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Hospital-Acquired Infections and Resistant Bacteria

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Nosocomial
Pertaining to a hospital or infirmary
Nosocomial Infection
Infection acquired in a hospital

End Hospital Secrecy and Save Lives!

StopHospitalInfections.org
Consumer Reports/Consumers Union is supporting this campaign to require mandatory reporting
of hospital acquired infections.

Share Your Hospital Infection Story



Resources



More people die every year from hospital infections (90,000) than from all accidental deaths (70,000), including motor vehicle crashes, fires, burns, falls, drownings, and poisonings.


National Resources

Emerging Infectious Diseases Journal (EID)

National Center for Infectious Diseases

Centers for Disease Control and Prevention (CDC)


What is the Best Way to Remove Germs on Your Hands? - When you're in the hospital, it's especially important to wash your hands thoroughly before eating, so as to avoid transmission of VRE - Vancomycin-Resistant Enterococcus


Management and Avoidance of Antibiotic Resistance [Medscape registration is free.]


Study Says Doctors Hygiene Worse Than Patients


Doctors Are The Third Leading Cause of Death in the US, Causing 250,000 Deaths Every Year [Hospital-acquired infections are the second most common factor.]

Deaths per year from:

  1. non-error, negative effects of drugs - 106,000
  2. infections in hospitals - 80,000
  3. other errors in hospitals - 20,000
  4. unnecessary surgery - 12,000
  5. medication errors in hospitals - 7,000
These total to 250,000 deaths per year from iatrogenic causes!!

The Story of Ignaz Semmelweis - History of Hospital-Acquired Infections (from Medscape) -  In Vienna in 1846, the ward where physicians attended births had a mortality rate as high as 31%,  in sharp contrast to the low mortality rate in the midwives' ward next door.  Ignaz Semmelweis was the first physician to identify childbed fever as a hospital-acquired infection caused by invasive techniques and failure to wash hands before attending a birth. Obstetricians ignored him then, and many continue to ignore him now . . . "One study indicates that less than 60 percent of doctors scrub their hands before handling patients."   [You can see a bit of original text from the Web site on Controlled Trials from History.]


Faith Gibson's letter of Sept. 11, 2004, contains a masterful summary of "The History of Obstetrics" about halfway down the page, with a generous portion describing the circumstances around the work of Ignaz Semmelweis.


Intrapartum Administration of Ampicillin Prophylaxis in GBS Mothers May Raise Risk of Neonatal E. coli Infection
Ob.Gyn.News April 15, 1998

Severe E. coli Tied to Intrapartum Ampicillin
from Pediatric News via Medscape

Neonatal early-onset Escherichia coli disease. The effect of intrapartum ampicillin.
Joseph TA, Pyati SP, Jacobs N
Arch Pediatr Adolesc Med 1998 Jan;152(1):35-40

Potential consequences of widespread antepartal use of ampicillin.
Towers CV, Carr MH, Padilla G, Asrat T
Am J Obstet Gynecol 1998 Oct;179(4):879-83

The increased administration of antenatal ampicillin to pregnant women may be responsible for the increased incidence of early-onset neonatal sepsis with non-group B streptococcal organisms that are resistant to ampicillin.

Questions and Answers about Hospital-Acquired And Antibiotic-Resistant Infections, especially Vancomycin-Resistant Enterococcus (VRE). Special section on implications for Pregnancy and Birth


Recent News Reports about Hospital-Acquired Infections and Antibiotic-Resistant Infections


References to More Scientific Sources of Information about Hospital-Acquired Infections and Antibiotic-Resistant Infections


Newborns and Hospital-Acquired Infections


Antibiotic-resistant Germs Flourish in Hospitals


September 29, 1999

SAN FRANCISCO (AP) - A drug described as the first entirely new kind of antibiotic in more than 35 years is expected to give doctors a fresh weapon against germs that are resistant to anything science now has. The medicine, called Zyvox, appears to work as well as standard antibiotics against garden-variety germs and can also kill those that are resistant to everything else, including vancomycin, now the drug of last resort for stubborn infections. Researchers presented the results of several large studies on the drug Monday at a conference sponsored by the American Society for Microbiology. Its maker, Pharmacia & Upjohn, plans to seek approval for Zyvox from the Food and Drug Administration and other regulatory agencies around the world by the end of the year.


