84 to approximately 10% in 1985/86, coinciding with a drop in the prevalence of Pro- isolates. All strains were susceptible to cefuroxime and spectinomycin and highly susceptible to cefotaxime and ciprofloxacin.

Serovars, auxotypes, and plasmid contents of PPNG strains from outbreak in Amsterdam.

The first outbreak of penicillinase producing strains of Neisseria gonorrhoeae (PPNG) in Amsterdam in 1981-2 was caused mainly by African strains carrying the 24 megadalton transfer plasmid (Afr+) that were non-requiring (NR) and inhibited by phenylalanine (pheni), but African strains without the transfer plasmid (Afr-) that were NRpheni and Afr+ NR strains were also found. Serological classification, using two monoclonal antibody systems, showed that three main serovars (Ae/Av, Aedih/Arst, and Bacejk/Brpyust) could be distinguished in these PPNG strains, which indicated exchanges of plasmids in these serovars. The serovar Ae/Av predominated in the Afr+ and Bacejk/Brpyust in the Afr- strains.

Alpha-hemolytic streptococcal septicemia with severe complications during neutropenia in childhood cancer.

After introduction of selective decontamination of the digestive tract (SDD), a change toward an increase of infections by Staphylococcus epidermidis and alpha-hemolytic Streptococci has been noticed in the predominant etiology of infections during neutropenia. During a 27-month study period, 165 positive blood cultures were obtained from 64 neutropenic children. In 26 cases there was septicemia caused by Streptococci. Alpha-hemolytic Streptococci were isolated from blood culture in 25 cases. In 1 case septicemia was caused by beta-hemolytic Streptococcus of group G. In 10 patients, all with hematologic malignancies, septicemia attended with complications. We suggest that patients with hematologic malignancies are at risk of an unusually severe clinical course of streptococcal septicemia.

Comparison of oral treatment of uncomplicated urogenital and rectal gonorrhoea with cefuroxime axetil ester or clavulanic acid potentiated amoxycillin (Augmentin).

In a randomised study of two drugs for the oral treatment of uncomplicated urogenital and rectal gonorrhoea the therapeutic effect of cefuroxime axetil ester (CAE) and amoxycillin plus clavulanic acid (A + C) was compared. Cefuroxime axetil ester 1.5 g was given to 129 men and 118 women. Amoxycillin 3.0 g and clavulanic acid 0.25 g was given to 131 men and 122 women. Both treatments were combined with probenecid 1.0 g and administered in a single oral dose. Of the 500 patients thus treated, 376 were assessable. In the group taking CAE, failure rates were 0.9% for the men and 0% for the women; and the overall failure rate was 0.5%. In the group taking A + C the equivalent failure rates were 4.6%, 1.2%, and 3.1%. The differences were not significant. Penicillinase producing Neisseria gonorrhoeae (PPNG) was isolated from 5.6% of the assessable patients. All 10 PPNG infections in the group taking CAE and four of 11 PPNG infections in the group taking A + C were cured. These numbers were too small to draw a definite conclusion about the efficacy of both drugs in this type of infection. Postgonococcal urethritis was observed in 35% of the men in the group taking CAE and in 32% of those in the group taking A + C. Side effects were noted in 38% of the group taking CAE and 28% of the group taking A + C. Nausea and vomiting were more commonly observed in the group taking CAE; and diarrhoea was more commonly observed in the group taking A + C.

Relationship between auxotype, plasmid pattern and susceptibility to antibiotics in penicillinase-producing Neisseria gonorrhoeae.

The relationship between auxotype, plasmid pattern and susceptibility to antibiotics has been studied in 2396 penicillinase-producing Neisseria gonorrhoeae isolated in The Netherlands during 1982 and 1983. The most prevalent auxotypes were proline requiring (Pro-; 44%) and non-requiring with inhibition by phenylalanine (NR Pheni; 39%). The majority (97%) of the Pro- strains carried the 4.5 Mdal resistance plasmid and 99% of the prototrophic strains the 3.2 Mdal plasmid. MICs were determined for cefuroxime, cefotaxime, erythromycin, tetracycline, thiamphenicol and sulphamethoxazole. Pro- isolates were usually less susceptible to antibiotics than prototrophic strains. Evidence was obtained that the level of relative resistance is related to the nutritional requirement as well as the plasmid type.

