Routine Swabs Research Articles

Whatʼs in a Nail?

To determine the incidence of subclinical infection using routine swab methods in asymptomatic patients, 30 consecutive hollow intramedullary nails were studied. Variables identified were leukocyte count and differential, patient complaints, time elapsed from injury to nail implantation, duration of nail implantation, and the size of the nail. Specimens were gathered from the lumen of intramedullary nails using the routine swab method for bacterial culture as well as fungal and acid-fast growth. This material was also subjected to pathologic review with routine hematoxylin and eosin staining. There were no significant positive cultures in this study. The pathologic review indicated that the material in the canal of an intramedullary nail was either granulation tissue, fibrous tissue, or osseous tissue. No patient had a deep or superficial wound infection after implant removal. The results of this study indicate that the material in the lumen of the hollow intramedullary nail will fail to grew organisms when the swab method is used in gathering the specimen or the material is sent for quantitative bacteriology.

Mycotic endometritis in mares review and clinical observations

Abstract Extract Mycotic infections of the nonpregnant equine uterus have become more frequent with the widespread use of antibiotics and the increasingly intensive management and manipulation of reproduction in mares. Although fungi and yeasts have often been blamed for uterine infection, their precise relations to clinical uterine disease are often unclear. These organisms are common in the environment and their recovery in routine culture swabs from mares' uteri may be considerably more frequent than their involvement in the aetiology of uterine disease.

Candida infection in massively burned patients.

Immunosuppressed burned patients receiving antibiotics for suppression of bacterial infection are ideal hosts for opportunistic fungi. Massive excision of burns with autograft and homograft coverage has radically changed the course of disease. Three hundred ninety-three patients were admitted to the Shriners Burns Institute, of whom 125 patients had fungus cultured during their hospitalization and 42 patients subsequently developed involvement of three or more organs. Twenty-one of the 42 patients developed Candida septicemia requiring amphotericin B or flucytosine therapy. The mean third-degree burn in patients with Candida septicemia was 65% total body surface area compared to three-organ involvement/no clinical sepsis at 38% mean third-degree burn. Patients developing candidemia did so during the first week postburn and 7 days after excision therapy. It is hypothesized that massive burns with immunosuppression are further suppressed by repeated surgical intervention, anesthesia, and perioperative use of broad-spectrum antibiotics, further predisposing these patients to early development of Candida septicemia. With early recognition of burn wound invasion by routine biopsies, wound swabs, and early amphotericin therapy, the mortality has been reduced to 14% compared to 60-90% reported in other series.

Estimating the infection rate in mothers following caesarean section

Some hospitals send comparatively few swabs to their laboratories for examination, consequently any measure of infection that depends on routinely analysed swabs is likely to underestimate the actual level of infection. In a survey of routine wound swabs from mothers following caesarean section, it was found that the average infection rate in 31 hospitals was 6%, with considerable variation between the hospitals. Further consideration of the data as described in this paper shows that the actual infection rate was about 14%, with much less variation between hospitals.

Chlamydial infections of the urethra in women.

Cervical and endourethral swabs from 360 untreated women attending a sexually transmitted disease (STD) clinic were cultured for Chlamydia trachomatis and other genitourinary pathogens. The patients included contacts of men with non-gonococcal urethritis, women with gonorrhoea, and those in whom symptoms suggestive of urinary tract infection were the main reasons for their attendance. Chlamydial infection of the urethra was less common than, and seldom occurred in the absence of, cervical chlamydial infection; it was frequently silent, producing no signs or symptoms of urethritis. Only 33/96 women with evidence of urethritis gave chlamydia positive urethral swabs, and 14 of them had other concurrent infections of the genitourinary tract. Chlamydia trachomatis thus does not appear to be a major cause of the signs and symptoms of urethritis commonly found in women attending STD clinics, and there seems to be no indication for taking routine urethral swabs to aid in the diagnosis of chlamydial infection in women.

