Clinical and histopathological features of myofibrillar myopathy in Warmblood horses.

BACKGROUND: To report a novel exertional myopathy, myofibrillar myopathy (MFM) in Warmblood (WB) horses. OBJECTIVES: To 1) describe the distinctive clinical and myopathic features of MFM in Warmblood horses and 2) investigate the potential inheritance of MFM in a Warmblood family. STUDY DESIGN: Retrospective selection of MFM cases and prospective evaluation of a Warmblood family. METHODS: Retrospectively, muscle biopsies were selected from Warmblood horses diagnosed with MFM and clinical histories obtained (n = 10). Prospectively, muscle biopsies were obtained from controls (n = 8) and a three generation WB family (n = 11). Samples were assessed for histopathology [scored 0-3], fibre types, cytoskeletal and Z disc protein aggregates, electron microscopic alterations (EM) and muscle glycogen concentrations. RESULTS: Myofibrillar myopathy-affected cases experienced exercise intolerance, reluctance to go forward, stiffness and poorly localised lameness. Abnormal aggregates of the cytoskeletal protein desmin were found in up to 120 type 2a and a few type 2x myofibres of MFM cases. Desmin positive fibres did not stain for developmental myosin, α actinin or dystrophin. Scores for internalised myonuclei (score MFM 0.83 ± 0.67, controls 0.22 ± 0.45), anguloid atrophy (MFM 0.95 ± 0.55, controls 0.31 ± 0.37) and total myopathic scores (MFM 5.85 ± 2.10, controls 1.41 ± 2.17) were significantly higher in MFM cases vs. CONTROLS: Focal Z disc degeneration, myofibrillar disruption and accumulation of irregular granular material was evident in MFM cases. Muscle glycogen concentrations were similar between MFM cases and controls. In the Warmblood family, desmin positive aggregates were found in myofibres of the founding dam and in horses from two subsequent generations. MAIN LIMITATIONS: Restricted sample size due to limited availability of well phenotyped cases. CONCLUSIONS: A distinctive and potentially heritable form of MFM exists in Warmblood horses that present with exercise intolerance and abnormal hindlimb gait. Muscle tissue is characterised by ectopic accumulation of desmin and Z disc and myofibrillar degeneration.

The flipped classroom stimulates greater learning and is a modern 21st century approach to teaching today's undergraduates.

Many classrooms in higher education still rely on a transformative approach to teaching where students attend lectures and earn course grades through examination. In the modern age, traditional lectures are argued by some as obsolete and do not address the learning needs of today's students. An emerging pedagogical approach is the concept of the flipped classroom. The flipped classroom can simply be described as students viewing asynchronous video lectures on their own and then engaging in active learning during scheduled class times. In this study, we examined the flipped classroom teaching environment on student learning gains in an Introduction to Equine Science course. Students (n = 130) were asked to view 7.5 h of recorded lectures divided into 8 learning modules, take online quizzes to enforce lecture viewing, take 3 in-class exams, and prepare to participate in active learning during scheduled class times. Active learning approaches included individual activities, paired activities, informal small groups, and large group activities. When compared to students in the traditional lecture format in earlier years, students in the flipped format scored higher on all 3 exams (P < 0.05), with both formats taught by the same instructor. Analysis of ACT scores demonstrated no intellectual capacity differences between the student populations. To evaluate any gains in critical thinking, flipped format students were asked to take the Cornell Critical Thinking Exam (version X). Scores improved from the pretest (50.8 ± 0.57) to the posttest (54.4 ± 0.58; P < 0.01). In the flipped course, no correlations were found with student performance and interactions with online content. Students were asked in class to evaluate their experiences based on a 5-point Likert scale: 1 (strongly disagree) to 5 (strongly agree). The flipped classroom was ranked as an enjoyable learning experience with a mean of 4.4 ± 0.10, while students responded positively to other pointed questions. In formal course evaluations, flipped format students ranked the following higher (P < 0.05): instructor availability to assist students; encouragement of independent, creative, and critical thinking; and amount learned. Overall, the flipped classroom proved to be a positive learning experience for students. As the classroom continues to modernize, pedagogical approaches such as the flipped classroom should be considered for many lecture-style courses taught in the animal sciences.

