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PubMedDate not supplied

[Risk of increase in nosocomial infections incidence in a surgical clinic. A case-control study].

The complex activities of epidemiological surveillance of nosocomial infections (NI) have, among the main objectives, the identification of the causes and the assessment of risk factors. In 2002, the Clinic Hospital of Pneumology Iasi had 220 beds and was divided into the following units: Pneumophtisiology Unit (PPU), Thoracic Surgery Unit (TSU) and Intensive Care Unit (ICU). The global incidence of NI was of 0.85%. The incidence of cases with NI in the TSU and ICU increased to 5.39% in the interval April-June 2002 so that urgent epidemiological measures were applied to limit the phenomenon. After that, a case-control study was proposed in order to identify and assess the risk levels. The retrospective study met the methodological conditions such as case definitions for NI and post-surgical NI, for extrinsic and intrinsic risk factors, the selection of cases according to inclusion and exclusion criteria, the formation of the representative sample. The study included 16 patients with pleural NI and 55 controls with the pleurotomy performed between April-June in the TCU, as a common feature. The factors that increased the probability of a post-surgical NI development were: the external pleural drainage maintained more than 30 days (OR = 185.5; p < 0.0001 for CI = 95%), tuberculosis as the most important associated disease among the patients' pathological history records (OR = 28.0; p < 0.0001; CI = 95%); the antibiotherapy with multiple associations (OR = 3.30; p < 0.04; CI = 95%). The conclusions underlined that the patients suffered from tuberculosis since the very admission, which need pleurotomy have an increased risk to develop a NI. This fact should require an appropriate epidemiological, clinical and microbiological surveillance and the empirical antibiotic strategy or that conducted by the antibiogram results has to be performed adequately, according to the operative recommendations.

Adult↗

PubMed2003

An outbreak of Methicillin-resistant Staphylococcus aureus cutaneous infection in a saturation diving facility.

We present a molecular epidemiological investigation of an outbreak of cutaneous tissue infection, which involved six divers during a 45 day saturation exposure dive. The cutaneous infection manifested as boils, foliculitis and small abscesses involving different body sites, including nose, external ear canal, necks, back, extremities, and buttocks. Staphylococcus aureus was consistently isolated from the skin lesions of affected divers. A study of the antibiogram revealed that all Staphylococcus aureus isolates were uniformly resistant to penicillin, oxacillin and erythromycin, but sensitive to clindamycin, tetracycline, trimethoprim-sulfamethoxazole, rifampin and vancomycin. Molecular typing by pulse field gel electrophoresis (PFGE) demonstrated that all the Methicillin-resistant Staphylococcus aureus (MRSA) isolates had an indistinguishable pulsed field gel electrophoresis pattern. The source of outbreak was identified as a colonized diver (diver D). Personal contact was most likely the mode of transmission among the six divers. Infection with MRSA should be suspected in outbreaks of boils that are not responding to standard antibiotic therapy among healthy divers and their close contacts. To our knowledge, this is the first report of Methicillin-resistant Staphylococcus aureus (MRSA) outbreak in a saturation diving facility.

Adult↗

PubMed1992

Vector potential of hospital houseflies with special reference to Klebsiella species.

The vector potential of houseflies (Musca domestica) for Klebsiella spp. was investigated. Klebsiella spp. (mostly Klebsiella pneumoniae) were isolated from 36.7% of hospital flies and 28.1% of infected wounds of patients. Antibiograms of Klebsiella spp. showed that 82.0% of isolates from hospital flies and 96.3% from infected wounds were resistant to four or more commonly used antimicrobials. In contrast, from the control group, only 8.7% klebsiella isolates showed similar antimicrobial resistance pattern (P less than 0.001). Similar strains of Klebsiella spp. were encountered among patients and hospital houseflies. The results indicate that flies in the hospital environs are potential vectors of hospital resistant strains of Klebsiella spp.

Animals↗

PubMed1992

The epidemiology of ciprofloxacin resistance in coagulase-negative staphylococci in CAPD patients.

