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Introduction: This ex vivo study evaluated the disinfecting and cleaning effects of root canal preparation using sodium hypochlorite irrigation with 3 different needle designs., Methods: Mesial roots from extracted mandibular molars with Vertucci class II configuration were anatomically matched based on micro-computed tomography (micro-CT) analyses and distributed into 3 groups (n = 18/group). The canals were contaminated with a mixed bacterial culture for 30 days and then subjected to preparation using 2.5% sodium hypochlorite irrigation with open-ended flat needle (3 mm short of the working length - WL), closed-ended side-vented irrigation needle (1 mm short of the WL), or a closed-ended plastic needle with 2 lateral outlets (TruNatomy) (1 mm short of the WL). Bacteriological samples were taken from the canals before (S1) and after preparation (S2). After another micro-CT scan, the roots were sectioned and samples were also taken from the apical canal segment (S3). Bacterial reduction was assessed by quantitative real-time polymerase chain reaction. The amount of accumulated hard tissue debris was evaluated by micro-CT., Results: A substantial reduction in bacterial counts was observed in all 3 groups when comparing S1 with S2 (99.95%, 98.93%, and 98.90% in the open-ended, closed-ended, and TruNatomy needle groups, respectively) (P < .01). No significant differences were observed between groups for bacterial reduction in the full and apical canal (P > .05). There were no intergroup differences in the amount of accumulated hard tissue debris either (P > .05). The open-ended needle group showed significantly more specimens with quantitative real-time polymerase chain reaction negative results for bacteria in S3 than TruNatomy (P < .05)., Conclusion: When used up to an appropriate insertion depth, the 3 needle types result in similar antibacterial and cleaning performance, provided variables such as needle size and irrigant type, volume and flow rate are controlled. Exclusive analysis of the apical segment, including the isthmus, revealed that the open-ended needle yielded more cases negative for bacteria., (Copyright © 2024 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.)

Rapid detection of plant diseases before they escalate can improve disease control. Our team has developed rapid nucleic acid extraction methods with microneedles and combined these with loop-mediated amplification (LAMP) assays for pathogen detection in the field. In this work, we developed LAMP assays for early blight ( Alternaria linariae , A. alternata , and A. solani ) and bacterial spot of tomato ( Xanthomonas perforans ) and validated these LAMP assays and two previously developed LAMP assays for tomato spotted wilt virus and late blight. Tomato plants were inoculated, and disease severity was measured. Extractions were performed using microneedles, and LAMP assays were run in tubes (with hydroxynaphthol blue) on a heat block or on a newly designed microfluidic slide chip on a heat block or a slide heater. Fluorescence on the microfluidic chip slides was visualized using EvaGreen and photographed on a smartphone. Plants inoculated with X. perforans or tomato spotted wilt virus tested positive prior to visible disease symptoms, whereas Phytophthora infestans and A. linariae were detected at the time of visual disease symptoms. LAMP assays were more sensitive than PCR, and the limit of detection was 1 pg of DNA for both A. linariae and X. perforans . The LAMP assay designed for early blight detected all three species of Alternaria that infect tomato and is thus an Alternaria spp. assay. This study demonstrates the utility of rapid microneedle extraction followed by LAMP on a microfluidic chip for rapid diagnosis of four important tomato pathogens., Competing Interests: The author(s) declare no conflict of interest.

Objective: To investigate the efficacy of formalin disinfection of the needle tip in transrectal prostate biopsy (TRB) procedure to reduce infectious complications. The primary aim is to assess the impact of formalin on bacterial contamination of biopsy needle tips and its association with post-biopsy infective events., Materials and Methods: We have employed a bacterial culture-based observational cohort design in this study. Two groups, formalin disinfection and non-formalin group, both underwent systematic 12-core TRB. In the formalin group, the biopsy needle tip was immersed in 10% formalin solution after each core, while in the non-formalin group, no formalin solution immersion was used. The primary outcomes include bacterial growth on biopsy needle tips and post-biopsy infective events., Results: Formalin disinfection significantly reduced bacterial growth on needle tips (P <.001). The formalin group had no post-biopsy infections or sepsis, while the non-formalin group experienced a 7.5% infective event rate after TRB., Conclusion: Formalin disinfection of biopsy needle tip significantly reduces bacterial growth on biopsy needle and urinary tract infectious complications developed secondary to TRB. Further multicenter randomized controlled studies with larger cohorts are warranted to validate and establish formalin disinfection as a routine practice in TRB procedures., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Purpose: To investigate biopsy needle tip culture after prostate biopsies for bacteria prediction and antibiotics selection., Materials and Methods: From May 2017 to April 2019, 121 patients who underwent a prostate biopsy were enrolled. All biopsy needle tips were sent for aerobic and anaerobic culture. Patients were divided into positive and negative culture groups. Perioperative data were recorded and compared between the two groups. The culture time and susceptibility of febrile patients were analyzed. Blood cultures were conducted for all patients who experienced fever after biopsy. The time and results of the needle and blood cultures were recoded for descriptive analysis., Results: There were 59 (48.8%) positive needle cultures. Other than fever (p = 0.023), there were no statistical significances in clinical data between the two groups. Fever occurred in eight patients, and seven febrile patients had positive needle cultures, six of whom had positive blood cultures. These six needle and blood cultures were consistent with the susceptibility test results. As compared to the waiting time for blood cultures, target antibiotics were administered at an average of 48.0 h earlier based on needle cultures. None of the patients with positive anaerobic cultures developed a fever, while all eight febrile patients had negative anaerobic cultures., Conclusion: Fevers developed at statistically significant higher rate among those who had positive needle cultures. Needle and blood cultures were consistent with the susceptibility test results. Needle cultures can help us administer target antibiotics earlier to febrile patients without the need to wait for blood cultures.

Skin infections caused by bacteria, viruses and fungi are difficult to treat by conventional topical administration because of poor drug penetration across the stratum corneum. This results in low bioavailability of drugs to the infection site, as well as the lack of prolonged release. Emerging antimicrobial transdermal and ocular microneedle patches have become promising medical devices for the delivery of various antibacterial, antifungal, and antiviral therapeutics. In the present review, skin anatomy and its barriers along with skin infection are discussed. Potential strategies for designing antimicrobial microneedles and their targeted therapy are outlined. Finally, biosensing microneedle patches associated with personalized drug therapy and selective toxicity toward specific microbial species are discussed., (© 2020 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.)

