[Bacteriological quality of air in a ward for sterile pharmaceutical preparations]. / Calidad microbiológica del aire de una unidad de preparados farmacéuticos estériles.

BACKGROUND: An extremely clean area is required for preparation of sterile pharmaceutical compounds, in compliance with international standards, to minimize the probability of microbial contamination. AIM: To evaluate the bacteriological quality of the air in the Sterile Pharmaceutical Preparation Unit of the University of Chile's Clinical Hospital and to set up alerts and action levels of bacterial growth. METHODS: We studied eight representative sites of our Unit on a daily basis from January to February 2005 and twice a week from June 2005 to February 2006. We collected 839 samples of air by impact in the Petri dish. RESULTS: 474 (56.5%) samples were positive; 17 (3.5%) of them had an inappropriate bacterial growth (2% of total samples). The samples from sites 1 and 2 (big and small biosafety cabinets) were negative. The countertop and transfer area occasionally exceeded the bacterial growth limits. The most frequently isolated bacteria were coagulase-negative staphylococci, Micrococcus spp and Corynebacterium spp, from skin microbiota, and Bacillus spp, an environmental bacteria. CONCLUSIONS: From a microbiological perspective, the air quality in our sterile preparation unit complied with international standards. Setting institutional alerts and action levels and appropriately identifying bacteria in sensitive areas permits quantification of the microbial load and application of preventive measures.

Calidad microbiológica del aire de una unidad de preparados farmacéuticos estériles / Bacteriological quality of air in a ward for sterile pharmaceutical preparations

Introducción: La elaboración de preparados farmacéuticos estériles requiere áreas limpias que deben cumplir estándares internacionales para minimizar la contaminación microbiana. Objetivo: Evaluar la calidad bacteriológica del aire de la Unidad de Preparados Farmacéuticos Estériles del Servicio de Farmacia del Hospital Clínico de la Universidad de Chile y establecer niveles de alerta y acción. Material y Métodos: Se monitorearon ocho puntos representativos de la unidad, diariamente entre enero y febrero de 2005 y bisemanal-mente de junio a febrero de 2006. Se estudiaron 839 muestras de aire, recolectadas mediante el método de impacto en placa (equipo MAS-100). Resultados: De las muestras estudiadas, 474 (56,5 por ciento) fueron positivas; de éstas, sólo 17 (3,5 por ciento) estuvieron fuera del rango permitido, porcentaje que representa el 2 por ciento del total. Las muestras de los sitios 1 y 2 (flujo laminar grande y pequeño), que corresponden al área de preparación de preparados estériles fueron negativas. Los sitios 3 (mesón) y 4 (transfer) presentaron ocasionalmente valores superiores a los límites. Los microorganismos más frecuentes fueron Staphylococcus coagulasa negativa, Micrococcus spp y Corynebacterium spp, agentes de la microbiota de la piel y, menor porcentaje, Bacillus spp, agente de la microbiota ambiental. Conclusiones: Desde el punto de vista microbiológico, la calidad del aire de la zona de preparaciones estériles descrita presenta niveles ajustados a estándares internacionales. El establecer niveles de alerta y acción institucionales y la identificación de los microorganismos obtenidos en las áreas más sensibles de la unidad permite cuantificar la carga microbiana y conocer sus componentes para determinar las intervenciones a realizar cuando ellas estén indicadas.

Background: An extremely clean area is required for preparation of sterile pharmaceutical compounds, in compliance with international standards, to minimize the probability of microbial contamination. Aim: To evaluate the bacteriological quality of the air in the Sterile Pharmaceutical Preparation Unit of the University of Chile's Clinical Hospital and to set up alerts and action levels of bacterial growth. Methods: We studied eight representative sites of our Unit on a daily basis from January to February 2005 and twice a week from June 2005 to February 2006. We collected 839 samples of air by impact in the Petri dish. Results: 474 (56.5 percent) samples were positive; 17 (3.5 percent) of them had an inappropriate bacterial growth (2 percent of total samples). The samples from sites 1 and 2 (big and small biosafety cabinets) were negative. The countertop and transfer area occasionally exceeded the bacterial growth limits. The most frequently isolated bacteria were coagulase-negative staphylococci, Micrococcus spp and Corynebacterium spp, from skin microbiota, and Bacillus spp, an environmental bacteria. Conclusions: From a microbiological perspective, the air quality in our sterile preparation unit complied with international standards. Setting institutional alerts and action levels and appropriately identifying bacteria in sensitive areas permits quantification of the microbial load and application of preventive measures.

