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PubMed1999

[Rational empiric antibiotic therapy of nosocomial pneumonia].

Antibiotic therapy is the method of choice for treatment of nosocomial pneumonia. It can be divided into empiric and specific therapy. First of them is based on predicting potential pathogens which may cause pneumonia. Important factors modifying the choice of initial empiric therapy are following: clinical history (e.g. time in hospital, type of hospital department, prior usage of antimicrobial agents), severity of pneumonia, presence of other risk factors and information given by direct microscopic examination of pulmonary secretions. Based on them it is frequently possible to select group of possible pathogens and then choose effective antibiotics with broad coverage. After a few days when specific etiology is found and antibiogram is performed antibiotic with narrow coverage should replace previous one. Specific therapy possesses several advantages when comparing with empiric therapy. It is more effective and cheaper. But necessity to wait a few days for the result of culture and its relatively low reliability are clear disadvantages.

Aminoglycosides↗
PubMed1998

[Burkholderia cepacia isolation and characterization from hospital infections].

The evolution of reanimation and functional exploration techniques has led to and explosion of nosocomial infections. They are prevailing in Intensive Care and Neonatal Units. This study deals with B. cepacia strains isolated in 1996 in a pediatric hospital of the Dakar University Hospital Center, following the installation of tracheo-bronchial exhausters which are used for obstruction removal among children. The 44 B. cepacia strains examined come from 42 blood cultures done among 29 boys and 13 girls aged between 5 days and 7 years, and from 2 exhausters. After identification by API20 NE (bio Merieux), a standard antibiogram, a 3 characters biotyping (O.N.P.G., esculin, nitrate reductase) and a study of the polymorphism of the DNA enzymatic restriction profile obtained by an pulsed field electrophoresis are performed on the isolates. The contamination come from the exhausters. All the strains produce an orange-colored yellow pigment. Only an O.N.P.G. (+), nitrate reductase (+) biotype was identified. The antibiotic susceptibility profile is almost pathognomonic for the 44 tested strains: sensitivity (100%) to ceftriaxone, to ceftazidime, to aztreonam: to contrimoxazole (96%) and to chloramphenicol (91%). Search for widen spectrum beta-lactamses and antibiotics resistance plasmids was negative. However, those strains that are multiples resistant, discharge others 8.1. isofocal point beta-lactamases. The R.F.L.P. study demonstrated a unique profile. The B. cepacia transmission is the result of the installation of medical reanimation equipment that are not well taken care of. The nosocomial infections ascertained so far are ordinary bacteremias. Strain's phenotypical and genotypical identification shows the presence of only one clone. To overcome there nosocomial infections, hygienic measures have to be reinforced.

Burkholderia Infections↗
PubMed1999

Association of tuberculosis with malignancy at KIMIO--an oncology centre.

The association of tuberculosis and malignancy was studied at an oncology centre in Bangalore. The study period was from January 1981 to December 1995. A total of 8779 clinical material obtained from patients were screened for Mycobacterium tuberculosis infection. Out of which 675 were positive for acidfast bacilli, 385 from non malignant conditions and 290 from malignant conditions. Highest incidence is seen in Head and Neck cancer (42%) followed by Gastrointestinal cancer (14.1%), Lung cancer (13.8%), Haematological cancer (10.7%), Reproductive cancer (10.3%) and miscellaneous group (9%), Antibiogram of Mycobacterial cultures was done in 282 subjects. Resistance patterns to antitubercular drugs showed highest with Isonicotinic acid hydrochloride (INH) (17.7%), followed by para amino salicylic acid (PAS) (8.5%), Streptomycin (SM) (6.7%), Rifampicin (RIF) (4.6%) and Ethambutol (EM) (0.35%).

Cancer Care Facilities↗
PubMedDate not supplied

A retrospective study on 16 collodion babies.

Sixteen collodion babies followed in the Neonatal Care Unit between January 1982 and December 1994 were evaluated retrospectively. The preterm/term ratio was 1.6, and complete shedding of the collodion membrane took an average of 21.9 days (range 18-46 days). Problems noted were marked temperature instability, defective barrier function, increased insensible water loss predisposing to hypernatremic dehydration, cutaneous infections and septicemia. Hypernatremia was observed in 11 (68.7%) and septic infection in seven patients (43.7%). All the infants were treated topically with vaseline containing five percent lactic acid. In the hypernatremic infants, intravenous fluid was administered for rehydration. In the septic infants, antibiotics were used according to the antibiogram. Four of the infants died due to septicemia. The mortality rate was 25 percent, and the major complications included hypernatremia, cutaneous infection and sepsis.

