Characterisation of Staphylococcus Aureus Bacteraemia at Tygerberg Hospital

To elucidate the local epidemiology of Staphylococcus aureus bacteraemia; we characterised blood culture isolates using molecular methods and prospectively collected clinical data to determine the occurrence of community-acquired; methicillin-resistant S. aureus (MRSA). Consecutive S. aureus blood culture isolates were collected over a one-year period from patients who were admitted to Tygerberg Academic Hospital in the Western Cape. A multiplex polymerase chain reaction (PCR) was used for the detection of spa; mecA and lukS/F-PV genes. Strain typing was performed using spa typing. Multiplex PCR for staphylococcal cassette chromosome mec (SCCmec) typing was also performed; as well as multilocus sequence typing (MLST) on selected isolates. Cases were categorised by clinical data as either hospital-acquired; healthcare-associated or community-acquired. One hundred and thirteen S. aureus isolates (30 MRSA) were collected from 104 cases of bacteraemia. According to clinical data; all community-acquired infections; 54 of hospital-acquired cases and the majority of healthcare-associated cases were due to methicillin-sensitive S. aureus (MSSA). Furthermore; all Panton-Valentine leukocidin (PVL)-positive isolates (15.9 of all S. aureus) were MSSA. MRSA strains were isolated from hospital-acquired cases (with a minority of healthcare-associated cases) and clustered mainly in spa-CC701 and CC012. SCCmec type IV was predominant. MLST clones included ST239-MRSAIII; ST36-MRSA-II and ST612-MRSA-IV. The predominant source for S. aureus bacteraemia was catheter-related infection (39). Community-acquired S. aureus infections in our setting remain sensitive to methicillin and current treatment guidelines suffice. The majority of hospital-acquired and healthcare-associated infections were catheter-related. Prevention and treatment should be targeted accordingly

Superior Detection of Pathogens in Synovial Fluid by the Bactec 9240 Peds Plus/F System Compared to the Conventional Agar-Based Culture Method

Abstract:To improve culture yield in cases of possible septic arthritis; we compared culture of joint fluid aspirates on conventional agar-based media to culture in Bactec 9240 Peds/Plus F blood culture bottles with and without the addition of fastidious organism supplement (FOS). Over a period of 21 months; we analysed 123 synovial fluid samples and isolated 20 pathogens. The Bactec methods proved superior by yielding more pathogens than the conventional culture method (p=0.074). However; this method also yielded more contaminants within the first three days of incubation (p=0.027). All contaminants detected after three days of incubation were the result of overgrowth on conventional method agar plates. The Bactec methods provided clinicians with a positive pathogen result one day earlier than the conventional counterpart (p=0.001). Four isolates of Neisseria gonorrhoeae were only cultured with the Bactec method. No significant benefit was demonstrated by supplementing blood culture bottles with FOS. We recommend that whenever infection by fastidious organisms is suspected; synovial fluid aspirates should be cultured using automated blood culture systems to increase the culture yield and to decrease the time to detection

Edema agudo de pulmäo em hipertensäo severa na gravidez: apresentaçäo de um caso / Pulmonary edema in severe hypertension and pregnancy: a case report

Os autores descrevem caso de doença hipertensiva vascular crônica que complicou com edema agudo de pulmäo. Para melhora do quadro clínico respiratório optou-se porcesariana "in extremis", que trouxe reversäo imediata da petologia pulmonar. Evoluiu bem nos 30 dias subsequentes, mas no 31º dia fez novo edema agudo e faleceu, fato que, concordante com literatura, é complicaçäo comum