Multicenter survey of the changing in vitro antimicrobial susceptibilities of clinical isolates of Bacteroides fragilis group, Prevotella, Fusobacterium, Porphyromonas, and Peptostreptococcus species

In vitro surveys of antimicrobial resistance among clinically important anaerobes are an important source of information that can be used for clinical decisions in the choice of empiric antimicrobial therapy. This study surveyed the susceptibilities of 556 clinical anaerobic isolates from four large medical centers using a broth microdilution method. Piperacillin-tazobactam was the only antimicrobial agent to which all the isolates were susceptible. Similarly, imipenem, meropenem, and metronidazole were highly active (resistance, <0.5%), whereas the lowest susceptibility rates were noted for penicillin G, ciprofloxacin, and clindamycin. For most antibiotics, blood isolates were less susceptible than isolates from intra-abdominal, obstetric-gynecologic, and other sources. All isolates of the Bacteroides fragilis group were susceptible to piperacillin-tazobactam and metronidazole, while resistance to imipenem and meropenem was low (<2%). For these same isolates, resistance rates (intermediate and resistant MICs) to ampicillin-sulbactam, cefoxitin, trovafloxacin, and clindamycin were 11, 8, 7, and 29%, respectively. Among the individual species of the B. fragilis group, the highest resistance rates were noted among the following organism-drug combinations: for clindamycin, Bacteroides distasonis and Bacteroides ovatus; for cefoxitin, Bacteroides thetaiotaomicron, B. distasonis, and Bacteroides uniformis; for ampicillin-sulbactam, B. distasonis, B. ovatus, and B. uniformis; and for trovafloxacin, Bacteroides vulgatus. For the carbapenens, imipenem resistance was noted among B. fragilis and meropenem resistance was seen among B. fragilis, B. vulgatus, and B. uniformis. With few exceptions all antimicrobial agents were highly active against isolates of Prevotella, Fusobacterium, Porphyromonas, and Peptostreptococcus. These data further establish and confirm that clinically important anaerobes can vary widely in their antimicrobial susceptibilities. Fortunately most antimicrobial agents were active against the test isolates. However, concern is warranted for what appears to be a significant increases in resistance to ampicillin-sulbactam and clindamycin.

Does the admissions committee select medical students in its own image?

A previous issue of the Journal referred to a national study of the Myers-Briggs Type Indicator (MBTI) in which 12 schools participated. A comparison of our students' type preference with that of their peers at the 11 other schools revealed that only two of the 11 schools demonstrated our strong preference for the combination of sensing, thinking, and judging. We wondered if our Admissions Committee members, too, would demonstrate a preference for the same combination of Myers-Briggs dimensions. In fact, students' trait preferences matched those of Admissions Committee members on all MBTI dichotomies, suggesting that the Committee's own image may have influenced the selection of medical students. A Committee member's awareness and appreciation of his own personality characteristics may be extremely helpful in the admissions process.

Comparison of the scope of allopathic and osteopathic medical school health promotion programs for students

PURPOSE

To compare the number and scope of health promotion programs for students in allopathic and osteopathic medical schools in the U.S. and Canada.

DESIGN

A one-time cross-sectional survey design was applied in this study.

SETTING

This study was conducted in 141 accredited allopathic and 17 accredited osteopathic medical schools.

SUBJECTS

A total of 158 representatives from the allopathic and osteopathic medical schools participated in this study. The response rate for the survey was 100%.

MEASURES

A structured telephone interview was conducted to survey representatives from the medical schools. The survey contained 85 multiple-choice questions organized into four sections: administrative characteristics, types of institutional and health promotion program policies, participation incentives and facilities, and type/scope of health promotion program activities. Chi-square analysis was used to analyze survey variables by type of medical education and level of intervention.

RESULTS

Of the 158 medical schools, only 20% (n = 32) provided a health promotion program for students. Although osteopathic institutions (29.4%) had a greater percentage of programs than allopathic schools (19.2%), there was no significant difference in scope of program offerings by type of medical education. Allopathic programs offered exercise and nutrition/weight management significantly more often and at a higher level of intervention. Lastly, allopathic programs had significantly more monetary resources available for programming. Following prudent research protocol, investigators should be mindful of the limitations of this study. In this study, some school representatives chose not to answer personnel- and finance-related questions. Additionally, because of the self-report nature of the survey, the responses given to the questions may not have been accurate.

CONCLUSION

Allopathic and osteopathic medical school health promotion programs for students were very similar in scope.

Allergic rhinoconjunctivitis and contact lens intolerance

To investigate whether underlying rhinoconjunctivitis contributes to contact lens intolerance, we surveyed 885 contact lens wearers by questionnaire. Allergic rhinoconjunctivitis was defined as the presence of nasal symptoms and positive skin tests for inhalant allergens (definite allergy group). Subjects with nasal symptoms and positive family history of atopy or seasonality of symptoms were grouped under presumptive allergy. Absolute intolerance (AI) was defined as abandoning lenses and wearing glasses. Partial intolerance (PI) was defined as changing lenses or cleaning solutions to alleviate eye discomfort. Seventy-six percent of those with allergy exhibited AI or PI as compared to 60% of those with no allergy. Furthermore, the frequency of seasonal exacerbation of eye symptoms when using contact lenses was significantly higher in subjects with allergy compared to those without allergy (spring, 49% vs. 19%, P less than .0001; summer, 35% vs. 20%, P less than .001; fall, 27% vs. 12%, P less than .0001). We conclude that underlying allergic rhinoconjunctivitis may contribute to contact lens intolerance.