The source of recurrent bacteremia identified by trans-esophageal echocardiography

Article Abstract:

Patients with bacteremia, or the presence of bacteria in the blood, caused by Staphylococcus aureus bacteria can be grouped into two categories: one, in which a primary, or original, site of infection is identified and two, in which the primary site of infection is not identifiable. Patients with an unidentifiable site of primary bacteremia often have endocarditis, or inflammation of the lining of the chambers and valves of the heart. Echocardiography, which uses ultrasound to examine the internal structure and motion of the heart, is used to diagnose endocarditis. However, if the site of infection is small, echocardiography may not be sensitive enough to visualize it. The use of trans-esophageal echocardiography (directed through the esophagus, the muscular tube between the throat and the stomach) increases the sensitivity of detecting endocarditis. A case study reported a woman who had recurrent bacteremia due to Staphylococcus aureus. The primary site of infection could not be located with chest X-ray, computed tomography (CT), magnetic resonance imaging (MRI), or transthoracic echocardiography (directed through the exterior chest wall). However, trans-esophageal echocardiography detected a bacterial mass in the cavity of the right atrium, a chamber of the heart, where a wire had been left after previous heart surgery. This study demonstrates the importance of trans-esophageal echocardiography as a technique for effectively visualizing the heart. (Consumer Summary produced by Reliance Medical Information, Inc.)

Usage, Evaluation, Diagnosis, Causes of, Heart, Echocardiography, Endocarditis, Bacterial, Bacterial endocarditis, Bacteremia, Staphylococcal infections, Transesophageal echocardiography

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Methicillin-resistant staphylococcal colonization and infection in a long-term care facility

Article Abstract:

Methicillin-resistant Staphylococcus aureus (MRSA) is frequently the cause of hospital-acquired infection. MRSA poses infection control problems because of its resistance to antibiotics and its frequent carriage in the nasal passages of patients and staff. The danger of MRSA to patients in acute-care hospitals is well-recognized, but the risk of MRSA to patients in long-term facilities is not known. One hundred and ninety-seven patients in a Veterans Administration long-term facility were studied. Ninety-nine of these patients resided on the intermediate care ward and 98 on the nursing home ward, with the former group having a greater degree of medical illness than the latter. All patients were cultured for nasal carriage of S. aureus, which was then subtyped as resistant or sensitive to methicillin. Twenty-five percent of those with MRSA experienced a documented staphylococcal infection compared with 4.0 percent of methicillin-sensitive S. aureus carriers. In addition, infections occurred in 4.5 percent of patients who were not carriers. Few prior studies have evaluated the significance of MRSA carriage in long-term care facilities, and the current investigation raises a number of questions about the need for culturing patients for MRSA; the isolation of these patients; and what treatment strategies are appropriate. Future studies should address these issues in greater detail. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Demographic aspects, Staphylococcus aureus, Drug resistance in microorganisms, Microbial drug resistance, Nosocomial infections, Cross infection, Long-term care facilities, Long term care facilities

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