Cases reported "Cross Infection"

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1/35. serratia marcescens bacteremia after carotid endarterectomy and coronary artery bypass grafting.

    serratia marcescens is a common, water-borne hospital colonizer. Respiratory secretions, wounds, and urine are frequently recognized areas of Serratia colonization. Serratia bacteremias usually occur nosocomially and are associated with high mortality and morbidity rates. Serratia bacteremias may be primary or secondary from an identifiable source. Hospital-acquired S marcescens bacteremias have no known source in half of the cases. We present a case of nosocomial primary S marcescens bacteremia in a surgical patient successfully treated with levofloxacin.
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ranking = 1
keywords = wound
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2/35. herpes simplex virus infection in a paediatric burn patient: case report and review.

    herpes simplex virus (HSV) infection in the burn patient is thought to occur relatively frequently. Most commonly, children with significant burns, particularly involving the head and neck, are affected. Burn related immunosuppression is thought to allow reactivation of latent HSV in most cases, although primary HSV infection has been recognized. Clinical manifestations vary from asymptomatic viral shedding, to prolonged fever with eruption of vesicles, to rare cases of systemic visceral dissemination. Healing partial thickness wounds and donor sites are most prone to infection. Laboratory confirmation of HSV infection relies on direct demonstration of the virus and/or observation of a rise in antibody titer. Treatment of an established HSV infection includes use of IV acyclovir, meticulous wound care, and efforts to prevent nosocomial spread. The vast majority of cases resolve without sequelae unless complicated by systemic, multiorgan HSV infection.
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ranking = 2
keywords = wound
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3/35. Sternal osteomyelitis and mediastinitis after open-heart operation: pathogenesis and prevention.

    Sternal osteomyelitis and mediastinitis caused by pseudomonas cepacia developed in a patient undergoing coronary artery bypass two weeks after the operation. P. cepacia bacteremia from a contaminated pressure transducer had preceded and probably caused the chest infection. While other authors have suggested that postoperative sternal osteomyelitis and mediastinitis result from local wound contamination, this case suggests the importance of bacteremia as a cause of such gram-negative infections. Since patients undergoing open-heart operation are exposed to many sources of bacteremia, prevention of severe postoperative chest infections may depend in large part on careful preoperative evaluation of each patienc antibiotic regimens, and, as shown in this patient, on very thorough periodic review of equipment sterilization and intravascular monitoring practices.
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ranking = 1
keywords = wound
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4/35. Outbreak of nosocomial infections due to extended-spectrum beta-lactamase-producing strains of enteric group 137, a new member of the family enterobacteriaceae closely related to citrobacter farmeri and citrobacter amalonaticus.

    A member of the enterobacteriaceae initially identified as kluyvera cryocrescens by the MicroScan Gram-Negative Combo 13 panel caused an outbreak of nosocomial infections in four patients (pneumonia, n = 2; urinary tract infection, n = 1; wound infection, n = 1) and urinary tract colonization in one patient. When the strains were tested by the Enteric Reference Laboratory of the Centers for disease Control and Prevention, biochemical results were most compatible with yersinia intermedia, kluyvera cryocrescens, and citrobacter farmeri but identification scores were low and test results were discrepant. However, when the biochemical test profile was placed in the computer database as a new organism, all strains were identified as the organism with high identification scores (0. 999968 to 0.999997) and no discrepant test results. By 16S rRNA sequence analysis the organism clustered most closely with, but was distinct from, citrobacter farmeri and citrobacter amalonaticus. Based on its unique biochemical profile and rRNA sequence, this organism is designated Enteric Group 137. Restriction endonuclease analysis and taxonomic antibiograms of strains causing the outbreak demonstrated a single clone of Enteric Group 137, and antibiotic susceptibility testing revealed the presence of extended-spectrum beta-lactamase (ESBL) resistance. Enteric Group 137 appears to be a new opportunistic pathogen that can serve as a source of ESBL resistance in the hospital.
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ranking = 151.93656552622
keywords = wound infection, wound
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5/35. Candida osteomyelitis and diskitis after spinal surgery: an outbreak that implicates artificial nail use.

    Postoperative wound infection after laminectomy is uncommon. In February 1997, 3 patients were confirmed to have postlaminectomy deep wound infections due to candida albicans. No similar case had been seen during the previous 10 years. The infections were indolent, with a mean time from initial operation to diagnosis of 54 days (range, 26-83 days). All patients were successfully treated. Pulsed-field gel electrophoresis revealed the Candida isolates to be identical. A case-controlled study and medical record review revealed that a single operating room technician scrubbed on all 3 infected case patients but on only 32% of the uninfected controls. The technician had worn artificial nails for a 3-month period that included the dates of laminectomy site infections, and C. albicans was isolated from her throat. She was treated with fluconazole and removed from duty. No subsequent cases have occurred during the ensuing 3 years. Artificial nails are known to promote subungual growth of gram-negative bacilli and yeast. This may be clinically relevant, and hospitals should enforce policies to prevent operating room personnel from wearing artificial nails.
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ranking = 303.87313105243
keywords = wound infection, wound
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6/35. Cluster of cases of invasive aspergillosis in a transplant intensive care unit: evidence of person-to-person airborne transmission.

