Eradication of methicillin-resistant Staphylococcus aureus from a health center ward and associated nursing home.

BACKGROUND: Long-term health care facilities have been recognized as reservoirs of multiresistant bacterial strains, especially methicillin-resistant Staphylococcus aureus (MRSA). Efforts to control MRSA in this setting usually have been only partially effective. We describe herein the eradication of epidemic MRSA from a Finnish health care center ward and affiliated nursing home. METHODS: The methods to control MRSA included (1) contact isolation precautions, (2) screening for asymptomatic carriage, (3) eradication of carriage, and (4) education of staff on hygienic measures. The first 6 patients with MRSA-positive findings were referred without delay to the Infectious Diseases Unit of the adjacent university hospital for eradication treatment. Later, an isolation unit of 6 rooms was founded in the health care center, where the MRSA-colonized patients were nursed as a separate cohort until they, in succession, were referred to the Infectious Diseases Unit for decolonization. RESULTS: From May 20 through August 17, 1993, the epidemic MRSA strain was isolated from 8 long-term patients on the 40-bed ward of the health care center, 4 of the 59 residents of the nursing home, and 1 member of the staff. Eradication of carriage was successful in all except 1 patient with dementia, who was nursed in contact isolation in the health care center until his death 21 months later. CONCLUSIONS: It is possible to eradicate MRSA from a long-term health care facility even after 13 cases by applying strict control measures. Our experience may be valuable in the future decision-making process for control of new and more challenging multiresistant bacteria, eg, vancomycin-resistant strains of MRSA.

Parainfluenza virus type 3 infections in a hematology unit.

Parainfluenza virus type 3 (PIV3) is associated with a high mortality rate in BMT recipients with lower respiratory tract infections. We describe nine patients with hematological malignancies (five having undergone either allogeneic or autologous stem cell transplantation) identified as having PIV3 infection during a 2-month period in a Hematology Unit. Four patients with infiltrates on chest radiograph received intravenous ribavirin therapy; all survived. The infection was community-acquired in two patients, while nosocomial origin of the disease was evident, or presumed, in the remaining seven. The policy implemented to control the spread of PIV3 was as follows: (1) nasopharyngeal samples for antigen detection were obtained from all patients presenting with respiratory symptoms; (2) all diagnosed (or suspected) PIV3-positive hematological patients were nursed following contact isolation precautions, preferably in the Infectious Diseases Unit; and (3) staff were given further education on hospital hygiene. Our experience shows that it may be possible to avoid mortality for PIV3 lower respiratory tract infection in immunocompromised patients by early commencement of intravenous ribavirin. It is also possible, even without closing the ward, to contain nosocomial spread of PIV3 by implementing systematic nasopharyngeal sampling for rapid diagnostics, and by strict adherence to cohorting and contact isolation precautions.

Eradication of the long-term carriage of methicillin-resistant Staphylococcus aureus in patients wearing dentures: a follow-up of 10 patients.

To cure the long-term carriage of methicillin-resistant Staphylococcus aureus (MRSA), eradication treatment was given to 10 patients wearing complete dentures. In addition to multiple body sites, MRSA was cultured from the dentures of six patients. The contaminated dentures were rebased and sterilized with heat in order to prevent recolonization. The patients did not use their dentures during the decolonization therapy. Subsequently, MRSA was eradicated from three of these patients but three others remained MRSA-positive despite at least two courses of combined systemic and topical eradication treatment. These particular patients had persistent stomatitis and their dentures were a poor fit, in poor condition and repeatedly grew MRSA. Eradication treatment was successful in the remaining four patients whose dentures were MRSA-negative. These results confirm that dentures may function as foreign bodies and sustain persistent nasopharyngeal. MRSA colonization. Therefore, we suggest that whenever eradication of MRSA is deemed necessary in cases of nasal, oral or pharyngeal carriage, heat treatment of the dentures should be included. Further comparative studies with larger patient populations are needed to evaluate the contribution of dentures to the long-term carriage of MRSA, as well as to assess the value of denture sterilization during the eradication course.

Immediate information expected by the neonatologist from the placenta.

As the obstetrician attends to the mother and the pediatrician to the child, the placenta often tends to be ignored. Nevertheless, essential anamnestic information about the condition of a newborn infant, and especially of a premature, can be gained from careful scrutiny of the placenta and fetal membranes. This paper emphasizes the importance of gross examination of the placenta and membranes as a source of immediate information to the pediatrician within the delivery room.

The prevalence of chronic diseases in children in out-hospital care in Finland.

The records of public health nurses have been used for an estimate of the prevalence of children in domestic care and suffering from various kinds of chronic diseases. This estimate provided a basis for computation of the number of chronically ill children in out-hospital care in Finland. The research was carried out as a sample research and this inquiry resulted in the information of the anamnesis of 12,721 chronic children under 16 years of age taken care of at home. We have counted as chronics those children whose disease is lingering either due to its mechanism of origin or to its nature or known to be such from experience. The total prevalence was 53% of the child population in Finland which corresponds to 59,000 chronically sick children. The geographical distributions of the groups of the diseases were not quite alike in the different parts in our land. The greater prevalences were found on the other hand in Northern Finland and in the wide archipelago of Southwestern Finland. The most common types of the chronic diseases of children were found to be those of sense organs (the total prevalence was 18%). The prevalence of allergic diseases varies between 6--12% and the disease group of endocrinic glands 1.0--3.4%. The prevalence of the neurological diseases was 2.3% and the biggest group consists of the convulsive. The prevalence of the other groups of diseases were: the psychiatric diseases 2.2%, the urological diseases 1.4% and the hematological diseases 0.8%.