Why You Donít Need Antibacterial Soap By Tabitha Alterman - antiseptic ingredients added to numerous products are not effective and may actually be harmful.



Vancomycin-Resistant Enterococcus



100% of Surveyed Hospitals are Infected with VRE
San Francisco Bay Area - Sept. 14, 1997

A number of years ago, in Nashville, there was an outbreak of a resistant enterobacter (I believe) brought in to the hospital by a dairy farmers wife, who was giving birth. A number of the bottle-fed babies in the nursery died.


It's very sad. One of my hopes is that some good may come out of the VRE problem - maybe more women will be motivated to breastfeed their babies.



Likelihood of Vancomycin-Resistant GBS



[A]bout 4% of GBS isolates demonstrate penicillin tolerance (from Merck Manual).


The particularly frightening thing is that many of the samples in the San Francisco Study (100% of hospitals infected with VRE - 1997) appear to come from carriers, i.e. people who aren't suffering any acute symptoms. And it seems almost to be chance that they happened to be doing urinalysis and found the VRE there. It's almost certain the VRE came from their digestive system. Given that the estimate for carrying GBS is at least 30%, one can guess that there are some number of women who are asymptomatic carriers of a super strain of GBS.

I don't know what OBs would do if they knew a woman was carrying a super strain of GBS. Obviously, antibiotics won't help, and they aren't really conversant with alternative methods for reducing infection. And there's a weird phenomenon (yes, I've been reading the CDC pages a lot this week), whereby the resistant strains tend also to be more virulent, i.e. cause worse problems. Then, of course, the poor baby is likely to end up in NICU, where there could be more exposure to new strains.

My suspicion is that we're going to end up with the sort of weird patterns of neonatal problems that happened with Rh- babies - first babies OK, second or later babies devastated. For many women, childbirth is their first episode of being hospitalized. The VRE has been found in hospital cafeteria food and in dog food sold in the U.S. It hasn't yet been reported as being "in the community", i.e. picked up by someone outside of the hospitals in the U.S., but this has already happened in Europe, which is a few years ahead of us in VRE because of a similar antibiotic they use there.

So, some number of women who happen to be exposed to VRE during hospitalization for childbirth will come home with it, and then there will be time before the next pregnancy for the VRE to share the resistance with anything else it comes across. Staph and strep are the most likely to pick up the resistance.

I just came across this line in my notes from the CDC Web pages

Transmission of VRE from a recently discharged patient to a family member suggests that household contact, including food preparation, may lead to community transmission in the United States.
The CDC pages say that hospital-acquired infections are among the ten leading causes of death in the U.S. With VRE in the picture, I'm just wondering how long it will take before it's number one.

I'll tell you, after reading all this, I'm thinking about not doing hospital labor coaching except for friends. And if I do find myself in a hospital, I'll be watching what I touch and washing my hands thoroughly and often. And I don't think I'll be eating in the cafeteria.


Well, at LAST someone admits there is a problem with enterococcus!! As recently as June, hospitals in NY were denying that they had this problem DESPITE press releases from the CDC and several teaching hospitals on the east coast. There is also a hospital in NY that recently shut down its NICU because a "mysterious" bacterial infection resulted in the deaths of 4 preemies there.


Strep is one of the least mutable organisms. That's why strep throat can still be treated with penicillin. This is a different type of strep, though.


I was surprised to read that Enterococcus used to be considered a member of the strep family. In fact, my Taber's (from 1989) defines Enterococcus as "any species of streptococcus inhabiting the human intestine".

So, until recently, GBS would have been considered an Enterococcus. I don't understand the subtle difference between Enterococcus and streptococcus, and I don't have a clue how the small differences affect the likelihood of transmitting resistance.

And, of course, strep. pneumoniae has already developed a resistance to penicillin, so they're now sometimes having to resort to vancomycin. And we can guess where this will lead.

Part of my fear about VRE and GBS is that it will be largely ignored because it "only" affects newborns and new mothers, and the small numbers may be lost in the statistical shuffle for a few years.

However, the expectation appears very high that VRE will readily transmit vancomycin resistance to other gut bacteria it comes across. So any woman carrying GBS who happens to pick up VRE will likely find herself carrying VRGBS.


