[Incidence of transmission of pathogens in intensive care units. Results of the SIR 3 study]. / Inzidenz der Ubertragung von Infektionserregern von einem Intensivpatienten zum anderen. Ergebnisse der SIR-3-Studie.

The objective of this study was to determine the incidence of episodes of transmission of nosocomial pathogens and of those pathogens leading to nosocomial infections. Over a period of 18 months all patients from 5 intensive care units (ICUs) who stayed for more than 2 days were included in this study. Surveillance of nosocomial infections was carried out and all isolates of 10 of the most frequent pathogens in ICUs (indicator pathogens) were collected and typed. A total of 28,498 patient days and 431 nosocomial infections were observed (incidence density 15.1 per 1,000 patient days), among them 278 caused by 1 of the selected indicator pathogens. A total of 141 episodes of transmissions were identified, corresponding to an incidence of episodes of transmission of 5.0 per 1,000 patient days and 41 nosocomial infections were transmission-associated, corresponding to 14.5% of all nosocomial infections. The data of this study demonstrate that even in ICUs with average nosocomial infection rates, some nosocomial infections could be avoided.

Application of subtyping by combined allozyme, whole-cell protein and antibiotic resistance analysis in epidemiological investigations of food-borne infections.

Allozyme pattern, whole-cell protein pattern and antibiotic resistance were used as markers for epidemiological subtyping (below the species level) of food-relevant bacteria. The results of this study confirm the applicability of these patterns as epidemiological markers also for this special purpose. Electrotyping using also a reduced allozyme set seems to be the method with the highest discriminatory power of the three methods evaluated. Several examples demonstrate that complex typing of bacteria based on a combination of these three methods is useful for the analysis of food-borne infections and establishment of their causes but also for zoonotic studies. We see, beyond this, further applications of molecular subtyping methods in food microbiology and food hygiene such as safety checking in food industry or monitoring in biotechnological processes.

[Nosocomial infections with the detection of Staphylococcus aureus in an average hospital--an 11-year analysis]. / Nosokomiale Infektionen mit Nachweis von Staphylococcus aureus in einem mittleren Krankenhaus--eine 11-Jahres-analyse.

Nosocomial infections over an 11 years period were monitored prospectively in a district hospital. A total of nosocomial infections among 162.197 patients discharged from 1980-1990 were analyzed. The incidence rate of nosocomial infections was 3.6%. The predominant isolates were Escherichia coli and Staphylococcus aureus (11%). The highest rates of S. aureus infections were established in wound infections and skin and mucosal infections at surgery, gynaecology and paediatrics departments. The number of multiply resistant S. aureus strains has decreased and those of sensitive isolates has increased. 72% of 652 S. aureus isolates have been typed by phage typing and biotyping. Statistical analysis could not establish a significant relationship between phage patterns and nosocomial infections. The spectrum of phage patterns of these nosocomial strains was the same as those of the endogenous colonization of men. Nosocomial outbreaks could not been realized.

Analysis of Legionella pneumophila strains associated with nosocomial pneumonia in a neonatal intensive care unit.

A premature child received continuous mechanical ventilation in a neonatal intensive care unit. On day 10 of his life he developed pneumonia due to Legionella pneumophila serogroup 1, monoclonal subtype Bellingham. The strain was cultured from a tracheal secretion taken on day 10 and detected by immunofluorescence using monoclonal antibodies on days 10, 12 and 17. Legionella pneumophila serogroups 1 and 6 (10(2)-4 x 10(4) cfu/l) were cultured from both central and peripheral hot water systems. Monoclonal antibody testing, macrorestriction analysis of the genomic DNA using pulse-field electrophoresis, and electrophoretic alloenzyme typing showed the isolate from the child to be identical to the serogroup 1 strains from the hot water system. Four unrelated Legionella strains of the same monoclonal subgroup Bellingham were studied for comparison. Legionellae were also isolated from two other incubators, but no clinical or microbiological indications of legionellosis were found in the neonates hospitalised there. Serogroup 1 strains isolated from the patient and from the hot water system and serogroup 6 isolates from the hot water supply were able to multiply in cultured Acanthamoeba castellanii cells and in guinea pigs. The serogroup 6 strain, although prevalent in the incubators, was not found in any of the clinical specimens by either culture of immunofluorescence.

[Clonal spreading of a multidrug resistance Citrobacter freundii strain at a neonatal intensive care unit]. / Untersuchungen zur klonalen Verbreitung eines multiresistenten Citrobacter-freundii-Stammes auf einer neonatologischen Intensivtherapiestation.

This paper reports on the epidemic spreading of a multiresistant Citrobacter (C.) freundii strain at a neonatal intensive care unit. A premature baby of the 27th week of pregnancy died from septic shock caused by this strain. According to the result of a statistical analysis of risk factors a connection between the colonization of neonates and the feeding with an enteral feeding tube was probably. This suspicion could be confirmed by the detection of the multiresistant strain in the infant formula. Plasmid analysis, examination of outer membrane proteins and lipopolysaccharides of these C. freundii strains demonstrated the identity of all isolates. The resistance to antibiotics of this multiresistant C. freundii clone was determined by a plasmid belonging to incompatibility group C with a molecular weight of 110 MDa. This plasmid was involved also in other nosocomial outbreaks. It persisted more than 7 years in the hospital flora of the intensive care unit.

[Early recognition of fungal infection by detection of Candida albicans on catheter tips]. / Früherkennung der Pilzsepsis durch Nachweis von Candida albicans aus Katheterspitzen.

The demonstration of Candida (C.) albicans from the tip of indwelling venous catheters may be regarded as a sign of contamination, colonization or Candida sepsis. Diagnostic and therapeutic possibilities in a district hospital are dealt with.

[Staphylococcus epidermidis as a rare cause of sepsis]. / Staphylococcus epidermidis als seltene Ursache einer Sepsis.

Implanted synthetic materials have to be included into the differential diagnosis of sepsis. This paper reports on a case of sepsis caused by Staphylococcus epidermidis in connection with a Spitz-Holter shunt. The interval between the implantation and the recognition of the endoplastitis took 4 years. The attempt of an antibiotic sanitation had no results. The fitness for work could be restored by removal of the shunt and reimplantation.