[Prevention of ventilator associated pneumonia in an intensive care unit]. / Forebyggelse af ventilatorassocieret pneumoni på en intensivafdeling.

Important pathogenic mechanisms in ventilator associated pneumonia (VAP) are pharyngeal colonization, micro-aspiration, and exogenously acquired pathogens. Semirecumbent positioning, subglottic suctioning, non-invasive ventilation, oropharyngeal application of chlorhexidine or antibiotics, and selective digestive decontamination (SDD) have all been shown to lower the incidence of VAP. However, regular use of SDD is not recommended in recent guidelines due to the risk of antimicrobial resistance. High hygienic standards and routine surveillance of VAP incidence are mandatory.

[Epidemic increase in methicillin-resistant Staphylococcus aureus in Copenhagen]. / Epidemisk stigning af methicillinresistente Staphylococcus aureus i København.

INTRODUCTION: We have found an epidemic increase in methicillin-resistant Staphylococcus aureus (MRSA) in Copenhagen. The increase has a complex background and involves hospitals, nursing homes and persons nursed in their own home. MATERIAL AND METHODS: We found 33 MRSA patients in 2003 and 121 in 2004. All isolates have been spa-typed and epidemiologic information collected. RESULTS: The number of MRSA cases has a doubling time of about six months. The epidemic has been caused by many different MRSA types and 31 staphylococcus protein A genotypes (spa types). MRSA has caused several hospital outbreaks and is endemic in 10 nursing homes. Five staff members from nursing homes have been infected with MRSA. MRSA commonly causes skin and soft tissue infections (76%), but serious infections such as septicaemia and pneumonia are also found. CONCLUSION: Treatment of MRSA-infected patients is costly due to isolation regimes, increase in bed-days and treatment with special antibiotics. After treatment of the infection and in cases of MRSA carriage, MRSA is found on the skin and in the nose. Carriage of MRSA can be eradicated by washing with chlorhexidine and nasal administration of mupirocin. The necessary resources for handling the epidemic are not available. Without active intervention, this situation will have serious implications for the health care system.