Antibodies to herpesvirus hominis types 1 and 2 among women with neoplastic change of uterine cervix.

The occurrence of antibodies to herpesvirus hominis types 1 and 2 was studied in Finland among patients with a neoplastic change of the uterine cervix. The following groups were studied: 220 patients with malignant or premalignant lesions of the uterine cervix, 143 control patients matched for age, socioeconomic level, marital status, home district and number of deliveries and 82 patients with breast or stomach cancer. Antibodies to HVH types 1 and 2 were determined using the neutralization test. Sera showing an index of less than or equal to 100 were accepted as positive to type 1 and those of greater than or equal to 85 as positive to type 2. Among patients with a neoplastic change of the uterine cervix the frequency of type 1 antibodies varied between 70% and 79%. In the control group the frequency was 84% and among patients with some other malignancy 91%. These differences in the frequencies of type 1 antibody were not statistically significant. Type 2 antibodies were present in 35 to 47% among dysplasia and malignancy of the cervix. In the control group it was 18% and in other malignancies 20%. The differences between these groups and the controls were almost significant, significant and highly significant, respectively. Differences could also be observed in the distribution of neutralization indexes. The average index calculated from all sera was 48 both in the control group and in the group of other malignancies, while in sera of patients with dysplasia, carcinoma in situ and invasive carcinoma the respective vlaues were 70, 66 and 79. The results are discussed in terms of the role of herpesvirus hominis type 2 in the development of cervical cancer.

Sudden unexpected infantile death (SUD) of a healthy boy occurring on the doctor's examining table at a well baby clinic.

The child described was 1 year 1 month, and was well developed and healthy. He underwent SUD following the doctor's examination in the presence of the doctor, nurse and mother. The case terminated fatally despite adequate resuscitation. The post mortem examination did not reveal the cause of death. The authors feel that the case supports their previously presented hypothesis of infant neurocirculatory dystony as the cause of SUD. When the infant mortality drops below 15% SUD remains as one of the chief causes of infant death.

Effect of a non-steroidal anti-inflammatory drug, naproxen, on faecal microbial flora.

Faecal Clostridium perfringens counts have been observed to be elevated in RA patients. The use of NSAIDs has been suggested as being responsible for this increase. To clarify the potential of NSAIDs to change faecal flora, 10 male volunteers were given naproxen 500 mg twice daily for 2 weeks in a randomized, placebo-controlled and double-blind study, and 10 other volunteers were given a placebo in tablets of identical appearance. Stool samples were collected and subjected to direct stool sample gas-liquid chromatography of bacterial fatty acids. The method has proved to be practical and sensitive in detecting overall changes in faecal flora. The samples were also cultured for Cl. perfringens. No significant change of faecal flora was observed by either method. The results show that naproxen given in doses and over a period in excess of the levels reported to increase intestinal permeability, does not change intestinal flora.

Disappearance of tracheobronchial fluid at birth in the lamb.

Bronchography was performed in lambs before, during and after the first breath. Swallowing of the contrast medium containing tracheobronchial fluid was observed before the first breath. Intratracheal pressure changes ranging up to 20 mmHg were observed during respiratory movements which did not open the alveoli. The lamb did not start breathing as long as the snout was covered although there was a direct connection between the trachea and atmospheric air through a tracheostomy. When the snout was uncovered a lamb in good condition drew its first breath and the spreading of the contrast material into the peripheral parts of the lungs was almost explosive. The diameter of the tracheobronchial tree widened as a result of the initiation of respiration. It is suggested that both swallowing in the pharynx and absorption into the blood circulation below the larynx play an essential role in the disappearance of the tracheobronchial fluid. Intrauterine aspiration seems less probable in the light of these observations.

An uncooked vegan diet shifts the profile of human fecal microflora: computerized analysis of direct stool sample gas-liquid chromatography profiles of bacterial cellular fatty acids.

The effect of an uncooked extreme vegan diet on fecal microflora was studied by direct stool sample gas-liquid chromatography (GLC) of bacterial cellular fatty acids and by quantitative bacterial culture by using classical microbiological techniques of isolation, identification, and enumeration of different bacterial species. Eighteen volunteers were divided randomly into two groups. The test group received an uncooked vegan diet for 1 month and a conventional diet of mixed Western type for the other month of the study. The control group consumed a conventional diet throughout the study period. Stool samples were collected. Bacterial cellular fatty acids were extracted directly from the stool samples and measured by GLC. Computerized analysis of the resulting fatty acid profiles was performed. Such a profile represents all bacterial cellular fatty acids in a sample and thus reflects its microflora and can be used to detect changes, differences, or similarities of bacterial flora between individual samples or sample groups. GLC profiles changed significantly in the test group after the induction and discontinuation of the vegan diet but not in the control group at any time, whereas quantitative bacterial culture did not detect any significant change in fecal bacteriology in either of the groups. The results suggest that an uncooked extreme vegan diet alters the fecal bacterial flora significantly when it is measured by direct stool sample GLC of bacterial fatty acids.

Group F beta-hemolytic streptococcus, tonsillitis and myocarditis.

A case of tonsillitis and myocarditis is reported, where the only positive microbiological finding was a throat swab growing group F beta-hemolytic streptococci. The patient made an uneventful recovery after treatment with benzylpenicillin and clindamycin.