Antibiotic susceptibility of clinical isolates of Staphylococcus intermedius and Staphylococcus aureus from dogs in Grenada.

Sixty-nine Staphylococcus intermedius isolates from various clinical conditions in dogs over a 3 year period were evaluated for in vitro susceptibility to 8 antibiotics using the disk diffusion method. The majority of the isolates originated from cases of pyoderma (30.4%), and otitis externa (29.0%). The least resistance was seen against cephalothin (1.6% of the 64 isolates, followed by chloramphenicol (3.9% of 26 isolates). Highest resistance was seen against ampicillin (34.4% of 32 isolates), followed by tertracycline (29.0% of 69 isolates). Resistance rates to other drugs were as follows: enrofloxacin 17.1%, gentamicin 7.3%, neomycin 6.1% and amoxicillin-clavulanic acid, 4.6%. Eleven isolates of S. aureus, showed no resistance to cephalothin. Overall the S. intermedius and S. aureus isolates were highly sensitive to cephalothin (98.7% susceptibility), suggesting that the first generation cephalosporins may be most useful drugs for treatment of Staphylococcus infection in dogs in Grenada.

Prevalence of Shigella serogroups and their antimicrobial resistance patterns in southern Trinidad.

The serogroup distribution and antimicrobial susceptibility patterns of Shigella isolates obtained from stool specimens of persons with acute diarrhoea in community-based studies from southern Trinidad during 1997-2006 were reviewed. Of the 5,187 stool specimens, 392 (8 per cent) were positive for Shigella organisms. From these 392 isolates, 88.8 per cent were recovered from children aged >0-10 year(s). Shigella sonnei was the most frequently-isolated serogroup (75 per cent), followed by S. flexneri (19 per cent), S. boydii (4.1 per cent), and S. dysenteriae (1.8 per cent). S. flexneri was the major isolate among the >20-30 years age-group. The most common drug resistance among all age-groups was to ampicillin. All strains of S. flexneri, S. boydii, and S. dysenteriae were fully susceptible to aztreonam, gentamicin, and ciprofloxacin. S. sonnei, the most common species isolated, showed resistance to all antibiotics tested. The data showed that, throughout the study period, the resistance to commonly-used drugs was relatively low. Since resistance to several drugs seems to be emerging, continuous monitoring of resistance patterns is mandatory for the appropriate selection of empiric antimicrobial drugs in the therapy of suspected cases of shigellosis.

Antibiotic susceptibility of clinical isolates of Staphylococcus intermedius and Staphylococcus aureus from dogs in Grenada.

Sixty-nine Staphylococcus intermedius isolates from various clinical conditions in dogs over a 3 year period were evaluated for in vitro susceptibility to 8 antibiotics using the disk diffusion method. The majority of the isolates originated from cases of pyoderma (30.4%), and otitis externa (29.0%). The least resistance was seen against cephalothin (1.6% of the 64 isolates, followed by chloramphenicol (3.9% of 26 isolates). Highest resistance was seen against ampicillin (34.4% of 32 isolates), followed by tertracycline (29.0% of 69 isolates). Resistance rates to other drugs were as follows: enrofloxacin 17.1%, gentamicin 7.3%, neomycin 6.1% and amoxicillin-clavulanic acid, 4.6%. Eleven isolates of S. aureus, showed no resistance to cephalothin. Overall the S. intermedius and S. aureus isolates were highly sensitive to cephalothin (98.7% susceptibility), suggesting that the first generation cephalosporins may be most useful drugs for treatment of Staphylococcus infection in dogs in Grenada.

