Helicobactor pylori (H. pylori) is suspected to be one of the factors triggeringrheumatoidarthritis. The aim of this study was to evaluate the effect of H. pylori eradication on inflammatory disease activity in patients with rheumatoid arthritis. The presence of H. pylori was assessed in 59 patients with rheumatoid arthritis from whom H. pylori was eradicated. The level of inflammatory disease activity was evaluated before eradication and during a 42-week follow- up period, as well as the inflammatory disease. The activity of H. pylori in uninfected patients was evaluated with similar time intervals. A significant improvement was seen in the patients' ESR after H. pylori eradication, although this was non-significant after adjustment for multiple comparisons. A significantly reduced number of tender joints was observed in patients unaffected by H. pylori, possibly due to altered DMARD-treatment in 17% of the patients. Our results indicate the role of H. pylori on the inflammatory state of rheumatoid arthritis, but further studies on larger populations are necessary for final conclusions to be drawn.

OBJECTIVES:the aim was to examine factors associated with acquisition and elimination of bacterial vaginosis in pregnancy.METHODS:a group of 229 pregnant women were randomly selected from a population-based prospective cohort study of 2927. They were examined at enrollment (mean gestational weeks 16w+0d) and again in mid-third trimester (mean gestational age 32w+3d).MEASURES:BV (Amsel's clinical criteria), microbiological cultures of the genital tract and questionnaire data.RESULTS:BV prevalence decreased from 17% in early second trimester to 14% in mid-third trimester due to a tenfold higher elimination rate (39%) than incidence rate (4%). Heavy smokers (>10/d) in early pregnancy were at increased risk (5.3[1.1-25]) for the acquisition of BV during pregnancy, as were women receiving public benefits (4.8[1.0-22]), having a vaginal pH above 4.5(6.3[1.4-29]) or vaginal anaerobe bacteria (18[2.7-122]) at enrollment. A previous use of combined oral contraceptives was preventive for the acquisition of BV (0.2[0.03-0.96]). Elimination of BV in pregnancy tended to be associated with a heavy growth of Lactobacillus(3.2[0.8-13]) at enrollment.CONCLUSIONS:acquisition of BV during pregnancy is rare and is associated with smoking, while the presence of anaerobe bacteria and a vaginal pH >4.5 are interpreted as steps on a gradual change towards BV. In the same way heavy growth of Lactobacillus spp in early pregnancy may be an indicator of women on the way to eliminate BV.

From February through July, 2000, there was an accumulation of mecA-negative borderline resistant Staphylococcus aureus (BORSA) in the Department of Dermatology. BORSA was isolated in 37 samples from 11 patients. The isolates were typed by antibiogram, phage type, pulsed-field gel electrophoresis (PFGE), and spa genotyping that confirmed that they were indistinguishable from one another. In May, 2000, an intervention was initiated focusing on infection control. In-patients with BORSA were discharged and antibiotic treatment was stopped, if possible. Emphasis was put on disinfection of shared utensils and individualization of previously shared creams and lotions. After the intervention, BORSA was isolated from another 3 patients before the outbreak was terminated. A case-control study was undertaken to identify possible risk factors for being a BORSA patient. Compared to the controls, the patients with BORSA had more severe skin disease, were more often hospitalized, and had more bed days.

ABSTRACT A nested case-control study of low birth weight and preterm delivery was performed with singleton women. Immunoglobulin A (IgA) against the Gardnerella vaginalis hemolysin (anti-Gvh IgA) and sialidase and prolidase activities were determined in vaginal fluid at 17 weeks of gestation. Sialidase positivity and bacterial vaginosis with high prolidase activity were associated with 2- and 11-fold increased risks for low birth weight, respectively. No woman with bacterial vaginosis plus a strong anti-Gvh IgA response had an adverse outcome.

We did a survey of postoperative wound infection rates in our department over a 10-year period. It was based on the results of forms completed by surgeons in the department after each operation and when an infection was diagnosed (primary registration). These forms were sent to the electronic data processing department for registration of data in a database. Every third month, detailed reports of the data were discussed with the surgeons. The quality of this routine survey was evaluated as follows: 1) Every year, the year's data in the surveys database were compared with those in the National Patient Register and, in case of discrepancies, the patient's records were checked and missing information about the operation and infections were recorded in the surveys database (secondary registration). 2) In case of a primary registered infection, the patient's record was carefully examined. Infections not fulfilling the criteria for an infection were called registration failures. The primary registration of operations reached an acceptable level (about 95%) after 5 years of the survey, but the recording of infections was unreliable throughout the study due to an unacceptably low registration rate (about 60%) and to a high rate of registration failures.