Sterile 'Judas' carp--Surgical sterilisation does not impair growth, endocrine and behavioural responses of male carp.

Use of 'Judas' fish to betray the locations of conspecifics is a powerful tool in management of invasive pest fish but poses a risk of contributing to recruitment. Our aim therefore was to generate surgically sterilised male common carp (Cyprinus carpio) and test whether they readily assimilate into wild populations, retain sexual behaviour and successfully betray the locations of feral carp. Male common carp were surgically sterilised (n=44) adopting a two-point nip technique, using either a haemoclip, suture or electro cautery to tie each of the testicular ducts about 2.5 cm cranial to urogenital sinus-retaining all of the glandular testis tissue. Observed survival (95%) and success (>70%) rates were relatively high. Plasma steroids (11-keto testosterone and 17ß-estradiol) were quantified by immunoassay. A subset of sterile and control male fish (n=7 each) were implanted with radio-transmitters and released into Lake Sorell (50 km(2)) and their ability to betray the location of feral carp was assessed by radio tracking and targeted fishing. There was a statistically significant difference in 11-keto testosterone and 17ß-estradiol levels over time (P<0.05), but not between the sterile and control groups within each sampling time (P>0.05), implying that surgery did not compromise the animals physiologically. The sterile Judas fish integrated well into the population-behaving similarly to control Judas males and assisted in the capture of feral carp. The study marks a significant breakthrough in the management of this pest fish with potential adoption to the management of other pest fish globally.

Whipple's Disease in an Afro-Caribbean National.

Whipple's disease is a rare multi-organ infectious disease caused by Tropheryma whipplei. It is fatal without treatment. We report on a 40-year old Afro-Jamaican man who presented with a six-month history of weight loss and diarrhoea. Investigations revealed iron deficiency anaemia and hypoalbuminaemia. Upper gastrointestinal endoscopy revealed white patchy lesions in the duodenum. The duodenal biopsy showed broadening and thickening of the villi by a dense infiltrate of foamy histiocytes within the lamina propria and focally extending into the attached submucosa. Periodic Acid-Schiff stains were positive. Electron microscopy was confirmatory and polymerase chain reaction testing conclusively identified the organisms as T whipplei. Antibiotic treatment resulted in resolution of symptoms. Although the diagnosis of Whipple's disease is difficult, increased awareness should lead to an increase in reported cases with the improvements in diagnostic capabilities.

Preferential selection of MnSOD transcripts in proliferating normal and cancer cells.

Manganese superoxide dismutase (MnSOD) is a nuclear encoded and mitochondrial matrix-localized redox enzyme that is known to regulate the cellular redox environment. Cellular redox environment changes during transitions between quiescent and proliferative cycles. Human MnSOD has two poly(A) sites resulting in two transcripts: 1.5 and 4.2 kb. The present study investigates if the 3'-untranslated region (UTR) of MnSOD regulates its expression during transitions between quiescent and proliferating cycles, and in response to radiation. A preferential increase in the levels of the 1.5-kb MnSOD transcript was observed in quiescent cells, whereas the abundance of the longer transcript showed a direct correlation with the percentage of S-phase cells. The log-transformed expression ratio of the longer to the shorter transcript was also higher in proliferating normal and cancer cells. Deletion and reporter assays showed a significant decrease in reporter activity in constructs carrying multiple AU-rich sequence that are present in the 3'-UTR of the longer MnSOD transcript. Overexpression of the MnSOD 3'-UTR representing the longer transcript enhanced endogenous MnSOD mRNA levels, which was associated with an increase in MnSOD protein levels and a decrease in the percentage of S-phase cells. Irradiation increases the mRNA levels of the 1.5-kb MnSOD transcript, which was consistent with a significant increase in the reporter activity of the construct carrying the 3'-UTR of the shorter transcript. We conclude that the 3'-UTR of MnSOD regulates MnSOD expression in response to different growth states and radiation.

