Anti-HBs levels after hepatitis B immunisation depend on test reagents: routinely determined 10 and 100 IU/l seroprotection levels unreliable.

In a large series of post-vaccination samples we compared the result of three commercially available anti-HBs assays (AxSYM, Architect and Access) on the quantitation of anti-HBs after immunisation with Engerix-B (HBsAg/ad) and GenHevacB (HBsAg/ay) vaccine. Two of the assays (AxSYM, Architect: Abbott Laboratories) gave related but not identical results with HBsAg from different sources. The result of the third assay (Access, Beckman Coulter) was related to that of AxSYM and Architect only for GenHevacB anti-HBs but differed for Engerix-B anti-HBs (P<0.001). This vaccine dependent discrepancy was also observed with the Vidas anti-HBs assay (BioMerieux). An external WHO reference panel could harmonise geometric mean anti-HBs levels from the four assays for GenHevacB but not for Engerix-B vaccination sera. We conclude that the individually determined anti-HBs level (IU/l) strongly depend on the test reagents and the vaccine under study.

Clinical relevance of herpes simplex virus in the throat of elderly with Salmonella enteritidis gastroenteritis.

It is not known whether the presence of Herpes simplex virus in the throat of elderly patients with severe gastroenteritis and pulmonary implications is of clinical relevance. We cultured throat swabs and faeces of elderly patients with (n = 11) and without (n = 12) severe Salmonella gastroenteritis for viruses and bacteria to study the aetiology of respiratory complications. Complement fixation titers for anti-Herpes simplex antibodies in paired sera were also ascertained. Throat swabs of 6 out of 11 elderly patients with severe Salmonella enteritidis gastroenteritis were positive for Herpes simplex virus type 1. However, a four-fold increase of anti-Herpes simplex antibody titers in paired sera could not be demonstrated. None of the 12 throat swabs of elderly patients without gastro enteritis grew Herpes simplex virus. No other pathogens causing pulmonary complications could be demonstrated in throat swabs of the elderly patients. Herpes simplex virus present in the throat of the elderly patients was very probably not the agent responsible for the pulmonary complications and consequently treatment with acyclovir was not indicated. Weakness caused by severe gastroenteritis and the relative T-lymphocyte immunodeficiency state in the elderly probably enhanced the shedding of Herpes simplex virus in the throat of the elderly patients, without clinical relevance.

Control of an epidemic spread of a multi-resistant strain of Acinetobacter calcoaceticus in a hospital.

The spread of a multi-resistant glucose-acidifying Acinetobacter calcoaceticus strain in a community hospital was studied. After admission of a colonized patient to the hospital the strain was found in clinical specimens from ICU patients and subsequently from several of these patients after transfer to medical wards. Environmental specimens from the ICU and medical wards were analysed in order to investigate the mode of spread of the strain. Isolates of A. calcoaceticus were screened by their antibiotic resistance pattern. In addition, the cell envelope protein electrophoretic profiles were used as epidemiological markers. The multi-resistant acinetobacters all had the same protein profile. To prevent spread of the epidemic strain strict hygienic measures were enforced, e.g. scrupulous cleaning of the room after discharge of any colonized patient and increased attention to the hand hygiene of the medical and nursing staff. Furthermore, the use of antibiotics was restricted. Although this strain was only eradicated with difficulty in the affected patients, it did not spread throughout the hospital. Colonization of patients with the multi-resistant micro-organism was predominantly localized to the ICU.

Efficacy and safety of pefloxacin in the treatment of patients with complicated urinary tract infections.

One hundred and four patients with complicated urinary tract infections (prolonged severe chronic infections or with complicated postoperative conditions) were treated for ten days with pefloxacin 400 mg bid. Bacteriological eradication of the initial pathogen was achieved in 98% of the patients. After six weeks 93% of the patients were still free of the initial infecting microorganism. Clinical improvement was achieved in 77% of the patients five to seven days after cessation of treatment. The side-effects which were definitely related to pefloxacin occurred in 9% of patients and were mostly of a gastro-intestinal, a neurological, or an allergic nature. No significant biochemical or haematological adverse reactions occurred.