F 25

BRUCELLOSIS IN THE COUNTY OF TRIKALA

T.K. Galeas, A. Papadopoulos, S. Mylonas, V. Galea, K. Ranellou, E. Militsi, M. Lemoni
B’ Internal Medicine of Trikala, Microbiology Laboratory, General Hospital of Trikala, Greece

The purpose of the work is to show the incidence of brucellosis (an animal transmitted disease caused by brucella) in man the last 30 years in the county of Trikala.

Patients-Method: From the hospital files we wrote down the patients admitted the last 30 years with brucellosis. We divided these 30 years in six five-year periods with the exception of 1995-1997 period when files had been destroyed by flood.

Results: In a total number of 1387 patients with brucellosis we had 1969-73: 400, 1974-79: 388, 1980-84: 144, 1985-89: 140, 1990-94: 17, 1998-2002: 300.

In 1975 a project was applied for the extinction of the disease in animals and consequently in man but for some reasons it was interrupted.

In conclusion: Brucellosis had been decreased for some years.
However the incomplete application of brucellosis extermination programme had as a result the increase of brucellosis in man in the levels of 30 years ago.

F 26

POLYMORPHIC GENES OF TNF-alpha AND IL-8 IN PATIENTS WITH HELICOBACTER PYLORI-INDUCED PEPTIC ULCER

Y. Mándi, Z. Gyulai, G. Klausz, A. Tiszai, J. Lonovics
Department of Medical Microbiology and Immunobiology, 1st Department of Internal Medicine, Faculty of Medicine, University Szeged, Hungary

Background: Activation of inflammatory cytokines plays an important role in the pathogenesis of peptic ulcer. The aim of this study was to investigate the TNF-alpha and IL-8 levels in gastric biopsy samples of ulcer patients. Since cytokine production is often determined by the nucleotide polymorphisms of cytokine genes, we investigated the relationship of the TNF-alpha and IL-8 polymorphisms and the development of H. pylori-induced duodenal ulcer.

Methods: Gastric biopsy samples from 40 H. pylori positive duodenal ulcer (DU) patients were used for determination of local cytokine production by ELISA. DNA from 80 H. pylori positive DU patients were used for genetical experiments. The -308 polymorphism of TNF-alpha gene was determined by NcoI RFLP, and the polymorphism for IL-8 – 251 by ARMS methods. DNA isolated from healthy blood donors (n=50) served as controls.

Results: The production of TNF-alpha and IL-8 was significantly higher (p < 0.001) in antral mucosa in DU patients than in H. pylori negative subjects (n=12). A significant difference however could not be observed in TNF-alpha -308 polymorphism between ulcer patients and the healthy controls. In contrast, allelic frequencies proved to be higher (72%) for the IL-8 –251 A allele, resulting in a significant overproduction of IL-8.

Conclusion: Host factors play an important role in H. pylori-induced ulcer. TNF-alpha and IL-8 production are increased after H. pylori infection. Analysis of genetic predisposition for enhanced cytokine production resulted in a significant association only for the IL-8 polymorphism.

F 27

AN EXOTIX CASE OF PNEUMONIA

M. Széll, H. Laferl, H. Pichler
4th Medical Department with Infectious Diseases and Tropical Medicine
Kaiser-Franz-Josef-Hospital, Vienna, Austria

We present a case of a 73-year-old woman with severe pneumonia on return from a 4-month stay on Fiji Islands.
The patient had spent the winter months on Viti Levu island where her daughter is living. Two days after returning to Vienna in January 2002 she developed severe watery diarrhea (up to 30 bowel movements daily) without nausea, vomiting or abdominal pain. In the following days her general condition deteriorated with extreme fatigue and fainting. Her general practitioner diagnosed “rhythm problems” due to exsiccosis and she was referred to our intermediate care unit.
On admission she was afebrile (temperature, however, rose to 38.4°C within 12 hours), had tachypnoea with bilateral rhonchi and blood gas analysis revealed partial respiratory insufficiency. Chest X-ray showed bilateral infiltrates. ECG confirmed atrial fibrillation. Laboratory investigations showed leukocytosis and marked elevations of C-reactive protein, liver enzymes and creatinkinase. Severe community acquired pneumonia was diagnosed and an empiric antibiotic treatment with cefuroxime and clarithromycin was started. Urinary antigen tests for pneumococci and legionella were negative. Multiple blood cultures showed no growth. Serological testing for rickettsia, chlamydia and mycoplasma did not yield any positive results. There were, however, high IgM and IgG antibody titers against leptospira. Antibiotic treatment was changed to oral doxycycline. The patient recovered slowly and was discharged in good condition after 18 days. She recalled close contact to healthy pet cats during her stay on Fiji but not to any rodents.

