A Review of 11 Years ofStenotrophomonas maltophiliaBlood Isolates at a Tertiary Care Institute in Canada

BACKGROUND:Stenotrophomonas maltophiliahas emerged as a significant nosocomial pathogen with increasing resistance to trimethoprim/sulphamethoxazole (TMP/SMX), the current drug of choice for treatment.OBJECTIVES: To describe the microbiological and clinical characteristics ofS maltophiliabloodstream infections (BSIs) over an 11-year period at a tertiary care centre in Canada.METHODS: All adultS maltophiliaBSIs from 1999 to 2009 in a 750-bed tertiary care teaching hospital (University of Alberta Hospital, Edmonton, Alberta) were identified through the infection control nosocomial infection surveillance program. Demographic and clinical data were extracted from the infection control database and from patient charts. Microbiological data were confirmed through the laboratory information system.RESULTS: Twenty-five episodes ofS maltophiliaBSI (0.9% of all BSIs) involving 24 patients were identified between 1999 and 2009. The patient age range was 18 to 83 years (average 45.7 years). The majority were men (14 of 24 [58.3%]). The mean length of hospital stay was 83.3 days (range eight to 310 days). The rate ofS maltophiliaBSIs per 1000 admissions ranged from 0.04 to 0.22 (average 0.09). Greater than one-half of the episodes (13 of 25 [52%]) were admitted to the intensive care unit before BSI onset. Laboratory data were available for 24 of the 25 isolates. Polymicrobial infections were present in 11 of 24 (45.8%) patients. Resistance to TMP/SMX occurred in 8.3% of all infections. Fifteen per cent of isolates were resistant to ticarcillin/clavulanate. Mortality attributed to bacteremia was 16.7%.CONCLUSIONS: In the University of Alberta Hospital, the rate ofS maltophiliaBSI remains low and constant, and TMP/SMX remains the drug of choice for treatment.

Trends in Nosocomial Bloodstream Infections following Health Care Restructuring in Alberta between 1999 and 2005

OBJECTIVE: A previous study at the University of Alberta Hospital/Stollery Children’s Hospital in Edmonton, Alberta, revealed an increase in hospital-acquired bloodstream infection (BSI) rates associated with an increase in patient acuity during a period of public health care delivery restructuring between 1993 and 1996. The present study assessed trends in BSIs since the end of the restructuring.DESIGN: Prospective surveillance for BSIs was performed using Centers for Disease Control and Prevention (USA) criteria for infection. BSI cases between January 1, 1999, and December 31, 2005, were reviewed. Available measures of patient volumes, acuity and BSI risk factors between 1999 and 2005 were also reviewed from hospital records.SETTING: The University of Alberta Hospital/Stollery Children’s Hospital (617 adult and 139 pediatric beds, respectively).PATIENTS: All pediatric and adult patients admitted during the above-specified period with one or more episodes of BSIs.RESULTS: There was a significant overall decline in the BSI number and rate over the study period between 1999 and 2005. The downward trend was widespread, involving both adult and pediatric populations, as well as primary and secondary BSIs. During this period, the number of hospital-wide and intensive care unit admissions, intensive care unit central venous catheter-days, total parenteral nutrition days and number of solid-organ transplants were either unchanged or increased. Gram-positive bacterial causes of BSIs showed significant downward trends, but Gram-negative bacterial and fungal etiologies were unchanged.CONCLUSIONS: These data imply that, over time, hospitals can gradually adjust to changing patient care circumstances and, in this example, control infectious complications of health care delivery.

Methicillin-ResistantStaphylococcus aureusin a Canadian Intensive Care Unit: Delays in Initiating Effective Therapy Due to the Low Prevalence of Infection

INTRODUCTION: Methicillin-resistantStaphylococcus aureus(MRSA) infection in intensive care units (ICUs) has increased dramatically in prevalence in recent years, and is associated with increased morbidity, mortality and cost of care. The aim of the present study was to describe the epidemiology and outcomes of MRSA infection in the general systems ICU at the University of Alberta Hospital in Edmonton, Alberta.METHODS: A retrospective cohort analysis of patients infected with MRSA in a general systems ICU was conducted from January 1, 1997, to August 15, 2005.RESULTS: Forty-six cases of MRSA were identified, of which 36 (78.3%) were infected. The most common admitting diagnoses included respiratory failure (41.7%) and sepsis or septic shock (36.1%). Infection was hospital acquired in 58.3% of cases (10 cases ICU acquired), with a median time to infection of 11 days. The most common sites of infection were the respiratory tract, skin and blood. Median lengths of stay were 13 days in the unit and 27 days in-hospital. Crude mortality was 55.6%. Time to appropriate antimicrobial treatment was delayed in 80.5% of patients. Four prototypical Canadian MRSA (CMRSA) strains were identified by pulsed-field gel electrophoresis. Hospital-acquired strains were predominantly CMRSA-2 (59%), indicating that this clone circulates at the University of Alberta Hospital.CONCLUSIONS: MRSA infection remains uncommon at the University of Alberta Hospital, resulting in delays in instituting appropriate antimicrobial therapy. To date, only a few community-acquired strains have been noted. ICU acquisition of MRSA remains rare, with only 10 cases over the past nine years. The majority of hospital-acquired strains were CMRSA-2.

Forensic Psychiatry and Occupational Therapy

At the Alberta Hospital Edmonton, one ward employs social learning as the major mode of treatment of character disorders. To meet the demands of working in a therapeutic community all disciplines have had to extend their traditional roles. Occupational therapy role extension has been in the area of assessment and goal planning. This article discusses the occupational therapist's involvement in the forensic psychiatric unit.