RESUMEN
Vancomycin-resistant enterococcus (VRE) has not been reported previously in Pakistan. This is the first report where in vancomycin-resistant Enterococcus faecium was isolated from the clinical specimens of six patients admitted to the intensive care unit (ICU) and neonatal intensive care unit (NICU) of the Aga Khan University Hospital, Karachi. To identify the extent of the outbreak, rectal swabs were obtained from all the patients admitted to the ICU and NICU at that time. A total of 10 strains of vancomycin-resistant Enterococcus faecium were isolated. All the strains showed high-level resistance to both glycopeptides (vancomycin and teicoplanin) with a vancomycin minimum inhibitory concentration greater than 256 mg/L. All isolates had the vanA gene detected by polymerase chain reaction. The contour-clamped homogeneous electric field (CHEF) pattern demonstrated that all but one of the isolates were of a single clone, suggesting that they were derived from common source. Use of vancomycin and prolonged hospitalization were common features in all cases investigated.
Asunto(s)
Enfermedades Transmisibles Emergentes/epidemiología , Enfermedades Transmisibles Emergentes/microbiología , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Brotes de Enfermedades/estadística & datos numéricos , Enterococcus faecium , Infecciones por Bacterias Grampositivas/epidemiología , Infecciones por Bacterias Grampositivas/microbiología , Resistencia a la Vancomicina , Adulto , Proteínas Bacterianas/genética , Técnicas de Tipificación Bacteriana/métodos , Ligasas de Carbono-Oxígeno/genética , Enfermedades Transmisibles Emergentes/prevención & control , Infección Hospitalaria/prevención & control , Electroforesis en Gel de Campo Pulsado , Enterococcus faecium/clasificación , Enterococcus faecium/genética , Infecciones por Bacterias Grampositivas/prevención & control , Hospitales de Enseñanza , Humanos , Recién Nacido , Control de Infecciones/métodos , Unidades de Cuidados Intensivos , Unidades de Cuidado Intensivo Neonatal , Tiempo de Internación/estadística & datos numéricos , Pruebas de Sensibilidad Microbiana , Pakistán/epidemiología , Reacción en Cadena de la Polimerasa/métodosRESUMEN
OBJECTIVE: To compare the efficacy of four methods of simulated single-rescuer bystander cardiopulmonary resuscitation (CPR) in a clinically relevant swine model of prehospital pediatric asphyxial cardiac arrest. DESIGN: Prospective, randomized study. SUBJECTS: Thirty-nine anesthetized domestic piglets. INTERVENTIONS: Asphyxial cardiac arrest was produced by clamping the endotracheal tubes of the piglets. For 8 mins of simulated bystander CPR, animals were randomly assigned to the following groups: group 1, chest compressions and simulated mouth-to-mouth ventilation (FI(O2) = 0.17, FI(CO2) = 0.04) (CC+V); group 2, chest compressions only (CC); group 3, simulated mouth-to-mouth ventilation only (V); and group 4, no CPR (control group). Standard advanced life support was then provided, simulating paramedic arrival. Animals that were successfully resuscitated received 1 hr of intensive care support and were observed for 24 hrs. MEASUREMENTS AND MAIN RESULTS: Electrocardiogram, aortic blood pressure, right atrial blood pressure, and end-tidal CO2 were monitored continuously until the intensive care period ended. Arterial and mixed venous blood gases were measured at baseline, 1 min after cardiac arrest, and 7 mins after cardiac arrest. Minute ventilation was determined during each minute of bystander CPR. Survival and neurologic outcome were determined. Twenty-four-hour survival was attained in eight of 10 group 1 (CC+V) piglets vs. three of 14 group 2 (CC) piglets (p < or = .01), one of seven group 3 (V) piglets (p < or = .05), and two of eight group 4 (control) piglets (p < or = .05). Twenty-four-hour neurologically normal survival occurred in seven of 10 group 1 (CC+V) piglets vs. one of 14 group 2 (CC) piglets (p < or = .01), one of seven group 3 (V) piglets (p < or = .05), and none of eight group 4 (control) piglets (p < or = .01). Arterial oxygenation and pH were markedly better during CPR in group 1 than in group 2. Within 5 mins of bystander CPR, six of 10 group 1 (CC+V) piglets attained sustained return of spontaneous circulation vs. only two of 14 group 2 (CC) piglets and none of the piglets in the other two groups (p < or = .05 for all groups). CONCLUSIONS: In this pediatric asphyxial model of prehospital single-rescuer bystander CPR, chest compressions plus simulated mouth-to-mouth ventilation improved systemic oxygenation, coronary perfusion pressures, early return of spontaneous circulation, and 24-hr survival compared with the other three approaches.