Conclusion: In patients with pneumonia on return from tropical countries leptospirosis should be ruled out.

F 28

PHARMACODYNAMIC TARGET ATTAINMENT ANALYSIS AGAINST STREPTOCOCCUS PNEUMONIAE USING LEVOFLOXACIN 500 MG AND 750 MG ONCE DAILY IN HOSPITALIZED PATIENTS WITH COMMUNITY ACQUIRED PNEUMONIA

A. Noreddin, T. Marras, C. Chan, D. Hoban, G. Zhanel
University of Manitoba, Medical Microbiology, Winnipeg, Canada;
University of Toronto, University Health Network, Toronto, Canada

Objective: This work aimed at simulating pharmacodynamic target attainment potential against Streptococcus pneumoniae using levofloxacin 500 mg and 750 mg once daily in hospitalized patients with community acquired pneumonia (CAP).

Methods: Pharmacokinetic simulations of susceptibility data with S. pneumoniae from our ongoing national surveillance study (Canadian Respiratory Organism Susceptibility Study-CROSS) were used to produce pharmacodynamic indices of AUC0-24/MIC90. Monte Carlo simulations were then used to analyze target attainment of levofloxacin using doses of 500 mg and 750 mg once daily to achieve free drug AUC0-24/MIC90 of 30 for. S. pneumoniae in patients with CAP.

Results: Pharmacokinetics of levofloxacin simulated after both 500 mg and 750 mg doses resulted in levofloxacin clearance: elderly patients < immunocompromised patients < young patients = healthy volunteers. Levofloxacin t 1/2 values were the longest in elderly patients (14.7 - 8.5 h) as well as immunocompromised patients (13.0 - 10.1 h), while young patients with CAP (8.9 - 5.8 h) had a slightly longer t 1/2 than healthy volunteers (7.4 - 0.9 h). Free levofloxacin AUC0-24 as well as AUC0-24/MIC90 for S. pneumoniae were highest in elderly patients followed by immunocompromised patients > young patients > volunteers. Monte Carlo simulation using levofloxacin 500 mg yielded probabilities of achieving free-drug AUC0-24/MIC90 of 30 at 95.9%, 83.8%, 71.9% and 78.5% for elderly patients, immunocompromised patients, young patients and healthy volunteers, respectively.

Conclusion: Using levofloxacin 750 mg, the probability of achieving free-drug AUC0-24/MIC90 of 30 was 98.5%, 96.4%, 89.5% and 93.3% for elderly patients, immuno-compromised patients, young patients and healthy volunteers, respectively. We conclude that levofloxacin pharmacokinetics in elderly patients with CAP are markedly different than those of young patients or healthy volunteers. Higher levofloxacin AUC and longer t 1/2 values in elderly patients with CAP compared to healthy volunteers provide better pharmacodynamic parameters (free-Drug AUC0-24/MIC) leading to higher probability of pharmacodynamic target attainment and improved bacteriological outcome against S. pneumoniae.

F 29

ANTIBIOTICS IN HOME FIRST-AID SETS

S.K. Zenkova, V.M. Semenov, V.V. Skvortsova, T.I. Dmitrachenko
Vitebsk State Medical University, Republic Belarus