Third generation cephalosporin use in a tertiary hospital in Port of Spain, Trinidad: need for an antibiotic policy

BACKGROUND: Tertiary care hospitals are a potential source for development and spread of bacterial resistance being in the loop to receive outpatients and referrals from community nursing homes and hospitals. The liberal use of third-generation cephalosporins (3GCs) in these hospitals has been associated with the emergence of extended-spectrum beta- lactamases (ESBLs) presenting concerns for bacterial resistance in therapeutics. We studied the 3GC utilization in a tertiary care teaching hospital, in warded patients (medical, surgical, gynaecology, orthopedic) prescribed these drugs. METHODS: Clinical data of patients (>or= 13 years) admitted to the General Hospital, Port of Spain (POSGH) from January to June 2000, and who had received 3GCs based on the Pharmacy records were studied. The Sanford Antibiotic Guide 2000, was used to determine appropriateness of therapy. The agency which procures drugs for the Ministry of Health supplied the cost of drugs. RESULTS: The prevalence rate of use of 3GCs was 9.5 per 1000 admissions and was higher in surgical and gynecological admissions (21/1000) compared with medical and orthopedic (8 /1000) services (p < 0.05). Ceftriaxone was the most frequently used 3GC. Sixty-nine (36%) patients without clinical evidence of infection received 3Gcs and prescribing was based on therapeutic recommendations in 4% of patients. At least 62% of all prescriptions were inappropriate with significant associations for patients from gynaecology (p < 0.003), empirical prescribing (p < 0.48), patients with undetermined infection sites (p < 0.007), and for single drug use compared with multiple antibiotics (p < 0.001). Treatment was twice as costly when prescribing was inappropriate. CONCLUSIONS: There is extensive inappropriate 3GC utilization in tertiary care in Trinidad. We recommend hospital laboratories undertake continuous surveillance of antibiotic resistance patterns so that appropriate changes in prescribing guidelines can be developed and implemented. Though guidelines for rational antibiotic use were developed they have not been re-visited or encouraged, suggesting urgent antibiotic review of the hospital formulary and instituting an infection control team. Monitoring antibiotic use with microbiology laboratory support can promote rational drug utilization, cut costs, halt inappropriate 3GC prescribing, and delay the emergence of resistant organisms. An ongoing antibiotic peer audit is suggested.

Caregivers' practices, knowledge and beliefs of antibiotics in paediatric upper respiratory tract infections in Trinidad and Tobago: a cross-sectional study

BACKGROUND: Antibiotic overuse and misuse for upper respiratory tract infections in children is widespread and fuelled by public attitudes and expectations. This study assessed knowledge, beliefs, and practices regarding antibiotic use for these paediatric infections among children's caregivers' in Trinidad and Tobago in the English speaking Caribbean. METHODS: In a cross-sectional observational study, by random survey children's adult caregivers gave a telephone interview from November 1998 to January 1999. On a pilot-tested evaluation instrument, respondents provided information about their knowledge and beliefs of antibiotics, and their use of these agents to treat recent episodes (< previous 30 days) of upper respiratory tract infections in children under their care. Caregivers were scored on an antibiotic knowledge test and divided based on their score. Differences between those with high and low scores were compared using the chi-square test. RESULTS: Of the 417 caregivers, 70% were female and between 18-40 years, 77% were educated to high school and beyond and 43% lived in urban areas. Two hundred and forty nine (60%) respondents scored high (>or12) on antibiotic knowledge and 149 (34%) had used antibiotics in the preceding year. More caregivers with a high knowledge score had private health insurance (33%), (p < 0.02), high school education (57%) (p < 0.002), and had used antibiotics in the preceding year (p < 0.008) and within the last 30 days (p < 0.05). Caregivers with high scores were less likely to demand antibiotics (p < 0.05) or keep them at home (p < 0.001), but more likely to self-treat with antibiotics (p < 0.001). Caregivers administered antibiotics in 241/288 (84%) self-assessed severe episodes of infection (p < 0.001) and in 59/126 (43%) cough and cold episodes without visiting a health clinic or private physician (p < 0.05). CONCLUSIONS: In Trinidad and Tobago, caregivers scoring low on antibiotic knowledge have erroneous beliefs and use antibiotics inappropriately. Children in their care receive antibiotics for upper respiratory tract infections without visiting a health clinic or a physician. Educational interventions in the community on the consequences of inappropriate antibiotic use in children are recommended. Our findings emphasise the need to address information, training, legislation and education at all levels of the drug delivery system towards discouraging self-medication with antibiotics in children.