Halophilic vibrios in human tissue infections

Vibrios that need 0.07-0.4 M Na + for growth in vitro are common in inshore sea waters, especially in the summer. Assimilation tests differentiate 11 species and a heterogenous group of the genus Beneckea. and 3 species of the genus Photobacterium. One species, B. parahaemolyticus. has been implicated for some years in food-poisoning. This species and B. alginolyticus and the lactose-fermenting B. vulnificus have been isolated from human tissue infections in the northern hemisphere, with a few cases in Australia. We isolated 16 strains of the 3 species from routine swabs of ear and wound infections, pneumonia and salpingitis, identified them using the ‘expanded’ API 20E kit plus NaCl tolerance. The species were confirmed by assimilation tests. Vibrios that need 0.07-0.4 M Na + for growth in vitro are common in inshore sea waters, especially in the summer. Assimilation tests differentiate 11 species and a heterogenous group of the genus Beneckea. and 3 species of the genus Photobacterium. One species, B. parahaemolyticus. has been implicated for some years in food-poisoning. This species and B. alginolyticus and the lactose-fermenting B. vulnificus have been isolated from human tissue infections in the northern hemisphere, with a few cases in Australia. We isolated 16 strains of the 3 species from routine swabs of ear and wound infections, pneumonia and salpingitis, identified them using the ‘expanded’ API 20E kit plus NaCl tolerance. The species were confirmed by assimilation tests.

T‐TYPING OF GROUP A STREPTOCOCCI FROM CLINICAL SPECIMENS: RESTRICTION OF THE NUMBER OF IMPLIED M TYPES IN EACH T‐PATTERN BY TESTS FOR OPACITY FACTOR AND NICOTINAMIDE ADENINE DINUCLEOTIDE GLYCOHYDROLASE

117 group A streptococci, consecutively isolated from routine throat swab cultures, were T-typed and further characterized according to their enzyme reactions. The results of typing with two different commercial kits of anti-T sera showed good agreement. 89 per cent of the strains were typable by either of these kits. 68 per cent of the strains were OF-positive and 95 per cent NADse-positive. With T-typing alone, 22 per cent of the strains showed agglutination patterns implying only one M type each. When considered together, the T-typing and enzyme reactions made it possible to implicate one M type only for each of 45 per cent of the strains. In a further 34 per cent of the strains, the possible M type of each strain was restricted to four types. However, these findings were hampered by the fact that the T patterns of a number of more seldom met group A streptococci have not been investigated adequately.

Amoxycillin and co-trimoxazole in presumed viral respiratory infections of childhood: placebo-controlled trial.

A double-blind randomized controlled trial of amoxycillin, co-trimoxazole, and placebo was conducted on 197 children presenting with presumed viral respiratory infections. Routine throat swabs were taken to exclude streptococcal diseases. The three disease categories studied--nasopharyngitis, pharyngotonsillitis, and bronchitis (including laryngotracheobronchitis)--showed a generally similar pattern of resolution irrespective of treatment. Nevertheless, seven out of 66 children receiving placebo were withdrawn from the trial with unremitting symptoms or complications thought to require antimicrobial treatment. Only two of 56 children receiving amoxycillin and none of 75 receiving co-trimoxazole were withdrawn. Three other children receiving amoxycillin and three receiving placebo were seen during the trial but further treatment was not thought to be necessary. Thus the return consultation rate in children receiving placebo therapy was 15% compared with 4% for those receiving antimicrobial treatment. Antimicrobial treatment was associated with less nasal discharge on the eighth day of treatment. Placebo treatment allowed an earlier return to normal activity. There was a high incidence of possible side effects on all regimens including placebo. It is concluded that the benefits of antimicrobial treatment in presumed viral respiratory infections are marginal, and they should not be routinely prescribed for these conditions.

Kurthia, An Unusual Isolate

The genus Kurthia is made up of Gram-positive, actively motile, biochemically inactive bacilli of the family Brevibacteriaceae. An isolate from a routine eye swab which produced a heavy, pure growth of a Kurthia species is described. The organism was identified by Gram stain, motility and biochemical reactions and the morphology confirmed by electron microscopy. No conjunctivitis was present in the eye from which the Kurthia was isolated. A review of the literature of human isolates of Kurthia confirms that the association of this organism with disease is doubtful except in cases of diarrhea in which it has been isolated in pure culture.

The isolation of anaerobic bacteria from wound swabs

The isolation of anaerobic bacteria from routine wound swabs by three procedures was evaluated. Recovery of anaerobic organisms was doubled by immediate incubation of seeded plates, and the recovery could be further dramatically improved by the use of prereduced media, in conjunction with an anaerobic chamber. Recommendations for the treatment of swabs and cultures for anaerobic investigation are made.

