Effect of the initial specimen diversion technique on blood culture contamination rates.

The initial specimen diversion technique (ISDT) was first described by Patton and Schmitt (J. Clin. Microbiol.

A vignette-based survey to assess clinical decision making regarding antibiotic use and hospitalization of patients with probable aseptic meningitis.

Background: The many etiologies of meningitis influence disease severity - most viral causes are self-limiting, while bacterial etiologies require antibiotics and hospitalization. Aided by laboratory findings, the physician judges whether to admit and empirically treat the patient (presuming a bacterial cause), or to treat supportively as if it were viral.

Objective: To determine factors that lead infectious disease specialists to admit and treat in cases of suspected meningitis.

Clinical presentation of patients with aseptic meningitis, factors influencing treatment and hospitalization, and consequences of enterovirus cerebrospinal fluid polymerase chain reaction testing.

Introduction: Clinical and laboratory features of enteroviral meningitis may overlap with those of bacterial meningitis. In the present retrospective review, we compared features of enteroviral (EV)-positive and -negative patients to determine those that were most influential in admission, discharge and in anti-infective administration.

Methods: Data were analyzed from the records of 117 pediatric and adult patients who underwent cerebrospinal fluid (CSF) EV testing over a three-year period.

Clinical effectiveness of rapid tests for methicillin resistant Staphylococcus aureus (MRSA) in hospitalized patients: a systematic review.

Background: Methicillin resistant Staphylococcus aureus (MRSA) are often resistant to multiple classes of antibiotics. The research objectives of this systematic review were to evaluate the clinical effectiveness of polymerase chain reaction (PCR) versus chromogenic agar for MRSA screening, and PCR versus no screening for several clinical outcomes, including MRSA colonization and infection rates.

Methods: An electronic literature search was conducted on studies evaluating polymerase chain reaction techniques and methicillin (also spelled meticillin) resistant Staphylococcus aureus that were published from 1993 onwards using Medline, Medline In-Process & Other Non-Indexed Citations, BIOSIS Previews, and EMBASE.

Risk of coinfection with Chlamydia trachomatis and Neisseria gonorrhoeae in Nova Scotia.

Background: The frequency of Chlamydia trachomatis and Neisseria gonorrhoeae coinfection can vary depending on their individual incidence and prevalence rates.

Objective: To determine the frequency of C trachomatis and N gonorrhoeae coinfections by evaluating the results of testing in 2007 and 2008 to better inform testing and treatment decisions.

Methods: Specimens from the same patient submitted on the same day served as the basis for the present study.

Analysis of 3789 in- and outpatient Escherichia coli isolates from across Canada--results of the CANWARD 2007-2009 study.

Escherichia coli was the most commonly isolated pathogen in the Canadian Ward Surveillance Study 2007-2009 (3789 isolates). Susceptibility to cefazolin (34.1%), trimethoprim-sulfamethoxazole (73.

The value of multiple surveillance cultures for methicillin-resistant Staphylococcus aureus.

Background: We evaluated our experience in a low prevalence setting to determine the extent to which multiple swabs increased detection rates and the incremental costs of doing so.

Methods: Nasal and groin swabs submitted in pairs were cultured onto a single plate (Oxoid MRSA Denim Blue Agar; Oxoid Company, Napean, ON, Canada). We determined whether MRSA was detected when swabs submitted in the preceding 3 days were negative.

Switching gears for an influenza pandemic: validation of a duplex reverse transcriptase PCR assay for simultaneous detection and confirmatory identification of pandemic (H1N1) 2009 influenza virus.

Rapid methods for the detection and confirmatory identification of pandemic influenza A virus (also known as pandemic [H1N1] 2009) are of utmost importance. In this study, a conventional reverse transcriptase PCR (RT-PCR) assay for the detection of influenza A virus and the hemagglutinin of swine lineage H1 (swH1) was designed, optimized, and validated. Nucleic acids were extracted from 198 consecutive nasopharyngeal, nasal, or throat swab specimens collected early in the outbreak (127 negative specimens, 66 specimens with pandemic [H1N1] 2009 influenza virus, 3 specimens with seasonal [H1N1] influenza A virus, and 2 specimens with seasonal [H3N2] influenza A virus).

Gender differences in knowledge about chlamydia among rural high school students in Nova Scotia, Canada.

Background: Chlamydia is the most prevalent sexually transmissible infection (STI) in Canadian adolescents. STI account for 20% of cases of infertility in Canada and 42% of ectopic pregnancies are attributable to previous chlamydia infection. Despite the importance of this infection, little is understood about young people's knowledge of it.

A study of the prevalence of cytotoxic and non-cytotoxic Klebsiella oxytoca fecal colonization in two patient populations.

Background: Klebsiella oxytoca is a cause of antibiotic-associated hemorrhagic colitis. Few reports of the occurrence of K oxytoca within stool exist and there is no gold standard method for its isolation.

Methods: MacConkey agar was modified to culture K oxytoca.

A pilot project for chlamydia screening in adolescent females using self-testing: characteristics of participants and non-participants.

