RESUMEN
BACKGROUND: In low- as well as in high-prevalence settings, healthcare workers (HCWs) may be a substantial, under-recognized, reservoir of meticillin-resistant Staphylococcus aureus (MRSA) and an important potential source of transmission to patients. AIM: To report an outbreak of MRSA in a cardiac surgery unit in England over a 10-month period. METHODS: Cases were defined as patients and staff on the cardiac surgery unit from whom the outbreak strain was newly isolated between 20 May 2011 and 16 March 2012. Representative isolates from all cases were characterized by spa-typing, pulsed-field gel electrophoresis and multi-locus variable-number tandem-repeat analysis (MLVA). FINDINGS: Four patients appeared to acquire MRSA during their inpatient stay on the cardiac surgery unit. All four patients and one HCW were found to be carrying an identical epidemic (E)MRSA-15 strain (spa t032, pulsotype A, MLVA profile 16-6-3-1-1-17-1-4). No other members of staff were found to be colonized with MRSA. The colonized HCW was thought to be the source of the outbreak and was decolonized using a combination of nasal mupirocin, chlorhexidine body wash and oral rifampicin and doxycycline. CONCLUSIONS: This report highlights recent changes in the epidemiology of MRSA in England and suggests an important role for colonized HCWs in the transmission of MRSA to patients. Screening HCWs may provide an increasingly valuable strategy in managing linked hospital acquisitions and well-defined outbreaks where initial investigation does not reveal a source.
Asunto(s)
Infección Hospitalaria/epidemiología , Brotes de Enfermedades , Personal de Salud , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Infecciones Estafilocócicas/epidemiología , Adulto , Anciano de 80 o más Años , Servicio de Cardiología en Hospital , Infección Hospitalaria/microbiología , Infección Hospitalaria/transmisión , Inglaterra/epidemiología , Femenino , Genotipo , Humanos , Masculino , Staphylococcus aureus Resistente a Meticilina/clasificación , Staphylococcus aureus Resistente a Meticilina/genética , Persona de Mediana Edad , Epidemiología Molecular , Tipificación Molecular , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/transmisiónRESUMEN
Twenty ASA I-II patients received either 2 or 3 x ED95 doses of rocuronium bromide during nitrous oxide, oxygen, propofol, fentanyl-based anaesthesia. The mean times to maximum block were 98 s and 74 s and the mean duration of clinical relaxation (recovery to 25% T1) was 35 min and 46 min following 620 micrograms kg-1 and 930 micrograms kg-1, respectively. Neuromuscular blockade was antagonized with either neostigmine or edrophonium from a twitch height of 25%. Although there was no significant difference between the recovery times neostigmine appeared to give more consistent antagonism of rocuronium-induced blockade.
Asunto(s)
Androstanoles/farmacología , Fármacos Neuromusculares no Despolarizantes/farmacología , Adolescente , Adulto , Androstanoles/administración & dosificación , Androstanoles/antagonistas & inhibidores , Anestesia , Inhibidores de la Colinesterasa/farmacología , Método Doble Ciego , Edrofonio/farmacología , Humanos , Persona de Mediana Edad , Relajación Muscular/efectos de los fármacos , Neostigmina/farmacología , Fármacos Neuromusculares no Despolarizantes/administración & dosificación , Fármacos Neuromusculares no Despolarizantes/antagonistas & inhibidores , Rocuronio , Factores de TiempoRESUMEN
A case of bradycardia during the insertion and inflation of tissue expanders under the scalp on two separate occasions is described. The possible mechanisms of this complication are discussed.