Epidemiologic investigation of an outbreak of coagulase-negative Staphylococcus primary bacteremia in a newborn intensive care unit.

Infections due to coagulase-negative Staphylococcus (CNS) are an ever-increasing nosocomial problem, particularly in the pediatric population. The authors describe a cluster of three primary bloodstream infections due to CNS in a newborn intensive care unit that occurred between November 23 and December 2, 1992. Two children died as a direct consequence of the bacteremia; at autopsy, one had a large bacteria-containing thrombus extending from the insertion site of a central catheter to the superior vena cava. The children were placed in isolation, and the nursing and medical staff were given topical nasal mupirocin. Plasmid analysis performed later disclosed three different blood isolates that also were different from any of the staff's nasal isolates. The authors concluded that molecular methods such as plasmid analysis are important tools in identifying true outbreaks and can prevent needless interventions, such as those during this cluster.

[Preoperative HIV infection in cardiovascular surgery]. / Infecção pré-operatória pelo vírus HIV em cirurgia cardiovascular.

PURPOSE: To evaluate patients in the preoperative period of cardiovascular surgery for HIV antibody in the serum. MATERIAL AND METHODS: 1200 patients older than 15 years tested for HIV antibody before cardiovascular surgery with an enzyme immunoassay test (ELISA). When the results were ELISA positive ou inconclusive, another sample was collected for confirmatory test (Western Blot). We also analysed risk factors, clinical status of HIV infection and postoperative evolution. RESULTS: ELISA test for HIV antibody were negative in 1180 (98.3%) patients, inconclusive in 14 and positive in 6. One ELISA inconclusive and six ELISA positive patients resulted Western Blot positive. All of the seven patients were asymptomatic (group II) in relation to HIV infection, including four bisexual men, two transfusion recipients men and a woman with an undetermined source of infection. Only the two transfusion recipients had their risk factor identified before testing. All of them were submitted to surgery with no immediate postoperative complication. CONCLUSION: Seven (0.58%) patients had HIV antibody (Western Blot assay) but in only two risk factors were identified by routine preoperative anamnesis.

[Hospital bacteremia at the "Instituto do Coração do Hospital das Clínicas da FMUSP": a four-year retrospective study]. / Bacteremias hospitalares no Instituto do Coração do Hospital das Clínicas da FMUSP: estudo retrospectivo de quatro anos consecutivos.

We conducted a retrospective study to establish mortality rates and prevalence of nosocomial bacteremias at our institute. We found 1.21 nosocomial bacteremias per 100 hospital discharges with an overall Mortality rate of 29.5%. Primary bacteremias increased during the four-year-study-period from 31 to 41%. Staphylococcus, both coagulase-positive and coagulase-negative, was the bacteria most frequently isolated. An abrupt increase in the isolation of P.aeruginosa occurred in 1992. We concluded that a blood-culture surveillance program is required for determining an endemic rate.