Actinomicosis torácica con compromiso pericárdico y pulmonar / Pericardium and lung involvement by actinomyces israelii: case report

Se reporta un caso de actinomicosis con compromiso pulmonar, pericárdico y de la pared torácica. el compromiso pericárdico estuvo asociado a un exudado hemorrágico de gran cuantía con celularidad aumentada, de predominio polimorfonuclear. El caso fue adecuadamente documentado por la demostración bacteriológica de actinomyces isrraelli desde una muestra obtenida de una tumoración inflamatoria paraesternal. El paciente respondió favorablemente al uso prolongado de bencilpenicilina sódica en altas dosis por vía intravenosa y a tetraciclina oral subsecuentemente

Síndrome de schock tóxico por streptococcus B-hemolítico grupo A: estudio de la relación clonal entre un caso y sus contactos / Toxic shock syndrome: clonal relatedness among group A streptococcus isolates from a case and its contacts

Group A Streptococcal infections have increased in severity and frequency worldwide. We report a female patient that was admitted by Group A Streptococal lethal toxic shock syndrome due to pharyngitis as the primary focus and without cutaneous involvement. Streptococcus pyogenes was isolated from blood cultures and case definition fulfilled standard recommendations. Epidemiological studies among family members showed that two children (aged 5 and 12 years) harbored the same strain in their pharynxes as confirmed by arbitrarily primed PCR (AP-PCR) using primers ERIC and Pn-1. Control strains were included in the analysis. None of three health care workers involved in intubation and laryngoscopic procedures with the patient carried S pyogenes. AP-PCR appears to be a useful and rapid procedure to demonstrate clonal relatedness among S pyogenes strains

Infecciones oportunistas por hafnia alvei: descripción de tres casos y revisión de la literatura / Opportunistic infections caused by hafnia alvei: report of 3 cases and review of literature

Las infecciones por Hafnia alvei son muy infrecuentes en la práctica clínica y se presentan primordialmente como infecciones oportunistas. Describimos tres pacientes con infecciones asociadas a aislamiento de H. alvei en diferentes sitios anatómicos. En dos casos H. alvei se recuperó de hemocultivos en pacientes afectados por un nódulo pulmonar inflamatorio inespecífico y cáncer de páncreas respectivamente. En un tercer caso este agente se aisló de secreción traqueal en un paciente ingresado por un traumatismo complicado de cráneo. Los casos se asociaron a sepsis o fiebre y la trascendencia clínica de H. alvei fue evidente en sólo uno con bacteremia, con recuperación tras terapia antimicrobiana. La respuesta terapéutica fue incierta cuando H. alvei se recuperó del tracto respiratorio en un paciente o incluso no fue necesaria en una bacteremia autolimitada que afectó a un paciente con cáncer de páncreas. La sensibilidad antimicrobiana fue variable, en un caso enteramente sensible y en otro completamente resistente. Se adjunta revisión de la literatura

Síndrome disentérico, insuficiencia renal aguda y shock séptico letal asociados a infección por salmonella enteritidis: descripción de 3 casos / Dysentery, acute renal failure and septic shock caused by salmonella enteritidis: report of 3 cases

Chile is being affected by an epidemic of S enteritidis infections since 1994, an increasingly important cause of morbidity wordwide. Although infections by this bacteria have been commonly associated ti diarrhea and patients are usually not affected by complications, three patients required admission by dysentery (not reported in most published series), acute renal failure (ARF) and septic shock (SS), respectively, at the end of the summer season. S enteritidis was isolated from stool cultures in all three cases. A female patient (24) with dysentery presented with fever and diarrhea associated with blood and mucus and localized abdominal pain in the lower right quadrant. Surgery was not required although laparotomy was considered in the first hours after admission. ARF was demonstrated in a male patient (50) by dehidration, increased creatinine plasma and BUN level (7,19 and 103 mg/dl, respectively), and increased urinary Na level and anion gap (35 mEq/l). Hemodialysis was not required. A third patient was admitted by SS (male, 57, alcoholic), as demonstrated by hypotension despite fluid reposition, altered mental status, and multiorgan compromise. Haemodynamic monitorization showed a high cardiac index and a low systemic vascular resistence. CPK serum determinations indicated rhabdomyolysis. Patients recovered satisfactorily, except SS patient, who died