Current Microbial Isolates from Wound Swabs,Their Culture and Sensitivity Pattern at the Niger Delta University Teaching Hospital,Okolobiri, Nigeria

Background: Wound infections continue to be problematic in clinical practice where empiric treatment of infections is routine. Objectives: A retrospective cross-sectional study to determine the current causative organisms of wound infections and their antibiotic susceptibility patterns in the Niger Delta University Teaching Hospital (NDUTH), Okolobiri, Bayelsa State of Nigeria. Methods: Records of wound swabs collected from 101 patients with high suspicion of wound infection were analysed. Smears from the wound swabs were inoculated on appropriate media and cultured. Bacterial colonies were Gram stained and microscopically examined. Biochemical tests were done to identify pathogen species. The Kirby-Bauer disk diffusion method was used for antibiotic testing. Results: Prevalence of wound infection was 86.13% (CI: 79.41–92.85). Most bacteria were Gram negative bacilli with Pseudomonas aeruginosa being the most prevalent pathogen isolated. The bacterial isolates exhibited a high degree of resistance to the antibiotics tested (42.8% to 100% resistance). All isolates were resistant to cloxacillin. Age group and sex did not exert any effect on prevalence, aetiological agent or antimicrobial resistance pattern. Conclusion: We suggest a multidisciplinary approach to wound management, routine microbiological surveillance of wounds, rational drug use and the institution of strong infection control policies.     

Influenza-associated bacterial pathogens in patients with 2009 influenza A (H1N1) infection: impact of community-associated methicillin-resistant Staphylococcus aureus in Queensland, Australia

Background: Secondary bacterial pneumonia due to community onset methicillin‐resistant Staphylococcus aureus (MRSA) has become a highly publicised cause of influenza‐associated death. There is a risk that case reports of fatal outcomes with post‐influenza MRSA pneumonia may unduly influence antibiotic prescribing. Aims: The aim of this study was to demonstrate the incidence of community‐onset MRSA pneumonia in 2009 H1N1 influenza patients. Methods: The microbiology records of patients positive for influenza A (H1N1) in 2009 were reviewed for positive blood or respiratory tract cultures and urinary pneumococcal antigen results within a Queensland database. Patients with such positive results within 48 h of hospital admission and a positive H1N1 influenza result in the prior 6 weeks were included. Results: In 2009, 4491 laboratory‐confirmed pandemic influenza A (H1N1) infections were detected. Fifty patients (1.1% of the H1N1 cohort) who were hospitalised with H1N1 and who had a bacterial respiratory tract pathogen were identified. Streptococcus pneumoniae (16 patients; 32%), Staphylococcus aureus (13 patients; 26%) and Haemophilus influenzae (9 patients; 18%) were the most commonly cultured organisms. Of the cohort of 4491 patients, MRSA was detected in only two patients, both of whom were admitted to intensive care units and survived after prolonged admissions. Conclusions: Influenza‐associated community‐onset MRSA pneumonia was infrequently identified in the 2009 H1N1 season in Queensland, despite community‐onset MRSA skin and soft tissue infections being very common. Although post‐influenza MRSA pneumonia is of great concern, its influence on empiric‐prescribing guidelines should take into account its incidence relative to other secondary bacterial pathogens.     

The identification of genetically related bacterial isolates using pulsed field gel electrophoresis on nursing home units: a clinical experience

OBJECTIVES: To describe a laboratory-based technique to track nursing home infections. DESIGN: Retrospective data analysis. SETTING: A 721-bed skilled care facility with 14 nursing units. PARTICIPANTS: Residents in a nursing home, average age 76+/-10, 78% male. MEASUREMENTS: Bacterial isolates were listed for each nursing unit. Clusters of identical species and antibiotic susceptibility were identified followed by pulsed-field gel electrophoresis (PFGE). If the genetic analysis yielded related strains, the director of nursing performed a clinical investigation. PFGE is available through reference laboratories at a cost of approximately 75 dollars/isolate. RESULTS: Twenty-four clinical clusters of phenotypically identical bacteria (species, antibiotic susceptibility) were identified. Fourteen included genetically related isolates. CONCLUSION: Approximately half of the phenotypically identical clusters contained genetically related isolates. The identification of genetically related bacterial isolates on nursing units by PFGE provides staff with a specific circumstance to review secretion precautions. Genetic analysis may also demonstrate that apparent clusters are unrelated.     

