BACKGROUND: Some countries have implemented reuse of laparoscopic instruments for cost-effective purposes. An accurate cleaning as the first step of reprocessing would lead to the effective sterilization. The purpose was to evaluate the effect of cleaning guidelines implementation on microbial load of laparoscopic instruments which were used in laparoscopic cholecystectomy surgery.
METHODS: This experimental study was done in an educational hospital, in 2017 and included a total of 128 laparoscopic instruments randomly selected from cholecystectomy surgeries and divided into two cleaning groups. The instruments were checked out in terms of number (colony-forming units [CFU]/mL) and type of microorganisms in two groups of routine cleaning and according to guideline cleaning. This guideline was indigenous and taken from successful instruction in this context that was presented by the Association for the Advancement of Medical Instrumentation (AAMI). The appropriate statistical analysis was conducted by SPSS version 19.
RESULTS: The average microbial load was 2.4 × 106 CFU/100 mL after clinical use. It was reduced to 7.2 × 105 CFU/100 mL in the control group and 3.4 × 104 CFU/100 mL in the intervention group, after the cleaning process. The most common microorganisms that were isolated immediately after clinical use were Escherichia coli 81.2%, Pseudomonas 68.8%, Klebsiella 57.8%, and spp., and so on.
CONCLUSIONS: The AAMI cleaning method is recommended to be utilized by operating room nurses for laparoscopic instruments.

Urinary tract infections (UTI) are very common throughout life and account for the majority of the workload in the clinical microbiology laboratory. Clear instructions for the interpretation of urine cultures by the laboratory technicians are indispensable to obtain standardized, reliable, and clinically useful results. In literature, there is often a lack of evidence-based practice in processing urinary samples in the laboratory. In this consensus document, the BILULU Study Group presents a practical approach for the implementation of existing guidelines for the culture of urine in the microbiology laboratory and offers answers for issues where no clear solution is available in the guidelines.

OBJECTIVE: Bacteria adherent to long-term urinary catheters (LTUC) may give misleading urine culture results. Guidelines in the USA recommend changing LTUC before urine collection to diagnose UTI and before commencing appropriate antimicrobial treatment. However, in the UK there is no such guidance. In this study, we evaluated differences in urine cultures before and after changing LTUC.
METHODS: In a prospective study in a UK urology department, we made a quantitative and qualitative comparison between paired urines collected before and after catheter change in patients with LTUC. We measured culture growth on a four-point ordinal scale as nil, scanty (< 107 cfu/L), moderate (107-108 cfu/L) or heavy (> 108 cfu/L) and recorded the range of bacterial species isolated. Statistical analysis was by Wilcoxon matched-pairs test.
RESULTS: Sixty-six patients (55 males, 11 females) took part in the study. Urines with no growth increased from 7/66 (11%) before change of catheter to 21/66(32%) after change of catheter. Cultures reported as heavy growth (> 108 cfu/L) reduced from 48/66 (73%) to 25/66 (38%) after catheter change (p < 0.001). Except for Pseudomonas spp., other organisms were isolated less frequently after catheter change. No Proteus spp. was isolated after catheter change.
CONCLUSIONS: This study confirms that failure to change long-term catheters before collecting urine for culture may give misleading results. In the interest of accurate diagnosis and antimicrobial stewardship, UK guidelines should recommend changing long-term urinary catheters before collection of urine for culture.