Background: Needle-free connectors (NFCs) were introduced to eliminate the use of needles in intravascular catheters, and their newest generations were designed to improve patient safety and reduce catheter-related bloodstream infection (CRBSI) risks. The aim of this meta-analysis was to compare NFCs with 3-way stopcocks (3WSCs) and their effects on CRBSI rates., Methods: A meta-analysis was conducted using a research protocol consistent with the PRISMA statement for reporting meta-analyses. The Cochrane Database of Systematic Reviews and MEDLINE were searched for relevant randomized studies published from January 2000 to September 2018., Results: We identified and selected for the meta-analysis 8 studies comparing CRBSI rates (according to the Centers for Disease Control and Prevention's National Healthcare Safety Network definition) associated with NFCs utilizing negative-displacement, neutral-displacement, or positive-displacement devices with rates for 3WSCs. Relative risk was 0.53 with a 95% CI of 0.28 to 1.00, and the relative difference was -0.018 with a 95% CI of -0.039 to 0.004., Conclusions: CRBSI risk was statistically higher for 3WSCs compared to NFCs., (Copyright © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Microorganisms causing catheter-related bloodstream infections colonize to intravenous catheters (IVC)-particularly to connectors mounted to catheters. The aim of this study was to examine the colonization in 3-way stopcock (TWS) connectors and needleless connectors (NCs) that integrated into central, port, and peripheral venous catheters., Methods: This random, experimental study consisted of 180 connectors that were inserted into the IVCs of patients in general surgery, reanimation intensive care, and daily chemotherapy units. Cultures of the connectors were obtained at least 48 hours after connecting to IVCs., Results: This study showed that gram-negative, gram-positive, and other pathogens reproduced, although their colonization level was not high enough to develop an infection. When the results of colonization for patients using TWS and NC were compared, the peripheral venous catheters (using a TWS) resulted in a significantly higher increase in reproduction than in patients using NC (P ≤ .01) and no significant difference in the level of colonization in other types of connectors or catheters (P ˃ .05)., Conclusions: The study's results indicated no significant difference between NC and TWSs in terms of reproduction. It should also be noted that connectors integrated into IVC pose a risk in the development of catheter-related bloodstream infections., (Copyright © 2019 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Health care-associated hepatitis C virus outbreaks from contaminated medication vials continue to be reported even though most practitioners deny reusing needles or syringes. The hypothesis was that when caring for hepatitis C virus-infected patients, healthcare providers may inadvertently contaminate the medication vial diaphragm and that subsequent access with sterile needles and syringes can transfer hepatitis C virus into the medication, where it remains stable in sufficient quantities to infect subsequent patients., Methods: A parallel-arm lab study (n = 9) was performed in which contamination of medication vials in healthcare settings was simulated using cell culture-derived hepatitis C virus. First, surface-contaminated vials were accessed with sterile needles and syringes, and then hepatitis C virus contamination was assessed in cell culture. Second, after contaminating several medications with hepatitis C virus, viral infectivity over time was assessed. Last, surface-contaminated vial diaphragms were disinfected with 70% isopropyl alcohol to determine whether disinfection of the vial surface was sufficient to eliminate hepatitis C virus infectivity., Results: Contamination of medication vials with hepatitis C virus and subsequent access with sterile needles and syringes resulted in contamination of the vial contents in sufficient quantities to initiate an infection in cell culture. Hepatitis C virus remained viable for several days in several commonly used medications. Finally, a single or 2- to 3-s wipe of the vial diaphragm with 70% isopropyl alcohol was not sufficient to eliminate hepatitis C virus infectivity., Conclusions: Hepatitis C virus can be transferred into commonly used medications when using sterile single-use needles and syringes where it remains viable for several days. Furthermore, cleaning the vial diaphragm with 70% isopropyl alcohol is not sufficient to eliminate the risk of hepatitis C virus infectivity. This highlights the potential risks associated with sharing medications between patients.

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive procedure with a high diagnostic yield in lesions adjacent to the airways. However, complications associated with EBUS-TBNA, such as mediastinitis, have recently been reported. Oral bacteria contamination in punctured lymph nodes can cause severe infections. In the current study, we investigated whether endobronchial intubation using EBUS-TBNA can prevent oral bacterial contamination of punctured lymph nodes., Methods: We retrospectively evaluated 80 patients (102 lymph nodes) who had undergone EBUS-TBNA and divided them two groups: Group A comprised 60 patients who had undergone EBUS-TBNA with endobronchial intubation and Group B consisted of 20 patients who had undergone EBUS-TBNA without endobronchial intubation. The patients' medical records were examined and the two groups were compared using the unpaired Student's t-test., Results: EBUS-TBNA needle wash cultures were positive in only two Group A cases (3.3%), but in all 20 Group B cases (100%) (P < 0.05). Except for one case of Mycobacterium tuberculosis, all bacterial isolates yielded typical oropharyngeal commensal flora. Fever (≥ 38.0 °C) was observed in six Group A cases (10%) and two Group B cases (10%; P = 0.526). This was treated by cooling, a single administration of non-steroidal anti-inflammatory drugs, and/or antibiotic therapy. Fever was not associated with any clinical features, including malignancy in punctured lesions, number of punctures, echo features, simultaneous peripheral biopsy, additional oral prophylactic antibiotics, or positive needle wash cultures., Conclusions: Endobronchial intubation may prevent contamination by oropharyngeal commensal bacteria., (Copyright © 2018 The Japanese Respiratory Society. Published by Elsevier B.V. All rights reserved.)