Antimicrobial susceptibility survey of Pseudomonas aeruginosa strains isolated from clinical sources

A two-year prospective study of 554 Pseudomonas aeruginosa isolates was recovered from various clinical sources throughout Trinidad, and their resistance patterns to antipseudomonal antimicrobial agents were determined. Of the 554 P. aeruginosa isolates, 20.6% (114/554) were community isolates, 17.3% (96/554) from the intensive care unit (ICU), 10.1% (56/554) from the nursery, and the remaining 52% (288/554) were from other hospital inpatient services. Respiratory tract infections were the predominant source of P. aeruginosa isolates from the ICU--46.9% (45/96)--and nursery--21.4% (12/56), whereas wounds were the principal source of P. aeruginosa from the surgical services--77.0% (141/183). Community isolates of P. aeruginosa were predominantly from ear--100% (51/51)--and urinary tract infections--35.5%, (33/93). The overall prevalence of resistance was low for both hospital isolates (13.9%) and community isolates (3.8%). All community isolates were fully sensitive to four of the nine antimicrobials tested. Resistance rates among community strains ranged from 2.6% (ciprofloxacin and ceftazidime) to 12.3% for piperacillin. All isolates from hospital were fully sensitive to imipenem, but resistance rates for the other drugs ranged between 2.5% and 27.3%. The study showed that the overall resistance pattern of P. aeruginosa was relatively low. This is an encouraging observation but invites caution since resistance to the newly introduced drug, cefepime, has now emerged within the hospital environment and may present serious therapeutic problems within the near future. Policies governing the use of antimicrobials in many institutions are lacking. Such policies must be instituted in order to limit the spread of resistance and also to reduce the emergence of resistance to newly commissioned drugs within the country.

The general public's perceptions and use of antimicrobials in Trinidad and Tobago

Objective: To determine the general public's perception and use of antibiotics in Trinidad and Tobago, a two-island republic in the Caribbean. Methods. This prospective study surveyed 824 randomly selected households listed in the telephone directory, from November 1998 to January 1999. Through telephone interviews we determined knowledge about antibiotics and beliefs concerning their safety and efficacy. We studied the influence of age, gender, education, and having private health insurance on knowledge, self-medication, storing medication at home for emergency use ("hoarding"), and asking a private doctor to prescribe antibiotics ("demand prescribing"). Results. For the 824 telephone calls that the interviewers completed, 753 of the households agreed to participate (91.4 percent response rate). Of those 753 participants, 699 of them (93 percent) knew the term "antibiotic", 29 percent (206/699) said it was a drug for bacterial infections, and 25 percent (170/690) had asked a doctor for an antibiotic prescription. Penicillin was correctly identified as an antibiotic across age, gender, and education categories, but 36 percent of respondents incorrectly said Benadryl (diphenhydramine), a common over-the-counter cough and cold formulation, was an antibiotic. Gender was not significantly associated with knowledge of antibiotic safety, with self-medication, or with hoarding antibiotics. On the other hand, completion of tertiary (university) education was significantly associated with correct knowledge of the safety of antibiotics and whether they could cure all infections. Of the various antimicrobials, beta-lactams were the ones that survey respondents had used most frequently in the preceding year, and 20 percent of antibiotics users had used multiple antibiotics in that period. In comparison to persons with private health insurance, more individuals without private health insurance said that antibiotics are safe and do not have side effects, and more of them also incorrectly called aspirin and Benadryl antibiotics. Conclusions. In Trinidad and Tobago, inappropriate use of antimicrobials results from self-medication, over-the-counter availability at the community pharmacy, prescribing on demand, and lack of regulatory control. In order to contain antibiotic abuse, both the Drug Inspectorate of the Ministry of Health and the Pharmacy Board should exert stricter control on the dispensing of antibiotics at private pharmacies. Further, education of the general public and of health care professionals on antibiotic misuse and appropriate use must be instituted, along with community-based surveillance of antimicrobial resistance trends (AU)

