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`
`JOURNAL OF CLINICAL MICROBIOLOGY
`VOLUME 32 0 SEPTEMBER 1994 0 NUMBER 9
`
`Richard C. Tilton, Editor in Cliief (1994)
`North /lmerican Laboratory Group, Ltd.
`New Britnirt, Conn.
`
`Richard F. D’Amato, Editor (1997)
`The Catholic illedical Center of
`Brooklyn and Queens, Inc.
`Jamaica,
`l\l.Y.
`
`Patrick R. Murray, Editor (1999)
`Wusliingtort Ut'ziversit_y School ofil/[edicinc
`St. Louis, Mo.
`
`Andrew B. Ontlerdonk, Editor (1998)
`Chtinning Laboratory
`Boston,
`ll/lass.
`
`Frank G. Rodgers, Editor (1996)
`University of New Hampshire
`Durham, NH.
`
`Ira F. Salkin, Editor (1995)
`NY. State Department of Health
`Albany, N. Y.
`
`Joseph L. Staneck, Editor (1999)
`University Hospital
`Ciricimiati, Ohio
`
`Stephen A. Spector, Editor (1997)
`University of California, San Diego
`La Jolla, Calif
`
`Soman N. Abraham (1996)
`Daniel Amsterdam (1994)
`Peter Appelbaum (1994)
`Michael Ascher (1995)
`Ellen Jo Baron (1994)
`Vickie S. Baselski (1994)
`Barbara A. Body (1995)
`Victor D. Bokkenhauser (1994)
`Carol A. Bolin (1996)
`William Bonnez (1994)
`Patrick J. Brennan (1996)
`Don J. Brenner (1995)
`Kenneth Bromberg (1994)
`B. Kay Buchanan (1996)
`Steven M. Callistcr (1996)
`Joseph M. Campus (1995)
`Roberta B. Carey (1994)
`Stephen J. Cavalieri (1995)
`H. Fred Clark (1994)
`Richard B. Clark (1995)
`Richard W. Cone (1995)
`Chester R. Cooper (1994)
`Alan L. Coykendall (1995)
`Wayne Dankner (1996)
`Paola DeGirolami (1995)
`Dennis Dixon (1994)
`Sam T. Donta (1995)
`David W. Dorward (1996)
`Edward J. Dubovi (1994)
`Stephen C. Edberg (1995)
`Paul H. Edelstein (1994)
`John A. Elliott (1994)
`J. J. Farmer III (1995)
`Daniel P. Fedorko (1995)
`Paul M. Feurino (1996)
`Patricia Ferrieri (1995)
`Rita M. Gander (1995)
`Lynn S. Garcia (1995)
`Patricia Garrett (1996)
`Claude F. Garon (1995)
`Michael A. Gerber (1996)
`Mary J. Gilchrist (1996)
`Aaron Glatt (1996)
`
`EDITORIAL BOARD
`Aaron B. Margolin (1996)
`Joanna B. Goldberg (1996)
`W. J. Martin (1995)
`Paul A. Granato (1996)
`Octavio V. Martinez (1995)
`Larry D. Gray (1996)
`Kenneth H. Mayer (1994)
`Harry Greenberg (1996)
`Leonard VV. Mayer (1996)
`Peter A. Gross (1995)
`William G. Merz (1996)
`Wendy M. Gross (1995)
`Dennis J. McCance (1994)
`Ian D. Gust (1994)
`Margaret R. Hammerschlag (1996)
`.loseph E. McDade (1994)
`Patrick L. McDonough (1996)
`Maurice W. Harmon (1994)
`Geolfrey A. McKinley (1994)
`William J. Hausler (1995)
`John C. McKitrick (1996)
`George R. Healy (1995)
`James C. McLaughlin (1996)
`Klaus Hedman (1995)
`Patricia Mickelsen (1995)
`Nancy K. Henry (1994)
`John E. Hcrrman (1995)
`J. l\'Iichael Miller (1995)
`Roger H. Miller (1994)
`Kenneth L. Herrmann (1994)
`Lillian V. H. Moore (1994)
`Dwight C. Hirsh (1995)
`Stephen A. Morse (1995)
`Rick Hodinka (1995)
`Brian R. Murphy (1994)
`Barry Holmes (1994)
`Irving Naehamkin (1994)
`Russell C. Johnson (1994)
`Cynthia Needham (1996)
`Wendy M. Johnson ( 1994)
`Marguerite A. Neill (1996)
`James H. Jorgensen (1994)
`David E. Normansell (1994)
`Daniel L. Kacian (1995)
`Paul A. Offit (1995)
`Naynesh Kamani (1996)
`Orjan Olsvik (1995)
`Raymond L. Kaplan ( 1996)
`Joseph V. Osterman (1994)
`Mohamed A. Karmali (1996)
`Timothy L. Overman (1994)
`Neil E. Kay (1994)
`Andrew Paehner (1996)
`Mark G. Keen (1995)
`Charlotte D. Parker (1995)
`George E. Kenny (1994)
`A. William Pasculle (1995)
`Pamela C. Kibsey (1994)
`David H. Persing (1995)
`Timothy E. Kiehn (1996)
`Edward Pesanti (1994)
`Mt-gens Kilian (1994)
`Sandra L. Klespies (1996)
`Ellena M. Peterson (1995)
`Stephen R. Pettcway, Jr. (1996)
`Wesley E. Kloos (1994)
`Marie T. Pezzlo (1995)
`Peter J. Krausc ( 1996)
`Michael A. Pfaller (1996)
`Barry N. Krieswirth (1996)
`M. John Pickett (1994)
`Alan Landay (1994)
`David II. Pincus (1995)
`Brent A. Lasker (1995)
`Leon N. D. Potgieter (1994)
