Timothy F. Kirn

INDIAN WELLS, CALIF. — Preimplantation genetic diagnosis using fluorescent in situ hybridization has a positive predictive value of 83% and a negative predictive value of 81% when a panel of probes for five chromosomes is used, Catherine M. De Ugarte, M.D., said at the annual meeting of the Pacific Coast Reproductive Society.

In a study that involved 241 IVF embryos, 34 of 198 embryos that were initially found to be abnormal with fluorescent in-situ hybridization (FISH) were later shown to be normal with subsequent FISH analyses. Of 43 embryos initially called normal with FISH, 8 were later shown to have an abnormality, said Dr. De Ugarte of the division of reproductive endocrinology and infertility at the University of California, Los Angeles, Medical Center.

Certain chromosomal abnormalities were more likely to be missed, including monosomies. Turner's syndrome, in particular, was highly likely to be falsely identified. Only 17% of embryos initially identified as affected with Turner's syndrome were confirmed as having the disorder.

Dr. De Ugarte said 45% of the time the initial FISH analysis indicated that an embryo was abnormal, confirmation revealed a different abnormality than initially diagnosed. There were various reasons for these misdiagnoses, including failure of the probes to hybridize when they should have and situations in which two chromosomes overlapped, preventing visualization of a probe.

One significant limitation is that the study used embryos that were initially found to be abnormal or unsuitable for freezing and preserving, said L. Michael Kettel, M.D., who commented on the study at the meeting.

Nevertheless, the study results, while perhaps disheartening, are “probably not surprising,” said Dr. Kettel, a reproductive endocrinologist in San Diego.

“As this technology is applied more and more often, it is important to understand the potential and significant limitations that this technology presents,” he said.

INDIAN WELLS, CALIF. — Preimplantation genetic diagnosis using fluorescent in situ hybridization has a positive predictive value of 83% and a negative predictive value of 81% when a panel of probes for five chromosomes is used, Catherine M. De Ugarte, M.D., said at the annual meeting of the Pacific Coast Reproductive Society.

In a study that involved 241 IVF embryos, 34 of 198 embryos that were initially found to be abnormal with fluorescent in-situ hybridization (FISH) were later shown to be normal with subsequent FISH analyses. Of 43 embryos initially called normal with FISH, 8 were later shown to have an abnormality, said Dr. De Ugarte of the division of reproductive endocrinology and infertility at the University of California, Los Angeles, Medical Center.

Certain chromosomal abnormalities were more likely to be missed, including monosomies. Turner's syndrome, in particular, was highly likely to be falsely identified. Only 17% of embryos initially identified as affected with Turner's syndrome were confirmed as having the disorder.

Dr. De Ugarte said 45% of the time the initial FISH analysis indicated that an embryo was abnormal, confirmation revealed a different abnormality than initially diagnosed. There were various reasons for these misdiagnoses, including failure of the probes to hybridize when they should have and situations in which two chromosomes overlapped, preventing visualization of a probe.

One significant limitation is that the study used embryos that were initially found to be abnormal or unsuitable for freezing and preserving, said L. Michael Kettel, M.D., who commented on the study at the meeting.

Nevertheless, the study results, while perhaps disheartening, are “probably not surprising,” said Dr. Kettel, a reproductive endocrinologist in San Diego.

“As this technology is applied more and more often, it is important to understand the potential and significant limitations that this technology presents,” he said.

INDIAN WELLS, CALIF. — Preimplantation genetic diagnosis using fluorescent in situ hybridization has a positive predictive value of 83% and a negative predictive value of 81% when a panel of probes for five chromosomes is used, Catherine M. De Ugarte, M.D., said at the annual meeting of the Pacific Coast Reproductive Society.

In a study that involved 241 IVF embryos, 34 of 198 embryos that were initially found to be abnormal with fluorescent in-situ hybridization (FISH) were later shown to be normal with subsequent FISH analyses. Of 43 embryos initially called normal with FISH, 8 were later shown to have an abnormality, said Dr. De Ugarte of the division of reproductive endocrinology and infertility at the University of California, Los Angeles, Medical Center.

Certain chromosomal abnormalities were more likely to be missed, including monosomies. Turner's syndrome, in particular, was highly likely to be falsely identified. Only 17% of embryos initially identified as affected with Turner's syndrome were confirmed as having the disorder.

Dr. De Ugarte said 45% of the time the initial FISH analysis indicated that an embryo was abnormal, confirmation revealed a different abnormality than initially diagnosed. There were various reasons for these misdiagnoses, including failure of the probes to hybridize when they should have and situations in which two chromosomes overlapped, preventing visualization of a probe.

One significant limitation is that the study used embryos that were initially found to be abnormal or unsuitable for freezing and preserving, said L. Michael Kettel, M.D., who commented on the study at the meeting.

Nevertheless, the study results, while perhaps disheartening, are “probably not surprising,” said Dr. Kettel, a reproductive endocrinologist in San Diego.

“As this technology is applied more and more often, it is important to understand the potential and significant limitations that this technology presents,” he said.

LOS ANGELES — Hormonal contraception does not appear to affect cardiovascular risk factors in adolescents, Jennifer G. Kapella, M.D., said at the annual meeting of the Society for Adolescent Medicine.

In a study that enrolled 50 adolescent subjects just starting on oral contraception, 22 subjects starting depot medroxyprogesterone acetate, and 53 control subjects, hormonal contraception had no effect on cholesterol levels, and may have had a slightly beneficial effect on carotid artery intima-media thickness over a period of 18 months, said Dr. Kapella of the department of pediatrics at the Metro-Health Medical Center in Cleveland.

There was a slight decrease over the 18 months in intima-media thickness in the control subjects, and a greater decrease in the subjects on either form of hormonal contraception. There was no difference in the decrease between the types of contraception used in the study.

Because all the groups had a decrease in intima-media thickness, and because it is not known how the hormonal milieu of adolescence might change that thickness, Dr. Kapella combined the figures for the three groups of subjects in her presentation.

Overall, the study found a mean 2% drop in thickness at 12 months and a mean 6% drop at 18 months, equal to about 0.02 mm.

Previous studies of intima-media thickness in adolescent girls have found no change over time, while in adolescent boys there appears to be a progression in thickness over time, Dr. Kapella said.

By way of comparison, a 0.02-mm decrease in intima-media thickness is what is seen in statin trials of similar duration, she added.

The fact that a significant decrease in intima-media thickness was seen in the medroxyprogesterone group as well as the oral contraception group was unexpected, and difficult to explain, Dr. Kapella noted.

“We have to consider factors other than contraception as coming into play as the cause of the regression,” she said.

LOS ANGELES — Hormonal contraception does not appear to affect cardiovascular risk factors in adolescents, Jennifer G. Kapella, M.D., said at the annual meeting of the Society for Adolescent Medicine.

In a study that enrolled 50 adolescent subjects just starting on oral contraception, 22 subjects starting depot medroxyprogesterone acetate, and 53 control subjects, hormonal contraception had no effect on cholesterol levels, and may have had a slightly beneficial effect on carotid artery intima-media thickness over a period of 18 months, said Dr. Kapella of the department of pediatrics at the Metro-Health Medical Center in Cleveland.

There was a slight decrease over the 18 months in intima-media thickness in the control subjects, and a greater decrease in the subjects on either form of hormonal contraception. There was no difference in the decrease between the types of contraception used in the study.

Because all the groups had a decrease in intima-media thickness, and because it is not known how the hormonal milieu of adolescence might change that thickness, Dr. Kapella combined the figures for the three groups of subjects in her presentation.

Overall, the study found a mean 2% drop in thickness at 12 months and a mean 6% drop at 18 months, equal to about 0.02 mm.

Previous studies of intima-media thickness in adolescent girls have found no change over time, while in adolescent boys there appears to be a progression in thickness over time, Dr. Kapella said.

By way of comparison, a 0.02-mm decrease in intima-media thickness is what is seen in statin trials of similar duration, she added.

The fact that a significant decrease in intima-media thickness was seen in the medroxyprogesterone group as well as the oral contraception group was unexpected, and difficult to explain, Dr. Kapella noted.

“We have to consider factors other than contraception as coming into play as the cause of the regression,” she said.

LOS ANGELES — Hormonal contraception does not appear to affect cardiovascular risk factors in adolescents, Jennifer G. Kapella, M.D., said at the annual meeting of the Society for Adolescent Medicine.