The detection of mupirocin resistance and the distribution of methicillin-resistant Staphylococcus aureus at the University Hospital of the West Indies, Jamaica.

OBJECTIVES: The objectives of this study were to determine the susceptibility of Methicillin Resistant Staphylococcus aureus (MRSA) isolates to Mupirocin and other antimicrobial agents and to record the prevalence and distribution of this organism at the University Hospital of the West Indies (UHWI). METHODS: MRSA isolates collected between January 1, 2008 and December 31, 2008, were tested for low and high level resistance to Mupirocin. Susceptibility testing to other antibiotics including cotrimoxazole, minocycline, tetracycline, clindamycin, erythromycin, gentamicin and vancomycin was also done. Laboratory records for all patients from whom MRSA was recovered were reviewed and data on type and source of isolates, clinical diagnosis, history of previous hospitalization and use of mupirocin were extracted. In addition, the laboratory records for 2004 and 2005 were also reviewed to determine prevalence during these periods. RESULTS: Seven per cent of Staphylococcus aureus isolates were resistant to methicillin (MRSA) and of these, 30% and 24% showed low level and high level resistance to mupirocin, respectively. Ninety-four per cent of MRSA strains were resistant to erythromycin while 52% showed resistance to clindamycin. Resistance to tetracycline, co-trimoxazole and minocycline was 27%, 12% and 6%, respectively, while about one-third of the isolates were resistant to gentamicin. There was no resistance to vancomycin. More than half (58%) of the isolates were from skin and soft tissue specimens while isolates from respiratory and urinary tracts and the bloodstream accounted for 19%, 13% and 4%, respectively. There has been a steady increase in prevalence from 4% in 2004 to 5% in 2007 and 7% in 2008. CONCLUSION: Resistance of MRSA to mupirocin appears to be an emerging problem at the UHWI and must be monitored carefully. There is also significant resistance to commonly used antimicrobial agents and strict adherence to antibiotic policy is required to preserve the usefulness of these agents.

Distribution of nosocomial organisms and their resistance patterns in the intensive care unit of the University Hospital of the West Indies, Kingston, Jamaica.

OBJECTIVES: To determine the distribution and antibiotic susceptibility patterns of nosocomial pathogens in the Intensive Care Unit (ICU) at the University Hospital of the West Indies (UHWI). METHODS: A retrospective review of the laboratory records of all ICU patients from 2002-2004 was done. All organisms isolated from blood, urine, sputum, wound swabs and CVP tips were recorded. Sensitivity reports for organisms isolated in 2004 were also obtained. Results were analysed according to source of isolates and type of infection. RESULTS: Gram-negative organisms account for the majority oflCU isolates and show resistance to multiple antibiotics. The common Gram negative pathogens in the ICU are Pseudomonas aeruginosa, Acinetobacter spp and Stenotrophomonas maltophilia while the common Gram positive nosocomial organisms are Group D Streptococcus and coagulase negative Staphylococcus. CONCLUSION: The organisms isolated in the ICU at the UHWI are similar to those isolated in many ICUs all over the world. Surveillance data are necessary to monitor nosocomial pathogens and their resistance patterns to guide empirical antibiotic therapy.

Predictors of poor outcome in neonates with bacterial sepsis admitted to the University Hospital of the West Indies.