Objective: To compare 3 prophylactic regimens to assess their impact on postbiopsy sepsis incidence., Methods: Data were reviewed for 829 consecutive patients who underwent prostate biopsy in a community practice setting between January 2013 and October 2017. Group 1 patients received ciprofloxacin 500 mg two times a day orally for 4 days starting the day prior to biopsy and gentamicin 80 mg intramuscularly 20 minutes prior to biopsy. From April 2015 to October 2017, 2 groups of patients were followed in parallel in a randomized manner. Group 2 received ciprofloxacin 500 mg two times a day orally for 4 days starting the day prior to biopsy and ceftriaxone 1 g intramuscularly 20 minutes prior to biopsy. Group 3 received the same antibiotic regimen as group 2 and also underwent isopropyl alcohol needle washing., Results: All study groups were demographically equivalent. Microscopic bacterial counts were substantially decreased after isopropyl alcohol needle washing. Incidence of postbiopsy sepsis in groups 1 (n = 313), 2 (n = 259), and 3 (n = 257) was 3.8%, 2%, and 0%, respectively (analysis of variance; P = .006). Risk factors for sepsis included elevated body mass index, Charlson Comorbidity Score, and presence of type 2 diabetes mellitus., Conclusion: There was a significant reduction in the incidence of sepsis after prostate biopsy using a combination of a ciprofloxacin-ceftriaxone antibiotic regimen and isopropyl alcohol needle washing. The technique for needle washing is inexpensive and quick, and can be easily adopted into current biopsy protocols., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Objectives: To determine whether a needle disinfectant step during transrectal ultrasonography (TRUS)-guided prostate biopsy is associated with lower rates of infection-related hospitalisation., Patients and Methods: We conducted a retrospective analysis of all TRUS-guided prostate biopsies taken across the Michigan Urological Surgery Improvement Collaborative (MUSIC) from January 2012 to March 2015. Natural variation in technique allowed us to evaluate for differences in infection-related hospitalisations based on whether or not a needle disinfectant technique was used. The disinfectant technique was an intra-procedural step to cleanse the biopsy needle with antibacterial solution after each core was sampled (i.e., 10% formalin or 70% isopropyl alcohol). After grouping biopsies according to whether or not the procedure included a needle disinfectant step, we compared the rate of infection-related hospitalisations within 30 days of biopsy. Generalised estimating equation models were fit to adjust for potential confounders., Results: During the evaluated period, 17 954 TRUS-guided prostate biopsies were taken with 5 321 (29.6%) including a disinfectant step. The observed rate of infection-related hospitalisation was lower when a disinfectant technique was used during biopsy (0.60% vs 0.90%; P = 0.04). After accounting for differences between groups the adjusted hospitalisation rate in the disinfectant group was 0.85% vs 1.12% in the no disinfectant group (adjusted odds ratio 0.76, 95% confidence interval 0.50-1.15; P = 0.19)., Conclusions: In this observational analysis, hospitalisations for infectious complications were less common when the TRUS-guided prostate biopsy included a needle disinfection step. However, after adjusting for potential confounders the effect of needle disinfection was not statistically significant. Prospective evaluation is warranted to determine if this step provides a scalable and effective method to minimise infectious complications., (© 2017 The Authors BJU International © 2017 BJU International Published by John Wiley & Sons Ltd.)

This study was conducted according to the method presented in the Republic of Korea Pharmacopoeia 11th Revision, aseptic test method to evaluate the suitability of sterilization for a sterile needle (4 Pin Multi-needle). In this study, four tests were conducted: sterility test, cytotoxicity test, acute toxicity test, skin sensitization test. First, in the aseptic test, the microorganism was not proliferated in the aseptic test of the medium. As a result of the performance test of the medium, it was confirmed that the microorganism developed within 3 days and the fungus was evident within 5 days. Based on this, it was confirmed that the medium was suitable, and as a result of the aseptic test, the development of microorganisms was not observed during the total culture period. Based on these results, tests were conducted which were confirmed to be suitable for aseptic testing because the development of bacteria on the provided samples was not recognized. For cytotoxicity tests ISO10993-5; 2009 (Biological Evaluation of Medical Devices, Part 5: Test for in vitro Cytotoxicity). As a result, the MEM eluate of the test substance caused very slight cytotoxicity to the fibroblasts of the mouse and was judged to be Grade 1 (Slightly cytotoxic) according to the judgment standard of ISO 10993-5. On the other hand, solvent control, negative control and positive control showed the expected results on the test. Acute Toxicity Test Results: It was judged that there was no systemic toxicity change when ICR mice were treated with 50 mL/kg B.W. of the eluate of sterile injectable needle for 72 hours. Skin sensitization test result: The Hartley guinea pig was evaluated as a substance which is evaluated as a substance which does not induce any skin reaction when skin sensitization is applied to the dissected material of the sterile injectable needle and is weak in skin sensitivity. Based on the above tests, we will study the stability and efficacy of more reliable medical devices based on the verification and performance of medical devices.

Background: Percutaneous neurostimulation of the peripheral nervous system involves the insertion of a wire "lead" through an introducing needle to target a nerve/plexus or a motor point within a muscle. Electrical current may then be passed from an external generator through the skin via the lead for various therapeutic goals, including providing analgesia. With extended use of percutaneous leads sometimes greater than a month, infection is a concern. It was hypothesized that the infection rate of leads with a coiled design is lower than for leads with a noncoiled cylindrical design., Methods: The literature was retrospectively reviewed for clinical studies of percutaneous neurostimulation of the peripheral nervous system of greater than 2 days that included explicit information on adverse events. The primary endpoint was the number of infections per 1,000 indwelling days., Results: Forty-three studies were identified that met inclusion criteria involving coiled (n = 21) and noncoiled (n = 25) leads (3 studies involved both). The risk of infection with noncoiled leads was estimated to be 25 times greater than with coiled leads (95% confidence interval [CI] 2 to 407, P = 0.006). The infection rates were estimated to be 0.03 (95% CI 0.01 to 0.13) infections per 1,000 indwelling days for coiled leads and 0.83 (95% CI 0.16 to 4.33) infections per 1,000 indwelling days for noncoiled leads (P = 0.006)., Conclusions: Percutaneous leads used for neurostimulation of the peripheral nervous system have a much lower risk of infection with a coiled design compared with noncoiled leads: approximately 1 infection for every 30,000 vs. 1,200 indwelling days, respectively., (© 2016 The Authors. Pain Practice published by Wiley Periodicals, Inc. on behalf of World Institute of Pain.)

Background and Aim: Endoscopic ultrasound (EUS) aspiration needles are single-use devices. However, in many centers, because of cost-constraints, these devices are reused multiple times. We studied microbiological contamination and bioburden on reprocessed needles to evaluate whether these devices can be successfully sterilized., Methods: We studied 10 EUS needles each of 19 G, 22 G, and 25 G in size, and five 22-G ProCore needles. After initial use, each needle was reprocessed by a standardized protocol. We used standard microbiological cultures, as well as ATP bioluminescence technique to quantify bioburden as relative light units (RLU). We defined significant soil contamination by RLU values >200. We also used extractant fluid to disrupt cell membranes in an attempt to enhance ATP detection., Results: We found culture positivity in 3/34 (8.8%), and detectable bioburden on the exposed surface of 33/35 (94.3%), and inside lumen of 29 (82.9%) reprocessed FNA needles. Significant bioburden was found in three (8.6%) and two (5.7%) needles on the surface and lumen, respectively. We found that use of extractant fluid enhanced detection of bioburden. Larger (19 G) needles had higher surface contamination (P = 0.016), but there was no relation of luminal contamination with needle diameter (P = 0.138). Sheath design and presence of side bevel did not influence extent of contamination. There was significant correlation between the surface and intraluminal bioburden (P < 0.001)., Conclusions: There is significant bioburden in reprocessed EUS needles; standard microbiological cultures have low sensitivity for detection of needle contamination. We have provided objective evidence for the futility of reprocessing attempts, and practice of EUS needle reuse should be discontinued., (© 2016 Japan Gastroenterological Endoscopy Society.)