Adverse events associated with methicillin-resistant Staphylococcus aureus in a nursing home

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) generates concern in nursing homes. Restrictive isolation precautions may be applied for indefinite periods. Adverse events driving these concerns include transmission and infection. METHODS: The 721-bed Wisconsin Veterans Home in King performs approximately 645 cultures annually. The site, severity, and number of MRSA infections were determined for 69 months. Pulsed-field gel electrophoresis was performed on all initial isolates, followed by a statistical cluster analysis looking for evidence of transmission. RESULTS: Sixty-seven MRSA infections were identified (1.6 per 100 residents per year); many were polymicrobial, and it was difficult to determine the proportionate role of MRSA in morbidity or mortality. There was an episode of rapidly fatal MRSA septicemia in which empiric antibiotic therapy was ineffective. Twenty-one genetic strains were encountered. Statistical analysis identified 13 clusters of genetically identical strains clustered in time and space (P<.05). CONCLUSIONS: Infections with MRSA were identified at relatively low rates; however, the etiology of many serious nursing home infections is not determined, especially pneumonia. Statistical analysis revealed clustering and evidence of transmission. Nursing home practitioners should consider MRSA when applying empiric treatment to serious infections. We recommend a program including (1) judicious use of antibiotics, including topical agents, to reduce selection of resistant organisms; (2) obtaining and tracking cultures of infectious secretions to diagnose MRSA infections and focus antibiotic therapy; (3) universal standard secretion precautions because any resident could be a carrier; and (4) a detailed assessment and care plan for the carrier that maximizes containment of secretions and independence in activities. However, basic hygiene cannot be maintained in communal areas by some residents without restriction of activities of daily living.     

The respiratory threat posed by multidrug resistant Gram‐negative bacteria

Respiratory infections are a major cause of global mortality and morbidity. In recent years, an increased incidence of multidrug‐resistant (MDR) Gram‐negative bacteria (GNB) has been described. Microorganisms such as Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae or Acinetobacter baumannii have been identified as causative pathogens of different respiratory tract infections. Several studies have detected MDR‐GNB in patients with community‐acquired and nosocomial pneumonia. Furthermore, MDR‐GNB have also been isolated in patients with chronic obstructive pulmonary disease and bronchiectasis having acute or chronic bronchial infection. Prevalence varies depending on the geographical area but MDR‐GNB has been reported in the Asia‐Pacific region, Europe and the United States, reaching rates of 70% in hospital‐acquired infection. The presence of MDR‐GNB has been related to poor clinical outcomes, including increased mortality, although data regarding this relationship are limited. This is probably linked to inappropriate selection of empiric antibiotic treatment; this poses a threat of widespread resistance. GNB antibiotic resistance and the absence of new antibiotics are a major concern given limited treatment options; an aspect that deserves future research. We review current literature, highlight prevalence of MDR‐GNB in different respiratory infections and explore their impact on clinical outcomes.     

Pseudomonas aeruginosa bacteremia over a 10-year period: multidrug resistance and outcomes in transplant recipients

