Summary. Sorbitol-MacConkey medium has become widely used for the isolation of verotoxigenic (VT') Escherichia coli 0 1 57. However, many organisms other than VT+ E. coli 0157, especially other serogroups of E. coli and Proteus spp., may not ferment sorbitol, and thus may be confused initially with VT+ E. coli 0157. Rhamnose is not fermented by VT+ E. coli 0157, but is by most sorbitol non-fermenting E. coli of other serogroups. Cefixime is a cephalosporin antibiotic that is more active against Proteus spp. than against E. coli. Inclusion of rhamnose and cefixime in sorbitol-MacConkey agar improves its selectivity for the isolation of VT' E. coli 0157.
Summary. The number of anaerobes in selected sputum samples from patients with cystic fibrosis (CF) was investigated. When cultured by a semi-quantitative method, 26 (23.85%) of 109 sputum specimens from 21 C F patients contained > lo5 cfu of anaerobic organisms/ml. Nine (42.7%) of the 21 patients produced sputum containing such concentrations of anaerobes on at least one occasion. Anaerobes were isolated from repeated sputum specimens from five patients. The anaerobes most often isolated were Bacteroides disiens, pigmented Bacteroides spp. and anaerobic grampositive cocci. Anaerobes were isolated more often from sputum liquefied by sonication than from unliquefied sputum, suggesting that they were unlikely to be oropharyngeal contaminants.
Summary. Men with indwelling catheters and men and women with suprapubic catheters were studied in their homes. Urine and blood were cultured and body temperature recorded after every catheter change. Nearly all patients had infected urine after 4 weeks of catheterisation, and all had bacteriuria after longer periods, usually with a mixture of organisms. Culture on selective media revealed a wider range of organisms than was detected on routine C.L.E.D. and blood agar with antibiotic sensitivity disks, but routine culture gave adequate information for clinical purposes. Bacteraemia was demonstrated after 20 of 197 changes of urethral catheter and after one of 19 changes of suprapubic catheter; but no patient had pyrexia or other symptoms. However, two had rigors on other occasions. When assessing "risk factors" for blood-stream infection in catheterised patients, it is important to record the total incidence of bacteraemia, asymptomatic as well as symptomatic.
During 2002, an upsurge in frequency of hepatitis A outbreaks among injecting drug users was observed in England and Wales. As lack of risk factor information and the high mobility of the cases made linkage of outbreaks difficult, the relationship of nucleotide sequences in the VP1/2PA junction of the hepatitis A virus (HAV) genome amplified from serum of case-patients was investigated. A total of 204 HAV RNA positive sera obtained from a network of 23 laboratories were studied. Comparison of the sequences identified two principal strains: ES1 (n=95) belonging to type IB, and ES2 (n=72) to type IIIA. Of the remaining samples, 15 were type IA, 11 were type IB and 11 were type IIIA. ES1 predominated in Doncaster and other towns in Trent and northern England, and ES2 in the Midlands and southern England; the difference in geographical distribution between these two strains was significant (P<0.0001). In comparison to the sporadic cases, cases infected by either ES1 or ES2 tended to be younger, injecting drug users, people in contact with injecting drug users, or those with a history of incarceration in prisons or homelessness (P<0.0001). Cases infected by ES1 tended to be younger than those by ES2 (P<0.0001). The association of the outbreaks to two geographically restricted strains implicates two principal transmission pathways associated with injecting behavior. Identifying these routes may be conducive to preventing further outbreaks.
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