In a study that enrolled 50 adolescent subjects just starting on oral contraception, 22 subjects starting depot medroxyprogesterone acetate, and 53 control subjects, hormonal contraception had no effect on cholesterol levels, and may have had a slightly beneficial effect on carotid artery intima-media thickness over a period of 18 months, said Dr. Kapella of the department of pediatrics at the Metro-Health Medical Center in Cleveland.

There was a slight decrease over the 18 months in intima-media thickness in the control subjects, and a greater decrease in the subjects on either form of hormonal contraception. There was no difference in the decrease between the types of contraception used in the study.

Because all the groups had a decrease in intima-media thickness, and because it is not known how the hormonal milieu of adolescence might change that thickness, Dr. Kapella combined the figures for the three groups of subjects in her presentation.

Overall, the study found a mean 2% drop in thickness at 12 months and a mean 6% drop at 18 months, equal to about 0.02 mm.

Previous studies of intima-media thickness in adolescent girls have found no change over time, while in adolescent boys there appears to be a progression in thickness over time, Dr. Kapella said.

By way of comparison, a 0.02-mm decrease in intima-media thickness is what is seen in statin trials of similar duration, she added.

The fact that a significant decrease in intima-media thickness was seen in the medroxyprogesterone group as well as the oral contraception group was unexpected, and difficult to explain, Dr. Kapella noted.

“We have to consider factors other than contraception as coming into play as the cause of the regression,” she said.

SAN FRANCISCO — Linezolid is being used too often for staphylococcal infections when other options are available, William E. Dismukes, M.D., said at the annual meeting of the American College of Physicians.

For example, linezolid is being used increasingly often for treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia.

The drug is approved for the treatment of hospital-acquired MRSA pneumonia, and its use may be increasing largely in response to an article published in 2003 in the journal Chest, said Dr. Dismukes, director of the division of infectious diseases at the University of Alabama, Birmingham.

In the paper, the authors combined data from two separate studies in which vancomycin and linezolid were used. They concluded that survival and clinical cure rates were both better with linezolid.

The survival rate was reported to be 80% with linezolid versus 63% with vancomycin. The clinical cure rate, defined as resolution of signs and symptoms at the end of treatment with improvement or no change in x-rays, was 59% for linezolid and 35% for vancomycin (Chest 2003;124:1789–97).

But not everyone is convinced, including Dr. Dismukes. “This paper has generated all kinds of controversy,” he said.

In his opinion, the analysis is less than definitive because it included groups from two different trials, and there were only 160 MRSA patients. “You do get higher lung-tissue levels with linezolid,” Dr. Dismukes said. “But I am skeptical.”

Another use for linezolid that is becoming increasingly common is staphylococcal endocarditis. There are anecdotal reports of successful treatments, but no clinical trial data. In contrast, much experience and data are available on use of nafcillin and gentamicin, or vancomycin with or without gentamicin, Dr. Dismukes said.

“I think we use too much of this drug for indications such as this for which there are no data,” he said.

Linezolid is approved for complicated and uncomplicated soft tissue infections, both methicillin resistant and methicillin susceptible. But community-acquired MRSA infections are different from hospital-acquired MRSA, and so, for uncomplicated infections, cost is an issue.

Hospital-acquired Staphylococcus aureus that is methicillin resistant most often has a resistance pattern that includes resistance to other non-β-lactam antibiotics, because the gene that confers methicillin resistance most commonly comes as part of a cassette chromosome that contains other resistance determinants.

But that is not generally true of community-acquired MRSA, which is usually susceptible to doxycycline, trimethoprim/sulfamethoxazole, and quinolones, Dr. Dismukes said.

A single course of linezolid can cost over $1,000, whereas in some of these cases trimethoprim/sulfamethoxazole would do, he said.

Moreover, adverse events do occur. Linezolid can cause bone marrow suppression, neuropathies with long-term use, and serotonin syndrome in patients on drugs such as selective serotonin reuptake inhibitors.

Dr. Dismukes commented that he has seen three cases of serotonin syndrome in patients taking linezolid during recent months.

SAN FRANCISCO — Linezolid is being used too often for staphylococcal infections when other options are available, William E. Dismukes, M.D., said at the annual meeting of the American College of Physicians.

For example, linezolid is being used increasingly often for treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia.

The drug is approved for the treatment of hospital-acquired MRSA pneumonia, and its use may be increasing largely in response to an article published in 2003 in the journal Chest, said Dr. Dismukes, director of the division of infectious diseases at the University of Alabama, Birmingham.

In the paper, the authors combined data from two separate studies in which vancomycin and linezolid were used. They concluded that survival and clinical cure rates were both better with linezolid.

The survival rate was reported to be 80% with linezolid versus 63% with vancomycin. The clinical cure rate, defined as resolution of signs and symptoms at the end of treatment with improvement or no change in x-rays, was 59% for linezolid and 35% for vancomycin (Chest 2003;124:1789–97).

But not everyone is convinced, including Dr. Dismukes. “This paper has generated all kinds of controversy,” he said.

In his opinion, the analysis is less than definitive because it included groups from two different trials, and there were only 160 MRSA patients. “You do get higher lung-tissue levels with linezolid,” Dr. Dismukes said. “But I am skeptical.”

Another use for linezolid that is becoming increasingly common is staphylococcal endocarditis. There are anecdotal reports of successful treatments, but no clinical trial data. In contrast, much experience and data are available on use of nafcillin and gentamicin, or vancomycin with or without gentamicin, Dr. Dismukes said.

“I think we use too much of this drug for indications such as this for which there are no data,” he said.

Linezolid is approved for complicated and uncomplicated soft tissue infections, both methicillin resistant and methicillin susceptible. But community-acquired MRSA infections are different from hospital-acquired MRSA, and so, for uncomplicated infections, cost is an issue.

Hospital-acquired Staphylococcus aureus that is methicillin resistant most often has a resistance pattern that includes resistance to other non-β-lactam antibiotics, because the gene that confers methicillin resistance most commonly comes as part of a cassette chromosome that contains other resistance determinants.

But that is not generally true of community-acquired MRSA, which is usually susceptible to doxycycline, trimethoprim/sulfamethoxazole, and quinolones, Dr. Dismukes said.

A single course of linezolid can cost over $1,000, whereas in some of these cases trimethoprim/sulfamethoxazole would do, he said.

Moreover, adverse events do occur. Linezolid can cause bone marrow suppression, neuropathies with long-term use, and serotonin syndrome in patients on drugs such as selective serotonin reuptake inhibitors.

Dr. Dismukes commented that he has seen three cases of serotonin syndrome in patients taking linezolid during recent months.

SAN FRANCISCO — Linezolid is being used too often for staphylococcal infections when other options are available, William E. Dismukes, M.D., said at the annual meeting of the American College of Physicians.

For example, linezolid is being used increasingly often for treatment of methicillin-resistant Staphylococcus aureus (MRSA) pneumonia.

The drug is approved for the treatment of hospital-acquired MRSA pneumonia, and its use may be increasing largely in response to an article published in 2003 in the journal Chest, said Dr. Dismukes, director of the division of infectious diseases at the University of Alabama, Birmingham.

In the paper, the authors combined data from two separate studies in which vancomycin and linezolid were used. They concluded that survival and clinical cure rates were both better with linezolid.

The survival rate was reported to be 80% with linezolid versus 63% with vancomycin. The clinical cure rate, defined as resolution of signs and symptoms at the end of treatment with improvement or no change in x-rays, was 59% for linezolid and 35% for vancomycin (Chest 2003;124:1789–97).

But not everyone is convinced, including Dr. Dismukes. “This paper has generated all kinds of controversy,” he said.

In his opinion, the analysis is less than definitive because it included groups from two different trials, and there were only 160 MRSA patients. “You do get higher lung-tissue levels with linezolid,” Dr. Dismukes said. “But I am skeptical.”

Another use for linezolid that is becoming increasingly common is staphylococcal endocarditis. There are anecdotal reports of successful treatments, but no clinical trial data. In contrast, much experience and data are available on use of nafcillin and gentamicin, or vancomycin with or without gentamicin, Dr. Dismukes said.

“I think we use too much of this drug for indications such as this for which there are no data,” he said.

Linezolid is approved for complicated and uncomplicated soft tissue infections, both methicillin resistant and methicillin susceptible. But community-acquired MRSA infections are different from hospital-acquired MRSA, and so, for uncomplicated infections, cost is an issue.

Hospital-acquired Staphylococcus aureus that is methicillin resistant most often has a resistance pattern that includes resistance to other non-β-lactam antibiotics, because the gene that confers methicillin resistance most commonly comes as part of a cassette chromosome that contains other resistance determinants.

