Pattern of malignant diseases at the University of Benin Teaching Hospital

This study was designed to evaluate the pattern of malignant diseases seen at the University of Benin Teaching Hospital over a 20-year period (January 1980-December 1999). A total of 2258 histologically confirmed malignant diseases were seen with the predominant tumours comprising carcinoma of the cervix (20.59%), breast (18.25%), prostate (7.13%), endometrium (6.47%) and colon and rectum (5.71%).We believe that the figure reported here represents an underestimate of the frequency of malignant tumours seen in the hospital and recommend the establishment of hospital- and population-based cancer registries to ensure proper documentation of malignant diseases within the region.     

尿路感染的诊断与治疗尿路感染的发病机制

尿路感染 (简称尿感 )是由多种病原微生物引起的尿道、膀胱、输尿管、肾盂粘膜和 (或 )肾间质的炎症。病原微生物主要是细菌 ,极少数为病毒、真菌、衣原体和支原体。尿感是泌尿内科最常见的疾病 ,人群发病率约为 2 %。尿感按其是否伴有易患因素分为单纯性尿感和复杂性尿感。单纯性尿感不伴有易患因素 ,主要为女性的急性膀胱炎 ,大多可经简单治疗而痊愈 ;复杂性尿感伴有某些易患因素 ,易于复发 ,且发病后难以治愈。据我们追踪 2 2年的一组 46例尿感患者 ,其中 4例发展为慢性肾盂肾炎者均为复杂性尿感患者。1　尿路感染的易患因素尿感的易患因…     

Nosocomial infection of the urinary tract

Urinary tract infections appear to be responsible for 35 percent of all hospital-acquired infections, occurring in approximately two patients per 100 admissions. The great majority of infections are associated with urinary tract instrumentation. Female sex, advanced age and debilitating underlying illness appear to be associated with an increased risk of infection, but other risk factors have been poorly defined and case-control studies assessing excess morbidity and mortality associated with nosocomial bacteriuria have not been made. In most instances, the hospitalized patients are the reservoirs for the etiologic organisms, but cross infection from other infected patients also occurs. Current preventive efforts have been primarily directed at aseptic catheter care techniques and reducing catheter use. Further developments in our prevention and control of these infections require an understanding of the mechanisms responsible for colonization of the urethra and bladder with gram-negative organisms and ways to discriminate patients at especial risk.     

Uncomplicated urinary tract infection and treatment

Urinary tract infections (UTI) are frequent infections in the outpatient and hospital setting. With respect to treatment options, UTI can generally be stratified into uncomplicated and complicated / nosocomial infections. Uncomplicated UTI are represented by the acute uncomplicated cystitis and the uncomplicated pyelonephritis. They are mainly caused by E. coli. There are, however, also increasing resistance rates found in uncomplicated UTI, e. g., against aminopenicillins, cotrimoxazole and increasingly also fluoroquinolones. This development has called for a new evaluation of the treatment recommendations in uncomplicated UTI. As an empirical therapy for uncomplicated cystitis fosfomycin trometamol, nitrofurantoin or pivmecillinam are recommended as first-line agents. As the oral first line therapy for uncomplicated pyelonephritis fluroquinolones in high dosages are recommended. The frequent asymptomatic bacteriuria does not need to be treated, with only a few exceptions. Due to the increasing antibiotic resistance and the emergence of multiresistant uropathogens, empirical antibiotic treatment becomes more difficult. Therefore the results of susceptibility testing should be awaited whenever possible.     

Review of adolescent urinary tract infection

The diagnosis and management of adolescent urinary tract infection (UTI) shares some of the clinical features seen in infections of the young and old. Whereas most infections in the young patient demand an extensive radiologic work-up, the teenager with a UTI is not so straightforward. The clinical must balance being too aggressive with being too conservative in the diagnosis and management of these patients. UTIs occur most frequently among adolescent females and are usually uncomplicated and not associated with underlying anatomic abnormalities. Smaller numbers of adolescent males suffer from UTIs, and the need to search for underlying abnormalities is not clear. Adolescent UTI is associated with nascent sexual activity and is also more common in voiding/elimination syndromes. Future studies examining UTI, specifically in the adolescent age group, will help provide clinicians with a more focused algorithm in the diagnosis and management of adolescent UTIs.     