The floral organisms that are totally ubiquitous are the ones that mutate the most readily. It's their adaptability that makes them so ubiquitous. E coli is found in the gut of every mammal on the planet. Enterobacter, staph aureus, staph epidermis, hemophillus influenza..... It's our day to day germs.


Yes, and unfortunately GBS has become a day-to-day germ for many women. Statistics are varied, but a variety of sources seem to acknowledge that about 40% of women will have a positive GBS culture.

Europe is a few years ahead of the U.S. in the VRE arena, and research there shows some fairly high rates of community carriers - 3.5% in one report, 5% in another. Compound that with 40% GBS and you've got about 2% of women carrying VRGBS. Maybe the numbers aren't really playing out that way - maybe the European members of the list can offer some enlightenment?

The percentage of babies who would have problems because of exposure to GBS is still pretty small - less than 1% - but that's with old-fashioned GBS. It appears that the suite of resistance genes also confers a higher level of virulence along with the resistance.

My knowledge of microbiology is limited, and perhaps I'm seeing potential disaster where none will happen. But when I read things about this past summer such as, "The horse is out of the barn", and "[this] can be viewed as a sentinel event predictive of future increases in serious clinical infections", I get a little nervous.


And little chunks of genetic material called plasmids can pass from one type of bacteria to the next. Passing on the resistance.


Isn't it amazing? I find myself in awe of their strategies, and it does appear that there may be multiple strategies operating in different strains. Some of them seem to have figured out the general antibiotic strategy and have evolved to counter them.

I find myself imagining this large swarm of bacteria that have nothing better to do with their lives than figure out how to become resistant to yet another antibiotic. And then I think of the small numbers of scientists working on the problem, and I'm pretty sure I know which side is going to win, at least in the short term.

I find myself glad that I have a smattering of knowledge about herbs and homeopathy and will certainly be cultivating those friendships with homeopaths.


Yes, GBS is a rare but very real threat to newborns.

Women who assume they are protecting their babies by getting antibiotics in labor are assuming that the strain of GBS they are carrying is not resistant to antibiotics.

We're starting to hear the first rumblings of reports of resistant GBS. (Surprise, surprise - how many women with GBS have been getting antibiotics? What happens when you expose germs to antibiotics, especially the short course used with women in labor? They develop resistance and live to pass it on.)

In addition, it is inevitable that the vancomycin-resistant enterococcus that is spreading throughout the world will share its resistance genes with GBS. Sometimes I wonder how many women who go into the hospital for a first baby pick up VRE there and then breed and carry a GBS strain that is also very resistant. (VRE is estimated at being in 3.5% of the population in Europe - they're just a few years ahead of the U.S. 100% of the San Francisco Bay Area hospitals are infected with VRE.)

Anyway, my original intent in writing this message was to encourage women not to rely on antibiotics to protect their baby, especially if it's unknown whether the strain of GBS they carry is resistant to penicillin.

It's much safer for the woman to reduce the colonization through holistic methods, even if she also chooses to receive antibiotics in labor.



Penicillin Resistant Group B Strep



[11 July 1997 from ob-gyn-l]


Is anyone aware of the incidence of Penicillin resistant Group B strep? We have a local attending come in with a culture from the office with a strep screen with sensitivities showing pen resistance. Our lab does not test B strep against penicillin because it's considered "pan sensitive". Does anyone have any experience with this?


A few years ago, when we were just beginning to hear of GBS, between my back-up and myself we had 3 GBS pos babies in just over a week. -- Purely anecdotal! I know..

Anyway, the first was my client. She was 41 weeks with her 3rd. Normal pregnancy. She called with the first sign of labor at 7:40 am and delivered at about 10:00 am. AROM about 5 min before delivery. The baby looked fine and I went home without a worry in the world about that babe.

At about 1:00 am , the mom called, very worried. The baby was lethargic and difficult to rouse. I had her meet me at the hospital, and initially when I saw her, I felt like a dork, bringing a healthy baby in-- By this time she was awake. I didn't note any abnormalities in respirations, etc.etc, and the nurse didn't either. Then as we waited for the ped, she began to look bad. I don't remember all of the gory details of her symptoms, but I do remember that watching her go down was dramatic. She had some questionable symptoms by the time the ped came in, and her labs were bad. By that time, all you had to do was look at her to see she was in trouble. It took about 3 hours for the ped to decide to ship her. She was in NICU for 3 months, then back in and out for another few weeks with a strain of GBS that was resistant to any of the antibiotics they could come up with. She's fine, now.

