Sánchez F

Morbidity Associated with Long-Term Use of Totally Implantable Ports in Patients with AIDS

To determine the morbidity associated with long-term use of a totally implantable central venous access device (Port-A-Cath [PAC]) in patients with AIDS, we studied 68 consecutive patients with AIDS requiring 79 such devices for long-term use, inserted over a period of 5 years. The total number of PAC-days was 20,159. At least one PAC-related complication occurred with 40 of 79 PACs (50.6% [95% confidence interval (CI): 39.6%-61.6%]), and 16 devices (20.2% [95% CI, 11.4%-29.0%]) had to be removed because of complications. Device-related infection occurred with 33 of 79 PACs (41.7% [95 CI, 30.8%-52.6%]). The predominant infection occurring with PACs was chamber infection, with an incidence of 0.16 per 100 PAC-days. The predominant organisms isolated from patients with chamber infections but also from those with device-related bacteremia were gram-positive cocci (79.4%). The presence of neutropenia (odds ratio [OR] = 9.72; 95% CI, 3.0-31.3; P < .001) and a CD4 cell count lower than 0.025 x 10(9)/L (OR = 6.14; 95% CI, 1.9-19.2; P = .002) were independent predictors of infection. The antibiotic lock technique was associated with decreased device loss when compared with isolated systemic antibiotic therapy (OR = 0.05; 95% CI, 0.0-0.59; P = .008). This technique may be useful to treat PAC infection in patients with AIDS, for whom the risk of PAC-related complications is very high.

Nosocomial outbreak of Blastoschizomyces capitatus associated with contaminated milk in a haematological unit

In July 2002, Blastoschizomyces capitatus was isolated from four neutropenic patients in a haematology unit. Two patients died due to disseminated infection while the other two had oropharyngeal colonisation. Nosocomial acquisition of the fungus was suspected and epidemiological and environmental studies were undertaken. To determine the potential source for the acquisition of the fungus, epidemiological relationships between the patients were investigated. We performed surveillance cultures on all patients and took environmental cultures of air, inanimate surfaces, food samples, blood products and chemotherapy drugs. No direct contact transmission between patients was found and B. capitatus was isolated only in vacuum flasks used for breakfast milk distribution. All isolates were compared by four independent molecular typing methods: pulsed-field gel electrophoresis, genomic DNA restriction endonuclease analysis, randomly amplified polymorphic DNA, and polymerase chain reaction fingerprinting using a single primer specific for one minisatellite or two microsatellite DNAs. Milk vacuum flasks and clinical strains were genetically indistinguishable by all typing techniques. Milk vacuum flasks were withdrawn from all hospital units and no further B. capitatus infection was detected. Our findings suggest that clonal dissemination of a single strain of B. capitatus from vacuum flasks used for milk distribution was responsible for this nosocomial outbreak in the haematological unit.

Sensibilidad del neumococo a los antimicrobianos

Resumen Fundamento En las ultimas decadas la resistencia del neumococo a la penicilina se ha incrementado significativamente en Espana y otros paises. Material y metodos Este estudio retrospectivo recoge los datos de sensibilidad a los antimicrobianos de los neumococos aislados en el periodo 1986-1999 en el Laboratorio de Microbiologia del Hospital de la Santa Creu i Sant Pau; se han estudiado un total de 1.005 cepas con significacion clinica, 490 procedentes de infecciones sistemicas, 269 de muestras respiratorias, 211 pararrespiratorias y 32 de otras procedencias. El estudio de la sensibilidad se realizo mediante tecnica de difusion en agar y complementariamente por tecnica de microdilucion en medio liquido, y se evaluo la sensibilidad a la penicilina, cefotaxima, vancomicina, eritromicina, clindamicina, rifampicina, cloranfenicol, tetraciclina, cotrimoxazol y ciprofloxacino. Resultados El 43% de las cepas fueron resistentes a la penicilina y se observo una elevada tasa de resistencia a los otros antimicrobianos estudiados (cotrimoxazol, 57%; tetraciclina, 40%; cloranfenicol, 29%; eritromicina, 24%, y clindamicina, 21,5%); se detectaron diferencias entre las cepas invasivas, mas sensibles (un 33% de resistencia a la penicilina) y el resto de cepas estudiadas. El 73% de las cepas resistentes a la penicilina tuvieron un patron de multirresistencia asociado, que implicaba en la mayoria de los casos al cotrimoxazol y a la eritromicina. Los serotipos mas frecuentemente aislados en la enfermedad invasiva fueron el 23F, 14, 3, 4, 6B, 8 y 9V, y los serotipos 23F, 6B, 14, 9V y 19F fueron los que presentaron un porcentaje superior de cepas resistentes a la penicilina. Conclusiones En nuestro medio la resistencia del neumococo a los antimicrobianos es elevada y a expensas selectivamente de la circulacion de mas serotipos.

Ability of the new VITEK® 2Neisseria-Haemophilus card for the identification of fastidious organisms

The ability of the new VITEK 2Neisseria-Haemophilus card (bioMérieux) for the identification ofNeisseria, Haemophilus and other fastidious Gram-negative organisms was compared with 16S rRNA gene sequencing and others reference methods, in a clinical microbiology laboratory. The VITEK 2 NH card correctly identified 100 isolates (95%) of 105 isolates. Four isolates were misidentified (1Campylobacter coli, 1Campylobacter jejuni, 1Neisseria meningitidis and 1Haemophilus influenzae) and oneC. coli was unidentified. With its extended database and results available within 6 hours, this card could be considered a useful tool for routine use in clinical microbiology laboratory.