One of the most important ways of the development of antibiotic resistance is the overusage of antibiotics by the patients. To assess the level of antibiotics abuse we have investigated the content of home first-aid sets of 186 families living in Vitebsk, Minsk, Bobruysk and Molodechno.
We have revealed that 144 (77.4%) of all interviewed families had some kind of antibiotics in their home first-aid set. The quantity of antibiotics was 1-7, and 11.7% of it were of expired date but, according to respondents opinion, they were fit for use. The most frequent were ampicillin (77.8%), erythromycin (30.5%), tetracycline (29.1%), co-trimoxazol (27.8%), doxycyclin (27.8%), chloramphenicol (22.2%).
Only 4.17% of families applied antibacterial preparations according to the prescriptions of their physicians. Only 22.2% of people interviewed knew the correct indications for usage of antibacterial preparations from their first-aid set, 30% didn’t know these indications, and 30.5% of respondents knew the indications partially. There was no sufficient difference between urban and rural population in the patterns of incorrect usage of antibiotics. 37.3% of families having children gave the incorrect answers concerning the usage of antibiotics in children.
According to respondents opinion, the main indications for the antibiotics application are any increase of temperature, rhinitis, cough or stomachache. The majority of them used antibiotics irregularly, 1-2 times a day for 1-3 days.
Our analysis indicates wide uncontrolled application of antibiotics by the population what may be a possible cause for increasing antibiotic resistance of bacteria. To solve this problem it is necessary to prohibit selling antibiotics without prescription.

F 30

Analysis of the prevalence and RFLP subtyping of Borrelia burgdorferi sensu lato (Bb) in Ixodes ricinus ticks from an endemic area in Austria

M. Glatz, V. Fingerle, B. Wilske, R.R. Müllegger
Department of Dermatology, Univ. Graz, Austria

Objective:
(i) To determine the prevalence of Bb in Ixodes ricinus ticks in an highly endemic area for tick-transmitted diseases in Austria (city of Graz) by PCR.
(ii) To identify the borrelia genotypes present in those ticks by RFLP (restriction fragment length polymorphism) analysis.

Methods: 131 ticks were collected in June 2002 by the flagging method in a woodland recreation area of Graz. All ticks were placed into humidified tubes and stored at 4°C until separate DNA extraction for each tick with a commercial preparation kit (Roche). Extracted DNA was analysed using a semi-nested PCR with 2 primer pairs specific for an 818 bp fragment of the Bb ospA gene to detect infection of ticks followed by RFLP analysis with 5 endonucleases for genotype identification of positive samples.

Results: 27/131 (21%) ticks were found to be positive for Bb, 14 of which were nymphs and 13 were adults. RFLP analysis revealed 18 (67%) ticks to be infected with the genotype B. afzelii, 5 (19%) with Bb s.s., 3 (11%) with B. garinii, and 1 (3%) with B. valaisiana.

Conclusion:
(i) A high percentage of ticks in Graz is infected with Bb.
(ii) Tick nymphs have the potential to transmit Bb.
(iii) B. afzelii is the most prevalent genotype and Bb s.s. is found more frequently than expected.
(iv) B. valaisiana was detected for the first time in Austria in this study.

F 31

MIDECAMYCIN IN TREATMENT OF CHRONIC UROGENITAL CHLAMIDIOSIS

V.M. Kozin, A.N. Gorodovich
Vitebsk State Medical University, Republic Belarus

We have studied the clinical efficiency of midecamycin application in 23 patients ill with chronic urogenital chlamidiosis aged 19-54 (16 men and 7 women). In male patients there were the signs of anterior urethritis (4), total urethritis (7) and urethroprostatitis (5). In female patients we have revealed the signs of urethritis and cervicitis, and also subacute endometritis and parametritis (2). The majority of patients had different complaints as itch, small pain during the emiction, genital discomfort. Some patients had perineum and femoral aches. All patients had positive results of immunofluorescence reaction (IFR) for the chlamidia antigens made in scraping smears. All patients were treated with injections of midecamycin (400 mg 3 times a day). We have also prescribed enterol with the aim of biocorrection (250 mg 2 times a day). Female patients were recommended to introduce anti-candidosis drugs into vagina.
We assessed the dynamics of the symptoms for the time of treatment. The control of cure was made in 1, 2 and 3 months from the last day of treatment. All patients overcame the injections well. We haven’t seen any cases of intolerance. Finally, all patients became symptoms-free, including women suffering from endometritis and parametritis. We haven’t found chlamidia in urethra smears of 15 men using IFR. Chlamidia was also eliminated in 6 women including suffering from endometritis and parametritis.
Thus, application of midecamycin in a complex treatment of patients with chronic urogenital chlamidiosis results in full clinical and microbiological cure in 89% of patients.