To determine factors that affect outcome in neonates with culture-proven sepsis, the charts of all neonates with culture-proven sepsis admitted to the University Hospital of the West Indies between January 1995 and December 2000 were reviewed retrospectively. Neonates who survived without developing any complications (favourable outcome group) were compared with those who died and/or developed severe complications during the course of treatment (poor outcome group). Chi-square tests were done to determine factors associated with poor outcome; univariate and multivariate logistic regression analyses were also performed. One hundred and thirty-five neonates had culture-proven sepsis, of which 89 (66%) were term infants and 46 (34%) were preterm. Male to female ratio was 1.6:1. One hundred and twenty-six (93%) survived and 9 (7%) died. Case fatality rates were higher for premature infants (15%) than for term infants (2%). Twenty-four (18%) of the neonates with culture proven sepsis had a poor outcome. Gram negative organisms accounted for 19 (70%) of the cases with poor outcome. Prematurity (p < 0.001), very low birthweight (p < 0.001) and female gender (p < 0.05) were factors associated with poor outcome. Strategies aimed at decreasing morbidity and mortality in neonates with sepsis must include measures that will decrease the incidence of prematurity and low birthweight.

The changing pattern of Tinea capitis in Jamaica.

The species of dermatophyte fungi causing tinea capitis vary from country to country and may also change with time. This study was done to identify the predominant organisms causing tinea capitis in the Jamaican population. It was a retrospective study looking at all fungal culture requests to the Microbiology Department at the University Hospital of the West Indies during the period January 1, 1998 to December 31, 2002. The results showed a gradual switch from the dominance of Microsporum audouinii (61.5%) in 1998 to the dominance of Trichophyton tonsurans (85%) in 2002. The mean age was 8.6. Females constituted 55.7% of positive cases and males, 44.3%.

Predictors of poor outcome in neonates with bacterial sepsis admitted to the University Hospital of the West Indies / Predictores de resultados clínicos pobres en recién nacidos con sepsis bacteriana, ingresados en el Hospital Universitario de West Indies

To determine factors that affect outcome in neonates with culture-proven sepsis, the charts of all neonates with culture-proven sepsis admitted to the University Hospital of the West Indies between January 1995 and December 2000 were reviewed retrospectively. Neonates who survived without developing any complications (favourable outcome group) were compared with those who died and/or developed severe complications during the course of treatment (poor outcome group). Chi-square tests were done to determine factors associated with poor outcome; univariate and multivariate logistic regression analyses were also performed. One hundred and thirty-five neonates had culture-proven sepsis, of which 89 (66) were term infants and 46 (34) were preterm. Male to female ratio was 1.6:1. One hundred and twenty-six (93) survived and 9 (7) died. Case fatality rates were higher for premature infants (15) than for term infants (2). Twenty-four (18) of the neonates with culture proven sepsis had a poor outcome. Gram negative organisms accounted for 19 (70) of the cases with poor outcome. Prematurity (p < 0.001), very low birthweight (p < 0.001) and female gender (p < 0.05) were factors associated with poor outcome. Strategies aimed at decreasing morbidity and mortality in neonates with sepsis must include measures that will decrease the incidence of prematurity and low birthweight.

A fin de determinar los factores que afectan la evolución clínica de los recién nacidos con sepsis probada por cultivo, se realizo un estudio retrospectivo de las estadísticas de todos los neonatos con sepsis probada por cultivo, ingresados en el Hospital Universitario de West Indies entre enero de 1995 y diciembre de 2000. Los neonatos que sobrevivieron sin desarrollar complicación alguna (el grupo de resultados clínicos favorables) fueron comparados con los que murieron y/o desarrollaron complicaciones severas durante el curso del tratamiento (el grupo de resultados clínicos pobres). Se realizaron pruebas de chi-cuadrado para determinar los factores asociados con los resultados clínicos pobres. También se llevaron a cabo análisis de regresión logística univariable y multivariable. Ciento treinta y cinco recién nacidos presentaron sepsis probada por cultivo. De ellos, 89 (66%) eran infantes de término y 46 (34%) de pre-término. La proporción varón/hembra fue 1.6:1. Ciento veintiséis (93%) sobrevivieron y 9 (7%) murieron. Las tasas de fatalidades fueron más altas para los infantes prematuros (15%) que para los infantes de término (2%). Veinticuatro (18%) de los neonatos con sepsis probada por cultivo tuvieron resultados clínicos pobres. Organismos gram-negativos fueron la causa de 19 (70%) de los casos con resultado clínico pobre. La prematuridad (p <0.001), el peso extremadamente bajo al nacer (p <0.001) y el sexo femenino (p <0.05) fueron factores asociados con el resultado clínico pobre. Las estrategias dirigidas a disminuir la morbilidad y la mortalidad en los recién nacidos con sepsis tienen que incluir medidas que reduzcan la incidencia de la prematuridad y el bajo peso.