`Rance B. LcFebvre (1995)
`Martin A. Preston (1996)
`Paul F. Lehmann (1995)
`Lucille E. Rasmussen (1994)
`Phyllis A. Leist (1996)
`Kurt D. Reed (1996)
`Walter J. Loesche (1994)
`Russell L. Regnery (1995)
`Louis A. Magnarelli (1995)
`Jack S. Remington (1995)
`James B. Mahony (1994)
`
`Michael Rinaldi (1994)
`W. Gerard Robey (1994)
`Barbara Robinson-Dunn (1995)
`David M. Rollins (1996)
`Richard 1+‘. Ross (1995)
`Steve Rowell ( 1995)
`Lorry G. Rubin (1996)
`Raymond W. Ryan (1994)
`Eugene W. Rypka (1995)
`Daniel F. Sahm (1996)
`Max Salfinger (1996)
`Mark Sawyer (1996)
`Wiley A. Schell (1996)
`Paul C. Schreckenbergcr (1996)
`Ted E. Schutzbank (1996)
`Tom G. Schwan (1994)
`Joseph D. Schwartzman (1994)
`Susan E. Sharp (1995)
`Emmett B. Shotts, Jr. (1995)
`Lynne Sigler (1994)
`Paul E. Steele (1994)
`Nancy A. Strockhine (1994)
`Terrence L. Stull (1994)
`Richard Summerbell (1994)
`Phillip Tarr (1994)
`Patricia E. Taylor (1994)
`Fred C. Tenover (1996)
`Kenneth W. Theil (1994)
`Richard B. Thomson (1996)
`Grace M. Thorne (1994)
`Lauri D. Thrupp (1995)
`Thomas J. Tinghitella (1994)
`Alexander Von Graevenitz (1995)
`Thomas J. Walsh (1994)
`Joseph L. Waner (1995)
`Lawrence G. Wayne (1995)
`Melvin P. Weinstein (1995)
`Robert W. Wilmott (1994)
`Kwei-Hay D. Wong (1995)
`G. N. Woode ( 1994)
`Stephen A. Young (1996)
`Charles H. Zierdt (1994)
`Steven Zuekerman ( 1994)
`
`Barbara H. lglewski, Chairman, Publications Board
`Kathleen M. Whalen, Production Editor
`
`Linda M. Illig, Director, Journals
`Beverley J. Bennett, Assistant Production Editor
`
`The Journal of(.'lim'crzl .11/lit,-roliiology, a publication of the American Society for Microbiology (ASM), 1325 Massachusetts Ave., N.W., Washington, DC 20005-4171, is
`devoted to the dissemination of new knowledge concerning the applied microbiological aspects of human and animal infections and infestations, particularly regarding
`their etiologic agents, diagnosis. and epidemiology. Papers dealing with antibiotics and antimicrobial agents and chemotherapy, with fundamental aspects of infection
`and immunity. and with food or dairy microbiology fall within the scope of other AS M publications. Instructions to authors are published in the January issue each year;
`rcprints are available from the editors and the Journals l)ivision. The Journal is published monthly, one volume per year. The nonmember print subscription prices are
`$264 (US) (Canadians add 7% GST) and $310 (other countries) per year: single copies are $43 (Canadians add 7% GST). The member print subscription prices are
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`of submitted manuscripts, proofs, and general editorial matters should he directed to the Journals Department, American Society for Microbiology. 1325 Massachusetts
`Ave., N.W., Washington, DC 20005-4171. Phone: (202) 737-3600.
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`POSTMASTER: Send address changes to Journal of Clinirtil Microl>ir)l0ggJ, ASM, 1325 Massachusetts Ave., NW., Washington, DC 20005-4171.
`Made in the United States of America. Printed on acid-lrcc paper.
`ISSN 0095-1137
`Copyright © 1994, American Society for Microbiology. All Rights Reserved.
`The code at the top of the first page of an article in this journal indicates the copyright owner‘s consent that copies of the article may he made for personal use or for
`personal use of specific clicnts. This consent is given on the condition, however, that the copier pay the stated per-copy fee through the Copyright Clearance Center,
`Inc., 222 Rosewood Drive, Danvcrs, MA 01923, for copying beyond that permitted by Sections 107 and 108 of the U.S. Copyright Law. This consent does not extend
`to other kinds of copying, such as copying for general distribution. for advertising or promotional purposes, for creating new collective works, or for resale.