Then the day after that birth, we had a client we'd co-managed for a hospital birth. A primip with a normal pregnancy. 6 hour labor - 4 hours ROM. The baby weighed 8#. Similar to the first, she seemed fine for the first few hours. Then she became tachypneic and spiked a temp, and was in NICU for just a week. She did fine.

Just over a week later, my back-up had another one. The situation was similar - no risk factors. Normal IUP, normal birth. This baby appeared to be sick pretty quickly after the birth, was shipped out, and died in the NICU on it's 3rd day.

Anyway, none of these moms had prolonged rupture, preterm labor , amnionitis or elevated temps. Just bad luck, I guess. And isn't it funny how bad luck comes in 3s? Or is it just me?


WHOA! there.

What's this about a resistant strain of GBS?

Could you please share everything you know about this, including place and date? What did it seem resistant to? What was it cultured as resistant to? What ended up working?

Did the mom continue providing breastmilk during this time, and did that seem to be an important factor?

Do you know if this case was written up and/or reported to people who are keeping track and need to know?

Resistant strains of GBS are a very serious matter. In addition to rendering current prophylaxis strategies useless, it adds other problems, as the resistant strains appear also to attack more rapidly and more severely.

I wonder if this is why there were problems, even in the absence of "risk factors"?

This is one of the reasons I think it's so important to work out "alternative" methods for reducing GBS colonization rather than relying on antibiotics.


My exact thoughts, epidemiologically, 3 cases together. I wonder if they were similar strains?



Resistant Pneumonia



Subject: Drug-resistant pneumonia doubles in NY

Date: Thu, 10 Apr 1997 16:51:36 PDT
UPI Science News

ATLANTA, APRIL 10 (UPI) -- Health officials say the threat of drug- resistant disease continues to grow in New York, reporting the rate of penicillin-resistant pneumonia Streptococcus doubled from 1993 to 1995.

The Centers for Disease Control and Prevention in Atlanta reported today (Thursday) the city recorded penicillin resistant Streptococcal pneumonia increased from 7 percent of all cases in 1993 to 15 percent in 1995.

The report in the CDC's Morbidity and Mortality Weekly Report accompanies a warning that doctors must change the way they treat these infections in order to combat them.

Children, the elderly and adults infected with the HIV-AIDS virus are most at risk of the infection which is also developing a tolerance to other antibiotics.

CDC officials say the disease is usually ``community acquired'' and treatment with antibiotics other than penicillin has to be decided on with a community-by-community approach. Local physicians are urged to keep track of the resistance in their towns and cities and modify prescriptions accordingly.

In December 1994, New York City began to require that all drug- tolerant forms of pneumonia be reported to the city Department of Health. In 1995 a total of 282 resistant cases were reported.

Of 130 persons who developed the invasive form of the illness, where the bacteria spread to the blood, ear or other parts of the body, eight died. HIV was a factor in 52 of those cases.

The highest rate of illness is among children under 5 years of age. Twenty-seven of the invasive cases involved young children, 14 had either HIV, AIDS or a chronic lung disorder.

(Written by Mike Pezzella in New York)


Drug-Resistant Pneumonia Spreading

From: C-upi@clari.net (UPI / LIDIA WASOWICZ, UPI Science Writer)

Date: Fri, 23 May 1997 0:51:30 PDT
DRUG-RESISTANT BUGS WINNING WAR: Drug-resistant bugs that cause respiratory illnesses are spreading with the speed of a common cold across the United States -- with the incidence of microbes immune to penicillin jumping nearly fourfold just since 1994. That cautionary note comes from researchers who analyzed more than 15,000 tissue samples from around the country. The scientists from the State University of New York in Buffalo and the University of Iowa College of Medicine in Iowa City found the alarming increase among Streptococcus pneumoniae, a common cause of respiratory infections. They found that 10.5 percent of the samples were highly resistant to antibiotics and 24.9 percent moderately resistant. In 1994, those figures stood at only 3.2 percent and 14.1 percent, respectively. In the words of the study presenters, ``These bugs among us are a growing threat in our communities.''


