A method of clinical staging for infants with necrotizing enterocolitis (NEC) is proposed. On the basis of assigned stage at the time of diagnosis, 48 infants were treated with graded intervention. For Stage I infants, vigorous diagnostic and supportive measures are appropriate. Stage II infants are treated medically, including parenteral and gavage aminoglycoside antibiotic, and Stage III patients require operation. All Stage I patients survived, and 32 of 38 Stage II and III patients (85%) survived the acute episode of NEC. Bacteriologic evaluation of the gastrointestinal microflora in these neonates has revealed a wide range of enteric organisms including anaerobes. Enteric organisms were cultured from the blood of four infants dying of NEC. Sequential cultures of enteric organisms reveal an alteration of flora during gavage antibiotic therapy. These studies support the use of combination antimicrobial therapy in the treatment of infants with NEC.

Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging

Economic Control of Quality of Manufactured Product.

Bacteria belonging to the genus Klebsiella frequently cause human nosocomial infections. In particular, the medically most important Klebsiella species, Klebsiella pneumoniae, accounts for a significant proportion of hospital-acquired urinary tract infections, pneumonia, septicemias, and soft tissue infections. The principal pathogenic reservoirs for transmission of Klebsiella are the gastrointestinal tract and the hands of hospital personnel. Because of their ability to spread rapidly in the hospital environment, these bacteria tend to cause nosocomial outbreaks. Hospital outbreaks of multidrug-resistant Klebsiella spp., especially those in neonatal wards, are often caused by new types of strains, the so-called extended-spectrum-β-lactamase (ESBL) producers. The incidence of ESBL-producing strains among clinical Klebsiella isolates has been steadily increasing over the past years. The resulting limitations on the therapeutic options demand new measures for the management of Klebsiella hospital infections. While the different typing methods are useful epidemiological tools for infection control, recent findings about Klebsiella virulence factors have provided new insights into the pathogenic strategies of these bacteria. Klebsiella pathogenicity factors such as capsules or lipopolysaccharides are presently considered to be promising candidates for vaccination efforts that may serve as immunological infection control measures.

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Klebsiella spp. as Nosocomial Pathogens: Epidemiology, Taxonomy, Typing Methods, and Pathogenicity Factors

A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. The update, which has incorporated recommendations for children (following the adult recommendations for epidemiology, diagnosis, and treatment), includes significant changes in the management of this infection and reflects the evolving controversy over best methods for diagnosis. Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. Moreover, C. difficile has established itself as an important community pathogen. Although the prevalence of the epidemic and virulent ribotype 027 strain has declined markedly along with overall CDI rates in parts of Europe, it remains one of the most commonly identified strains in the United States where it causes a sizable minority of CDIs, especially healthcare-associated CDIs. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management.

/pdf/clinical-practice-guidelines-for-clostridium-difficile-4hs0j01jnf.pdf

Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)

Microbial pathogenesis in cystic fibrosis: mucoid Pseudomonas aeruginosa and Burkholderia cepacia.

Nosocomial colonization with Klebsiella, type 26, in a neonatal intensive-care unit associated with an outbreak of sepsis, meningitis, and necrotizing enterocolitis.

Seven laboratories participated in a collaborative study to evaluate the Autobac 1 system. Results obtained with this assay system were compared to those obtained by the standardized Bauer-Kirby disk diffusion test, and each of these two methods was compared to the agar dilution technique. Comparison of the Autobac 1 and the disk diffusion results from the seven laboratories showed an overall average of 91.5% interpretive agreement with the 17 antimicrobial agents tested. The distribution in the levels of Autobac 1/disk diffusion agreement was such that with 13 antimicrobial drugs agreement was 90% or higher; with three, between 85 and 90%; and with one, 77% (nitrofurantoin). Comparison of the Autobac 1 and disk diffusion tests with the International Collaborative Study agar dilution test showed that both methods gave levels of agreement with the International Collaborative Study agar dilution technique that were generally high and equivalent. The average overall agreement between the agar dilution test and each of the other two methods was approximately 90%. Disagreements that did occur tended to involve organisms that were drug susceptible by the Autobac 1 system but intermediate or resistant by the other two methods. This was in part due to the narrow intermediate interpretive zone of the Autobac 1 test. In reproducibility studies with the Autobac 1 and disk diffusion methods, no significant differences were observed between the interpretive reproducibility of the two methods. Images

Laboratory Evaluation of a Rapid, Automated Susceptibility Testing System: Report of a Collaborative Study

The pseudomonad EO-1 (Eugonic Oxidizer Group 1) or Pseudomonas cepacia, multivorans, or kingii was isolated from 41 patients over a two-year period at the University of Minnesota Hospitals. All patients had significant underlying medical problems. Thirty-seven of the 41 patients had prior instrumentation or a manipulative procedure that directly involved the body site from which the organism was isolated. The mean duration of hospital stay at the time of initial isolation was 19 days (median, 14 days and range, one to 127 days). Sixty-nine percent of patients were receiving one or more antibiotics at the time P. cepacia was first isolated. These strains were consistently susceptible only to the sulfonamides, chloramphenicol, and naladixic acid and were routinely resistant to gentamicin and the polymyxins.

Colonization and. Infection with Pseudomonas cepacia

A multilaboratory in vitro study was carried out to determine disk diffusion susceptibility testing quality control limits for two new semisynthetic penicillins, mezlocillin and piperacillin. Existing limits for carbenicillin and ampicillin were reevaluated. Multiple tests (which followed standards set by the National Committee for Clinical Laboratory Standards ASM-2 revised) were performed in nine laboratories by different technologists using disks and Mueller-Hinton agar from different manufacturers. Clinically significant differences between disks produced by different manufacturers were not noted. Inhibitory zone diameter measurements from all laboratories were analyzed, and upper and lower control limits were established by using the overall median +/-0.5 the median range of the individual laboratory measurements as determining parameters. Close agreement of the data in this study with the results of national proficiency testing and quality control programs for ampicillin and carbenicillin supports the validity of our approach to making initial recommendations for quality control guidelines for new antimicrobial agents.

https://jcm.asm.org/content/jcm/14/1/67.full.pdf

Quality control limits for ampicillin, carbenicillin, mezlocillin, and piperacillin disk diffusion susceptibility tests: a collaborative study.

THE pseudomonad EO-1 (Eugonic OxidizerGroup 1) has been identified sporadically from various patient sources since 1966 in the University of Minnesota Hospitals. An unusually high frequency of isol...

John M. Matsen

Papers

Nosocomial colonization with Klebsiella, type 26, in a neonatal intensive-care unit associated with an outbreak of sepsis, meningitis, and necrotizing enterocolitis.

Laboratory Evaluation of a Rapid, Automated Susceptibility Testing System: Report of a Collaborative Study

Colonization and. Infection with Pseudomonas cepacia

Quality control limits for ampicillin, carbenicillin, mezlocillin, and piperacillin disk diffusion susceptibility tests: a collaborative study.

Contamination of Commercially Packaged Urinary Catheter Kits with the Pseudomonad EO-1