`
`CODEN: JCMIDW
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`

`
`JOURNAL OF CLINICAL MICROBIOLOGY
`
`September 1994
`
`BACTERIOLOGY
`
`Demonstration of Circulating Group B Streptococcal
`Iximune Complexes in Neonates with Meningitis
`
`(‘linical Comparison of Isolator and Thiol Broth with ESP
`Aerobic and Anaerobic Bottles for Recovery of Pathogens
`from Blood
`
`Evaluation of RapiDEC Staph for Identification of
`.L : phylococcus aureus, Staphylococcus epidermidis, and
`Staphylococcus saprophyticus
`
`Application of Typing by Pulsed-Field Gel Electrophoresis to
`the Study of Clostridium dtfiicile in a Neonatal Intensive
`Care Unit
`
`Spread and Maintenance of a Dominant
`Llethicillin-Resistant Staphylococcus aureus (MRSA) Clone
`during an Outbreak of MRSA Disease in a Spanish Hospital
`Controlled Evaluation of 5 versus 10 Milliliters of Blood
`F ‘ultured in Aerobic BacT/Alert Blood Culture Bottles
`
`Concordance of Endotoxemia with Gram-Negative
`Pacteremia in Patients with Gram-Negative Sepsis: a
`Meta-Analysis
`
`:7-enital Flora in Pregnancy and Its Association with
`Intrauterine Growth Retardation
`
`“apid Detection of Vancomycin-Resistant Enterococci
`
`Characterization of Strains of Neisseria meningitidis
`Recovered from Complement-Suflicient and
`Complement-Deficient Patients in the Western Cape
`Province, South Africa
`
`ulomparison of Sensititre Broth Microdilution and Agar
`Dilution Susceptibility Testing Techniques for Meropenem
`30 Determine Accuracy, Reproducibility, and Predictive
`Values
`
`Evaluation of Two BBL Crystal Systems for Identification
`wf Some Clinically Important Gram-Negative Bacteria
`
`Comparison of PCR with Culture for Detection of
`dreaplasma urealyticum in Clinical Samples from Patients
`with Urogential Infections
`
`Comparison of Three Commercial MIC Systems, E test,
`.~“astidious Antimicrobial Susceptibility Panel, and FOX
`Fastidious Panel, for Confirmation of Penicillin and
`Jephalosporin Resistance in Streptococcus pneumoniae
`
`‘losocomial Infection by Staphylococcus haemolyticus and
`Typing Methods for Epidemiological Study
`
`Jesus G. Vallejo, Carol J. Baker,
`and Morven S. Edwards
`
`J. A. Kellogg, D. A. Bankcrt, J. P.
`Manzella, K. S. Parsey, S. L.
`Scott, and S. H. Cavanaugh
`
`William M. Janda, Kathy Ristow,
`and Denise Novak
`
`Haru Kato, Naoki Kato, Kunitorno
`Watanabc, Kazuc Ueno, Hiroshi
`Ushijima, Shintaro Hashira, and
`Toshiaki Abe
`
`M. Angeles Dominguez, Herminia
`de Lencastre, Josefina Linares,
`and Alexander Tomasz
`Melvin P. Weinstein, Stanley
`Mirrett, Michael L. Wilson, Larry
`G. Reimer, and L. Barth Reller
`
`2041-2045
`
`2050-2055
`
`2056-2059
`
`2067-2070
`
`2081-2087
`
`2103-2106
`
`James C. Hurley
`
`2120-2127
`
`Marc Germain, Marijane A.
`Krohn, Sharon L. Hillier, and
`David A. Eschenbach
`
`Stephen C. Edberg, Catherine J.
`Hardalo, Christine Kontnick, and
`Sheldon Campbell
`
`A. Orren, D. A. Caugant, C. A. P.
`Fijen, J. Dankert, E. J. van
`Schalkwyk, J. T. Poolman, and
`G. J. Coetzcc
`
`Michael J. Dowzicky, Harriette L.
`Nadler, and Waheed Shcikh
`
`B. Holmes, M. Costas, T. Thaker,
`and M. Stevens
`
`Kui Teng, Muyiao Li, Wanfang
`Yu, Houjun Li, Dawei Shen, and
`Dcxiang Liu
`
`Karen K. Krisher and Andrea
`Linscott
`
`J. E. Degcncr, M. E. O. C. Heck,
`W. J. van Leeuwen, C.