Hospital Bacteria Spread by Contaminated Instruments



From: C-upi@clari.net (UPI)

Subject: Hospital instruments tied to resistant TB

Organization: Copyright 1997 by United Press International

Date: Tue, 30 Sep 1997 14:52:07 PDT
CHICAGO, Sept. 30 (UPI) -- Health officials say dirty hospital instruments were responsible for spreading drug-resistant tuberculosis.

Scientists fear that sloppy hospitals could expose thousands to the TB bug every year. Researchers at the Centers for Disease Control and Prevention in Atlanta used DNA fingerprinting to identify the culprit -- an unsterilized bronchoscope --in an eight-person outbreak of a rare, drug-resistant strain of the disease in South Carolina in 1995.

In another study, Johns Hopkins University scientists discovered a case in which TB was spread from an infected woman to a cancer patient because the hospital had not adequately cleaned the bronchoscope, an instrument used to examine the lungs.

The studies appear in the Journal of the American Medical Association.

Tracy Agerton, CDC epidemic intelligence service officer, says infection control guidelines have been in place for years, but these studies show that not every hospital is following them.

Agerton says the hospital neglected a key step -- dunking the bronchoscope in disinfectant.

She says TB bugs can survive outside a body, sitting dormant on a medical instrument for a long time, although researchers are not sure exactly how long.

In an editorial in JAMA, Drs. Richard P. Wenzel and Michael B. Edmond, of Virginia Commonwealth University Medical College of Virginia estimate that such practices could expose up to 2,300 patients to the TB bug each year.

They say ``hospitals and clinics cannot afford to trivialize the importance of routine and thorough cleaning of reusable parts of the bronchoscope.''

About 460,000 patients, they say, have lung examinations with bronchoscopes each year in the United States.

(Written by Mara Bovsun in New York)



Hospital Bacteria Also Spread by non-Caregiver Hospital Personnel



Subject: UPI Science Briefs [May 7]

Organization: Copyright 1997 by United Press International

Date: Wed, 7 May 1997 1:00:45 PDT
PESKY BACTERIA

Even hands who don't touch patients can spread bacteria around hospitals. At the annual meeting of the American Society for Microbiology in Miami Beach, an infectious disease expert says health care workers who don't deal directly with patients still accumulate a load of bacteria. That includes bacteria that are resistant to most antibiotics.



Synercid - Promising Experimental Antibiotic



Subject: UPI Science Briefs [May 9]

Date: Fri, 9 May 1997 0:50:48 PDT
NEW DRUGS FOR DRUG-RESISTANT BACTERIA

The most powerful antibiotics increasingly are no match for a growing number of drug-resistant bacteria. one experimental drug, Synercid, is showing promise against the killer microbes. A University of Iowa professor warns that up to 70 percent of one common strain of bacteria is resistant to the most potent of licensed antibiotics.


From: C-upi@clari.net (UPI / ED SUSMAN)

Organization: Copyright 1997 by United Press International

Subject: Resistant bugs on rise; drug promising

Date: Thu, 8 May 1997 14:31:41 PDT
UPI Science News

MIAMI BEACH, Fla., May 8 (UPI) -- A nationwide hospital survey shows more bacteria strains resistant to even the strongest antibiotics.

But at least one experimental drug -- now available in emergencies -- demonstrates promise against the killer microbes.

At the annual meeting of the American Society for Microbiology in Miami Beach, Fla., scientists warn today (Thursday) as many as 70 percent of one common strain of bacteria is resistant to vancomycin -- considered the most potent of licensed antibiotics.

Dr. Ron Jones, professor of medical microbiology at the University of Iowa, Iowa City, says, ``The situation with resistance to antibiotics gets more serious every day.''

Jones and colleagues at Millard Fillmore Hospital, Buffalo, analyze new data -- 17,000 samples of resistant microbes acquired from 215 hospitals in the Synercid Microbiology Assessment of Resistance Trends (SMART).

He finds that the common hospital-acquired bacteria Enterococci faecium (``ent-ur-oh-COX-sigh FEE-see-um'') is resistant to vancomycin as much as 70 percent of the time. Other antibiotics such as cephalosporins, fluoroquinolones and erythromycin are virtually useless against these E. faecium strains.

