Outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit linked to onychomycosis in a healthcare worker

OBJETIVO: Descrever surto por Klebsiella pneumoniae produtora de beta-lactamase de espectro estendido em berçário de risco intermediário. MÉTODOS: Após identificação dos primeiros casos, a situação foi conduzida como surto, sendo intensificadas as medidas básicas de prevenção de infecções hospitalares e investigadas possíveis fontes de disseminação da bactéria. RESULTADOS: O surto durou 6 meses e atingiu 36 recém-nascidos, causando sete infecções e 29 colonizações. Na primeira fase do surto, os portadores evoluíram com infecção, porém, na segunda fase, os portadores eram assintomáticos e só foram identificados por culturas de vigilância. O surto foi resolvido após identificação e tratamento de profissional de saúde que apresentava onicomicose e era portadora de Klebsiella pneumoniae produtora de beta-lactamase de espectro estendido nas mãos. CONCLUSÃO: Detecção e controle da disseminação oculta da bactéria multirresistente entre os recém-nascidos de menor risco evitou sua instalação endêmica no berçário, bem como a conseqüente exposição dos pacientes mais graves e suscetíveis à infecção.

OBJECTIVE: To describe an outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intermediate-risk neonatal unit. METHODS: After the identification of the first cases, the situation was regarded as an outbreak, and basic preventive measures against nosocomial infections were strictly enforced, and possible sources of dissemination were investigated. RESULTS: The outbreak lasted for 6 months and affected 36 newborn infants, causing seven infections and 29 colonizations. In the first stage of the outbreak, patients developed infection, but in the second stage, they were asymptomatic and were only identified by surveillance cultures. The outbreak was controlled after the identification and treatment of the healthcare worker who had been diagnosed with onychomycosis and whose hands were contaminated with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae. CONCLUSION: The detection and control of occult dissemination of this multiresistant bacterium among low-risk newborn infants prevented its endemic dissemination in the neonatal unit, as well as the exposure of critically ill and susceptible patients to the infection.

Valor pronóstico de la hiperuricemia en la insuficiencia cardiaca crónica / Prognostic value of hyperuricemia in chronic heart failure

BACKGROUND: Hyperuricemia has been proposed as a risk marker in chronic heart failure, but its value as an independent prognostic is not well established. AIM: To determine the prognostic value of hyperuricemia, in patients with chronic stable heart failure. PATIENTS AND METHODS: Forty six male patients with chronic heart failure, aged 62 +/- 13 years, were studied. Their election fraction was less than 40% and their serum creatinine was less than 2 mg/dl. Serum uric acid and catecholamines, maximal oxygen consumption (VO2 max) and left ventricular ejection fraction were measured. Mortality and the need for cardiac transplant were recorded as endpoints during a mean follow up of 39 +/- 18 months. The relationship between basal measures and the occurrence of events was analyzed using univariate and multivariate methods. RESULTS: Basal VO2 max and left ventricular ejection fraction were 16 +/- 4.6 ml/kg/min and 22 +/- 7% respectively. Eighteen patients died and three required transplantation during the follow up. Patients reaching these endpoints had a lower VO2 max and left ventricular ejection fraction and higher uric acid levels. Multivariate analysis accepted left ventricular ejection fraction (relative risk 0.89, 95% CI 0.82-0.97) and serum uric acid (relative risk 1.335 95% CI 1.02-1.74) as significant predictors of events. The relative risk for cardiac transplantation was 7.07 times higher among those with a serum uric acid over 7 mg/dl. CONCLUSIONS: A high serum uric acid is an independent predictor of bad prognosis in patients with stable chronic heart failure.