The changing pattern of Tinea capitis in Jamaica / El patrón cambiante de la tinea capitis en Jamaica

The species of dermatophyte fungi causing tinea capitis vary from country to country and may also change with time. This study was done to identify the predominant organisms causing tinea capitis in the Jamaican population. It was a retrospective study looking at all fungal culture requests to the Microbiology Department at the University Hospital of the West Indies during the period January 1, 1998 to December 31, 2002. The results showed a gradual switch from the dominance of Microsporum audouinii (61.5) in 1998 to the dominance of Trichophyton tonsurans (85) in 2002. The mean age was 8.6. Females constituted 55.7of positive cases and males, 44.3.

Las especies de hongos dermatofitos que causan la tinea capitis varían de país en país, y también pueden cambiar con el tiempo. Este estudio se realizó con el propósito de identificar los organismos predominantes que causan la tinea capitis en la población jamaicana. Se trata de un estudio retrospectivo que revisó todas las solicitudes de cultivos fúngicos hechas al Departamento de Microbiología del Hospital Universitario de West Indies durante el periodo del 1ero. de enero de 1998 al 31 de diciembre de 2002. Los resultados mostraron un cambio gradual del predominio de Microsporum audoinii (61.5%) en 1998 al predominio de Trichophyton tonsurans (85%) en 2002. La edad promedio fue 8.6. Las hembras constituyeron el 55.7%, y los varones el 44.3% de los casos positivos, respectivamente.

Extended spectrum beta-lactamase producing organisms at the University Hospital of the West Indies.

Extended spectrum beta-lactamases (ESBL) represent a major group of beta-lactamases that have the ability to inactivate beta-lactam antibiotics containing an oxyimino group such as third generation cephalosporins and monobactams. These enzymes are produced by gram negative organisms, especially members of the Enterobacteriaceae family such as Klebsiella pneumoniae and Escherichia coli. The prevalence of these organisms varies widely internationally, as well as within the same country. This is the first study on ESBL production in K pneumoniae and E coli at the University Hospital of the West Indies, a tertiary care hospital in Jamaica. Two-hundred and sixty-four isolates of K pneumoniae and 300 isolates of E coli were collected over the study period January 2002 to December 2002. Forty-eight (18.2%) K pneumoniae isolates were confirmed to be ESBL producers, while there was no ESBL producing E coli. Infections with ESBL producing organisms can pose a therapeutic challenge, leading to treatment failure if the wrong class of antibiotics is used. With increasing resistance to all classes of antibiotics, there is a narrowing of available treatment options. It is very important that these organisms be monitored and antibiotic policies as well as infection control policies be in place to curtail their spread.

Disseminated histoplasmosis and AIDS at the University Hospital of the West Indies. A case report.