But that is not generally true of community-acquired MRSA, which is usually susceptible to doxycycline, trimethoprim/sulfamethoxazole, and quinolones, Dr. Dismukes said.

A single course of linezolid can cost over $1,000, whereas in some of these cases trimethoprim/sulfamethoxazole would do, he said.

Moreover, adverse events do occur. Linezolid can cause bone marrow suppression, neuropathies with long-term use, and serotonin syndrome in patients on drugs such as selective serotonin reuptake inhibitors.

Dr. Dismukes commented that he has seen three cases of serotonin syndrome in patients taking linezolid during recent months.

SAN FRANCISCO — There are two important things to know about the recently identified threat of staphylococcal necrotizing pneumonia: It generally follows an influenza illness, and a physician seeing a patient in the clinic or office is not going to miss it.

That was the message of John G. Bartlett, M.D., who has been involved with four cases of necrotizing pneumonia seen in Baltimore recently. All of the cases occurred during a period of 2 months in the winter of 2003–2004, and all were community acquired, he said at the annual meeting of the American College of Physicians.

“These patients are not subtle. They are severely ill,” said Dr. Bartlett, chief of the division of infectious diseases at Johns Hopkins University, Baltimore.

Each of the four cases occurred in previously healthy individuals without risk factors for staphylococcal infection. This is what makes the cases worrisome and something physicians everywhere should be familiar with, even though the chances of seeing a case at present are extremely low and a physician encountering such a patient would likely recognize right away that he or she was not dealing with bronchitis or viral pneumonia, Dr. Bartlett said.

The course of these infections appears to progress very rapidly. Two of the patients had been vomiting, and each had severe dyspnea and/or hemoptysis and shock.

All of the patients appeared to have had influenza prior to their bacterial pneumonia, and it is well known that staphylococcal pneumonia is generally a superinfection following influenza, Dr. Bartlett said.

Two of the patients had serologic evidence of influenza A infection, and two of the patients were not tested but were determined to have an influenza-like prodrome.

One of the patients died, and two needed below-the-knee amputations.

In each of the cases, the only bacterial pathogen recovered from the patients was methicillin-resistant Staphylococcus aureus (MRSA), and the cases therefore provide further evidence that methicillin resistance is becoming more prevalent among community-acquired staphylococcus infections.

Cases of necrotizing pneumonia have been reported previously in Europe. A paper published in April in the New England Journal of Medicine reported 14 cases of MRSA necrotizing fasciitis, and another article in the same issue said that 8%–20% of MRSA isolates being collected by laboratories are not coming from the hospital.

An increase in the prevalence of MRSA has also been reported in California jails.

MRSA in the community is different from MRSA in the hospital, Dr. Bartlett said. Hospital-acquired MRSA generally has other resistance factors that make it resistant to trimethoprim/sulfamethoxazole, doxycycline, clindamycin, rifampin, and the quinolones.

Community-acquired MRSA tends to be susceptible to those agents, but it often has genes for encoding Panton-Valentine leukocidin, which is the presumed virulence factor for its necrotizing ability.

Leukocidin pulls in monocytes and macrophages and then lyses them, releasing cytokines.

“People have called this fatal attraction,” Dr. Bartlett said.

Because the four necrotizing pneumonia patients had such bad outcomes despite treatment with antibiotics to which the organisms should have been susceptible, “I almost have the feeling we are going to have to do something different in these cases, such as [intravenous immunoglobulin],” he said.

“I'd like to tell you how to treat these, but I really don't know,” Dr. Bartlett added.

SAN FRANCISCO — There are two important things to know about the recently identified threat of staphylococcal necrotizing pneumonia: It generally follows an influenza illness, and a physician seeing a patient in the clinic or office is not going to miss it.

That was the message of John G. Bartlett, M.D., who has been involved with four cases of necrotizing pneumonia seen in Baltimore recently. All of the cases occurred during a period of 2 months in the winter of 2003–2004, and all were community acquired, he said at the annual meeting of the American College of Physicians.

“These patients are not subtle. They are severely ill,” said Dr. Bartlett, chief of the division of infectious diseases at Johns Hopkins University, Baltimore.

Each of the four cases occurred in previously healthy individuals without risk factors for staphylococcal infection. This is what makes the cases worrisome and something physicians everywhere should be familiar with, even though the chances of seeing a case at present are extremely low and a physician encountering such a patient would likely recognize right away that he or she was not dealing with bronchitis or viral pneumonia, Dr. Bartlett said.

The course of these infections appears to progress very rapidly. Two of the patients had been vomiting, and each had severe dyspnea and/or hemoptysis and shock.

All of the patients appeared to have had influenza prior to their bacterial pneumonia, and it is well known that staphylococcal pneumonia is generally a superinfection following influenza, Dr. Bartlett said.

Two of the patients had serologic evidence of influenza A infection, and two of the patients were not tested but were determined to have an influenza-like prodrome.

One of the patients died, and two needed below-the-knee amputations.

In each of the cases, the only bacterial pathogen recovered from the patients was methicillin-resistant Staphylococcus aureus (MRSA), and the cases therefore provide further evidence that methicillin resistance is becoming more prevalent among community-acquired staphylococcus infections.

Cases of necrotizing pneumonia have been reported previously in Europe. A paper published in April in the New England Journal of Medicine reported 14 cases of MRSA necrotizing fasciitis, and another article in the same issue said that 8%–20% of MRSA isolates being collected by laboratories are not coming from the hospital.

An increase in the prevalence of MRSA has also been reported in California jails.

MRSA in the community is different from MRSA in the hospital, Dr. Bartlett said. Hospital-acquired MRSA generally has other resistance factors that make it resistant to trimethoprim/sulfamethoxazole, doxycycline, clindamycin, rifampin, and the quinolones.

Community-acquired MRSA tends to be susceptible to those agents, but it often has genes for encoding Panton-Valentine leukocidin, which is the presumed virulence factor for its necrotizing ability.

Leukocidin pulls in monocytes and macrophages and then lyses them, releasing cytokines.

“People have called this fatal attraction,” Dr. Bartlett said.

Because the four necrotizing pneumonia patients had such bad outcomes despite treatment with antibiotics to which the organisms should have been susceptible, “I almost have the feeling we are going to have to do something different in these cases, such as [intravenous immunoglobulin],” he said.

“I'd like to tell you how to treat these, but I really don't know,” Dr. Bartlett added.

SAN FRANCISCO — There are two important things to know about the recently identified threat of staphylococcal necrotizing pneumonia: It generally follows an influenza illness, and a physician seeing a patient in the clinic or office is not going to miss it.

That was the message of John G. Bartlett, M.D., who has been involved with four cases of necrotizing pneumonia seen in Baltimore recently. All of the cases occurred during a period of 2 months in the winter of 2003–2004, and all were community acquired, he said at the annual meeting of the American College of Physicians.

“These patients are not subtle. They are severely ill,” said Dr. Bartlett, chief of the division of infectious diseases at Johns Hopkins University, Baltimore.

Each of the four cases occurred in previously healthy individuals without risk factors for staphylococcal infection. This is what makes the cases worrisome and something physicians everywhere should be familiar with, even though the chances of seeing a case at present are extremely low and a physician encountering such a patient would likely recognize right away that he or she was not dealing with bronchitis or viral pneumonia, Dr. Bartlett said.

The course of these infections appears to progress very rapidly. Two of the patients had been vomiting, and each had severe dyspnea and/or hemoptysis and shock.

All of the patients appeared to have had influenza prior to their bacterial pneumonia, and it is well known that staphylococcal pneumonia is generally a superinfection following influenza, Dr. Bartlett said.

Two of the patients had serologic evidence of influenza A infection, and two of the patients were not tested but were determined to have an influenza-like prodrome.

One of the patients died, and two needed below-the-knee amputations.

In each of the cases, the only bacterial pathogen recovered from the patients was methicillin-resistant Staphylococcus aureus (MRSA), and the cases therefore provide further evidence that methicillin resistance is becoming more prevalent among community-acquired staphylococcus infections.

Cases of necrotizing pneumonia have been reported previously in Europe. A paper published in April in the New England Journal of Medicine reported 14 cases of MRSA necrotizing fasciitis, and another article in the same issue said that 8%–20% of MRSA isolates being collected by laboratories are not coming from the hospital.

An increase in the prevalence of MRSA has also been reported in California jails.

