Environmental transmission of hepatitis B and hepatitis C viruses within the hemodialysis unit.

The hepatitis B virus (HBV) can be transmitted in the dialysis setting through blood transfusions and environmental surfaces. Transfusion related hepatitis C virus (HCV) infection is very well known, but only recently the environmental transmission of this virus was postulated. In order to study the prevalence, mechanisms of transmission, and the ALT patterns of HBV and HCV infections in hemodialysis and CAPD patients before the implementation of HBV vaccination and HCV screening in the blood bank, we conducted a study from January 1987 to January 1990. Sera from 185 hemodialysis and 124 CAPD patients were stored in this period and later analyzed for HBsAg, anti-HBc, anti-HBs, and anti-HCV (second generation ELISA). The prevalence of any HBV marker was 55.7% (103/185) for hemodialysis patients and 31.5% (39/124) for CAPD patients (hemodialysis vs. CAPD, p < 0.001). The prevalence of positive anti-HCV was 35.1% (65/185) for hemodialysis and 33.9% (42/124) for CAPD patients (not significant). There was a significant association between HBV markers positivity and anti-HCV positivity. The multivariate analysis of risk factors revealed an association of the positivity of each virus with the duration of renal replacement therapy (RRT), number of previous blood transfusions, and past history of hemodialysis treatment. Thus, besides the transfusion-related transmission, hemodialysis environmental transmission may also occur for both viruses. The findings of a high prevalence of both viruses and evidence for environmental transmission in the dialysis setting are of major importance for the planning of future preventive measures.

[Sensitivity profile of 147 strains of S. aureus isolated from patients in continuous ambulatory peritoneal dialysis]. / Perfil de sensibilidade de 147 cepas de "S. aureus" isoladas de pacientes em diálise peritoneal ambulatorial contínua.

Staphylococcus aureus is reported to be the most common organism to cause peritonitis in continuous ambulatorial peritoneal dialysis (CAPD). Staphylococcal nasal carriage is frequently seen in these patients. The authors studied the sensitivity of S. aureus strains isolated from CAPD patients and some close family contacts. Susceptibility of 147 strains of S. aureus to 23 antimicrobial agents were determined based on 348 samples. All strains tested were susceptible to vancomycin. Penicillin resistance was found in nearly all strains. Resistance to rifampicin was seen in just 5% of the strains. A high rate of resistance to ampicillin, amoxicillin, tetracycline, and also to cotrimoxazole, gentamicin, and tobramycin were observed. Cephalosporins and some aminoglycosides (amicacin and netilmicin) have a good in vitro bactericidal activity anti-S. aureus. Knowledge of the susceptibility profile of bacteria frequently isolated at a given hospital ward will provide the basis for a more effective empirical antibiotic treatment in such ward.