Administration, Topical↗
PubMed2000

[Isolated infective endocarditis of pulmonary valve in patient with interventricular septal defect].

A case of isolated infective endocarditis of the pulmonary valve in a patient with known subpulmonary interventricular septal defect that had, as major complication pulmonary septic embolization, was reported by the authors. The disease followed an insidious course, diagnosed by the presence of vegetations in the echocardiogram, some of them larger than 1 cm. They were found in the right ventricular infundibulum and in the pulmonary valve leaflets. The isolation of Estreptococcus viridans in blood cultures has confirmed the diagnosis. In spite of appropriate antimicrobial therapy, according to the antibiogram data (with Ampicillin and Gentamicin), fever lasted for more than three weeks. This event suggested medical treatment failure and the possibility of surgery was considered. However, the endocarditis eventually healed with medical therapy alone, and this unusual course with prolonged fever was presumed to be caused by lung metastatic infection secondary to septic embolization. This complication is relatively common, but lung involvement is usually a subclinical event, not responsible for such persistent fever, as happened in the case now reported. We emphasize the rarity of this case, the unusual clinical course and the discussion concerning the therapeutic options.

Adult↗
PubMed2000

Antibiotic resistance: a clinician's perspective.

Since the introduction of antimicrobial agents, resistance has increased steadily across all classes of antibiotics. Organisms vary in susceptibility. Therefore, an antibiogram or susceptibility profile is needed for each infecting organism to determine the most appropriate antibiotic. When the infecting organism has not yet been identified, an informed decision can be made only by obtaining an accurate profile of antibiotic resistance in the hospital, the community, and, in some instances, the world. The appropriate use of antibiotics is correlated with a more favorable clinical outcome and also delays the emergence of resistance. Ensuring such prescribing behavior requires a multidisciplinary approach. Familiarity with the trends and prevalence of antibiotic resistance also facilitates the early identification of individuals harboring resistant organisms. Early isolation can then be initiated, thereby minimizing the risk of nosocomial cross-infection. This article offers a clinician's pragmatic view of antimicrobial resistance.

Anti-Bacterial Agents↗
PubMed2000

[Pathogenicity of Enterococcus spp. Characteristics of 169 hospital isolates].

BACKGROUND: To know the characteristics of Enterococcus spp. strains isolated in the hospital; to analyse the importance of this microorganism and its resistance to antimicrobial agents. PATIENTS AND METHODS: Retrospective analysis of the case histories of 169 patients with Enterococcus spp. isolates, selected at random at the Infanta Cristina Hospital in Badajoz. Investigation was carried out on: age, date of admission and discharge, clinical symptoms, risk factors, previous antibiotic treatment, clinical and microbiological evolution, recommended treatment and prescribed treatment. Identification of microorganisms and antibiogram with Pos Combo 41 microScam panels, read on Baxter WalkAway-40 equipment. RESULTS: The most frequently found species was Enterococcus faecalis. In 75 cases the isolations were polymicrobial. The enterococci were isolated mainly from urinary infections (27%), skin infections (20%), intrabdominal infections (14%) and infections from surgical wounds (14%). The existence of peripheral catheter was the main risk factor. All the strains of E. faecalis were susceptible to the glycopeptides. Two strains of Enterococcus faecium were not susceptible to vancomycin and one of these was not susceptible to teicoplanin. Mortality was from 21-27.5%. CONCLUSIONS: Enterococcus spp. is frequently isolated in nosocomial infections, although in approximately half the cases it is associated with other bacteria. For this reason, it is not always possible to determine its pathogenic contribution. The isolated strains, except two strains of E. faecium, are susceptible to vancomycin. A relation exists between high resistance to aminoglucosides and resistance to fluoroquinolones.

Enterococcus↗
PubMed1975

Frequency distribution of S. typhi-murium phage types in various countries.