The U.S. Food and Drug Administration requires food processors to implement and validate processes that will result in significantly minimizing or preventing the occurrence of hazards that are reasonably foreseeable in food production. During production of fresh-cut leafy vegetables, microbial contamination that may be present on the product can spread throughout the production batch when the product is washed, thus increasing the risk of illnesses. The use of antimicrobials in the wash water is a critical step in preventing such water-mediated cross-contamination; however, many factors can affect antimicrobial efficacy in the production of fresh-cut leafy vegetables, and the procedures for validating this key preventive control have not been articulated. Producers may consider three options for validating antimicrobial washing as a preventive control for cross-contamination. Option 1 involves the use of a surrogate for the microbial hazard and the demonstration that cross-contamination is prevented by the antimicrobial wash. Option 2 involves the use of antimicrobial sensors and the demonstration that a critical antimicrobial level is maintained during worst-case operating conditions. Option 3 validates the placement of the sensors in the processing equipment with the demonstration that a critical antimicrobial level is maintained at all locations, regardless of operating conditions. These validation options developed for fresh-cut leafy vegetables may serve as examples for validating processes that prevent cross-contamination during washing of other fresh produce commodities.

The BacT/ALERT microbial detection system (bioMerieux, Inc, Durham, NC) is in routine use in many blood centers as a prerelease test for platelet collections. Published reports document wide variation in practices and outcomes. A systematic review of the English literature was performed to describe publications assessing the use of the BacT/ALERT culture system on platelet collections as a routine screen test of more than 10000 platelet components. Sixteen publications report the use of confirmatory testing to substantiate initial positive culture results but use varying nomenclature to classify the results. Preanalytical and analytical variables that may affect the outcomes differ widely between centers. Incomplete description of protocol details complicates comparison between sites. Initial positive culture results range from 539 to 10606 per million (0.054%-1.061%) and confirmed positive from 127 to 1035 per million (0.013%-0.104%) donations. False-negative results determined by outdate culture range from 662 to 2173 per million (0.066%-0.217%) and by septic reactions from 0 to 66 per million (0%-0.007%) collections. Current culture protocols represent pragmatic compromises between optimizing analytical sensitivity and ensuring the timely availability of platelets for clinical needs. Insights into the effect of protocol variations on outcomes are generally restricted to individual sites that implement limited changes to their protocols over time. Platelet manufacturers should reassess the adequacy of their BacT/ALERT screening protocols in light of the growing international experience and provide detailed documentation of all variables that may affect culture outcomes when reporting results. We propose a framework for a standardized nomenclature for reporting of the results of BacT/ALERT screening.

OBJECTIVE: The goal of this study was to determine the prevalence of bacteremia in pediatric patients with community-acquired pneumonia (CAP) at our institution and to test the effectiveness of newly developed guidelines for obtaining blood cultures.
METHODS: Using recent literature and local expert opinion, institutional guidelines for obtaining blood cultures in pediatric patients with CAP were developed. A retrospective chart review of children treated in the emergency department or admitted for CAP from January 2010 through June 2011 was conducted. Demographic and clinical data were collected, including results of blood cultures. Chi2 tests assessed for variables associated with bacteremia, whether a blood culture was obtained, and if the decision to obtain a culture was appropriate based on our guidelines.
RESULTS: The study included 330 patients; 155 (47%) blood cultures were obtained in our patient population. Five cultures were true-positive findings, making the prevalence of bacteremia 3.2% in patients with blood cultures and 1.5% in all patients. All 5 true positive results met criteria for blood culture based on our guidelines. Applying our guidelines retrospectively, the decision to obtain a blood culture met criteria in 55% of the cases. Bivariate analysis showed that patients discharged from the emergency department had higher rates of guideline-appropriate decisions than patients admitted. Radiographic findings were associated with making a guideline-appropriate decision regarding blood culture.
CONCLUSIONS: Instituting local guidelines that limit the frequency of obtaining blood cultures in pediatric patients with CAP is likely to capture any patient with bacteremia. This study suggests that blood cultures may not need to be routinely obtained in all patients admitted to the hospital with CAP.

Three previously described methods for culture of Clostridium difficile from meats were evaluated by microbiologists with experience in C. difficile culture and identification. A consensus protocol using BHI broth enrichment followed by ethanol shock and plating to selective and non-selective media was selected for use, and all participating laboratories received hands-on training in the use of this method prior to study initiation. Retail meat products (N = 1755) were cultured for C. difficile over 12 months during 2010-2011 at 9 U.S. FoodNet sites. No C. difficile was recovered, although other clostridia were isolated.

