Inpatient Proton Pump Inhibitor Administration and Hospital-Acquired Clostridium difficile Infection: Evidence and Possible Mechanism

The incidence of Clostridium difficile infection continues to increase globally. Particularly concerning are hospital-acquired cases that attribute significant morbidity, mortality, and expenditures to the health care system. Proton pump inhibitors, which are widely prescribed and generally considered to have minimal adverse effects, have recently come under scrutiny for positive associations with C. difficile infection development. This article will specifically review the current state of evidence demonstrating a positive association between nosocomial proton pump inhibitor administration and the incidence of hospital-acquired C. difficile infection. In addition, the article delivers state-of-the-art knowledge relative to mechanisms by which proton pump inhibitor exposure may propagate the manifestation of C. difficile infection.     

A double-blind controlled trial of metronidazole suppositories in children undergoing appendicectomy

Summary

A total of 133 children, aged 16 months to 15 years (mean 6.7 years), with presumptive acute appendicitis, was included in a double-blind, placebo-controlled trial of the short-term (72 hour) use of metronidazole suppositories as prophylaxis against post-operative infection. There was no significant difference in the incidence or severity of wound infection or post-operative intra-abdominal sepsis between the metronidazole-treated and placebo groups. It is suggested that intra-rectal metronidazole, when used exclusively, is not sufficient for effective prophylaxis for appendicitis in childhood.     

The role of telavancin in the treatment of MRSA infections in hospital

Background: Serious infections caused by Gram-positive bacteria, particularly multi-drug resistant, are an important cause of morbidity and mortality in patients admitted to intensive care units. Thus, new antibiotics covering these pathogens are urgently needed. Objective: To review characteristics of telavancin, a novel antibiotic intended to use for treating infections caused by difficult Gram-positive bacteria, such as Staphylococcus aureus, resistant to meticillin or vancomycin, multi-drug-resistant Streptococcus pneumoniae or glycopeptide-resistant enterococci. Methods: The studies on microbiological activity, clinical efficacy and safety of telavancin were reviewed. Results/conclusion: Telavancin is a lipoglycopeptide administered intravenously once-daily and excreted with urine. It proved to be microbiologically active against numerous Gram-positive pathogens including drug-resistant staphylococci, enterococci and pneumococci. Large randomized Phase II and III clinical trials on efficacy and safety of telavancin in treating complicated skin and skin structure infections reported telavancin to be non-inferior to standard treatment (mostly vancomycin). Preliminary data on telavancin in hospital-acquired pneumonia, including ventilator-associated pneumonia, documented that telavancin was efficacious for this indication. Overall incidence of adverse events was similar for telavancin and the comparator arms. Mild and transient disgeusia, nausea and vomiting resulted to be more frequent in telavancin group. Increase in creatinine values was also observed in telavancin arm.     

The role of infection and immunity in atherosclerosis

Cardiovascular diseases account for 20% of deaths worldwide, rising to 50% in developed countries. Current understanding of atherosclerosis derives from a combination of research in animals and cell cultures, analysis of human lesions, clinical investigations of patients with acute coronary syndromes and epidemiological studies of coronary artery disease. By measuring serologic titers in the serum of patients after cardiovascular events, it was observed that the greater the infectious exposure of a patient, the larger the atherosclerotic lesion extension. In addition, gene targeting or pharmacological inhibition of certain cytokines aggravates atherosclerosis in animal experiments. Other animal experiments have succeeded in proving that B cells play a protective role in atherosclerosis through induced immunity against oxidized low-density lipoprotein and other epitopes. Molecular mimicry might respond to the question of how infection may trigger vulnerability in previously stable atherosclerotic lesions. The FLU Vaccination Acute Coronary Syndromes trial enhanced the debate on atherosclerosis prevention by the application of antiflu vaccine. So far, antibiotics have failed to reduce cardiovascular risk, as recent trials could not demonstrate a statistically significant risk reduction. Having assumed atherosclerosis to be an inflammatory disease, the WHO considered the possible role of secondary prevention with antiflu vaccine.     

