Genetic characteristics and molecular epidemiology of vancomycin-resistant Enterococci isolates from Caribbean countries.

Emergence of vancomycin-resistant Enterococci (VRE) that first appeared on the stage about three decades ago is now a major concern worldwide as it has globally reached every continent. Our aim was to simply undertake a multinational study to delineate the resistance and virulence genes of clinical isolates of VRE isolates from the Caribbean. We employed both conventional (standard microbiological methods including use of E-test strips, chromogenic agar) and molecular methods (polymerase chain reactions-PCR, pulsed-field gel electrophoresis-PFGE and multilocus sequence typing-MLST) to analyze and characterize 245 Enterococci species and 77 VRE isolates from twelve hospitals from eight countries in the Caribbean. The PCR confirmed and demonstrated the resistance and virulence genes (vanA and esp) among all confirmed VRE isolates. The PFGE delineated clonally related isolates from patients from the same country and other countries in the region. The main sequence types of the VRE isolates from the region included STs 412, 750, 203, 736 and 18, all from the common ancestor for clonal complex 17 (CC17). Despite this common ancestor and association of outbreaks of this lineage clones, there has been no reports of outbreaks of infection by VRE in several hospitals in the Caribbean.

Microorganisms encountered in blood cultures at the Queen Elizabeth Hospital and their antibiotic sensitivity pattern

The importance of blood cultures in the early detection of organisms is examined with the following conclusions. The isolation of of gram-positive and gram negative organisms are isolated from blood cultures with equal frequency. K. pneumoniae and E. coli are the most frequently isolated gram gram-negataive organisms. Staph, epidermis is isolated more frequently than Stap. aureus. Gentamcin was found to be the most effective antibiotic against Gram-negative blood culture isolates. Clindamycin and cloxacillin were found to be the most effective antibiotics against the gram-positive isolates. Chloramphenicol was found to be the most effective agent against the anaerobes as a group

Prevalence of HIV infection in STD clinic attenders in Barbados - abstract

In October 1987, an HIV counselling and testing study was initiated at Barbados' principal STD Clinic. The aim of the study was to determine the asymptomatic HIV carriage rate in a potentially high-risk population. Sequentially selected patients were counselled, and those agreeing to the HIV test were screened for antibodies, using Karpas AIDS test and the Abbott Recombinant ELISA test. Seropositive results were confirmed by Western Blot at CAREC. One hundred and eighteen males and eighty females were counselled. One hundred and eight males agreed to be tested and six (5.5 percent) were positve. Seventy-six females accepted the test and one (1.3 percent) was positive. The Karpas AIDS test as a screening test correlates satisfactorily with the Abbot ELISA. Of the seropositive patients for whom information is available, five of five males admitted to sex with prostitutes, three of five patients claimed sexual contact with tourists and five of five males admitted to sex with prostitutes, three of five patients claimed sexual contact with tourists and five of six had had a positive VDRL test for syphilis in the previous five years. The females was a prostitute and one of the positive males was bisexual. This male and one other positive male had received a blood transfusion in the previous five years. In this study population, HIV infection appears to be predominantly heterosexually acquired and particularly associated with sexual contact with prostitutes. A possible association between HIV infection sex with tourist needs further study (AU)

Childhood gastroenteritis in Barbados: occurrence of Campylobacter and Rotavirus

Four hundred children with diarrhoea whose ages ranged from 3 months to 6 years were investigated to determine the aetiology of childhood gastroenteritis in Barbados. Rotavirus (11 percent) was the most frequently identified pathogen, followed by Shigella (7 percent), enteropathogenic E. coli (4 percent), Salmonella (3 percent) and C. jejuni (1.3 percent) with 2 percent of patients having multiple pathogens. No pathogens were identified in the remaining cases studied. The ages of the patients with C. jejuni enteritis ranged from between 4 months and 2 years (mean 1.3 years). The male/female ratio was 2:1. The most frequent symptoms were fever (66 percent) and bloody diarrhoea (66 percent). The duration of stool excretion ranged from between 1 and 7 weeks. The organisms were uniformly sensitive to antibiotic tests against erythromycin, tetracycline, chloramphenicol, gentamicin and nitrofurantoin. In contrast, the ages of patients with rotavirus enteritis ranged between 3 months and 4 years (mean 1.3 years) with a male/female ratio of 1:1, and the most frequent symptoms were diarrhoea (80 percent), vomiting (70 percent) and upper respiratory infections. In 60 percent of patients, hospitalisation was necessary. All patients had an uneventful recovery (AU)

The epidemiology of acquired immune deficiency syndrome in Barbados (1984-1986) - abstract

