A wide spectrum of fastidious and ampicillin-susceptible bacteria dominate in animal-caused wounds.

The main purpose of this study was to assess the actual occurrence of Gram-negative oxidase-positive bacteria (GNOP) in human wounds caused by animals, mostly cat and dog bites and scratches, and with signs of infection. We report a prospective series of 92 wound samples. Routine culturing was combined with a procedure optimised for fastidious GNOP. All GNOP isolates were identified by 16S rDNA sequencing to the species level. We observed a more prominent role of GNOP, including at least 30 species mostly in the families Flavobacteriaceae, Neisseriaceae and Pasteurellaceae, and less of Staphylococcus aureus and streptococci. The antibiotic susceptibility pattern was investigated, as GNOP are associated with sudden onset of serious infections, making an early decision on antibiotic treatment vital. All GNOP isolates judged to be clinically relevant displayed susceptibility to ampicillin and meropenem, but resistance to oxacillin, clindamycin and gentamicin was frequent. Our findings emphasise the need to cover GNOP as recommended in guidelines, and not only common wound pathogens, when treating an animal-caused wound.

Nosocomial transmission of hepatitis B virus infection through multiple-dose vials.

The source of acute hepatitis B virus (HBV) infection in two women (55 and 72 years old) was investigated. They displayed no risk factors for acquiring HBV infection, other than treatment with local anaesthetic injections some months previously. The HBV strains were sequenced and showed distinct homology to strains seen in Swedish intravenous drug users (IVDU). Prior to these patients' acute infection, an outbreak of HBV had occurred among IVDU in the same county. Analysis of the HBV strains from six of these IVDUs showed their core promoter, precore and pre-S sequences (679 nucleotides) to be identical to those from the two patients. Cross-contamination between samples was excluded and the most likely source of infection was thought to be multiple-dose vials of local anaesthetic that had been contaminated with the HBV strain circulating among the IVDU population in the community. We believe that multiple-dose vials have no place in modern healthcare and recommend sequence homology analysis as an alternative or additional way to trace a source of HBV infection.

The risk of Guillain-Barré syndrome following infection with Campylobacter jejuni.

To estimate the incidence of Guillain-Barré syndrome (GBS) following Campylobacter jejuni infection (CI) we studied three populations where outbreaks of CI had occurred involving an estimated 8000 cases. No case of GBS was detected in the 6 months following the outbreaks in the local populations. The point estimate for the risk of GBS following CI estimated in this study was 0 in 8000 (95% confidence interval 0-3).

Immunity in the Swedish population: diphtheria, tetanus and poliomyelitis.

BACKGROUND: Large-scale vaccination programmes have been carried out for a long time in Sweden, as in many other countries. However, often little is known of the effects of these vaccinations. During 1990 and 1991 a survey of immunity based on a random adult population sample was carried out. The main purpose was to estimate the level of immunity to diphtheria, tetanus and polio of the adult population in Sweden. In total 4800 people were randomly selected according to a stratified, two-stage, sampling plan. METHODS: Based on standard sampling theory, methods for calculations of estimates and confidence intervals of the proportion of the population that is immune are given. The response patterns and its possible effects on the estimates are discussed. RESULTS: In total, 70.6% of the 4800 selected gave a blood sample. The response rate differs for men and women and for different age groups. Among the oldest, the response rate was close to 80%, but it was only about 60% among the youngest. CONCLUSIONS: With the survey design used, it was possible to obtain a sufficient degree of response. Our experience is that the response rate depends to a large extent on the efforts made to explain and motivate participation.

Immunity to tetanus, diphtheria and poliomyelitis in the adult population of Sweden in 1991.

BACKGROUND: During 1990 and 1991 a survey of immunity was carried out in Sweden. The main purpose was to estimate the level of immunity to diphtheria, tetanus and polio in the adult population. In total, 4800 people, randomly selected according to a stratified, two-stage, sampling plan, were contacted and asked to contribute a blood sample. Of those selected, 70.6% gave a blood sample. METHODS: Estimates and confidence intervals of the proportion of the population with antibodies exceeding some titre was calculated. The population was divided according to sex, year of birth (five age groups) and residence (four regions). RESULTS: In age groups that were born after the introduction of childhood vaccination, > or =90% and 75-90% of people have demonstrable antibodies at a protective level against tetanus and diphtheria respectively. Those born earlier, especially women, are poorly protected with less than 50% having protective antibody levels for both tetanus and diphtheria. Differences between men and women were particularly seen in the age groups born between 1930 and 1950. Less than 5% of the Swedish population lacked the protective level antibodies against polio types 1, 2 and 3 respectively. CONCLUSIONS: Vaccination against tetanus, which can be combined with vaccination against diphtheria, can be recommended especially to women born before 1950 and with no documented previous vaccination. The same recommendation can be given for men born before the 1930s. As regards poliomyelitis, general booster vaccination of the adult population does not appear to be necessary at present.