RESUMO
Immunization programs have produced a significant trend toward reducing the occurrence of disease in the United States. The resurgence of vaccine-preventable diseases, however, is a reminder that many goals have not yet been achieved. The methods discussed in this article may be useful in delivering vaccines to the pediatric population.
Assuntos
Esquemas de Imunização , Cooperação do Paciente , Criança , Acessibilidade aos Serviços de Saúde , Humanos , Sistemas de AlertaAssuntos
Procedimentos Cirúrgicos Cardíacos , Infecções Estafilocócicas/fisiopatologia , Staphylococcus aureus , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/fisiopatologia , Humanos , Resistência a Meticilina , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/patogenicidadeRESUMO
In a community hospital in Brooklyn, New York, over a 3-year period, 79 methicillin-resistant Staphylococcus aureus (MRSA) isolates from five different case clusters were subtyped by Southern blot hybridization with two previously characterized gene probes, mec and Tn554. Together, the genotyping enabled the hospital infection control team to differentiate simultaneous MRSA clusters in the surgical intensive care unit (type I:A) and the open heart unit (type II:J), document the spread of one strain (type I:A) between roommates, identify an endemic strain (type II:J) from cardiac monitors and medical personnel, and identify an unrelated outbreak strain (type II:NH) in the labor and delivery unit. On the basis of this investigation it is clear that the routine DNA fingerprinting of MRSA in health care facilities, to monitor their spread and identify cases of nosocomial infections, is an important infection control measure.
Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Genes Bacterianos/genética , Resistência a Meticilina/genética , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/genética , Southern Blotting , Infecção Hospitalar/transmissão , Impressões Digitais de DNA , Sondas de DNA , DNA Bacteriano , Humanos , Meticilina/farmacologia , Testes de Sensibilidade Microbiana , Epidemiologia Molecular , Cidade de Nova Iorque/epidemiologia , Penicilinas/farmacologia , Infecções Estafilocócicas/transmissãoRESUMO
Mucormycosis is an unusual complication of cardiothoracic surgery. The fungi may infect the sternotomy wound causing a progressive gangrene or seed the implanted prosthetic valve or graft resulting in endocarditis or graft failure. There have been six previous reports of mucormycosis following cardiothoracic surgical procedures. Four cases involved prosthetic devices, the remaining two are examples of sternal wound mucormycosis acquired from the use of contaminated elasticized bandages. The first case of sternal wound mucormycosis not associated with elasticized bandages is reported here. The infection occurred in a diabetic patient who had undergone coronary artery bypass surgery and mitral valve replacement. The patient received corticosteroids and broad-spectrum antibiotics at the time of and after operation. The patient developed invasive sternal mucormycosis and died on day 10 after surgery, despite aggressive surgical débridement and amphotericin B therapy. No elasticized bandages were used and the source of the infection was not identified. Previous cases of mucormycosis in cardiothoracic surgery are reviewed and the specific clinical setting in which this fungal disease should be suspected defined.
