An outbreak of
Acinetobacter baumannii colonization and infection occurred in 19 patients over a 14-month period during 1998–1999 on a neurosurgical intensive care unit. During efforts to control the ...outbreak a significant correlation was observed between the number of environmental isolates of
A. baumannii obtained during each monthly screening and the number of patients with
A. baumannii colonization/infection in the same calendar month (
P
=
0.004). Use of 1000
ppm hypochlorite solution and the introduction of new cleaning protocols reduced the number of environmental isolates. Failure to maintain low levels of environmental contamination with
A. baumannii resulted in increases in patient colonization. This study showed that high standards of cleaning play an integral role in controlling outbreaks of
A. baumannii in the intensive care unit setting.
Wound botulism is a rare infectious disease due to neurotoxin release from the anaerobic, spore-forming bacterium Clostridium botulinum that is becoming an ever more frequent complication of ...parenteral drug abuse in the Western world. Before the year 2000, no such cases had been reported in the UK and Ireland, but since then the number of proven and suspected cases of wound botulism occurring in parenteral drug users has increased markedly. The diagnosis is often difficult, based on a high degree of clinical suspicion and if not considered in the initial differential diagnosis, then considerable delays in treatment may result. This is the case report of a male heroin user who presented three times to an Emergency Department in the UK before a diagnosis of wound botulism was made and treatment commenced. It is important that emergency clinicians are aware of the possibility of wound botulism in parenteral drug users that present with unusual neurological or respiratory symptomatology.
For over 12 months all patients attending our regional cystic fibrosis unit have had throat swabs analysed routinely for viruses with the polymerase chain reaction before starting intravenous ...antibiotics.
Methicillin-resistant Staphylococcus aureus (MRSA) infection has increased at an alarming rate in the recent past and has major cost implications. The aim of this study is to assess the impact of a ...policy of pre-operative MRSA prophylaxis on the incidence of MRSA infection in patients undergoing liver resection.
A total of 585 patients underwent hepatectomy in a tertiary referral centre between January 2000 and September 2005. In September 2003, a policy of MRSA prophylaxis (nasal mupirocin and triclosan wash for 5 days) was introduced within this unit. Demographic, pathological and outcome data were compared between the pre- and post-MRSA prophylaxis cohorts.
The prevalence of MRSA infection prior to initiating the prophylaxis protocol was 29 patients (8.3%) and this fell to 9 patients (3.8%; P = 0.029). Furthermore, patients who had MRSA-related infection had a higher incidence of additional complications compared to the rest of the cohort (P = 0.001). Total cost savings incurred as a result of this protocol over the past 2 years has been approximated at 28,893 pounds.
Introduction of a simple MRSA prophylaxis policy has had a significant reduction on the incidence MRSA-related infection within our patient population, leading to reduced morbidity and cost saving to the UK National Health Service.
Sixteen strains of Escherichia coli with high-level resistance to extended-spectrum cephalosporins and other classes of antibiotic have been isolated at St James' University Hospital, Leeds. They ...produce up to three separate beta-lactamases: TEM-1, SHV-5 and, in five isolates, a plasmid-mediated AmpC-type enzyme. With the exception of carbapenems, the isolates reported in this study were resistant to all beta-lactam antibiotics including extended-spectrum cephalosporins and the monobactam aztreonam. There was evidence of the spread of a plasmid encoding SHV-5, particularly amongst patients on the liver transplant unit. Sensitivity to beta-lactam antibiotics in five isolates expressing the AmpC-type beta-lactamase was not restored by the beta-lactamase inhibitor clavulanic acid. These bacteria also carried blaSHV-5 on a large plasmid. PCR-amplification of the structural gene and digestion with restriction endonucleases demonstrated that the plasmid-mediated blaAmpC probably identified as BIL-1 using the criteria available. Four of the five patients carrying isolates that carried the plasmid-located blaAmpC gene had recently visited the Indian subcontinent and we presume that they returned carrying these bacteria. Restriction fragment length polymorphism analysis using pulsed field gel electrophoresis (PFGE) suggests that at least four distinct strains existed amongst these five isolates. The two isolates that had very similar PFGE patterns had different plasmid profiles and were isolated from different locations in the hospital and at different times. This study demonstrates the ease with which highly resistant bacteria can be imported into the UK and spread within hospitals.
There is no cure for cystic fibrosis but recent advances in care have increased the average life expectancy to over 30 years. However, patients may find themselves prescribed over seven to eight ...different medications a day, some of which are laborious and time consuming to administer. The physician should balance potential benefits from treatments against quality-of-life requirements. In this review, the authors examine the place in the overall treatment regimen of recently available, and often expensive, drugs. The review concentrates on eradication regimens for early or recurrent Pseudomonas aeruginosa infection; inhaled tobramycin therapy; regular versus on-demand intravenous antibiotics; treatment of respiratory methicillin-resistant Staphylococcus aureus infection; the role of macrolide antibiotics and the role of inhaled dornase alfa in early treatment.
Heterogeneity of beta-lactamase production by 17 clinical and nine environmental isolates of Stenotrophomonas maltophilia was investigated using MICs of six different beta-lactam antibiotics, ...isoelectric focusing (IEF) and pulsed field gel electrophoresis. There was no clear correlation between the results of IEF, genotype and MIC determination. Environmental isolates were more susceptible than clinical isolates; eight clinical and none of the environmental isolates expressed high-level resistance to meropenem. Only two isolates expressed high-level resistance to ceftazidime. These results indicate that further studies are required to elucidate the extent of genetic heterogeneity within the L1 and L2 beta-lactamase genes.
PDF