Abstract: Aim. Transplant recipients are at risk for hospital‐acquired infections (HAIs), including those caused by Pseudomonas aeruginosa. Of all HAIs, bloodstream infection (BSI) remains one of the most life‐threatening. Methods. Over a 10‐year period, we studied 503 patients, including 149 transplant recipients, with pseudomonal BSI from the University of Pittsburgh Medical Center. Trends in antimicrobial susceptibility, risk factors for multidrug resistance (MDR), and outcomes were compared between transplant and non‐transplant patients. Results. Resistance to all antibiotic classes was significantly greater in pseudomonal blood culture isolates from transplant compared with non‐transplant patients (P<0.001). Of isolates from transplant recipients (n=207), 43% were MDR, compared with 18% of isolates from non‐transplant patients (n=391) (odds ratio [OR] 3.47; 95% confidence interval [CI] 2.34–5.14, P<0.001). Among all patients, independent risk factors for MDR P. aeruginosa BSI included previous transplantation (OR 2.38; 95% CI 1.51–3.76, P<0.001), hospital‐acquired BSI (OR 2.41; 95% CI 1.39–4.18, P=0.002), and prior intensive care unit (ICU) admission (OR 2.04; 95% CI 1.15–3.63, P=0.015). Mortality among transplant recipients was 42%, compared with 32% in non‐transplant patients (OR 1.55; 95% CI 0.87–2.76, P=0.108). For transplant recipients, onset of BSI in the ICU was the only independent predictor of mortality (OR 8.00; 95% CI 1.71–37.42, P=0.008). Conclusions. Transplant recipients are at greater risk of MDR P. aeruginosa BSI, with an appreciable mortality. Future management must concentrate on the implementation of effective preventative strategies.     

Nosocomial and community acquired uropathogenic isolates of Proteus mirabilis and antimicrobial susceptibility profiles at a university hospital in Sub–Saharan Africa

ObjectiveTo ascertain antimicrobial susceptibility profile of Proteus mirabilis (P. mirabilis) from clinical urine specimens at a university hospital in the spate of its recorded increasing resistance patterns.MethodsThe study was retrospective in nature. Data generated from urine cultures of patients at University of Calabar Teaching Hospital for a period of five years (2004–2009) were compiled. Relevant information obtained were age and gender of patients, organisms recovered and their antibiotic susceptibility patterns. P. mirabilis was identified using standard laboratory procedures.ResultsP. mirabilis showed the highest resistance against ampicillin, cloxacillin, amoxicillin, tetracycline, co-trimoxazole, erythromycin and chloramphenicol (100%–37.2%) while colistin, ofloxacin, ciprofloxacin, ceftriaxone, nalidixic acid and nitrofurantoin recorded the highest activity (59.1%–96.9%) with no drug recording 100% activity. The resistance of the nosocomial isolates of the organism were significantly higher than the community acquired isolates against that of the common antibiotics in use (P<0.05).ConclusionsExtreme caution should be exercised in antibiotic administration in hospital setting and the potential benefits adequately assessed while control of nosocomial infections be given a priority so as to limit the spread of resistant bacteria.     

Incidence, spectrum and antibiotic sensitivity pattern of bacterial infections among patients with acute pancreatitis

BACKGROUND AND AIM: Secondary infection of pancreatic necrotic tissue and peripancreatic fluid is a serious complication of acute pancreatitis resulting in significant morbidity and mortality. The aim of this study was to find out the spectrum of bacterial infections, and their antibiotic sensitivity pattern in patients with acute pancreatitis. METHODS: All consecutive patients with acute pancreatitis were studied prospectively. Detailed investigations were carried out to identify bacterial infections and their antibiotic sensitivities in patients with suspected infection. These investigations included cultures of various body fluids, throat swabs, indwelling cannula and catheter tips. Pancreatic tissue was obtained by using needle aspiration or at surgery for Gram's stain, culture and sensitivity. All cultures were repeated until the presence of infection was confirmed or excluded. RESULTS: A total of 169 patients with acute pancreatitis were studied during the period between January 1997 and June 2000 (mean age 41.3 years; 116 males and 53 females). Of the 169 patients, 63 had infections at various sites. A total of 80 cultures were positive, and 12 different bacterial isolates were cultured from samples taken from these 63 patients. Polymicrobial infection was seen in 32% of patients. Twenty-four patients had a confirmed pancreatic infection. Blood cultures had a growth of organisms in 19 patients, with evidence of ongoing or worsening pancreatitis, thus raising a strong suspicion of infected necrosis in them. The commonest organisms were Escherichia coli from 20 cultures and Pseudomonas aeruginosa from 18 cultures. The antibiotic sensitivity pattern showed that most bacteria were sensitive to third generation cephalosporins and quinolones; notably among them were cefotaxime, ceftazidime, and ciprofloxacin. CONCLUSION: Bacterial infections were seen in 37% of patients with acute pancreatitis. The commonest organisms were Pseudomonas aeruginosa and Escherichia coli. Most bacterial isolates were sensitive to third generation cephalosporins and quinolones.     