The epidemiology of urinary tract infection

Urinary tract infections (UTIs) are among the most common bacterial infections acquired in the community and in hospitals. In individuals without anatomical or functional abnormalities, UTIs are generally self limiting, but have a propensity to recur. Uropathogens have specialized characteristics, such as the production of adhesins, siderophores and toxins that enable them to colonize and invade the urinary tract, and are transmitted between individuals both through person-to-person contact and possibly via food or water. Although generally self limiting, treatment of UTIs with antibiotics leads to a more rapid resolution of symptoms and is more likely to clear bacteriuria, but also selects for resistant uropathogens and commensal bacteria and adversely affects the gut and vaginal microbiota. As uropathogens are increasingly becoming resistant to currently available antibiotics, it may be time to explore alternative strategies for managing UTI.     

Non-antibiotic prevention of urinary tract infection

Summary The identification of several glycoconjugates as receptors for attaching bacteria has resulted in optimism regarding the use of receptor analogues in preventing infection. The structure of receptor-active oligosaccharides and the patient groups which might benefit from such treatment are most thoroughly understood for urinary tract infections. Prevention of adhesion and delay or decrease of infection was achieved using oligosaccharides from the globoseries of glycolipids containing Gal14Gal. This minimal receptor structure as a free saccharide was, however, not sufficient. It was the intact P, P₁ and p^k determinants which showed optimal activityin vitro. In addition, protection against experimental UTI results from previous exposure to whole bacteria or isolated antigens. The mechanism(s) of protection and their relevance in clinical UTI remain to be defined.

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Nicht-antibiotische Prävention von Harnwegsinfektionen

Zusammenfassung Verschiedene Glykokonjugate wurden als Rezeptoren für anheftende Bakterien identifiziert; daher besteht Hoffnung auf die Anwendung von Rezeptoranaloga zur Infektionsverhütung. Die Strukturen der Rezeptor-wirksamen Oligosaccharide und Patientengruppen, die von einer solchen Therapie profitieren könnten, sind für Harnwegsinfektionen sorgfältig erforscht. Mit Oligosacchariden der Globoserie von Glykolipiden, die Gal 14Gal enthalten, ist es gelungen, das Anheften zu verhindern und die Infektion zu verzögern oder zu vermindern. Jedoch erwies sich diese minimale Rezeptorstruktur als freies Saccharid als nicht ausreichend.In vitro konnte vielmehr durch die intakten P-, P₁- und p^k-Determinanten eine optimale Wirkung erzielt werden. Eine Schutzwirkung vor experimenteller Harnwegsinfektion entsteht zusätzlich durch frühere Exposition gegenüber den kompletten Bakterien oder isolierten Antigenen. Auf welche Weise die Protektion zustande kommt und welche Bedeutung sie für klinische Harnwegsinfektionen hat, muß noch geklärt werden.

     

Mortality of tetanus at the Lagos University Teaching Hospital, Nigeria

Records of 349 tetanus patients, aged 10 years and above, admitted to the Lagos University Teaching Hospital, Nigeria, between 1990 and 1999 were reviewed. The male:female ratio was 1.98:1, and the ages were between 10 and 88 years, with a mean age of 29.8 years.The overall case fatality rate (CFR) of tetanus was 36.96% (33.19% for men and 44.44% for women). The CFR is similar to that previously reported in the hospital, but higher than that reported from Europe and North America. The lowest CFR was in the 10-19-year age group, and there was a trend towards increasing CFR with increasing age.Tetanus patients in the intensive care unit (ICU) had a significantly higher CFR than those in the medical wards.Unlike in developed countries, where management of tetanus in ICU has resulted in a decrease in CFR, the CFR of tetanus at the Lagos University Teaching Hospital has not significantly reduced over the years.     

