Phenotypic and genetic characterisation of methicillin-resistant Staphylococcus aureus strains isolated from the university hospitals of Debrecen.

The purpose of this study was to characterise methicillin-resistant Staphylococcus aureus (MRSA) strains isolated in 2005 at the university hospitals of Debrecen, Hungary. Three hundred and thirty-nine MRSA strains were isolated from 102 patients at 18 different clinics. Their sensitivity to oxacillin and ten other antibiotics was determined. For genotypic analysis, phage typing and pulsed-field gel electrophoresis (PFGE) was performed. The rate of MRSA strains increased to 7.2% in 2005, especially at the clinics of surgery, pulmonology and paediatrics. No vancomycin- or teicoplanin-resistant strains were found. The resistance to erythromycin, clindamycin and ciprofloxacin was nearly 100% and multi-resistance was very frequent. Fifty-eight percent of the isolates belonged to mixed phage types and 8% was non-typable. One PFGE clone contained 58.2% of all strains and two further major clones were found at a separately located clinical block, indicating intra-hospital spread. We can conclude that MRSA exhibits an increasing nosocomial problem also in Hungary.

[The role of infection control in the prevention of postoperative endophthalmitis]. / Die Bedeutung der Infektionskontrolle in der Prävention der postoperativen Endophthalmitiden.

INTRODUCTION: Infection control programs play an important role in the fight against nosocomial infections. They include all written protocols used and practical procedures performed before, during and after surgery. The authors describe the role of infection control in the prevention of postoperative endophthalmitis. PATIENTS AND METHODS: Retrospective data of endophthalmitis cases following elective eye penetrating surgeries performed at the Departments of Ophthalmology of the University of Debrecen and of the Hajdú-Bihar County Hospital in the periods between 1997-2001 and 2002-2003 were evaluated. Infection control methods for prevention have been in use in both institutes since 2002. RESULTS: The incidences of postoperative endophthalmitis before and after 2002 were 0.09 % and 0.07 %, respectively. Endophthalmitis cases in both periods occurred sporadically. Between 1997 and 2001 women accounted for 63.6 %, while they made up 80 % between 2002 and 2003; In the first period 63.6 % were older than 60 years whereas this group made up and 100 % in the second period. During the two periods accompanying chronic systemic diseases also had to be taken into consideration in 80 % and in 63.6 % of the cases, respectively. Intraoperative loss of the vitreous body was present in 27.2 % (1997-2001), and in 20 % (2002-2003) of the cases. CONCLUSIONS: We did not find any statistically significant difference between the incidence of postoperative endophthalmitis in the two periods. We think, however, that further studies involving more patients and longer study periods will reveal a correlation between the use of infection control methods and the prevention of both sporadic and epidemic cases of endophthalmitis, therefore all available data concerning this problem should be published. Moreover, the introduction of infection control policies into clinical practice will make prevention deliberate and more effective.

Studies of phagocytic and killing activities of alveolar macrophages in patients with sarcoidosis.

Phagocytosis and killing activities of alveolar macrophages were compared in 17 patients with stage 1 sarcoidosis and 6 healthy controls. The average total cell count of bronchoalveolar lavage fluid from patients with sarcoidosis was 7.8 +/- 7.5 x 10(6) cells; 70.4 +/- 15% of these cells were alveolar macrophages and 25.9 +/- 16.2% lymphocytes. Average total cell count from controls was 8.33 +/- 8.6 x 10(6) cells, with 92.7 +/- 5.9% alveolar macrophages and 6.6 +/- 4.4% lymphocytes. Purified alveolar macrophages were tested in in vitro antibacterial assays using S. aureus as a test microbe. Moderate decreases in the kinetics of staphylococcal ingestion were detected in the sarcoidosis group. The intracellular killing activity of macrophages was much lower in the patients with sarcoid than in control subjects. In a pilot study, intracellular killing activity of macrophages from 1 patient with sarcoidosis was greatly enhanced by 24 hr treatment with transfer factor. In summary, alveolar macrophages from patients with radiographic stage 1 sarcoidosis have decreased bacterial ingestion and intracellular killing activities. These results suggest that macrophages undergo complex functional changes in sarcoidosis that may influence both disease development and host defenses.

Early clinical experience with a simple method for autotransfusion in cardiac surgery.

A simple method for intraoperative autotransfusion (ATF) in open-heart surgery was tested in a prospective clinical trial. The patients were randomly assigned to a control group (33) or to the ATF group (35). The intraoperative ATF was combined with preoperative collection of blood and postoperative ATF. The postoperative chest-tube drainage was reduced by 24.3%, the donor-blood requirement by 43.3% and the consumption of fresh-frozen plasma by 43.9% in the ATF group as compared with the controls (all differences statistically significant). To investigate possible haematologic side effects of ATF, measurements of haemoglobin, haematocrit, fibrinogen concentration, thrombin, prothrombin and partial thromboplastin time, antithrombin-III and fibrinolytic activity were made in all patients preoperatively and on postoperative days 1 and 2. No statistical differences were then found between the controls and the ATF group. Microbiologic tests of blood sampled from the cardiotomy reservoir gave satisfactory results.