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To characterize the epidemiological relationships among Stenotrophomonas maltophilia isolates in the neonatology unit of our institution over a 4-month period in which an increased number of isolates was observed.
The neonatology ward in a 2,000-bed university hospital in Madrid, Spain.
A retrospective molecular epidemiological analysis using three different typing methods, arbitrarily primed polymerase chain reaction (PCR), pulsed-field gel electrophoresis, and enterobacterial repetitive intergenic consensus-PCR, was performed with 11 isolates obtained from seven neonates over a 4-month period. Presumed unrelated isolates also were included as controls. A similarity dendrogram was obtained, to analyze the genetic relatedness among the isolates.
All isolates from the neonates, except one, showed a remarkably high homology among their typing patterns for the three methods assayed and clustered in the relatedness dendrogram at 96% similarity. The unrelated strains selected as controls were unclustered. The index case was considered to be a newborn who had an S maltophilia isolate from a culture drawn on the day of admission to the neonatology unit and which was included in the clustered similarity group.
Such a high genetic similarity among the isolates, together with the presence of an index case who had been colonized or infected by S maltophilia before arrival at our institution, constitutes the first evidence of nosocomial cross-transmission of this microorganism.
To evaluate the efficacy of an educational program for the prevention of catheter colonization.
Two cross-sectional studies were carried out in a 500-bed randomly selected area of the hospital, separated by an educational program on the care of intravenous lines based on the Centers for Disease Control and Prevention (CDC) recommendations for the control of catheter-related infections.
A 2,100-bed urban general hospital affiliated with the University of Madrid (Spain).
Characteristics of patients and catheters and appropriateness of catheter care were evaluated. Cultures were taken from the point of insertion of the vascular catheter, the hubs, and infusion fluids. When catheter-associated infection was suspected, the distal end of the catheter was sent for culture and two blood cultures were taken. We compared the clinical and microbiological data before and after carrying out an educational program based on CDC recommendations for the control of catheter-related infections.
Characteristics of patients and catheters did not differ between the two cross-sectional studies. Compared with baseline data, after the educational program we observed a reduction of inappropriate catheter care, from 83% to 38% (45% difference, 95% confidence interval [CI95], 55% to 35%, P<0.0000), and a reduction in the rate of skin colonization, from 34% to 18% (16% difference, CI95, 26% to 5%, P<0.001). The frequency of phlebitis (15% versus 14%), hub colonizations (12% versus 11%), catheter colonizations (2% versus 1%), and catheter-related bacteremias (0% versus 0%) remained unchanged between the two cross-sectional studies.
Our educational program improved catheter care and reduced significantly the proportion of skin colonization around the insertion point. However, the educational program did not modify the proportion of hub colonization; because hub colonization has been demonstrated to be a source of line sepsis, our data suggest the need for a specific program directed to the maintenance of catheter hubs.
Determine the epidemiology and risk factors for colonization with vancomycin-resistant Enterococcus faecium.
Survey; case-control study.
Pediatric oncology patients.
Contact isolation, restriction of vancomycin prescribing.
There was a high prevalence of colonization with vancomycin-resistant enterococci among pediatric oncology patients. The length of hospitalization and the administration of vancomycin and other intravenous antibiotics was associated with colonization. Prevention of colonization was associated with restriction of vancomycin use and contact isolation.
Vancomycin use may predispose to colonization with vancomycin-resistant E faecium. Vancomycin-resistant E faecium may be nosocomially spread. Contact isolation and restriction of vancomycin use may prevent spread of vancomycin-resistant E faecium.
To describe the characteristics and the problems arising from the use of vascular catheterization in a general hospital and to identify avoidable risk factors associated with catheter-related infections.
Cross-sectional, including the entire hospitalized population.
A university-affiliated hospital.
Three-hundred fifty-three intravascular catheters were implanted in 315 of a total of 1,838 hospitalized patients (17.1%, confidence interval [CI] = 15.7-18.5). Of the 353 intravascular catheters, 26 (7.3%) were intraarterial, 273 (77.3%) were peripheral, and 54 (15.3%) were central. The median (range) duration of the catheterization was 3 (1-1 1) days for arterial catheters, 1 (1-24) for peripheral catheters, and 5 (1- 130) for central catheters. Fifty-three (15%, CI = 11.5-19.5) showed signs of infection. Independent risk factors associated with infection were the presence of infection located elsewhere (odds ratio [OR]=8.7, CI=4.13-18.3, p<.0001), inappropriate catheter care (OR= 5.3, CI = 2.5-11.2, p<.0001), inappropriate length of catheter use (OR= 3.5, CI = 1.4-9.02, p<.01), and duration of hospitalization exceeding 14 days (OR=2.6, CI=O.9-7.83,p=.07).
The risk factors associated with catheter-related infections suggest that many are preventable by improved protocols for management. This hypothesis can easily be tested.
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