A cluster of nosocomial Klebsiella oxytoca bloodstream infections in a university hospital.

BACKGROUND: On February 19, 2003, four patients (patients 1-4) in the neurology ward underwent cranial magnetic resonance angiography (MRA) and developed fever within 1 hour afterward. Klebsiella oxytoca was isolated from blood cultures of patients 1 through 3. OBJECTIVE: To identify the source of this cluster of nosocomial K. oxytoca bloodstream infections. DESIGN: Outbreak investigation. SETTING: A 1,000-bed university hospital. METHODS: The infection control team reviewed patient charts and interviewed nursing staff about the preparation and administration of parenteral fluids. The procedure of cranial MRA was observed. Arbitrarily primed polymerase chain reaction (AP-PCR) was performed to show the clonal relationship among these three strains. RESULTS: AP-PCR revealed that three K. oxytoca isolates had the same molecular profile. Cranial MRA was found to be the only common source among these patients. During MRA, before injection of the contrast medium, normal saline solution was infused to check the functioning of the intravenous catheter. Use of the solution for multiple patients was routine, but the access diaphragm of the bottle was not cleansed. The bottle of normal saline solution used on February 19 had already been discarded and the culture sample taken from the solution on the day of observation was sterile. CONCLUSIONS: We speculate that normal saline solution became contaminated during manipulation and that successive uses might have been responsible for this cluster. Poor aseptic techniques employed during successive uses appear to be the most likely route of contamination. Use of parenteral solutions for multiple patients was discontinued.

Successful outpatient management of pelvic actinomycosis by ceftriaxone: a report of three cases.

Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by actinomyces israeli. Intravenous penicillin is the preferred antimicrobial but it requires hospitalization up to one month. An outpatient treatment strategy would be cost effective and a good choice for patients. Here we present three cases in which intramuscular ceftriaxone was successfully used in the outpatient settings following surgery and IV penicillin treatment in the hospital.

Comparison of sampling methods for urine cultures.

PURPOSE: To compare efficacy and cost of conventional and alternative sampling methods concerning urine cultures. DESIGN AND METHODS: An experimental study with two replications was carried out in a 900-bed university hospital in Ankara, Turkey. The sample was 160 hospitalized female patients, who were asked to give urine specimens, September 10,2000 and September 1,2001. They were patients on urology and obstetrics and gynaecology wards. The authors informed the patients about the study first and then obtained two samples from each patient under their observation. The number of specimens was 320. Statistical methods were descriptive. FINDINGS: The rates of contamination and significant growth, respectively, were 4.4% and 7.5% for the conventional method and 5.6% and 10% for the alternative method. The cost per culture was 2.588.257 TL (2.10 USD) for the conventional method and 57.021 TL (0.05 USD) for the alternative method. The cost difference was statistically significant. CONCLUSIONS: The two methods yielded similar results but the alternative method was less expensive.

Invasive group A streptococcal infection with pancarditis caused by a new emm-type 12 allele of Streptococcus pyogenes.

Throughout the 1980s, a progressive increase in the incidence of Streptococcus pyogenes-related invasive infections has occurred. It has been suggested that a host-related immunogenetic background, as well as bacterial virulence factors may play an important role in the outcome of streptococcal infections. Here, we present the first case of pancarditis in the literature caused by direct bacterial invasion due to a new emm-type 12 allele of S. pyogenes in an immunocompetent patient. The pathogenesis of this invasive infection, as well as predictors of poor prognosis are discussed.

Successful outpatient management of pelvic actinomycosis by ceftriaxone: a report of three cases

Pelvic actinomycosis is a chronic granulomatous suppurative disease caused by actinomyces israeli. Intravenous penicillin is the preferred antimicrobial but it requires hospitalization up to one month. An outpatient treatment strategy would be cost effective and a good choice for patients. Here we present three cases in which intramuscular ceftriaxone was successfully used in the outpatient settings following surgery and IV penicillin treatment in the hospital.