Does screening neonates in the neonatal intensive care unit for Pseudomonas aeruginosa colonization help prevent infection?

BACKGROUND: Pseudomonas aeruginosa (PA) is a Gram-negative environmental organism that can cause severe infection in immunosuppressed patients, including preterm neonates. In recent years, it has become common practice to screen neonates for PA colonization. AIM: To assess the value of screening neonates for PA in (1) predicting the risk of developing severe PA infection and (2) directing infection control practice. METHODS: Between August 2012 and September 2015, babies admitted to the neonatal intensive care unit (NICU) at North Bristol NHS Trust were screened routinely for PA colonization on admission and weekly thereafter. Data were also collected on babies who developed PA infection. Environmental samples from the NICU were tested for the presence of PA. Variable number tandem repeat (VNTR) typing was performed on all strains of PA from babies and the environment. FINDINGS: No babies with positive screens subsequently developed PA infection. There was no VNTR strain evidence supporting cross-infection from the environment or other babies. CONCLUSION: Screening neonates for PA did not identify babies who subsequently developed PA infection. Following cessation of screening in September 2015, there was no increase in the number of babies identified with PA infection.

Impact of moving to a new hospital build, with a high proportion of single rooms, on healthcare-associated infections and outbreaks.

Clostridium difficile infection, meticillin-sensitive Staphylococcus aureus (MSSA) and Escherichia coli bacteraemia rates, and bed-days lost during norovirus outbreaks at North Bristol NHS Trust were analysed over a five-year period to determine whether moving to a new-build hospital with 75% single rooms reduced healthcare-associated infection rates. C. difficile, MSSA bacteraemia and E. coli bacteraemia showed no change in the rate of decline after the move. Bed-days lost due to norovirus were significantly lower after the move. Increased availability of single rooms had an impact on the transmission of highly contagious norovirus infection, dispersed via the airborne route, in contrast to bacterial infections, which may originate from patient's own colonizing flora and are not widely dispersed through airborne spread.

Role of early intravenous to oral antibiotic switch therapy in the management of prosthetic hip infection treated with one- or two-stage replacement.

OBJECTIVES: To determine outcomes for an antibiotic regimen using early switch to oral antibiotics for treatment of infected total hip replacement (THR) treated by either a one-stage or two-stage procedure. METHODS: Cases of infected THR were identified from the microbiology records on all orthopaedic infections in a 24 month period. Diagnosis was made by microbiological culture of theatre specimens and findings at the time of surgery. A standard approach of 10-14 days intravenous (iv) antibiotic followed by a switch to oral antibiotics either for 6-8 weeks until second-stage re-implantation or for up to 3 months following a one-stage procedure was used. The exact date of oral switch and antibiotic duration was determined by clinical resolution and C-reactive protein (CRP). Outcome was recorded as no microbiological or clinical evidence of relapse of infection or relapse after completing the antibiotic course. Follow-up duration for all cases at the time of study was 24-36 months after completion of antibiotic treatment. RESULTS: In 24 months, 19 patients underwent two-stage THR for infection, of which 17 were treated with oral antibiotics after a median of 14 days initial iv antibiotics. None relapsed. Four patients underwent one-stage THR and had 12-20 days iv then 6-26 weeks oral antibiotics with no relapse. CONCLUSIONS: Early oral antibiotic switch therapy was effective in patients treated at the Avon Orthopaedic Centre with infected THR and plays an important role in enabling patients to return to independence after revision surgery and avoid complications of prolonged iv access.

The use and therapeutic drug monitoring of teicoplanin in the UK.

Teicoplanin dosage recommendations for specific infections have been modified in recent years. However, there was no significant increase in the proportion of pre-dose concentrations > 20 mg/L between 1994 and 1998 in samples sent for teicoplanin assay at the Regional Antimicrobial Reference Laboratory, Bristol, UK. A questionnaire on the use of teicoplanin and therapeutic drug monitoring (TDM) was sent to all UK National External Quality Assurance Scheme antibiotic assay users. Teicoplanin was widely used in the UK, although vancomycin was more popular as a choice of glycopeptide. Fewer than 25% recommended teicoplanin TDM during routine use, the main reasons being perceived lack of toxicity and lack of evidence for the use of teicoplanin TDM. Pre-dose concentrations < 20 mg/L were considered appropriate for treatment of bacteraemia caused by methicillin-resistant Staphylococcus aureus by 53% of those responding. Data sheet advice was relied upon more than TDM as an indication of therapeutic dosing. Microbiologists who mainly used vancomycin tended to perform more TDM and seek higher serum concentrations when using teicoplanin than those who preferentially used teicoplanin.

Teicoplanin therapy for Staphylococcus aureus septicaemia: relationship between pre-dose serum concentrations and outcome.

Logistic regression analysis was performed on data drawn from a clinical trials database for Staphylococcus aureus septicaemia treated with teicoplanin. Variables analysed were age, body weight, mean pre-dose and post-dose serum teicoplanin concentrations, mean dose (mg or mg/kg body weight) and combination versus monotherapy. Only two variables correlated with clinical outcome at a significance level better than 0.05: age (P = 0.012) and mean pre-dose serum concentration (P = 0.010). The probability of successful treatment declined with age and increased with mean pre-dose serum concentration.

Use of meropenem 3 g once daily for outpatient treatment of infective exacerbations of bronchiectasis.

Meropenem administered as a single iv 3 g dose once every 24 h was used to treat nine ambulatory patients with infective exacerbations of bronchiectasis. Serum meropenem concentrations were measured before dosing and at 30 min after each 30 min infusion. Mean pre-dose concentrations were <0.1 mg/L and mean post-dose concentrations 93.9 +/- 29.5 mg/L (95% confidence interval (CI) 86. 2-101.6, n = 59). A pathogen was cultured from sputum in six patients and eradicated (<100 cfu/g sputum) in all but one by day 6 of therapy. Previous work on animals has shown that a bacteriostatic effect is seen with meropenem when t > MIC is greater than 20-30% of the dose interval. In these nine patients, this could be achieved and was associated with successful outcome for pathogens for which MICs are

Septic sacroiliitis: an unusual causative organism in a rare condition.

Streptococcus pneumoniae is a relatively uncommon cause of septic arthritis, and Infection of the sacroiliac joint by this organism has been rarely described. We present such a case.