The phage type and antibiogram of 5199 S. typhi murium strains from 13 countries and of 4949 strains from The Netherlands was determined. For a number of countries it could be established that types predominating in pigs or calves predominate also in humans in that country. However, the predominant phage types were not the same in the various countries. Type 505 predominated in The Netherlands and, to a lesser degree, also in Belgium and the German Federal Republic. Type 131 predominated in Poland and was also frequently found in the German Democratic Republic. In the German Democratic Republic, type 450 was the most frequently found type. Phage patterns not accepted as a type and occurring one country only, were found to predominate in Italy, Hungary, Israel and Sweden. The majority of antibiotic-resistant strains belonged to a limited number of phage types only.

Animals↗
PubMedDate not supplied

[Therapeutic pneumothorax--an effective adjuvant method in treating multidrug-resistant tuberculosis].

Treatment of multidrug-resistant TB is difficult, even when all alternative drugs are at hand, due to important side effects and high cost, buying seldom efficient. Therapeutic pneumothorax (TP) proved its efficacy in pre-antibiotic era, so one can assume that it can be applied with the same success in multidrug resistant TB. Three MDR TB cases are presented (resistance to 2, 3 and 4 drugs), with unilateral lesions, in which TP was applied as a help for the drug treatment which was guided by the antibiogram. Favorable results were obtained in all 3 cases, with constant bacteriological negativity. In one of the cases (with 4 drugs resistance), treatment was completed after 3 months by a lobectomy; they were all considered healed after 18 months. In conclusion, in some cases of MDR TB, the TP (if there are no pleural adherences) may lead to good results. This presentation aims to remind the pulmonologists the favourable effects of TP in selected cases.

Adult↗
PubMed2000

Epidemiological analysis of methicillin resistant Staphylococcus aureus in Thailand.

The geographical distribution of 65 clinical isolates of methicillin resistant Staphylococcus aureus (MRSA) recovered from 7 hospitals in Thailand was investigated. The presence of mecA gene in MRSA was determined by specific PCR with the use of primers 5'-GTAGTTGTCGGGTTTGGT-3' and 5'-GGTATCATCTTGTACCCA-3'. Chromosomal DNA restriction analysis with SmaI was resolved by pulsed-field gel electrophoresis (PFGE) compared with antibiotype analysis and phage type analysis. All 65 strains carried mecA gene. They all were resistant to penicillin, tetracycline, erythromycin, amoxicillin/clavulanic acid and variably resistant to gentamicin, ofloxacin, trimethoprim-sulfamethoxazole, chloramphenicol, fosfomycin and clindamycin; and all isolates were susceptible to vancomycin. A total of 19 PFGE patterns designated as type A, A1, A2, A3, A4, B, B1, C, D, E, E1, E2, F, F1, F2, G, H, I and J was identified. Type A4 and E were commonly found in every studied areas. Phage typing showed even greater variability that 52 (80%) isolates belonged to 25 different phage types; 13 (20%) isolates were non-typable. The clarity and polymorphism of the PFGE patterns enable us to discriminate between isolates which could not be differentiated by antibiogram or phage type analysis. The findings demonstrate the existence of a common epidemic MRSA clone in Thailand.

Bacterial Typing Techniques↗
PubMed2000

[Personal experience with use of the antimicrobial agent, Neloren R, in maxillofacial surgery].

During the treatment of sick as well as injured and operated patients it was used the therapy according to the clinical experience of doctors and possibility of the choice of some antibiotic. It was used the therapy according to antibiogram whenever it was possible. In the study the results of using of Neloren-antibiotic, linkomicin, produced in "Bosnalijek" Sarajevo, were followed up comparing to the other antibiotics. Neloren effects on Streptococcus pyogenes, Streptococcus penumoniae, S. viridian's, Staphylococcus aureus (resistant on Penicillin), Corynebacterium diphteriae, Bacillus anthracis Bateroides fragilis, Rikecia prowaseki and some dostridiaes. In developing of the study the patients were involved who had bone fracture caused by influence of different exogene ethiological factors and the patients with benign pathological process in bone structure, the most often osteomyelitis or abscess caused by dentogene source as well as the patients who were treated by functional or corrective aesthetic operations such as osteoplastic of jaw or correction of bone deformation. The results were shown by chart and graphic representation and they will be compared to the results around the world.

Anti-Bacterial Agents↗
PubMed1999

Community acquired methicillin resistant Staphylococcsus aureus: a new threat for hospital outbreaks?