Disseminated histoplasmosis is rare in Jamaica. However, with the increase in the number of immunocompromised patients in the population, the prevalence of this infection is likely to increase. We present a case of disseminated histoplasmosis in a 16-year-old girl with the acquired immune deficiency syndrome who presented to the Paediatric Infectious Diseases Service of the University Hospital of the West Indies, with cervical lymphadenitis progressing to ulcers and abscesses showing granulomatous inflammation likely to be of fungal aetiology. She later presented to the Emergency Room, with respiratory and gastrointestinal symptoms and was admitted to hospital, disoriented and with a persistent fever. She developed nuchal rigidity while in hospital and was anaemic, leukopaenic and thrombocytopaenic. She died of gastrointestinal bleed ten days post admission. She was the oldest known survivor of mother-to-child-transmission of human immunodeficiency virus in Jamaica. The slow growing fungus, Histoplasma capsulatum, was isolated from the patient's blood three weeks after the specimen was sent to the laboratory.

The emergence of Stenotrophomonas maltophilia as a significant nosocomial pathogen at the University Hospital of the West Indies.

Stenotrophomonas maltophilia is emerging worldwide as a nosocomial pathogen. It is associated with certain risk factors and a wide range of infections. This study was done to document its emergence at the University Hospital of the West Indies and to determine the incidence, distribution and risk factors associated with it. A retrospective study was conducted over the period April 1997 to December 2000. Clinical records were available for 46 of the 66 patients identified over the study period. Fifty-five per cent of the cases came from the Intensive Care Unit (ICU) and the rest from other wards. There was a slight increase in the prevalence of infection with increasing age. The surgical service accounted for the largest number of isolates. Of the cases presented, 95.7% were exposed to a wide range of antibiotics and had some form of instrumentation. Underlying disease was found in 71.7% of the patients. S maltophilia was found most often in the sputum of ICU patients whereas it was most often isolated from wound swabs in the ward patients. The organism was isolated from blood more often in ICU patients (23.3%) than in ward patients (9.5%) and there was a 44% mortality rate among the cases in ICU compared with those on the wards (4.8%). Stenotrophomonas maltophilia is an important nosocomial pathogen and occurs in a wide cross-section of patients. The risk factors must be addressed and infection control measures implemented to restrict the spread of this organism.

Disseminated histoplasmosis and AIDS at the University Hospital of the West Indies. A case report

Disseminated histoplasmosis is rare in Jamaica. However, with the increase in the number of immunocompromised patients in the population, the prevalence of this infection is likely to increase. We present a case of disseminated histoplasmosis in a 16-year-old girl with the acquired immune deficiency syndrome who presented to the Paediatric Infectious Diseases Service of the University Hospital of the West Indies, with cervical lymphadenitis progressing to ulcers and abscesses showing granulomatous inflammation likely to be of fungal aetiology. She later presented to the Emergency Room, with respiratory and gastrointestinal symptoms and was admitted to hospital, disoriented and with a persistent fever. She developed nuchal rigidity while in hospital and was anaemic, leukopaenic and thrombocytopaenic. She died of gastrointestinal bleed ten days post admission. She was the oldest known survivor of mother-to-child-transmission of human immunodeficiency virus in Jamaica. The slow growing fungus, Histoplasma capsulatum, was isolated from the patient's blood three weeks after the specimen was sent to the laboratory

Extended spectrum beta-lactamase producing organisms at the University Hospital of the West Indies

Extended spectrum beta-lactamases (ESBL) represent a major group of beta-lactamases that have the ability to inactivate beta-lactam antibiotics containing an oxyimino group such as third generation cephalosporins and monobactams. These enzymes are produced by gram negative organisms, especially members of the Enterobacteriaceae family such as Klebsiella pneumoniae and Escherichia coli. The prevalence of these organisms varies widely internationally, as well as within the same country. This is the first study on ESBL production in K pneumoniae and E coli at the University Hospital of the West Indies, a tertiary care hospital in Jamaica. Two-hundred and sixty-four isolates of K pneumoniae and 300 isolates of E coli were collected over the study period January 2002 to December 2002. Forty-eight (18.2) K pneumoniae isolates were confirmed to be ESBL producers, while there was no ESBL producing E coli. Infections with ESBL producing organisms can pose a therapeutic challenge, leading to treatment failure if the wrong class of antibiotics is used. With increasing resistance to all classes of antibiotics, there is a narrowing of available treatment options. It is very important that these organisms be monitored and antibiotic policies as well as infection control policies be in place to curtail their spread

