An outbreak of pemphigus neonatorum

During the summer of 1987, an epidemic of pemphigus neonatorum took place at Guy's Hospital. It involved more than 80 neonates in the maternity unit. Swabs from the umbilical stumps of the babies and from the noses of several attending midwives yielded Staphylococcus aureus of phage-type Group II 3A/3C. Despite an extensive disinfection policy, which included identification and treatment of carriers, the outbreak persisted for 3 months. Final resolution came only after detailed epidemiological research revealed those midwives most likely to be involved. After these had been singled out for further treatment, the outbreak ended. The epidemic strains were later subjected to reverse phage-typing, plasmid profiling and in vivo testing for production of epidermolytic toxin in order to confirm true carriers and cases. Retrospective analysis identified those persons most likely to have been responsible for propagation of the epidemic strain. The exact course of the outbreak was then clarified.     

The effects of vocational noise exposure on hearing aid battery subjective life

This study examined the effects of vocational training noise on subjective battery life and on battery current drain, in 5 different class B hearing aids worn by students at a school for the deaf. Each S used a mercury battery in the morning in an average listening school environment with a 2-hr period of vocational noise exposure included, and another battery in an average school listening environment from after lunch to bed time. Voltage measurements and usage hrs were recorded until S reported the battery was not working. There were no mean differences in subjective battery life nor in recorded voltage drop between the two conditions. Battery life in 2 batteries exposed to vocational noise may have been extended due to a 10-day rest period during the spring break for these 2 students.     

Auditory versus visual practice effects in the intelligibility of words in everyday sentences

The improvement in speech reception from a TV screen was investigated in 15 young adults with normal audition (A) and vision (V) in the A-only and the V-only modes. Trial 1 consisted of 100 key words from Lists A, B, C, D of the Revised CID Everyday Sentences. S wrote down as much of the sentences as was perceived. In the A mode the speech and a white noise both at azimuth 0 degree were both at 65 db SPL. A and V modes were randomized across Ss. After 30 min, Trial 2 repeated Trial 1 exactly. The mean improvement in the A mode was 10.3 percentage points (words) (p less than .01), in the V mode 3.4 points (p less than .05). Improvement in the A mode was significantly (p less than .01) the greater. The r for individual change from Trial 1 to Trial 2 for the A vs the V mode was only +.13 (p much greater than .05). These practice-only effects are comparable to those reported for similar procedures in training (with feedback) in these modes, and call into question the interpretation of the efficacy of such training procedures, and question the advisability of generalizing the effects of training across essentially independent modalities.     

Outbreak of staphylococcal scalded skin syndrome among neonates

Over a period of 2 months, 12 babies born in the maternity unit at Guy's Hospital developed staphylococcal scalded skin syndrome in two distinct outbreaks. Staphylococci isolated from the babies, together with those from the mothers and attending medical staff were phage-typed. All isolates from the babies were of type 3A/3C. During the first outbreak only one carrier of the epidemic strain (a paediatrician) was found but a further 12 persons were identified as possible carriers during the second outbreak. In order to confirm the link between outbreaks, all phage group II isolates were subjected to reverse phage-typing, testing for metal-ion resistance, plasmid profiling and in-vivo testing for production of epidermolytic toxin. It was shown that the same epidemic strain of toxin-producing Staphylococcus aureus was responsible for both outbreaks. The affected neonates responded rapidly to a short course of intravenous flucloxacillin. The outbreak ceased after appropriate treatment of all carriers and the implementation of an extensive disinfection policy within the maternity unit.     

The effect of antibiotics on methicillin-resistant Staphylococcus aureus

Antimicrobial drugs encourage the overgrowth of organisms resistant to the agents used. Acquisition and subsequent overgrowth of methicillin-resistant Staphylococcus aureus (MRSA) are particularly associated with beta-lactam antibiotics and quinolones. These drugs allow rapid proliferation of an organism that might have been merely colonizing the skin, leading to clinical infection, treatment difficulties and potential transmission to others. In addition, there is increasing evidence that inappropriate antibiotics not only encourage overgrowth with MRSA but may also enhance pathogenicity. Such virulence is not necessarily due to simple expansion of MRSA across skin and mucosal surfaces; there appear to be molecular changes that facilitate mechanisms such as quorum sensing, adhesion, phage mobilization, exotoxin production, intracellular persistence and biofilm formation, all of which contribute towards more severe infection. This review examines the association between MRSA and certain classes of antibiotics and explores the molecular mechanisms underlying a perceived increase in virulence following inappropriate therapy. It is possible that empirical prescribing has a significant impact on the management of MRSA infections and ultimately patient outcome. It is time to challenge the prescribers' right to prescribe what they like, when they like, for patients at risk of MRSA.