Background: Methicillin-resistant Staphylococcus aureus (MRSA) has become one of the most widespread causes of nosocomial infections worldwide. Recently, reports have emerged that S. aureus strains recovered from community-acquired infections are also methicillin-resistant. This study was undertaken to analyze the prevalence of methicillin resistance among isolates at a regional hospital in Trinidad, and document the current resistance profile of MRSA and methicillinsensitive Staphylococcus aureus (MSSA) to the commonly used anti-staphylococcal agents.

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The carriage rate of GBS among pregnant women in the present and a previous study, remain high. Attempts to establish and implement a program aimed at GBS disease prevention have met with repeated failure. Data on the prevalence of GBS neonatal disease, preventative measures and outcome of infected infants are greatly needed.

A total of 132 neonatal deaths among 627 infants admitted to the neonatal ward of the San Fernando General Hospital, Trinidad over a 2-year period were reviewed. The most common cause of death was prematurity (43.9%). Infection was the second most common cause (21.2%). Pseudomonas aeruginosa and Staphylococcus aureus were the most frequently isolated organisms (43%). The major drugs used empirically in suspected cases of sepsis were ampicillin or ceftazidime plus gentamicin. About 85% of S. aureus were resistant to ampicillin, and P. aeruginosa resistance to ceftazidime and gentamicin was 76.7% and 72.1%, respectively. Significant risk factors in maternal history were infrequent antenatal care and prolonged rupture of membranes. The incidence of infection among low birthweight infants was 85.6%. Early-onset sepsis (86.4%) seemed to have a nosocomial origin because of the type of pathogens seen. There is an urgent need to improve the staff-to-patient ratio in the neonatal unit and for staff to be constantly reminded to employ simple infection control practices such as proper hand-washing to reduce cross-infections.

The serogroup distribution and antimicrobial susceptibility patterns of Shigella isolates obtained from stool specimens of persons with acute diarrhoea in community-based studies from southern Trinidad during 1997-2006 were reviewed. Of the 5,187 stool specimens, 392 (8%) were positive for Shigella organisms. From these 392 isolates, 88.8% were recovered from children aged >0-10 year(s). Shigella sonnei was the most frequently-isolated serogroup (75%), followed by S. flexneri (19%), S. boydii (4.1%), and S. dysenteriae (1.8%). S. flexneri was the major isolate among the >20-30 years age-group. The most common drug resistance among all age-groups was to ampicillin. All strains of S. flexneri, S. boydii, and S. dysenteriae were fully susceptible to aztreonam, gentamicin, and ciprofloxacin. S. sonnei, the most common species isolated, showed resistance to all antibiotics tested. The data showed that, throughout the study period, the resistance to commonly-used drugs was relatively low. Since resistance to several drugs seems to be emerging, continuous monitoring of resistance patterns is mandatory for the appropriate selection of empiric antimicrobial drugs in the therapy of suspected cases of shigellosis.

Strict adherence to proper infection control practices, such as handwashing techniques, and improvement of facilities are crucial steps in preventing cross-infections in the hospital environment. Implementing these measures may substantially reduce the massive drain on the hospital budget in treating nosocomial infections. The saved revenue could go toward improvement of ward facilities and reduction of overcrowding, thus further reducing cross-infection.

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The bacteremia rate was found to be 8.4% among hospitalized children suspected of having sepsis and from whom a blood culture was positive. Bacteremia was also associated with a high mortality rate of 15.1%. An unusually high level of bacteremia with Gram-negative enteric bacteria was seen, which might indicate cross infection and reflect a breakdown in infection control measures. Relatively high-level resistance of S. pneumoniae to penicillin and ceftriaxone was not seen, even though the overall prevalence of resistance to other antibiotics among other pathogens was relatively low. The drugs that showed the greatest efficacy were imipenem, gentamicin, ciprofloxacin, and the cephalosporins ceftazidime and ceftriaxone.