Preintubation Pap Smears of Vocal Cords and Larynx

To the Editor.— We note in theQUESTIONS AND ANSWERSsection of your March 27th issue that Dr. Sam Nixon of Floresville, Tex, is interested in the possibility of early diagnosis of laryngeal carcinoma by routine swabbing of the vocal cords, prior to intubation, by the anesthesiologist. Dr. William J. Fable of Richmond, Va, answered that this could very well be done if an interested anesthesiologist were to be found. We, in fact, are very interested in the development of diagnostic procedures for the early detection of unsuspected airway cancers in anesthetized patients undergoing routine surgery. Procedures which might be tedious in the awake subject become simple under narcosis. Since 1969, we have been conducting a research project for the early diagnosis of bronchogenic carcinoma during general endotracheal anesthesia. Through the support of various grants we have been able to maintain a fully staffed cytology laboratory on the operating room

Gonococcal infection in a prenatal clinic

Routine cervical swabs for N. gonorrheae were taken in 3,375 Obstetric patients and in Gynecologic outpatients and their treatment and follow-up reviewed. In 3 years 229 cases of venereal disease were detected, but only 75.9 per cent of the 207 cases of gonorrhea received full treatment and only 45.9 per cent were completely followed until cured. One hundred and one cases of venereal disease were seen in the Obstetric patients, and 75 per cent of 86 cases of gonorrhea were asymptomatic. As a result of the study the treatment schedule for gonorrhea was altered, and the importance of routine screening of prenatal patients for gonorrhea was emphasized.

A study of two screening techniques in the school health service: 1—Routine throat swabs

Throat swabs were taken from 600 children in the 5, 11 and 14 year age groups who were attending for routine medical examination by the Aberdeen School Health Service. The carrier rates for beta h˦molytic streptococci and for Lancefield Group A ( str. pyogenes ) were respectively 17·7 per cent. and 11·3 per cent. The prevalence of staphylococcus aureus throat carriers was 25 per cent. and the proportion of strains of staph aureus resistant to penicillin was 30 per cent. The carrier rates were higher in children with tonsils than among those whose tonsils had been removed, but neither social class nor family size appeared to influence the rates. In view of the relationship between these pathogens and diseases such as rheumatic fever, nephritis and skin sepsis, it is suggested that serious consideration be given to the desirability of controlled experiments to lower these high carrier rates. Finally, it is proposed that throat swabbing should become a regular screening technique in school health examinations.

Suction and quantitative methods for culture of rectal mucus in bacillary dysentery.

Summary The suction method for the culture of Shigella, and its quantitative variation, using rectal mucus from dysentery patients and carriers, appears to be a feasible bacteriological diagnostic technique. Shigella isolations by this procedure are more numerous than by the routine swab or fecal culture methods, especially when small numbers of organisms are excreted, as from patients after treatment, or from carriers. Shigella titers obtained by the suction method can be of assistance in checking the status of patients and carriers during the course of illness and convalescence. The method also appears to be reliable for the detection of carriers as sources of infection in limited outbreaks.

The hemorrhages of late pregnancy and labor: Placenta previa and ablatio placentae

The essence of therapy for placenta previa includes these measures: 1. 1. Arrest hemorrhage promptly (respect blood losses) by Hicks version, or by hystereurysis, or even by the objectionable tampon when needful. 2. 2. Give timely blood or saline transfusions on indication. 3. 3. Employ measures for delivery which are slow but sure. 4. 4. Whatever the temptation may be, never practice rapid extraction of the fetus. 5. 5. Circumspect management of the third stage. 6. 6. On proper indication tampon the uterus and vagina— never the vagina alone. 7. 7. Never repair the lacerated cervix unless the woman is in a remarkably fine condition. A secondary repair is always strongly desirable. If the tear bleeds the uterovaginal tampon will arrest it. A vaginal tampon is a transgression. 8. 8. The routine swabbing of the vagina with an approved antiseptic (mercurochrome or liquor cresolis), where possible, will sterilize the vagina to a degree: or these antiseptic may be instilled into the vagina by means of a catheter. Bichloride of mercury is absolutely contramdicated where there is blood or its serum, as was pointed out by Lister himself.

A simple tellurite-chocolate-agar medium for the typing and isolation of Corynebacterium diphtheriae

1. A simply made selective tellurite medium for the isolation of Corynebacterium diphtheriae and the identification of its types has been described.2. The ingredients of this medium are easily obtained and can be stored for any length of time making the medium readily available at short notice.3. Large or small quantities of the medium can be made with equal facility.4. When grown on the medium, C. diphtheriae will produce colonies characteristic of its type, be it gravis, mitis or intermediate.5. The appearance of the colonies has been described and has been shown to resemble closely, in the case of each type respectively, the appearances described by the Leeds workers (Anderson et al. (1931)) on their medium in the original papers.6. The possibilities of the use of this medium for diagnostic routine swab examinations have been briefly referred to.