Ciprofloxacin was used as empirical therapy for peritonitis in patients receiving continuous ambulatory peritoneal dialysis (CAPD) for 26 months, providing an opportunity to study the epidemiology of ciprofloxacin resistance amongst coagulase-negative staphylococci (CNS). Swabs were collected from the CAPD patients, staff, and clinic environment before, during and after the time this antibiotic was prescribed. Clinical isolates were also studied, and records kept of patient hospital attendance. Ciprofloxacin-resistant staphylococci were typed by antibiogram, biotype, plasmid profile, SDS-PAGE, and immunoblotting. No resistant strains were detected before the use of ciprofloxacin. During its use 30% of patients became skin carriers, and resistant strains caused 8% of peritonitis episodes in 7% of patients (38% of carriers). Resistant strains were isolated from the environment, but never from attending members of staff. A total of 208 resistant isolates with MIC's between 8 and 128 mg/l was collected and identified as Staphylococcus epidermidis or S. haemolyticus. Sixteen strain types were distinguished. There was epidemiological evidence for selection of resistant strains derived from the host commensal flora and also for cross-colonization, and cross-infection. Carriage of resistant strains fell to 15% of patients, 6 months after the use of ciprofloxacin had ceased.

Air Microbiology↗

PubMedDate not supplied

[Enterobacteria isolated from different pathological products and their sensitivity to antibiotics].

The objectives of the study we have enhanced have focused on identifying the etiological implication of the Enterobacteria isolated from different pathological products and determining their sensitivity to the main antibiotics. We observed that from pharyngeal exudate and sputum the Enterobacter spp. strains were isolated the most frequently while from purulent secretion, urine, puncture liquids and blood, E. coli strains were the most frequently implicated. For all the categories etiologically implicated, there were selected strains resistant to one or more of the antibiotics tested, showing once again the importance of antibiogram in the initiation and control of infections disease treatment.

Anti-Bacterial Agents↗

PubMedDate not supplied

[A comparative study of resistance phenotypes in E. coli strains isolated in urine from hospitalized and ambulatory patients].

112 strains of E coli from 620 urocultures of hospitalized and ambulatory patients where isolated between March-June 2002. Our purpose was to make a comparative study of the susceptibility to antibiotics of 31 strains of E coli isolated in hospital (County Clinical Hospital Nr. 1 Timisoara--Urology Clinic and Intensive Care Unit) and 81 strains collected from ambulatory patients. Identification of germs was performed using the automatic API system, and the susceptibility tests were performed using disc-diffusion and the agar dilution test. By analyzing the extended antibiograms we categorized the germs considering their phenotypes of resistance and remarked a high percentage of E coli strains from hospitalized showing multiple resistance to antibiotics.

Adult↗

PubMedDate not supplied

Management of purulent pericarditis.

A 50 year old man was admitted to ICU due to purulent pericarditis, purulent inflammation of the soft tissue of the neck, purulent mediastinitis and pneumonia. Subxyphoid periocardiotomy followed by the insertion of a drain into the pericardial space was performed. Four other drains were also inserted to drain purulent fluid from the neck (two drains) and mediastinum (two drains). During the surgical procedure, 700 ml of purulent pericardial fluid from the pericardial sac and 200 ml of purulent fluid from the mediastinum were drained. Antibiotic therapy was started upon admission to the hospital. Streptococcus species, Acinetobacter baumani and Enterococcus casseliflavus were cultured. Antibiotic therapy was adjusted to the results of the antibiogram. Despite revised antibiotic therapy, daily drainage from the pericardium--during several days after surgery--was around 200 ml. Due to the huge purulent pericardial drainage streptokinase, delivered directly into pericardial space, was given. The clinical effect of intrapericardial streptokinase administration was excellent. After 17 days drainage of purulent pericardial fluid was not observed. No clinical signs and symptoms of constrictive pericarditis developed. Repeated echocardiography examinations showed no signs of constrictive pericarditis and no pericardial fluid. The patient was discharged in good general condition.

Acinetobacter baumannii↗

PubMed2004

Enterococcal infections with special reference to phenotypic characterization & drug resistance.

