A comparison of antimicrobial susceptibility profile of urinary pathogens for the years, 1999 and 2003 / Una comparación del perfil de susceptibilidad antimicrobiana de los patógenos urinarios en los Años 1999 y 2003

Urinary tract infection is a common condition worldwide; responsible for significant morbidity in both hospitalized and community patients. The laboratory records, for microbial isolates of infected urine and their susceptibility profiles for the years 1999 and 2003 were retrospectively reviewed and compared. In 2003, there was a significant decline in recovery ofCitrobacter spp compared to 1999. Conversely, the proportion of K pneumoniae, E coli and Enterococci increased dramatically in 2003, in both practices. For Proteus vulgaris and Proteus mirabilis, rates of isolation were increased in 2003, in hospital practice and community practice, respectively. Significant changes in antimicrobial susceptibility were also evident. A greater proportion of isolates from both practices were resistant to ampicillin, amoxicillin-clavulanic acid, cefuroxime, ceftazidime and cotrimoxazole in 2003 when compared to 1999. With respect to E coli, there were significant increases in prevalence of resistance to cefuroxime and amoxicillin-clavulanic acid. The overall resistance rate for norfloxacin remained relatively low and was unchanged for E coli. Continued surveillance of uropathogen resistance trends is important and this information should be communicated to clinicians. The feasibility of using the fluoroquinolones as a first line of therapy in urinary tract infection should be considered.

La infección del tracto urinario es una condición común a nivel mundial. Esa condición es significativamente responsable de la morbilidad, tanto en los pacientes hospitalizados como en los no hospitalizados. Los datos de laboratorio en relación con los aislados microbianos de la orina infectada y sus perfiles de susceptibilidad en los años 1999 y 2003, fueron revisados y comparados de manera retrospectiva. En 2003, se produjo un descenso significativo de la recuperación de infecciones por Citrobacter spp, en comparación con 1999. En contraste con ello, la proporción de K pneumoniae, E coli y Enterococci en ambas prácticas, aumentó dramáticamente en 2003. En el caso de Proteus vulgaris y Proteus mirabilis, las tasas de aislamiento aumentaron en el año 2003 en la práctica médica hospitalaria y comunitaria respectivamente. También aquí se hicieron evidentes cambios significativos en la susceptibilidad antimicrobiana. Una proporción mayor de aislados de ambas prácticas resultó ser resistente a la ampicilina, la combinación amoxicilina/ácido clavulánico, la ceftazidima y el cotrimoxazol en 2003, en comparación con 1999. Con respecto al E coli, hubo aumentos significativos en la prevalencia de la resistencia a la cefuroxima y la asociación amoxicilina/ácido clavulánico La tasa de resistencia general frente a la norfloxacina permaneció relativamente baja y no presentó variaciones frente al E coli. La vigilancia permanente de las tendencias de la resistencia a los patógenos es importante, y la investigación así obtenida, debe ser comunicada a los clínicos. Debe considerarse la factibilidad de usar fluoroquinolonas como terapia de primera línea.

Nosocomial infections in an intensive care unit in a private hospital

The nosocomial infection rate in the intensive care unit (ICU) of a private hospital was assessed during an 18-month survey. From 629 admissions to the ICU, 139 hospital-acquired infections were identified. The rate was 22.1 compared to the overall nosocomial infection rate of 15.3 for the entire hospital. In the ICU, the main infections occurred in the respiratory tract, 41 (29.5), followed by surgical wounds, 35 (25.2), urinary tract, 28 (20.1) and the blood stream, 24 (17.3). From 165 bacterial isolates, 80 of isolates were gram-negative rods, with P aeruginosa, 48 (36.6), being the predominant gram-negative isolate followed by Klebsiella pneumoniae, 27 (20.6), and Enterobacter sp, 22 (16.8). The main gram-positive isolates were S aureus, 23 (41.8), coagulase-negative Staphylococci, 17 (30.9), and Enterococci, 11 (20.0). Of the 23 S aureus strains, 15 (65.2) were methicillin-resistant (MRSA), (8 MRSA were from surgical wounds, 5 from the respiratory tract and 2 from infected urine). Only 2 of the 17 (11.8) coagulase-negative staphylococci were methicillin-resistant, and both were isolated from wounds. Resistance to ampicillin and augmentin (amoxicillin-clavulanic acid) was high, 81.9 and 55.4, respectively. Gentamicin, aztreonam, piperacillin and piperacillin-tazobactam showed resistance rates of less than 15. Infection control measures aimed at reducing nosocomial infections at the hospital are often frustrated by apathy of hospital administrators who apparently are insensitive to the high nosocomial infection rate. Effort by the infection control team through seminars, lectures and newsletters have begun to show improvements in attitude and awareness of staff to infection control and preventative measures within the institution.

Infectious mononucleosis in the University of the West Indies

The clinical features and laboratory parameters in sixteen confirmed cases of Infectious Mononucleosis (IM) seen at the University Hospital of the West Indies between 1975 and 1989 were reviewed. The common presenting features were lymphadenopathy (14/16), fever (13/16) and pharyngitis (7/16). Atypical lymphocytosis was present in 10 cases and heterophile antibodies (HA) in 9 cases. The aetiology and laboratory diagnosis of IM are briefly discussed.

Knowledge and understanding of AIDS among health-care workers in Jamaica

Six hundred and fifty questionnaires were sent to Health-care Workers (HCW) in four hospitals to assess the knowledge and understanding on HIV transmission and isolation precautions to be instituted for control and also ascertain whether any differences in knowledge existed between HCW of teaching and nonteaching hospitals. Five hundred and nine questionnaires were returned, a response rate of 79%. Questions on HIV transmission via blood transfusión and sexual intercourse and proper disposal of sharp instruments received the highest scores (85-100), embracing all groups of teaching and non-teaching hospitals. The greast area of misconception and misunderstanding was reflected in responses obtained on isolation precautions (<30) for both teaching and non-teaching hospitals. Oure study emphasizes an urgent need for a comprehensive, continuous education of HCW on prevention and control of HIV infections in Jamaica