Nosocomial bacterial infection

Kocher S, Muller W, Resch B. Linezolid treatment of nosocomial bacterial infection with multiresistant Gram-positive pathogens in preterm infants a systematic review. Int J Antimicrob Agents 2010 36 (2) 106-10. 

Urinary infections are common during the first month following transplantation. They are usually nosocomial bacterial infections, sometimes facilitated by the presence of catheters, which can lead to real pyelonephritis of the graft or the development of renal or perirenal abscesses. Sometimes, perigraft... 

Sottile FD, Marrie TJ, Prough DS, et al. Nosocomial pulmonary infection possible etiologic significance of bacterial adhesion to endotracheal tubes. Ciit Care Med 1986 14 265-270. 

Infectious complications persist as a major cause of death, especially within the first year of heart transplantation (Hosenpud et al. 2000). Within the first month of transplantation, infections are usually of nosocomial bacterial origin, including Pseudomonas aeruginosa. Staphylococcus aureus. Enterococci, and Enterobacteriaceae. These organisms can cause pneumonia, urinary tract and wound infections. Later infections are commonly caused by viruses and opportunistic fungi (e.g., Pneumocystis, Candida, and Aspergillus) (Miniati and Robbin 2002). 

Agents used to treat nosocomial infections in the intensive care unit (e.g., expanded gram-negative bacterial spectrum) should not be routinely used to treat community-acquired infections. 

Levofloxacin (1), the levo-isomer or the (5)-enantiomer of ofloxacin, received FDA approval in 1996 (Fish, 2003 Hurst et al., 2002 Mascaretti, 2003 Norrby, 1999 North et al., 1998). The initial approval covered community-acquired pneumonia, acute bacterial exacerbation of chronic bronchitis, acute maxillary sinusitis, uncomplicated skin and skin structure infections, acute pyelonephritis, and complicated urinary tract infections (North et al., 1998). Four years later, the levofloxacin indication list grew to include community-acquired pneumonia caused by penicillin-resistant Streptococcus pneumoniae. In addition, in 2002, nosocomial (hospital-acquired) pneumonia caused by methicillin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa, Serratia marcescens, Haemophilus influenzae, Kliebsella pneumoniae, and Escherichia coli was added (Hurst et al., 2002). Finally in 2004, LVX was approved as a post-exposure treatment for individuals exposed to Bacillus anthracis, the microbe that causes anthrax, via inhalation (FDA, 2004). 

Gastric acid is an important barrier to colonization and infection of the stomach and intestine from ingested bacteria. Increases in gastric bacterial concentrations are detected in patients taking proton pump inhibitors, which is of unknown clinical significance. Some studies have reported an increased risk of both community-acquired respiratory infections and nosocomial pneumonia among patients taking proton pump inhibitors. 

Vancomycin inhibits bacterial cell wall synthesis and is bactericidal during cell division at therapeutic concentrations. Bacterial resistance to vancomycin has not been an issue during the first decades of its use. More recently, vancomycin-resistant enterococci have been recovered with increasing frequency from hospitalized patients. In some institutions, multidrug-resistant and vancomycin-resistant enterococci have become important nosocomial pathogens, difficult to treat. Vancomycin-resistant enter-ococcal bacteremia is associated with a poor prognosis. Judicious use of vancomycin and broad-spectrum antibiotics is recommended, and strict infection control measures must be implemented to prevent nosocomial transmission of these organisms (5). 

Navajas MF-C, Chacon DJ, Solvas JRG, et al. Bacterial contamination of enteral feeds as a possible risk of nosocomial infection. J Hosp Infect 1992 21 111-120. 

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