However, Jones says that the experimental drug, Synercid -- a combination of drugs from a class known as streptogramins -- is nearly 100 percent effective against these vancomycin-resistant strains. Another drug, chloramphenicol also is active against these strains, but its side effects can be severe, Jones says. Other experimental drugs are in the pharmaceutical industry pipeline.

Jones says Synercid -- awaiting Food and Drug Administration approval -- is available for emergencies. It has been used about 1,500 times and has been successful in saving the patient up to 70 percent of the time, Jones said.

He notes, ``By the time these patients get approval to use Synercid, they've failed all other medications and they are very sick. The fact that Synercid can save 60 to 70 percent of them is impressive.''



Staph Strain Resistant to Everything



Subject: UPI Science Briefs [May 29]

Date: Thu, 29 May 1997 1:01:00 PDT
NASTY BUG IS DEFYING DRUGS

Federal health officials confirm the first case in which a common, potentially lethal bacteria shows resistance to the most powerful antibiotic available.

The case involves a 4-month-old Japanese heart patient. Doctors are worried because they say the staph bug that has infected the boy is very common.


The Associated Press has reported that Japan has identified a case with a staph infection resistant to vancomycin(05/29/97). What are known vectors in post-op c-section staph infections? What could account for vary rates of these infections among different institutions?


My understanding is that the way you develop a Staph post-C/S infection is:

1. The patient is a carrier.

2. A HCW is a carrier (e.g. nasal carriage, furuncles)

It would be rare to have Staph as the result of improper sterilization techniques, since those were one of the first organisms to be targeted... most techniques I would think kill Staph really well.


Here is what I have on Enterococcus, the newest, baddest, staph bug on the block.

US Centers for Disease Control and Prevention:

Nine out of ten staphylococcal strains which cause infections in post-operative incisions and IV lines are penicillin resistant.

antibiotic use and bacterial mutations can run rampant in hospitals, nursing homes, and day-care centers. Today, enterococci, which cause bloodstream and heart valve infections, are sweeping through hospitals across the US. The only defense is vancomycin, and already the bug is showing resistance to it. In addition, outbreaks of cephalosporin resistant klebsiella, which causes hospital acquired pneumonia, have been reported. And about half of hospital born staphylococci are resistant to ALL antibiotics.


keep in mind that this means resistant to all penicillin "based" antibiotics too, such as ceclor, ampicillin, amoxicillin, etc.


Jerome Schentag, Pharm.D. Professor of pharmacy at NYSU in Buffalo:

"Vancomycin resistant Enterococcus is moving so rapidly that whole hospitals are closing units because there are no antibiotics left to treat it"

"If there has been a medical advance that has prolonged life, it's antibiotics, but you should never declare victory against bacteria. We got caught flat footed. Now we're caught in the middle of a disaster."


MRSA, is indeed, correctly known as Methicillin-Resistant Staphylococcus Aureus, not Multi-Drug Resistant S. Aureus. MDR-TB is the Multi-Drug Resistant Tuberculosis (this may be where the "Multi-Drug Resistant" part came from). VRE is Vancomycin-Resistant Enterococcus. And now, we have the new nosocomial infection, VRSA: Vancomycin-Resistant Staphylococcus Aureus, three confirmed cases and growing; one here in Michigan.

Another reason to stay out of the hospital :^)



General Info about Resistant Infections



Robert Rapp, Pharm.D. Professor of pharmacy at University of Kentucky, Lexington:

"By the year 2010, many antibiotics used today won't be worth the plastic they're bottled in"


It takes almost 10 years of trials and government perusal to create an antibiotic. No new antibiotic families are expected until around 2000.

If anyone wants a chart specifying which antibiotic is appropriate for which type if infection, please let me know. The use of broad spectrum antibiotics is flat out dangerous as is using antibiotics to treat viruses or other ailments not directly shown to be bacterial. Right now it is recommended that all vulnerable people, children, elderly, immune system deficient, receive the proper immunizations, as antibiotic treatment may be incapable of curing some of the diseases we have inoculations against. One very under-used vaccination is for strep-pneumoniae, which is one of the current troubling outbreaks. The CDC estimates that only 20 percent of those who should receive this vaccination are actually getting it. I also have info on what types of bacterial infections should be left alone unless they become serious, such as otitis media, and "travelers diarrhea". The CDC also recommends receiving antibiotic treatment at home if possible since resistance is common in hospitals because of the quantity of antibiotics used and the lack of isolation of infected patients. "Administering IV antibiotics at home can lower your risk of secondary infection from 10% in hospital to less than 2%" Alan Tice, infectious diseases specialist.