BACKGROUND: AphA is the master quorum-sensing (QS) regulator operating at low cell density in vibrios. Molecular regulation of target genes by AphA has been characterized in Vibrio harveyi and V. cholerae, but it is still poorly understood in V. parahaemolyticus.
RESULTS: The AphA proteins are extremely conserved in V. parahaemolyticus, Vibrio sp. Ex25, Vibrio sp. EJY3, V. harveyi, V. vulnificus, V. splendidus, V. anguillarum, V. cholerae, and V. furnissii. The above nine AphA orthologs appear to recognize conserved cis-acting DNA signals which can be represented by two consensus constructs, a 20 bp box sequence and a position frequency matrix. V. parahaemolyticus AphA represses the transcription of ahpA, qrr4, and opaR through direct AphA-target promoter DNA association, while it inhibits the qrr2-3 transcription in an indirect manner. Translation and transcription starts, core promoter elements for sigma factor recognition, Shine-Dalgarno sequences for ribosome recognition, and AphA-binding sites (containing corresponding AphA box-like sequences) were determined for the three direct AphA targets ahpA, qrr4, and opaR in V. parahaemolyticus.
CONCLUSIONS: AphA-mediated repression of ahpA, qrr2-4, and opaR was characterized in V. parahaemolyticus by using multiple biochemical and molecular experiments. The computational promoter analysis indicated the conserved mechanism of transcriptional regulation of QS regulator-encoding genes ahpA, qrr4, and opaR in vibrios.

Group B streptococcus is the leading cause of early-onset neonatal sepsis in the United States. Universal screening is recommended for pregnant women at 35 to 37 weeks\' gestation. The Centers for Disease Control and Prevention recently updated its guideline for the prevention of early-onset neonatal group B streptococcal disease. The new guideline contains six important changes. First, there is a recommendation to consider using sensitive nucleic acid amplification tests, rather than just routine cultures, for detection of group B streptococcus in rectal and vaginal specimens. Second, the colony count required to consider a urine specimen positive is at least 104 colony-forming units per mL. Third, the new guideline presents separate algorithms for management of preterm labor and preterm premature rupture of membranes, rather than a single algorithm for both conditions. Fourth, there are minor changes in the recommended dose of penicillin G for intrapartum chemoprophylaxis. Fifth, the guideline provides new recommendations about antibiotic regimens for women with penicillin allergy. Cefazolin is recommended for women with minor allergies. For those at serious risk of anaphylaxis, clindamycin is recommended if the organism is susceptible [corrected] and vancomycin is recommended if there is clindamycin resistance or if susceptibility is unknown. [corrected]. Finally, the new algorithm for secondary prevention of early-onset group B streptococcal disease in newborns should be applied to all infants, not only those at high risk of infection. The algorithm clarifies the extent of evaluation and duration of observation required for infants in different risk categories.

A method is described for growth of a Lactobacillus plantarum starter culture in jars of commercially available pasteurized fresh-pack kosher dill cucumbers so that jars can be used to inoculate commercial scale cucumber fermentation tanks. A procedure is also described to transfer lactic acid bacteria from frozen storage in MRS broth into cucumber juice and commercial jars of kosher dill cucumbers so that a selected strain of lactic acid bacteria can be kosher certified for commercial fermentations in processing plants that operate under kosher certification. The strain of L. plantarum used in these experiments grew to maximum cell numbers in 4 d at 20 to 25 °C and then maintained viable cell numbers for 2 wk at >10(8) CFU/mL so the culture was suitable for inoculation of fermentation tanks. Refrigeration of jars of culture after they grow to maximum numbers minimizes die-off of cells sufficiently so that a pure culture can be maintained by aseptically transferring brine containing viable bacteria to a new pH-adjusted jar only once every 4 mo.
CONCLUSIONS: This report describes a method to prepare a lactic acid bacteria starter culture suitable for kosher vegetable fermentations.