Infektionen im Alter – was ist anders?

Infectious diseases are a common cause of increased morbidity and mortality in elderly patients and present a frequent problem in the geriatrician's daily practice. Infections in the elderly are quite different from infections in a younger population. These differences are due to Age-related alterations in immunology Different epidemiology and bacteriology Increased morbidity and mortality Altered clinical presentation Concommittant disability and comorbidity in many older patients Different approaches to therapy. This article is an attempt to discuss these various aspects of infectious disease in the elderly. The most important infections in the elderly are caused by bacteria. Incidence and bacterial spectrum depends on the site of infection and whether the patient is hospitalized, living in a nursing home or in the community. Pneumonia, UTI and pressure ulcer infections are more frequent in patients living in nursing homes than in community dwelling older people. Infections are a frequent cause of hospitalization in elderly people and hospitalization on the other hand is a risk factor for life-threatening nosocomial infections, caused by invasive diagnostic procedures and frequent use of urinary and venous catheters. Infections in the elderly are often accompanied by serious complications as bacteriemia (pneumonia), frequent recurrence (UTI), perforation and abscess (abdominal infections) and severe disability (pressure ulcer infections). Because of these serious and frequent complications mortality of infections is higher in older patients than in younger people. Elderly patients with infectious disease often present in the same way as younger patients do. Many elderly however present with non-specific clinical symptoms and non-specific functional decline which makes an accurate diagnosis difficult and may lead to a life-threatening delay of diagnosis and therapy. In older patients with unexplained functional decline, physicians must be aware of the possibility of a serious infection. Moreover, the physician can not rely on typical signs of infections as fever. In the elderly the fever response is often blunted even in the presence of bacteremia. Leokocytosis may be absent and elevation of acute phase protein is a more reliable marker of infection than elevation of erythrocyte sedimentation rate. Clinical suspicion of bacterial infection in elderly patient should prompt Careful anamnesis and clinical investigation Hospitalization if necessary Diagnostic procedures without delay including blood cultures Immediate empiric antibiotic therapy taking into account the site of infection, if the infection is community acquired or nosocomial and the most likely bacterial spectrum and local resistance factors. The use of broad spectrum antibiotic substances with a low side effect profile and pharmacokinetic properties which are suitable for elderly patients.     

Antibiotic and infection tracking in Minnesota long-term care facilities

OBJECTIVES: To describe current systems used to track infections, antibiotic use, and antibiotic-resistant infections in Minnesota long-term care facilities (LTCFs). DESIGN: Self-administered multiple-choice survey assessing the methods, frequency, content, and dissemination of information used to track infections and antibiotic use. SETTING: Licensed Minnesota LTCFs providing skilled nursing care to geriatric residents as of June 2005. PARTICIPANTS: Surveys addressed to the director of nursing at 393 eligible LTCFs. MEASUREMENTS: Responses to survey questions, assessed by percentage of all responders. Of the 345 surveys returned, the majority had a system to track infections (94.1%), antibiotics prescribed (80.6%), and antibiotic-resistant infections (86.2%). Most facilities used only a nonelectronic format to track antibiotic use (73.4%) and antibiotic-resistant infections (72.4%). Respondents collected information on antibiotic susceptibility results from cultures of blood (49.0%), urine (53.0%), sputum (50.0%), or wounds (50.0%). One third of attending clinicians were routinely informed of trends in facility antibiotic use. In 42% of facilities, less than 5 hours per month of paid time for an infection control practitioner was provided. Two-thirds of responders (64.2%) described their systems as not or somewhat effective at optimizing appropriate antibiotic use in their facilities. CONCLUSION: Most facilities in Minnesota have a system in place to track infections, antibiotic use, and antibiotic resistance. These systems may not collect or disseminate information effectively enough to identify or address the development of antibiotic resistance. Paid infection control practitioner time is limited.     

Empiric antibiotic prescribing for patients with community‐acquired pneumonia: where can we improve?