F 32

FIBRONECIN IN ACUTE AND CHRONIC HEPATITIS B

P. Khaykin
Dnepropetrovsk Medical Academy,Ukraine

Objectives: The aim of the research was to carry out a comparative analysis of free and combined with circulated immune complexes (CIC) fibronectin (FN) contents in acute and chronic hepatitis B.

Methods: 57 patients with acute hepatitis B (1 group), 32 patients with chronic hepatitis B (2 group) and 30 healthy persons were investigated. The parameters were determined in plasma at the first day of stay in the hospital and 1 month later. Contents of free and combined FN were determined using ELISA, FN degradation products – using Western Blot with the rabbit antibodies to FN, level of CIC – using precipitation with 3% PEG 6000. Results in acute hepatitis B the average contents of free FN was higher than in control group and chronic patients (t=6.93; p < 0.001; t=8.63; p < 0.001). Lowering of free FN contents was observed in dynamic (t = 5.23; p < 0.001). The level of CIC at the first investigation in both groups exceeded such in a control group (t = 6.14; p < 0.001; t = 5.11; p < 0.005). In acute hepatitis B the lowering of a CIC level (t = 3.92, p < 0.01) was observed. It was determined that concentration of combined FN was higher in acute hepatitis patients than in control group and chronic hepatitis (U = 83.2; p < 0.05; U=68.3; p < 0.05). We detected products of a combined FN degradation in the majority of the chronic hepatitis B patients, in 1 group – less than for half of patients and in control group only in 1/6.

Conclusion:
1. In patients with acute hepatitis B the contents of free and combined FN increase in the beginning of disease and decrease in the dynamics simultaneously with a level of CIC.
2. In patients with chronic hepatitis reduced contents of free and combined FN and degradation of combined FN are observed.

F 33

LAMIVUDINE IN SEVERE ACUTE VIRAL HEPATITIS

M. Hurmuzache,V. Luca, O. Mihoc
UNIV. MED & PH, Iasi, Romania

Objective: The aim of study is to show the effectiveness of lamivudine in children aged under 16 with severe B acute viral hepatitis (AVBH), including fulminant and subfulminant.

Methods: Retroprospective study, comparing two groups of children who were admitted in the Univ. Hosp. of Inf. Diseases, Iasi, Romania, one of them between 1995-1998 (19 patients=group A) who did not receive lamivudine and a second group (B=16 patients) admitted 1999-2002 who received 100 mg lamivudine, daily. Each group was divided as follows: group A: A1 (13 severe AVBH), A2 (5 fulminant ac.B hep.) and A3 (1 subfulminant). Group B: B1 (11 severe AVBH), B2 (4 fulminant), B3 (1 subfulminant). Inclusion in one of these subgroups was decided in day 7 from admission for group A and according to the clinical profile in the first day of lamivudine administration for group B. Criteria to maintain patients in the study included at least one of the next: symptomatology unchanged or worsened for 10-14 days after admission, high levels of total bilirubin (> 20 mg%), leuco/thrombopaenia, presence of haemorrhagic syndrome (clinical+Quick < 35%), neurological signs. Treatment with lamivudine was not begun before serological diagnosis was established (IgM HBc +). Some of the patients with fulminant hepatitis received also alpha interferon (2 in groupA, 2 in group B). R=recovered, D=deaths.

Results: Group A1 (13 patients, severe AVBH, lamivudine-): R=9 (69%), D=4 (31%, evolution toward acute liver failure); group A2 (5 patients, fulminant hepatitis, lamivudine-): R=2 (40%), D=3 (60%); 1 R and 1 D received also alpha interferon. Group A3 (1 patient, subfulminant hepatitis, lamivudine-): R=1 (100%). Group B1 (11 patients, severe AVBH, lamivudine+): R=10 (91%), D=1 (9%). Group B2 (4 patients, fulminant hepatitis, lamivudine+): R=2 (50%), D=2 (50%). 1 R and 1 D received also interferon alpha. Group B3 (1 patient, subfulminant hepatitis, lamivudine+): R=1 (100%).