Background: There is little evidence to inform practice regarding the optimum aseptic technique of drawing up saline for epidural insertion. Our regional practice is to draw up saline from a non-sterile packaged plastic ampoule, therefore introducing the risk of bacterial contamination. Usually, the anaesthetist draws up saline directly from the vial held by an assistant using a needle (needle technique). Alternatively, the saline vial is emptied onto a sterile tray by an assistant and then drawn up by the anaesthetist (tray technique). We hypothesised that the latter will lead to an increase in the number of contaminated saline samples as they are exposed to the environment., Methods: In labour rooms and before epidural catheter insertion, 110 samples of saline 20mL were randomly drawn up using our hospital's recommended epidural aseptic precautions, using either the needle or the tray technique. Equal amounts of saline were inoculated into aerobic and anaerobic blood culture bottles., Results: Eleven percent of samples in the needle arm and 24% of samples in the tray arm grew commensal micro-organisms including coagulase-negative Staphylococcus, Micrococcus luteus and Streptococcus viridans. A two-sided Fisher's exact test for categorical unpaired data showed no statistical difference between the two arms of the trial (P=0.13)., Conclusion: The difference in the saline contamination rate between the two techniques did not reach statistical significance. As bacterial contamination occurred with both techniques, we recommend using sterile saline pre-packaged in the epidural tray or individually wrapped sterile glass saline ampoules., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Bacterial infection of tattoos remains a common complication. Pyogenic bacteria can cause infections shortly after the tattoo is made. Severity of infection varies from minor to major, ultimately with life-threatening septicemia. Viral infections may be introduced, i.e. HVB, HVC, and HIV. The risk of infection depends on the following triad: microbial pathogen and its aggressiveness, individual resistance of the tattooed, and inoculation and exposures by the tattoo needle and in the tattoo parlor. Some infectious risks can be controlled. Persons with weaknesses can refrain from tattooing. Tattoo parlors and tattooing can be hygienic and clean albeit not sterile; much has improved helped by hygiene guidelines of professional tattooists' organizations and through control instituted by local and national authorities. Tattoo inks remain a potential source of infection difficult to control in a low-priced competitive market operating over the Internet and across national borders. Ten percent of new inks are contaminated with bacteria pathogenic to humans, independent of a claim of 'sterility'. Known brands and established manufacturers are considered safer. Work is in progress aiming at common European standards for tattoo hygiene. Doctors have a role not only in treating tattoo infections but also in reporting cases to the competent authority in their country to support the monitoring of tattoo infections at any time, as an instrument for the authority to detect local outbreaks of tattoo infections early and prevent that new tattoo customers become infected. It is a potential risk of the future that new and very aggressive bacteria not seen in the past may unexpectedly show up in the tattoo scene., (© 2017 S. Karger AG, Basel.)

Purpose: To detect and quantify vitreous contamination after intravitreal injection using an experimental vitreous contamination model., Methods: Enucleated porcine eyes served as a Type 1 experimental vitreous contamination model with fluoresbrite carboxylate microspheres applied to the conjunctival surface. Saline solution (0.05 mL) was injected using a 27-, 30-, or 32-gauge (G) needle. Injection procedures were monitored using an intraocular fiber catheter. Condensed microspheres were applied to an excised sheet of porcine sclera (Type 2 experimental vitreous contamination model). Saline solution (0.05 mL) was injected from the top of an applied condensed microsphere through the sclera using a needle of one of the aforementioned gauges, and samples were then collected. The fluorescence strength of samples was measured using fluorophotometry., Results: We visually detected fluorescent microspheres in 10/10, 9/10, and 9/10 eyes injected with 27-G, 30-G, and 32-G needles, respectively. In the experimental quantification study, values at all needle gauges were significantly higher than those of controls (P < 0.01). Fluorescence strength was significantly higher in the 27-G group than in the 30- (P < 0.01) and 32-G (P < 0.01) groups., Conclusion: Intravitreal injection carries the risk of introducing contamination directly into the eyes even when a 32-G needle is used. Furthermore, the 27-G needle carries the highest contamination risk.

Purpose: The purpose of this laboratory study was to assess the effect of povidone-iodine (PI) use topically on the conjunctiva in regard to needle bore contamination and to compare these results with our previous findings from an evaluation of bacterial contamination following gatifloxacin and moxifloxacin administration., Methods: We performed 100 conjunctival 27-gauge needle penetrations of both eyes of 13 fresh cadavers. Eyes were then soaked in 10% PI, after which conjunctiva was again penetrated 100 times. After conjunctival penetration, the needles were irrigated, and the irrigant was assessed for bacterial growth. Results were compared with previous work assessing fluoroquinolone effectiveness through the same model., Results: We observed a 28% (P = 0.003) decrease in bacterial growth and 40% (P < 0.0001) decrease in colony counts after PI placement. Differences between the effect of PI versus moxifloxacin and gatifloxacin were not statistically significant., Conclusions: There is a greater decrease in bacterial load after treatment with PI for surface cultures than for cultures obtained through a needle bore passed through the conjunctiva. PI is a superior approach to topical antibiotics to decrease conjunctival bacterial load.

Objective: To determine by use of an in vitro model the potential for translocating sufficient numbers of bacteria into a joint during arthrocentesis through cellulitic tissue to cause sepsis., Sample: Culture media containing 4 concentrations of Staphylococcus aureus and needles of 3 sizes., Procedures: Needles (22, 20, and 19 gauge) were inserted through Mueller-Hinton agar that contained known concentrations of S aureus (10(3),10(4),10(5), and 10(6) CFUs/mL). After a needle exited through the medium, any agar plug within the needle bore was ejected into a sterile syringe and the contaminated portion of the needle was harvested. Sterile saline (0.9% NaCl) solution was used to emulsify the agar plug and wash the contaminated portion of the needle. The resulting solution was cultured to determine the number of bacterial CFUs that could be deposited into a joint during arthrocentesis through contaminated tissue., Results: Needle gauge and bacterial concentration were both associated with the number of bacterial CFUs deposited after insertion through contaminated agar. Although all needle sizes were capable of bacterial translocation sufficient to cause septic arthritis, ORs for 20- and 22-gauge needles translocating > 33 CFUs of S aureus were significantly higher than the OR for a 19-gauge needle. The ORs for 20- or 22-gauge needles translocating > 33 CFUs of S aureus (the minimum population of S aureus known to cause joint sepsis) were 0.22., Conclusions and Clinical Relevance: Results for this in vitro model indicated that caution should be used when performing arthrocentesis through cellulitic tissue.