Prevention of catheter-associated urinary tract infection

PURPOSE OF REVIEW: The underlying cause of catheter-associated urinary tract infection is biofilm formation by uropathogens on the urinary catheter. Biofilm is a relatively new concept in medicine, and current measures to prevent biofilm formation are inadequate. Considerable work is being done in this area, but little clinical progress has been made. The purpose of this review is to analyze recent publications concerning prevention of catheter-associated urinary tract infection. RECENT FINDINGS: Several recent studies have elucidated aspects of biofilm formation in catheter-associated urinary tract infection. Other researchers are working on methods to disrupt biofilm formation on catheter surfaces. At the same time, the magnitude of the problem of catheter-associated urinary tract infection has increased awareness of the effectiveness of basic infection control measures. A modern approach to infection control may include computerized ordering systems that minimize unnecessary days of catheterization. Finally, consumption of cranberry juice products and bacterial interference are two novel approaches to urinary tract infection prevention. SUMMARY: Biofilm-disrupting strategies offer promise for the future but have little immediate applicability. Implementation of infection control measures to improve catheter function and remove unnecessary catheters can be done at the present time. In general, prevention of catheter-associated urinary tract infection remains an elusive goal. More basic research at the level of pathogenesis is needed so that novel strategies can be designed.     

尿路感染的诊断和鉴别诊断

尿路感染 (简称尿感 )是指尿路内有大量微生物繁殖而引起尿路某一部分的炎症 ,可以有或没有临床症状。尿感可分为上尿路感染 (主要是肾盂肾炎 )和下尿路感染 (主要是膀胱炎 )。尿感是最常见的泌尿系统疾病 ,是所有的细菌性感染疾病中最常见的一种 ,无论男女老少均可发病 ,特别以女性最常见。任何细菌入侵尿路均可导致尿路感染 ,但最常见的致病菌是革兰阴性杆菌 ,占 90 %以上 ,其中以大肠杆菌最为常见。绝大多数尿感是上行感染引起 ,即细菌经尿道上行至膀胱 ,再到肾盂引起感染。血行感染途径虽少见 ,但细菌从体内的感染灶侵入血流 ,到达肾脏…     

A new look at the diagnosis of infection of the urinary tract and its adjacent structures

The criterion enunciated by Kass for interpreting the quantitative examination of urine is critically reappraised. The role of organisms other than those of the aerobic bowel flora, especially fastidious organisms, in urinary tract infections is discussed in detail. Clinical microbiologists are urged to pay more attention to the bacteriological examination of urine and to play a greater part in the diagnosis and treatment of infections of the urinary tract and its adjacent structures.     

Respiratory tract infection caused by bacteria (non-Mycobacterium) and their antibiogram in HIV-positive patients

Abstract. This study was undertaken from 1995-2000 to investigate the cause of respiratory tract infection among 481 patients with human immunodeficiency virus (HIV) at Siriraj Hospital, Bangkok, Thailand. The positive rate of bacterial pathogens was 38.46%. Pseudomonas aeruginosa appeared to be the most common pathogen (32.97%), followed by Staphylococcus aureus (18.92%), Klebsiella pneumoniae (10.81 %), Haemophilus influenzae (7.57%), and Acinetobacter baumannii (5.95%). P. aeruginosa was sensitive to netilmycin, amikacin, imipenem, meropenem, cefoperazone/sulbactam, piperacillin/tazobactam, and gentamicin (67-84%). S. aureus was sensitive to vancomycin and teicoplanin (100%).     