2 types of "superbugs"

  1. MRSA (methicillin-resistant staph aureus) which only responds to vancomycin but not all people can take this, it's very potent and can be harsh, dose must  be closely monitored.
  2. VRE ( vancomycin resistant enterococci) even vancomycin doesn't work
Precautions
  1. Keep your babies in your room at all times.
  2. Insist everyone (yes, even the doctors) wash their hands in your presence for at least 30 seconds before touching your or your baby.
  3. If someone comes in your room already wearing gloves, make them take them off, wash their hands and reapply.
VRE still rare and these patients are in isolation MRSA not uncommon but generally not fatal, just diff to treat. Of course, MRSA in a newborn definitely to be avoided.  These bacteria are uncommon on delivery wards where the patients are usually not sick, just pregnant. But people can come in already colonized or cross-contamination can occur if the disease is present elsewhere in the hospital. Be particularly careful of handwashing in staff that moves between hospital wards (lab, X-ray, respiratory...) as they could have come from the room of a sick person.

The hospitals I have worked at track the incidence of these diseases to check for cross-contamination and spread throughout the hospital. Yes, this problem has been found to repeatedly occur. At times, entire hospital wards have been closed for disinfection due to consistent problems with particular bacterial strains showing up in patients.



Necrotizing Fasciitis/Flesh-Eating Bacteria/Death from Post-Cesarean Infection



Organization: Copyright 1997 by United Press International

Date: Mon, 19 May 1997
FLESH EATING BACTERIA IN NEW YORK

A man in his 30s is in critical condition with the flesh eating disease, in a Rochester, New York hospital. The man was transferred there from Livingston County, where nine other people have contracted the disease, known as necrotizing fasciitis. The most recent case was a woman who died in March from a post-operative infection after a Cesarean delivery.


The disease is a strep infection and comes from bacteria commonly found in the throat and on the skin. It is spread by direct contact with nose and throat discharges from an infected person.



Post-Op and IV Infections



The frequency of glove contamination during cesarean delivery.
Yancey MK, Clark P, Duff P
Obstet Gynecol 1994 Apr;83(4):538-42

Nine of 25 cultures (36%) performed immediately before fetal extraction were positive for staphylococci.

9 out of 10 staphylococcal strains which can cause infections in post operative incisions and IV lines are penicillin resistant-this also applies to penicillin "based" antibiotics such as ampicillin, amoxicillin, cefaclor- according to the US centers for Disease Control and Prevention.

"About 50% of all hospital-borne staphylococci are resistant to ALL antibiotics currently in use."- Robert Rapp Pharm.D, professor of pharmacy at the University of Kentucky.



Neonatal Infections



Beth Israel Deaconess, Public Health
Boston hospital cited after staph outbreak among mothers, newborns
By Liz Kowalczyk, Globe Staff

State public health officials have cited Beth Israel Deaconess Medical Center for serious problems with its infection control practices, after 18 mothers and 19 infants contracted antibiotic-resistant staph infections over the past six months.


Antibiotic Use in Neonatal Sepsis - An eye-opening introduction to newborn infections, their causes and treatment.


Risk factors for neonatal sepsis.
Yancey MK, Duff P, Kubilis P, Clark P, Frentzen BH
Obstet Gynecol 1996 Feb;87(2):188-94

This is a good intro. into Medline for neonatal infections.  Follow the above link and then go to "Related Articles".


The March 1, 1999 Ob.Gyn.News reports a presentation at the Society for Maternal-Fetal Medicine which found ampicillin resistance in 45% of septic neonates who had been exposed to antibiotics in the prepartum or intrapartum period.  Their retrospective study included 8593 births at 6 hospitals between 7-97 and 2-98, and looked at the 96 neonates who were clinically ill with a positive blood or cerebrospinal fluid culture.  70% of these had been exposed to either prepartum or intrapartum antibiotic tx.