Aims: Needleless connectors may develop bacterial contamination and cause central-line-associated bloodstream infections (CLABSI) despite rigorous application of best-practice. Ultraviolet (UV) light-emitting diodes (LED) are an emerging, increasingly affordable disinfection technology. We tested the hypothesis that a low-power UV LED could reliably eliminate bacteria on needleless central-line ports in a laboratory model of central-line contamination., Methods and Results: Needleless central-line connectors were inoculated with Staphylococcus aureus. A 285 nm UV LED was used in calibrated fashion to expose contaminated connectors. Ports were directly applied to agar plates and flushed with sterile saline, allowing assessment of bacterial survival on the port surface and in simulated usage flow-through fluid. UV applied to needleless central-line connectors was highly lethal at 0·5 cm distance at all tested exposure times. At distances >1·5 cm both simulated flow-through and port surface cultures demonstrated significant bacterial growth following UV exposure. Logarithmic-phase S. aureus subcultures were highly susceptible to UV induction/maintenance dosing., Conclusions: Low-power UV LED doses at fixed time and distance from needleless central-line connector ports reduced cultivable S. aureus from >10(6) CFU to below detectable levels in this laboratory simulation of central-line port contamination., Significance and Impact of the Study: Low-power UV LEDs may represent a feasible alternative to current best-practice in connector decontamination., (© 2015 The Society for Applied Microbiology.)

A study was undertaken to compare a commercialized needle filter with a 0.2-μm filtered epidural set and a non-filtered standard needle. No culturable bacteria were detected following filtration through the 0.2-μm filter. Bacterial breakthrough was observed with the filtered needle (pore size 5 μm) and the non-filtered needle. Filtered systems (0.2 μm) should be employed to achieve total bacterial retention. This highlights that filtration systems with different pore sizes will have varying ability to retain bacteria. Healthcare professionals need to know what type/capability of filter is implied on labels used by manufacturers, and to assess whether the specification has the desired functionality to prevent bacterial translocation through needles., (Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Tattooing became a popular phenomenon during the late twentieth century. Because the act of tattooing involves repeated injection of ink through the skin, a risk of contracting infections from contaminated tattooing equipment and ink and the surrounding environment exists. Progress has been made in infection control strategies; however, contraction of bacterial and viral infections from tattooing continues to occur. The risk of acquiring a tattoo-related infection largely depends on the hygiene conditions under which the tattoo is applied. Nevertheless, even when adequate hygiene and sanitation measures are taken, the inks themselves may contain infectious microorganisms that are able to survive under hostile conditions, such as in inks. The results of the few studies on the microbiological quality of unopened and opened tattoo inks are reported. Some authors' conclusions demonstrated that the current ink sterilisation systems show a low capability to inactivate microbial contamination in tattoo inks. At the moment, European Resolution ResAP2008-1 recommends that the ink be sterile and supplied in containers that maintain the sterility of the product until application. In light of the outcomes of published studies, at the moment, preservation of the microbial quality and safety of ink seems challenging and still difficult to reach., (© 2015 S. Karger AG, Basel.)

Objective: The Dutch national patient safety platform developed a protocol for the preparation of intravenous medication; the Aseptic Non-Touch Technique (ANTT). Use of ANTT on nursing wards has shown to reduce contamination of intravenous medication. Therefore it is dictated by the Dutch Healthcare Inspectorate that this technique has to be used at all departments in the hospital, including the operating theatre. However, because of the use of air treatment and operating theatre uniforms, the operating theatre cannot be compared with a nursing ward. In this study, the bacterial contamination of syringes prepared in the operating theatre by anesthesia nurses was determined., Design: Simulation study, Method: 45 anesthesia nurses prepared 1000 syringes of 10 ml bacterial culture medium, using their routine method of drawing up iv medication from vials. Turbidity in a syringe after culturing for 14 days at 30° C was used as evidence for bacterial contamination. Using questionnaires, nurses were interviewed in what degree their working method equals ANTT-protocol. We calculated how much extra time must be invested when using the strict ANTT-protocol in the operating theatre., Results: Six syringes (0,6%) were contaminated. Normal dermal bacteria were identified in all syringes. The nurses who prepared the contaminated syringes worked similar manner as their colleagues. It takes an additional 54 minutes per day per operating theatre to work strictly using the ANTT technique., Conclusion: Contamination rates of aseptic preparations in the OR are very low, and are as low as ANTT preparations in a GMP-certified hospital pharmacy. Therefore it is legitimate to develop a modified ANTT-protocol for use in the operating theatre.

Background/purpose: To evaluate the risk of intravitreal needle contamination through speaking versus breathing in an office setting., Methods: This was a prospective sampling assay. Participants held a sterile 30-gauge half-inch needle 25 cm from their mouth for 30 seconds under 2 conditions: (1) while speaking and (2) while breathing silently. Needles were then cultured and assayed after 6 days of incubation. Absolute colony-forming units were compared between conditions and against control sterile needles and oral swab cultures., Results: Ten physicians were sampled with 15 samples per physician. Participants grew an average of 0.21 colonies (median = 1 CFU) from their talking samples and 0.07 colonies (median = 1 CFU) from their silent breathing samples. Oral swab plates grew an average of 373.4 colonies. None of the control needle plates grew colony-forming units. A nominal regression analysis showed no significant difference between talking and silent samples (P = 0.457)., Conclusion: No significant difference in needle contamination was found between talking and breathing. Compared with oral swab plates, a significant difference exists between the amount of flora colonizing the oropharynx and that which was found on the needle cultures (P < 0.0001). These findings suggest that speaking versus remaining silent makes no difference in regard to needle contamination with oral flora during intravitreal injection.

Exposure to blood and body fluids is an occupational hazard in healthcare. Although the potential for blood-borne virus transmission through needlestick injury has been widely studied, the risk of this occurring through spatter contamination from safety-needle syringes is not well understood. This report examines this risk from three commonly used safety needles and suggests that this presents a new and significant hazard. Further work should be commissioned to quantify this hazard and determine which type of safety needle would minimize spatter contamination following syringe discharge and safety activation., (Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.)

Purpose: To compare the contamination rate between 27-gauge and 30-guage needles used for intravitreal injection (IVT)., Methods: Patients undergoing IVT injections were enrolled prospectively. Injections were performed with 27- or 30-gauge needles. All needle tips were collected and placed in brain-heart infusion broth. The contamination rates of needles were compared., Results: A total of 109 patients participated in the study and a total of 126 IVT injections were performed. Injections were performed by 27-gauge (49%) and 30-gauge (51%) needle. No patient developed endophthalmitis. The overall contamination rate of the used needles were 13% for 27-guage and 29% for 30-guage (p = 0.022). However, this difference was nonsignificant after Bonferroni's correction was applied. The most common bacteria isolated from the used needles are coagulase-negative Staphylococcus (CNS)., Conclusion: The results suggest that the needle bore size seems not to be a risk factor for contamination during IVT injection.

