Polymerase chain reaction identification of coagulase-negative staphylococci and of strain diversity and spread of Staphylococcus epidermidis in a major medical center in Lebanon

A 2-step polymerase chain reaction (PCR) assay and random amplification of polymorphic DNA (RAPD) analysis, respectively, were assessed to identify coagulase-negative staphylococci organisms to the species level and to determine the strain diversity and spread of Staphylococcus epidermidis, the most frequently isolated species, in a medical center in Beirut, Lebanon. Our data indicated that PCR was faster and was more efficient in identifying S. epidermidis isolates than is conventional biochemical testing. RAPD analysis have shown that S. epidermidis strains were scattered across the different clinical services, demonstrating various clusters of infection in the medical center. © 2006 by The Society for Healthcare Epidemiology of America. All rights reserved.ARBEIT RD, 1997, STAPHYLOCOCCI HUMAN, P253; Diekema DJ, 2001, CLIN INFECT DIS S2, V32, P114; Huebner J, 1999, ANNU REV MED, V50, P223; MARTIN MA, 1989, ANN INTERN MED, V110, P9; Martineau F, 2001, J CLIN MICROBIOL, V39, P2541, DOI 10.1128-JCM.39.7.2541-2547.2001; MATAR GM, 1995, LEB SCI B, V8, P63; Matar GM, 2005, BMC MICROBIOL, V5, DOI 10.1186-1471-2180-5-29; Mendoza M, 1998, INT J SYST BACTERIOL, V48, P1049; NCCLS (National Committee for Clinical Laboratory Standards), 2002, PERF STAND ANT SUSC; PATRICK CC, 1990, J PEDIATR-US, V116, P497, DOI 10.1016-S0022-3476(05)81593-8; PETERS G, 1995, CURR OPIN INFECT DIS, V8, pS12, DOI 10.1097-00001432-199503001-00004; PFALLER M A, 1988, Clinical Microbiology Reviews, V1, P281; Ronald A, 2002, AM J MED, V113, p14S52

A systematic review of outcome following synchronous carotid endarterectomy and coronary artery bypass: Influence of surgical and patient variables

AbstractObjectives: outcomes after synchronous carotid endarterectomy (CEA) plus coronary artery bypass (CABG) relative to surgical and patient based variables. Design: systematic review of 94 published series (7863 synchronous procedures). Results: 11.5% of patients died or suffered a stroke/myocardial infarction in the peri-operative period (95% CI 10.1-12.9). The risk of death/stroke appeared to significantly diminish in studies published between 1993-2002, compared with 1972-1992 (7.2% (95% CI 6.5-9.1) versus 10.7% (95% CI 8.9-12.5), p = 0.03). However, increasing operative experience was not associated with significantly lower risks of death/stroke; (1-49 cases (9.6% (95% CI 7.5-11.8); 50-99 cases (9.1% (95% CI 6.4-11.8); 100+ cases (8.4% (95% CI 6.9-10.1) (p = 0.64)). Patients with severe bilateral carotid disease were significantly more likely to suffer death and/or stroke compared to patients with unilateral disease (odds ratio 2.5, 95% CI 1.4-5.0, p = 0.001). Similarly, patients with a prior history of stroke/transient ischaemic attack (TIA) were significantly more likely to suffer a further stroke than asymptomatic patients (odds ratio 1.8, 95% CI 1.1-2.8, p = 0.008). There was no difference in the risk of death/stroke relative to the timing of CEA (pre- versus on-cardiopulmonary bypass), but recent small studies indicate that improved outcomes might be achieved by performing CABG ‘off-bypass’. Conclusions: synchronous CEA + CABG is associated with a not insignificant cardiovascular risk. No comparable information is available for similar patients undergoing CABG without prophylactic CEA.Eur J Vasc Endovasc Surg 26, 230-241 (2003