MRSA in the community is different from MRSA in the hospital, Dr. Bartlett said. Hospital-acquired MRSA generally has other resistance factors that make it resistant to trimethoprim/sulfamethoxazole, doxycycline, clindamycin, rifampin, and the quinolones.

Community-acquired MRSA tends to be susceptible to those agents, but it often has genes for encoding Panton-Valentine leukocidin, which is the presumed virulence factor for its necrotizing ability.

Leukocidin pulls in monocytes and macrophages and then lyses them, releasing cytokines.

“People have called this fatal attraction,” Dr. Bartlett said.

Because the four necrotizing pneumonia patients had such bad outcomes despite treatment with antibiotics to which the organisms should have been susceptible, “I almost have the feeling we are going to have to do something different in these cases, such as [intravenous immunoglobulin],” he said.

“I'd like to tell you how to treat these, but I really don't know,” Dr. Bartlett added.

INCLINE VILLAGE, NEV. — Freezing a food product does not always kill all the bacteria in it. Covering boiling water helps kill all the organisms in the pot. And houseflies can carry pathogenic Escherichia coli.

Those are some of the intriguing findings of recent studies in food-borne infectious disease, said Robert W. Derlet, M.D., at an annual emergency medicine meeting sponsored by the University of California, Davis.

U.S. Department of Agriculture researchers looked at whether refrigerating or freezing chicken at either 4°C or −20°C would kill Campylobacter jejuni, which is prevalent in U.S. poultry, said Dr. Derlet, who is chief of emergency medicine at the University of California, Davis.

The researchers found that when the chicken was frozen for 1 week, about 10% of the C. jejuni population survived, and when it was frozen for 2 weeks, 5% survived.

Obviously, most home refrigerators cannot achieve −20°C.

In addition, he said, “Other studies have shown that even with months of freezing, some bacteria that are hardy survive. E. coli, as well as salmonella, tend to be hardy environmental organisms.”

The researchers concluded that freezing is not a substitute for proper cooking (Appl. Environ. Microbiol. 2004;70:7103–9).

Researchers from the Centers for Disease Control and Prevention, who are studying Bacillus anthracis because of its potential use as a bioterrorism agent, investigated whether boiling water contaminated with the organisms would sterilize the water.

They found that when the water was covered and then boiled for either 3 minutes or 5 minutes, all the organisms were killed.

However, when the water was boiled uncovered, high numbers of the organisms survived (Emerg. Infect. Dis. 2004;10: 1887–8).

Some organisms can encapsulate into spores and survive intense temperatures, Dr. Derlet said. Clostridia, for example, form temperature-resistant capsules that break down when they cool, which is why there are instances of people becoming sick after eating soup that has cooled.

Researchers at Kansas State University collected flies from a cattle farm in that state to see if the insects could be contributing to dissemination of E. coli O157:H7, which may be present in up to 40% of beef that comes from a feedlot or passes through a stockyard.

They found that 6% of the flies collected harbored the organism, which can cause hemolytic-uremic syndrome (Appl. Environ. Microbiol. 2004;70:7578–80).

Flies can also carry shigella, salmonella, and cholera, and a fly needs only a second to get its mouth parts onto your food—though it is not known if in that time the fly can deposit enough organisms to make someone ill.

An investigation of an outbreak of perhaps 3,000 cases of salmonellosis contracted from raw tomatoes served at a fast-food restaurant chain in 1999 demonstrated that Salmonella enterica can be transferred from hands and grow rapidly in tomatoes, Dr. Derlet noted.

A recent study has now shown that S. enterica can survive on vegetables for 200 days, at least under experimental conditions (Appl. Environ. Microbiol. 2004;70:2497–502).

INCLINE VILLAGE, NEV. — Freezing a food product does not always kill all the bacteria in it. Covering boiling water helps kill all the organisms in the pot. And houseflies can carry pathogenic Escherichia coli.

Those are some of the intriguing findings of recent studies in food-borne infectious disease, said Robert W. Derlet, M.D., at an annual emergency medicine meeting sponsored by the University of California, Davis.

U.S. Department of Agriculture researchers looked at whether refrigerating or freezing chicken at either 4°C or −20°C would kill Campylobacter jejuni, which is prevalent in U.S. poultry, said Dr. Derlet, who is chief of emergency medicine at the University of California, Davis.

The researchers found that when the chicken was frozen for 1 week, about 10% of the C. jejuni population survived, and when it was frozen for 2 weeks, 5% survived.

Obviously, most home refrigerators cannot achieve −20°C.

In addition, he said, “Other studies have shown that even with months of freezing, some bacteria that are hardy survive. E. coli, as well as salmonella, tend to be hardy environmental organisms.”

The researchers concluded that freezing is not a substitute for proper cooking (Appl. Environ. Microbiol. 2004;70:7103–9).

Researchers from the Centers for Disease Control and Prevention, who are studying Bacillus anthracis because of its potential use as a bioterrorism agent, investigated whether boiling water contaminated with the organisms would sterilize the water.

They found that when the water was covered and then boiled for either 3 minutes or 5 minutes, all the organisms were killed.

However, when the water was boiled uncovered, high numbers of the organisms survived (Emerg. Infect. Dis. 2004;10: 1887–8).

Some organisms can encapsulate into spores and survive intense temperatures, Dr. Derlet said. Clostridia, for example, form temperature-resistant capsules that break down when they cool, which is why there are instances of people becoming sick after eating soup that has cooled.

Researchers at Kansas State University collected flies from a cattle farm in that state to see if the insects could be contributing to dissemination of E. coli O157:H7, which may be present in up to 40% of beef that comes from a feedlot or passes through a stockyard.

They found that 6% of the flies collected harbored the organism, which can cause hemolytic-uremic syndrome (Appl. Environ. Microbiol. 2004;70:7578–80).

Flies can also carry shigella, salmonella, and cholera, and a fly needs only a second to get its mouth parts onto your food—though it is not known if in that time the fly can deposit enough organisms to make someone ill.

An investigation of an outbreak of perhaps 3,000 cases of salmonellosis contracted from raw tomatoes served at a fast-food restaurant chain in 1999 demonstrated that Salmonella enterica can be transferred from hands and grow rapidly in tomatoes, Dr. Derlet noted.

A recent study has now shown that S. enterica can survive on vegetables for 200 days, at least under experimental conditions (Appl. Environ. Microbiol. 2004;70:2497–502).

INCLINE VILLAGE, NEV. — Freezing a food product does not always kill all the bacteria in it. Covering boiling water helps kill all the organisms in the pot. And houseflies can carry pathogenic Escherichia coli.

Those are some of the intriguing findings of recent studies in food-borne infectious disease, said Robert W. Derlet, M.D., at an annual emergency medicine meeting sponsored by the University of California, Davis.

U.S. Department of Agriculture researchers looked at whether refrigerating or freezing chicken at either 4°C or −20°C would kill Campylobacter jejuni, which is prevalent in U.S. poultry, said Dr. Derlet, who is chief of emergency medicine at the University of California, Davis.

The researchers found that when the chicken was frozen for 1 week, about 10% of the C. jejuni population survived, and when it was frozen for 2 weeks, 5% survived.

Obviously, most home refrigerators cannot achieve −20°C.

In addition, he said, “Other studies have shown that even with months of freezing, some bacteria that are hardy survive. E. coli, as well as salmonella, tend to be hardy environmental organisms.”

The researchers concluded that freezing is not a substitute for proper cooking (Appl. Environ. Microbiol. 2004;70:7103–9).

Researchers from the Centers for Disease Control and Prevention, who are studying Bacillus anthracis because of its potential use as a bioterrorism agent, investigated whether boiling water contaminated with the organisms would sterilize the water.

They found that when the water was covered and then boiled for either 3 minutes or 5 minutes, all the organisms were killed.

However, when the water was boiled uncovered, high numbers of the organisms survived (Emerg. Infect. Dis. 2004;10: 1887–8).

Some organisms can encapsulate into spores and survive intense temperatures, Dr. Derlet said. Clostridia, for example, form temperature-resistant capsules that break down when they cool, which is why there are instances of people becoming sick after eating soup that has cooled.

Researchers at Kansas State University collected flies from a cattle farm in that state to see if the insects could be contributing to dissemination of E. coli O157:H7, which may be present in up to 40% of beef that comes from a feedlot or passes through a stockyard.

They found that 6% of the flies collected harbored the organism, which can cause hemolytic-uremic syndrome (Appl. Environ. Microbiol. 2004;70:7578–80).