Background: Community acquired pneumonia is one of the most common infections for which antibiotics are prescribed in Australia. Methods: We audited empiric antibiotic prescribing for 392 adults with community‐acquired pneumonia. Results: Only 61.9% of patients received empiric antibiotic coverage for both typical and atypical pathogens. Of those who required intensive care unit management, 34.6% did not receive antibiotic cover for atypical pneumonia pathogens within the first 24 h. Approximately 21.9% of patients reporting antibiotic allergies were given antibiotics to which they had a documented allergy. Conclusion: Efforts to improve prescribing practices could be focused towards identifying patients with severe illness early and improving recognition of documented allergies.     

Viral and bacterial aetiology of community‐acquired pneumonia in adults

Please cite this paper as: Huijskens et al. (2012) Viral and bacterial aetiology of community‐acquired pneumonia in adults. Influenza and Other Respiratory Viruses 7(4), 567–573. Background Modern molecular techniques reveal new information on the role of respiratory viruses in community‐acquired pneumonia. In this study, we tried to determine the prevalence of respiratory viruses and bacteria in patients with community‐acquired pneumonia who were admitted to the hospital. Methods Between April 2008 and April 2009, 408 adult patients (aged between 20 and 94 years) with community‐acquired pneumonia were tested for the presence of respiratory pathogens using bacterial cultures, real‐time PCR for viruses and bacteria, urinary antigen testing for Legionella and Pneumococci and serology for the presence of viral and bacterial pathogens. Results Pathogens were identified in 263 (64·5%) of the 408 patients. The most common single organisms in these 263 patients were Streptococcus pneumoniae (22·8%), Coxiella burnetii (6·8%) and influenza A virus (3·8%). Of the 263 patients detected with pathogens, 117 (44·5%) patients were positive for one or more viral pathogens. Of these 117 patients, 52 (44·4%) had no bacterial pathogen. Multiple virus infections (≥2) were found in 16 patients. Conclusion In conclusion, respiratory viruses are frequently found in patients with CAP and may therefore play an important role in the aetiology of this disease.     

Antibiotic-resistant organisms among long-term care facility residents on admission to an inpatient geriatrics unit: Retrospective and prospective surveillance

BACKGROUND: There is limited information about antibiotic-resistant organisms in community long-term care facilities (LTCFs). The objective of this study was to obtain data on resistant organisms in residents from community LTCFs admitted to an inpatient acute geriatrics service (AGS). METHODS: Two studies were performed. In the first study, bacteriology records of all admissions to the AGS for the period from November 1, 1998, through June 30, 2000, were reviewed for resistant organisms (methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant enterococci [VRE], and resistant gram-negative bacilli). In the second study, residents admitted to the AGS during a 2-month period (N = 92 admissions) had surveillance cultures (nares, gastrostomy site, wounds, and urine) for resistant organisms done within 72 hours of admission. RESULTS: In the retrospective study, there were 727 admissions, of which 437 (60%) had 928 cultures within 72 hours of admission; 590 (64%) cultures grew 1 or more pathogens. Urine (65%) and blood (26%) cultures accounted for 91% of all cultures done. Rates of resistance by culture site were as follows: urine (resistant organism in 16.6% of 373 cultures), blood (6.7% of 60 cultures), wound (52% of 23 cultures), and sputum (40% of 20 cultures). MRSA and enterococci with high-level gentamicin resistance were the most common resistant organisms identified. No VRE were isolated; only 3% of 421 gram-negative isolates were considered resistant strains compared with 19% (P <.001) of gram-positive isolates. In the prospective study, 17% of 92 residents were found to have a resistant organism in 1 or more surveillance cultures; the most common resistant organisms were MRSA and high-level gentamicin-resistant enterococci. Only 1 resident was found to have VRE in a rectal swab culture; resistant gram-negative bacilli also were uncommon. CONCLUSIONS: Among residents of community LTCFs admitted to an AGS, resistant organisms were identified infrequently (<20% of admissions). MRSA was the most common resistant organism; VRE and resistant gram-negative bacilli were rare. These findings vary from other studies suggesting that there may be geographic variation in the epidemiology of resistant organisms among residents of community LTCFs.     

