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A nosocomial outbreak of infections due to multiply resistant Proteus mirabilis: role of intestinal colonization as a major reservoir.

An outbreak of nosocomial infections involving an unusual strain of multiply resistant Proteus mirabilis (phage type 8888) occurred in 15 patients, 14 of whom were in the surgical intensive care unit at that time. No common source of infection was identified, and person-to-person transmission was the most likely mode of spread. Case-control analysis indicated a significantly increased risk infection related to length of hospital stay (P less than 0.005), number of operations (P less than 0.005), proximity to another case (P less than 0.01), number of antibiotics received (P less than 0.02), and use of a respirator (P less than 0.01). Only the number of operations (P less than 0.01) and proximity to another case (P less than 0.05) remained significant risk factors when related parameters were controlled by multivariate analysis. Thirteen of 14 patients prospectively cultured were colonized by the epidemic organism in the intestinal tract, while rectal carriage preceded infection by the same strain in at least four patients. These data suggest that intestinal colonization may have been an important reservoir for this outbreak, and the findings may explain the unduly prolonged course of intrahospital spread as well as the difficulty encountered in the eradication and control of the outbreak.

Cross Infection↗

Prevalence of Proteus species in urinary tract infections in a regional hospital in Trinidad.

BACKGROUND: Proteus bacteria are a well-known cause of urinary tract infections (UTIs). The prevalence of UTIs is high among catheterized patients and those undergoing manipulation of the urinary tract. This study assessed the prevalence of UTIs due to Proteus species, the predisposing factors, complications and extent of antimicrobial resistance at a regional teaching hospital. METHODS: Urine samples in sterile containers from inpatients and outpatients were inoculated onto cysteine lactose electrolyte deficient agar and sheep blood agar plates with calibrated (0.001 ml) platinum loops and incubated aerobically at 35 degrees C to 37 degrees C for 18 to 24 hours. A colony count of 10(5) bacteria/ml or more was the criterion for significant bacteriuria. Proteus spp were identified and classified into four groups. Susceptibility testing was performed via the Kirby-Bauer disc diffusion technique on Müeller-Hinton agar using ampicillin (10 micrograms), tetracycline (30 micrograms), nalidixic acid (30 micrograms), gentamicin (10 micrograms), nitrofurantoin (30 micrograms), co-trimoxazole (30 micrograms) and cefuroxime (30 micrograms). RESULTS: Of 1,397 urine specimens from hospital and community patients, 414 had one or more species of bacteria isolated, of which 74 (17.9%) were Proteus spp. Hospital-acquired UTIs accounted for more than two-thirds (51/74, 68.9%) of Proteus spp isolates, while community-acquired UTIs accounted for approximately one-third (23/74, 31.1%) of all Proteus isolates. The prevalence of Proteus UTIs in males was 34 of 184 (18.5%) and was slightly higher than in females (40/230, 17.4%). P mirabilis was the most frequently isolated Proteus sp (55/74, 74.3%), followed by P vulgaris (9/74. 12.2%), Morganella morganii, (7/74, 9.5%) and Providencia rettgeri (3/74, 4.0%). Forty-nine of 55 (89%) P mirabilis isolates were biotype 2. Catheterization was the most common predisposing factor in 32.4% of hospital-acquired Proteus UTIs. More than 92% of Proteus isolates were sensitive to gentamicin and nalidixic acid, whereas, ampicillin (35%) and tetracycline (18%) were the least effective drugs. CONCLUSIONS: Proteus was isolated from about 18% of patients with significant bacteriuria. Most isolates occurred in hospitalized patients with indwelling urinary catheters and in patients with benign prostatic hypertrophy, diabetes and prostatectomy. Proper catheter care may improve infection control and reduce the morbidity of UTIs associated with Proteus spp.

Adolescent↗

[Tuberculous otitis media. Report of 3 cases].

Tuberculous otitis media (TOM) is a rare cause of chronic suppurative infection of the middle ear. Due to that the symptoms and signs are often indistinguishable from those of nontuberculosis chronic otitis media and the fact that the index of suspicion is low, there is frequently a considerable delay prior to diagnosis. This can lead to irreversible complications such as facial nerve paralysis and labyrinthitis. Medical therapy with antituberculous drugs is usually effective. We report three cases with TOM diagnosticated and followed up in our Service from january 1993 to july 2001. Their charts were retrospectively reviewed for relevant historical data, physical findings, complementary studies, treatment and clinical response. We performed a review of the literature, emphasizing that TOM should be considered in the differential diagnosis of chronic otitis media.

Adult↗