Evaluation of augmentin and cotrimoxazole against 276 pathogens in community acquired urinary tract infections [abstract]

OBJECTIVE: Augmentin and cotrimoxazole are the front-line drugs in the therapy of community acquired urinary tract infections. This report examines the in vitro efficacy of these two drugs against 276 urinary pathogens encountered from patients attending outpatient clinics at the University Hospital of the West Indies. METHODS: The urines collected from outpatients in 3 months (March to May, 2001) were cultured semi-quantitatively. The isolates (o 10 cfu/ml) were identified by routine methodology and antimicrobial susceptibilities were determined by the standard disc-diffusion technique. RESULTS: Of the 276 isolates, 190 (68.8 percent) were gram negative and 86 (31.2 percent ) were gram positive pathogens. The common isolates in order of frequency were: Escherichia coli 89 (32.2 percent), Enterococci/Group D Streptocci 33 (12.0 percent, Proyteus mirabilis 28 (10.1 percent), Klebsiella sp 25 (9.1 percent) and coagulase negative Staphulococci 20 (7.2 percent). These five organisms together accounted for over two-thirds (70.7 percent of all isolates. Augmentin was effective against 71.0 percent of all, 68.9 percent of gram negative and 75.6 percent of gram positive pathogens and cotimoxazole was effective against 63.0 percent of all, 58.4 percent gram negative and 73.3 percent of gram-positive isolates. CONCLUSION: Despite decades of their usage, augmentin and cotrimoxazole continue to be effective in community acquired urinary tract infections. (AU)

Antimicrobial sensitivity of Haemophilus influenzae isolates from bacterial conjunctivitis

Haemophilus influenzae is one of the common bacterial pathogens which affect children. Resistance to frequently use antibiotics is becoming a significant problem in community isolates of common pathogens. A retrospective review was conducted of the serotypes and antimicrobial sensitivity of H influenzae isolates from bacterial conjunctivitis, over an 18-month period. Data on antimicrobial sensitivity (obtained by the National Committee for Clinical Laboratory Standards disk diffusion method) and B-lactamase production, and typing results, were analysed. Ninety-nine islolates were recovered, of which 87 were typed. Most isolates were recovered from children under one year of age. Ninety-three percent were unencapsulated and biotypes I and IV were most common. H influenzae type b was recovered only twice. B-lactamase was produced by 41 percent isolates while four isolates were ampicillin-resistant but did not produce B-lactamase. All isolates were sensitive to chloramphenicol and 45 percent were co-trimoxazole sensitive. H influenzae is commonly isolated from bacterial conjunctivitis in Barbados and, as elsewhere, the majority of isolates are from small children and are non-encapsulated. However, there is a high prevalence of B-lactamase production, which may serve as a reservoir for transfer to more invasive encapsulated strains of H influenzae within the oropharyngeal flora.(Au)

The appropriateness of the current antibiotic empiric therapy based on the bacteria isolated from severely malnourished Jamaican children

We performed a retrospective audit of antimicrobial sensitivities of bacteria isolated from children admitted with a diagnosis of malnutrition to the Tropical Metabolism Research Unit (TMRU), University of the West Indies, between January 1995 and December 1999. There were 150 admissions for severe malnutrition to the TMRU during this period, which was approximately 50 percent fewer than in a previous TMRU study done ten years ago, between 1984 and 1989. In the present study, bacteraemia was documented in 10 percent of 150 severely malnourished children between 1 and 31 months of age. The most common organism isolated were coagulase-negative Staphylococci, which represented 40 percent of the total isolates. The micro-organism grown were most likely to be sensitive to amoxycillin/clavulanic acid. The current TMRU treatment protocol for severe malnutrition recommends use of crystalline penicillin plus gentamicin as empirical antibiotic therapy. This study has provided valuable information suggesting that the current empiric antibiotic therapy may be inappropriate. (AU)

