Nosocomial respiratory infection caused by Pseudomonas cepacia in immunocompromised hosts]

Pseudomonas cepacia is a gram negative rod, having no fermentative activity on glucose. This organism was detected in the sputum, throat swab, or throat washing of 22 inpatients treated between January, 1990, and December, 1990, at the First Department of Internal Medicine, Kagawa Medical School. The primary diseases for which these 22 patients were hospitalized were leukemia in 12, malignant lymphoma in 5, lung cancer in 2, myelodysplastic syndrome in 1, and embryonal cell carcinoma in 1. Twelve of the 22 patients had episodes of pneumonia which complied clinically with the diagnostic criteria provided to facilitate the National Nosocomial Infection Study. The complication of pneumonia occurred in 7 patients with leukemia, 2 with malignant lymphoma, 2 with lung cancer, and 1 with myelodysplastic syndrome. In 10 of these 12 patients, the organism was detected before the onset of pneumonia. All 22 patients in whom the organism was demonstrated had received antibiotics. The antibiotics which was most frequently used to treat these patients 1 month before detection of Pseudomonas cepacia were amikacin and ceftizoxime, which were used in 13 patients. Of the antibiotics in which the susceptibility to Pseudomonas cepacia was, evaluated, minocycline was effective in 100% (21/21), ceftazidime in 50% (11/22), and ofloxacin in 27.3% (6/22). Physicians should be especially aware of the possibility of colonization and nosocomial respiratory infection by Pseudomonas cepacia in patients with severe underlying diseases.     

Nosocomial infections by chlorhexidine solution contaminated with Pseudomonas pickettii (Biovar VA-I)

Over a period of 10 days, six patients in a cardiac intensive care unit developed Pseudomonas pickettii (biovar VA-I) septicaemia after installation of a venous catheter. The organism was also recovered from all the vials of the aqueous solution of 0.05 per cent chlorhexidine ('Hibitane') prepared with contaminated bidistilled water. There were no further cases of infection when the use of this water was prohibited.     

Favorable outcome in a renal transplant recipient with donor-derived infection due to multidrug-resistant Pseudomonas aeruginosa

Most cases of donor-derived infection due to Pseudomonas aeruginosa reported in the literature are associated with vascular dehiscence, all of which resulted either in death or graft failure requiring graft removal. We report the successful treatment of donor-derived infection due to multidrug-resistant P. aeruginosa in a 64-year-old male who presented with bacteremia and peritransplant renal fluid collection after undergoing deceased-donor renal transplantation. As a result of the report of positive donor cultures by the host Organ Procurement Organization, the infection was promptly identified by blood cultures drawn before appearance of symptoms. Surveillance blood cultures in recipients are not usually recommended. However, they should be done if donor cultures turn positive. Therefore, it is crucial to perform cultures in donors and to closely follow them up for early identification and prompt treatment of donor-transmitted infections due to organisms like P. aeruginosa that can be graft and/or life threatening.     

Nosocomial infections due to Xanthomonas maltophilia (Pseudomonas maltophilia) in patients with cancer

From December 1985 to May 1986, Xanthomonas maltophilia (formerly known as Pseudomonas maltophilia) was isolated at an increased rate at our institution; 52 isolates of X. maltophilia were obtained in cultures of clinical specimens from 38 patients during that time. The records of 35 of these patients form the basis of this study. Twelve (71%) of the 17 infected and nine (50%) of the 18 colonized patients had received or were receiving antimicrobial therapy. Eleven of 17 patients (three of seven with septicemia, three of five with pneumonia, three with urinary tract infection, and two with wound infection) responded to antimicrobial therapy. Microbiologic studies of the potential environmental sources revealed growth of X. maltophilia in two water faucets and in one water sample from the medical intensive care unit. X. maltophilia is emerging as an important nosocomial pathogen in immunocompromised patients, especially those receiving broad-spectrum antimicrobial therapy.     

Nosocomial infection in a newborn intensive care unit (NICU), South Korea

Background  

This study aimed to determine the occurrence of nosocomial infections (NIs), including infection rates, main infection sites, and common microorganisms. Patients included in the study were taken from a newborn intensive care unit (NICU), in a hospital in South Korea.     

Nosocomial infection caused by multidrug-resistant Staphylococcus aureus with reduced susceptibility to vancomycin and teicoplanin.--Yamagata Prefecture, Japan; May 2004-Jun 2005

Nosocomial infection caused by methicillin-resistant Staphylococcus aureus (MRSA) occurred at a major in Yamagata prefecture hospital between May 2004 and June 2005. We studied pulsed-field gel electrophoresis patterns, antimicrobial susceptibility patterns, and bacteriological features, such as coaglase type for eight isolates, including two of methicillin-resistant Staphylococcus epidermidis (MRSE). Our results suggest that this case was caused by a single strain of multidrug-resistant S. aureus. These 8 clinical isolates indicated reduced susceptibility to vancomycin and teicoplanin. PCR assay results for detection of the staphylococcal vanA, vanB, and vanC gene were all negative as all isolates. In transmission electron microscopy, cell walls appeared thicker than those of a susceptible strain from food poisoning. MRSA with reduced susceptibility to glycopeptide antibiotics may not be treated successfully with vancomycin or teicoplanin, making it important to closely observe MRSA with reduced susceptibility to glycopeptide antibiotics.     

