Use of an ultra-clean air flow for surgical field asepsis when performing intravitreous injections in an ambulatory surgical environment

Background Intravitreal injection of medications is one of the most common procedures performed in ophthalmology. Intravitreal anti-VEGF agents are currently the chosen treatment for ocular fundus diseases, including age-related macular degeneration and diabetic retinopathy. As an invasive procedure it involves risks. The most serious complication from intravitreal injection of anti-VEGF agents is endophthalmitis (EO). Although rare, EO can result in devastating loss of vision. This article evaluates whether the use of an ultra-clean air flow (UA) can be another useful tool in the prevention of EOs. Accordingly, the maintenance of asepsis of the surgical field of intravitreal injections was verified with and without the use of UA. Methods The study was conducted in operating room of an ambulatory surgery center on four different surgical days when just intravitreal injections were scheduled. Two experiments using two Blood Agar and two Chocolate Agar plates (first 2 days; 4 plates by day) were carried out by positioning an UA directed to the surgical table and two other experiments (last 2 days; 4 plates per day) were carried out using similar plates without the use of the UA. All Blood Agar and four Chocolate Agar plates were positioned on the surgical table, close to the surgical filed. At the end of the day, after the conclusion of the intravitreous injections, the plates were sent for a biomolecular study that was carried out after 1 day of incubation at 37 °C. Results The sixteen plates, eight Blood Agar and eight Chocolate Agar, were analyzed qualitatively for the growth or not of microorganism’s colonies and identification of their species. The biomolecular study demonstrated the growth of bacteria of the genus Micrococcus sp. with the use of the UA and without the the UA bacterias of the genera Bacillus sp, Staphylococcus haemolyticus, Staphylococcus aureus and Staphylococcus cohnii ssp urealyticus were found. Conclusion The use of UA close to the operating table prevented the growth of pathogenic bacteria and should be considered as an alternative tool to avoid the contamination of materials and drugs used for intravitreal injections.

Haemophilus paraphrophilus brain abscess in a 9-year-old boy: Case report and literature review

Human diseases due to A. paraphrophilus aren’t usual. The following case report describes the first isolated case of A. paraphrophilus brain abscess in our laboratory. A 9-year-old boy presented to pediatric emergencies for frontal headache, vomiting, blurred vision and left hemiparesis. Radiological diagnosis consists with a frontal abscess. Gram staining of purulent samples showed abundant neutrophils with gram negative bacilli. Culture was made on blood agar, chocolate agar, Chapman’s agar and incubated in 5% CO2 at 37°C for 24 hours. Positive culture was detected only on chocolate agar. It was monomicrobial with small yellowish non-hemolytic colonies. Gram stain of colonies showed pleomorphic gram-negative coccobacilli. The strain required V factor for growth. The isolated strain was sensitive to all antibiotics tested. The interest of this case is that it shows the emergence of A. paraphrophilus as a causative agent of brain abscesses on pediatric population without associated congenital heart disease. It may also help identifying risk factors of these infections and how to prevent them.

Isolation on Chocolate Agar Culture of Legionella pneumophila Isolates from Subcutaneous Abscesses in an Immunocompromised Patient

Cutaneous infections due toLegionellaspecies have rarely been reported (L. J. Padrnos, J. E. Blair, S. Kusne, D. J. DiCaudo, and J. R. Mikhael, Transpl Infect Dis 16:307–314, 2014; P. W. Lowry, R. J. Blankenship, W. Gridley, N. J. Troup, and L. S. Tompkins, N Engl J Med 324:109–113, 1991; M. K. Waldor, B. Wilson, and M. Swartz, Clin Infect Dis 16:51–53, 1993). Here we report the identification ofLegionella pneumophilaisolates, from subcutaneous abscesses in an immunocompromised patient, that grew in an unusual medium forLegionellabacteria.

Gonococcal infections: The trends of antimicrobial susceptibility of Neisseria gonorrhoeae in Western Nepal

Background: Gonorrhea is caused by Neisseria gonorrhoeae, is an important public health problem and is the second most common reportable sexually transmitted bacterial infection. Present study was conducted to determine the antimicrobial resistance pattern of Neisseria gonorrhoeae isolates from various clinical specimens. Methods: This is a hospital based retrospective study conducted at Manipal Teaching Hospital, Pokhara, Nepal. Various clinical specimens (urethral, cervical and conjunctival discharges) were collected from the suspected cases of gonococcal infections between January 2004 to December 2010. Specimens were subjected to Gram stain and culture on chocolate agar. Antibiotic susceptibility testing was performed on chocolate agar by Kirby Bauer’s disc diffusion method. Results: A total of 119 patients were tested for gonococcal infections. Forty-eight patients were diagnosed as having gonococcal infections, of which 40 cases were culture positive. Penicillin resistance was seen in 27 (67%) cases while all isolates were sensitive to ceftriaxone. Conclusion: Neisseria gonorrhoeae isolates are becoming increasingly resistant to antibiotics like penicillin, ciprofloxacin and tetracycline. Therefore, continuous surveillance of antibiotic resistance pattern is required in order to start empirical antibiotic therapy in high risk population like commercial sex workers. DOI: http://dx.doi.org/10.3126/njms.v1i2.6603 Nepal Journal of Medical Sciences. 2012;1(2): 74-78

Microbiological Appraisal of Three Different Brands of Commercially Available Irreversible Hydrocolloid Impression Materials: An in vitro Study

ABSTRACT Aim To evaluate factory-sealed containers of three different commercially available irreversible hydrocolloid impression materials for their microbial contamination and the type of microorganisms present. Materials and methods Thirty-six measured samples were taken of each brand and placed on chocolate agar plates or in thioglycolate broth tubes and were incubated along with appropriate parallel controls. After incubation, colonies were enumerated and identified using standard microbiological methods. Results The three brands contained viable microorganisms in 90% of the samples. Samples from the top, middle and bottom layers had approximately equal contamination frequencies. The concentration of organism varied from 25 to 74 CFUs per gram of contaminated sample. Conclusion and clinical significance The samples contained viable microorganism which may be potentially dangerous to immunocompromised patients. How to cite this article Guru R, Saleem M, Singh R, Patil A. Microbiological Appraisal of Three Different Brands of Commercially Available Irreversible Hydrocolloid Impression Materials: An in vitro Study. J Contemp Dent Pract 2011;12(1):35-40.