Bruce H. Hamory

Underreporting of needlestick injuries in a university hospital

A survey of 1429 university hospital employees was conducted to estimate the extent of unreported needlestick injuries. Data based on 726 responses show that 40% of needlestick injuries within the past 3 months and 75% of needlestick injuries in the previous year had not been reported. Employees who did not report needlestick injuries were more likely to be new employees (less than 2 years). In addition to nursing, laboratory, and housekeeping employees, inhalation therapists and pharmacists are also at high risk for needlestick injuries. Studies attempting to show a reduction in needlestick injury rate should not use employee health records to assess efficacy.

Staphylococcus epidermidis: A significant nosocomial pathogen

Staphylococcus epidermidis is an organism formerly believed to be nonpathogenic. It is now recognized as a pathogen, causing infections on implanted devices and among immunosuppressed patients. Further, it has been involved in the development of resistance to a number of antibiotics. The epidemiology of this organism, its pathogenesis, and its treatment are important to infection control practitioners.

Staphylococcus epidermidis arthritis following catheter-induced bacteremia in a neutropenic patient

Sepsis due to methicillin-resistant Staphylococcus epidermidis occurred in a neutropenic man during management with a Hickman-Broviac catheter. Despite catheter removal and 10 days of i.v. cefazolin therapy, he developed septic arthritis 6 weeks later in a nonprosthetic hip joint. S. epidermidis was isolated from the joint and found to have plasmid and phage susceptibility patterns identical to the previous blood isolate. This case is the first to document a metastatic infection from catheter-associated S. epidermidis bacteremia. It suggests that cephalosporins may not be optimal in such infections despite in vitro sensitivity. Vancomycin appears to be the drug of choice for S. epidermidis bacteremia in the neutropenic population.

Simplified method for the isolation, identification, and characterization of Staphylococcus epidermidis in epidemiologic studies

A simplified method for the isolation, identification, and characterization of Staphylococcus epidermidis from humans is described. Swabs of the nose and skin are cultured on mannitol salt agar. Isolated colonies not producing acid from mannitol (presumptive coagulase-negative staphylococci or micrococci) are then inoculated onto purple agar containing erythromycin and glycerol. All colonies growing on this medium are then replicated onto media that tests for the production of phosphatase, the production of acid from trehalose, and susceptibility to four antibiotics. All S. epidermidis sensu stricto are confirmed by the API Staph-Ident system. As a result, Staphylococcus aureus and all other coagulase-negative staphylococci are effectively identified and eliminated from further study and only strains of S. epidermidis are left for further characterization. Of the 252 isolates from 48 cultures of the nares and the fingers, 112 (44%) were eliminated during different stages of this isolation and identification procedure. The antibiotic susceptibility data further distinguished those isolates in the predominant API biochemical profile number. This scheme has applications in the early stages of either ecologic or epidemiologic studies of this important nosocomial pathogen.

Anaphylaxis Due to Chloramphenicol

A patient with group B Streptococcal meningitis and a history of penicillin allergy sustained an anaphylactic reaction following intravenous chloramphenicol. The purity of the infusate was confirmed by reverse-phase high-speed liquid chromatography. Anaphylaxis is a rare event following chloramphenicol administration, but physicians should be aware of this complication, especially in patients with prior exposure to the drug.

Rat bladder irrigation with PVP-I2.

Despite technical advances, Foley catheter associated urinary tract infections continue to be the leading cause of nosocomial infections. PVP-I2 has been shown to be nonirritating to abraded tissue and we have shown that dilute solutions are bactericidal for organisms causing Foley catheter associated urinary tract infections. The purpose of this study was to ascertain the toxicity of PVP-I2 on the catheterized rat bladder and to measure the systemic absorption of I2. Bladder catheters were surgically placed into each of 3 groups of rats: group 1, catheters only; group 2, irrigation with PBS q.8h; and group 3, irrigation with a 1:3 dilution of a 10 per cent PVP-1 per cent I2 solution q-8h. One-half of each group was sacrificed at 1 and 2 weeks respectively. Photographs of mounted bladders and histologic sections were then graded by 3 independent observers. Blood for protein bound iodine (PBI), T3 and T4 levels was obtained before the study and at sacrifice. No difference in ulcerations, erythema or inflammation was noted. PBI was higher in group 3 rats at conclusion than group 1 and 2 (6.88 mg./dl. versus 3.42 mg./dl.) (p less than 0.05). There was no difference in T3 or T4 levels. In this study, PVP-I2 was no more toxic to the bladder than catheterization alone or irrigation with PBS.

Peritonitis From Automated Peritoneal Dialysis

Three consecutive patients undergoing automated peritoneal dialysis developed peritonitis with a nonfermenting gram-negative rod. The same organism was recovered from the dialysate produced by the machine and from its tap water supply. This is the first such outbreak in which the causative organism was also recovered from the tap water supply to the machine. The organism persisted in the machine following standard 3% formaldehyde disinfection, but was eradicated by 10% formaldehyde disinfection.