BACKGROUND & OBJECTIVES: Enterococci, classified as group D streptococci, are the second leading cause of nosocomial infections. The incidence of enterococcal infections and species prevalent in India is not thoroughly investigated. The present study was undertaken to isolate and characterize enterococci from clinical specimens and determine the antimicrobial susceptibility pattern of these isolates. METHODS: Clinical specimens (blood, urine and swabs) were cultured on bile esculin azide agar (BEAA) for isolation of enterococci. The phenotype based scheme included Gram staining of growth on BEAA and subculturing of cocci on sheep blood agar plates for vancomycin disk diffusion and hydrolysis of L-pyrrolidonyl-beta-napthylamide (PYR) testing. The phenotypic method was used to surveillance cultures that yielded growth on BEAA. Enterococcal strains were further identified to the species level by conventional biochemical tests. PYR positive isolates were further characterized into vancomycin resistant enterococci (VRE) and nonVRE depending upon vancomycin inhibition zone size. The isolates were characterized into vanA, vanB and vanC depending upon minimum inhibitory concentration (MIC) values. Conventional method was used to study the antibiogram of isolates. RESULTS: A total of 52 isolates of enterococci (10 Enterococcus faecalis, 42 E. faecium) were isolated from 534 clinical specimens. Of the 52 isolates, 12 isolates were resistant to vancomycin with an MIC > 4 microg/ml but sensitive to teicoplanin (vanB isolates). INTERPRETATION & CONCLUSION: Our study reveals the problem of multiple drug resistant enterococci and emergence of VRE. Better susceptibility tests need to be used to measure the vancomycin resistance accurately.

Drug Resistance, Microbial↗

PubMed1992

[Evaluation of the efficacy of the combination amoxicillin-clavulanic acid-tobramycin for the prevention of infections after surgery for ORL cancers].

The clinic and economic evaluation of a probabilist antibiotherapy Augmentin/Nebcine administered until the wound healing was studied in 60 patients, operated of upper aerodigestives tracts cancer. The antibiotherapy efficiency was estimated at the end of 6 days in terms of clinic and bacteriologic results. In case of therapeutic failure, the treatment was adapted according to antibiogram results. The association Augmentin/Nebcine was effective in 93% of cases. Antibiotherapy was to be modified for five patients (one for allergy and four for bacteriological unsuccessful). The bacteriologic sample shows the predominance of Gram(-) germs. 83% of them were sensitive to one of these antibiotics in vitro. The daily mean cost of antibiotherapy was about FF 71. The overcost, due to antibiotherapy failures, represented only 1% of the whole cost of the 60 treatments. These results justify the use of a large spectrum antibiotherapy reaching Gram(-) germs.

Aged↗

PubMed2004

Research note: Molecular subtyping of Salmonella enterica serovar Tshiongwe recently isolated in Malaysia during 2001-2002.

Pulsed field gel electrophoresis (PFGE) and antimicrobial susceptibility analysis were undertaken on twenty-three strains of Salmonella enterica serovar Tshiongwe, an unusual serovar, which recently emerged in Malaysia. Antimicrobial susceptibility analysis showed that all the strains were sensitive to ampicilin, chloramphenicol, cotrimoxazole, and kanamycin. Twenty (87%) and 8 (3.5%) strains had resistance to tetracycline and streptomycin respectively. PFGE analysis subtyped 23 strains into 10 profiles (Dice coefficient of similarity, F = 0.7-1.0). The predominant profile, X1 was found in both clinical and environmental isolates and was widely distributed in different parts of Malaysia during the study period. In addition, isolates recovered from food, a hand-towel, apron and the surface of a table-top in one particular location had unique, indistinguishable profiles (X4/4a) and identical antibiograms. Similarly, isolates from cooked meat and a chopping board had PFGE profiles similar to some human isolates. These probably indicated cross-contamination and poor hygiene in food practices, hence contributing to Salmonellosis. Factors causing the emergence of this rare Salmonella serovar being responsible for food poisoning episodes during the study period remained unclear. The study reiterated the usefulness and versatility of PFGE in the molecular subtyping of this rare Salmonella serovar in Malaysia.

Anti-Bacterial Agents↗

PubMedDate not supplied

[Fournier's gangrene: case report and review of recent literature].

