[Epidemic occurrences of multiresistant Acinetobacter baumannii strains in a neonatal intensive care unit]. / Epidemisches Vorkommen multiresistenter Acinetobacter baumannii-Stämme auf einer neonatologischen Intensivstation.

In a period of nine months (May 1991 to January 1992), 39 infants were colonized with Acinetobacter baumannii in a paediatric intensive care unit. Colonization was observed mainly in premature infants, weighing between 680 g and 2,000 g, who were artificially ventilated. Shortly after birth, A. baumannii was isolated regularly from tracheal washings, and less frequently from other material, such as gastric juice, catheter tips, and umbilical swabs. In older children or adults, the bacteria were found only in very low frequency. In the intensive care unit, A. baumannii could be isolated from tap water, sinks, water traps of the ventilation devices, the inner wall of incubators, and from the hands of medical personnel. Patients strains of A. baumannii, and those isolated monitoring the intensive care unit had an identical biochemical profile and a similar pattern of antimicrobial resistance, as well as a similar reaction in other typing methods. Anti-infective measures are discussed.

[Outbreak of a nosocomial infection of SHV2-beta-lactamase-containing Klebsiella pneumonia strains in an operative intensive care unit]. / Ausbruch einer nosokomialen Infektion durch SHV2-Betalaktamase-bildende Klebsiella-pneumoniae-Stämme in einer operativen Intensivstation.

Resistant strains of Klebsiella pneumoniae were found in increasing frequency as a cause of nosocomial infection in an intensive care unit between July and October 1990. The isolated strains had an almost identical biochemical profile, showed a similar pattern of antibiotic resistance, and produced type SHV2-broad-spectrum betalactamase. Thus, it was assumed that the isolates were copies of identical strains, causing an outbreak of nosocomial infections. The bacteria were resistant to third-generation cephalosporins, such as cefotiam, cefotaxime and ceftriaxone, and also to aminoglycosides and acylaminopenicillins. Approximately half of the strains were resistant to ceftazidim and aztreonam. The bacteria were sensitive in vitro to ciprofloxacin, imipenem, latamoxef and cefotetan. During three months, 10% (11) of all patients became infected; four of these patients (36%) died from septicemia. After conventional hygiene programs had failed to stop the outbreak, the intensive care unit was closed and disinfected, a measure, which effectively interrupted the infection.

Group JK corynebacteria in skin flora of healthy persons and patients.

The presence of group JK corynebacteria in the skin flora of the axilla and inguinal regions was monitored for several months in three groups comprising 45 oncological patients, 49 dialysis patients and 36 healthy staff members. Oncology patients were colonised significantly more often (51%) than dialysis patients and staff members (33% and 36% respectively). The frequency of isolation did not differ between male patients and staff whereas female patients were colonised significantly more often than female staff members. The inguinal region was colonised more often than the axilla. Oncological patients had the highest proportion of antibiotic resistant group JK corynebacteria strains on their skin and staff members the lowest proportion.

Clinical evaluation of temocillin in urinary tract infections.

A group of 27 female and 2 male urological patients, aged 19 to 80 years (mean 44 years), were treated with intravenous temocillin 500 mg twice daily for 5 to 7 days. The diagnoses were acute pyelonephritis (n = 20), acute cystitis (n = 6), and acute cystitis and pyelonephritis combined (3). The causative organisms were Escherichia coli (n = 20). Proteus species (n = 9). Klebsiella species (n = 4). Streptococcus faecalis (n = 2). Staphylococcus epidermidis (n = 1), and Providencia stuartii (n = 1). 27 of the 29 patients (93%) were clinically and bacteriologically cured; bacteriuria persisted in 2 patients with prolonged obstructive uropathy. In acute non-obstructive pyelonephritis, the urinary excretion of beta-2-microglobulin rapidly decreased, documenting a prompt renal tubular restitution during therapy. The drug was well tolerated and proved very safe with regard to haematological, hepatic and renal parameters. Also, Candida haemagglutination titres did not increase significantly during therapy. Temocillin therapy should preferably be commenced after the results of the urine culture are available.

Isolation of Corynebacterium group JK from clinical specimens with a semiselective medium.

A semiselective medium for the detection of multiresistant lipophilic corynebacteria is described. The medium consisted of tryptose agar, supplemented with Tween 80, lecithin, histidine, glycerol, sodium thiosulfate, fosfomycin, ticarcillin, and 5-fluorocytosine. The medium was tentatively called lecithin-Tween medium (LT medium). It promoted mainly the growth of Corynebacterium group JK, which has recently been identified as a cause of serious infection in immunocompromised patients. The application of LT medium to 6,859 routine clinical specimens increased the percentage of Corynebacterium group JK isolation from 0.1 to 1.0%. Although a total of 72 isolates were found in 65 patients, on the basis of clinical criteria only 2 patients were regarded as having an infection with these bacteria. Consequently, Corynebacterium group JK infection can only be diagnosed through a combination of clinical and microbiological findings. In high-risk areas, however, the use of LT medium for surveillance may facilitate the early detection of these potentially dangerous organisms.