Methicillin resistant Staphylococcus aureus (MRSA) is a major nosocomial pathogen. Recently, there have been reports of increasing prevalence of MRSA in the community. We here report an outbreak of post operative wound sepsis by MRSA in the surgical ward of LN hospital. A surveillance study for MRSA was undertaken in the corresponding surgical ward, operation theater and OPD and the source of this outbreak was traced to an outdoor patient with community acquired MRSA infection. A total of 320 clinical and environmental samples were screened for MRSA. Seventy (21.8%) S. aureus were obtained, of which 12.8% were resistant to methicillin. 14% of the MRSA infections were from the community. Nasal carriage rates of MRSA in the screened hospital staff and admitted patients were 5.8% and 4.3% respectively. None of the environmental sites sampled yielded MRSA. A study of antibiogram revealed that all the MRSA were uniformly resistant to penicillin, erythromycin, gentamicin, tobramycin and tetracycline and sensitive to vancomycin. All isolates belonged to the same biotype and were nontypable by the standard set of phages.

Anti-Bacterial Agents↗
PubMed1999

Nasal carriage of methicillin resistant Staphylococcus aureus in a cardiovascular tertiary care centre and its detection by Lipovitellin Salt Mannitol Agar.

Ecological niches of Staphylococcus aureus are the anterior nares. Carriage of Staphylococcus aureus in the nose appears to play a key role in the epidemiology and pathogenesis of infection. Numerous studier have shown that elimination of nasal carriage using Mupirocin also eliminated hand carriage and the spread of infections in hospitals. Lipovitellin-Salt-Mannitol Agar was used for screening, isolation and presumptive identification of Staphylococcus aureus from nasal carriers. From November; 97 to August'98, 724 nasal swabs were cultured and 18.23% of health care workers were found to be nasal carriers of Staphylococcus aureus. Of these 12.15% were carriers of MRSA. The carrier rate was highest in December' 97 (32.07%). All MRSA carriers were treated with local application of Mupirocin for three days. A study of the antibiogram of the clinical isolates during the corresponding period showed 100% susceptibility of MRSA to Vancomycin. Susceptibility of MRSA to Clindamycin, Netilmycin, Rifampicin & Ofloxacin was 86.6%, 69.5%, 66% & 64.7% respectively.

Bacteriological Techniques↗
PubMed2000

Fatal multi-resistant Pseudomonas aeruginosa septicemia outbreak in a neonatal intensive care unit in Trinidad.

Between July 2-3, 1998, six infants on the neonatal intensive care unit (ICU) at San Fernando General Hospital died following septicemia with multi-resistant Pseudomonas aeruginosa. All patients were infected with the same strain and all were resistant to gentamicin, tobramycin, piperacillin and ceftazidime. Samples of hand washing liquids from the hands of the neonatal ICU staff were cultured and no P. aeruginosa was detected. Patients' environment and environmental surfaces: latches and interiors of incubators, sink traps and the operating theater environment and suction tubing were cultured, and P. aeruginosa with the same antibiogram was recovered from the suction tubing and the sink trap of the only tap on the neonatal ICU. Following the intervention of the infection control team and their strong re-emphasis on compliance with proper hand washing procedures and sterilization techniques, no cluster of infection with this strain or any other strain of P. aeruginosa were subsequently observed. The infecting strain may have been transferred from the operating theater via a neonate delivered by caesarean section and from this infant to the others by a neonatal health care worker who failed to wash hands properly between patients. This is the first documented fatal P. aeruginosa outbreak described at the San Fernando General hospital.

Bacteremia↗
PubMed2000

The isolation of Burkholderia cepacia in a hospital setting in Sri Lanka.