Laparoscopic appendectomy is increasingly used in treating acute appendicitis. Several controlled series have demonstrated the clinical benefit of the procedure. However, some basal pathophysiologic changes caused by the laparoscopy still need clarification, i.e., whether laparoscopy can give rise to bacteremia. The purpose of this randomized controlled study in 30 patients undergoing surgery due to suspected acute appendicitis, either by an open classic technique or by a laparoscopic technique, was (by collecting samples for blood culturing pre-, peri-, and postoperatively) to evaluate whether laparoscopy during carbon dioxide pneumoperitoneum could induce bacteremia. Six patients of 12 in the group treated by laparoscopy presented positive blood cultures peri-and postoperatively. No positive blood cultures were demonstrated in the open operated group. The difference was significant (P = 0.0183). The clinical significance of these findings should be clarified in further clinical investigations.

OBJECTIVE: To evaluate the association between various microorganisms isolated from the genital tract in pregnant women with bacterial vaginosis.STUDY DESIGN: A cross-sectional population-based study among pregnant women addressed at their first antenatal visit before 24 full gestational weeks from the referring area of the Department of Obstetrics and Gynecology at Odense University Hospital, Denmark, from November 1992 to February 1994. The main outcome measures were prevalence of various microorganisms and statistical estimates of interactions (crude, adjusted, and relative odds ratios) between the microorganisms isolated from the lower genital tract in pregnant women with and without clinical diagnosis of bacterial vaginosis.RESULTS: Three thousand five hundred ninety-six (3596) pregnant women were asked to participate. Of the 3596 pregnant women 3174 (88.4%) agreed to participate before 24 full gestational weeks. After controlling for the presence of other microorganisms, strong associations between Gardnerella vaginalis, anaerobic bacteria, Mycoplasma hominis, and present bacterial vaginosis were found. Similarly Lactobacillus spp. were found to be associated with the absence of bacterial vaginosis. The combination of G. vaginalis and anaerobic bacteria and/or M. hominis was found in 59.6% of the cases with bacterial vaginosis and in 3.9% of the cases without bacterial vaginosis (odds ratio 36.4, 95% confidence interval 27.8 to 47.8). The crude odds ratio was found to be as high as 74.8 (95% confidence interval 32.3 to 174.1) when the combination of G. vaginalis, M. hominis, anaerobic bacteria, and no Lactobacillus spp. was associated with bacterial vaginosis,CONCLUSION: There is a microbial foundation for bacterial vaginosis, and it is possibly due to an intermicrobial interaction in which the microorganisms G. vaginalis, anaerobic bacteria, and M. hominis are dominating, indicating that these constitute the pathologic core of bacterial vaginosis.

We performed a surveillance of postoperative wound infections at our department for a period of 8 years. The surveillance was based on forms completed by the surgeons at the department. Retrospectively, by scrutinizing the records of patients with recorded infections, the criteria for infections used by the surgeons were compared with the criteria recommended by the Centers for Disease Control, USA, for routine infection surveillance studies: 1) pus present in the wound, 2) bacteria isolated from the wound, 3) spontaneous wound breakdown or surgical intervention due to suspected infection; if culture is performed, it must be positive, 4) evidence of infection at reoperation or at radiologic or histopathologic examination (restricted to deep infections) or 5) diagnosis of infection by a surgeon. 182 infections were recorded; in 106 (58%) pus was present, drained either spontaneously or by surgical intervention, in 24 (13%) no pus was seen, but the culture was positive. In 116 cases, surgical intervention was performed or wounds spontaneously broke down; pus was found in 101 of these and culture of non-purulent material was positive in 13 and negative in 2. In 52 (29%) patients, only criterion 5 was fulfilled. In surveillance studies where the recordings are based on several observers, the subjective criterion 5 may, as in our study, give a falsely high number of infections, also preventing comparison between studies. We recommend that all suspected infections are cultured and that only criteria 1, 2 and 4 are used.

No standardized method of susceptibility testing for Helicobacter pylori is currently available, so before a large agar dilution study comprising 230 H. pylori strains belonging to more than 80 genetically different groups was initiated, we performed a relatively small preliminary study to determine the influences of medium, inoculum density, and incubation time. Seven media were investigated and were primarily evaluated on the basis of their abilities to support growth both semiquantitatively and qualitatively; Iso-Sensitest agar supplemented with 10% horse blood was found to be well suited for the purpose; this was closely followed by Mueller-Hinton agar with 10% horse blood, Mueller-Hinton with 10% sheep blood, and finally, 7% lysed horse blood agar. Investigations of two inoculum densities and two incubation times resulted in recommendations for the use of 10(9) CFU/ml (10[6] CFU/spot) as the inoculum and 72 h as the incubation time. A modest inoculum effect was noted for amoxicillin and metronidazole. By the methodology derived from our preliminary study, the susceptibilities of 230 H. pylori strains to six antibiotics were subsequently determined. The results were generally in accord with those of others, and apart from metronidazole, the MIC of which for approximately 25% of the strains tested was >8 microg/ml, resistance was low in Denmark. The situation might, however, quickly change when and if the number of indications for antibiotic therapy for H. pylori infections increase. Consequently, susceptibility testing of all H. pylori strains is recommended in order to survey the development of resistance, and in our hands the described methodology was relatively easy to perform and the results were easy to read.