Objectives: A self-test screening program for genital C. trachomatis infection in female students attending high school in rural Nova Scotia was introduced. The objectives of this pilot study were to determine the extent of uptake, reasons for being/not being screened, and whether students at risk would be more likely to be screened.

An evaluation of extended incubation time with blind subculture of blood cultures in patients with suspected endocarditis.

Background: In a small proportion of patients, bacterial endocarditis is due to organisms that grow slowly and may not be recovered in conventional blood cultures incubated for five days. This has led to recommendations for prolonged incubation and routine subculture of negative cultures.

Objective: The above-mentioned approach is evaluated.

A comparison between the Strep A Rapid Test Device and conventional culture for the diagnosis of streptococcal pharyngitis.

Background: Rapid antigen detection tests are frequently used to diagnose pharyngitis due to Streptococcus pyogenes. Because a large number of kits are available commercially, performance characteristics may vary considerably. The present study evaluated one such kit currently in use in Canadian laboratories for which published evaluations are not available.

Recovery of cephalosporin-resistant Escherichia coli and Salmonella from pork, beef and chicken marketed in Nova Scotia.

Background: Antimicrobial use in farm animals is a potentially important contributor to the emergence of antimicrobial resistance. Resistant Salmonella may lead to serious human infections and resistant Escherichia coli may transfer plasmid-encoded resistance genes to other pathogens.

Objective: To determine the prevalence of E coli and Salmonella species resistant to the third generation of cephalosporins in retail meat products in Halifax, Nova Scotia in 2002.

Predominance of herpes simplex virus type 1 from patients with genital herpes in Nova Scotia.

The epidemiology of genital herpes is changing with evidence to suggest an increasing incidence of herpes simplex virus type 1 (HSV-1) infections. The results of 6529 HSV genital cultures taken between April 1998 and December 2001 were reviewed. overall, HSV-1 was recovered more often than HSV-2; 1213 versus 1045.

Clinical utility of a Legionella pneumophila urinary antigen test in a large university teaching hospital.

Objective: To determine the clinical utility of diagnosing Legionella pneumonia by urinary antigen testing (LPUAT) in a low prevalence centre.

Design: The results of LPUATs were abstracted and analyzed from the authors' laboratory information system. Medical records were reviewed in detail for all positive tests and a random sample of 50 negative tests.

Antimicrobial resistance among invasive isolates of Streptococcus pneumoniae collected across Canada.

Between 2002 and 2003, 736 nonduplicate Streptococcus pneumoniae isolated from blood cultures were collected from 7 of 10 Canadian provinces (10 tertiary care centers). Microdilution broth susceptibility testing was performed using the method prescribed by the Clinical Laboratory Standards Institute. Of the isolates, 16.

Cephalosporin resistance in Klebsiella pneumoniae from Nova Scotia, Canada.

From 2116 Klebsiella pneumoniae strains isolated between January 2001 and December 2002 in Nova Scotia, Canada, 25 (1.18%) showed a reduced susceptibility to cefoxitin or extended-spectrum cephalosporins. Narrow-spectrum beta-lactamase genes (bla(SHV-11), bla(SHV-1), bla(SHV-26), bla(SHV-32), bla(SHV-36), and bla(SHV-40)) were the most prevalent.

In vitro antimicrobial susceptibilities of Streptococcus pneumoniae clinical isolates obtained in Canada in 2002.

Empirical treatment is best guided by current surveillance of local resistance patterns. The goal of this study is to characterize the prevalence of antimicrobial nonsusceptibility within pneumococcal isolates from Canada. The Canadian Bacterial Surveillance Network is comprised of laboratories from across Canada.

Screening for West Nile virus in organ transplantation: a medical decision analysis.

The Organ Procurement and Transplant Network (OPTN) has recently announced that screening for West Nile Virus (WNV) in deceased organ donors is not recommended at this time. The purpose of this report was to examine the impact of this recommendation by using medical decision analysis. Without screening the rate of disease transmission was assumed to be the same as in donated blood with a case fatality rate of 25%.

Cephamycin resistance in clinical isolates and laboratory-derived strains of Escherichia coli, Nova Scotia, Canada.

AmpC β-lactamase, altered porins, or both are usually responsible for cefoxitin resistance in . We examined the relative importance of each. We studied 18 strains of clinical isolates with reduced cefoxitin susceptibility and 10 initially-susceptible strains passaged through cefoxitin-gradient plates.

The impact of switching to polymerase chain reaction for the diagnosis of Chlamydia trachomatis infections in women.

Background: We noted a marked increase in Chlamydia trachomatis (CT) infections in the Capital Health Region of NS coincident with substitution of a PCR for an enzyme immunoassay (EIA). We reviewed our experience to determine the cost of switching and the impact on the number of new infections diagnosed.

Methods: Information on the number of EIA and PCR tests performed on women was retrieved from an abstracted laboratory information database.

Antimicrobial resistance among clinical isolates of Streptococcus pneumoniae in Canada during 2000.

A total of 2,245 clinical isolates of Streptococcus pneumoniae were collected from 63 microbiology laboratories from across Canada during 2000 and characterized at a central laboratory. Of these isolates, 12.4% were not susceptible to penicillin (penicillin MIC, >or=0.