aetiology and antimicrobial susceptibility pattern of the significant blood culture isolates from a district general hospital in England

To report the prevalence of pathogens causing blood stream infections [BSIs] and antibiotic susceptibility profile of blood culture isolates from district general hospital, southeast of England. This study was conducted at Southend Hospital, UK to provide data on common pathogens of BSIs and their susceptibility profiles. The microbiology laboratory information and hospital information systems and patients note records were retrospectively reviewed to determine the clinical significance of BSI isolates and the susceptibility pattern from August 2006 to July 2007. Blood cultures were processed by BACTEC, a continuous monitoring system and blood culture isolates were identified by standard conventional methods. Disc diffusion method was used for susceptibility testing according to the British Society of Antimicrobial Chemotherapy guidelines. A total of 699 isolates were analysed. Gram positive bacteria as a group were the most common cause of BSIs. Escherichia coli accounted for 18.8% [132 strains] of the total blood culture isolates; followed by Staphylococcus aureus [18.2%, 127 isolates], coagulase negative Staphylococcus [10.9%, 76 isolates], Streptococcus species [9.4%, 66 isolates] and Klebsiella species [6.72%, 47 isolates]. Anaerobes accounted for 3.9% of the total BSIs whilst only 19 Candida species were isolated. Antimicrobial sensitivity results showed that the majority of the Gram negative bacteria were sensitive to imipenem, meropenem, piperacillin/tazobactam and gentamicin while vancomycin showed good activity against Gram positive bacterial isolates. Better understanding of local prevalence of pathogens of BSI and their susceptibility profile can improve the efficiency of the empiric therapy. Active surveillance of pathogens causing BSI and their antimicrobial susceptibility patterns should be continuously practiced in healthcare settings in order to prevent the spread of multiresistant pathogens

incidence of Dengue disease in a University teaching hospital in Malaysia in 2002, 2003 and 2004

Dengue has been increasingly recognised as an emerging infectious disease for the last two decades. The global burden of dengue has grown dramatically in recent years. Several outbreaks have previously been reported from Malaysia. This study aims to determine the annual confirmed cases of dengue in the teaching hospital of University of Malaya, Kuala Lumpur, Malaysia. All cases of confirmed dengue from microbiology laboratory since 2002 to 2004 were included in this study. The dengue disease was confirmed by "Enzyme linked immunosorbent assay" [ELISA] and all patients were positive for the immunoglobulin-M [IgM]. However, virus culture was also performed in patients with negative IgM but with strong clinical suspicion of dengue disease. A total of 4753 confirmed cases of dengue were recorded during the study period. There were 2606 males and 2137 female. The most commonly affected age groups were 1 to 10 years, 21 to 30 and 11 to 20 years with 1630 patients, 880 patients and 662 patients respectively. Of the ethnic groups, Malays were the most affected people in thus study while Indians were least affected. Dengue fever accounted for 91% of the total dengue infections. There were only 5.5% cases classified as dengue haemorrhagic fever and only 15 cases of dengue shock syndrome recorded in 3 years. Serotype dengue-3 was predominant in 2002 and serotype dengue-1 remained the predominant during the rest of the study period. Dengue fever and dengue haemorrhagic fever remain a health problem in Malaysia. Dengue disease should be considered in the differential diagnosis of all patients who present with symptoms compatible with dengue. It is also imperative to implement and maintain an effective community based disease surveillance and prevention program

Compliance with MRSA hospital control guidelines in a district general hospital

Methicillin resistant Staphylococcus aureus [MRSA] poses increasing problems in hospitals throughout the world because of their propensity to spread and colonise debilitated patients and there are limited antibiotic options to treat systemic infections. 80[th] national and local guidelines are necessary to prevent further transmission of this organism. This audit was conducted to measure the compliance of a district general hospital's infection control policy to manage patients colonised or infected with MRSA. Thirty-nine patients with recent MRSA isolates were identified from the hospital information system and were evaluated at the bedside. Of the total, thirty two [82%] patient's files were not tagged with an MRSA alert label, 58% did not have chlorhexidine hair wash, 62% did not receive the hospital's patient information leaflet and 67% did not have a documented MRSA management plan in the case notes. The Infection Control Team needs to be more vigilant to breaches of the hospital's MRSA guidelines and clinical teams managing the patients need to show more commitment towards MRSA eradication as detailed in local policy

Management of vancomycin-resistant enterococci infections

The incidence of enterococci from clinical sources shows a significant increase with properties of intrinsic resistance to many antimicrobials particularly glycopeptides such as vancomycin. Vancomycin-resistant enterococci [VRE] are usually resistant to many antimicrobials and pose a great threat to the patient safety. The possibility of the transfer of the van A gene from enterococci to Staphylococcus aureus has caused much concern among scientists and clinicians. Management options for VRE infections are limited. Empirical therapy to treat VRE infections should be guided according to the local antimicrobial susceptibility patterns of VRE. Newly developed antibiotics like linezolid, daptomycin, quinupristinldalfopristin, have promising effects against VRE. The prudent use of antibiotics, strict guidelines for the use of new antimicrobials, adherence of infection control measures such as surveillance, hand hygiene, environmental disinfection continue to be essential components of the therapeutic management of colonisation and or infection due to VRE. The present study was undertaken to review VRE infections and the therapeutic options for the management of VRE infections

Hepatitis C virus infection: an enigma continues

Hepatitis C, caused by hepatitis C virus [HCV], has emerged as a major health problem not only in developing world but also in developed countries. HCV infects approximately 170 million people worldwide. HCV is the most efficiently transmitted through percutaneous exposure to blood, intravenous drug abuse, haemodialysis, nosocomial incidents [colonoscopy], inadequately sterilised medical instruments, high-risk sexual behaviour, body piercing, tattooing and vertical transmission. Most patients with acute HCV infection develop persistent infection and 75-85% patients develop chronic hepatitis. Chronic hepatitis C predisposes patients to progression to fibrosis, cirrhosis and hepatocellular carcinoma. The diagnosis of HCV infection by serological, virological, molecular tools and biopsy is essential in the management of HCV infection. Pegylated interferon a combined with ribavirin has been the mainstay of treatment of HCV infection. Awareness of health care workers and general population is important to curb this silent epidemic. This review is presented as an overview of epidemiology, virology, pathogenesis, clinical manifestations, diagnosis, treatment and prevention of HCV infection

Fatal septicemic melioidosis in young adult

Melioidosis caused by B. pseudomallei remains dormant for months, years and even decades but becomes active when host is immunocompromised by drugs or disease including diabetes mellitus. Patients with diabetes mellitus shows a severe serious presentation of melioidosis. This is a case report of a 26 year old man with diabetes mellitus presented with fever, shortness of breath, left loin pain, dysuria and haematuria. The outcome of this melioidosis case and differential diagnosis are discussed