Extensively drug-resistant Pseudomonas Aeruginosa outbreak in a burn unit: management and solutions.

Infections are still the main cause of mortality in burn patients. Multidrug resistant bacteria can cause outbreaks in critical care and burn units. We describe an outbreak of infection by extensively drug-resistant Pseudomonas aeruginosa in the Burn Unit of a University Hospital in Barcelona (Spain) between April and July 2016. A descriptive study of all cases, a bacterial colonization screening of all admitted patients and a microbiological environmental study were performed in order to detect a possible common focus. Contact isolation and cohortization of healthcare workers of all infected or colonized patients were applied. Environmental control measures were instituted for possible sources of infection. The outbreak was caused by a strain of P. aeruginosa only sensitive to colistin. Ten patients were infected or colonized and two of them died. The same strain was detected in several taps and drains in different rooms of the Unit. After applying control measures, changing faucets and drains, carrying out thermal disinfection of the hot water installation of the unit, disinfecting the rooms with ultraviolet radiation and placing antibacterial filtration devices in all the taps among other measures, an effective control of the outbreak was achieved.

Les infections sont toujours une cause majeure de mortalité chez les brûlés. Des épidémies à bactéries multirésistantes (BMR) dans les CTB sont régulièrement rapportées. Nous décrivons une épidémie due à Pseudomonas æruginosa BMR, sensible uniquement à la colimycine, survenue dans le CTB d'un hôpital universitaire de Barcelone entre avril et juillet 2016. Elle a touché 10 patients dont 2 sont morts. Une étude de chaque cas, un dépistage chez tous les entrants et une étude environnementale ont été réalisées, afin de trouver d'éventuelles similitudes. Un isolement contact et un cohorting ont été mis en place. Des mesures de contrôle de l'environnement ont été implémentées. La souche incriminée a été retrouvée dans plusieurs robinets et siphons du service. Cette épidémie a été résolue après, outre les mesures précitées, changement des robinets et des siphons (avec mise en place d'ultrafiltres sur les robinets), choc thermique du réseau d'adduction d'eau, désinfection terminale UV des chambres.

Epidemiología de las fiebres tifoidea y paratifoidea en España. A propósito de cuatro casos / Epidemiology of typhoid and paratyphoid fever in Spain. A study of four cases

Introducción: La fiebre entérica (término que incluye la fiebre tifoidea y paratifoidea) es una infección sistémica causada por Salmonella typhi y Salmonella paratyphi. En los países desarrollados, la fiebre entérica dejó de ser endémica para convertirse en una enfermedad frecuentemente asociada a los viajes a zonas endémicas. Pacientes y métodos: Revisión de los casos de fiebre entérica confirmados por hemocultivo, en el periodo comprendido entre el 1 de enero de 2009 y el 31 de diciembre de 2010. Resultados: Se recogieron cuatro casos: fiebre tifoidea en una niña de 12 años natural de Pakistán y en una niña de 13 años originaria de la India que residían en Barcelona y viajaron en vacaciones a su país de origen; fiebre paratifoidea en un niño inmigrante procedente de Senegal, y fiebre paratifoidea en un lactante asociada a una tortuga como vector de transmisión. En todos ellos la fiebre se presentó como síntoma y signo principal de la enfermedad. Todos respondieron bien al tratamiento con amoxicilina-ácido clavulánico. Ningún paciente presentó complicaciones graves. Discusión: Los niños inmigrantes que viajan a sus países de origen para visitar a amigos y familiares presentan un mayor riesgo de enfermar. Los reptiles, portadores habituales de diferentes serovariedades de Salmonella, pueden actuar como posibles vectores de transmisión(AU)

Introduction: Enteric fever (term including typhoid and paratyphoid fever) is a systemic infection caused by Salmonella typhi and Salmonella paratyphi. In developed countries, enteric fever is no longer an endemic disease and has become an infection frequently related to travel to endemic areas. Patients and methods: Review of cases of enteric fever confirmed by blood culture, during the period from January 1st2009 to December 31st 2010.Results: We present four cases: typhoid fever in a 12-yearold girl native of Pakistan and in a 13-year old girl from India, who both lived in Barcelona and traveled on vacation to their country of origin; paratyphoid fever in an immigrant child from Senegal and paratyphoid fever in an infant with a turtle as the vector of transmission. In all cases, fever was the main symptomand sign of the disease. All responded well to treatment with amoxicillin-clavulanate. None of the patients had serious complications. Discussion: Immigrant children who travel to their countries of origin to visit friends and/or relatives are at increased risk of disease. Reptiles, which are common carriers of different Salmonella serovars, may act as potential transmission vector(AU)

Guía para la elaboración de fórmulas infantiles en polvo en el medio hospitalario. Sistema de análisis de peligros y puntos de control crítico / Powdered infant formulae preparation guide for hospitals based on Hazard Analysis and Critical Control Points (HACCP) principles

Esta guía para la elaboración de fórmulas infantiles en polvo es el resultado del trabajo conjunto de varios servicios hospitalarios; adapta la reglamentación nacional y europea vigente, así como las recomendaciones de sociedades científicas y reuniones de expertos internacionales. Está basada en el sistema de evaluación de peligros y puntos de control críticos propuesto por el Codex Alimentarius y pone énfasis en las medidas de comprobación, en los controles microbiológicos del proceso y especifica las medidas correctoras en caso de que no se cumplan los límites propuestos. Es una guía dinámica que cuenta con procedimientos de evaluación que le permiten una adaptación constante (AU)

