The staphylococcus and the newborn child

Multiple intestinal ulcerations and perforations secondary to methicillin-resistant Staphylococcus aureus enteritis in infants

PURPOSE

The aim of this study was to define a distinctive clinical entity of multiple intestinal ulcerations and perforations in infants.

METHODS

Two infants underwent abdominal exploration for surgical abdomen and were noted to have multiple intestinal ulcerations and perforations. A peculiar and unique surgical finding, numerous transverse linear ulcerations scattered along the entire small intestine, prompted us to search for similar instances. Five similar cases were additionally identified by members of the Korean Association of Pediatric Surgeons. The clinical courses, the surgical findings, and the results of bacterial cultures were reviewed. As well, the tissues of resected intestines were examined histopathologically.

RESULTS

The characteristics of this entity are as follows. (1) It usually occurs in infants who have been treated with broad-spectrum antibiotics. (2) Despite broad-spectrum antibiotic treatment, diarrhea and abdominal distension developed progressively and deteriorated. (3) Histological evaluation showed mucosal ulcers with neutrophil infiltration, submucosal microabscesses, and colonies of Gram-positive cocci. (4) Methicillin-resistant Staphylococcus aureus (MRSA) was the predominant organism cultured from the body fluid. (5) Only two cases, the completely resected one and the one immediately treated postoperatively with vancomycin, survived.

CONCLUSIONS

This entity is caused by multiple intestinal ulcerations and perforations secondary to MRSA enteritis in infants. It has a high mortality rate because of its difficult diagnosis. However, early recognition of this entity can lead to successful treatment.

HOSPITAL INFECTIONS AND HOSPITAL HYGIENE AT MALMOE GENERAL HOSPITAL. 2. HYGIENIC MEASURES AND THEIR CORRELATION WITH THE INCIDENCE OF INFECTION

A hygienic programme, which has been developed and maintained during several years at a large Swedish university hospital, is presented in detail. The composition and working methods of the Infection Control Committee are described and some economic calculations given. The possible connexion between the hygienic measures and a marked decrease of the incidence of infections is discussed. This decrease did not occur until a satisfactory method for the routine hand disinfection had been introduced, using a commercial antibacterial cleaner containing 3% hexachlorophene.

Hexachlorophane powder and neonatal staphylococcal infection

An outbreak of Staphylococcus aureus infections occurred following discontinuation of antiseptic cord care on a neonatal unit. Multiple phage types were involved. The most common site of infection was the umbilicus. In addition, there were two clusters of methicillin-resistant S. aureus (MRSA) infection and one due to Streptococcus pyogenes. The outbreak was rapidly controlled by the reintroduction of hexachlorophane powder for cord care.

What cord care--if any?

The use of antiseptic treatment during cord care varies from unit to unit. Although it may reduce bacterial colonisation it may also delay cord separation. Where antiseptic treatment is used there is uncertainty as to the best agent. Hexachlorophane powder (0.3%) and 4% chlorhexidene detergent were each compared with dry cord care as a control on a two ward maternity unit in a six month open study. Of 133 infants treated with hexachlorophane 44 (33%) became heavily colonised with Staphylococcus aureus compared with 80 (47%) of 171 controls; a reduction of one third. Chlorhexidene reduced colonisation by more than half; 17 (16%) of 104 compared with 41 (42%) of 98 controls. Chlorhexidene was associated with cord attachment at 10 days in 29 (28%) infants compared with 31 of 515 (6%) infants when it was not used. Hexachlorophane was more acceptable to the nursing staff. The reduction in colonisation with the two compounds was largely due to the suppression of cross infection.

Staphylococcus aureus bacteraemia in children below the age of one year. A review of 407 cases

The bacteriology, epidemiology, infection types and mortality were reviewed in 407 cases of Staphylococcus aureus bacteraemia in the period 1967-1984 in children less than one year old. The number of bacteraemia cases in this age group increased in the seventies, but only 4% of the bacteraemias seemed to be due to epidemic spreading. Neonates might be at higher risk for S. aureus bacteraemia than older children less than one year old, and nearly all infections in the neonatal period were hospital-acquired. The mortality was 24%, and did not correlate with type of infection, but in neonates it correlated with low birthweight.

Postoperative wound infection in a pediatric surgical service

Seventy-two out of 1,325 consecutive pediatric patients (5.43%) developed an operative wound infection in a general pediatric surgery unit. The wound infection rate was observed to be highest in neonates (13.75%) as compared with the children over 5 years of age (2.93%). The increased susceptibility of newborns to wound infection was found to be statistically significant. Patients operated for gastrointestinal problems and solid abdominal neoplasms had the highest wound infection rate.

Erythromycin resistance in neonatal staphylococcal infection: a long-term survey

Twenty years ago staphylococcal infection was a major problem among newborn infants in hospitals. Hygienic measures had not proved very effective and the use of antibiotics, although clearly open to question, seemed a possible method of control. Erythromycin, a new antibiotic effective against staphylococci, had just been introduced but reports from the United States suggested that resistance could occur within months of usage. In trials in two hospitals in which erythromycin was not being used elsewhere, erythromycin resistance developed but took years to do so. The longer the period of usage was extended the greater the resistance. Withdrawal of the drug resulted ultimately in the disappearance of resistance. The resistant staphylococci spread throughout the hospital. The staphylococcal infection rate in the units where erythromycin was used did not fall but the mortality rate from staphylococcal infection did.

Wound infection in a children's hospital

The operation wounds of 20 per cent of the children operated on in one surgical unit of a children's hospital became infected. Infection was commonest in the newly born operated on as emergencies, 50 per cent of whose wounds became infected. No connection was found between injection and nasal carriage of staphylococci. A possible source of infection in the young may be the umbilicus.

Coliform bacteraemia in infants

The incidence of patients with positive blood cultures from which a single species of coliform bacillus was isolated is given for the years 1962 to 67. There has been an increase during these years particularly in neonatal infants: 91 cases were recorded in babies under 6 months of age, and the bacteriological and clinical findings have been related in 85. Children born either prematurely or as a multiple birth and those with congenital malformations showed a predisposition to this form of infection. Many of the remaining cases had an associated localised infection.

Some aspects of the cause of the increase in coliform bacteraemia in babies are discussed and the severity and possible implications of the infection are emphasised.