Distribution of nosocomial organisms and their resistance patterns in the Intensive Care Unit of the University Hospital of the West Indies, Kingston, Jamaica / Distribución de los organismos nosocomiales y sus patrones de resistencia en la Unidad de Cuidados Intensivos del Hospital Universitario de West Indies, Kingston, Jamaica

OBJETIVES: To determine the distribution and antibiotic susceptibility patterns of nosocomial pathogens in the Intensive Care Unit (ICU) at the University Hospital of the West Indies (UHWI). METHODS: A retrospective review of the laboratory records of all ICU patients from 2002-2004 was done. All organisms isolated from blood, urine, sputum, wound swabs and CVP tips were recorded. Sensitivity reports for organisms isolated in 2004 were also obtained. Results were analysed according to source of isolates and type of infection. RESULTS: Gram-negative organisms account for the majority of ICU isolates and show resistance to multiple antibiotics. The common Gram negative pathogens in the ICU are Pseudomonas aeruginosa, Acinetobacter spp and Stenotrophomonas maltophilia while the common Gram positive nosocomial organisms are Group D Streptococcus and coagulase negative Staphylococcus. CONCLUSION: The organisms isolated in the ICU at the UHWI are similar to those isolated in many ICUs all over the world. Surveillance data are necessary to monitor nosocomial pathogens and their resistance patterns to guide empirical antibiotic therapy.

OBJETIVOS: Determinar la distribución y los patrones de susceptibilidad antibiótica de los patógenos nosocomiales en la Unidad de Cuidados Intensivos (UCI) del Hospital Universitario de West Indies (HUWI). MÉTODOS: Se realizó una revisión retrospectiva de las historias clínicas de laboratorio de todos los pacientes de la UCI de 2002-2004. Se registraron todos los organismos aislados a partir de sangre, orina, esputo, hisopos de heridas, y las puntas de catéteres de PVC. Los resultados fueron analizados de acuerdo con las fuentes de los aislados y el tipo de infección. RESULTADOS: Los organismos gramnegativos representan la mayor parte de aislados de la UCI y muestran resistencia a múltiples antibióticos. Los patógenos gramnegativos comunes en la UCI son Pseudomonas aeruginosa, Acinetobacter spp y Stenotrophomonas maltophilia mientras que los organismos nosocomiales grampositivos comunes son Group D Streptococcus y coagulase negative Staphylococcus. CONCLUSIÓN: Los organismos aislados en la UCI en el HUWI son similares a los aislados en muchas UCIs en todo el mundo. La información sobre la vigilancia es necesaria a fin de monitorear los patógenos nosocomiales y sus patrones de resistencia para guiar la terapia antibiótica empírica.

Transplantation of benthic species to mitigate impacts of coastal development in Jamaica

Maintaining regional competitiveness and economic viability for Port Bustamante - Kingston Harbour, Jamaica, required improved accessibility to "Post Panamax" (too large to pass through the Panama Canal) container vessels. Removal of the northern portion of the shallow coral reef at Rackham's Cay, which was partially obstructing the western end of the east ship channel, was proposed. This aesthetically valuable reef was used by local fishermen and comprises part of the declared Palisadoes - Port Royal Protected Area. The proposal to transplant certain of the benthic species was advanced to mitigate loss of viable reef components. Between December 2001 and February 2002, sixty thousand items, consisting of reef building massive and branching corals; gorgonians; urchins (Diadema and Tripneustes spp.) and Thalassia meristems were relocated. During dredging, sedimentation rates from suspended solids in the water column were 0.003 g/cm(2)/day at the control site and 0.008 g/cm(2)/day at the dredge site. Coral cover in the relocation area increased from 15% to 20% while bare substrate decreased from 27% to 21%. This paper documents the mitigation required; some factors controlling the ecology of Rackham's Cay reef, the methodology of the relocation process; and the level of post-dredging survivorship of relocated corals. Political and economic realities of some proposed developments often override ecological considerations. Transplantation of important marine benthic species although time consuming, technically challenging, and expensive, may be one way for developers and ecologists to achieve sometimes disparate goals. This project cost US$1.7 million. The "items" moved were neither unique nor endemic and remain vulnerable to natural and anthropogenic impacts. This project increased public awareness and interest regarding the ecological and economic importance of reef ecosystems. It is anticipated that future coastal and inland developments will benefit from the lessons taught by these mitigative interventions

Extended spectrum beta-lactamase producing organisms at the University Hospital of the West Indies

Extended spectrum beta-lactamases (ESBL) represent a major group of beta-lactamases that have the ability to inactivate beta-lactam antibiotics containing an oxyimino group such as third generation cephalosporins and monobactams. These enzymes are produced by gram negative organisms, especially members of the Enterobacteriaceae family such as Klebsiella pneumoniae and Escherichia coli. The prevalence of these organisms varies widely internationally, as well as within the same country. This is the first study on ESBL production in K pneumoniae and E coli at the University Hospital of the West Indies, a tertiary care hospital in Jamaica. Two-hundred and sixty-four isolates of K pneumoniae and 300 isolates of E coli were collected over the study period January 2002 to December 2002. Forty-eight (18.2) K pneumoniae isolates were confirmed to be ESBL producers, while there was no ESBL producing E coli. Infections with ESBL producing organisms can pose a therapeutic challenge, leading to treatment failure if the wrong class of antibiotics is used. With increasing resistance to all classes of antibiotics, there is a narrowing of available treatment options. It is very important that these organisms be monitored and antibiotic policies as well as infection control policies be in place to curtail their spread