This guide for the preparation of powdered infant formulae in hospital environments is a collaborative work between several hospital services and is based on national and European regulations, international experts meetings and the recommendations of scientific societies. This guide also uses the Hazard Analysis and Critical Control Point principles proposed by Codex Alimentarius and emphasises effective verifying measures, microbiological controls of the process and the corrective actions when monitoring indicates that a critical control point is not under control. It is a dynamic guide and specifies the evaluation procedures that allow it to be constantly adapte (AU)

[Powdered infant formulae preparation guide for hospitals based on Hazard Analysis and Critical Control Points (HACCP) principles]. / Guía para la elaboración de fórmulas infantiles en polvo en el medio hospitalario. Sistema de análisis de peligros y puntos de control crítico.

This guide for the preparation of powdered infant formulae in hospital environments is a collaborative work between several hospital services and is based on national and European regulations, international experts meetings and the recommendations of scientific societies. This guide also uses the Hazard Analysis and Critical Control Point principles proposed by Codex Alimentarius and emphasises effective verifying measures, microbiological controls of the process and the corrective actions when monitoring indicates that a critical control point is not under control. It is a dynamic guide and specifies the evaluation procedures that allow it to be constantly adapted.

[The contamination of enteral nutrition in critical patients]. / Contaminación de nutriciones enterales en pacientes críticos.

Some previous studies have shown that administration of contaminated enteral diets may produce nosocomial infections in critical patients. There is a series of factors in these patients which may enhance the risk of clinical complications deriving from the administration of enteral nutrition (EN) contaminated by microorganisms (alteration of the immunological state, increased stomach pH, reduced intestinal motility, reduced mucosa production, etc.). This study examines EN contamination in critical patients admitted to the ICU of the Hospital Universitario de Traumatología y Rehabilitación de las C. S. Vall d'Hebron, suffering from cranial-encephalic traumatism and/or multiple traumatism. The data made it possible to create a working design which takes account of factors which may increase the risk of EN contamination. The work was done in three phases, involving different handling procedures (Phase 1, Phase 2 and Phase 3). The results of the three studies made it possible to describe a working method in which the following points are outstanding: handwashing with antiseptic soap prior to handling the EN, avoidance of reuse of containers (if necessary) for more than 24 hours, not to exceed 8 hours' perfusion of EN previously handled, and not to wash the container prior to adding new quantities of EN.

[Umbilical colonization in normal newborns. A comparative study of 4 methods for umbilical antisepsis]. / Colonización umbilical en recién nacidos normales. Estudio comparativo de cuatro métodos de antisepsia umbilical.

We report the results of a prospective study in which the effectiveness of 70% alcohol (A), mercurochrome (M), a solution of alcohol and mercurochrome (AM) and 1% chlorhexidine (C) as umbilical antiseptics was tested on 311 normal newborn infants. Similar results were obtained by using A, M, or AM; however, when C was used umbilical colonization was significantly reduced as compared to when the other three antiseptic agents were used. The umbilical cords that had been scrubbed with A, M or AM were detached by the 8th day after birth, whereas those treated with C took 14 days to fall off. The use of chlorhexidine resulted in a marked increase in pure cultures positive for Gram negative bacteria (Proteus spp. and Pseudomonas spp.) which was not the case with the other three antiseptics tested.

[The cut-off points used in chemiluminescent probes for the identification of mycobacteria]. / Estudio de los puntos de corte usados en sondas quimioluminiscentes para la identificación de micobacterias.

441 strain of mycobacteria were exposed to probes marked with luminous material belonged to M. tuberculosis complex and M. avium complex. We analyzed the following points: 1. If the cut-off points obtained with our strains were in accordance to those recommended by the manufacturer, using two different luminometers. 2. If the correlation constant makes possible the conversion of the units form one luminometer to the units obtained with the other one. 3. Data for sensibility, specificity and predictive positive and negative values using different cut-off points. Cut-off points were different in all cases except for the data obtained with one luminometer using a probe belonged to M. tuberculosis complex. In this case the correlation constant could not be used. In contrast, whichever the luminometer employed was, we found no significant differences between sensibility, specificity and predictive values.

[Use of DNA probes labelled with radioisotopes in the mycobacteria laboratory]. / Utilidad de las sondas de ADN, marcadas con isótopos radiactivos en el laboratorio de micobacterias.

We have studied 540 mycobacterial strains isolated in Lowestein-Jensen medium and 133 samples of different pathologic products against commercialized 125I-DNA Mycobacterium tuberculosis complex, Mycobacterium avitum-intracellulare and Mycobacterium gordonae. The sensitivity, specificity and positive and negative predictive values against isolated strains was 100% for the 3 studied probes. The 125I-DNA probe specific for M. tuberculosis complex is studied in samples with positive bacciloscopy; statistic values vary according to the cutting point of the different percentages of hybridization: at 1.5% the sensitivity, specificity and predictive negative and positive values are 38.6%, 71.4%, 97.5%, and 9.4% respectively, while if the cutting point percentage is 3% these values are: 33.1%, 100%, 100%, and 7.8% respectively. We believe that with these probes the identification time is limited to time needed for the incubation of prime cultures, and in some cases it can be performed on the day the samples reach the laboratory.