Interlaboratory variations of fluoroquinolone susceptibility testing. An international study to validate the quality of microbiology results reported during the fleroxacin clinical trials.

Fleroxacin, a newer fluoroquinolone, has been investigated extensively in worldwide clinical trials by laboratories using a variety of in vitro susceptibility testing methods. These methods differ in their technical details, leading to applied interpretive criteria that can also differ from nation to nation and from method to method. This retrospective three-phase investigation was designed to assess the disk diffusion and minimum inhibitory concentration (MIC) result variations produced by European laboratories participating in fleroxacin clinical trials as compared with the results of a reference laboratory performing National Committee for Clinical Laboratory Standards (NCCLS) tests. In "phase I," 105 clinical trial strains (1988-1989) from six European investigators were processed by the reference laboratory. In comparison of participant and reference laboratory zone diameters, absolute qualitative agreement was 88.7% for the approved NCCLS interpretive criteria and 94.8% for the criteria used in the fleroxacin urinary tract infection clinical trials. Only three false-susceptible results (3.1%) were reported by the investigators. In the remaining phases of this study (unknown challenge strains and contemporary clinical isolates), the investigator laboratory zone diameters and MICs were within limits of acceptable test variation, that is, +/- 4 mm by disk diffusion and +/- 1 log2 dilution step by the MIC method. For laboratories using the German (DIN) and French (SFM) methods, however, a trend toward larger zones was observed. The greatest variation between participant and NCCLS results was produced when fastidious isolates such as Haemophilus influenzae (significantly smaller zone diameters) were tested. In general, the European fleroxacin clinical trial laboratory results (organism identification and susceptibility tests) could be considered comparable to data produced with NCCLS reference methods, indicating that clinical trial results from wider sources could be used for drug registry by the US Food and Drug Administration (FDA) or by other national agencies.(ABSTRACT TRUNCATED AT 250 WORDS)

[Epidemiology of legionnaires' disease in Switzerland in 1988]. / Epidemiologie der Legionärskrankheit in der Schweiz im Jahre 1988.

Both sporadic cases and outbreaks of legionnaire's disease have been reported. To date, no outbreaks have occurred but several case reports have been published in Switzerland. The newly organized surveillance system of notifiable diseases, introduced in 1987, makes it possible for the first time to analyze reported sporadic cases more precisely. In 1988, the laboratories reported a total of 32 cases with cultural or serologic proof of legionellosis. In 75% of cases patients were aged over 40 years, 78% occurred among males. The majority of them were known to be smokers. In 9 cases an underlying predisposing condition was known: hairy cell leukemia (3 cases), immune hemolytic anemia (1), type 2 diabetes (2), chronic lung disease (1), heart failure (1). The case fatality was 9%. A possible source of exposure, such as air-conditioned rooms or evaporative condensers, was reported in 4 cases.

Infections due to Wangiella dermatitidis in humans: report of the first documented case from the United States and a review of the literature.

Wangiella dermatitidis, a normally saprophytic dematiaceous fungus, has rarely been reported as a cause of disease in humans. A review of the worldwide literature yielded eight validly documented cases of W. dermatitidis infections. Reported herein is a subcutaneous knee infection due to W. dermatitidis in a diabetic man with impaired T-cell function and cutaneous anergy. Repeated cultures of the lesion were positive for W. dermatitidis despite therapy with amphotericin B. It is believed that this represents the first well-documented case of infection due to W. dermatitidis in North America, although the fungus has previously been isolated from nature in several states. The current state of knowledge of this organism, based on previously reported cases and isolations from nature, are discussed. No curative medical therapy is known for this infection, but surgical excision seems to be the treatment of choice for circumscribed W. dermatitidis infections.