Relation between nutritional requirements and susceptibilities to antibiotics of strains of Neisseria gonorrhoeae from pharyngeal and anogenital sites.

Auxotyping and antibiotic susceptibility testing was carried out on 100 consecutive isolates of non-penicillinase producing strains of Neisseria gonorrhoeae (non-PPNG) taken on the same occasion from throat and anogenital sites, 100 non-PPNG strains isolated from the throat only, and 100 non-PPNG strains from anogenital sites only. Non-requiring, non-requiring and phenylalanine inhibited, proline requiring, amino acid group requiring, and arginine requiring auxotypes predominated in all groups of patients. Strains of the arginine requiring type found in anogenital sites tended to have additional requirements. The auxotypes and susceptibility to antibiotics of 93 of the 100 paired cultures from the throat and anogenital sites were identical. There appeared to be a slight preponderance of moderately susceptible strains in isolates from the throat. A strong correlation was found between nutritional requirements and sensitivity to antibiotics. Auxotypes of and minimum inhibitory concentrations (MICs) for N gonorrhoeae isolated from the throat were mostly the same as the auxotypes of and MICs for strains that were circulating during the study period in Amsterdam.

Epidemiology of PPNG infections in the Netherlands: analysis by auxanographic typing and plasmid identification.

We carried out auxanographic typing and plasmid identification on 1380 isolates of penicillinase producing Neisseria gonorrhoeae (PPNG) isolated in the Netherlands in 1982 and found four plasmid patterns and 24 auxotypes with noticeable local or regional variations. Among 756 strains harbouring the 3 X 2 megadalton (Mdal) resistance plasmid ("African" type), with or without the 24 Mdal transfer plasmid, 667 (88%) were non-requiring and inhibited by phenylalanine. This type was endemic in most of the cities or regions we studied. Twenty methionine requiring PPNG strains were found, all harbouring the 3.2 and 24 Mdal plasmid; virtually all of them were isolated or contracted in the region of Groningen. The predominant (443 (71%) auxotype among the 624 PPNG strains containing the 4.5 Mdal plasmid ("Asian" type) (with or without the 24 Mdal plasmid) was proline requiring. This auxotype (with the 4.5 Mdal and 24 Mdal plasmid) caused an outbreak in Amsterdam, and in Groningen replaced the local methionine requiring auxotype which had the 3.2 Mdal and 24 Mdal plasmids. Many auxotypes with the 4.5 Mdal plasmid, and requiring proline only, or proline and isoleucine, circulated in the Hague. Spread of imported strains by prostitution played an important part in the epidemiology of infection with PPNG strains.

Epidemiology of PPNG infections in Amsterdam: analysis by auxanographic typing and plasmid characterisation.

In January 1981 the incidence of penicillinase producing Neisseria gonorrhoeae (PPNG) strains in Amsterdam had increased to 18% of all new cases of gonorrhoea. Auxanographic typing in combination with plasmid determination of 729 PPNG strains showed that in 1981 the predominant and endemic types were those with the Africa plasmid and transfer factor which were non-requiring and inhibited by phenylalanine. In 1982 proline requiring strains with the Asia plasmid and transfer factor increased after being imported and spread by prostitution. Four different plasmid patterns and 12 auxotypes were distinguishable. Unusual auxotypes of both African and Asian plasmid types are frequently imported, some disappearing soon after their introduction into Holland but others providing an opportunity to trace sources and contacts. Prostitution and the biological properties of PPNG strains seem to play an important role in their spread. Only 2.6% of them were isolated from homosexual men. In areas where PPNG strains are prevalent, auxotyping is an important tool in their surveillance.