Prevalence of colonisation with third-generation cephalosporin-resistant Enterobacteriaceae in ICU patients of Heidelberg University Hospitals

Survival of Cephalosporin-Resistant Enterobacteriaceae on Fingers

Five strains ofEnterobacterspecies (n= 4) andPantoeaspecies (n= 1) resistant to third-generation cephalosporins and isolated from clusters of 3-25 premature infants and small children and 5 strains (4Enterobacterstrains and 1Pantoeastrain) with the same resistance pattern that were isolated from 1 premature infant or small child each were inoculated on the fingertips of 10 volunteer study participants to test whether survival on fingertips is correlated with horizontal transmission. Although there was no significant difference in survival between the groups of transmitted and sporadic strains, there were significant differences in bacterial survival between the participants.

Extended-spectrum beta-lactamase-producing Enterobacter cloacae in mobile dialysis units in the medical and surgical departments of a university hospital: a case-control study

The objective of this case-control study was to investigate the source of contamination and risk factors for colonisation and infection during an outbreak of extended-spectrum beta-lactamase (ESBL)-producing Enterobacter cloacae in the University Medical Center Freiburg. A risk factor analysis was performed on 23 patients with ESBL-producing E. cloacae in the medical and surgical departments by comparing them with 46 non-colonised controls, who were matched for ward and length of hospital stay. For these, a risk factor analysis was conducted. Suspected sources for transmission of ESBL were examined and staff received training in infection control measures. The higher risk in colonised patients was attributed to dialysis with mobile units [odds ratio (OR): 4.00; 95% confidence interval (CI): 1.05-15.234; P=0.04]. Dialysis units were examined, but no contamination was found. Improvement in dialysis procedures, additional staff training and renewed training in standard precautions led to a substantial fall in case numbers. Risk factor analysis showed that colonised patients carried more invasive devices than controls (central venous catheter: OR: 2.50; 95% CI: 0.74-8.45; P=0.14; Foley catheter: 5.08; 0.61-42.23; P=0.13) and were given a greater number of different antibiotics (penicillins: 2.52; 0.71-8.89; P=0.15; fluoroquinolones: 2.37; 0.77-7.28; P=0.13). The differences in mobile dialysis frequency and antibiotic use between cases and controls were relevant, although the latter was not statistically significant. It was possible to contain the high frequency of ESBL colonisation or infection by reinforcing infection control measures and training the staff involved.

Clinical microbiology of early-onset and late-onset neonatal sepsis, particularly among preterm babies

Prematurity has got special challenge for clinicians and also other medical staff, such as microbiologists. Immature host defense mechanisms support early-onset sepsis, which can be very serious with very high mortality. While the past decade has been marked by a significant decline in early-onset group B streptococcal (GBS) sepsis in both term and preterm neonates, the overall incidence of early-onset sepsis has not decreased in many centers, and several studies have found an increase in sepsis due to gram-negative organisms. With increasing survival of these more fastidious preterm infants, late-onset sepsis or specially nosocomial bloodstream infection (BSI) will continue to be a challenging complication that affects other morbidities, length of hospitalization, cost of care, and mortality rates. Especially the very low birthweight (VLBW) infants sensitive to serious systemic infection during their initial hospital stay. Sepsis caused by multiresistant organisms and Candida spp. are also increasing in incidence, has become the most common cause of death among preterm infants. This review focuses on the clinical microbiology of neonatal sepsis, particularly among preterm babies, summarizing the most frequent bacterial and fungal organisms causing perinatally acquired and also nosocomial sepsis.

Important Facts About Intestinal Feeding Tube Placement

Enteral feeding is desirable when the gastrointestinal tract is functional because it allows better use of nutrients, is safer, and is more cost-effective than parenteral nutrition. Feeding through a gastric tube, however, is often not feasible in severely ill adults and children because of gastric paresis leading to recurrent episodes of gastroesophageal reflux with the risk of subsequent aspiration. Feeding into the small intestine (duodenum or jejunum) through a nasointestinal tube, therefore, is preferred. Unfortunately, no method of enteral feeding is risk free. This literature review addresses the following 10 topics: (a) the reasons why nasointestinal tube feeding is better tolerated by some patients, (b) candidates for nasointestinal tube feeding, (c) options for selecting nasointestinal tubes, (d) recommended methods for predicting the distance to insert nasointestinal tubes, (e) recommended methods for placing nasointestinal tubes, (f) how promotility medications work and whether they facilitate nasointestinal tube placement, (g) nasointestinal tube placement error rate, (h) methods of determining the internal location of nasointestinal tubes, (i) complications associated with nasointestinal tube use, and (j) other pertinent issues surrounding feeding through nasointestinal tubes. The available research evidence is summarized and recommendations for future work are suggested.