A cohort of 4515 surgical patients was selected from ten different surgical intervention groups, and 291 of 317 with a postoperative wound infection were matched 1:1 with controls with regard to intervention, sex and age. The mortality rate was investigated from the time of operation, with a follow-up period from 4 years 4 months to 8 years 4 months. Eighty-seven patients with a deep infection had a significantly increased mortality rate, with a risk ratio of 1.7. Without a distinction between superficial and deep infection the former might mask the higher mortality rate associated with the latter.

The prevalence and antibiotic sensitivity patterns of bacteria collected consecutively from medical and surgical intensive care units (ICUs) and from hematology/oncology units in nine hospitals in Denmark were determined and compared to data collected simultaneously in 12 other European countries. Bacterial isolates from 794 Danish patients were tested and compared to 8,625 isolates from European patients. The minimal inhibitory concentrations of eight different antibiotics were determined using a microdilution plate. Similar to findings in European countries, the most common source of bacterial isolates in Danish units was the respiratory tract (49 %), followed by blood (18 %), urinary tract (14 %) and surgical wounds (10 %).Staphylococcus aureus was the most prevalent respiratory organism in Danish units, whereasEnterobacteriaceae andPseudomonas aeruginosa dominated in other countries. In blood,Escherichia coli was most prevalent in Denmark while coagulase-negative staphylococci were predominant in other countries. Urinary tract isolates were dominated byEscherichia coli in both Denmark and the other countries, butEnterococcus faecalis andPseudomonas aeruginosa were more frequently isolated in the other countries.Staphylococcus aureus was the most frequent wound isolate in Denmark, whileEnterobacteriaceae other thanEscherichia coli dominated in other European countries. Thus, in DenmarkEscherichia coli andStaphylococcus aureus, followed byPseudomonas aeruginosa andKlebsiella spp. (from ICUs) orEnterococcus spp. andKlebsiella spp. (from hematology/oncology units), are the most prominent pathogens in these units today. Indicator organisms of antibotic consumption (Pseudomonas aeruginosa and methicillin-resistant coagulase-negative staphylococci andStaphylococcus aureus) were more frequent in other European countries than Denmark. In general, the Danish isolates were more sensitive to antibiotics than the European isolates. Thus, the sensitivity of all organisms to third-generation cephalosporins was about 10 % higher in Denmark as compared to Europe, and for many frequent pathogens, the sensitivity matched the fourth-generation cephalosporin, cefpirome. A lower total antibiotic consumption and the infrequent use of broad-spectrum cephalosporins in Denmark may contribute to these differences.

The susceptibilities of 100 clinical isolates belonging to the Bacteroides fragilis group to 9 antibiotics, i.e. ampicillin, piperacillin, ceftriaxone, cefotaxime, cefoxitin, imipenem, erythromycin, clindamycin, and metronidazole, were tested using a standard agar dilution method and the E-test. Overall, 81% of the E-test MICs were within one log2 dilution step of the agar dilution MICs and 95% were within two log2 dilution steps. The E-test showed significantly lower MIC values than the agar dilution method for ampicillin, cefotaxime, and imipenem, and significantly higher MIC values for piperacillin, ceftriaxone, erythromycin, clindamycin, and metronidazole. However, this only resulted in minor discrepancies that did not change the susceptibility status. The E-test is easy to perform and read, and the MIC values correlated well with the MICs obtained by the agar dilution method when testing susceptibility of the Bacteroides fragilis group.

A prospective study on the prevalence of resistance to 16 antibiotics in 704 Gram-negative bacteria isolated from seven intensive care units was undertaken in 1990. A microtitre panel carrying 16 antibiotics was used for susceptibility testing. The study revealed minor differences in resistance between the participating centres. The overall resistance was relatively low in Denmark, but there was increased resistance among E. coli from intensive care units compared to E. coli isolates from bloodcultures collected in 1988. At one centre the susceptibility of P. aeruginosa to gentamicin was slightly lower than at other centres, indicating a minor outbreak during the collection period. P. aeruginosa and Enterobacteriaceae with inducible production of beta-lactamases showed cross-resistance between penicillins and cephalosporins, but not between penicillin/cephalosporins and imipenem gentamicin or ciprofloxacin. The resistance among the repeated isolates of inducible Enterobacteriaceae was slightly higher than among the initial isolates indicating acquisition of resistance or selection of resistant mutants.

A cohort of 4515 surgical patients in ten selected intervention groups was followed. Three hundred and seventeen developed postoperative wound infections, and 291 of these cases were matched 1:1 to controls by operation, sex and age. In comparison to the controls the cases stayed longer in hospital after the intervention and had more contact after discharge with the social security system. Using data from a national sentinel reference database of the incidence of postoperative wound infections, and using national activity data, we established an empirical cost model based on the estimated marginal costs of hospital resources and social sick pay. It showed that the hospital resources spent on the ten groups, which represent half of the postoperative wound infections in Denmark, amounted to approximately 0.5% of the annual national hospital budget. This stratified model creates a better basis for selecting groups of operations which need priority in terms of preventive measures.