Prevalence of resistance to antimicrobials of Escherichia coli isolates from clinical sources at a private hospital in Trinidad

Antimicrobial susceptibility patterns of strains of Escherichia coli isolated between 1994 and 1998 were studied. Of the 1,283 strains examined, 75% were recovered from urine, 8.7% from wounds, 3.2% from blood, 2.6% from pus, and 10.5% from other sources. Isolates from inpatients and outpatients accounted for 46.1% and 53.9%, respectively. Gentamicin and nalidixic acid showed the greatest efficacy against isolates from both inpatients and outpatients, revealing a >90% sensitivity. Drugs with the lowest efficacies were ampicillin and amoxicillin-clavulanic acid, which showed a >45% resistance. Tetracycline showed a significant decline in resistance from 1994 to 1998 among strains from both inpatients and outpatients (P < 0.001). This decline may be related to a policy of restrictive antibiotic reporting by the Microbiology Laboratory and seminars for general practitioners, subsequent to an island-wide survey an antibiotic resistance. A similar pattern of declining resistance was also observed for cefuroxime. E. coli sensitivity to co-trimoxazole was relatively stable during the study period. Although the overall prevalence of resistance among E. coli strains is relatively low, on-going surveillance of bacterial resistance must continue. The microbial antibiogram can provide general practitioners and clinicians with data essential for optimum empiric choices. Further, the introduction of a policy of restrictive reporting may act "synergistically" with the education of doctors on resistance patterns, to effect island-wide reduction of antimicrobial resistance.

Antibiotic susceptibility of clostridium difficile isolates from adult patients at two Jamaican hospitals. Clinical and epidemiological implications

The susceptibility of 39 toxin producing Clostridium difficile isolates from stools of hospitalized patients was determined, by disc diffusion, to six antibiotics. All but one isolate (toxin A negative) produced toxin A and Toxin B. A wide variation in susceptibility to clindamycin, tetracycline and chloramphenicol was noted. Erythromycin and cotrimoxazole showed a clear-cut discrimination in resistance and susceptibility, while all isolates were sensitive to vancomycin. Erythromycin sensitive isolates demonstrates a significant association with diarrhoea (60.9 percent, 14/23, p<0.001). These strains were predominantly found at the University Hospital of the West Indies (UHWI, 94.1 percent, 16/17). Strains resistant to erythromycin and clindamycin together were commonly found at the National Chest Hospital (NCH, 68.2 percent, 15/22). All erythromycin sensitive strains found at the NCH were from patients transfered to that hospital. These findings suggest that there is a common strain of C difficile (erythrmycin resistant) at the NCH different from that found at the UHWI; the resistant pattern seen with isolates from the NCH was typical of toxigenic serogroup C strain and could be typed by the disc diffusion method. Patients at the NCH who were colonized with either of the two strains of C difficile were likely to get diarrhoea, once there suppression of the normal microflora by antibiotics and colonic over growth with C difficile. (AU)

Evaluation of neonatal sepsis screening in a tropical area. Part II: Evaluation of intrapartum chemoprophylaxis protocol