    In October 1998, a patient developed deep surgical-site and organ-space infection with aspergillus fumigatus 11 days after undergoing liver retransplantation; subsequently, 2 additional patients in the transplant intensive care unit had invasive pulmonary infection with A. fumigatus diagnosed. It was determined that debriding and dressing wounds infected with Aspergillus species may result in aerosolization of spores and airborne person-to-person transmission.
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ranking = 1
keywords = wound
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7/35. Unusual nosocomial transmission of mycobacterium tuberculosis.

    This case report describes how a late diagnosis of a tuberculous abscess combined with daily irrigation of the wound without barrier precautions led to nosocomial transmission of mycobacterium tuberculosis. Among 372 hospital contacts, 16 had a tuberculin skin test conversion and two developed active pulmonary tuberculosis with the same strain as that isolated from the index patient's abscess. When a culture from an abscess remains negative, mycobacterium tuberculosis infection should be considered. Furthermore, wound irrigation should be done with proper barrier precautions because infectious aerosols can be created during the irrigation process.
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ranking = 2
keywords = wound
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8/35. Emergence of resistance of vancomycin-resistant enterococcus faecium in a thermal injury patient treated with quinupristin-dalfopristin and cultured epithelial autografts for wound closure.

    vancomycin-resistant enterococcus faecium and faecalis (VRE) remains a major complication among critically ill patients. A 26-year-old patient with 65% total body surface area burns (TBSA) was infected with several E. faecium strains during his admission that were resistant to vancomycin. Because chloramphenicol was the standard treatment at this time, this drug was initiated until, the organism was identified as E. faecium and reported as susceptible to quinupristin-dalfopristin. Given these data, it was then decided to discontinue the chloramphenicol therapy. Quinupristin-dalfopristin therapy resulted in initial reduction of fever and white blood cell counts that continued over the next 5 days. However, on day 7 of quinupristin-dalfopristin therapy, a return of fever and elevation of the white blood cell count was noted and a repeated E. faecium blood culture demonstrated sudden resistance to quinupristin-dalfopristin (Bauer-Kirby zone size <14 mm). chloramphenicol was restarted and the patient improved slowly over a period of 16 days. Our indigenous VRE had limited exposure to quinupristin-dalfopristin in the recent past; however, resistance emerged with the first commercial use of this agent in our burn treatment center. High-dose chloramphenicol treatment did not appear to impair engraftment of cultured epithelial autografts (CEA) in this patient.
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ranking = 4
keywords = wound
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9/35. mycoplasma hominis infection in heart and lung transplantation.

    "culture-negative" wound infection and mediastinitis secondary to mycoplasma hominis have been reported after cardiothoracic surgery but no case cluster has ever been described. We report 4 cases of infection in 3 cardiac and 1 bilateral sequential lung transplant recipient over 3 weeks of hospitalization. Successful treatment was achieved with early aggressive surgical intervention and combination antibiotics of clindamycin, doxycycline and/or ciprofloxacin. This cluster raises the question of nosocomial transmission of infection and supports a recommendation for single-room isolation and universal precautions for infected individuals.
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ranking = 151.93656552622
keywords = wound infection, wound
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10/35. Outbreak of invasive Aspergillus infection in surgical patients, associated with a contaminated air-handling system.

    An outbreak of Aspergillus infection at a tertiary care hospital was identified among inpatients who had amputation wounds, peritonitis, allograft nephritis, or mediastinitis. During a 2-year period, 6 patients were identified, all of whom had Aspergillus species recovered from samples from normally sterile sites. All cases clustered in the operating theater during a single 12-day period. To assess operating theater air quality, particle counts were measured as surrogate markers for Aspergillus conidia. A substantial increase in the proportion of airborne particles > or =3 microm in size (range, 3-fold to 1000-fold) was observed in many operating rooms. A confined space video camera identified moisture and contamination of insulating material in ductwork and variable airflow volume units downstream of final filters. No additional invasive Aspergillus wound infections were identified after the operating theater air-handling systems were remediated, suggesting that this unusual outbreak was due to the deterioration of insulating material in variable airflow volume units.
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ranking = 152.93656552622
keywords = wound infection, wound
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