`Heemskerk, A. Crielaard,
`P. Joosten, and P. Caesar
`
`2162-2168
`
`2182-2184
`
`2185-2191
`
`2204-2207
`
`2221-2224
`
`2232-2234
`
`2242-2245
`
`2260-2265
`
`Continued on following page
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`
`Continued from preceding page
`
`Opacification of Middlebrook Agar as an Aid in
`Distinguishing Nacardia farcinica within the Nocardia
`asteroides Complex
`
`Case Report and Review of Septicemia Due to Serratia
`ficaria
`
`Confirmation of Human Campylobacter concisus Isolates
`Misidentified as Campylobacter mucosalis and Suggestions
`for Improved Diiferentiation between the Two Species
`Demonstration of Borrelia burgdmferi DNA in Urine
`Samples from Healthy Humans Whose Sera Contain
`B. burgdarferi-Specific Antibodies
`
`Evaluation of E Test as a Rapid Method for Determining
`MICs for Nutritionally Variant Streptococci
`
`Demonstration of Persistence of Salmonella typhimurium in
`an AIDS Patient by Molecular Methods
`
`Hafnia alvei in Stool Specimens from Patients with Diarrhea
`and Healthy Controls
`
`CHLAMYDIOLOGY AND RICKETTSIOLOGY
`
`Western Immunoblot Analysis of Ehrlichia chafi"eensis,
`E. canis, or E. ewingii Infections in Dogs and Humans
`
`A 1-Year Evaluation of Syva MicroTrak Chlamydia Enzyme
`Immunoassay with Selective Confirmation by Direct
`Fluorescent-Antibody Assay in a High-Volume Laboratory
`
`MYCOBACTERIOLOGY AND AEROBIC
`ACTINOMYCETES
`
`Mara Carson and Andrew Hellyar
`
`2270-2271
`
`2285-2288
`
`2305-2306
`
`2312-2314
`
`2318-2320
`
`2327-2330
`
`H. Darbas, H. Jean-Pierre, and
`J. Paillisson
`
`Stephen L. W. On
`
`Helge Karch, Hans-Iko Huppertz,
`Matthias Bohme, Herbert Schmidt,
`Dieter Wiebeeke, and Andreas
`Schwarzkopf
`
`Christopher P. Douglas, Steven
`Siarakas, and Thomas Gottlieb
`
`Alberto E. Fica, Harold W.
`Horowitz, Hermy Lior, and Felipe
`C. Cabello
`
`Jouko Ridcll, Anja Siitonen, Lars
`Paulin, Leena Mattila, Hannu
`Korkeala, and M. John Albert
`
`Yasuko Rikihisa, S. A. Ewing, and
`J. C. Fox
`
`Edward L. Chan, Ken Brandt, and
`Greg B. Horsman
`
`2107-2112
`
`2208-2211
`
`Rendering of Mycobacteria Safe for Molecular Diagnostic
`Studies and Development of a Lysis Method for Strand
`Displacement Amplification and PCR
`
`Rapid Discrimination of Mycobacterium tuberculosis Strains
`by Random Amplified Polymorphic DNA Analysis
`
`Peter Zwadyk, Jr., James A.
`Down, Nancy Myers, and
`Margaret S. Dey
`C. J. Linton, H. Jalal, J. P.
`Leeming, and M. R. Millar
`
`MYCOLOGY
`
`Emergence of Fluconazole-Resistant Strains of Candida
`albicans in Patients with Recurrent Oropharyngeal
`Candidosis and Human Immunodeficiency Virus Infection
`
`Comparison of Broth Macrodilution, Broth Microdilution,
`and E Test Antifungal Susceptibility Tests for Fluconazole
`
`Elimination of False-Positive Serum Reactivity in Latex
`Agglutination Test for Cryptococcal Antigen in Human
`Immunodeficiency Virus-Infected Population
`Strain Relatedness of Candida albicans Strains Isolated from
`Children with Leukemia and Their Bedside Parents
`
`High Frequency of Yeast Carriage on Hands of Hospital
`Personnel
`
`M. Ruhnke, A. Eigler,
`I. Tennagen, B. Geilselcr,
`E. Engelmann, and M. Trautmann
`
`David L. Sewell, Michael A.
`Pfaller, and Arthur L. Barry
`
`Susan Whittier, Roy L. Hopfer,
`and Peter Gilligan
`
`Matsuko Doi, Miehio Homma,
`Shin-Ichi Iwaguchi, Keizo Horibe,
`and Kenji Tanaka
`
`Larry J. Strausbaugh, David L.
`Sewell, Thomas T. Ward, Michael
`A. Pfaller, Teri Heitzman, and Rita
`Tjoelker
`
`2140-2146
`
`2169-2174
`
`2092-2098
`
`2099-2102
`
`2158-2161
`
`2253-2259
`
`2299-2300
`
`Continued on following page
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`
`Continued _from preceding page
`
`First Report of Involvement of Nodulisporium Species in
`Human Disease
`
`Elfect of Potential Interference Factors on Performance of
`Enzyme Immunoassay and Latex Agglutination Assay for
`Cryptococcal Antigen
`
`Evaluation of New Monoclonal Antibody-Based Latex
`Agglutination Test for Detection of Cryptococcal
`Polysaccharide Antigen in Serum and Cerebrospinal Fluid
`
`Gary M. Cox, Wiley A. Schell,
`Richard L. Scher, and John R.
`Perfect
`
`Howard D. Engler and Yvonne R.
`Shea
`
`Deanna L. Kiska, Deborah R.