The coated antiseptic tip (CAT) syringe

Abstract

Catheter-related blood stream infections (CR-BSI) account for 30% of healthcare acquired infection (HAI). Colonization of connector hubs and contaminated syringes are thought to increase the risk of CR-BSI. The Coated Antiseptic Tip (CAT) syringe was developed to decontaminate connector hubs, thereby reducing the risk of CR-BSI. Needleless valves (n?=?20) and three-way connectors (n?=?20) were contaminated with common critical care pathogens. At hourly intervals, CAT syringes were inserted into the connector hubs and normal saline was injected through the connector. This was repeated with control (non-coated) syringes. The internal surface of the connector hubs were swabbed at t?=?0, t?=?1?h and t?=?4?h, inoculated onto blood agar plates and analysed by a blinded microbiologist. Growth was counted as the number of colony forming units. Baseline swabbing demonstrated 100% bacterial hub colonization in both connectors. The CAT syringe showed a significant reduction in CFU growth at 0 and 1?h compared with control syringes (p?<?0.05). At 4?h, the CAT syringe completely eliminated bacterial growth in both of the connector hubs. The CAT syringe can effectively disinfect both three-way and needleless connectors.     

Cutaneous histoplasmosis with prominent parasitization of epidermal keratinocytes: report of a case

Disseminated histoplasmosis most commonly occurs in immunosuppressed individuals and involves the skin in approximately 6% of patients. Cutaneous histoplasmosis with an intraepithelial‐predominant distribution has not been described. A 47‐year‐old man was admitted to our institution with fever and vancomycin‐resistant enterococcal bacteremia. He had been diagnosed with T‐cell prolymphocytic leukemia 4 years earlier and had undergone matched‐unrelated‐donor stem cell transplant 2 years earlier; on admission, he had relapsed disease. His medical history was significant for disseminated histoplasmosis 6 months before admission, controlled with multiple antifungal regimens. During this final hospitalization, the patient developed multiple 2–5 mm erythematous papules, a hemorrhagic crust across the chest, shoulders, forearms, dorsal aspect of the fingers, abdomen and thighs. Skin biopsy revealed clusters of oval yeast forms mostly confined to the cytoplasm of keratinocytes and within the stratum corneum; scattered organisms were present in the underlying superficial dermis without any significant associated inflammatory infiltrate. Special stains and immunohistochemical studies confirmed these to be Histoplasma organisms. We highlight this previously unrecognized pattern of cutaneous histoplasmosis to ensure its prompt recognition and appropriate antifungal therapy.     

Bioaerosol exposure to personnel in a clinical environment absent patients

Nosocomial infections pose a significant and escalating threat to both patients and healthcare workers (HCWs). By their nature, hospitals induce antibiotic resistance in virulent and commensal strains, leading to increasingly severe hospital-acquired infections. This study measured environmental exposure experienced by domestic staff cleaning vacated patient rooms of a community hospital to bacteria in ambient bioaerosols. While they cleaned the room, participants wore an N95 filtering facepiece respirator (FFR), from which coupons were cut and bacteria were extracted, cultured and enumerated. Extrapolation to the full area of the respirator yielded measured exposures of 0.2–1.4 × 10⁴ colony-forming units/hour, of which ～97% collected on the front layer of the N95, suggesting a possible role for minimal respiratory protection in nonpatient environments. Random resistance testing of 1.6% of the isolates showed that ～70% of both Gram-positive and Gram-negative organisms exhibited resistance to oxacillin and ～9% of the Gram-positives displayed resistance to vancomycin. These data provide an estimate for mask bioaerosol loading that can be used in risk modeling and to refine strategies for reuse of FFRs during critical shortages.     

Face shields for infection control: A review

Face shields are personal protective equipment devices that are used by many workers (e.g., medical, dental, veterinary) for protection of the facial area and associated mucous membranes (eyes, nose, mouth) from splashes, sprays, and spatter of body fluids. Face shields are generally not used alone, but in conjunction with other protective equipment and are therefore classified as adjunctive personal protective equipment. Although there are millions of potential users of face shields, guidelines for their use vary between governmental agencies and professional societies and little research is available regarding their efficacy.