上海地区复旦大学附属儿科医院近10年儿童泌尿道感染病原菌分布及其耐药性变迁

目的 了解泌尿道感染患儿病原菌的构成和耐药变化.方法 以复旦大学附属儿科医院2001年1月至2010年12月间临床诊断为泌尿道感染的患儿为研究对象,对尿液进行细菌培养和鉴定.药物敏感试验采用琼脂扩散法(KB).计数资料采用卡方检验,耐药率的趋势变化采用曲线回归分析.结果 10年间共分离到10 686株致病菌,致病菌构成比分析显示,大肠埃希菌的分离率最高,为38％～56％.粪肠球菌从0升至17％ (F=34.075,P=0.000),屎肠球菌从3％升至15％(F=7.139,P=0.028).大肠埃希菌对头孢唑啉、头孢呋辛钠、头孢噻肟、头孢他啶的耐药率呈上升趋势,分别从35.8％上升至62.3％(F=215.735,P=0.000)、33.1％上升至57.0％(F=70.674,P=0.000)、19.0％上升至56.5％(F=52.355,P=0.000)、2.1％上升至23.5％(F=16.807,P=0.003);大肠埃希菌对环丙沙星的耐药率在23.4％～33.8％(F=20.989,P=0.349),对阿米卡星及头孢哌酮/舒巴坦的耐药率均不超过7％,未发现对亚胺堵南耐药.屎肠球菌对氨苄西林、环丙沙星的耐药率分别超过60.0％及50.0％,对呋喃妥因的耐药率从32.0％降到9.4％(F=34.075,P=0.000).粪肠球菌对氨苄西林的耐药率由40.0％降到9.6％(F=17.497,P=0.009),对环丙沙星的耐药率从60.0％降到21.6％(F=12.826,P=0.009),对呋喃妥因的耐药率从9.2％降到1.4％(F=7.139,P=0.028).两种肠球菌对红霉素的耐药率均超过75.0％,未发现对万古霉素耐药的肠球菌.结论 大肠埃希菌、粪肠球菌、屎肠球菌是儿童泌尿道感染的三种主要致病菌,肠球菌在泌尿道感染致病菌中的构成比呈上升趋势.氨苄西林对粪肠球菌仍敏感,而屎肠球菌可选择药物已很少.     

Initial management of serious urinary tract infection

OBJECTIVE: To obtain information necessary for the development of initial antibiotic treatment guidelines for patients with serious urinary tract infections. DESIGN: Retrospective chart review. SETTING: The medical service of a 533-bed university-affiliated community hospital. PATIENTS: 253 unselected patients hospitalized between January 1985 and December 1987 given principal discharge diagnoses of urinary tract infection, pyelonephritis, or gram-negative rod bacteremia originating in the urinary tract. RESULTS: Three clinically distinct groups were identified: women under 50 years old, older women, and men. Escherichia coli was isolated from 93% of young women, 70% of older women, and 46% of men. Pseudomonas aeruginosa was isolated from 39% of men with one or more urinary tract risk factors, including recent or recurrent urinary tract infections and known genitourinary tract abnormality. The overall prevalence of Group D streptococci was only 1%. More than 20% of the patients in each group were bacteremic. In all groups, resistance to ampicillin and first-generation cephalosporins was common. Trimethoprim-sulfamethoxazole was active in 98% of young women and 85% of older women and men without urinary risk factors. CONCLUSIONS: Age and gender identify clinically important subgroups of patients with serious urinary tract infections. Pending culture results, all patients should be considered bacteremic, ampicillin alone should not be prescribed, and antibiotics effective against P. aeruginosa should be given to men, especially those with risk factors.     

Nursing leadership and the reduction of catheter-associated urinary tract infection

The prevention of infections continues to be a challenge for many hospitals. We examined specific features of nursing leadership and found improvements in leadership were associated with a decrease in catheter-associated urinary tract infection. Infection prevention efforts in acute care hospitals should focus on nurse leaders and their ability to provide the support necessary to improve care delivery—support that could be instrumental in the reduction and the elimination of catheter-associated urinary tract infection.