`Orkiszewski, Donna Howell, and
`Peter H. Gilligan
`
`PARASITOLOGY
`
`Diagnosis of Cutaneous Leishmaniasis and Species
`Discrimination of Parasites by PCR and Hybridization
`
`Usefulness of PCR for Detection of Pneumocystis carinii
`DNA
`
`VIROLOGY
`
`Evaluation of Two Commercial Human T-Cell
`Lymphotropic Virus Western Blot (Immunoblot) Kits with
`Problem Specimens
`
`Transient Antibody Responses to Hepatitis E Virus
`Detected by Western Immunoblot Using Open Reading
`Frame 2 and 3 and Glutathione S-Transferase Fusion
`Proteins
`
`Analysis of Sera Indeterminate by Ortho-HCV RIBA-2 by
`Using Three Confirmatory Assays for Anti-Hepatitis C Virus
`Antibody
`
`Reverse Transcription-PCR Detection of LaCrosse Virus in
`Mosquitoes and Comparison with Enzyme Immunoassay
`and Virus Isolation
`
`Comparison of Methods for Detection of Hepatitis B Virus
`DNA
`
`Comparison of Four Enzyme Immunoassays for Detection of
`Immunoglobulin M Antibodies against Rubella Virus
`
`Quantification of Human Immunodeficiency Virus Type
`1-Infected Mononuclear Cells in Peripheral Blood of
`Seropositive Subjects by Newly Developed Flow Cytometry
`Analysis of the Product of an In Situ PCR Assay
`
`Immunoalfinity Purification of Baculovirus-Expressed
`Rubella Virus E1 for Diagnostic Purposes
`
`Stabilities of Quantitative Plasma Culture for Human
`Immunodeficiency Virus, RNA, and p24 Antigen from
`Samples Collected in VACUTAINER CPT and Standard
`VACUTAINER Tubes
`
`Noris Rodriguez, Bernardo
`Guzman, A. Rodas, Howard
`Takiff, Barry R. Bloom, and
`Jacinto Convit
`
`P. Roux, I. Lavrard, J. L. Poirot,
`C. Chouaid, M. Denis, J. L.
`Olivier, M. Nigou, and M. Miltgen
`
`Dana Gallo, Janice L. Diggs, and
`Carl V. Hanson
`
`Fan Li, Hui Zhuang, Sotirios
`Kolivas, Stephen A. Locarnini,
`and David A. Anderson
`
`E. Dussaix, N. Charnaux,
`P. Laurent-Puig, S. Chopincau,
`Y. Laurian, and C. Buffet
`
`Leonard P. Wasieloski, Jr.,
`Alfredo Rayms-Kcllcr, Laura A.
`Curtis, Carol D. Blair, and Barry
`J . Beaty
`
`H. L. Zaaijer, F. ter Borg, H. T.
`M. Cuypcrs, M. C. A. H. Hermus,
`and P. N. Lelie
`
`Lukas Matter, Meri
`Gorgievski-Hrisoho, and Daniel
`Germann
`
`Maria C. Re, Giuliano Furlini,
`Davide Gibellini, Monica Vignoli,
`Eric Ramazzotti, Simona Lolli,
`Sergio Ranieri, and Michele La
`Placa
`
`Christer Lindqvist, Michel
`Schmidt, Johanna _Heinola, Risto
`Jaatinen, Monica Osterblad, Airno
`Salmi, Sirkka Keranen, Karl
`Akerman, and Christian
`Oker-Blom
`
`Larry Mole, Dan Margolis,
`Richard Carroll, John Todd, and
`Mark Holodniy
`
`2301-2304
`
`2307-2308
`
`2309-2311
`
`2246-2252
`
`2324-2326
`
`2046-2049
`
`2060-2066
`
`2071-2075
`
`2076-2080
`
`2088-2091
`
`2134-2139
`
`2152-2157
`
`2192-2196
`
`2212-2215
`
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`Continued on following page
`
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`

`
`Yeping Sun, Keerti V. Shah,
`Martin Miiller, Nubia Munoz,
`Xavier F. Bosch, and Raphael P.
`Viscidi
`
`Chau-Ting Yeh, Chia-Min Han,
`Shih-Yen Lo, Jing-Hsiung Ou,
`Kong-Dee Fan, I-Shyan Sheen,
`Chia-Ming Chu, and Yun—Fan Liaw
`
`Mary M. Aspin, Ghislaine M.
`Gallez-Hawkins, Terrence D.
`Giugni, Bernard Tegtmcier, David
`J. Lang, Gerhard M. Schmidt,
`Stephen J. Forman, and John A.
`Zaia
`
`D. Lavanchy, C. Mayerat, B.
`Morel, P. Schneider, C. Zuffercy,
`J.-J. Gonvers, A. Pécoud, and
`P. C. Frei
`
`Chatchawann Apichartpiyakul,
`Charoon Chittivudikarn, Hirofumi
`Miyajima, Morio Homma, and Hak
`Hotta
`
`Antonella Ravaggi, Antonella
`Zonaro, Maria Grazia Marin,
`Massimo Puoti, Alberto Albertini,
`and Elisabetta Cariani
`
`2216-2220
`
`2235-2241
`
`2266-2269
`
`2272-2275
`
`2276-2279
`
`2280-2284
`
`Brenda G. Brumback and C. Diane
`Wade
`
`2289-2290
`
`Anthony J. Japour, Susan A.
`Fiscus, Jean-Marie Arduino,
`Douglas L. Mayers, Patricia S.
`Reichelderfer, and Daniel R.