Conclusion: As it can be observed, treatment with lamivudine significantly reduces the number of severe acute B hepatitis with bad evolution toward acute liver failure and sometimes death (9% vs 31%) and improves mortality even in fulminant hepatitis, so it should be administered immediately after clinical or biological signs suggest an inadequate evolution.

F 34

APOPTOSIS/NECROSIS INDUCED BY METAL COMPLEXES OF ACICLOVIR AND OF THIOSEMICARBAZONES DURING HSV 1 INFECTION DEPENDS ON COMPLEX SPECIFICITIES

P. Genova, T. Varadinova, P. Souza, D. Kovala-Demertzi, A. Terron, A. Garcia-Raso, J. Fiol
Laboratory of Virology, Sofia University, Bulgaria; Universidad Autonoma de Madrid, Spain; Universitat de les Illes Balears, Palma de Mallorca; University of Ioannina, Ioannina, Greece

We previously reported the activity of complexes of aciclovir (ACV) and of thiosemicarbazones (pyridine-2-carbaldehyde - HFoTsc and bis-benzyl-Tsc) of bivalent metal ions during HSV infection. Here we present data on the effect of complexes of Zn(II), Co(II), Cd(II), Ni(II), Pt(II), Pd(I) and Ag(I) on apoptosis in HSV 1 infected and in noninfected MDBK cells. Apoptosis was identified by morphological criteria using both fluorescent acridine orange dye for DNA and Janus green B dye for mitochondria staining. The following two sets of data were found: (i) induction of apoptosis/necrosis by [Cd(ACV)Cl2].H2O, [Ni(ACV)(NO3)]3.5H2O, [Ni(ACV)2(H2O)4]Cl2.2ACV and Pd(II) complexes of Tsc derivatives manifested by vesiculation in the cytoplasm, nuclear fragmentation, chromatin condensation and clumping, as well as mitochondria condensation; (ii) no induction of apoptosis/necrosis under the influence of complexes of Zn(II), Co(II) and Ag(I) of ACV and of Pt(II) of HFoTsc. These data are in accordance with those previously published by other authors and confirm that the induction of apoptosis/necrosis depends on the specificities of the particular metal ion. Furthermore the induction of these processes is independent on whether cells are infected by HSV 1 or not.
(Project COST D20, 0006-01 and NSF, 1201)

F 35

USE OF PREFORMING PHYSICAL FACTORS IN THE COMPLEX RESTORING THERAPY OF CHILDREN WITH CHRONIC VIRAL HEPATITIS

O.V. Kuznetsova, I.N. Fedchuk
Odessa State Medical University, Odessa, Ukraine

The scope of the present work was to study the use of preforming physical factors such as He-Ne laser irradiation with the vacuum ultraphoresis of peloidin.
37 children with chronic viral hepatitis were under investigation in the period of aggravation. The diagnosis was stated on the basis of disease anamnesis and discrimination of hepatitis viruses markers B and C. The patients obtained traditional medicinal treatment accompanied by physiotherapy. The complex restoring therapy included 6 daily applications of laser bio-resonant irradiation of liver projection at the beginning and 6 applications of vacuum ultraphoresis of the mixture including peloidin.
It was discovered that the proposed method has led to quicker cupping of main syndromes of the disease. The positive dynamics of biochemical and immunological data shows the proposed complex therapy’s efficacy. Alaninaminotransferase’s activity level at the state of aggravation was registered as 0.72 ± 0.03 mM and after complex restoring application was reduced to 0.51 ± 0.05. At the stage of aggravation the T-lymphocytes number was lowered to 42.3 ± 0.6. After the complex restoring therapy application this number was increased to 56.6 ± 0.9 and the suppression index was correspondingly lowered from 4.94 ± 0.62 to 2.3 ± 0.52. We have registered as well the IgA level increase from 1.17 ± 0.02 mg/l to 1.39 ± 0.05 mg/l and IgG decrease from
12.5 ± 0.03 mg/l to 10.6 ± 0.05 mg/l. The catamnestic survey of the children group during 2 years showed the more prolonged stabilization of biochemical and immunological parameters of serum.

