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In one hospital, almost 50% of hand cultures from staff were positive at the end of their working shift (113).Factors such as debilitating clinical condition, lengthy ward-stay and frequent exposure to medical interventions, most likely act by necessitating increased frequency and intensity of direct contact with staff hands (111).Patients most at risk include those with debilitating or immunocompromising disorders, those treated with broad-spectrum antibiotics and patients in ICU who are subjected to invasive instrumentation.The indwelling urinary catheter is a major risk factor for infection.In keeping with its role as an agent of opportunistic infection, was traditionally associated with low intrinsic pathogenicity.Whilst almost all isolates produce extracellular products such as DNase, chitinase, lecithinase, lipase, gelatinase and siderophores, it appears that in secrete a pore-forming haemolysin, Sh IA, that is associated with cell cytotoxicity and the release of inflammatory mediators.

In the 1970s, however, gentamicin resistance was observed in identified from 1974 through 1977 were gentamicin resistant and that the emergence of this resistance paralleled the overall increased use of gentamicin in the hospital. Active against Amp C chromosomal b-lactamase-producing strains but precluded for the treatment of ESBL-positive isolates. Maybe combined with third-generation cephalosporins for the treatment of UTI or combined with fourth-generation cephalosporins or carbapenems for the treatment of serious infection. Flow Diagram for Gram Neg Rods on BAP & Mac Conkey (NOT for stool isolates) Bush K, et al. Enterobacteriaceae Producing ESBLs in the Community: Are They a Real Threat?

Once established, carriage is persistent and patients are likely to carry the organism at multiple sites, with the throat and nose identified as common sites in 59% and 31% of colonized patients, respectively (11).

Regardless of the source or reservoir, the predominant mode of spread of from hand cultures of hospital staff has been reported consistently in epidemiologic studies (39, 49).

Septic arthritis has also been reported following diagnostic and therapeutic intra-articular injections (76).

Over the years, infection has been attributed to many different sources.

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