`Kuritzkes
`
`D. D. Erdman, E. L. Durigon, and
`B. P. Holloway
`
`Paul J . Masendycz, Leanne E.
`Unicomb, Carl D. Kirkwood, and
`Ruth F. Bishop
`
`Adriana Kajon and Goran Wadell
`
`2291-2294
`
`2295-2298
`
`2315-2317
`
`2321-2323
`
`2331-2334
`
`2128-2133
`
`2147-2151
`
`2175-2181
`
`Continued from preceding page
`
`Comparison of Peptide Enzyme-Linked Immunosorbent
`Assay and Radioimmunoprecipitation Assay with In
`Vitro-Translated Proteins for Detection of Serum Antibodies
`to Human Papillomavirus Type 16 E6 and E7 Proteins
`
`Early Detection of Anti-HCc Antibody in Acute Hepatitis C
`Virus (HCV) by Western Blot (Immunoblot) Using a
`Recombinant HCV Core Protein Fragment
`
`Comparison of Plasma PCR and Bronchoalveolar Lavage
`Fluid Culture for Detection of Cytomegalovirus Infection in
`Adult Bone Marrow Transplant Recipients
`
`Evaluation of Third-Generation Assays for Detection of
`Anti-Hepatitis C Virus (HCV) Antibodies and Comparison
`with Presence of HCV RNA in Blood Donors Reactive to
`c100-3 Antigen
`
`Analysis of Hepatitis C Virus Isolates among Healthy Blood
`Donors and Drug Addicts in Chiang Mai, Thailand
`
`Distribution of Viral Genotypes in Italy Determined by
`Hepatitis C Virus Typing by DNA Immunoassay
`
`Simultaneous Culture for Adenovirus, Cytomegalovirus, and
`Herpes Simplex Virus in Same Shell Vial by Using
`Three-Color Fluorescence
`
`Standardized Microtiter Assay for Determination of
`Syncytium-Inducing Phenotypes of Clinical Human
`Immunodeficiency Virus Type 1 Isolates
`
`Detection of Human Parvovirus B19 DNA PCR Products by
`RNA Probe Hybridization Enzyme Immunoassay
`Rotavirus Serotypes Causing Severe Acute Diarrhea in
`Young Children in Six Australian Cities, 1989 to 1992
`
`Genome Analysis of South American Adenovirus Strains of
`Serotype 7 Collected over a 7-Year Period
`
`Quantitative Colorimetric Microneutralization Assay for
`Characterization of Adenoviruses
`
`Leta K. Crawford-Miksza and
`David P. Schnurr
`
`CLINICAL VETERINARY MICROBIOLOGY
`
`Differentiation of Salmonella Serovar Infantis Isolates from
`Human and Animal Sources by Fingerprinting IS200 and
`16S rm Loci
`
`Detection of Ehrlichia risticii from Feces of Infected Horses
`by Immunomagnetic Separation and PCR
`
`A Simple, Specific, and Highly Sensitive Blocking
`Enzyme-Linked Immunosorbent Assay for Detection of
`Antibodies to Bovine Herpesvirus 1
`
`Sinikka Pelkonen, Eeva-Liisa
`Romppanen, Anja Siitonen, and
`Jukka Pelkonen
`
`Biswajit Biswas, Ramesh
`Vemulapalli, and Sukanta K. Dutta
`
`J. A. Kramps, J. Magdalena, J.
`Quak, K. Weerdmeester, M. J.
`Kaashoek, M. A. Maris-Veldhuis,
`F. A. M. Rijsewijk, G. Kcil, and
`J. T. van Oirschot
`
`Continued on following page
`
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`
`Continued from preceding page
`
`Detection of Porcine Reproductive and Respiratory
`Syndrome Virus and Elficient Dilferentiation between
`Canadian and European Strains by Reverse Transcription
`and PCR Amplification
`
`Helmi Mardassi, Louise Wilson,
`Samir Mounir, and Serge Dea
`
`Development of Nested PCR Assays for Detection of Bovine
`Respiratory Syncytial Virus in Clinical Samples
`
`s. Vilcek, M. Elvander, A.
`Ballagi-Pordany, and S. Belak
`
`2197-2203
`
`2225-223 1
`
`2113-2119
`
`EPIDEMIOLOGY
`
`Eflicacy of Microbial Identification System for Epidemiologic
`Typing of Coagulase-Negative Staphylococci
`
`LETTERS TO THE EDITOR
`
`Tox-A Test for Clostridium difiicile
`
`Additional Data on Clinical Isolates of Campylobacter
`mucosalis
`
`Pitfalls in Immunoblot Detection of Aspergillus Antigens
`Associated with Invasive Infection
`
`Utility of Quantitative Enzyme Immunoassay Reactivity for
`Predicting Human Immunodeficiency Virus Seropositivity in
`Low- and High-Prevalence Populations
`
`E Test as Susceptibility Test for Evaluation of Neisseria
`meningitidis Isolates
`
`ERRA TA
`
`Evaluation of Specificity of Indirect Enzyme-Linked
`Immunosorbent Assay for Diagnosis of Human Q Fever
`
`Comparison of Four Immunoserologic Assays for Detection
`of Antibodies to Borrelia burgdotferi in Patients with
`Culture-Positive Erythema Migrans
`
`David Birnbaum, Loreen
`Herwaldt, Donald B. Low,
`Michael Noble, Michael Pfaller,
`Robert Sherertz, and Anthony W.