Flies can also carry shigella, salmonella, and cholera, and a fly needs only a second to get its mouth parts onto your food—though it is not known if in that time the fly can deposit enough organisms to make someone ill.

An investigation of an outbreak of perhaps 3,000 cases of salmonellosis contracted from raw tomatoes served at a fast-food restaurant chain in 1999 demonstrated that Salmonella enterica can be transferred from hands and grow rapidly in tomatoes, Dr. Derlet noted.

A recent study has now shown that S. enterica can survive on vegetables for 200 days, at least under experimental conditions (Appl. Environ. Microbiol. 2004;70:2497–502).

INCLINE VILLAGE, NEV. — Freezing a food does not always kill all the bacteria in it. Covering boiling water helps kill all the organisms in the pot. And houseflies can carry pathogenic Escherichia coli.

Those are some of the intriguing findings of recent studies about food-borne infectious disease, said Robert W. Derlet, M.D., at an annual emergency medicine meeting sponsored by the University of California, Davis.

U.S. Department of Agriculture researchers looked at whether refrigerating or freezing chicken at either 4° C or −20° C would kill Campylobacter jejuni, which is prevalent in U.S. poultry, said Dr. Derlet, chief of emergency medicine at the University of California, Davis.

They found that when the chicken was frozen for 1 week, about 10% of the C. jejuni population survived, and when it was frozen for 2 weeks, 5% survived.

However, most home refrigerators cannot achieve −20° C. In addition, he said, “Other studies have shown that even with months of freezing, some bacteria that are hardy survive. E. coli, as well as salmonella, tend to be hardy environmental organisms.”

The researchers concluded that freezing is not a substitute for proper cooking (Appl. Environ. Microbiol. 2004; 70:7103–9).

Researchers from the Centers for Disease Control and Prevention, who are studying Bacillus anthracis because of its potential use as a bioterrorism agent, investigated whether boiling water contaminated with the organisms would sterilize the water. They found that when the water was covered and boiled for 3 minutes or 5 minutes, all the organisms were killed. However, when the water was boiled uncovered, high numbers of the organisms survived (Emerg. Infect. Dis. 2004;10:1887–8).

Some organisms can encapsulate into spores and survive intense temperatures, Dr. Derlet said. Clostridia, for example, form temperature-resistant capsules that break down when they cool, which is why there are instances of people becoming sick after eating soup that has cooled.

Researchers at Kansas State University collected flies from a cattle farm in that state to see if the insects could be contributing to dissemination of E. coli O157:H7, which may be present in up to 40% of beef that comes from a feedlot or passes through a stockyard.

They found that 6% of the flies collected harbored the organism, which can cause hemolytic-uremic syndrome (Appl. Environ. Microbiol. 2004;70:7578–80).

Flies can also carry shigella, salmonella, and cholera, and a fly needs only a second to get its mouth parts onto your food—though it is not known if in that time the fly can deposit enough organisms to make someone ill.

An investigation of an outbreak of about 3,000 cases of salmonellosis contracted from raw tomatoes served at a fast-food restaurant chain in 1999 demonstrated that Salmonella enterica can be transferred from hands and grow rapidly in tomatoes, Dr. Derlet noted. A recent study has now shown that it can survive on vegetables for 200 days, at least under experimental conditions (Appl. Environ. Microbiol. 2004;70:2497–502).

INCLINE VILLAGE, NEV. — Freezing a food does not always kill all the bacteria in it. Covering boiling water helps kill all the organisms in the pot. And houseflies can carry pathogenic Escherichia coli.

Those are some of the intriguing findings of recent studies about food-borne infectious disease, said Robert W. Derlet, M.D., at an annual emergency medicine meeting sponsored by the University of California, Davis.

U.S. Department of Agriculture researchers looked at whether refrigerating or freezing chicken at either 4° C or −20° C would kill Campylobacter jejuni, which is prevalent in U.S. poultry, said Dr. Derlet, chief of emergency medicine at the University of California, Davis.

They found that when the chicken was frozen for 1 week, about 10% of the C. jejuni population survived, and when it was frozen for 2 weeks, 5% survived.

However, most home refrigerators cannot achieve −20° C. In addition, he said, “Other studies have shown that even with months of freezing, some bacteria that are hardy survive. E. coli, as well as salmonella, tend to be hardy environmental organisms.”

The researchers concluded that freezing is not a substitute for proper cooking (Appl. Environ. Microbiol. 2004; 70:7103–9).

Researchers from the Centers for Disease Control and Prevention, who are studying Bacillus anthracis because of its potential use as a bioterrorism agent, investigated whether boiling water contaminated with the organisms would sterilize the water. They found that when the water was covered and boiled for 3 minutes or 5 minutes, all the organisms were killed. However, when the water was boiled uncovered, high numbers of the organisms survived (Emerg. Infect. Dis. 2004;10:1887–8).

Some organisms can encapsulate into spores and survive intense temperatures, Dr. Derlet said. Clostridia, for example, form temperature-resistant capsules that break down when they cool, which is why there are instances of people becoming sick after eating soup that has cooled.

Researchers at Kansas State University collected flies from a cattle farm in that state to see if the insects could be contributing to dissemination of E. coli O157:H7, which may be present in up to 40% of beef that comes from a feedlot or passes through a stockyard.

They found that 6% of the flies collected harbored the organism, which can cause hemolytic-uremic syndrome (Appl. Environ. Microbiol. 2004;70:7578–80).

Flies can also carry shigella, salmonella, and cholera, and a fly needs only a second to get its mouth parts onto your food—though it is not known if in that time the fly can deposit enough organisms to make someone ill.

An investigation of an outbreak of about 3,000 cases of salmonellosis contracted from raw tomatoes served at a fast-food restaurant chain in 1999 demonstrated that Salmonella enterica can be transferred from hands and grow rapidly in tomatoes, Dr. Derlet noted. A recent study has now shown that it can survive on vegetables for 200 days, at least under experimental conditions (Appl. Environ. Microbiol. 2004;70:2497–502).

INCLINE VILLAGE, NEV. — Freezing a food does not always kill all the bacteria in it. Covering boiling water helps kill all the organisms in the pot. And houseflies can carry pathogenic Escherichia coli.

Those are some of the intriguing findings of recent studies about food-borne infectious disease, said Robert W. Derlet, M.D., at an annual emergency medicine meeting sponsored by the University of California, Davis.

U.S. Department of Agriculture researchers looked at whether refrigerating or freezing chicken at either 4° C or −20° C would kill Campylobacter jejuni, which is prevalent in U.S. poultry, said Dr. Derlet, chief of emergency medicine at the University of California, Davis.

They found that when the chicken was frozen for 1 week, about 10% of the C. jejuni population survived, and when it was frozen for 2 weeks, 5% survived.

However, most home refrigerators cannot achieve −20° C. In addition, he said, “Other studies have shown that even with months of freezing, some bacteria that are hardy survive. E. coli, as well as salmonella, tend to be hardy environmental organisms.”

The researchers concluded that freezing is not a substitute for proper cooking (Appl. Environ. Microbiol. 2004; 70:7103–9).

Researchers from the Centers for Disease Control and Prevention, who are studying Bacillus anthracis because of its potential use as a bioterrorism agent, investigated whether boiling water contaminated with the organisms would sterilize the water. They found that when the water was covered and boiled for 3 minutes or 5 minutes, all the organisms were killed. However, when the water was boiled uncovered, high numbers of the organisms survived (Emerg. Infect. Dis. 2004;10:1887–8).

Some organisms can encapsulate into spores and survive intense temperatures, Dr. Derlet said. Clostridia, for example, form temperature-resistant capsules that break down when they cool, which is why there are instances of people becoming sick after eating soup that has cooled.

Researchers at Kansas State University collected flies from a cattle farm in that state to see if the insects could be contributing to dissemination of E. coli O157:H7, which may be present in up to 40% of beef that comes from a feedlot or passes through a stockyard.

They found that 6% of the flies collected harbored the organism, which can cause hemolytic-uremic syndrome (Appl. Environ. Microbiol. 2004;70:7578–80).

Flies can also carry shigella, salmonella, and cholera, and a fly needs only a second to get its mouth parts onto your food—though it is not known if in that time the fly can deposit enough organisms to make someone ill.

An investigation of an outbreak of about 3,000 cases of salmonellosis contracted from raw tomatoes served at a fast-food restaurant chain in 1999 demonstrated that Salmonella enterica can be transferred from hands and grow rapidly in tomatoes, Dr. Derlet noted. A recent study has now shown that it can survive on vegetables for 200 days, at least under experimental conditions (Appl. Environ. Microbiol. 2004;70:2497–502).

