Outbreak of nosocomial sepsis and pneumonia in a newborn intensive care unit by multiresistant extended-spectrum beta-lactamase-producing Klebsiella pneumoniae: high impact on mortality.

We describe a case-control study of a small outbreak of nosocomial sepsis and pneumonia with high mortality due to clonal dissemination of a multiresistant Klebsiella pneumoniae in the neonatal intensive care unit of a Mexican institution. Our study helped to change nosocomial infection control policy in this hospital.

Clinical and bacteriologic efficacy of amoxycillin b.d. (45 mg/kg/day) versus amoxycillin t.d.s (40 mg/kg/day) in children with group A beta-hemolytic streptococcal tonsillopharyngitis.

This randomized, observer-blind, multicenter, parallel-group study compared the clinical and bacteriologic efficacy and safety of amoxycillin, 45 mg/kg/day b.d. and amoxycillin, 40 mg/kg/day t.d.s. after 7 days of treatment in 517 children with acute bacterial tonsillopharyngitis. At the end of treatment, a successful clinical response was recorded in more than 96% of patients in each of the treatment groups. A similar result was obtained at follow-up. Among those patients who were bacteriologically evaluable at the end of treatment, a successful bacteriologic response was achieved in more than 94% in each treatment group. Both treatments were well tolerated. Drug-related adverse events were recorded in just 12 patients (4.6%) in the b.d. group and six (2.4%) in the t.d.s. group. The study demonstrated that a twice-daily regimen of amoxycillin, 45 mg/kg/day, was as effective and as well tolerated as the standard three-times-daily regimen of amoxycillin, 40 mg/kg/day, in the treatment of acute bacterial tonsillopharyngitis in children.

[Epidemiology of nosocomial infections in a second level hospital]. / Epidemiología de las infecciones nosocomiales en un hospital de segundo nivel.

OBJECTIVE: To determine the incidence, specific rates, areas of greatest risk and causal agents of nosocomial infections at the Hospital General de Durango, of the Secretaría de Salud, Mexico. MATERIAL AND METHODS: Prospective study of nosocomial infection vigilance during one year including all patients discharged during this period. RESULTS: An overall rate of 9 infections per 100 discharged patients was found, the higher specific rates were in the areas of intensive pediatric care and births and the lowest were in the surgery, pediatric and gynecology and obstetrics departments. Infections were most frequent in urinary tract and surgical wounds as well as pneumonia among adults; among children, the most frequent were bacteremias and an epidemic outbreak with predominating Serratia marscecens was observed. Most patients presented one only infectious process and E coli, Klebsiello and Enterobacter sp. were the most frequently isolated microorganisms. CONCLUSIONS: The nosocomial infection rate observed in this study is higher than the average in Mexico for similar institutions. The most affected areas were those of critical patients and new births with urinary tract and surgical wound infections, and pneumonia, and the most frequent causal agents were enteric Gram-negative bacilli. These findings suggest guide lines for the design of a nosocomial infection control program, adjusted to the particular features of each institution.

[Nosocomial urinary tract infections at a second-level hospital]. / Infecciones nosocomiales de vías urinarias en un hospital de segundo nivel.

In order to investigate the incidence, etiologic agents and number of episodes of nosocomial urinary tract infections, a prospective study was carried on at the General Hospital in Durango, Mexico. All the patients admitted to the hospital during the period of March to June, 1991, and whose hospital stay was longer than 48 hours, were included. The infection rate in 962 patients was 12.9 episodes per hundred. The service of Internal Medicine had the highest rate and Pediatrics the lowest. The infection rate was higher among older patients and there was no significant difference between genders. 73% of the patients had only one episode of infection and the presence of a permanent urinary-catheter was the main clinical condition associated with infection. Escherichia coli and Klebsiella sp. were the most frequently isolated microorganisms. Nosocomial urinary tract infections have a very high incidence in a general hospital, therefore there is a pressing need to implement effective control programs.