The Journal of hospital infection
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Clinical Trial
Prevention of percutaneous endoscopic gastrostomy site infections caused by methicillin-resistant Staphylococcus aureus.
Percutaneous endoscopic gastrostomy (PEG) is widely used to maintain enteral nutrition in patients who are unable to swallow. Peristomal wound infection is the most common complication of this procedure. In a hospital endemic for methicillin-resistant Staphylococcus aureus (MRSA), MRSA can be the most common organism associated with these infections. ⋯ None of nine patients who received glycopeptide prophylaxis alone (Group C) were infected. The results suggest that the strategy of screening, decontamination and glycopeptide prophylaxis is effective in the prevention of PEG-site infections with MRSA. Further trials are necessary to confirm these findings.
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Ventilator-associated pneumonia is the most common nosocomial infection. Mortality rates, morbidity, and costs are all increased in the patient with VAP, and every measure should thus be taken to prevent its development. There are several clearly defined risk factors for VAP, and awareness of these can facilitate early diagnosis and hence treatment. In this article, we discuss the risk factors, strategies for prevention, approaches to diagnosis and management plan for the patient with VAP.
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Comparative Study
Molecular biology of extended-spectrum beta-lactamase-producing Enterobacteriaceae responsible for digestive tract colonization.
Twenty-nine extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae strains (14 Klebsiella pneumoniae, 10 Escherichia coli and five Citrobacter diversus) isolated from April to July 1996 from faecal carriers in a surgical intensive care unit at the university hospital of Casablanca (Morocco) were studied. Plasmid content and DNA macrorestriction polymorphism determined by pulsed-field gel electrophoresis (PFGE) were used to compare the strains. Restriction profiles of total genomic DNAs cleaved by XbaI and compared by PFGE revealed nine, four and two clones in K. pneumoniae, E. coli and C. diversus, respectively. ⋯ No plasmid transfer could be obtained from C. diversus strains. Restriction enzyme digests of plasmids from transconjugants (four transconjugants of K. pneumoniae and five transconjugants of E. coli) showed different patterns. In the surgical intensive care unit where the survey was conducted, the dissemination of ESBLs was due to a mix of strain spread and strain diversity rather than to plasmid dissemination.
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Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in patients on mechanical ventilation and results in increases in mortality, prolonged hospitalization and costs. Preventive measures for VAP are well-documented and evidence-based, yet remain poorly implemented in most intensive care units. We undertook an observational pre and post-intervention study to assess whether an educational programme focusing on preventive practices for VAP could reduce the incidence. ⋯ VAP infection rates reduced by 51%, from a mean of 13.2+/-1.2 in the pre-intervention period to 6.5+/-1.5/1000 device days in the post-intervention period (mean difference 6.7; 95% CI: 2.9-10.4, P =0.02). A multidisciplinary educational programme geared towards intensive care unit staff can successfully reduce the incidence rates of VAP. Further studies will be needed to assess the impact on broader outcome measures such as costs or mortality.