LOS ANGELES — Condom use does matter in human papillomavirus infections, because it is associated with a shorter persistence of infection in females, according to a study of 57 sexually active female adolescents.

The study, which followed the adolescents for an average 2.2 years and included periods during which the subjects collected vaginal swabs weekly, found that in those who reported the least-frequent condom use, the mean duration of an HPV infection was 251 days, compared with a mean duration of 138 days for those reporting the most, Marcia L. Shew, M.D., said at the annual meeting of the Society for Adolescent Medicine.

Noting that a recent National Institutes of Health report concluded that previous studies have not provided good enough evidence to know whether condom use prevents or influences HPV infection and transmission, Dr. Shew said, “We were so excited when we found out that condoms had a role, and it makes sense because condom use has clearly been shown to be associated with more frequent regression in cervical intraepithelial neoplasia.”

The study, which, in addition to the weekly vaginal swabs collected by the subjects themselves, looked at cervical swabs collected by the investigators every 3 months, found that 49 of the 57 subjects got at least one infection during the average 2.2 years, for a cumulative incidence of 86%, according to Dr. Shew of Indiana University, Indianapolis.

Among them, there were 241 individual infections, or an average of about 5 per individual.

Of those infections, 168 were of a high-risk, oncogenic type of papillomavirus, and 73 were of a low-risk type. The types most frequently detected were 52 and 16, both high-risk types, and 66, a low-risk type.

Factors the study found to be associated with longer duration of infection included oncogenic type, coinfection with chlamydia, a greater number of sexual partners, and less condom use.

Analysis indicated that the mean duration of infection with an oncogenic type papillomavirus was 226 days vs. a mean 159 days for the infections with nononcogenic types.

Mean duration of infection in those cases that occurred with a concurrent chlamydia infection was 333 days vs. 96 days.

And the average duration of an infection in an individual with multiple sexual partners was 436 days, vs. 96 days in those individuals who had only one or no partners during the infection.

Some of the possibilities that might explain why condom use results in shorter infections include that someone who is having repeated sex with an infected individual might be exposed to a higher viral load, or even that semen is proinflammatory, and that somehow contributes, Dr. Shew said.

“We feel these findings have substantial clinical and public health significance, and clearly may help to reduce viral transmission,” she added.

LOS ANGELES — Condom use does matter in human papillomavirus infections, because it is associated with a shorter persistence of infection in females, according to a study of 57 sexually active female adolescents.

The study, which followed the adolescents for an average 2.2 years and included periods during which the subjects collected vaginal swabs weekly, found that in those who reported the least-frequent condom use, the mean duration of an HPV infection was 251 days, compared with a mean duration of 138 days for those reporting the most, Marcia L. Shew, M.D., said at the annual meeting of the Society for Adolescent Medicine.

Noting that a recent National Institutes of Health report concluded that previous studies have not provided good enough evidence to know whether condom use prevents or influences HPV infection and transmission, Dr. Shew said, “We were so excited when we found out that condoms had a role, and it makes sense because condom use has clearly been shown to be associated with more frequent regression in cervical intraepithelial neoplasia.”

The study, which, in addition to the weekly vaginal swabs collected by the subjects themselves, looked at cervical swabs collected by the investigators every 3 months, found that 49 of the 57 subjects got at least one infection during the average 2.2 years, for a cumulative incidence of 86%, according to Dr. Shew of Indiana University, Indianapolis.

Among them, there were 241 individual infections, or an average of about 5 per individual.

Of those infections, 168 were of a high-risk, oncogenic type of papillomavirus, and 73 were of a low-risk type. The types most frequently detected were 52 and 16, both high-risk types, and 66, a low-risk type.

Factors the study found to be associated with longer duration of infection included oncogenic type, coinfection with chlamydia, a greater number of sexual partners, and less condom use.

Analysis indicated that the mean duration of infection with an oncogenic type papillomavirus was 226 days vs. a mean 159 days for the infections with nononcogenic types.

Mean duration of infection in those cases that occurred with a concurrent chlamydia infection was 333 days vs. 96 days.

And the average duration of an infection in an individual with multiple sexual partners was 436 days, vs. 96 days in those individuals who had only one or no partners during the infection.

Some of the possibilities that might explain why condom use results in shorter infections include that someone who is having repeated sex with an infected individual might be exposed to a higher viral load, or even that semen is proinflammatory, and that somehow contributes, Dr. Shew said.

“We feel these findings have substantial clinical and public health significance, and clearly may help to reduce viral transmission,” she added.

LOS ANGELES — Condom use does matter in human papillomavirus infections, because it is associated with a shorter persistence of infection in females, according to a study of 57 sexually active female adolescents.

The study, which followed the adolescents for an average 2.2 years and included periods during which the subjects collected vaginal swabs weekly, found that in those who reported the least-frequent condom use, the mean duration of an HPV infection was 251 days, compared with a mean duration of 138 days for those reporting the most, Marcia L. Shew, M.D., said at the annual meeting of the Society for Adolescent Medicine.

Noting that a recent National Institutes of Health report concluded that previous studies have not provided good enough evidence to know whether condom use prevents or influences HPV infection and transmission, Dr. Shew said, “We were so excited when we found out that condoms had a role, and it makes sense because condom use has clearly been shown to be associated with more frequent regression in cervical intraepithelial neoplasia.”

The study, which, in addition to the weekly vaginal swabs collected by the subjects themselves, looked at cervical swabs collected by the investigators every 3 months, found that 49 of the 57 subjects got at least one infection during the average 2.2 years, for a cumulative incidence of 86%, according to Dr. Shew of Indiana University, Indianapolis.

Among them, there were 241 individual infections, or an average of about 5 per individual.

Of those infections, 168 were of a high-risk, oncogenic type of papillomavirus, and 73 were of a low-risk type. The types most frequently detected were 52 and 16, both high-risk types, and 66, a low-risk type.

Factors the study found to be associated with longer duration of infection included oncogenic type, coinfection with chlamydia, a greater number of sexual partners, and less condom use.

Analysis indicated that the mean duration of infection with an oncogenic type papillomavirus was 226 days vs. a mean 159 days for the infections with nononcogenic types.

Mean duration of infection in those cases that occurred with a concurrent chlamydia infection was 333 days vs. 96 days.

And the average duration of an infection in an individual with multiple sexual partners was 436 days, vs. 96 days in those individuals who had only one or no partners during the infection.

Some of the possibilities that might explain why condom use results in shorter infections include that someone who is having repeated sex with an infected individual might be exposed to a higher viral load, or even that semen is proinflammatory, and that somehow contributes, Dr. Shew said.

“We feel these findings have substantial clinical and public health significance, and clearly may help to reduce viral transmission,” she added.

LOS ANGELES — Physicians mostly fail to follow up with adolescent patients they treat for a chlamydia infection, as recommendations state they should, according to a study conducted with the records from five, Northern California pediatrics clinics.

Only 10% of 122 patients testing positive for a Chlamydia trachomatis infection at the clinics received appropriate retesting, and many also did not appear to have been counseled about safer sex, did not notify their partners, or were not tested for other STDs, Loris Hwang, M.D., and her colleagues said in a poster presentation at the annual meeting of the Society for Adolescent Medicine.

Antibiotic resistance is not considered a problem with chlamydia, so treatment generally is successful and a follow-up visit is not necessary to test for cure. Rather, the reason for follow-up is that those who get infected tend to return to the same “sexual networks” where they got the infection in the first place, said Dr. Hwang of the University of California, San Francisco.

Because the study was conducted at clinics that were part of the Kaiser Permanente system, an HMO where return visits would presumably be fairly easy for patients, “the situation is probably worse in other clinics,” Dr. Hwang said in an interview.

Guidelines for chlamydia treatment from the Centers for Disease Control and Prevention recommend that patients have one follow-up visit for retesting at 3–4 months following a treatment visit, and then another within 12 months. Retesting at less than 3 weeks from treatment is specifically not recommended because nonculture tests can remain positive for that amount of time.

There were 122 individuals in the study, and 97% received appropriate antibiotics; of those, 22% were retested within 3 weeks of treatment. An additional 17% were retested after 3 weeks but before 3 months. And, 10% received retesting at some time after 3 months and before 12 months.

The remaining patients either had another visit but were not retested, were advised to return but did not, or had no records regarding a follow-up visit at all.

