The Journal of hospital infection
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Editorial Comparative Study
Antibiotic resistance associated with selective decontamination of the digestive tract.
Selective decontamination of the digestive tract (SDD) appears to reduce infection, particularly pneumonia, in intensive care, and some patients benefit markedly. Gram-positive overgrowth and antibiotic resistance in both Gram-positive and Gram-negative organisms has been recorded. However, the clinical and epidemiological significance of these observations is still debated. Future studies will need to be of sufficient size and duration to provide good quality data on which the safety and efficacy of SDD can be properly judged.
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Comparative Study
Pseudomonas cepacia pulmonary infection in adults with cystic fibrosis: is nosocomial acquisition occurring?
Ribotyping of 25 isolates of Pseudomonas cepacia taken from the sputum of 21 adults with cystic fibrosis (CF) who were registered at the Royal Brompton Hospital between 1987 and 1991, revealed that seven patients (33.3%) shared strains of a similar ribotype pattern with others, while 14 patients (63.7%) harboured strains unique to each individual. Constancy of sputum strain carriage was seen in two of three patients sampled twice over a 3-month period. Although no evidence for patient-to-patient transmission of P. cepacia within this group of patients was found, the fact that one third of CF patients shared strains of the same ribotype with others, suggests that nosocomial acquisition of this organism may have occurred.
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Although catheter-related sepsis (CRS) is an important cause of nosocomial infection and the major complication of intravenous catheter use, there is, as yet, no consensus concerning either a useful definition of CRS or the optimal method of catheter management and prevention of infection. Semiquantitative culture of catheter tips is a useful method of diagnosis of CRS but other techniques such as quantitative catheter blood cultures and Gram staining of the catheter have roles in selected patients. The most significant impact on the prevention of CRS is made by the introduction of an intravenous therapy team. ⋯ Techniques such as guide-wire exchange and catheters such as triple lumen and total implantable venous access devices have their own infection problems. Many new and interesting approaches to the prevention of CRS are being formulated. To facilitate further progress, a standardized definition for diagnosis, and revised recommendations for prevention of CRS would be helpful.
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Comparative Study
In-hospital evaluation of contamination of duodenoscopes: a quantitative assessment of the effect of drying.
A prospective, quantitative assessment was undertaken of the effect of drying on the bacterial load in duodenoscopes that had been used for endoscopic retrograde cholangiopancreatography procedures. The endoscopes were washed and disinfected using an automatic washer and samples were taken through the suction channel at 2, 24 and 48 h post-disinfection. Twenty-one of the 42 duodenoscopes tested were contaminated. ⋯ If the additional 10 min of drying was used, then no alcohol rinse was required. Although no infections related to use of contaminated endoscopes were reported, it was apparent that Gram-negative bacilli were multiplying to unacceptably high concentrations and that this could be prevented by an additional 10 min of drying. The additional drying was only required at the end of the endoscopy list and not between patients.
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Interactions between the indigenous flora of the gastrointestinal tract and immunologically competent cells in the gut mucosa, gut-associated lymphoid tissues and liver play an important role in normal immune homeostasis. The microbial flora of the normal gut is complex, yet remarkably constant over time. ⋯ On the other hand, overgrowth of the gut, particularly by Gram-negative bacteria or fungi, facilitates the translocation of bacteria into the host, and results in suppression of T-cell responses and altered hepatic Kupffer cell function. Bacterial overgrowth and the consequences of the interactions of this potentially pathogenic flora with the gut immune system may contribute to the septic state in critical illness, and to the syndrome of multiple organ failure.