The authors report on an analysis of a chemoprophylaxis protocol at the University Hospital of Guadeloupe in the Caribbean. This study comprised 6,060 consecutive deliveries and was initiated to assess the application of an intrapartum chemoprophylaxis protocol, evaluate the results, and try to identify possible necessary modifications to the existing protocol. Although more than 90 percent of women had at least one bacterial screening (vaginal or urinary) during the last trimester of pregnancy, approximately 75 percent of mothers who were heavily colonized group B streptococcus (GSB) at delivery were not detected by this systematic screening. As is also reported in other tropical areas where a great portion of nenonatal sepsis occurs in term babies, low birthweight was not a specific risk factor in this study when controlling for other major risk factor such as fever and premature rupture of membranes. Intrapartum chemoprophlaxis was associated wiyh an approximate three fold decrease in the risk of GBS neonatal bacteraemia among at risk deliveries. The results suggest that, in our tropical context, prolonged rupture of membranes of at least 12 hours' duration should be considered as a cause for intrapartum chemopropylaxis as it accounted for the majority of neonatal bacteraemia that escaped the existing protocol. (AU)

Invasive pneumococcal disease in homozygous sickle cell disease: Jamaican experience 1973-1997

OBJECTIVES: To examine the clinical features and epidemiology of invasive pneumococcal disease in homozygous sickle cell (SS) disease and the efficacy of pneumococcal prophylaxis. STUDY DESIGN: A retrospective study of 80 episodes in 68 patients in the Jamaican Sickle Cell Clinic in a 25-year period (1973-1997). RESULTS: Clinical features included a history of fever (94 percent), vomitting (70 percent), an ill appearance (80 percent), fever (89 percent), abnormal chest signs (43 percent), and meningismus (39 percent). There were 14 deaths - 13 among 68 initial episodes (6 of which were deaths on arrival) and one death during a recurrence. Thirteen episodes occurred in patients who should have been receiving antibiotic prophylaxis. Ten were due to failure to adhere to protocols, and 3 occurred during prophylaxis; one patient was receiving oral erythromycin, and two had received injections of benzathine penicillin 4 and 24 days before the episode. All but one of the pneumococcal isolates were susceptible to penicillin. The 32 patients who received pneumococcal vaccine had more mild clinical courses as indicated by a greater chance of being treated as outpatients or surviving after admission (Mann-Whitney U test, P = .03). CONCLUSIONS: Penicillin remains the mainstay of prophylaxis, although breakthroughs occur and will become more common with the increasing frequency of penicillin-resistant organisms. Pneumococcal immunization appears to ameliorate the course of invasive disease. (AU)

Epidemiology of haemophilus influenzae invasive disease in Jamaica, 1990-1993

Haemophilus influenzae (H influenzae) invasive disease was studied retrospectively over a four-year period in children admitted to the Bustamante Hospital for Children in Kingston, Jamaica. A total of 86cases were identified. The mean estimated annual incidence of H influenzae invasive disease in Kingston and St. Andrew was 39 per 100,000 children under 5 years of age. The majority (77percent) of cases were in the under 2-year age group. A distinct seasonal pattern was noted, with a significantly higher proportion of patients (57-73percent) presenting in the cooler months. Meningitis was the most common clinical diagnosis, accounting for 76percent of the cases. Poor outcome was demonstrated in 21.5percent of patients with meningitis. Sensitivity testing of H influenzae isolates revealed a resistance rate of 26percent for ampicillin and 7percent for chloramphenicol. The epidemiological findings in this study provide reasonable guidelines for empiric antibiotic therapy and also support the need to seriously consider vaccine prophylaxis in Jamaican children.(Au)

Current use of antibiotics in opthalmology

The use of antibiotics in opthmalmology is based on the information from sensitivity studies derived from the ocular microbiology laboratory and results of clinical studies. Because of systemic use of antibiotics, bacteria develop mechanisms of resistance over time. The organisms considered pathogens evolve to become less frequent, and unusual organisms become the primary culprit. We have found an increasing trend of gram positive organisms such as Staphylococci and a decreasing incidence of gram negatives. As the same time, the antibiotic sensitivity profile has changed. The fluoroquinolones have been the antibiotic of choice for the last decade. Current laboratory data show a decreasing sensitivity profile. Clinical data are beginning to emerge that mirror this information. Data show that aminoglycosides, penicillins and other antibiotics such as vancomycin and chloramphenicol may be more appropriate. New antibiotics such as the oxazliodones and new generation quinolones may soon become the antibiotics of choice. (AU)

