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Nosocomial infection with highly resistant, Proteus rettgeri. Report of an epidemic
Abstract:
Over 22-1/2 months an epidemic of at least 127 cases of nosocomial infection developed from a strain of Proteus rettgeri resistant to all antibiotics commonly tested in hospital laboratories. Although there were at least four cases of septicemia and one related death, the majority of cases consisted of asymptomatic bacteriuria or clinically mild urinary tract infection. Indwelling urinary tract devices and antibiotic therapy were important predisposing factors. Data supported an association between increasing use of gentamicin and increasing rates of resistant infection. No common source was found, and contact spread appeared more likely. Control measures included efforts to reduce unnecessary exposure to the incriminated risk factors and to improve asepsis in the management of catheterized patients. An additional 36 cases and one related death were identified in the 7-1/2 months following the investigation and institution of control measures. Nosocomial infection with extremely resistant organisms may pose a serious hazard wherever indwelling urinary tract devices and antibiotics are used together intensively.
Insights
A Proteus rettgeri strain caused a nosocomial infection epidemic, with antibiotic resistance linked to gentamicin use. Control measures were implemented to reduce spread of these resistant bacteria.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Antimicrobial Resistance
Background:
- Nosocomial infections pose a significant threat in healthcare settings.
- The emergence of antibiotic-resistant organisms complicates infection control.
- Proteus rettgeri is a bacterium that can cause urinary tract infections.
Purpose of the Study:
- To investigate an epidemic of nosocomial infections caused by a highly resistant Proteus rettgeri strain.
- To identify predisposing factors and transmission routes.
- To evaluate the effectiveness of control measures.
Main Methods:
- Epidemiological investigation over 22.5 months.
- Analysis of clinical data, including infection types and outcomes.
- Correlation of infection rates with antibiotic usage, particularly gentamicin.
- Assessment of transmission dynamics, considering common source vs. contact spread.
Main Results:
- At least 127 cases of nosocomial infection were identified, primarily mild urinary tract infections or asymptomatic bacteriuria.
- Four cases of septicemia and two related deaths occurred.
- Indwelling urinary tract devices and antibiotic therapy were identified as key predisposing factors.
- An association was found between increased gentamicin use and rising rates of resistant Proteus rettgeri infections.
- Contact spread was deemed more likely than a common source.
- An additional 36 cases and one death occurred post-intervention, indicating persistent challenges.
Conclusions:
- Extremely resistant organisms like Proteus rettgeri represent a serious hazard in healthcare.
- Intensive use of indwelling urinary tract devices and antibiotics creates a high-risk environment.
- Effective control requires reducing risk factors and improving aseptic techniques for catheterized patients.