Temporal changes in neutropenic blood culture isolates and disease associations: a single centre series of 1139 episodes

Neutropenic infections are life‐threatening and require empiric antibiotic treatment. We examined 1139 blood culture isolates from our institution over a 36‐year period from neutropenic patients to examine temporal trends and disease associations. Positive associations were found between viridans streptococci and acute myeloid leukaemia, coagulase negative staphylococci and acute lymphoblastic leukaemia and Pseudomonas aeruginosa and indolent B‐cell malignancies.     

Epidemiology of community-acquired and nosocomial bloodstream infections in tropical Australia: a 12-month prospective study

OBJECTIVES: To define the relative incidence of organisms causing blood stream infections in a tropical setting with a very low prevalence of human immunodeficiency virus infection (<1%). METHODS: A 12-month prospective study of blood stream infections in 2000 at Royal Darwin Hospital in the tropical north of Australia. RESULTS: Significant isolates were grown from 257 sets of blood cultures. Staphylococcus aureus was the most common isolate overall (28%); 26% of these were methicillin-resistant (MRSA). Escherichia coli was the most common cause of community-acquired bacteraemia. Burkholderia pseudomallei caused 32% of community acquired, bacteraemic pneumonia; 6% of bacteraemias overall. Vancomycin-resistant enterococci were not isolated. Crude mortality rates (13% overall; 9% attributable mortality) were lower than in most comparable studies. CONCLUSIONS: The major difference between these findings and surveys performed elsewhere is the presence of B. pseudomallei as a significant cause of bacteraemic community-acquired pneumonia. Our results demonstrate the effects of local environmental and patient characteristics on the range of organisms causing blood stream infections, and emphasize the important role of local microbiology laboratories in guiding empiric antibiotic therapy.     

Outcome predictors of cirrhotic patients with spontaneous bacterial empyema

Background: Spontaneous bacterial empyema (SBE) is a complication of cirrhotic patients in which a pre‐existing pleural effusion becomes infected. This retrospective study was designed to investigate the bacteriology and outcome predictors of SBE in cirrhotic patients. Methods: Medical records of cirrhotic patients treated in a tertiary care university hospital from December 2004 to December 2008 were retrospectively reviewed. Results: Of 3390 cirrhotic patients seen during the study period, 81 cases of SBE were diagnosed. The incidence of SBE was 2.4% (81/3390) in cirrhotic patients and 16% (81/508) in patients with cirrhosis with hydrothorax. There were 46 monomicrobial infections found in 46 SBE patients. Aerobic Gram‐negative organisms were the predominant pathogens (n=29, 63%), and Escherichia coli (n=9, 20%) was the most frequently isolated sole pathogen. The mortality rate of SBE was 38% (31/81). Univariate analysis showed that Child–Pugh score, model for end‐stage liver disease (MELD)–Na score, concomitant bacteraemia, concomitant spontaneous bacterial peritonitis, initial intensive care unit (ICU) admission and initial antibiotic treatment failure were predictors of poor outcomes. Multivariate regression analysis demonstrated that the independent factors related to a poor outcome were initial ICU admission [odds ratio (OR): 4.318; 95% confidence interval 1CI) 1.09–17.03; P=0.037], MELD–Na score (OR: 1.267; 95% CI 1.08–1.49; P=0.004) and initial antibiotic treatment failure (OR: 13.10; 95% CI 2.60–66.03). Conclusion: Spontaneous bacterial empyema in cirrhotic patients is a high mortality complication. The independent factors related to poor outcome are high MELD–Na score, initial ICU admission and initial antibiotic treatment failure. High MELD–Na score may be a useful mortality predictor of SBE in cirrhotic patients.     