Retrospective and longitudinal study of salmonellosis in captive wildlife in Trinidad

Morbidity and mortality of captive wildlife at the Emperor Valley Zoo, Trinidad from 1993 to 1996 were analysed to determine involvement of Salmonella spp. A 6 mo longitudinal study was conducted to determine the frequency of isolation of Salmonella spp. from apparently healthy, sick and dead wild mammals, birds, and reptiles. The antibiograms of Salmonella isolates were determined using the disc diffusion method. Fecal samples randomly selected from animal enclosures and cloacal swabs of snakes were cultured for Salmonella spp. following enrichment in tetrathionate and selenite cystine broths. For the 1993-96 period, Salmonella spp. was implicated in 17 (12%) of 141 sick or dead animals and the predominant serotype was S. typhimurium. During the 6 mo prospective study in a mean animal population of 1,186, there were 20 (2%) and 14 (1%) animals that were sick and died respectively; Salmonella spp. was implicated in only one mortality. Overall, of 1,012 samples from apparently healthy wildlife cultured, 66 (7%) yielded 24 serotypes of Salmonella. The predominant serotype were S. seigburg (16 isolates), S. gaminara (6 isolates), and S. thompson (6 isolates). None of the samples yielded S. typhimurium. The frequency of isolation of Salmonella spp. in reptiles (14%) was significantly higher than found in either mammals (7%) or birds (3%). Sixty-five (99%) of 66 Salmonella spp. isolates exhibited resistance to one or more of the nine antimicrobial agents tested. Resistance was high to cephalothin (92%), moderate to streptomycin (35%) and tetracycline (29%), but significantly low to gentamicin (2%), chloramphenicol (0%), and sulphamethoxazole/trimethoprim (0%). The prevalence of asymptomatic infections by Salmonella spp. in zoo animals was high and the very high prevalence of antimicrobial resistance could be a problem when treating salmonellosis.

La resistencia a antimicrobianos en las Americas / Antimicrobial resistance in the Americas

The increase in the resistance to antimicrobials has become a serious public health concern. Responding jointly to this problem, the Pan American Health Organization and the Pan American Association of Infectious Diseases, supported by the Ministry of Health and Social Welfare of Venezuela, organized the Pan American Conference on Antimicrobial Resistance, which was held in Caraballeda, Venezuela, from 2 to 4 November 1998. In this work the principal recommendations coming out of that conference are summarized for each subject addressed there: educating health professionals on the appropriate use of antibiotics, developing a Pan American network to monitor resistance, quality control and ways to achieve laboratory results that are consistent and comparable, and the appropriate use of antibiotics, both in hospitals and in the community (AU)

Methicillin resistant Staphylococcus aureus

The prevalence of methicillin resistant Staphylococcus aureus (MRSA) at the General Hospital, Port-of-Spain, between June 1995 and May 1996 was determined. The MRSA prevalence rate was 4.6 percent of all S aureus isolates, with all but one nosocomially acquired. 15 isolates were associated with infections, and three were colonizing strains. 17 of the 18 patients with MRSA had received antibiotics previously, including 13 who had received multiple antibiotics. Skin and soft tissue were the sites of infection and colonization in 12 cases; and surgical wards and the Intensive Care Unit (ICU) accounted for 16 MRSA isolates. All isolates were sensitive to vancomycin and all but one were resistant to gentamicin. MRSA occurred sporadically in a wide distribution of wards and physicians' services, although the isolation of three strains from the ICU and three strains from a surgical ward were temporally related. Only one of two deaths was attributable to MRSA. Control of the spread of MRSA in this hospital must include the reinforcement of the appropriate use of antibiotics, hand washing and appropriate isolation of patients in the surgical and intensive care wards.(Au)