A five year outbreak of methicillin-susceptible Staphylococcus aureus phage type 53,85 in a regional neonatal unit

We identified a 5-year outbreak of a methicillin-susceptible Staphylococcus aureus (MSSA) strain, affecting 202 babies on a neonatal unit, by routine weekly phage typing all S. aureus isolates. Multiple staged control measures including strict emphasis on hand hygiene, environmental and staff surveillance sampling, and application of topical hexachlorophane powder failed to end the outbreak. S. aureus PT 53,85 (SA5385) was found on opened packs of Stomahesive, used as a neonatal skin protectant. Only following the implementation of aseptic handling of Stomahesive, and the use of topical mupirocin for staff nasal carriers of SA5385, and for babies colonized or infected with S. aureus, did the isolation rate of SA5385 decline. DNA fingerprinting indicated that > or =, 95% of SA5385 isolates were clonal. In vitro death rates of SA5385 on Stomahesive with human serum were significantly lower than on Stomahesive alone (P = 0.04), and on cotton sheet with serum (P = 0.04), highlighting the potential of this material as a survival niche. Phage typing remains a valuable, inexpensive and simple method for monitoring nosocomial MSSA infection.     

Efficacy and tolerability of pantoprazole 40 mg versus 80 mg in patients with reflux oesophagitis.

BACKGROUND: Pantoprazole is a substituted benzimidazole which is a potent inhibitor of gastric acid secretion by its action upon H+, K+- ATPase. METHODS: Pantoprazole 40 mg and 80 mg were compared in a randomized double-blind study in 192 out-patients with stage II or III (Savary-Miller classification) reflux oesophagitis. Patients received either pantoprazole 40 mg (n = 97) or pantoprazole 80 mg (n = 95), once daily before breakfast for 4 weeks. Treatment was extended for a further 4 weeks if the oesophagitis had not healed. RESULTS: After 4 weeks complete healing of the reflux oesophagitis was seen in 78% of protocol-correct patients given pantoprazole 40 mg daily (n = 86), and in 72% in the 80 mg (n = 87) group. The cumulative healing rates after 8 weeks were 95 and 94%, respectively (P > 0.05, Cochran-Mantel- Haenszel), and time until healing of oesophagitis comparable in both groups. Differences between doses were also not significant in an intention-to-treat analysis. Both dosing schedules were well tolerated and the patients experienced remarkable symptom relief. No adverse event or changes in laboratory values of clinical significance could definitely be ascribed to the trial medication. CONCLUSION: The 40 mg pantoprazole dosage is comparable to 80 mg in reflux oesophagitis, both in efficacy and tolerability.     

NSAIDs, coxibs, and the intestine

Nonsteroidal anti-inflammatory drugs (NSAIDs) are capable of damaging the whole gastrointestinal tract. Small and large intestinal injuries manifest as acute changes in permeability with endoscopic erosions, chronic erosions and ulcers, diaphragms in the small bowel, and an increase in small and large bowel complications including perforation and diverticular bleeding. It is quite likely, though not proven, that such lesions contribute to anemia in patients taking them. A growing body of data shows that selective inhibitors of the cyclooxygenase-2 enzyme have much reduced toxicity in this respect. In addition, NSAID use has also been associated with development or relapse of ulcerative colitis. Whether the same is true of Crohn's disease, particularly of the small bowel, is less clear. An important point is that there are data that suggest that paracetamol may also not be devoid of toxicity. This makes use of selective cyclooxygenase-2 inhibitors attractive. There have been a number of reports of their use in inflammatory bowel disease. However, many of these have principally involved Crohn's disease and there have not been enough to be clear whether they affect the influence of relapse of ulcerative colitis.     

Novel beta-lactamase from Capnocytophaga sp

A novel beta-lactamase activity which confers resistance to expanded-spectrum cephalosporins and penicillins has been found in strain IC 5/21 of Capnocytophaga spp. Enzyme activity migrated at a molecular size of 38,000 daltons and at an isoelectric point of 3.6, with a minor band at 4.1. Kinetic studies suggested that it belonged to Richmond and Sykes beta-lactamase class 1c. Isoelectric focusing could be achieved only if a nonionic detergent was added to the gel, suggesting the presence of a hydrophobic enzyme akin to a membrane-bound beta-lactamase of gram-positive bacteria. The location of the gene coding for this beta-lactamase is not yet known.     

Severe haemolytic anaemia and disseminated intravascular coagulation in a wallaby (Macropus rufogriseus)

Severe haemolytic anaemia and diffuse intravascular coagulation were identified in a red-necked wallaby which was also suffering from necrobacillosis. Since no other cause of the haemolysis could be identified, the anaemia was probably due to haemolysins produced by the anaerobic organisms of the necrobacillosis lesion.