Purpose: To determine the bacterial contamination rate of a 27-gauge needle bore during conjunctival penetration in donor eye bank eyes and the effect of short-term use of topical 0.3% gatifloxacin and 0.5% moxifloxacin., Methods: One hundred consecutive human donors had 10 conjunctival penetrations per 10 syringes per eye before antibiotic placement; this was repeated 15 min after antibiotic use. Samples were cultured by expressing 0.3 mL of saline through the needle. Positive cultures were speciated., Results: There were 1,033 positive cultures (25.8% of all cultures); 568 (28.4%) pre-antibiotics, 249 (24.9%) after gatifloxacin (P=0.04, compared to the pre-antibiotic rate), and 216 (21.6%) after moxifloxacin (P<0.001). The most common organism was Staphylococcus epidermidis [334 positive cultures (8.4%)]. No antibiotic effect was seen on this or other organisms except S. aureus [4.6% pre-antibiotic, 2.8% after gatifloxacin (P=0.02), and 1.8% after moxifloxacin (P<0.001)] and other Staphylococcus species [5.3% pre-antibiotic, 3.6% after gatifloxacin (P=0.04), and 3.2% after moxifloxacin (P=0.01)]., Conclusions: Transconjunctival penetration often results in needle bore contamination; bacteria are included in an injected solution. Fifteen minutes of exposure to 2 topical antibiotics had a minimal effect on bacterial contamination and no significant effect on many common pathogens.

We examined the incidence and types of bacterial contamination in 265 infusion set needles in adult critically ill patients. Bacterial contamination was detected in 15 samples (5.7%), and a total of 17 organisms were isolated. Ten were coagulase-negative staphylococci (CNS) and Staphylococcus aureus, and the remainder were α-Streptococcus, Corynebacterium, and gram-negative rods. Although the contamination was not directly related to catheter-related bloodstream infections exchanging infusion bottles can cause intraluminal contamination and is a possible route of these infections., (Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)

Central needle embolization is a rare complication of intravenous drug abuse which has only been reported on a handful of occasions. Previously reported cases of needle embolization to the heart have been managed conservatively (observation alone) or by surgical intervention. We report a case of purulent pericarditis without evidence of valvular vegetations resulting from an embolized, infected needle fragment. In the present case, the needle was successfully removed from the right ventricle percutaneously. This case illustrates the unique finding of purulent pericarditis due to a persistent foreign body in the right ventricle, and the nontraditional intervention performed for needle fragment removal which resulted in full clinical recovery of the patient., (Copyright © 2011 Wiley Periodicals, Inc.)

Purpose: The study was designed to prospectively evaluate the bacterial contamination of needles used for intravitreal injection during surgery., Material and Methods: Between December 2007 and December 2010, 549 eyes of 413 patients were treated with intravitreal injections of 1.25 mg bevacizumab. Of the patients 322 received a single injection and 91 multiple injections. Preoperatively the periorbital skin of all patients was treated with 10% povidone iodine (PVI) and the conjunctival sac was irrigated with 1% PVI. No pre-injection antibiotics were administered. Immediately after the injection the needles were rinsed 3 times in thioglycolate broth which was then cultured at 37°C for 5 days. As a negative control 73 sterile unused needles were treated in the same way., Results: Out of the 549 needle points tested 8 (1,45%) were found to be contaminated after intravitreal injections. The isolated bacteria were coagulase negative Staphylococcus (n = 7), Propionibacterium acnes (n = 1) and Klebsiella pneumoniae (n = 1) (co-contamination in one case)., Conclusion: Contamination of needles is minimal after prophylactic povidone iodine irrigation before intravitreal injections. Therefore, this prophylaxis technique is recommended before intravitreal injections in order to prevent postoperative infections.

Purpose: To investigate the effectiveness of 3 surgical preparation techniques in decreasing bacterial contamination of needles and suture material during strabismus surgery., Methods: Consecutive patients requiring 2-muscle strabismus surgery were randomized into 1 of 3 groups. In Group A, patients' periocular skin and bulbar conjunctivae underwent preparation with 5% povidone-iodine; the drape was placed without regard to eyebrows; and an open wire-loop lid speculum was used. Group B patients underwent the same preparation as Group A patients; however, the eyelashes and eyebrows were scrubbed with 5% povidone-iodine on cotton tip applicators, and the drape was placed to exclude the eyebrows from the surgical field. Group C patients underwent the same preparation as Group B patients; however, a bladed lid speculum was used during surgery to exclude some of the eyelashes from the surgical field. After the procedure, all needles and suture materials were sent separately for aerobic culture. The data were analyzed for differences in contamination rates between the groups., Results: Of 77 patients, 24 (31.4%) had either a needle and/or suture contaminant. Groups A, B, and C had mean contamination rates of 29.6%, 34.6%, and 29.2%, respectively. There was no significant statistical variation in contamination among the 3 groups. The most common organism identified was a coagulase-negative staphylococcus strain., Conclusions: More meticulous sterile preparation of the surgical field did not result in a meaningful reduction in suture or needle contamination rates during strabismus surgery., (Copyright © 2011 American Association for Pediatric Ophthalmology and Strabismus. Published by Mosby, Inc. All rights reserved.)

Decorative tattooing is made by introducing exogenous pigments and/or dyes into the dermis to permanently mark the body for decorative or other reasons. Unfortunately, this procedure is not harmless and various complications may occur including the potential inoculation of virulent microorganisms in the dermis. Cutaneous infections usually develop within days to weeks after the procedure and may include: pyogenic infections (staphylococcus, streptococcus, Pseudomonas aeruginosa, etc.), but also atypical bacteria (commensal mycobacteria, tuberculosis, leprosy, etc.), viral infections (molluscum contagiosum, verruca vulgaris, herpes, etc.), and also fungal and parasitic infections. This review focuses on dermatological infections occurring on tattoos and their management., (Copyright © 2010 Elsevier Masson SAS. All rights reserved.)

Purpose: To determine the incidence of bacterial contamination of needles used for intravitreal injections., Methods: Patients undergoing intravitreal injections were enrolled prospectively. No pre-injection antibiotics were administered. Following povidone-iodine irrigation, conjunctival cultures were taken and the injection was performed. The needle was cultured. A dry control needle was exposed to the surgical field and cultured., Results: No patients developed endophthalmitis. Eighteen injection needles (18%) yielded positive bacterial growth. The most commonly encountered organisms were Propionibacterium acnes (n = 8) and Staphylococcus epidermidis (n = 6). Four control needles showed positive growth, in 2 cases with the same organism as a matching positive used needle. The difference between contamination rates of used and control needles was significant (p = .002, McNemar's test)., Conclusions: Bacterial contaminants are present on a substantial proportion of needles. Since the needle contacts both the ocular surface and the vitreous, it is possible that inoculation of the vitreous cavity occurs in such cases.