Twenty-eight cases of the acquired immune deficiency syndrome (AIDS) were reported from the Queen Elizabeth Hospital (QEH), Barbados, during the period December, 1984 to October, 1986. All cases were identified using the WHO/CDC and the WHO clinical case definitions. There were 23 men, 5 women and 3 children. The case fatality rate was 61 percent. All cases were from recognised high-risk groups for AIDS; of the men, 26 percent admitted to being homosexual or bisexual; the women had multiple heterosexual contacts an the parents of the children were in the high-risk groups for AIDS. To date, intravenous drug abuse and tansfusion with blood and blood products, have not been implicated in any of the cases reported. In the adult patients, pnuemocystis carinii pneumonia was the most common opportunistic infection present. There were no cases of AIDS-associated malignancies. So far, over fifty per cent of the cases with opportunistic infections have died. AIDS in Barbados is increasing at the rate of about one new case each month, and appropritate educational and public health strategies have been instituted. (AU)

Current problems of neonatal septicaemia in Barbados - abstract

Neonatal septicaemia is a common cause of mortality and morbidity in the neonatal period, contributing factors being rapidly changing causative organisms and increasing resistance of gram-negative organisms. In this study, current problems of neonatal sepsis at the Queen Elizabeth Hospital were analysed in 227 infants suspected of having sepsis and who were admitted to a neonatal special care unit, during a two year period. There were 134 (59 percent) males and 93 (41 percent) females, a ratio of 1.4:1. Most patients (131 or 61 percent) presented at less than 24 hours of age, the most related obstetric factor being spontaneous vaginal delivery in 162 patients (71 percent). One hundred and twenty-one (50 percent) were low birth weight and 53 percent mothers had ruptured membranes for less than 12 hours. There were 24 deaths, 12 (50 percent) occurring during a Klebsiella epidemic. The mean hospital stay per patient was 12 days. One hundred and sixty-one bacterial isolates were recovered - 47 (29 percent) gram-positive and 114 (71 percent) gram-negative. Staph. albus, Staph. aureus, Klebsiella and E. coli were the most frequent isolates. Bacteriological sensitivity analysis revealed gram-negatives as highly sensitive to gentamycin and tobramycin and gram-positives as highly sensitive to cloxacillin. Proven sepsis was predominantly gram-negative. We recommend practising routine surveillance, aggressive investigation and no change in antibiotic policy at this time.

Nosocomial Klebsiella pneumoniae colonization in a neonatal special care unit

During the 1950s Staphylococcus aureus was the most frequently reported cause of nosocomial infection in hospitals. This paper describes an outbreak of colonization and infection due to Klebsiella pneumoniae in 14 infants in a neonatal special care unit

Campylobacter and rotavirus enteritis in Barbados - abstract

Childhood gastroenteritis is a universal disease which continues to be a major contributor to infant mortality, especially in developing countries. Within recent years rotavirus and, most recently, Campylobacter jejuni have been identified as the most common pathogens in childhood gastroenteritis. We present a pilot study of 400 children and aged 3 months to 6 years with gastroenteritis who were studied between July 15, 1983 and July 14, 1984. Rotavirus (11 percent), was the most frequently identified pathogen followed by Shigella in 7 percent, enteropathogenic E. coli in 4 percent, Salmonella species in 3 percent and C. jejuni in 1 percent of children; 8 (2 percent) had multiple pathogens. Rotavirus and C. jejuni cases were analysed in detail. Of the patients with C. jejuni, 66 percent presented with bloody diarrhoea, and fever, while for Rotavirus 80 percent of cases had diarrhoea, 70 percent vomiting and 43 percent upper respiratory symptoms. C. jejuni strains were uniformly sensitive to Erythromycin, Tetracycline, Chloramphenicol, Gentamicin and Nitrofurantoin. All patients had an uneventful recovery after their illness (AU)

Surveillance of nosocomial infections in Barbados - abstract

The results of surveillance of nosocomial infections at the 600-bed Queen Elizabeth Hospital for a period of 6 months are reported. All services of the hospital except obstetrical were included, because of its large population and very rapid turnover of patients. An 8.5 percent nosocomial infection rate was detected with a total of 569 infections in 463 patients among 6667 cases discharged from the services surveyed. Urinary tract infections accounted for 31.6 percent, surgical wound infections 21 percent, respiratory tract infection 14.4 percent, bacteraemia/septicaemia 6.5 percent, gastroenteritis 4.9 percent and miscellaneous, 21.6 percent. The most common organisms cultured in association with these infections were E. coli (22.0 percent Klebsiella sp. (17.2 percent), staphylococcus aureus (16.5 percent), neonatal care unit (12 percent) and general medical ward (9.1 percent). Infection rates of <3 percent were observed in paediatrics, opthalmology and oncology, with otolaryngology having the lowest nosocomial infection rate of 1.3 percent (AU)