F 36

ETHNOLOGICAL STRUCTURE AND SUSCEPTIBILITY TO ANTIBACTERIAL AGENTS OF MICROORGANISMS ISOLATED FROM PATIENTS WITH URINARY TRACT INFECTIONS

K. Bojkova, V. Russev, V. Kaludova, V. Kamenova
Varna, Bulgaria

Objective: To analyze the frequency and antibacterial susceptibility of urinary pathogens in hospitalized patients.

Methods: All urine isolates from in-patients were collected. The analysis was based on the microbiology data. The identification of isolates and antibacterial susceptibility test was performed using the disk diffusion method.

Results: We received 21 620 urine samples of which 27% fulfilled the criteria for significant bacteriuria (pure growth of 10 000 CFU/ml urine). The ten most commonly isolated microorganisms were in decreasing order: Escherichia coli 38.17%, Proteus spp. 9.8%, CNS 8.5%, Pseudomonas spp. 7.5%, Candida spp. 7.4%, Klebsiella spp. 7.2%, Enterobacter spp. 6.6%, Streptococcus spp. gr. D 6.5%, Streptococcus spp. 3.3%, S. aureus 2.3%.
Escherichia coli was highly susceptible > 90% to Cefuroxim, Ceftriaxone, Ceftazidime, Gentamicin, Ciprofloxacin and more than 80% of E. coli isolates were also sensitive to Piperacillin, Ampicillin/Clavulanic acid, Trimethoprim/Sulfamethoxazole and Nalidix acid. Coagulase-negative staphylococci were predominantly susceptible to Ampicillin/Clavulanic acid - 90%; to Oxacillin - 92%; to Ciprofloxacin - 85%. Pseudomonas spp. presented rates of resistance as hight as 67% to Ceftriaxone, 22% to Amikacin, 34% to Gentamicin, 26% to Ciprofloxacin, 19% to Piperacillin. All the tested gram-positive pathogens were susceptible to vancomycin.

Conclusion: The most common pathogen in the area of the university hospital among isolates from urine cultures was Escherichia coli. Ampicillin/Clavulanic acid, Trimethoprim/Sulfamethoxazole and Nalidix acid can be used for empiric treatment of UTI.

F 37

BACTERIAL SPECTRUM IN URINARY TRACT INFECTIONS IN ELDERLY PEOPLE

TK. Galeas, A. Kauloumvaki, V. Galea, A. Rematisios, M. Lemoni
B' Internal Medicine Clinic, Microbiology Laboratory, General Hospital of Trikala, Greece

The purpose of this study was to examine the bacterial spectrum in urinary tract infections, in elderly people, in order to manage the most efficient therapeutic approach.
Material-method: Material of the study were 110 patients, 43 male aged 76.25 ± 7.56 and 67 female aged 75.74 ± 6.02. Other 57 patients, 21 male aged 46.38 ± 15.2 and 36 female aged 46.41 ± 14.15 were the control group. They were hospitalized in the General Hospital of Trikala from 1/1/1993 to 20/10/1993. The patients were separated according to gender, age and the isolated infectious factors in urine culture. Cultures were considered positive when concentrations of infectious factors was over 100.000/ml.

a) Increased incidence of urinary tract infections is mostly observed in the elderly compared with the middle aged people.
b) Isolated bacteria are observed with different frequency in both ages, significantly in men. Most usual bacterium is E. coli followed by staphylococcus and
pseudomonas

Conclusion: 1. Pseudomonas appears to be increased in male patients of the third age, although it is the third cause of urinary tract infection.
2. E coli is the main cause of urinary tract infections in female patients of the third age.

F 38

POSITIVE CULTURE OF NEGATIVE SUCTION DRAIN TIPS - A PREDICTOR OF EARLY WOUND INFECTION?

B. Sankar, G. Kumar, J. Rai
PGIMER, Chandigarh, lndia

Introduction: Use of closed negative suction drain is an accepted form of surgical wound drainage The most common source of postoperative infection is wound contamination at surgery.

Aim: To determine whether bacterial growth in the cultures of drain tips and drain fluid from suction drains correlates with early postoperative infection.