`Chow
`
`Tracy D. Wilkins and David M.
`Lyerly
`A. J. Lastovica, Elza Le Roux,
`Rob Warren, and Horst Klump
`
`Luc M. Wijnands, Frans M. van
`Leusden, Rob J. T. Puyk, Marcel
`P. M. Hofstee, and H. W.
`Boudewijn Engel
`Frank J. Michalski
`
`Emilio Pérez-Trallero, Nieves
`Gomez, and José Maria
`Garcia-Arenzana
`
`2341—2342
`
`Iyorlumun J . Uhaa, Daniel B.
`Fishbein, James G. Olson,
`Cornelia C. Rives, David M.
`Waag, and Jim C. Williams
`Paul D. Mitchell, Kurt D. Reed,
`Teresa L. Aspeslet, Mary F.
`Vandermause, and John W. Melski
`
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`

`
`This material may be protected by Copyright law (Title 17 U.S. Code)
`
`JOURNAL OF CLINICAL MICROBIOLOGY, Sept. 1994, p. 2299-2300
`00951137/94/$04.00+0
`Copyright © 1994, American Society for Microbiology
`
`
`
`Vol. 32, No. 9
`
`High Frequency of Yeast Carriage on Hands
`of Hospital Personnel
`
`LARRY J. STRAUSBAUGlI,l’2* DAVID L. SEWELL,3’4 THOMAS T. WARD,” MICHAEL A. PF/\LLER,47"
`TERI HEITZMAN,5 r—L\'D RITA TJOELKER5
`
`Infectious Disease Section, Medical Service,‘ Laboratory Service,3 and Nursing SerVice,5 Veterans Affairs Medical
`Center, and Division of Infectious Diseases, Department of Meclicine} and Department of Palliologyf‘
`Sclzool ofMedicine, Oregon Health Sciences University, Portland, Oregon
`
`Received 8 April 1994/Returned for modification 10 May 1994/Accepted 14 June 1994
`
`The hands of 36 nurses and 21 nonnursing hospital employees were tested by culture with a modification of
`the broth wash technique. Seventy-five percent of the nurses and 81% of the nonnurses were found to harbor
`yeasts on their hands; 58% of nurses and 38% of nonnurses were carrying Candida spp.
`
`During an investigation of funguria in our nursing home care
`unit (NHCU), 75% of 28 nurses were found to harbor yeasts
`on their hands (9). Since previous studies, which were summa-
`rized by Odds (7), reported rates of yeast carriage on hands
`and fingers of patients and healthy subjects ranging from 0 to
`17%, we were quite surprised. Accordingly, we designed the
`present study to examine the frequency of yeast carriage on the
`hands of nurses working in three separate hospital units and to
`compare the frequency of yeast carriage in the nurses with that
`in nonnursing personnel working in nonclinical areas of our
`medical center.
`
`Of the 36 nurses who participated in this study, 12 worked in
`the NHCU, 12 worked in either the medical or surgical
`intensive care unit, and 12 worked in the outpatient clinics. Of
`the 21 nonnursing personnel who also participated, 7 each
`were from our personnel, supply, and fiscal departments. A
`short questionnaire regarding hand washing practices was
`administered to all participants. Without any preparation of
`the hands, cultures were obtained by using the standard broth
`bag technique (5, 6). Both hands of all participants were placed
`in 20 ml of brain heart infusion broth contained in a plastic
`bag. Broth specimens were then transferred to sterile plastic
`cups. When the specimens arrived in the laboratory, gentami—
`ci11 and vancomycin were added to yield a final concentration
`of 50 pig/ml. The cups were incubated for 6 days at 30°C, and
`0.1—ml aliquots were subcultured to Bromcresol Green and
`Inhibitory Mold agar plates (PML Microbiologicals, Tualatin,
`Oreg.) on days 1 and 6. Control cultures of medium—containing
`bags (no handwashing and no antibiotics) were performed
`simultaneously. No yeasts were recovered from the control
`cultures.
`
`Yeasts recovered were identified with MicroScan Rapid
`Yeast Identification panels (Baxter Healthcare Corporation,
`West Sacremento, Calif.) (4). The Rapid Yeast Identification
`panels, containing 96 microdilution wells with 27 dehydrated
`substrates, were inoculated with a yeast suspension calibrated
`against a MicroScan turbidity standard and incubated at 37"C
`for 4 h in the MicroScan Walkaway system. After addition of
`sodium hydroxide or peptidase reagent to appropriate sub-
`strate wells, plates were analyzed for enzyme activity as
`
`* Corresponding author. Mailing address: Medical Service (111F),
`Portland VA Medical Center, PO. Box 1034, Portland, OR 97207.
`Phone: (503) 2208262, ext. 7140. Fax: (503) 273-5348.
`'3‘ Present address: Department of Pathology, University of Iowa
`College of Medicine, Iowa City, IA 52242.