Sepsis was 19.3 times more common in preterm babies (57 vs 3.1/1000).  Ampicillin resistance was found in 50.1% of preterm babies, vs 20.6% of term babies.  Intrapartum exposure was more likely to result in resistance than prepartum exposure (56.7 vs 16.7%)    Most common organisms for early onset sepsis were GBS and e coli; for late onset, staph, e coli and candida.

There were 11 early onset GBS cases (1.4/1000), which the presenter commented was about the same incidence as is usually reported.  (So does that mean that even though 70% had antibiotics, the rate of GBS was no different than if nobody got them, or does it mean that the 1.4/100 is what is expected when antibiotics are given?)  They did find less GBS in those who had intrapartum antibiotics vs those who had prepartum antibiotics (10% vs 32%).  It still leaves me wondering if this experiment (lots of antibiotics to a wide range of moms in the name of prevention, vs tx) is really working out when you look at the big picture, or will this too fall by the wayside as more is known?


Automated postdischarge surveillance for postpartum and neonatal nosocomial infections.
Holbrook KF, Nottebart VF, Hameed SR, Platt R
Am J Med 1991 Sep 16;91(3B):125S-130S
A Good overview of issues of nosocomial neonatal infection in the U.S.


Nosocomial infection in neonatal intensive care units.
Donowitz LG
Am J Infect Control 1989 Oct;17(5):250-257
Nosocomial neonatal infection in NICU


I'm trying to track down information on 12 neonates who died in the same NICU within 30 days of each other from klebsiella infection caused by improper sterilization of some medical equipment. FDA confirms the event; but by law, cannot reveal the institution. I fear the parents may never have been informed of the real cause of death. This incident was reported to the FDA in March of 1995.

If anyone knows of any case of multiple death in the NICU from klebsiella, please contact me at: idsvoogny@aol.com or call me (Karl Idsvoog) at 212-744-4884.

Thank you.



Alternative Treatment for Infections



Honey Helps Problem Wounds - [7/27/06] - A household remedy millennia old is being reinstated: honey helps the treatment of some wounds better than the most modern antibiotics. For several years now medical experts from the University of Bonn have been clocking up largely positive experience with what is known as medihoney. Even chronic wounds infected with multi-resistant bacteria often healed within a few weeks. . . . Medihoney bears the CE seal for medical products; its quality is regularly tested. The success is astonishing: "Dead tissue is rejected faster, and the wounds heals more rapidly," Kai Sofka, wound specialist at the University Children's Clinic, emphasises. "What is more, changing dressings is less painful, since the poultices are easier to remove without damaging the newly formed layers of skin." Some wounds often smell unpleasant -- an enormous strain on the patient. Yet honey helps here too by reducing the smell. "Even wounds which consistently refused to heal for years can, in our experience, be brought under control with medihoney -- and this frequently happens within a few weeks," Kai Sofka says.


Essential Oils to Reduce Pathogens


AMICBASE-EssOil - The Database on Antimicrobials


Cascade has a terrific section of books about " Natural Health and Medicine":
http:


You might want to get Doctor Mom's Quick Reference Guide to Natural Healthcare at Home by Kathy Duerr and use the tips for your own minor digestive and respiratory illnesses.


Healthy Healing - A Guide To Self Healing For Everyone by Linda Rector Page
How to Be Your Own Herbal Pharmacist by Linda Rector-Page
Wise Woman Herbal for the Childbearing Year by Susun S. Weed
The Complete Homeopathy Handbook: A Guide to Everyday Health Care by Miranda Castro
Homeopathy for Pregnancy, Birth, and Your Baby's First Year by Miranda Castro
Spontaneous Healing : How to Discover and Embrace Your Body's Natural Ability to Maintain and Heal Itself by Andrew Weil M.D.
Encyclopedia of Essential Oils: The Complete Guide to the Use of Aromatic Oils in Aromatherapy, Herbalism, Health & Well-Being by Julia Lawless


Tri-Light Herbs has an excellent symptom and remedy flowchart: http:


Researcher Finds New Method to treat AIDS, Cancer and Heart disease - Induced Remission Therapy® (IRT), pioneered by Dr. Sam Chachoua.  [Related Quackwatch article.]


Essential Oils as Antiseptics

 




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