No abstract

To our knowledge, this is the first reported hospital outbreak that provides evidence that food can be a transmission vector for ESBL K. pneumoniae.

The group Streptococcus milleri (SM) includes several species of pathogenic streptococci associated with pyogenic infections. In 1956 O. Guthof was the first to use the name SM when referring to nonhaemolytic species of streptococci found in the oral cavity [1]. WHILEY and coworkers [2,3], through phenotypic and deoxyribonucleic acid (DNA)-DNA hybridization studies, affirmed the existence of at least three well-differentiated species: S. constellatus, S. intermedius and S. anginosus. Many authors prefer to continue using the term SM for the three species for two reasons: firstly, because the term is useful to the clinician, since it warns of the presence of a suppurative process [4,5] and secondly, because the three species appear to be equally represented as a cause of thoracic infection [6,7].The SM group is part of the usual flora of the mouth, but its true prevalence is unknown. It is also found among normal faecal flora in 16-67% of healthy adults and has been isolated from normal appendix and from vaginal secretions [3,[8][9][10]. The most important clinical feature of these micro-organisms is their tendency to cause suppurative infections at various sites, ranging from dental abscesses to deep visceral abscesses [1,4,8,[11][12][13][14][15].The purpose of this study was to contribute to a better understanding of the importance of members of the SM group as respiratory pathogens, by studying the epidemiological and clinical features of thoracic infections caused by SM and contrasting the features of empyema caused by SM with those in cases of pneumococcal aetiology. Patients and methodsA review was undertaken of the clinical histories and microbiological reports of episodes of infection by SM isolated from clinically significant samples in our institution, an acute care general hospital serving around 250,000 inhabitants, between January 1988 and December 1995. Only those cases in which some type of thoracic infection was diagnosed were analysed. The cases of pneumococcal empyema that occurred during the same period were also analysed. For the purposes of this study, thoracic infection was defined as all processes of an infectious nature localized to any of the organs, systems or anatomical structures in the thoracic cavity, except intravascular lesions with endothelial infection. Infections were considered to be acquired The clinical histories and microbiology reports were reviewed in 27 cases of thoracic infection caused by SM over a period of 8 yrs. Cases of pneumococcal empyema that occurred during the same period were also analysed.Diagnoses were made of cases of empyema, including six with pneumonia and one with pulmonary abscess, three cases of pneumonia and two of mediastinitis. In 17 cases, SM was the only pathogen isolated. There was a history of instrument or surgical procedures on the digestive or respiratory tract in 59%. Secondary bacteraemia was documented in three cases. The treatment administered, a combination of antibiotics and surgery, was successful in 22 of 27 (81%) of cases. All strai...

To determine the impact of a multimodal intervention designed to reduce the incidence of catheter-related bloodstream infections (CRBSIs) outside the ICU, we conducted a prospective, quasi-experimental, before-after intervention study in 11 hospitals participating in the VINCat programme in Catalonia, Spain. The intervention consists of: (i) an evidence-based bundle of practices relating to catheter insertion and maintenance; (ii) a training programme for healthcare workers; (iii) four point-prevalence surveys to track the status of the catheters; and (iv) feedback reports to the staff involved. The study included both central (CVC) and peripheral venous catheters (PVCs). Rates of CRBSI per 1000 patient-days were prospectively measured in 2009 (pre-intervention period) and 2010 (post-intervention period). The analysis included 1 191 843 patient-days in 2009 and 1 173 672 patient-days in 2010. The overall incidence of CRBSI decreased from 0.19 to 0.15 (p 0.04) and the incidence of CRBSI associated with a CVC decreased from 0.14 to 0.10 (p 0.004) after the intervention. The incidence in PVCs remained unchanged. There was a statistically significant improvement in the adequate maintenance of both CVCs and PVCs. Among the CRBSIs originating in PVCs, 61.8% appeared more than 72 h every insertion. There was a lower infection rate in the hospitals with a higher adherence to the recommendation to replace PVCs after 72 h. Our findings suggest that the implementation of intervention programmes similar to ours could have a major impact on patient safety by reducing the incidence of CRBSIs, and that routine replacement of PVCs might additionally prevent a significant number of bloodstream infections.