1/21. Fatal multi-resistant pseudomonas aeruginosa septicemia outbreak in a neonatal intensive care unit in Trinidad.Between July 2-3, 1998, six infants on the neonatal intensive care unit (ICU) at San Fernando General Hospital died following septicemia with multi-resistant pseudomonas aeruginosa. All patients were infected with the same strain and all were resistant to gentamicin, tobramycin, piperacillin and ceftazidime. Samples of hand washing liquids from the hands of the neonatal ICU staff were cultured and no P. aeruginosa was detected. Patients' environment and environmental surfaces: latches and interiors of incubators, sink traps and the operating theater environment and suction tubing were cultured, and P. aeruginosa with the same antibiogram was recovered from the suction tubing and the sink trap of the only tap on the neonatal ICU. Following the intervention of the infection control team and their strong re-emphasis on compliance with proper hand washing procedures and sterilization techniques, no cluster of infection with this strain or any other strain of P. aeruginosa were subsequently observed. The infecting strain may have been transferred from the operating theater via a neonate delivered by caesarean section and from this infant to the others by a neonatal health care worker who failed to wash hands properly between patients. This is the first documented fatal P. aeruginosa outbreak described at the San Fernando General hospital.- - - - - - - - - - ranking = 1keywords = environment (Clic here for more details about this article) |
2/21. superinfection with a transmissible strain of pseudomonas aeruginosa in adults with cystic fibrosis chronically colonised by P aeruginosa.Infection with transmissible strains of pseudomonas aeruginosa can occur in uncolonised patients, but cross infection (superinfection) of patients already colonised withP aeruginosa has not been reported. With genotypic identification, we found superinfection by a multiresistant transmissible strain of P aeruginosa in four patients with cystic fibrosis (CF) who were already colonised by unique strains of P aeruginosa. No evidence of environmental contamination was found, but all patients became superinfected after contact with colonised individuals during inpatient stays. inpatients with CF who are colonised with P aeruginosa should be separated by strain type. Such strain typing can only be reliably done by genomic methods, but this has resource implications.- - - - - - - - - - ranking = 0.33333333333333keywords = environment (Clic here for more details about this article) |
3/21. Community-acquired pseudomonas aeruginosa pneumonia complicated with loculated empyema in an infant with selective iga deficiency.pseudomonas aeruginosa is widely prevalent in the hospital environment, especially in intensive care units. Selective iga deficiency is characterized by a serum IgA level less than 5 mg/dl with no deficiency of other immunoglobulins. The occurrence of community-acquired P. aeruginosa pneumonia with empyema is rare in pediatric patients. We present a 10-month-old male infant who was referred due to persistent fever and progressive respiratory distress for 1 week. A chest radiograph revealed a right lobar pneumonia with pleural effusion. P. aeruginosa that was subsequently isolated from both blood and pleural effusion cultures. The patient received treatment with ceftazidime and intrapleural instillation of urokinase to promote drainage of empyema. Subsequent immunological screening revealed a very low serum IgA level (<5 mg/dl). We present our experience in successfully treating a loculated empyema with intrapleural instillation of urokinase in an infant. It is also important for pediatricians to be aware that they should be alert for the patient who present with respiratory infections due to unusual organisms. An advanced immunological study to investigate the underlying disorders in these patients is mandatory.- - - - - - - - - - ranking = 0.33333333333333keywords = environment (Clic here for more details about this article) |
4/21. Fulminant primary pseudomonas aeruginosa pneumonia and septicaemia in previously well adults.We report two cases of primary, community acquired, pseudomonas aeruginosa pneumonia, occurring in previously well adults without any recognisable environmental risk factors. Both patients died within 36 h of the onset of symptoms, despite broad spectrum antibiotics and aggressive supportive care. In neither case was the diagnosis considered in life and neither patient received adequate anti-pseudomonas therapy. Heightened awareness of this rare, fulminant, variant of primary Pseudomonas pneumonia is required if specific anti-pseudomonas therapy is to have any impact on outcome.- - - - - - - - - - ranking = 0.33333333333333keywords = environment (Clic here for more details about this article) |
5/21. An outbreak of pseudomonas aeruginosa pneumonia and bloodstream infection associated with intermittent otitis externa in a healthcare worker.OBJECTIVES: To investigate an outbreak of pseudomonas aeruginosa pneumonia and bloodstream infection among four neonates, determine risk factors for infection, and implement preventive strategies. DESIGN: Retrospective case finding; prospective surveillance cultures of patients, personnel, and environmental sites; molecular typing by pulsed-field gel electrophoresis; and a matched case-control study. PATIENTS AND SETTING: Neonates in the level-III neonatal intensive care unit of a tertiary-care pediatric institution. INTERVENTIONS: Cohorting of patients with positive results for P. aeruginosa, work restrictions for staff with positive results, implementation of an alcohol-based hand product, review of infection control policies and procedures, and closure of the unit until completion of the investigation. RESULTS: Seven (4%) of 190 environmental cultures and 5 (3%) of 178 cultures of individual healthcare workers' hands grew P. aeruginosa. All four outbreak isolates and one previous bloodstream isolate were genotypically identical, as were the P. aeruginosa isolates from the hands and external auditory canal of a healthcare worker with intermittent otitis externa. Four of 5 case-patients versus 5 of 15 matched control-patients had been cared for by this healthcare worker (P = .05). The healthcare worker was treated and no further cases occurred. CONCLUSIONS: These findings suggest that a healthcare worker with intermittent otitis externa may have caused this cluster of fatal P. aeruginosa infections, adding the external ear to the list of colonized body sites that may serve as a source of potentially pathogenic organisms.- - - - - - - - - - ranking = 0.66666666666667keywords = environment (Clic here for more details about this article) |