Although outbreaks of Mycobacterium abscessus infection have been reported, none of these reports has identified the potential sources of infection and modes of transmission. In April 2008, we identified and investigated an outbreak of M. abscessus skin and soft tissue infections following acupuncture among the patients who visited an oriental medical clinic. Active surveillance of patients who had visited the clinic was conducted to define the extent of the outbreak. Environmental cultures and a case-control study were performed to elucidate the source of infection and mode of transmission. From 1002 patients interviewed, 109 patients were identified as having suffered M. abscessus skin and soft tissue infections at acupuncture sites. A single strain of M. abscessus was isolated from the wounds of 31 patients and nine environmental samples, including a diluted glutaraldehyde solution. The case-control study revealed that a higher numbers of visits to the clinic for acupuncture (adjusted OR (aOR) 20.12; 95% CI 4.34-93.35) and the use of interferential current therapy or low-frequency therapy (aOR 36.12; 95% CI 5.54-235.44) were associated with the development of M. abscessus infection. The contaminated diluted glutaraldehyde solution that was used to disinfect the physical therapy devices may have been the source of the outbreak of M. abscessus infection in the 109 patients who underwent acupuncture.

Methods: In this study we determined, for the first time, the ability of microorganisms to traverse microneedle-induced holes using two different in vitro models., Results: When employing Silescol membranes, the numbers of Candida albicans, Pseudomonas aeruginosa and Staphylococcus epidermidis crossing the membranes were an order of magnitude lower when the membranes were punctured by microneedles rather than a 21G hypodermic needle. Apart from the movement of C. albicans across hypodermic needle-punctured membranes, where 40.2% of the microbial load on control membranes permeated the barrier over 24 h, the numbers of permeating microorganisms was less than 5% of the original microbial load on control membranes. Experiments employing excised porcine skin and radiolabelled microorganisms showed that the numbers of microorganisms penetrating skin beyond the stratum corneum were approximately an order of magnitude greater than the numbers crossing Silescol membranes in the corresponding experiments. Approximately 10(3) cfu of each microorganism adhered to hypodermic needles during insertion. The numbers of microorganisms adhering to MN arrays were an order of magnitude higher in each case., Conclusion: We have shown here that microneedle puncture resulted in significantly less microbial penetration than did hypodermic needle puncture and that no microorganisms crossed the viable epidermis in microneedle-punctured skin, in contrast to needle-punctured skin. Given the antimicrobial properties of skin, it is, therefore, likely that application of microneedle arrays to skin in an appropriate manner would not cause either local or systemic infection in normal circumstances in immune-competent patients. In supporting widespread clinical use of microneedle-based delivery systems, appropriate animal studies are now needed to conclusively demonstrate this in vivo. Safety in patients will be enhanced by aseptic or sterile manufacture and by fabricating microneedles from self-disabling materials (e.g. dissolving or biodegradable polymers) to prevent inappropriate or accidental reuse.

Purpose: Evaluation of the magnitude and pattern of bacterial contamination of needle points with conjunctival bacteria during the intravitreal injection. Analysis of the efficacy of preinjection prophylaxis., Methods: A total of 550 intravitreal injections were done in 414 patients (n=425 eyes). A total of 289 patients were injected once, while 125 patients received several injections. Before the intravitreal injection in the operation room, the following standard preoperative preparation of the eye-10% povidone iodine scrub on the eyelids, eyelashes, and forehead and irrigation of the conjunctival sac with 1% povidone iodine-was carried out. Immediately after the injection, the needle points were rinsed three times in thioglycolate broth, which was cultured at 35 degrees C for 5 days afterwards. As a negative control, 200 sterile unused needle points were treated the same way., Results: Only 2 out of 550 (0.36%) needle points were contaminated after intravitreal injection. In sensitivity testing, the isolated Staphylococcus epidermidis and Corynebacterium sp did not show multidrug resistance. All 200 unused needle points proved to be sterile after 5 days of cultivation., Conclusions: Contamination of needle points is minimal after iodine irrigation prophylaxis before intravitreal injection. Therefore, we recommend this prophylaxis technique before intravitreal injections. The low incidence of contaminated needle points, however, shows that there still is a risk of bacteria entering into the eye during injection.

The prevalence rates of illicit drug consumption within the prison system are much higher than those in the Canadian population in general. Of the substances used in detention, those of most concern to prison and public health authorities are injection drugs, as the sharing of injection drug equipment may be responsible for the high prevalence of blood-borne diseases in prison facilities. Faced with this situation, the Correctional Service of Canada put in practice a number of harm reduction strategies targeting injection drug users, such as methadone maintenance programs and access to bleach. However, despite their use in the community, needle-exchange programs are not yet allowed in penitentiaries. This article analyzes the limits of harm reduction strategies approved by the prison authorities and discusses the sources of resistance that continue to impede the realization of a pilot project to assess the feasibility of needle-exchange programs in detention in Canada.

Background: Cutaneous injection-related infections (CIRI), such as abscesses and cellulitis, are common and preventable among injection drug users (IDU). However, risk factors for CIRI have not been well described in the literature. We sought to characterize the risk factors for current CIRI among individuals who use North America's first supervised injection facility (SIF)., Methods: A longitudinal analysis of factors associated with developing a CIRI among participants enrolled in the Scientific Evaluation of Supervised Injecting (SEOSI) cohort between January 1, 2004 and December 31, 2005 was conducted using generalized linear mixed-effects modelling., Results: In total, 1065 participants were eligible for this study. The proportion of participants with a CIRI remained under 10% during the study period. In a multivariate generalized linear mixed-effects model, female sex (Adjusted Odds Ratio (AOR) = 1.68 [95% Confidence Interval (CI): 1.16-2.43]), unstable housing (AOR = 1.49 [95% CI: 1.10-2.03]), borrowing a used syringe (AOR = 1.60 [95% CI: 1.03-2.48]), requiring help injecting (AOR = 1.42 [95% CI: 1.03-1.94]), and injecting cocaine daily (AOR = 1.41 [95% CI: 1.02-1.95]) were associated with an increased risk of having a CIRI., Conclusion: CIRI were common among a subset of IDU in this study, including females, those injecting cocaine daily, living in unstable housing, requiring help injecting or borrowing syringes. In order to reduce the burden of morbidity associated with CIRI, targeted interventions that address a range of factors, including social and environmental conditions, are needed.

Purpose: To evaluate potential sources of bacterial contamination during intravitreal (IVT) injection procedures., Methods: Patients scheduled for IVT injection were asked to enroll in the study at the California Vitreoretinal Center (Menlo Park, CA) and the Vantage Eye Center (Salinas, CA) between October 2004 and April 2005. A total of 104 patients participated in the study, with a total of 118 IVT injection procedures performed on 107 eyes. Standard microbiological techniques were used to culture, identify, and quantify bacterial contamination of injection needles and the bulbar conjunctiva at the injection site in patients undergoing IVT injections. The main outcomes measured were type and quantity of bacterial isolates., Results: Two (2%) of 114 needles collected were contaminated with bacteria. The prevalence of bacterial contamination of the injection site on the bulbar conjunctiva was 43% before prophylaxis on the day of the injection with topical antibiotics and povidone-iodine, with a statistically significant reduction to 13% after prophylaxis (P < 0.0001). Coagulase-negative Staphylococcus, the most common bacterium isolated from the ocular surface, was isolated from both culture-positive needles., Conclusions: IVT injection needles became contaminated with bacteria during the injection procedure. Although the contamination rate was low, this supports a mechanism of postinjection endophthalmitis in which there is direct inoculation of ocular surface flora into the vitreous cavity by the injection needle.

