Neisseria meningitidis is a leading cause of bacterial meningitis and sepsis among older children and young adults in the United States. N. meningitidis usually is transmitted through close contact with aerosols or secretions from the human nasopharynx. Although N. meningitidis is regularly isolated in clinical laboratories, it has infrequently been reported as a cause of laboratory-acquired infection. This report describes two probable cases of fatal laboratory-acquired meningococcal disease and the results of an inquiry to identify previously unreported cases. The findings indicate that N. meningitidis isolates pose a risk for microbiologists and should be handled in a manner that minimizes risk for exposure to aerosols or droplets. (+info)
Suspected cutaneous anthrax in a laboratory worker--Texas, 2002.
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On March 6, 2002, CDC's National Institute for Occupational Safety and Health (NIOSH) received a request for a health hazard evaluation from the director of Laboratory A to assist in the evaluation of a worker who had been diagnosed with cutaneous anthrax. Laboratory A, a provisionally approved Laboratory Response Network level B laboratory, had been processing environmental samples for Bacillus anthracis in support of CDC investigations of the bioterrorist attacks in the United States during fall 2001. Since March 7, CDC has interviewed the ill laboratory worker and other workers at the laboratory and conducted environmental assessments of the workplace. This report summarizes the epidemiologic and environmental investigation of this case, which indicates that the likely source of exposure was the surface of vials containing B. anthracis isolates that the worker placed in a freezer on March 1. Laboratory workers handling specimens of B. anthracis should follow recommended procedures to minimize the risk of B. anthracis transmission and anthrax. (+info)
Assessment of susceptibility testing practices for Streptococcus pneumoniae--United States, February 2000.
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Streptococcus pneumoniae is the leading cause of community-acquired pneumonia, otitis media, and meningitis in the United States. Antimicrobial susceptibility results are important for guiding therapy decisions and monitoring emerging resistance patterns. Appropriate methods for pneumococcal susceptibility testing are recommended by the National Committee for Clinical Laboratory Standards (NCCLS). Recommendations for pneumococcal susceptibility testing are reviewed annually and were the same in 2000 and 2001. To assess laboratory practices for Streptococcus pneumoniae susceptibility testing on sterile site isolates, in February 2000, CDC conducted a multistate survey of clinical laboratories. This report summarizes the survey results, which found that most practices of clinical laboratories were consistent with NCCLS recommendations; however, some inconsistencies were noted. As antimicrobial resistance in pneumococci continues to worsen, clinical laboratories should be aware of emerging resistance patterns and follow new recommendations to provide clinicians with precise information about antimicrobial susceptibility. (+info)
Exposure of laboratory workers to Francisella tularensis despite a bioterrorism procedure.
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A rapidly fatal case of pulmonary tularemia in a 43-year-old man who was transferred to a tertiary care facility is presented. The microbiology laboratory and autopsy services were not notified of the clinical suspicion of tularemia by the service caring for the patient. Despite having a laboratory bioterrorism procedure in place and adhering to established laboratory protocol, 12 microbiology laboratory employees were exposed to Francisella tularensis and the identification of the organism was delayed due to lack of notification of the laboratory of the clinical suspicion of tularemia. A total of 11 microbiology employees and two persons involved in performing the patient's autopsy received prophylactic doxycycline due to concerns of transmission. None of them developed signs or symptoms of tularemia. One microbiology laboratory employee was pregnant and declined prophylactic antibiotics. As a result of this event, the microbiology laboratory has incorporated flow charts directly into the bench procedures for several highly infectious agents that may be agents of bioterrorism. This should permit more rapid recognition of an isolate for referral to a Level B laboratory for definitive identification and should improve laboratory safety. (+info)
Update: Cutaneous anthrax in a laboratory worker--Texas, 2002.
