ABSTRACT
The epidemiological characterization of multiply resistant Acinetobacter baumannii isolates from a six-bed Intensive Care Unit (ICU) is described. Investigations for A. baumannii were performed in three subsequent surveillance studies. In the first study, surveillance cultures were taken from patients, health care personnel and the environment; in the second study surveillance cultures were taken at 0, 4, and 7 days from all patients admitted consecutively to the ward; and in the third study surveillance cultures were taken from patients, health care personnel and the environment. During the first study all four hospitalized patients were found to harbour A. baumannii. Hand cultures did not grow any A. baumannii when staff entered the ward from home, but 7 positive health care workers were identified out of 25 samples taken during work, and two cultures of environmental specimens grew A. baumannii. During the second study, 4 of 86 (4.6%) patients resulted colonized with A. baumannii. In the third epidemiological study, no A. baumannii was cultured from either patients, health care personnel or the environment. All isolates recovered from various patients or sources produced conserved macrorestriction Pulsed-Field Gel Electrophoresis (PFGE) patterns and showed the same antibiotic resistance; therefore, they can be considered indistinguishable. The same antibiotic resistance and macrorestriction patterns were observed in previously isolated A. baumannii strains in the ward during May 1997, suggesting the persistence of a single A. baumannii in the ICU. The present study confirms that molecular typing is an essential tool in the epidemiology and control of nosocomial infections, showing here the persistence of a single A. baumannii clone in the ICU. The origin of this strain remains unknown but, when basic infection control measures were reinforced, emphasizing the importance of hand antisepsis and judicious use of gloves, control of A. baumannii spread in the ward was achieved.
Subject(s)
Acinetobacter baumannii/isolation & purification , Humans , Intensive Care UnitsSubject(s)
Aspergillosis/etiology , Aspergillus flavus/isolation & purification , Blood Vessel Prosthesis/adverse effects , Prosthesis-Related Infections/etiology , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Aorta, Abdominal , Aspergillosis/diagnosis , Aspergillosis/drug therapy , Aspergillus flavus/pathogenicity , Blood Vessel Prosthesis/microbiology , Diagnosis, Differential , Fatal Outcome , Humans , Male , Middle Aged , Multiple Organ Failure/etiology , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/drug therapy , Reoperation , Shock, Septic/etiology , Time FactorsABSTRACT
This study reports variations observed under general anesthesia through small-bore endotracheal tubes in PO2, PCO2, HCO3, percentage saturation of O2, and pH levels in 39 patients who underwent laryngeal microsurgery lasting from 10 to 100 minutes. The tendency to an increase in PCO2 levels reached statistical significance only at the 100th minute but did not constitute a risk for patients as values remained within the limits of "permitted hypercapnia." PO2, percentage saturation of oxygen, and HCO3 levels did not vary significantly. pH values tended to fall (respiratory acidosis) in correlation to the increase in PCO2. Small-bore endotracheal tubes can safely be used for laryngeal microsurgery when operating times are not longer than 100 minutes.