6/21. Healing an intractable wound using bio-electrical stimulation therapy.Clinicians involved in the conservative care of chronic wounds have many treatment interventions from which to choose, including debridement/irrigation, dressings, and pressure-relieving devices, to name a few. All are physical treatments that create an ideal wound healing environment. Unfortunately, many wounds heal very slowly, do not heal, or worsen. This situation relates to the woman in this case study who had a non-healing leg ulcer for 12 months. One of the interventions commonly used to treat chronic wounds is bio-electrical stimulation therapy (BEST) and the rationale for use of this method is based on the fact that the human body has an endogenous bioelectric system that enhances healing of bone fractures and soft-tissue wounds. When the body's endogenous bioelectric system fails and cannot contribute to wound repair processes, therapeutic levels of electrical current may be delivered into the wound tissue from an external source.- - - - - - - - - - ranking = 0.33333333333333keywords = environment (Clic here for more details about this article) |
7/21. pseudomonas mendocina, an environmental bacterium isolated from a patient with human infective endocarditis.pseudomonas mendocina has been isolated from soil and water samples. Although it has been recovered from some human clinical samples, its pathogenic role has not yet been documented. We report the first known case of endocarditis in humans due to P. mendocina.- - - - - - - - - - ranking = 1.3333333333333keywords = environment (Clic here for more details about this article) |
8/21. peritonitis with multiple rare environmental bacteria in a patient receiving long-term peritoneal dialysis.We describe a patient receiving long-term peritoneal dialysis who experienced 2 episodes of peritonitis in successive months caused by unusual bacteria of environmental origin: agrobacterium radiobacter, Pseudomonas oryzihabitans, and corynebacterium aquaticum. A radiobacter and P oryzihabitans occurred simultaneously in the first episode of peritonitis, and C aquaticum, in the second episode. The patient's vocation necessitated exposure to moist soiled conditions. Both episodes responded promptly to antibiotics commonly used to treat peritonitis. Although these organisms rarely lead to loss of life and commonly are considered to be contaminants, they can cause symptomatic peritonitis and peritoneal dialysis catheter loss. A review of previous case reports is included.- - - - - - - - - - ranking = 1.6666666666667keywords = environment (Clic here for more details about this article) |
9/21. Infections with Pseudomonas paucimobilis: report of four cases and review.Pseudomonas paucimobilis (formerly CDC group IIK, biotype 1) is a strictly aerobic, nonfermenting, oxidase- and catalase-positive, gram-negative bacillus that is widely distributed in water and soil. Its name derives from the difficulty encountered in demonstrating its motility, even in liquid media. This microorganism is responsible for two types of infection in humans: sporadic or community-acquired infections, probably of endogenous or environmental origin (bacteremia, meningitis, urinary tract infection, and wound infection); and outbreaks of nosocomial infection associated with the contamination of sterile fluids employed in hospitals. We present four cases of infection caused by P. paucimobilis (two of bacteremia, one of leg ulcer infection, and one of cervical adenitis). The majority of infections produced by P. paucimobilis have a good prognosis; no deaths related to this entity have been reported in the literature. The published results of susceptibility tests suggest that the aminoglycosides (either alone or in combination with a beta-lactam antibiotic) or the quinolone may be the agents of choice in the treatment of these infections.- - - - - - - - - - ranking = 0.33333333333333keywords = environment (Clic here for more details about this article) |
10/21. Flavimonas oryzihabitans (Pseudomonas oryzihabitans; CDC group Ve-2) bacteremia in the immunocompromised host.Flavimonas oryzihabitans, known previously as Pseudomonas oryzihabitans, and a member of the Centers for disease Control group Ve-2, is a gram-negative organism that has rarely been implicated as a human pathogen. Flavimonas oryzihabitans appears to be a soil and saprophytic organism that survives in moist environments and is indigenous to rice paddles. To our knowledge, only seven cases of human infection caused by this organism have been reported; they involved four patients with bacteremia and three patients with peritonitis who were receiving continuous ambulatory peritoneal dialysis. In this report, we describe three immunocompromised patients with catheter-associated bacteremia: a patient with cancer, a patient with acquired immunodeficiency syndrome, and a patient with sickle cell disease. There is emerging clinical evidence that F oryzihabitans should be recognized as an organism that is capable of causing human disease, particularly in immunocompromised patients and with the increased usage of permanent catheters.- - - - - - - - - - ranking = 0.33333333333333keywords = environment (Clic here for more details about this article) |
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