Aim: To identify predisposing factors and to define clinical and microbiological characteristics of bacterial keratitis in current practice. Methods: A retrospective analysis of the hospital records of patients presenting with bacterial keratitis and treated at the Quinze-Vingts National Center of Ophthalmology, Paris, France, was performed during a 20 month period. A bacterial keratitis was defined as a suppurative corneal infiltrate and overlying epithelial defect associated with presence of bacteria on corneal scraping and/or that was cured with antibiotic therapy. Risk factors, clinical and microbiological data were collected. Results: 300 cases (291 patients) of presumed bacterial keratitis were included. Potential predisposing factors, usually multiple, were identified in 90.6% of cases. Contact lens wear was the main risk factor (50.3%). Trauma or a history of keratopathy was found in 15% and 21% of cases, respectively. An organism was identified in 201 eyes (68%). 83% of the infections involved Gram positive bacteria, 17% involved Gram negative bacteria, and 2% were polymicrobial. Gram negative bacteria were associated with severe anterior chamber inflammation (p=0.004), as well as greater surface of infiltrates (p=0.01). 99% of ulcers resolved with treatment, but only 60% of patients had visual acuity better than the level at admission, and 5% had very poor visual outcome. Conclusions: Contact lens wear is the most important risk factor. Most community acquired bacterial ulcers resolve with appropriate treatment.

No abstract

Risk factors for C. parapsilosis keratitis may include corticosteroid use and prior corneal transplantation. The prognosis of C. parapsilosis keratitis with antifungal and surgical therapy may vary from good visual outcome to intraocular extension with phthisis bulbi.

A 70-year-old man was referred to us with a 2-year, progressive, painless decrease in visual acuity in the right eye. Ocular history included extraction of a traumatic cataract with a transclerally fixated posterior chamber intraocular lens. Slitlamp examination showed a raised, white, vascularized mass covering the cornea. The lesion was removed by superficial lamellar keratectomy. Light microscopy examination confirmed the diagnosis of corneal keloid. These uncommon lesions usually develop in adults after corneal traumas, surgery, or inflammatory processes. They have also been described in children with Lowe's syndrome, Rubinstein-Taybi syndrome, and other ocular developmental disorders.

Summary. Blood cultures were taken from 47 patients 1-2 min after dental extraction. These samples were tested by the radiometric Bactec 460 and Oxoid Signal systems for the detection of streptococcal and anaerobic bacteraemias. Streptococci were isolated from 19 (40 YO) patients and anaerobes from 15 (32 YO). In this study the Oxoid Signal system was significantly better for isolating oral anaerobes than the Bactec system ; five isolates were obtained with the Bactec system and 14 with the Signal system. There was no significant difference in the isolation of streptococci between these two systems (Bactec 14, Oxoid Signal 10). The contamination rate was 4-1 YO for Bactec and 7.5 YO for the Oxoid Signal system.

SUMMARY To detect streptococcal bacteraemia in patients undergoing dental extraction blood cultures containing glucose broth with 0 05% sodium polyanethol sulphonate (Liquoid) were compared with identical cultures without Liquoid.Optimal techniques for blood culture are important for the reliable detection of low grade bacteraemia caused by Viridans streptococcus and are especially relevant for the microbiological diagnosis of infective endocarditis. Previous in vitro studies suggested that the inclusion of 0-05% sodium polyanethol sulphonate (Liquoid) in blood culture broths would increase the recovery of streptococcus by neutralising the antibacterial effects of fresh human blood' and that at least a 1/30 dilution of blood in broth would be required for the optimal recovery of streptococci in broths without Liquoid.2 It has also been suggested that occasional strains of Viridans streptococcus may be inhibited by 0 05% Liquoid.3 A survey in Britain showed that about half of all laboratories included Liquoid in blood culture broths for isolating aerobes.4 Many laboratories in Britain use 50 ml glucose broth for the culture of 5 ml blood samples, and it is sometimes assumed in practice that a 1/10 dilution ofblood in broth will inactivate the antibacterial effect of fresh blood. We decided to compare these glucose broths with and without 0-05% Liquoid for the recovery of Viridans streptococcus from the blood of patients undergoing dental extraction. Material and methodsPatients requiring dental extraction under general anaesthesia who had not received recent antibiotics were included in the study. Most patients did not have obvious dental sepsis at the time of extraction. Blood was collected for culture about one and a half minutes after extraction of the first tooth. Blood culture bottles were supplied by Southern Group Laboratories, (Hither Green, London) containing 50 ml digest broth with 0 1% glucose. Identical broths with and without about 0 05% Liquoid were supplied ready for use. BROTH CULTURE METHODImmediately after 30 ml blood had been collected from each patient 5 ml was added to each of six blood culture broths. Alternate inoculation of broths with and without Liquoid was carried out, so that each type of broth was tested in triplicate. Broths were incubated at 35°C and subcultured after 1, 3, 5, and 10 days on to blood agar. The blood agar plates were also inoculated with a Staphylococcus aureus streak to assist with the isolation of any pyridoxal dependent satellite streptococcus. The subculture plates were incubated aerobically for 48 hours in a carbon dioxide incubator. IDENTIFICATION OF STREPTOCOCCIAlpha or non-haemolytic Gram positive cocci on blood agar that grew aerobically and were coagulase negative, catalase negative, and optochin resistant were presumptively identified as Viridans streptococcus. These were further identified by the API 20 streptococcal identification test (API Laboratory Products, Basingstoke, Hampshire).

The use of extracorporeal membrane oxygenation (ECMO) has greatly increased over the years; however, the survival rate is only above 56%. There has been a drastic increase in ECMO centers and cases. ECMO has become a popular therapy route for patients with respiratory and cardiac complications; however, patient safety is a major concern. Perfusion and non-perfusion students from the University of Nebraska Medical Center were recruited to participate in three simulation trials. The trials consisted of five different tasks that are required for managing or preventing catastrophic events on ECMO. Students were evaluated for the time it took to complete each task, number of errors made, and protocol referencing. The data indicated that there was a decrease in time for the 1st vs. 2nd trial (p = .02) for perfusion students and a decrease from the 1st to 3rd trial (p = .001) for the circuit set-up simulation. There was a decrease in priming time from the 1st to 3rd trial (p = .02) and for the pump change (p = .0098) for the perfusion students as well. The non-perfusion students had a significant decrease in time for the circuit set-up in the 1st vs. 2nd (p = .004) and 1st vs. 3rd trial (p = .002). There was a decrease in time for priming (.004), pump change (p = .002), tubing change (p = .0098), and errors during the tubing change (p = .02) in the non-perfusion students. Both groups felt more confident after the simulations and the non-perfusion students specifically felt like they were more familiar with the purpose of ECMO after the simulation. ECMO simulations and protocols may improve patient safety by strengthening the skills needed for rapid management, fewer errors, and higher levels of confidence during the management of ECMO and catastrophic events.

No abstract