The emergence of Stenotrophomonas maltophilia as a significant nosocomial pathogen at the University Hospital of the West Indies

Stenotrophomonas maltophilia is emerging worldwide as a nosocomial pathogen. It is associated with certain risk factors and a wide range of infections. This study was done to document its emergence at the University Hospital of the West Indies and to determine the incidence, distribution and risk factors associated with it. A retrospective study was conducted over the period April 1997 to December 2000. Clinical records were available for 46 of the 66 patients identified over the study period. Fifty-five per cent of the cases came from the Intensive Care Unit (ICU) and the rest from other wards. There was a slight increase in the prevalence of infection with increasing age. The surgical service accounted for the largest number of isolates. Of the cases presented, 95.7 were exposed to a wide range of antibiotics and had some form of instrumentation. Underlying disease was found in 71.7 of the patients. S maltophilia was found most often in the sputum of ICU patients whereas it was most often isolated from wound swabs in the ward patients. The organism was isolated from blood more often in ICU patients (23.3) than in ward patients (9.5) and there was a 44 mortality rate among the cases in ICU compared with those on the wards (4.8). Stenotrophomonas maltophilia is an important nosocomial pathogen and occurs in a wide cross-section of patients. The risk factors must be addressed and infection control measures implemented to restrict the spread of this organism

Surveillance of nosocomial "alert organisms" at the UHWI - 1995-1997 - Poster presentation

This survey was conducted to determine the types, prevalence and distribution of "alert" organisms within the UHWI. Continuous surveillance of "alert organisms" at the University Hospital has been conducted since 1995. Amongst the Gram positive isolates, Methicillin-resistant Coagulase-negative Staphylococci and Enterococci were more often reported (30 - 37 percent) than Methicillin-resistant Staph. aureus (9 - 13 percent) (MRSA). Pseudomonas aeruginosa accounted for the largest number of Gram-negative isolates (25 - 36 percent) followed by Acinetobacter and Klebsiellae (11 - 19 percent). Resistance to several groups of antibiotics was especially notable in Acinetobacter and Klebsiellae during 1997. Extended-spectrum betalactamase-producing Klebsiellae emerged in late 1996 (6.3 percent) and showed an increase in 1997 (37.1 percent). Ceftazidime-resistant Ps. Aeruginosa increased from 2.7 percent to 7.2 percent over the period. The types of organisms and their characteristic antibiogram can be used to direct further treatment and infection control policies.(AU)

The emergence of stenotrophomonas maltophilia as a pathogen in the UHWI

Stenotrophomonas maltophilia is a Gram-negative bacillus, which is known to occur in hospitals and especially in Intensive Care Units. We reported the emergence of the organism at the UHWI for the first time in 1996. During routine infection control surveillance, conducted by the Microbiology Department, Steno maltophilia was first identified in the ICU, UHWI in October 1996 and was the only case reported in that year. Isolates were obtained from blood, urine, sputum, trap sputum, wound, skin, catheter tips and environmental samplimg. Patient's clinical records were reviewed and an attempt made to determine possible risk factors. In 1997 there was a total of 7 patients with Steno. Matophilia with 4 (57 percent) of these coming from the ICU. Up to July 1999, 26 cases were isolated, of these 15 (58 percent cases) came from ICU. The organism was mainly resistant to Menonem, Imipenem, Gentamicin and sensitive largely to Ciprofloxacin and Ceftazidime. Since it was first reported in 1996, Steno. Malto has emerged as a significant pathogen at UHWI. Patients most at risk are those in the ICU. Its multi-drug-resistance characteristics distinguish it as a potentially dangerous nosocomial pathogen and impose the necessity for urgent action to prevent and control its spread.(AU)