Regarding the other recommendations in the CDC guidelines, Dr. Hwang and her colleagues found that the physicians tended to do better with the female patients than the males.

Eighty-three percent of the study's 96 adolescent women were counseled on safer sex, compared with 62% of the study's 26 adolescent men.

Thirty-eight percent of the women were screened for other sexually transmitted diseases, compared with 31% of the men.

And, partners were notified or treated for 57% of the females, but only 31% of the men.

LOS ANGELES — Physicians mostly fail to follow up with adolescent patients they treat for a chlamydia infection, as recommendations state they should, according to a study conducted with the records from five, Northern California pediatrics clinics.

Only 10% of 122 patients testing positive for a Chlamydia trachomatis infection at the clinics received appropriate retesting, and many also did not appear to have been counseled about safer sex, did not notify their partners, or were not tested for other STDs, Loris Hwang, M.D., and her colleagues said in a poster presentation at the annual meeting of the Society for Adolescent Medicine.

Antibiotic resistance is not considered a problem with chlamydia, so treatment generally is successful and a follow-up visit is not necessary to test for cure. Rather, the reason for follow-up is that those who get infected tend to return to the same “sexual networks” where they got the infection in the first place, said Dr. Hwang of the University of California, San Francisco.

Because the study was conducted at clinics that were part of the Kaiser Permanente system, an HMO where return visits would presumably be fairly easy for patients, “the situation is probably worse in other clinics,” Dr. Hwang said in an interview.

Guidelines for chlamydia treatment from the Centers for Disease Control and Prevention recommend that patients have one follow-up visit for retesting at 3–4 months following a treatment visit, and then another within 12 months. Retesting at less than 3 weeks from treatment is specifically not recommended because nonculture tests can remain positive for that amount of time.

There were 122 individuals in the study, and 97% received appropriate antibiotics; of those, 22% were retested within 3 weeks of treatment. An additional 17% were retested after 3 weeks but before 3 months. And, 10% received retesting at some time after 3 months and before 12 months.

The remaining patients either had another visit but were not retested, were advised to return but did not, or had no records regarding a follow-up visit at all.

Regarding the other recommendations in the CDC guidelines, Dr. Hwang and her colleagues found that the physicians tended to do better with the female patients than the males.

Eighty-three percent of the study's 96 adolescent women were counseled on safer sex, compared with 62% of the study's 26 adolescent men.

Thirty-eight percent of the women were screened for other sexually transmitted diseases, compared with 31% of the men.

And, partners were notified or treated for 57% of the females, but only 31% of the men.

LOS ANGELES — Physicians mostly fail to follow up with adolescent patients they treat for a chlamydia infection, as recommendations state they should, according to a study conducted with the records from five, Northern California pediatrics clinics.

Only 10% of 122 patients testing positive for a Chlamydia trachomatis infection at the clinics received appropriate retesting, and many also did not appear to have been counseled about safer sex, did not notify their partners, or were not tested for other STDs, Loris Hwang, M.D., and her colleagues said in a poster presentation at the annual meeting of the Society for Adolescent Medicine.

Antibiotic resistance is not considered a problem with chlamydia, so treatment generally is successful and a follow-up visit is not necessary to test for cure. Rather, the reason for follow-up is that those who get infected tend to return to the same “sexual networks” where they got the infection in the first place, said Dr. Hwang of the University of California, San Francisco.

Because the study was conducted at clinics that were part of the Kaiser Permanente system, an HMO where return visits would presumably be fairly easy for patients, “the situation is probably worse in other clinics,” Dr. Hwang said in an interview.

Guidelines for chlamydia treatment from the Centers for Disease Control and Prevention recommend that patients have one follow-up visit for retesting at 3–4 months following a treatment visit, and then another within 12 months. Retesting at less than 3 weeks from treatment is specifically not recommended because nonculture tests can remain positive for that amount of time.

There were 122 individuals in the study, and 97% received appropriate antibiotics; of those, 22% were retested within 3 weeks of treatment. An additional 17% were retested after 3 weeks but before 3 months. And, 10% received retesting at some time after 3 months and before 12 months.

The remaining patients either had another visit but were not retested, were advised to return but did not, or had no records regarding a follow-up visit at all.

Regarding the other recommendations in the CDC guidelines, Dr. Hwang and her colleagues found that the physicians tended to do better with the female patients than the males.

Eighty-three percent of the study's 96 adolescent women were counseled on safer sex, compared with 62% of the study's 26 adolescent men.

Thirty-eight percent of the women were screened for other sexually transmitted diseases, compared with 31% of the men.

And, partners were notified or treated for 57% of the females, but only 31% of the men.

INCLINE VILLAGE, NEV. — Freezing a food does not always kill all the bacteria in it.

Covering boiling water helps kill all the organisms in the pot.

And houseflies can carry pathogenic Escherichia coli.

Those are some of the intriguing findings of recent studies in food-borne infectious disease, said Robert W. Derlet, M.D., at an annual emergency medicine meeting sponsored by the University of California, Davis.

U.S. Department of Agriculture researchers looked at whether refrigerating or freezing chicken at either 4° C or −20° C would kill Campylobacter jejuni, which is prevalent in U.S. poultry, according to Dr. Derlet, who is the chief of emergency medicine at the University of California, Davis.

They found that when the chicken was frozen for 1 week, about 10% of the C. jejuni population survived, and when it was frozen for 2 weeks, 5% survived.

Obviously, most home refrigerators cannot achieve −20° C.

In addition, he said, “Other studies have shown that even with months of freezing, some bacteria that are hardy survive. E. coli, as well as Salmonella, tend to be hardy environmental organisms.”

The researchers concluded that freezing is not a substitute for proper cooking (Appl. Environ. Microbiol. 2004;70:7103–9).

Researchers from the Centers for Disease Control and Prevention, who are studying Bacillus anthracis because of its potential use as a bioterrorism agent, investigated whether boiling water contaminated with the organisms would sterilize the water. They found that when the water was covered and boiled for 3 minutes or 5 minutes, all the organisms were killed.

However, when the water was boiled uncovered, high numbers of the organisms survived (Emerg. Infect. Dis. 2004;10:1887–8).

Some organisms can encapsulate into spores and survive intense temperatures, Dr. Derlet said. Clostridia, for example, form temperature-resistant capsules that break down when they cool, which is why there are instances of people becoming sick after eating soup that has cooled.

Researchers at Kansas State University collected flies from a cattle farm in that state to see if the insects could be contributing to dissemination of E. coli O157:H7, which may be present in up to 40% of beef that comes from a feedlot or passes through a stockyard.

The investigators found that 6% of the flies collected harbored the organism, which can cause hemolytic-uremic syndrome (Appl. Environ. Microbiol. 2004;70:7578–80).

Flies can also carry Shigella, Salmonella, and cholera, and a fly needs only a second to get its mouth parts onto your food—though it is not known if in that time the fly can deposit enough organisms to make someone ill.

An investigation of an outbreak of perhaps 3,000 cases of salmonellosis contracted from raw tomatoes served at a fast-food restaurant chain in 1999 demonstrated that Salmonella enterica can be transferred from hands and grow rapidly in tomatoes, Dr. Derlet noted.

A recent study has now shown that it can survive on vegetables for 200 days, at least under experimental conditions (Appl. Environ. Microbiol. 2004;70:2497–502).

INCLINE VILLAGE, NEV. — Freezing a food does not always kill all the bacteria in it.

Covering boiling water helps kill all the organisms in the pot.

And houseflies can carry pathogenic Escherichia coli.

Those are some of the intriguing findings of recent studies in food-borne infectious disease, said Robert W. Derlet, M.D., at an annual emergency medicine meeting sponsored by the University of California, Davis.

U.S. Department of Agriculture researchers looked at whether refrigerating or freezing chicken at either 4° C or −20° C would kill Campylobacter jejuni, which is prevalent in U.S. poultry, according to Dr. Derlet, who is the chief of emergency medicine at the University of California, Davis.

They found that when the chicken was frozen for 1 week, about 10% of the C. jejuni population survived, and when it was frozen for 2 weeks, 5% survived.

Obviously, most home refrigerators cannot achieve −20° C.

In addition, he said, “Other studies have shown that even with months of freezing, some bacteria that are hardy survive. E. coli, as well as Salmonella, tend to be hardy environmental organisms.”

The researchers concluded that freezing is not a substitute for proper cooking (Appl. Environ. Microbiol. 2004;70:7103–9).