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On April 5, 2002, CDC reported a case of suspected cutaneous anthrax in a worker at laboratory A who had been processing environmental samples for Bacillus anthracis in support of CDC investigations of the 2001 bioterrorist attacks in the United States. Since the initial report, the worker had serial serology performed at the CDC laboratory. A greater than fourfold rise from baseline in the concentration of immunoglobulin G to protective antigen was demonstrated. The peak antibody level was observed 7-8 weeks after the onset of symptoms, and the time course and levels of detectable antibodies were consistent with those seen in other cases of cutaneous anthrax. On the basis of case definitions developed during the recent investigation, these additional findings confirm this as a case of cutaneous anthrax. This case brings the number of anthrax cases identified in the United States since October 3, 2001, to 23, including 11 inhalation and 12 cutaneous (eight confirmed and four suspected). This is the first laboratory-acquired case of anthrax associated with the recent investigation. (+info)
Minimizing the workup of blood culture contaminants: implementation and evaluation of a laboratory-based algorithm.
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An algorithm was implemented in the clinical microbiology laboratory to assess the clinical significance of organisms that are often considered contaminants (coagulase-negative staphylococci, aerobic and anaerobic diphtheroids, Micrococcus spp., Bacillus spp., and viridans group streptococci) when isolated from blood cultures. From 25 August 1999 through 30 April 2000, 12,374 blood cultures were submitted to the University of Iowa Clinical Microbiology Laboratory. Potential contaminants were recovered from 495 of 1,040 positive blood cultures. If one or more additional blood cultures were obtained within +/-48 h and all were negative, the isolate was considered a contaminant. Antimicrobial susceptibility testing (AST) of these probable contaminants was not performed unless requested. If no additional blood cultures were submitted or there were additional positive blood cultures (within +/-48 h), a pathology resident gathered patient clinical information and made a judgment regarding the isolate's significance. To evaluate the accuracy of these algorithm-based assignments, a nurse epidemiologist in approximately 60% of the cases performed a retrospective chart review. Agreement between the findings of the retrospective chart review and the automatic classification of the isolates with additional negative blood cultures as probable contaminants occurred among 85.8% of 225 isolates. In response to physician requests, AST had been performed on 15 of the 32 isolates with additional negative cultures considered significant by retrospective chart review. Agreement of pathology resident assignment with the retrospective chart review occurred among 74.6% of 71 isolates. The laboratory-based algorithm provided an acceptably accurate means for assessing the clinical significance of potential contaminants recovered from blood cultures. (+info)
Outcomes of improved anaerobic techniques in clinical microbiology.
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To our knowledge, the effects of the use of improved anaerobic techniques have not been documented. We compared data on patients during 2 different time periods-the first when anaerobic cultures were done by standard techniques (the control or "before" group) and the second when anaerobic cultures were done after an intensive program to improve anaerobic techniques (IAT). The program consisted of the use of an anaerobe chamber, improved anaerobic transport and media, and education of clinicians and microbiologists. There were 74 diagnosis-related group (DRG)-matched patients in the controls and 76 in the IAT group. The average turnaround time for preliminary anaerobic data was decreased in the IAT group (124 hours per specimen for controls and 107 for IAT, P=.001). The cost of achieving anaerobic conditions for a plate was approximately $0.09 when the anaerobic chamber was used and $0.96 when the bio-bag system was used. The crude mortality rate was 10.8% in controls and 1.3% in the IAT group (P=.06). The average length of stay was 10.2 days per patient in controls and 8.9 in the IAT group (P=.91). The average variable cost was $6865 per patient in the control group and $4432 in the IAT group (P=.21). The average laboratory cost was $723 per patient in the control group and $380 in the IAT group (P=.08). In conclusion, benefits associated with improved anaerobic testing were documented. We could expect to save >$630,000 every year with improved anaerobic processes. (+info)
Speculations on the microbiology laboratory of the future.
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Changes in the availability of skilled laboratory personnel, new technologies, and the financial environment will all influence the practice of diagnostic microbiology in the near and more distant future. Because of the special expertise needed for the accurate identification of anaerobic bacteria, the ability to diagnose anaerobic infections may decline as a consequence of these changes. Physicians should anticipate a difficult time in the years between the loss of expertise in traditional methods and development of reliable and accurate molecular assays. (+info)