OBJECTIVE: The authors report their experience in diagnosis and treatment of one case of Fournier's gangrene; recent international literature review. EXPERIMENTAL DESIGN: Complete clinical report. Diagnostic, clinical and prognostic indication, evaluation of effectiveness of surgical treatment (debridement and necrosectomy) and follow-up; comparison between indications and multidisciplinary approach proposed by international literature. SETTING: Operative Unit of General and Thoracic Surgery. University "Paolo Giaccone" of Palermo. INTERVENTION: Repeated surgical treatment previous multimodal approach, according to international guide-lines. RESULTS: Complete recovery with "restitutio ad integrum". No relapse were recorded at follow up. CONCLUSIONS: Fournier's gangrene is an uncommon and aggressive synergistic fasciitis of the perineum and genital organs, which may bring the patient to death; it is a true surgical emergency. The disease can no longer be considered to be idiopathic; in most cases a urologic, colorectal or cutaneous source can be identified. Despite antibiotics and aggressive debridement, the mortality rate remains high, particularly in the elderly, in patients with renal failure, and in patients with extensive disease. The presentation is highly variable, necessitating a high index of suspicion. High risk patients include diabetics, alcoholics and debilitated and immunosuppressed individuals. As the AIDS population increases, the incidence of Fournier's gangrene may increase as well. In questionable cases, imaging modalities should be performed to allow early diagnosis and to reduce misses diagnosis. Broad spectrum antibiotics (while waiting for the results of culture and antibiogram effectuated on tissue specimens obtained during necrosectomy) and aggressive debridement remain the hallmarks of treatment. Hyperbaric oxygen therapy and improved local wound care may decrease the extent of tissue destruction. The surgical operation has to be performed in emergency to avoid a rapid spread of tissue necrosis and a possible development towards septic shock. Reconstructive techniques afford better cosmetic results. With early recognition, prompt treatment, improved wound care and reconstructive efforts, the mortality rates and cosmetic results should continue to improve.

Debridement↗

PubMedDate not supplied

[Molecular identification of mycobacteria and detection of antibiotic resistance].

Mycobacteria are responsible for many human infections, especially species of tuberculosis complex, causative agents of tuberculosis. With nine millions new cases every year, this disease is responsible for more than two millions of deaths. Nontuberculous mycobacteria (e.g. Mycobacterium avium-intracellulare, Mycobacterium kansasii, Mycobacterium xenopi or Mycobacterium ulcerans) can cause infections too, usually in particular clinical settings. Standard diagnosis of mycobacterial infections relies on direct examination and culture. Although culture in liquid media allows the detection of mycobacterial growth at an earlier stage, isolation and phenotypic identification requires several weeks, as does antimicrobial susceptibility testing. Nowadays, molecular tools are available, allowing quicker accurate diagnosis. Detection of Mycobacterium tuberculosis complex by amplification-based tests can be performed directly from clinical samples, although most identifications are successfully after isolation. Several commercial techniques are now available but identification is limited to selected species, at a high cost. Sequencing of genomic targets (such as rrs, rpoB, gyrB, 16S-23S intergenic spacer or hsp65) allows accurate and quick identifications but requires access to a sequencer. Eventually, our better knowledge of the action mechanisms of the different drugs allows genotypic detection of most antibiotic resistances. Indeed, characterization of mutations in specific target genes (such as rpoB, katG, embB, pncA, gyrA or rrl) should be an effective tool for rapid detection of resistance, although this method has only been used so far for rifampin resistance detection. Nevertheless, this approach, limited to reference laboratories, should always be performed in conjunction with antibiogram.

Bacteriological Techniques↗

PubMedDate not supplied

[Bacterial strains isolated in high nosocomial risk departments].

We collected 312 samples from hospitalized patients in two hospitals in Timişoara between September-December 2003. We isolated 83 strains with nosocomial potential. Identification of the germs was performed using the automatic API system, and the susceptibility tests were performed using disc-diffusion and the agar dilution test. By analyzing the extended antibiograms we categorized the germs considering their phenotypes of resistance and we remarked a high percentage of E. coli, Klebsiella pneumoniae pneumoniae and S. aureus with multiple resistance to antibiotics.

Anti-Bacterial Agents↗

PubMed2004

Direct rapid diagnosis of rifampicin-resistant M. tuberculosis infection in clinical samples by line probe assay (INNO LiPA Rif-TB).

M. tuberculosis is one of the leading causes of death worldwide and Multi Drug Resistant Tuberculosis (MDR-TB) is associated with a high case-fatality rate. Rapid identification of resistant strains is crucial to institute prompt appropriate therapy, and prevent the development of further resistance and spreading of MDR strains. The INNO-LiPA Rif. TB is a commercial reverse hybridisation line probe assay designed for rapid detection of rpoB gene mutations in clinical isolates. We applied this test directly to 44 smear-positive and 45 smear-negative clinical specimens collected from patients suspected of active TB. The capability of this technique to correctly identify local MDR-TB strains was tested on 50 MDR strains isolated in Italy. Results of the test were compared to conventional antibiogram performed on isolated strains. The concordance rate of the LiPA test results on clinical specimens with those obtained with "in vitro" sensitivity was 100%. These results show that the LiPA test can be useful in rapid detection and prompt management of tuberculosis when MDR disease is suspected.