Researchers from the Centers for Disease Control and Prevention, who are studying Bacillus anthracis because of its potential use as a bioterrorism agent, investigated whether boiling water contaminated with the organisms would sterilize the water. They found that when the water was covered and boiled for 3 minutes or 5 minutes, all the organisms were killed.

However, when the water was boiled uncovered, high numbers of the organisms survived (Emerg. Infect. Dis. 2004;10:1887–8).

Some organisms can encapsulate into spores and survive intense temperatures, Dr. Derlet said. Clostridia, for example, form temperature-resistant capsules that break down when they cool, which is why there are instances of people becoming sick after eating soup that has cooled.

Researchers at Kansas State University collected flies from a cattle farm in that state to see if the insects could be contributing to dissemination of E. coli O157:H7, which may be present in up to 40% of beef that comes from a feedlot or passes through a stockyard.

The investigators found that 6% of the flies collected harbored the organism, which can cause hemolytic-uremic syndrome (Appl. Environ. Microbiol. 2004;70:7578–80).

Flies can also carry Shigella, Salmonella, and cholera, and a fly needs only a second to get its mouth parts onto your food—though it is not known if in that time the fly can deposit enough organisms to make someone ill.

An investigation of an outbreak of perhaps 3,000 cases of salmonellosis contracted from raw tomatoes served at a fast-food restaurant chain in 1999 demonstrated that Salmonella enterica can be transferred from hands and grow rapidly in tomatoes, Dr. Derlet noted.

A recent study has now shown that it can survive on vegetables for 200 days, at least under experimental conditions (Appl. Environ. Microbiol. 2004;70:2497–502).

INCLINE VILLAGE, NEV. — Freezing a food does not always kill all the bacteria in it.

Covering boiling water helps kill all the organisms in the pot.

And houseflies can carry pathogenic Escherichia coli.

Those are some of the intriguing findings of recent studies in food-borne infectious disease, said Robert W. Derlet, M.D., at an annual emergency medicine meeting sponsored by the University of California, Davis.

U.S. Department of Agriculture researchers looked at whether refrigerating or freezing chicken at either 4° C or −20° C would kill Campylobacter jejuni, which is prevalent in U.S. poultry, according to Dr. Derlet, who is the chief of emergency medicine at the University of California, Davis.

They found that when the chicken was frozen for 1 week, about 10% of the C. jejuni population survived, and when it was frozen for 2 weeks, 5% survived.

Obviously, most home refrigerators cannot achieve −20° C.

In addition, he said, “Other studies have shown that even with months of freezing, some bacteria that are hardy survive. E. coli, as well as Salmonella, tend to be hardy environmental organisms.”

The researchers concluded that freezing is not a substitute for proper cooking (Appl. Environ. Microbiol. 2004;70:7103–9).

Researchers from the Centers for Disease Control and Prevention, who are studying Bacillus anthracis because of its potential use as a bioterrorism agent, investigated whether boiling water contaminated with the organisms would sterilize the water. They found that when the water was covered and boiled for 3 minutes or 5 minutes, all the organisms were killed.

However, when the water was boiled uncovered, high numbers of the organisms survived (Emerg. Infect. Dis. 2004;10:1887–8).

Some organisms can encapsulate into spores and survive intense temperatures, Dr. Derlet said. Clostridia, for example, form temperature-resistant capsules that break down when they cool, which is why there are instances of people becoming sick after eating soup that has cooled.

Researchers at Kansas State University collected flies from a cattle farm in that state to see if the insects could be contributing to dissemination of E. coli O157:H7, which may be present in up to 40% of beef that comes from a feedlot or passes through a stockyard.

The investigators found that 6% of the flies collected harbored the organism, which can cause hemolytic-uremic syndrome (Appl. Environ. Microbiol. 2004;70:7578–80).

Flies can also carry Shigella, Salmonella, and cholera, and a fly needs only a second to get its mouth parts onto your food—though it is not known if in that time the fly can deposit enough organisms to make someone ill.

An investigation of an outbreak of perhaps 3,000 cases of salmonellosis contracted from raw tomatoes served at a fast-food restaurant chain in 1999 demonstrated that Salmonella enterica can be transferred from hands and grow rapidly in tomatoes, Dr. Derlet noted.

A recent study has now shown that it can survive on vegetables for 200 days, at least under experimental conditions (Appl. Environ. Microbiol. 2004;70:2497–502).

LOS ANGELES — Adolescents treated for pelvic inflammatory disease are not likely to complete a 14-day course of antibiotics nor return for 72-hour evaluation, according to a study designed to see if implementation of a rigorous institutional protocol could improve care.

The protocol helped, but only somewhat, Maria Trent, M.D., said at the annual meeting of the Society for Adolescent Medicine. Previous studies have suggested that even adults have a difficult time adhering to the outpatient regimen.

The study compared management of 56 adolescent females diagnosed with pelvic inflammatory disease (PID) before implementation of the protocol with the management of 72 females seen afterward.

The protocol included disseminating a treatment algorithm and a clinical practice guideline based on Centers for Disease Control and Prevention recommendations, making available a full 14-day course of medications at discharge, providing written discharge instructions, and following up by telephone 24 hours to 2 weeks after the patients were initially seen. The patients were seen in a pediatric emergency department or a primary care clinic in urban Baltimore.

Before the intervention, 38% of patients did not receive an appropriate regimen, and only 10% returned at 72 hours to check on resolution of symptoms, as the CDC guidelines recommend, said Dr. Trent, an adolescent medicine specialist at Johns Hopkins University, Baltimore.

During the intervention, 91% of patients received an appropriate regimen. But only 43% returned for reevaluation, and an interview with 28 patients contacted after treatment found that only 61% had taken all of their doses.

Physicians should give serious consideration to inpatient treatment, she said.

LOS ANGELES — Adolescents treated for pelvic inflammatory disease are not likely to complete a 14-day course of antibiotics nor return for 72-hour evaluation, according to a study designed to see if implementation of a rigorous institutional protocol could improve care.

The protocol helped, but only somewhat, Maria Trent, M.D., said at the annual meeting of the Society for Adolescent Medicine. Previous studies have suggested that even adults have a difficult time adhering to the outpatient regimen.

The study compared management of 56 adolescent females diagnosed with pelvic inflammatory disease (PID) before implementation of the protocol with the management of 72 females seen afterward.

The protocol included disseminating a treatment algorithm and a clinical practice guideline based on Centers for Disease Control and Prevention recommendations, making available a full 14-day course of medications at discharge, providing written discharge instructions, and following up by telephone 24 hours to 2 weeks after the patients were initially seen. The patients were seen in a pediatric emergency department or a primary care clinic in urban Baltimore.

Before the intervention, 38% of patients did not receive an appropriate regimen, and only 10% returned at 72 hours to check on resolution of symptoms, as the CDC guidelines recommend, said Dr. Trent, an adolescent medicine specialist at Johns Hopkins University, Baltimore.

During the intervention, 91% of patients received an appropriate regimen. But only 43% returned for reevaluation, and an interview with 28 patients contacted after treatment found that only 61% had taken all of their doses.

Physicians should give serious consideration to inpatient treatment, she said.

LOS ANGELES — Adolescents treated for pelvic inflammatory disease are not likely to complete a 14-day course of antibiotics nor return for 72-hour evaluation, according to a study designed to see if implementation of a rigorous institutional protocol could improve care.

The protocol helped, but only somewhat, Maria Trent, M.D., said at the annual meeting of the Society for Adolescent Medicine. Previous studies have suggested that even adults have a difficult time adhering to the outpatient regimen.

The study compared management of 56 adolescent females diagnosed with pelvic inflammatory disease (PID) before implementation of the protocol with the management of 72 females seen afterward.

The protocol included disseminating a treatment algorithm and a clinical practice guideline based on Centers for Disease Control and Prevention recommendations, making available a full 14-day course of medications at discharge, providing written discharge instructions, and following up by telephone 24 hours to 2 weeks after the patients were initially seen. The patients were seen in a pediatric emergency department or a primary care clinic in urban Baltimore.

Before the intervention, 38% of patients did not receive an appropriate regimen, and only 10% returned at 72 hours to check on resolution of symptoms, as the CDC guidelines recommend, said Dr. Trent, an adolescent medicine specialist at Johns Hopkins University, Baltimore.

During the intervention, 91% of patients received an appropriate regimen. But only 43% returned for reevaluation, and an interview with 28 patients contacted after treatment found that only 61% had taken all of their doses.

Physicians should give serious consideration to inpatient treatment, she said.