Ofloxacin: new applications for the prevention of urinary tract infections in renal graft recipients

C. Rafat, S. Vimont, P.Y. Ancel, Y.C. Xu‐Dubois, L. Mesnard, N. Ouali, M. Denis, A. Vandewalle, E. Rondeau, A. Hertig. Ofloxacin: new applications for the prevention of urinary tract infections in renal graft recipients
Transpl Infect Dis 2011: 13: 344–352. All rights reserved Abstract: Background. Urinary tract infections (UTIs), the most common form of bacterial infection in kidney transplant recipients, recently have been demonstrated to be detrimental for long‐term graft outcome. Therefore, reinforcing antibiotic prophylaxis might be vital, in addition to basic hygiene recommendations, surgical care, and prophylaxis by trimethoprim–sulfamethoxazole. Methods. In 2006, a Legionella pneumophila contamination of our department's water pipes meant that all the patients undergoing renal transplantation underwent a 1‐month regimen of ofloxacin (OFLO) (200 mg every other day). We took this opportunity to measure the incidence of UTI, including acute pyelonephritis (APN), in 100 consecutive patients transplanted before (n=50) and after (n=50) this treatment decision was reached. We also studied the antimicrobial resistance profiles in our department and in the rest of the hospital. Results. No patient developed Legionnaire's disease. A dramatic decrease in the incidence of UTI (?63%) was also seen in patients undergoing OFLO treatment. Logistic regression analysis demonstrated that the use of OFLO was independently associated with a reduction in UTI (odd ratio [OR]=0.31%, 95% confidence interval [CI] 0.11–0.84, P=0.02) and APN (OR=0.21%, 95% CI 0.07–0.98, P=0.045). This protection was sustained during the whole first year post transplantation. As for resistance rates, we observed a decrease in the susceptibility of Pseudomonas aeruginosa to ciprofloxacin in our nephrology department, compared with that observed in the rest of the hospital. The incidence of multi‐resistant bacteria was stable. Discussion. Our unintentional extension of prophylactic antibiotherapy with OFLO gave rise to a dramatic decrease in the 1‐year incidence of UTI and APN in kidney recipients. Emergence of resistant strains is, however, a major concern.     

Antimicrobial stewardship opportunities among inpatients with diabetic foot infections: microbiology results from a tertiary hospital multidisciplinary unit

Among 125 inpatients with diabetic foot infections managed by a multidisciplinary foot ulcer unit, knowledge of methicillin‐resistant Staphylococcus aureus colonisation status assisted decision‐making to prescribe appropriately or with‐hold empiric anti‐methicillin‐resistant Staphylococcus aureus therapy. Despite adherence to national guidelines, apparent overuse of anti‐pseudomonal therapy was frequent, providing potential antimicrobial stewardship opportunities.     

Bloodstream infections in a secondary and tertiary care hospital setting

Background: Bloodstream infections (BSI) occurring in community and health‐care settings vary with the patient group and treatment of underlying medical conditions. We studied the clinical infectious syndromes occurring in patients with positive blood cultures routinely obtained at a regional secondary and tertiary care hospital. Methods: BSI were categorized as either community‐acquired (C‐BSI), or health‐care‐associated (H‐BSI) acquired either as a (i) non‐inpatient (outpatient) or (ii) hospital inpatient. Clinical information was collected prospectively during the 1‐year study. Results: There were 193 C‐BSI and 230 H‐BSI. The large majority of C‐BSI were caused by bacterial pathogens susceptible to narrow‐spectrum antibiotics, particularly in children. Cefuroxime was active against 90% of C‐BSI isolates and 46% of H‐BSI isolates, excluding anaerobes. Of all H‐BSI, the 35% occurring in outpatients had a similar source, microbiological cause and bacterial susceptibilities to the inpatients. H‐BSI were infrequently due to enterococci (4%), Candida (3%) or methicillin‐resistant Staphylococcus aureus (0.4%). No BSI were due to vancomycin‐resistant enterococci or extended‐spectrum β‐lactamase producing Enterobacteriaciae. I.v. catheters, predominantly central lines, were the source of 60% of all H‐BSI, mostly in haematology–oncology or neonatal patients. Mortality at 1 month was 12% overall for both C‐BSI and H‐BSI, varying markedly by underlying disease and increasing age (for C‐BSI). Conclusion: In this population, C‐BSI have remained susceptible to narrow‐spectrum antibiotics, whereas H‐BSI due to multiresistant organisms were rare. Obtaining a history of recent medical procedures is important for community patients presenting with a BSI.