Methods and materials: During the period April 1998 to April 1999 details of 214 consecutive clean orthopaedic operations which needed suction drains were prospectively recorded. The data collected included duration and number of drains used, results of fluid and tip cultures and clinical impression of the surgical wound in the two weeks after operation.

Results: A total of 8 out of 214 had clinical signs of infection within the first two weeks. Drain tips were positive in 12 cases of which 6 had positive clinical findings. Drain fluid cultures were positive in 7 cases of which only 1 had positive clinical findings. In 1 case both cultures were negative but had positive clinical findings of infection. When wound infection occurred, drain tip cultures were abte to predict this earlier by an average of 1.3 days.

Discussion: Infection in orthopaedic surgery is a disaster. If the micro organism(s) involved is/are identified at an earlier stage then appropriate treatment could be instituted faster. The results of this study show that positive culture from drain tips can give very early indication of wound infection much before clinical symptoms are evident.
We think that it is worthwhile to perform cultures of drain tips in patients who are at high risk for developing post operative wound infection.

F 39

INFECTIONS AFTER INTRAORAL TUMOR SURGERY: BACTERIA AND ANTIBIOTICS

A. W. Eckert, P. Maurer, D. Wilhelms, J. Schubert
Universitätsklinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie,
Institut für Medizinische Mikrobiologie der Martin-Luther Universität Halle-Wittenberg, Germany

Introduction: Infections after resection of oral cancer often require the administration of antibiotics. However, the bacterial spectra include isolates of Enterobacteriaceae and gram-negative aerobic Bacilli and resistance to penicillins and cephalosporins have been described. The purpose of this study was to determine the present bacterial spectrum and antibiotical resistance after oral cancer surgery.

Materials and methods: 27 patients underwent ablative tumor surgery, in which cefotiam was parenterally admninistered from the start of the surgery as prophylaxis. Swabs were taken from 41 clinically acute and severe infections after tumor surgery. Additionally, all specimens of swabs were collected into a transport media and transported to the laboratory within 24 hours.

Results: A total of 108 bacterial strains were isolated. The ratio between aerobic and anaerobic bacteria was 4:1. The predominant aerobes were Enterobacteriaceae (20 isolates) followed by Staphylococci (18 isolates) and Streptococci (17 isolates). The majority of anaerobes were Prevotella (8 isolates) and Fusobacterium (5 isolates).
Penicillin, Doxycyclin and Erythromycin were less active (66%, 45% and 56% respectively). Ciprofloxacin, Cefotiam and Piperacillin/Tazobactam showed a better efficiency, the resistance was nearly 18%. Imipenem and Meropenem were highly active to most of the bacteria: the resistance was approximately 10%. In vitro Vancomycin and Teicoplanin were still the most active of all antibiotics tested.

Conclusion: The operative field in oral cancer surgery was colonized by the normal oral flora and Enterobacteriaceae. Extended spectrum beta-lactamase (ESBL) production among members of the family Enterobacteriaceae involves resistance to Penicillins, Cephalosporins and Monobactams and causes serious therapeutic problems. ESBL are often encoded by multi-resistant plasmids carrying genes conferring resistance to other antimicrobials. Therefore, antibiotic administration in patients who underwent oral tumor surgery should be performed after controlling the microbiological culture and resitogramm.

F 40

BACTERIOLOGY AND ANTIBIOTIC SUSCEPTIBILITY IN ODONTOGENIC INFECTIONS

A. W. Eckert, P. Maurer, D. Wilhelms, J. Schubert
Universitätsklinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie,
Institut für Medizinische Mikrobiologie der Martin-Luther Universität Halle-Wittenberg, Germany

Introduction: Odontogenic infections are polymicrobial with a predominance of anaerobes. With respect to the widespread resistance in anaerobes to common antibiotics the aim of the present investigation was to evaluate the bacterial spectra and resistance patterns in odontogenic infections.

Materials and methods: Pus sampies were collected from 65 patients with acute odontogenic infections by sterile needle aspiration immediately before incision of abscesses and/or collected into an anaerobic transport system. All samples arrived at the microbial laboratory within 1 hour.