`
`2299
`
`determined by color changes. Test results were digitized and
`compared to a computerized database to generate a list of
`probable species. Identifications were accepted when the per-
`cent probability exceeded 85%.
`Overall, 75% of the nurses were found to harbor yeasts on
`their hands; 58% were intensive care unit nurses, 75% were
`outpatient clinic nurses, and 92% were NHC U nurses (Table
`1). The hand cultures of five (83%) of six male nurses and 22
`(73%) of 30 female nurses were positive for yeasts. Five of the
`nurses Carried two species of yeasts, and 22 carried only one.
`Fifty-eight percent of the nurses had a Candida sp. on their
`hands; 1 1 had Candida parapsilosis, 8 had C. albicans, 2 had C.
`lasitaniae, and 1 had C. guillermondi. Other yeasts recovered
`from nurses included Rlzodotorula sp.
`(from six persons)
`Tomlopsis candida (from one), Sporobolomyces sp. (from one),
`Trichosporon beigelii (from one), and Sacclzaromyces cerevisiae
`(from one).
`Eighty—one percent of the nonnursing participants harbored
`yeasts on their hands: 71% of the participants in the personnel
`department, 71% of those in the fiscal department, and 100%
`of those in the supply department. The hand cultures of five
`(100%) of five male participants and 12 (75%) of 16 female
`participants were positive for yeasts. Two individuals carried
`two yeast species, and 15 carried only one. Thirty-eight percent
`of the nonnursing participants harbored a Candida sp. on their
`hands; six had C. parapsilosis, 3 had C. albicans. Rliodotorula
`sp. was isolated from nine individuals, and an unidentifiable
`yeast was isolated from one. None of the differences between
`nurses and nonnurses were statistically significant, a somewhat
`unexpected finding in light of the ditferences in hand washing
`practices disclosed by the questionnaire.
`Questionnaire results indicated that 92% of the nurses and
`only 28% of the nonnurses had washed their hands one or
`more times at work that day prior to participating in the study.
`Most of the nurses had washed their hands three, four, or more
`times, whereas none of the nonnurses had washed more than
`once or twice. Similarly, 50 and 78% of the nurses but none of
`the nonnurses had worn gloves and had direct patient contact,
`respectively, prior to participating in the study. About half of
`the nurses who had worn gloves had already used more than
`three pairs that day prior to participating in the study. In
`contrast, most of the nonnursing personnel had not worn
`gloves during the preceding week. On the morning of the
`study, hand lotion had been used by 40% of nurses and 43% of
`nonnurses. Lastly, about 20% of nurses, but none of the
`nonnurses, reported l1( ving eczema or other problems with the
`
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`2300
`
`NOTES
`
`J. CLIN. MICROBIOL.
`
`TABLE 1. Hand carriage of yeasts by hospital personnel
`
`Group and
`subgroup (no. of
`persons)
`
`Nurses (36)
`ICU“ (12)
`OPC” (12)
`NHCU (12)
`
`Nonnurses (21)
`Personnel (7)
`Fiscal (7)
`Supply (7)
`" ICU, intensive care unit.
`” OPC. outpatient clinic.
`
`Any .V"3i15t
`
`27 (75)
`7 (58)
`9 (75)
`ll (92)
`
`17 (81)
`5 (71)
`5 (71)
`7 (100)
`
`NO‘ (%) Wlth:
`
`Candida
`7 Sp
`
`21 (58)
`4 (33)
`8 (66)
`9 (75)
`
`8 (38)
`3 (43)
`2 (28)
`3 (43)
`
`skin of their hands. Neither hand washing practice, glove use,
`hand lotion use, nor eczema had any association with yeast
`carriage.
`The results of this study indicate that hospital personnel in a
`variety of clinical and nonclinical settings frequently carry
`pathogenic yeasts on their hands. The discrepancy between our
`results and data previously reported probably reflects method-
`ological differences and not unusual characteristics of our
`study participants. Swab techniques, which were used in the
`four studies summarized by Odds (7), may be insensitive,
`yielding yeasts only when large numbers are present. Other
`investigators using the broth wash technique have reported
`higher yields of yeasts (1, 2, 8). For example, Horn and
`colleagues retrieved yeasts from 27% of nonmedieal subjects,
`from 28% of nurses and physicians working in dermatology,
`and from 54% of nurses and physicians working on an oncol-
`ogy ward (2). Rhodotomla sp. and C. parapsilosis were the
`isolates most frequently recovered. The higher yields in the
`present study probably derived not only from use of the broth
`wash technique but also from addition of antibiotics to the
`broth, the 6-day incubation time, and use of selective media for
`recovery of yeasts. These methodological
`features were
`adopted from the study reported by Isenberg and associates
`(3), which linked an outbreak 01' C. tropicalis wound infections
`following cardiac surgery to a colonized scrub nurse. Trans-
`mission of yeasts by hand carriers has also figured prominently
`
`in two reports of nosocomial C. albicans outbreaks and in our
`own NHCU funguria investigation (1, 8, 9).
`If transient
`carriage of small numbers of yeasts on the hands of health care
`workers can l