Background: Decorin-binding proteins (Dbps) A and B of Borrelia burgdorferi, the agent of Lyme disease, are surface-exposed lipoproteins that presumably bind to the extracellular matrix proteoglycan, decorin. B. burgdorferi infects various tissues including the bladder, heart, joints, skin and the central nervous system, and the ability of B. burgdorferi to bind decorin has been hypothesized to be important for this disseminatory pathogenic strategy., Results: To determine the role of DbpBA in the infectious lifecycle of B. burgdorferi, we created a DbpBA-deficient mutant of B. burgdorferi strain 297 and compared the infectious phenotype of the mutant to the wild-type strain in the experimental murine model of Lyme borreliosis. The mutant strain exhibited a 4-log decrease in infectivity, relative to the wild-type strain, when needle inoculated into mice. Upon complementation of the DbpBA-mutant strain with DbpA, the wild-type level of infectivity was restored. In addition, we demonstrated that the DbpBA-deficient mutant was able to colonize Ixodes scapularis larval ticks after feeding on infected mice and persist within the ticks during the molt to the nymphal state. Moreover, surprisingly, the DbpBA-mutant strain was capable of being transmitted to naïve mice via tick bite, giving rise to infected mice., Conclusion: These results suggest that DbpBA is not required for the natural tick-transmission process to mammals, despite inferences from needle-inoculation experiments implying a requirement for DbpBA during mammalian infection. The combined findings also send a cautionary note regarding how results from needle-inoculation experiments with mice should be interpreted.

Background: Intraluminal contamination of catheter hubs has been recognized as the most frequent cause of catheter-related blood stream infections. We have investigated the efficacy of a new hub device, Planecta SC(R) (PNSC), in preventing endoluminal catheter contamination, compared to a conventional three-way stopcock., Material/methods: Adults patients requiring an intravascular catheter placement for at least 48 hours in intensive care units were randomly assigned to receive either the infusion device with the newly designed hub, PNSC (P group, n=89), or with a conventional three-way stopcock (C group, n=73). To evaluate intraluminal contamination, we examined the bacteria isolated in the inline bacterial filters which were attached to downstream of the injection ports. In addition to the clinical study, we conducted a bench study to investigate if use of protection caps or strict disinfection technique prevented intraluminal contamination with this new needleless connector., Results: The incidence of bacterial contamination was not significantly different between the groups (P group 9/89 (10.1%) vs. C group 6/73 (8.2%), P=0.79). There was no correlation between the numbers of injections, duration of the use of the device or the microbial contamination rate. In the bench study, protection caps and disinfection technique significantly decreased microbial transfer from the hub to the fluid space., Conclusions: We concluded that the use of the new hub device did not reduce endoluminal bacterial contamination rate in comparison with that of a three way stopcock. Intraluminal bacterial contamination may be reduced by either strict disinfection technique or when a protection cap is use.

The rate of the onset of methicillin-resistant Staphylococcus epidermidis infections is increasing in Tunisia. We have isolated 32 S. epidermidis strains from dialysis fluid and needle cultures in dialysis service. The strains were identified by classic methods (colonial morphology, Gram staining, catalase test, coagulase test, and DNase test) as well as by API ID32 Staph. Susceptibilities to 18 antibiotics were tested with the ATB Staph kit. Most of the tested strains were resistant to penicillin. In addition, the presence of multidrug resistant strains that showed resistance to different antibiotics was recorded. We have characterized these strains by multiplex PCR assay to identify intercellular adhesion genes icaA/icaD associated with the adhesiveness of staphylococci in biomaterials, and to identify representative resistant genes: oxacillin resistance, mecA; erythromycin methylase (ermA, ermB, and ermC), and macrolide efflux gene (msrA and mef). The frequency of the carriage of these genes was icaA/icaD (71.9%), mecA (78.1%), ermA (12.5%), ermB (31.3%), ermC (53.1%), msrA (68.8%), and mef (O%). Although the carriage of the genes and the results of susceptibility testing did not match exactly, it could be judged that the PCR identification of antibiotic resistance genes is rapid and supplementary methods for identifying staphylococci or epidemiological study used for the control of nosocomial infection.

Background: Coagulase-negative staphylococci (CoNS) have emerged as an important opportunistic pathogen isolated in hospital. Several species of CoNS have been implicated in human infections and disease especially in patients with poor health status., Methods: A total of 71 clinical strains of CoNS were isolated from dialysis fluid and needles in a dialysis unit and characterized. Susceptibility to antibiotics, biofilm production and molecular typing by pulsed-field gel electrophoresis (PFGE) were achieved., Results: The main isolated CoNS strains were Staphylococcus epidermidis (45%), Staphylococcus hominis (14%) and Staphylococcus haemolyticus (12.7%). The susceptibility profile of all strains revealed high resistance level to penicillin and oxacillin. PCR detection of oxacillin resistance gene (mecA gene) revealed a higher percentage of positive strains than the classic test (ATB Staph). Slime production test was positive in 60.6% of CoNS strains. PFGE analysis showed the presence of 69 restriction profiles clustered in 56 patterns., Conclusions: Profiles of all isolates were generally heterogeneous, suggesting independent circulation with some evidence of cross-transmission.

Study Design: Case report of a 64-year-old man with psoas abscesses, epidural abscess and spondylitis after acupuncture., Objective: To report a case of paraplegia caused by spinal infection after acupuncture., Setting: Seoul, Korea., Case Report: A 64-year-old man came to an emergency room because of severe back pain. At 3 days prior to visit, the patient received acupuncture therapy to the low back with a needle about 10 cm in length because of back pain. Pain was aggravated gradually for 3 days. Escherichia coli sepsis developed with altered mentality during admission. At hospital day 9, he regained his consciousness and was found to have paraplegia. Abdominal computerized tomography (CT) and lumbar spine magnetic resonance imaging (MRI) revealed abscesses of bilateral psoas muscles and spondylitis with epidural abscess. After conservative management with intravenous administration of antibiotics, infection was controlled but the patient remained paraplegic (ASIA scale C L1 level) without neurological recovery., Conclusion: Paraplegia might result from complications of an acupuncture therapy.