Emergence of VIM-4 metallo-ß-lactamase-producing Klebsiella pneumoniae ST15 clone in the Clinical Centre University of Pécs, Hungary.

Since November 2009 carbapenemase-producing Klebsiella pneumoniae isolates have been detected in increasing numbers at the Clinical Centre University of Pécs. Molecular typing was performed for 102 clinical isolates originating from different time periods and various departments of the Clinical Centre. Pulsed-field gel electrophoresis revealed the predominance of a single clone (101/102), identified as sequence type ST15. PCR and sequencing showed the presence of blaCTX-M-15 and blaVIM-4 genes. The blaVIM-4 was located on a class 1 integron designated In238b. To our knowledge, this is the first description of a blaVIM-4 gene in the predominant CTX-M-15 extended spectrum ß-lactamase-producing Hungarian Epidemic Clone/ST15.

Efficacy of spray disinfection with a 2-propanol and benzalkonium chloride containing solution before epidural catheter insertion--a prospective, randomized, clinical trial.

BACKGROUND: Skin disinfection before neuroaxial blockade procedures is usually obtained with sterile swabs impregnated in disinfectant. Spray disinfection is also an option which is frequently used in minor invasive procedures. The purpose of our study was to compare the efficacy of conventional swab disinfection with spray disinfection prior to epidural catheterization. METHODS: Seventy patients who requested epidural analgesia were randomly selected. The first group (n=35) received disinfection with swabs (SW) containing 2-propanol and benzalkonium chloride. The other 35 patients received spray (SP) disinfection with the same solution. Three microbiological cultures were obtained: one culture prior to skin disinfection, a second immediately after disinfection and a third from the tip of the epidural catheter upon removal. RESULTS: One patient in the SW group had a positive skin culture immediately after the disinfection with a very low number of colony forming units. The other skin culture specimens were all sterile in both groups. The colonization rate of catheters was not statistically different between the groups at removal. CONCLUSION: In this study, spray disinfection was equally efficacious compared with the conventional skin disinfectant technique. Our results support the routine use of this simple and cheap alternative method of skin disinfection before epidural anaesthesia.