A 10-year prospective surveillance of nosocomial infections in neonatal intensive care units.

BACKGROUND: We report on nosocomial infections (NIs), causative organisms, and antimicrobial susceptibility patterns in neonates who were admitted to neonatal intensive care units (NICUs), and assess the performance of birth weight (BW) as a variable for risk-stratified NI rate reporting. METHODS: A prospective, 10-year follow-up, open cohort study that involved six Brazilian NICUs was conducted. The NI incidence rates were calculated using different denominators. RESULTS: Six thousand two hundred forty-three newborns and 450 NICU-months of data were available for analysis. This included 3603 NIs that occurred in 2286 newborns over 121,008 patient-days. The most frequent NIs were primary bloodstream infection (pBSI; 45.9%), conjunctivitis (12.1%), skin infections (9.6%), and pneumonia (6.8%). Only the pBSI (but not pneumonia or central venous catheter-related pBSI) rate distribution differed significantly with varying BW. Gram-negative rods (mainly Klebsiella sp. and Escherichia coli) were responsible for 51.6% episodes of pBSI. Gram-positive organisms (mainly coagulase-positive staphylococci) accounted for 37.4%. Candida sp. was the fourth isolated organism. A high resistance to third-generation cephalosporins was recorded in K pneumoniae and E coli isolates. CONCLUSIONS: This report highlights the burden of NI, and identifies the major focus for future NI control and prevention programs. Except for pBSI, BW had a poor performance as a variable for risk-stratified NI rate reporting.

Vigilancia de susceptibilidad de cocáceas grampositivas a betalactámicos, glicopéptidos y otros antimicrobianos / Surveillance of gram positive cocci susceptibility to betalactamics, glycopeptides and other antimicrobials

Background: During the last decade, there has been a progressive increase in the resistance of gram (+) cocci to betalactamics and other antimicrobials. Therefore, vancomycin and teicoplanin have incorporated as alternative antimicrobial drugs. Aim: To assess the susceptibility of gram (+) cocci to different antimicrobials including vancomycin and teicoplanin. Material and methods: We studied 447 strains of gram (+) cocci coming from ambulatory and hospitalized patients. These included 308 enterococcus sp strains, 99 staphycoccus aureus strains and 40 coagulase negative staphylococci strains. Enterococci susceptibility was measured using minimal inhibitory concentrations in agar and that of staphylococci, through diffusion. Susceptibility to vancomycin and teicoplanin was measured using minimal inhibitory concentrations in all strains. Results: Enterococcus faecalis was 100 percent susceptible to ampicillin, penicillin, vancomycin and teicoplanin, 23 percent susceptible to tetracyclin and 47 percent to chloramphenicol. Susceptibility of E faecium was 61 percent to penicillin, 49 percent to chloramphenicol, 41 percent to tetracyclin, 100 percent to vancomycin and teicoplanin. Of 19 enterococcus spp strains, 90 percent were susceptible to ampicillin, 80 percent to penicillin, 55 percent to chloramphenicol and 45 percent to tetracyclin. Only one E casseiflavus strain had a low level resistance to vancomycin and was susceptible to teicoplanin. No staphylococcus aureus strain was resistant to vancomycin or teicoplanin. Conclusions: A permanent surveillance of gram (+) cocci antimicrobial susceptibility is required to update therapeutic schemes

Leuconostoc species: rara infección presentada en la mano / Leuconostoc species: rare infection presental in the hand

Se presenta un caso de infección por leuconostoc spp en la mano, probablemente como secuela de infiltración por dedo en gatillo, estudiado y tratado por un equipo de profesionales de varias especialidades: cirujanos, internistas, infectólogos, patólogos, laboratorio y rehabilitación. El motivo de consulta fue por incapacidad funcional de la mano, con todos los Signos de Celso en el dedo anular derecho, sin mejoría con el tratamiento previo a realizarse el diagnóstico, que fué hecho por el cultivo del espécimen quirúrgico de la sinovitis extirpada quirúrgicamente, reafirmado que se trataba de Leuconostoc spp en el CDC de Atlanta USA. El paciente se reintegró a todas sus actividades después de la cirugía, tratamiento con Clindamicina IV, por 3 semanas y 12 semanas de rehabilitación