Clonotypes of Staphylococcus aureus isolated from continuous ambulatory peritoneal dialysis patients: what is the vector between nares and infection site?

Staphylococcus aureus is frequently isolated from patients with infections related to continuous ambulatory peritoneal dialysis (CAPD). In many cases, the organism is also isolated simultaneously from the anterior nares. To clarify the transmission trail of S. aureus, we used DNA analysis to identify clonotypes of clinical strains. The nares and exit sites of 32 CAPD patients were swabbed, and PD fluid samples were taken for pathogen culture. Genome DNA of S. aureus was digested with restriction enzyme Sma I for pulsed-field gel electrophoresis. We also asked the patients how they usually performed the PD procedure. S. aureus was isolated from 4 patients, including 3 who hosted two strains isolated separately from different sites. The DNA patterns of the strains isolated from these latter 3 patients were identical. However, the clonotypes from all 4 patients were different. Most of the patients did not wash their hands and wear masks while exchanging PD bags and caring for their exit sites. After the patients were disinfected and re-educated in proper procedures, S. aureus was not detected in any of them. These data suggest that no outbreak occurred in our hospital and that the vectors of endogenous infection were the patients themselves, probably their hands. A bacteriological study presents an efficient opportunity to re-educate patients in PD procedure.

[Factors related to ADL of stroke patients three months after discharge].

Focusing on the ADL of stroke patients, 94 hemiplegia cases in rehabilitation units of acute care general hospitals were studied to identify factors affecting ADL, measured using the Barthel Index, 3 months after discharge. The main results were as follows: 1. The 8 independent variables: age, gender, length of hospitalization, degree of paralysis of lower extremities at discharge, motivation toward rehabilitation, sight, Barthel scores at discharge, and the expression of one's intentions emerged as the 8 reliable predictive factors (R = .904, R2 = .817). 2. It may be deduced that in older patients in particular, a status of amyotrophy has a significant influence on ADL after discharge. The 94 stroke patients were divided into two age groups-44 patients aged 64 years or younger, and 50 patients aged 65 years or older. Barthel scores at 3 months after discharge were analyzed by multiple regression analysis in both groups. The result was that ADL, after discharge, of the aged 65 years or older group, was more affected by their status at discharge, than was it with the 64 years or younger group (64 years or younger; R = .871, R2 = .758, 65 years or older; R = .934, R2 = .873). 3. For patients in the 64 years or younger group, Barthel scores at 3 months after discharge were significantly related to age, length of hospitalization, sight, Barthel scores at discharge and expression of one's intentions. For patients in the 65 years or older group, the results were significantly related to sight, Barthel scores at discharge, and motivation for rehabilitation.