Molecular Epidemiologic Analysis of Methicillin-Resistant Staphylococcus aureus Isolates from Bacteremia and Nasal Colonization at 10 Intensive Care Units: Multicenter Prospective Study in Korea

We investigated molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) isolated at 10 intensive care units (ICUs) in Korea. MRSA isolates from bacteremia and nasal colonization were collected prospectively from October 2008 through May 2009 at 10 University-affiliated hospital ICUs. A total of 83 and 175 MRSA strains were isolated from bacteremia and nasal colonization, respectively. Acquired group accounted for 69.9% (n = 58) of bacteremia and 73.1% (n = 128) of nasal colonization. Pulsed-field gel electrophoresis (PFGE) type B (SCCmec type II/ST5) was dominant in the acquired group followed by PFGE type D (SCCmec type IVA/ST72; a community genotype). Seven of 58 (12.1%) acquired bacteremia and 15 of 128 (11.8%) acquired nasal colonizations had SCCmec type IVA/ST72 genotype, which indicated that the community genotype had already emerged as a cause of ICU acquired MRSA infection or colonization. Antibiotic resistance rates to ciprofloxacin, tetracycline, clindamycin and trimethoprim/sulfamethoxazole were 84.4%, 67.1%, 78.1%, and 12.0%, respectively. Susceptibility to ciprofloxacin best predicted a community genotype (sensitivity 96.5%; specificity 96.9%; odds ratio 861; 95% confidence interval 169-4,390, P < 0.001) and the positive predictive value was 90.2%. Among 23 nasal re-colonized strains, 7 MRSA strains (30.4%) were different from the originally colonized strains on the basis of PFGE types.

Th-1 and Th-2 cytokine production in infants with virus-associated wheezing

Wheezing associated with respiratory viral infections in infancy is very common and results in high morbidity worldwide. The Th1/Th2 pattern of immune response in these patients remains unclear and previous studies have shown controversial results. The aim of the present study was to compare the type of Th1/Th2 cytokine response between infants with acute bronchiolitis, recurrent wheezing and upper respiratory infections from a developing country. Infants younger than 2 years of age admitted to Hospital São Lucas, Porto Alegre, RS, Brazil, between May and November 2001, with an acute episode of wheezing associated with viral respiratory infection were selected. Subjects with upper respiratory infections from the emergency department were selected for the control group. Interferon-gamma (IFN-gamma) and interleukin-4 (IL-4) levels from nasal aspirates were determined by ELISA from peripheral mononuclear cell cultures. Twenty-nine subjects with acute bronchiolitis, 18 with recurrent wheezing and 15 with upper respiratory infections were enrolled. There were no differences in family history of atopy or parental smoking between groups. Oxygen requirement was similar for the acute bronchiolitis and recurrent wheezing groups. The percentage of positive tests for the cytokines studied and the IFN-gamma/IL-4 ratio was similar for all groups. Comparison of the polarized Th1/Th2 cytokine results for the various groups showed no specific pattern of cytokine production. Infants with wheezing from a developing country do not show any specific predominant pattern of Th1/Th2 cytokine production, suggesting that multiple factors may be involved in the pathogenesis of this illness.

Comparación de fluticasona, beclometasona y lavados nasales en infecciones y recidivas de polipectomía nasosinusal / A comparison of fluticasone, beclomethasone and nasal lavages in infection and recidives after rhinosinusal polypectomy

Propósito : El objetivo del estudio fue valorar si el uso de esteroides tópicos nasales en el postoperatorio de polipectomia por vía endoscopica aumentaba la incidencia de infección postoperatoria. Material y métodos: Cuarenta y cinco pacientes con indicación de polipectomía fueron divididos de manera aleatoria en 3 grupos de 15 pacientes cada uno. A los pacientes del primer grupo se les realizó curación con lavados nasales exclusivamente. A los pacientes del segundo grupo se les aplicaron además 400 mcg de propionato de fluticasona al día. A los pacientes del tercer grupo se les administraron 600 mcg de dipropionato de beclometasona al día. Se comparó la prevalencia de infección y de recidiva de poliposis en el postoperatorio de los tres grupos de pacientes. Resultados : En ninguno de los 45 pacientes se presento infección en los primeros 3 meses del postoperatorio. Hubo recidiva en 46 por ciento de los pacientes sin esteroide tópico en comparación de 7 por ciento en el grupo de Fluticasona y de 13 por ciento en el grupo de Beclometasona. Conclusión : En la polipectomia endoscópica, los esteroides tópicos nasales disminuyen el porcentaje de recidivas tempranas sin provocar infección postoperatoria