The role of personality traits and profiles in posttrauma comorbidity.

Many service members experience symptoms of posttraumatic stress disorder (PTSD) after deployment. PTSD can vary widely in its presentation and associated features, such as comorbid conditions. Research has shown that veterans with PTSD and an internalizing personality profile are more likely to experience internalizing comorbidity (e.g., anxiety, depression), whereas veterans with PTSD and an externalizing personality profile are more likely to experience externalizing comorbidity (e.g., substance abuse, aggression). To date, however, this research has been limited by a focus on diagnosable disorders and personality categories. In a nonclinical sample of 224 National Guard/Reserve service members who had served since 2001, we explored whether personality traits (measured continuously) moderated associations of PTSD symptom severity with the severity of internalizing (depression, anxiety) and externalizing (alcohol abuse, aggression) symptoms. Results showed that the association of PTSD with anxiety was stronger when extraversion was lower (corresponding to an internalizing personality profile). Moreover, the association of PTSD with alcohol abuse was stronger when extraversion was high and conscientiousness was low (corresponding to an externalizing personality profile). Surprisingly, this association was also stronger when extraversion was low and conscientiousness was high. Results offer additional insights into prior research on personality and comorbidity.

Haemophilus influenzae from four laboratories in one Canadian city.

Serotype, biotype and antimicrobial susceptibilities of 250 clinical isolates of Haemophilus influenzae from University, affiliated and community hospitals and a private laboratory were compared. For each drug, agar dilution susceptibility testing was compared to at least one other method (modified Kirby-Bauer and/or microdilution). Most isolates (86%) were non-typable, 10% were type b. Biotype II was most common (58%). The highest prevalence of serotype b (28%) was seen in the community hospital, which also had only 4% of all biotype III isolates. beta-Lactamase production ranged from 20% (private laboratory) to 5% (affiliated hospital); it was higher among type b (23%), biotype II (17%), and from non-respiratory (26%) than respiratory sites (8%). 51% of 35 beta-lactamase producers were found in the 24% of patients under age 6. Microdilution missed seven while agar dilution and disc diffusion detected all. All isolates were susceptible to cefamandole, cefuroxime, cotrimoxazole and chloramphenicol, 86%, 98%, 99% and 27% to ampicillin, cefaclor, tetracycline and erythromycin respectively. Microdilution is unreliable for detection of ampicillin resistance mediated by beta-lactamase production.

Improving our ability to diagnose infections associated with central venous catheters: value of Gram's staining and culture of entry site swabs.

We prospectively studied 45 central venous catheters to determine whether Gram's staining and culture of skin swabs from the entry site could be used to predict catheter-related infection. Data were collected from insertion site swabs, intracutaneous and intravascular catheter segments, and blood cultures. Surveillance site cultures at the time of dressing changes showed that bacterial growth, once established, persisted until removal of the catheter but that the time of onset of infection was not predictable. Gram's staining alone and Gram's staining combined with culture were tested for their ability to predict catheter colonization and catheter-related infection. Bacteria seen with Gram's staining invariably denoted catheter colonization. When bacteria were not seen with Gram's staining, positive results of culture did not change the pretest probabilities of colonization or infection; however, negative results of culture reduced the probability of colonization to low levels (likelihood ratio less than 0.06). We conclude that Gram's staining and culture of skin swabs from the entry site provide, without line removal, a simple, inexpensive and practical test for the diagnosis of catheter-related infection.

Ciprofloxacin treatment of Staphylococcus aureus infections.

Ciprofloxacin appears to be safe and effective for a wide variety of clinical infections. In-vitro and animal studies point to high cure rates for both methicillin-sensitive and methicillin-resistant Staphylococcus aureus infections. Seventeen patients with staphylococcal infections severe enough to require hospital admission and initial parenteral therapy were treated with ciprofloxacin; the results were poor, with clinical failure in five and bacteriological failure in 12. All pathogens isolated were susceptible to ciprofloxacin both before and after therapy and tolerance was not detected. Further study is required before ciprofloxacin can be recommended for life threatening staphylococcal infections.

Septicemia due to coagulase-negative Staphylococcus in a community hospital.

The experience with septicemia due to coagulase-negative Staphylococcus at a 623-bed primary care hospital between 1980 and 1984 was reviewed. A total of 38 episodes in 37 patients were documented; data were available on 37 episodes in 36 patients. The organism accounted for 3.8% of all cases of septicemia and 6.7% of cases of nosocomial septicemia and was associated with 0.03% of all admissions. The incidence remained stable over the 5 years. The rate of survival 28 days after the episode was 78%. Most of the episodes (31) originated from infected vascular access sites. Of the 37 isolates 15 (41%), all S. epidermidis, were slime producing. S. epidermidis accounted for 33 of the isolates; of the 33, 5 were methicillin-resistant and slime producing. Various in-vitro susceptibility testing methods and testing for beta-lactamase production yielded conflicting results. Methicillin resistance, slime production and speciation as S. epidermidis were not confirmed as virulence markers. Five patients with methicillin-resistant organisms were treated with cephalosporins, and all recovered. These findings as well as examination of the literature do not support the recommendations that laboratories report such isolates as resistant to all beta-lactam agents and that vancomycin be given in all such infections. The different case mix in community hospitals as compared with university centres results in different patterns of nosocomial infection. Since the community hospital patient population is much larger, more information on the patterns of infections in these centres is needed.

Campylobacter and endovascular lesions.

Because of the gaps in our knowledge of the epidemiology and pathogenesis of Campylobacter infections, particularly the propensity of Campylobacter fetus ssp fetus to infect vascular endothelium, the authors describe the case of a 56-year-old woman with C. fetus ssp fetus infection of an aortic aneurysm. She recovered after a one-stage surgical repair and antibiotic therapy with erythromycin. The organism was cultured from samples of the stool and tissue obtained at operation. It was identified from its typical characteristics: morphology, microaerophilic, able to grow at 22 degrees C and 37 degrees C but not at 42 degrees C, catalase and oxidase positive and resistant to nalidixic acid but susceptible to cephalothin.

Mycobacterium chelonei: report of a case of septicemia and review of the literature.

Mycobacterium chelonei was originally included in group IV of Runyon's classification of "anonymous" or "atypical" mycobacteria. Although a frequent contaminant without clinical significance, this organism has definite pathogenic potential. A compromised host with M. chelonei septicemia and disseminated candidiasis is described. A review of the literature on M. chelonei human infections is also presented.