Results: 65 patients (39 men and 26 women) with an odontogenic abscess were investigated. In the "closed" odontogenic abscess samples, a total of 226 bacterial strains were isolated; 150 (66.4%) were anaerobes and 76 (33.6%) were aerobes. The mean number of bacterial strains per sample was 3.47. Streptococci, Staphylococci and Neisseria were the most common aerobic isolates. The majority of anaerobes were Prevotella (46 isolates), Fusobacterium (21 isolates), Eubacterium (19 isolates) and Peptostreptococcus (16 isolates). Most of the anaerobes were highly susceptible to Clindamycin (1.4% resistant strains), Ampicillin (2.6% resistant strains) and Penicillin G (8.1% resistant strains). The best antimicrobial activities showed Imipenem (0.7% resitance), Ampicillin/Sulbactam (0% resistance) and Amoxicillin/Clavulanic acid (0% resistance).

Conclusion: Penicillins are still suitable for the first antimicrobial therapy in the treatment of odontogenic infections. However, because after beta-lactam administration increases the appearance of beta-lactam-producing bacteria, beta-Iactam-stable antibiotics or Clindamycin should be prescribed to this patients. The antimicrobial efficiency of modern Fluorochinolones or Azithromycin will be the topic of further investigations.

F 41

A LEVEL OF AN ALPHA-1-PROTEININHIBITOR IN PATIENTS WITH CHRONIC BRONCHITIS AND LUNG TUBERCULOSIS

M.N. Akhtar, O.A. Dmitrikova, N.A. Zucashaevich
Department of Facultative Surgery Donetsk Medical State University, Department of
Facultative Surgery, Ukraine

Aim: The purpose of our research was to define a level of alpha-1-proteininhibitor in patients with chronic bronchitis and lung tuberculosis.

Materials and rnethods: Research of an alpha-1-proteininhibitor level was carried out in 96 patients, suffering from a cornbination of chronic bronchitis and lung tuberculosis. The control group (49 persons) consisted only in patients with tuberculosis. The basic surveyed group was subdivided into 3 subgroups and consisted of 24 patients.

Results: The reduction of an alpha-1-proteininhibitor level up to a low limit have took in 3 (3.1%) patients of the first group, in the second group - 8.9. The tuberculosis in them was developed after 3.5. It were serious patients with emphysema of 2-3 degree. The level of an alpha-1-proteininhibitor in them has made 0.101, 0.15 and 0.25 mg/ml, the fraction of an alpha-1-globulin in an albuminous spectrum of electrophotogramm in them was reduced in 5 times, testifies about homozygous failure. In two groups and in control of similar decrease we have not met. An average level of an alpha-1-proteininhibitor in 11 (50.5%) persons of the first group, 12 (23.7%) - the second group, in 5 (20.8%) persons of the third group and 2 (6.1%) in control. In total in all surveyed groups of average deficiency is revealed in 28 (29.1 %) patients, corresponds to heterozygotic insufficiency. The fraction of an alpha-1-globulin of an albuminous spectrum was reduced in 85 cases. Increase of a level of an alpha-1-proteininhibitor have a place in 4 (17.4%) patients of first group, 12 (42.9%) survey of the second group, 7 (25%) persons of the third group and 11 (29%) persons of control, that reflects intensity of inflammatory and destructive processes in an organism.

Conclusion: However, revealed in 3.1% patients of the first group of low deficiency and in 28 (29.1 %) patients of moderate deficiency of alpha-1-proteininhibitor testifies about genetically caused inability of an organism to provide adequate protection of pulmonary tissues from injuring influence of bacterial and leukocytic proteinase.

F 42

CASE REPORT: RECURRENT ATTACKS OF FEVER AND ABDOMINAL PAIN

R. Gattringer
Department of Internal Medicine I, Division of Infectious Diseases and
Chemotherapy, University of Vienna, Vienna General Hospital, Austria

A 27 year old female patient came to the outpatient clinic with severe abdominal pain and fever (39°C). The inflammatory parameters were elevated: white blood count 12 G/I, C-reactive protein 17.9 mg/dl, the blood sedimentation rate 60.
The local abdominal tenderness has been existing since one week and started suddenly.
A short story of diagnostics and clinical course.