INTRODUCTION: Burkholderia cepacia is widely prevalent in nature. The natural habitat of this organism is soil, water and vegetation, but the hospital environment remains the main source of infection. It causes a wide variety of infections in hospitalised patients. Since there are no reports of its prevalence in Sri Lanka, a data retrieval and analysis was undertaken to determine its incidence among patients at Sri Jayawardenepura General Hospital (SJGH). OBJECTIVE: To determine the prevalence, morphological characteristics, biochemical profile and antibiotic susceptibility pattern of B cepacia in a Sri Lankan tertiary care hospital. METHODS: Relevant clinical data were retrieved from all isolates of B cepacia from SJGH for 12 months from October 1996. Standard procedures were used to isolate the organism from clinical specimens. API 20E was employed for biochemical identification. Antibiotic susceptibility tests was carried out using the modified Kirby Bauer method. RESULTS: B cepacia was isolated from 17 patients. 16 of them were hospitalised and were from the medical, surgical, and intensive care units. All were in a compromised state of health. The organism was isolated from a variety of specimens which included swabs of surgical wounds, chronic ulcers, sputum, bronchial lavage, endotracheal aspirate, urine, peritoneal fluid and blood. Blood agar, MacConkey agar and cystine lactose electrolyte deficient medium supported the growth of all strains. They were motile Gram negative rods. All strains were oxidase positive. Strains gave variable results with other biochemical tests. Antibiograms too were variable. All strains were sensitive to ceftazidime, and the majority of the strains were sensitive to the other third generation cephalosporines. All strains were resistant to four or more antimicrobial agents included in the study. Of the 17 patients from whom B cepacia was isolated, only 9 seem to have had actual infection; others were probably instances of colonisation or contamination. CONCLUSIONS: The present report confirms the prevalence and importance of B cepacia as a hospital pathogen in Sri Lanka. Hospital laboratories should be equipped to isolate, identify and perform antibiotic sensitivity test on these strains. Antibiotic susceptibility testing is necessary as the patterns seem to differ among strains. The multiple drug resistant nature of the organism warrants strict infection control measures to prevent spread in a hospital setting.

Adolescent↗
PubMed2000

[Pulmonary Nocardia otitidiscaviarum infection in an immunocompetent host].

A rare case of pulmonary Nocardia otitidiscaviarum (N. otitidiscaviarum) was encountered in an immunocompetent host. A 74-year-old man was admitted to our hospital with a high fever and a productive cough. His chest radiograph and CT scan revealed infiltrative shadows in the right middle and lower lung fields. Although several antibiotics (third-generation cephalosporin, minocycline, imipenem) were administered, the fever and cough persisted, and C-reactive protein remained elevated. Repeated sputum cultures showed normal flora, so a transbronchial lung biopsy and bronchoalveolar lavage (BAL) were performed bronchoscopically at the right S5. The BAL fluid contained acid-fast, branching filamentous structures. The microorganism was identified as N. otitidiscaviarum by the Research Center for Pathogenic Fungi and Microbial Toxicoses (Chiba University). Trimethoprim-sulfamethoxazole was therefore administered, but the fever continued to rise daily, and C-reactive protein remained elevated. This isolated N. otitidiscaviarum showed resistance to multiple antimicrobial agents in vitro when examined by the disk diffusion method, and so, on the basis of the antibiogram, the patient was treated with clarithromycin (oral, 600 mg/day) plus amikacin (400 mg/day), which proved successful. Testing for pulmonary nocardiosis should be added to the differential diagnosis procedures for refractory pneumonia as an opportunistic infection and for community-acquired pneumonia.

Aged↗
PubMed2001

Adhesion of a Staphylococcus aureus strain to biomaterials does not select methicillin-resistant mutants.

Bacterial adhesion to polymethylmethacrylate and to silicon elastomer, materials frequently used in clinical applications, has been investigated to assess whether adhesion selects methicillin-resistant mutants in the bacterial population in contact with the materials. The methicillin susceptibility of a susceptible Staphylococcus aureus (ATCC 25923) was measured by a modification of plate antibiogram Kirby-Bauer method, which allows optimised detection of small variations in antibiotic susceptibility. In both adherent and non-adherent bacterial subpopulations, the presence of mecA gene, which encodes for the protein PBP 2a responsible for methicillin resistance was searched for by Polymerase Chain Reaction (PCR). The contact with the two polymers did not induce in the bacteria population any phenotypic increase in methicillin resistance, or the selection of mutants carrying the mecA gene.

Bacterial Adhesion↗
PubMed2001

Adhesion to a polymeric biomaterial affects the antibiotic resistance of Staphylococcus epidermidis.

The antibiotic-resistance both of adherent bacteria to polymethylmethacrylate (PMMA) and of bacteria which, although exposed to the material, had not undergone adhesion, was measured as bacterial growth inhibition area onto a plate antibiogram, according to Kirby-Bauer and using a dedicated image analyzer system. The adhesion onto PMMA induces a marked (about 30%) increase in resistance to beta-lactam antibiotics (cefamandole, cefazolin, imipenem and ampicillin) and a lower (about 15%) but significant increase to the macrolide erythromycin, to two aminoglycosides (amikacin, netilmicin) and to vancomycin, chloramphenicol and trimethoprim-sulfamethoxazole.

Aminoglycosides↗