We analyzed the effect of perioperative elimination of nasal carriage of Staphylococcus aureus using mupirocin nasal ointment on the reduction of the postoperative wound infection rate in orthopedics. In an unblinded intervention trial, we compared 1,044 patients treated with mupirocin (intervention group) with 1,260 historical controls (control group). From each group a random sample of 50 patients was taken. Risk factors were analyzed in these random samples and we found it unlikely that different distributions of risk factors might have influenced the results. The wound infection rates were 14/1,044 in the intervention group and 34/1,260 in the control group (p = 0.02). The rates of wound infections caused by S. aureus were subsequently 7/1,044 and 14/1,260 (p = 0.3). On checking the data we found that prophylaxis had unintentionally not been given to 172 patients in the intervention group. Correction of the data gave a comparable total infection rate, but a further reduced infection rate by S. aureus. Our findings suggest that prophylactic treatment with mupirocin in orthopedic surgery can reduce the infection rate.

The incidence of gastrointestinal diseases was studied in a community-based study in four regions of The Netherlands. Two grades of severity were distinguished--1: diarrhoea or vomiting and at least 2 additional symptoms within the period of 1 week, and 2: diarrhoea or vomiting and at least 2 additional symptoms occurring on the same day lasting at least 2 days within the period of 1 week. The incidence of gastrointestinal episodes was calculated to be 630 for grade 1 and 180 for grade 2 disease per 1000 person-years, after correction for age and sex. The incidence was higher for women than for men (relative risk 1.25) and lower for those in the 19-64-year-old age group when compared to those younger or older (relative risk 0.75 and 0.40, respectively). Independent of the degree of severity of the symptoms, about 20% of the patients had consulted a general practitioner, about half in person and half by telephone. It is concluded that community studies are essential to assess the real incidence of gastrointestinal diseases in the population.

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Fifty-two unselected patients referred to for upper gastrointestinal endoscopy were evaluated in several ways to determine the presence of Campylobacter pylori. Antibodies against this microorganism were measured to assess the value of serology for the diagnosis of C, pylori infection. Five antral biopsy specimens were taken in each patient for culture and bacteriological determinations, histology [moφhology and Warthin-Starry (WS) staining] and the urease test (2, 3 and 24 h). Serum antibodies against a sonicate of 6 strains of microorganisms were assayed by enzyme-linked immunoassay (ELISA) and an immunoblotting technique. In 14 of the 52 patients the histology of the antrum was normal, 18 patients had chronic active gastritis and 20 had chronic gastritis without polymorphonuclear infiltration. In the group with normal histology, only 1 patient was positive for C. pylori with all methods, and 1 other subject was positive for IgG and 2 for IgA only with ELISA. In the group with chronic active gastritis, 14 were positive with all methods, 1 was negative by WS only and another was negative for IgA according to ELISA, WS and antibodies. Among the patients with chronic gastritis, 7 were positive and 7 negative with all tests; in the other 6 patients the results obtained with the various tests were divergent. Four serological tests were studied and validated against culture, WS and urease test which were considered to be the reference methods. The serological tests showed high sensitivity and specificity for the detection of C. pylori-associated active chronic gastritis of the antrum, and can therefore serve as noninvasive methods to identify individuals with this condition.

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