Airborne outbreak of nosocomial Scedosporium prolificans infection.

We describe six inpatients with acute non-lymphocytic leukaemia who developed invasive infection with Scedosporium prolificans resistant to amphotericin B, flucytosine, ketoconazole, fluconazole, and itraconazole. All six patients died. Phenotypic and genotypic assessment of samples from clinical material and ambient air from the isolation rooms where the patients were being treated showed that the epidemic was caused by a single strain. After implementation of aerial control measures, there were no further infections with this organism. We conclude that fatal multidrug-resistant S prolificans epidemics can be aerially transmitted and can be prevented with implementation of appropriate infection-control measures.

[Visual evoked potentials in children with tension headaches and migraine]. / Potenciales evocados visuales en niños con cefalea tensional y migraña.

OBJECTIVE: To determine whether visual evoked potentials (VEP) change, and to what degree, in different types of headache (migraine with or without aura, or tension headache). PATIENTS AND METHODS: We made a transversal study of 78 children (aged 3-14 years) studied between March 1997 and August 1998, classified into three groups according to HIS diagnostic criteria of 1988 and HIS-R 1997. A VEP of geometric pattern was done using the recording technique recommended by the International Society in their standards for VEP and the reference values were used for an amplitude of less than 5 microV and a latency of P100 +/- 15 ms. The qualitative variable was frequency, and the quantitative variables were the mean and the standard deviation. We studied the association between qualitative variables using the chi-squared test and the differences in means between the groups with ANOVA. All differences were considered to be statistically significant when p < 0.05. RESULTS: Girls made up 55%, with an average age of 8.84 years and a standard deviation of 3 years. There were no statistically significant differences in the mean of the VEP findings between the different types of headache with regard to amplitude (p = 0.975) and latency (p = 0.941). Neither were there any significant differences in the response to VEP in the different types of headache as far as sex and age were concerned, with p = 0.268 and p = 0.147 respectively. CONCLUSION: Our results show no statistically significant differences and do not support the idea of using VEP as a neurophysiological method for studying headaches and differentiating the various types.

[Antibiotic sensitivity of anaerobic bacteria isolated during one year (1993)]. / Susceptibilidad antimicrobiana de bacterias anaerobias aisladas en un año (1993).

BACKGROUND: The aim of this study was to determine the antimicrobian susceptibility of the anaerobe bacteria isolated from clinical samples in the authors' department in 1993. METHODS: The minimum inhibitory concentrations of 10 antimicrobians were determined in microgram/ml for 129 anaerobe bacterias by the microdilution in broth method recommended by the NCCLS. RESULTS: All The strains were sensitive to chloramphenicol. Metronidazole inhibited all the isolates except A. meyeri and 50% of other non spored gram-positive bacilli. Imipenen and piperacillin-tazobactam were the most active beta lactamics, with only 1 B. fragilis being resistant to both. Clavulanic amoxycillin presented good activity with only 5% from the B. fragilis group, 1 F. mortiferum and 2 P. anaerobius being resistant. In the B. fragilis group 10% were resistant to cefoxitin and 15% to piperacillin. The remaining isolates were sensitive to both antimicrobians. Resistance to clindamycin in the B. fragilis group was 16.7%. There were also strains resistant to Peptostreptococcus, Prevotella and aerotolerant non spored gram-positive bacilli. Penicillin and amoxycillin were the least active antimicrobians. CONCLUSIONS: Chloramphenicol, metronidazole, imipenem, piperacillin-tazobactam and clavulanic amoxycillin were very effective and showed a wide spectrum of activity versus the strains studied. Cefoxitin, piperacillin and clindamycin maintain good antianaerobe activity.

[Microbiological characteristics and spectrum of infections of 108 Streptococcus anginosus isolated]. / Características microbiológicas y espectro de infecciones de 108 Streptococcus anginosus aislados.

BACKGROUND: The aim of the present study was to assess the key microbiologic characteristics aid in the identification of Streptococcus anginosus in the laboratory and know the spectrum of clinical infections it produces. METHODS: From March 1991 to April 1992 all the isolated strains of clinical significant samples were collected. For identification the API 20 STREP (BioMérieux) system was used. The histories of the patients with infection by S. anginosus were retrospectively reviewed to collect clinical and microbiologic data of interest. RESULTS: The 108 strains of St. anginosus isolated were diminute colonies on sheep blood agar with CO2 enrichment. They had a characteristic smell, were beta-hemolitic or non hemolitic and of the Lancefield group A, C, F, G or not groupable. All had invariable biochemical features in the API 20 STREP: produced acetone and alkaline phosphatase, hydrolized arginine, did not hydrolize hypurate nor did they ferment ribose. Streptococcus anginosus produced purulent infections of different localization: abdominal, head-neck, pleuro-pulmonary, muscle-skeletal, skin and soft tissues and miscellaneous. Most of these infections were polymicrobial (81.5%). CONCLUSIONS: St. anginosus was easily identified in the laboratory by its morphologic characteristics and biochemical reaction in the API 20 STREP. It produced a wide variety of supurative infections, some being severe: cerebral, pulmonary, hepatic, empyema abscess. The identification of this microorganism at a species level should contribute to better recognition as a pathogen of occassionally severe supurative infections.

Prevention of nosocomial infection in critically ill patients by selective decontamination of the digestive tract. A randomized, double blind, placebo-controlled study.

OBJECTIVE: To evaluate the effect of a method of Selective Decontamination of the Digestive Tract (SDD) on colonization, nosocomial infection (NI), bacterial resistance, mortality and economic costs. DESIGN: Randomized, double blind, placebo controlled study. SETTING: Polyvalent intensive care unit (ICU) of a tertiary care hospital with 27 beds. PATIENTS: 101 patients with > 3 days of mechanical ventilation and > 5 days of stay, without infection at the start of the study. 47 belonged to the Treated Group (TG) and 54 to the Placebo Group (PG). INTERVENTIONS: The TG was given Cefotaxime i.v. (6 g/day) for the first four days and an association of Polymyxin E, Tobramycin and Amphotericin B at the oropharyngeal and gastrointestinal level throughout the whole stay. RESULTS: In the TG, colonization by gram-negative agents at oropharyngeal, tracheal and gastrointestinal level fell significantly. There was a significant drop in the overall, respiratory and urinary NI (26% vs 63%, p < 0.001; 15% vs 46%, p < 0.001; 9% vs 31%, p < 0.01). The overall mortality and NI related mortality was less in the TG (21% vs 44%, p < 0.05; 2% vs 20%, p < 0.01). The economic costs, mechanical ventilation time and length of stay were similar. The percentage of bacterial isolations resistant to Cefotaxime and Tobramycin was greater in the TG (38% vs 15% and 38% vs 9%, p < 0.001). CONCLUSIONS: colonization by gram-negative bacilli, NI and the mortality related to it can be modified by SDD. Continuous bacteriological surveillance is necessary.