Læknablaðið - 15.04.1997, Page 9

LÆKNABLAÐIÐ 1997; 83
205
Útbreiðsla ampicillín ónæmra
enterókokka á Landspítalanum og
sýklalyfjanæmi enterókokka
Ólafur Guðlaugsson1), Karl G. Kristinsson2’
Guðlaugsson Ó, Kristinsson KG
Ampicillin resistant enterococci at Landspítalinn
University Hospital and antimicrobial susceptibili-
ties of enterococci in Iceland
Læknablaðið 1997; 83: 205-10
Hospital acquired infections caused by enterococci
are an increasing problem, due to an increased num-
ber of infections and increasing bacterial resistance
to antibiotics. During 1994 ampicillin resistant enter-
ococci were discovered in specimens from three pa-
tients in one ward over a short time period.
The patients were isolated and stool cultures were
taken from everyone in the ward for selective cul-
ture for enterococci and subsequent antimicrobial
susceptibility tests. Additional screening cultures
were taken from patients in the intensive care unit,
the oncology ward, one surgical and one paediatric
ward. Cultures were also taken from the hospital
sewage system. Antibiotic susceptibility of entero-
cocci isolated from urine samples submitted to the
Microbiology Department, Landspítalinn, during
1994 and 1995 were reviewed.
In the index ward, specimens were obtained from 30
individuals for culture. One additional patient and
one staff member were found to be colonised with
ampicillin resistant enterococci. In the other wards a
total of 23 samples were taken from selected pa-
tients for culture, but none of these cultures yielded
ampicillin resistant enterococci. No ampicillin re-
sistant enterococci were found in the sewage system
of the hospital. Of a total of 41,181 urine specimens
Frá '’lyflækningadeild og 2)sýklafræðideild Landspítalans.
Fyrirspurnir, bréfaskipti: Karl <3. Kristinsson, sýklafræðideild
Landspítalans, Pósthólf 1465, 121 Reykjavík. Netfang:
karl@rsp.is
Lykilorð: enterókokkar, sýklalyfjanæmi, ónæmi, spítala-
sýkingar.
cultured at the Microbiology Department, 1,513
contained enterococci of which five were resistant to
ampicillin (0.3%, all from 1994).
We conclude that ampicillin resistant enterococci
have not become established at Landspítalinn. It
may be difficult to maintain a susceptible enterococ-
cal population, however isolation of carriers and
sensible use of broad spectrum antibiotics are likely
to delay the establishment of multiresistant entero-
cocci in Iceland.
Keywords: enterococcus, antimicrobials, resistance,
hospital infection.
Ágrip
Spítalasýkingar af völdum enterókokka eru
vaxandi vandamál vegna aukinnar tíðni þeirra
og minnkandi næmis fyrir sýklalyfjum. Arið
1994 fundust ampicillín ónæmir enterókokkar
hjá þremur sjúklingum á sömu deild Landspít-
alans á stuttum tíma. Slíkir stofnar voru nær
óþekktir á Islandi og því talið mikilvægt að
koma í veg fyrir frekari útbreiðslu. Sjúkling-
arnir voru einangraðir og teknar skimræktanir
frá öðrum sjúklingum deildarinnar og starfs-
fólki, þar sem leitað var að ampicillín ónæmum
enterókokkum. Síðan voru gerðar skimrækt-
anir á völdum sjúklingum annarra deilda spít-
alans svo og farið yfir næmi innsendra þvag-
sýna sem enterókokkar höfðu ræktast úr.
Einangrunin var samkvæmt leiðbeiningum
Bandarísku sjúkdómavarnarstofnunarinnar
(Centers for Disease Control). Saurræktanir
voru teknar frá öllum sjúklingum og starfsfólki
sjúkradeildarinnar. Skimræktanir voru einnig
teknar frá sjúklingum á gjörgæsludeild, skurð-
deild, barnadeild og krabbameinslækninga-
deild. Ræktanir voru teknar úr holræsum
hverrar álmu Landspítalans. Farið var yfir