Neonatal and maternal postpartum bacteroides bacteremia.

OBJECTIVE: A unique case of Bacteroides fragilis bacteremia in a mother and her infant prompted a review of these infections in neonates and postpartum mothers during a five-year period at two institutions in Winnipeg, Manitoba. The purpose was to determine the frequency of these infections and ascertain commonly associated factors. METHODS: Infants and postpartum mothers diagnosed with bacteroides bacteremia were identified from laboratory records in both hospitals, and their medical charts were retrospectively reviewed. RESULTS: Bacteroides species were isolated in 10 maternal and four neonatal blood cultures. This represented 8.1% of the positive maternal and 1.2% of the positive neonatal blood cultures obtained during the review. The incidence of maternal infection was 2.56/10,000 deliveries, while that of neonatal infection was 1.03/10,000 live births. Postpartum fever and emergency caesarean section were often noted with maternal postpartum bacteroides bacteremia, while fetal distress, low Apgar scores and respiratory distress were frequent in neonatal bacteremia. CONCLUSION: Postpartum bacteroides bacteremia should be suspected among women with postpartum fever after emergency caesarean section. However, the occurrence of postpartum fever following emergency caesarian section is not necessarily associated with neonatal bacteroides bacteremia. Neonatal bacteroides bacteremia may not be readily suspected on clinical grounds, so clinicians should ensure that the laboratory procedures routinely used to evaluate neonatal bacteremia at their institutions reliably detect these organisms.

Transmission of Ureaplasma urealyticum from mothers to full and preterm infants.

This study assessed maternal genital colonization and subsequent neonatal transmission rate of Ureaplasma urealyticum in pregnant women in an average socioeconomic population. In addition very low birth weight infants were assessed to determine whether the presence of U. urealyticum correlated with increased risk of developing respiratory problems. The study group consisted of 108 sequential full term mothers and 104 preterm mothers delivering in a tertiary care hospital in central Canada. The genital carriage rates (assessed using placental sampling) of ureaplasmas in term and preterm mothers were 25.9 and 19.2%, respectively (P = 0.3185). Acquisition of ureaplasmas in the neonatal respiratory tract of neonates occurred significantly (P = 0.0182) more often in preterm neonates (11 of 130; 8.5%) than in term neonates (2 of 110; 0.9%). Very low birth weight (VLBW) infants (< or = 1500 g) were at greater risk (P = 0.042) of acquiring ureaplasmas in their respiratory tracts (5 of 26; 19%) than larger preterm neonates (6 of 104; 5.8%). All VLBW infants with respiratory colonization by ureaplasmas (5 of 5) developed bronchopulmonary dysplasia compared with 33% (7 of 21) of VLBW neonates without ureaplasmas (P = 0.028). This difference in bronchopulmonary dysplasia development among VLBW infants was independent of further stratification by birth weight. These VLBW neonates with ureaplasmas also stayed significantly (P = 0.037) longer in the neonatal intensive care unit (43.6 +/- 10.4 days) than did other preterm neonates (22.1 +/- 20.8 days). Our results demonstrate that VLBW preterm neonates have increased risk of acquiring U. urealyticum.(ABSTRACT TRUNCATED AT 250 WORDS)

Throat colonization of neonatal nursery staff by Ureaplasma urealyticum: An infection control or occupational health consideration?

Very low birth weight infants often have protracted respiratory tract colonization with Ureaplasma urealyticum. To determine whether prolonged contact with very low birth weight infants resulted in higher rates of upper respiratory tract colonization with this organism for caregivers, throat swabs for U urealyticum culture were obtained from medical, nursing and other support staff working in the neonatal intensive care and level II nurseries at the Health Sciences Centre and the St Boniface Hospital in Winnipeg, Manitoba. Throat colonization by U urealyticum was demonstrated in 7.3% (95% ci 0 to 15.6%) of 41 nurses working in the intensive care nurseries but in none of the 48 nurses working in other locations or the 66 other individuals tested (P=0.02). However, throat colonization was not significantly higher among the neonatal intensive care nurses than among the women delivering at one of the study institutions. Close contact with very low birth weight infants appears to constitute a minimal risk for increased throat colonization with U urealyticum among hospital staff members.

Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates.

Handwashing is the single most important procedure in the prevention of nosocomial infections and yet it remains the most violated of all infection control procedures. With a sequential intervention study in an intensive care unit we have demonstrated that poor handwashing practices are associated with a high nosocomial infection rate, whereas good handwashing practices are associated with a low nosocomial infection rate. An educational and enforcement program designed to improve handwashing procedures can significantly reduce endemic nosocomial infection rates.

