Resistant enterococci are recognized as important h osp ital acquired pathogens. They are generally sensitive to ampicillin but intrinsically resis tant to cephalosporins and aminoglycosides and are known to acquire high level resistance to these drugs. High level resistance has serious implications for treatment of patients infected with lhese organisms and for infection control activities. Coloni s ation of the gastrointestinal tract is a prerequi, site to infection. A number of fa ctors a re known to contribute to acquiring co lonisa tion by resistant enterococci according to studies conducted · in the West. The present s tud y determines the prevalence of resis tant enterococci on admission in a cohort of hospitalised patients, and identifies SOll1e risk factors that are significantly associated with acquiring resistant enterococci during hospital s tay .A prospective s tud y conducted over three months, on 125 patien ts in orthopaedic units and the burns unit of the Nationa l Hos pital of Sri Lanka, to de termine colonisation showed that 5 .6 % we re colonised on admi ssion and 16.8% acquired ampicillin re s istant ente rococci (ARE) during hospitalisa tion. No va ncomycin resis tant enterococci (V RE) were isola led. Risk faclors
Senior Registrar i11 Microbiologythat were s ignificantly associated w ith colonisation were empiric use of antibiotics, trealment w ith ampiCillin, multiple use of antibiotics, prior ho spitalisa tion and presence of diabetes mellitus. These features wi ll be helpful in identifying pOSS ible patients for screening for resistant enterococci, with a view to implementing more sh'ingent infection conlrol measures La prevent spread of these organisms,
We present two patients with haematological malignancies who developed skin lesions while neutropaenic and were subsequently diagnosed as having fusariosis. Although fusariosis is not as common as other fungal infections such as aspergillosis and candidiasis, it has to be considered in the diagnosis of immunocompromised patients who present with skin manifestations. Awareness of fusariosis, and early diagnosis and appropriate treatment is essential to reduce mortality.
Fusarium species are plant pathogens which exist ubiquitously in the environment. While they can cause superficial and subcutaneous infections in healthy individuals, they can give rise to deep and disseminated infections in immunocompromised patients, particularly in patients with haematological malignancies with a high risk of mortality. This case describes a young male diagnosed with B Cell Acute Lymphoblastic Leukaemia (B-ALL) who developed disseminated Fusarium infection with febrile neutropenia following induction chemotherapy. Necrotic skin lesions led to the diagnosis in this patient. Though the patient had a clinical recurrence of infection due to inadequate treatment initially, he was finally completely cured with combined antifungal therapy using amphotericin B and voriconazole.
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