ABSTRACT
Twenty intensive care patients were diagnosed as infected or colonized by Pseudomonas aeruginosa within a one-month period; a rate three to four times higher than the typical background frequency of this infection in the intensive care unit (ICU). Patients with positive respiratory specimens were mechanically ventilated, which included re-used disinfected bite blocks during intubation. Fourteen specimens from 20 positive patients originated in the respiratory tract. Seven clonal variants were isolated and identified as originating from the same strain by pulsed-field analysis. These isolates were also matched to the strain detected on the re-used bite blocks, which had been disinfected with 140ppm sodium hydrochloride. Notably, Staphylococcus aureus was also detected on bite blocks sterilized with ethylene dioxide, indicating incomplete disinfection. In immunocompromised patients, re-use of bite blocks during intubation must be prohibited. Single-use kits or intubation without the use of bite blocks is recommended.
Subject(s)
Carbapenems/pharmacology , Cross Infection/epidemiology , Disease Outbreaks , Equipment Contamination , Pseudomonas Infections/epidemiology , Pseudomonas aeruginosa/pathogenicity , Cross Infection/microbiology , Cross Infection/prevention & control , Disease Outbreaks/prevention & control , Disinfection/methods , Drug Resistance, Bacterial/drug effects , Drug Resistance, Bacterial/genetics , Equipment Reuse/standards , Hospitals, University , Humans , Immunocompromised Host , Intensive Care Units , Intubation, Intratracheal/adverse effects , Japan/epidemiology , Pneumonia, Ventilator-Associated/epidemiology , Pneumonia, Ventilator-Associated/genetics , Pneumonia, Ventilator-Associated/microbiology , Pseudomonas Infections/drug therapy , Pseudomonas Infections/genetics , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/genetics , Respiration, Artificial/adverse effectsABSTRACT
The purpose of our investigation was to monitor current trends in the susceptibility patterns of clinical bacterial isolates to roxithromycin (RXM). We measured the MICs of macrolide antibiotics, such as RXM, erythromycin (EM), clarithromycin (CAM), rokitamycin (RKM) and midecamycin (MDM), and other classes of antibacterial compounds against various clinical isolates at seven institutions between October and December in 1994 and 1995. RXM had excellent antibacterial activities for S. pyogenes, S. agalactiae, M. (B.) catarrhalis and methicillin sensitive S. aureus. Against methicillin sensitive S. epidermidis, RXM activity was fairly good but about 20% of the strains had MIC > or = 128 micrograms/ml. The activity against S. pneumoniae was not so potent and similar to activities of EM, CAM, MDM, and clindamycin. The vast majority of methicillin resistant S. aureus and S. epidermidis were also resistant to macrolide antibiotics and other classes of compounds tested. In conclusion, RXM is an unique macrolide antibiotic by retaining potent activity against S. pyogenes, S. agalactiae, S. aureus except MRSA, M. (B.) catarrhalis and M. pneumoniae.