Is ingestion of milk-associated bacteria by premature infants fed raw human milk controlled by routine bacteriologic screening?

Expressed human milk is often used to feed premature infants. Raw milk contains bacteria which may be a source of infection. Milk banks have developed screening programs which combine periodic quantitative milk cultures with arbitrary rules specifying limits of bacterial concentration. It is unknown whether such programs succeed in preventing infants from being fed milk containing bacteria. At the Health Sciences Centre (Winnipeg, Manitoba, Canada), milk is screened once weekly. When a woman's milk is found to have excess bacteria, it is discarded only if she is an unrelated donor (as opposed to an infant's mother). To assess the effectiveness of this screening program, we determined the frequency at which infants fed raw human milk were exposed to milk-associated bacteria and compared the bacterial contents of donor and maternal milk. From February 1986 to April 1987, all human milk fed to 98 premature infants during the first 2 weeks of feeding (n = 10,128 feeds) was cultured quantitatively. Among study infants, 100% were exposed at least once to coagulase-negative staphylococci, 41% were exposed to Staphylococcus aureus, and 64% were exposed to gram-negative bacilli. The proportions of feeds containing bacteria and the quantities (log10 CFU [mean +/- standard deviation]) ingested per positive feed were: 39% and 5.9 +/- 0.5 for coagulase-negative staphylococci; 2.4% and 5.1 +/- 1.0 for S. aureus; and 5.2% and 4.8 +/- 1.1 for gram-negative bacilli. There were no adverse events attributable to ingestion of milk-associated bacteria. Milk coagulase-negative staphylococcal isolates were multiply antibiotic susceptible, whereas infant isolates were antibiotic resistant. Donor milk was significantly less likely than maternal milk to contain coagulase-negative staphylococcal species in any quantity (40 versus 93% of samples, respectively [P < 0.001]) or in concentrations exceeding 10(8) CFU/liter (3 versus 27% of samples, respectively [P < 0.0001]). There was no difference between milk from either source in terms of S. aureus or gram-negative bacterial content (4 to 6%). These results suggest that the Health Sciences Centre screening program is effective in limiting the number of harmless coagulase-negative staphylococcal species but has no impact on the quantity of potentially pathogenic bacteria ingested by premature infants. Implications for screening donor milk are discussed.

Randomized, double-blind comparison of cefotaxime, cefoxitin, cefazolin or placebo as prophylaxis during gastric, small bowel or complicated biliary surgery.

In a double-blinded trial, 142 patients were randomized to receive placebo, cefazolin, cefoxitin or cefotaxime during high-risk gastroduodenal, biliary tract or small bowel surgery. Of the 125 evaluable patient trials, postoperative wound infection or intra-abdominal sepsis developed in 14/29 (48%) of placebo controls, 8/24 (33%) cefazolin, 7/37 (19%) cefoxitin, and in 2/35 (6%) of cefotaxime recipients. When patients undergoing vagotomy and pyloroplasty with prior cimetidine therapy were excluded, cefotaxime was superior to cefoxitin prophylaxis (2/26 versus 7/28, P = 0.014). Cefotaxime may be useful as a prophylactic agent in high-risk upper gastrointestinal surgery.

Investigations of the occurrence of gentamicin-resistant Staphylococcus aureus.

During the 19-month period from June 1976 to December 1977, 90 patients became colonized or infected with gentamicin-resistant Staphylococcus aureus (GRS). Of 63 adults, 56 had hospital-acquired GRS, whereas only 9 of 27 children had hospital-acquired GRS (P < 0.001). The other 7 adults and 18 children had GRS present on admission. More than half of those who acquired GRS in the hospital had received prior aminoglycoside therapy. Attack rates were higher in adults than in children and significantly higher on the plastic surgery service than on any other adult service. Phage typing revealed a single-strain outbreak on the plastic surgery ward involving 11 patients, whereas other isolates were of several phage types. Community-acquired GRS occurred more frequently in rural native communities (P < 0.02) and may be related to the use of topical gentamicin. Of 17 native children, 10 were from the same area but there was no common phage type. Agar dilution minimal inhibitory concentration (MIC) testing confirmed that all isolates were gentamicin resistant (MIC >/= 8 mug/ml) and almost all were tobramycin resistant (MIC >/= 8 mug/ml). Although the MIC distribution between gentamicin disk-susceptible and -resistant strains was significantly different, MIC's for 90% of gentamicin disk-resistant strains were