Antibiotics, Antitubercular↗

PubMed2004

An outbreak of hospital acquired diarrhea due to Aeromonas sobria.

Six children admitted in a 18 bedded hematology-oncology unit, developed acute diarrhea in a four week period between March and April 2001. Salmonella senftenberg was the additional pathogen in the stool sample of one patient who developed cola colored urine and pneumonia in the course of his illness. All the Aeromonas strains had a similar biotype and antibiogram. The diarrhea subsided spontaneously in two children whilst three responded to antimicrobial therapy. One patient sought discharge and did not return for a follow up. Aeromonas sobria with a similar profile as the isolates from the patients could be isolated from only one of several environmental sites. The outbreak could be contained by appropriate interventional measures.

Aeromonas↗

PubMed2003

[Antibiotic resistance].

INTRODUCTION: After six decades of antibiotic use, the prevalence of antibiotic-resistant bacteria is increasing, and organisms resistant to almost all antibiotics have been identified. ANTIBIOTIC RESISTANCE: It is important to understand why antibiotic resistance develops, in order to design strategies for its prevention. Factors that promote antibiotic resistance in community and hospital settings are: antibiotic selective pressure, prolonged antibiotic treatment, inadequate doses, prior use of a less effective drug of the same antibiotic class, protected sites or foreign bodies, and poor infection control practice. The best available ways to decrease and control antibiotic resistance are: rational use of antibiotics (e.g. appropriate selection of drug, dose, duration of treatment), good infection control procedures (hygienic practice and isolation), as well as local, national and global surveillance networks for monitoring dissemination of antimicrobial resistance and detection of new resistance mechanisms. CONCLUSION: Clinical guidelines, direct education, and regular reports on antibiograms may contribute to more prudent use of antibiotics. Overall, the problem of antibiotic resistance is global. However, measures need to be taken at an individual, institutional, and ultimately at national healthcare level.

Drug Resistance, Bacterial↗

PubMed1992

Pseudomonas septicemia due to deficient disinfectant mixing during reuse.

We describe a cluster of four septicemias with pseudomonas, that occurred in a unit performing formaldehyde reuse of capillary dialyzers. Samples of blood, heparin solutions, dialysate and effluent of reused dialyzers, were evaluated bacteriologically and upon the adequacy of the reuse procedure. Pseudomonas aeruginosa, vesicularis and/or xanthomonas maltophilia were found on the blood cultures obtained during the septicemic reactions, and in the effluent of two reprocessed dialyzers not yet used (greater than 10(4) CFU/ml). These two dialyzers had also extremely low formaldehyde concentrations (0.0014 and 0.005% versus the expected 4%). Membrane and antibiogram characteristics of a Pseudomonas aeruginosa strain, recovered from the blood cultures in one patient, and of a strain found in the effluent of one of the two contaminated reprocessed dialyzers, were the same. The problem was attributed to the inadequate mixing of the disinfectant with the tap water used in the automated reprocessing device, in the absence of an alarm disclosing this failure.

Aged↗

PubMed2004

Periimplantitis.

Orodental rehabilitation through the use of implants offers very high success rates. In this paper, we describe some of the complications involved with this technique, such as periimplant disease and, within this category, periimplantitis, an inflammatory reaction in which there is a loss of the bony support of the implant accompanied by inflammation. The aetiology of the disease is conditioned by the status of the tissue surrounding the implant, implant design, degree of roughness, the poor alignment of implant components, external morphology and excessive mechanical load. The microorganisms most commonly associated with implant failure are spirochetes and mobile forms of Gram-negative anaerobes, unless the origin is the result of simple mechanical overload. Diagnosis is based on changes of colour in the gum, bleeding and probing depth of periimplant pockets, suppuration, x-ray and gradual loss of bone height around the tooth. Treatment will differ depending upon whether it is a case of mucositis or periimplantitis. Therapeutic objectives focus on correcting technical defects by means of surgery and decontamination techniques (abrasion with carbon particles, citric acid solution, topical tetracycline application and laser surgery). This study also presents a microbiological study of periimplantitis conducted by the Barcelona School of Dentistry that determined that the antibiotic therapy proven to be most efficacious in the antibiogram was the association of amoxycillin and clavulanic acid.

Alveolar Bone Loss↗