Role of dogs in the spread of Lamblia (Giardia) intestinalis infection

Above 3,300 cases of human lambliasis have been annually notified in Perm since 2004 as shown by the data of the Board of the Federal Service for Surveillance on Consumer Rights Protection. Serological studies show that 22.29% of the Perm dogs have antibodies against Lamblia intestinalis antigens. Social (domestic and working) dogs have been found to be vectors of Lamblia in the urban population. Excretion of Giardia sp. cysts has been recorded in 0.28% of the domestic dogs. Overall, dogs are of no epidemiological value in spreading human lambliasis.     

产ESBLs大肠埃希菌和肺炎克雷伯菌医院感染危险因素及耐药性分析

目的探讨我院产超广谱β-内酰胺酶(ESBLs)大肠埃希菌和肺炎克雷伯菌医院感染的危险因素及耐药性。方法回顾性调查2003年7月～2004年8月67例,院内感染其中产ESBLs大肠埃希菌70株,产ESBLs肺炎克雷伯菌36株,并对其临床相关资料及体外药敏结果进行分析。结果90%以上具有基础疾病,平均年龄超过70岁,医院感染科室10个,100%前期用过抗菌素,住院时间大于30天占61.2%,同时或先后接受过多种或多次侵入性操作者占83.5%,对氨苄西林、头孢菌素类、氨基糖苷类、喹诺酮多重耐药,亚胺培南是目前对ESBLs高度稳定的少数品种之一。结论严重多种疾病并多种侵入性操作是主要危险因素,其次是病程长和广谱抗菌素的长期使用,多种危险因素易导致产ESBLs杆菌感染的产生,应尽早根据病原微生物检查,根据药敏结果选择抗菌素。     

耐多药肺结核继发肺部真菌感染51例临床分析

目的探讨耐多药肺结核继发肺部真菌感染的危险因素、临床特点及诊治方法，以提高对2病并存时临床表现的认识和综合处理的能力。方法回顾湖北黄石市二医院2002年以来收治的51例耐多药肺结核合并肺部真菌感染的病历资料，并进行分析。结果合并肺部真菌感染的耐多药肺结核均有明显易感因素，其临床特点：结核病史长；复治病例多；年龄偏大；肺部病变广泛，空洞多，病情较重；主要致病真菌为念珠菌。结论耐多药肺结核易继发肺部真菌感染，提高对2病并存的认识，有利于耐多药肺结核病的控制及降低死亡率。     

控制多耐药细菌医院内感染任重道远

近两年来,笔者参加各种抗感染相关的会议,被问到频率最高的一个问题就是危重监护病房(ICU)患者痰培养到泛耐药的鲍曼不动杆菌如何治疗。这个问题一方面反映国内泛耐药的鲍曼不动杆菌流行已成燎原之势,细菌耐药的形势非常严峻;但从另一     

Efficacy of various disinfectants in killing a resistant strain of Pseudomonas Aeruginosa by comparing zones of inhibition: implications for endoscopic equipment reprocessing

Objective: Previous studies have shown that high-level disinfection of GI endoscopes may not be reliably achieved using glutaraldehyde at room temperature. In our laboratory, we have isolated a strain of Pseudomonas aeruginosa that is resistant to disinfection with glutaraldehyde. We compared the bactericidal activity of various disinfectants against this organism.
Methods: One hundred microliters of an overnight culture of this organism was spread onto blood agar plates. Twenty microliters of a disinfectant was placed on a sterile 7-mm filter paper, placed on the blood agar plate, and incubated overnight at 37°C to determine the zone of inhibition for each disinfectant tested. Disinfectants included Cidex, Dispatch, Virahol, OMNI II, Lysol, IodoFive, Lysol I.C. Spray, and Chlorox. The zone of inhibition ( i.e ., clearing) roughly correlates with the bactericidal strength of the disinfectant.
Results: Compared with the glutaraldehyde-containing solution Cidex, the alcohol-containing disinfectants Lysol I.C. Spray and Virahol had the largest mean zones of inhibition (11.33 vs 20.60 and 20.55 mm;   p = 0.0001  ). The hypochlorite compounds Chlorox (1:10 dilution) and Dispatch had mean zones of inhibition similar to that of Cidex (11.08 and 11.25 mm vs 11.33 mm;   p = not significant  ). The phenolic compounds OMNI II and Lysol had mean zones of inhibition smaller than that of Cidex (10.50 and 10.35 mm vs 11.33 mm;   p < 0.006  ), and the phosphoric acid and iodine–containing IodoFive had the smallest mean zone of inhibition (9.70 vs 11.33 mm;   p = 0.0001  ).
Conclusions: The alcohol-containing disinfectants had the largest zones of inhibition against resistant P. aeruginosa . These compounds may be more effective than glutaraldehyde for endoscopic equipment reprocessing.