Clinically silent infections in patients with oligoarthritis: results of a prospective study.

Oligoarticular synovitis of undetermined origin can closely resemble an incomplete form of reactive arthritis/Reiter's syndrome. Eighty three patients with oligoarthritis of undetermined origin were studied prospectively to identify asymptomatic infections potentially triggering the inflammatory response in the synovial fluid. At the time of initial evaluation, 57 (69%) of the patients with oligoarthritis and 4/20 (20%) of the control subjects were carriers of clinically silent infections. Evidence for persistent or prior chlamydial infections was frequently and exclusively found in the study group (30/83 (36%) patients v no controls), whereas undetected urogenital infections with mycoplasma were present in nine (11%) patients and four (20%) controls. Eleven (13%) of the patients carried cellular and humoral responses to Borrelia burgdorferi. The HLA-B27 haplotype represented a major risk factor for the development of oligoarthritis but not for development of sacroiliitis. Re-evaluation after one year showed that the course and outcome of the oligoarticular disease did not correlate with a specific infectious organism and were not affected by antibiotic treatment sufficient to treat the carrier state.     

Frequency of broviac catheter infections in pediatric oncology patients

Indwelling, right atrial catheters are important in the care of children with cancer, despite the risk of infection. We have reviewed the records of 64 pediatric oncology patients with 70 Broviac catheters. Fifty infections (17 exit site, 25 septic, and 8 combined) occurred during 17,581 catheter-days, a crude rate of 2.8 infections/1,000 catheter-days. The risk of infection correlated most strongly with age; for example, only children aged one through four years had multiple infections. Overall, 70% of infections were cured without removing the catheter, including 83% of septic infections. However, as compared with newly inserted catheters, the subsequent mean infection-free interval was greatly reduced for catheters associated with a previous, cured infection. Thus, although most Broviac catheter infections can be cured without catheter removal, insertion of a new catheter may nonetheless be necessary in patients who may need prolonged intravenous therapy.     

Bacillus cereus infections among oncology patients at a children's hospital

BACKGROUND: Bacillus cereus can cause severe infections in immunocompromised persons. METHODS: We report 3 cases of bacteremia/septicemia (1 fatal) among oncology patients in a children's hospital. Because all cases occurred during a 10-day period, a common source outbreak was suspected. An epidemiologic investigation was performed. Molecular comparison of patient and environmental isolates was performed by using pulsed-field gel electrophoresis. RESULTS: After an extensive investigation, no common hospital source could be found. Pulsed-field gel electrophoresis proved that the isolates were not related. CONCLUSION: Sporadic infections in immunocompromised persons do occur and can be associated with significant morbidity.     

Nosocomial infections in the pediatric patient: an update

Substantial progress has been made in measuring the burden of nosocomial infection in pediatric patients, particularly in certain populations (e.g., critical care, immunocompromised, chronic care, and patients with acquired immunodeficiency syndrome) and after certain procedures (e.g., central catheter lines and open-sternum cardiovascular surgery). Preventive measures, such as the use of goggles, gowns, and gloves, have been subjected to new and additional study. The following report is a summary of recent progress. A review of factors responsible for infection in various patient care populations and settings and recommendations for control are presented.     

Alcohol consumption among unemployed youths: results from a prospective study

A prospective study, including all 1083 pupils in the final year of compulsory schooling in a municipality in northern Sweden, was performed. Ninety-seven point nine per cent of the pupils were followed up after five years. They completed a comprehensive self-administered questionnaire including questions on alcohol consumption. Among men a positive correlation between long-standing unemployment (> 20 weeks) and alcohol consumption at the beginning and at the end of the study, as well as the change in consumption during the follow-up period was seen. This correlation was still present when earlier alcohol consumption and socio-economic variables were controlled for. In women there was a positive correlation between unemployment and the level of alcohol consumption, but a negative correlation between unemployment and change in consumption. When controlling for motherhood and alcohol intake at the start of the study the correlation turned positive. Unemployment among women did not seem to affect recruitment to the high consumption group. Our remits support the suggestion that unemployment may be a risk indicator for increasing alcohol consumption among young people, particularly in young men.     

A prospective incidence study of nosocomial infections in a neonatal care unit

BACKGROUND: Health care improvements and technical advances for diagnostic and therapeutic management in the neonatal care unit (NCU) have made possible the increasing survival of neonates with severe pathologic conditions. However, nosocomial infections (NI) still represent an important cause of morbidity and mortality in this population. OBJECTIVE: To describe the epidemiologic profile of NI in the NCU. METHODS: A prospective surveillance study was performed in the NCU at a university hospital in Barcelona during 6 months. Two hundred sixty-eight neonates were admitted during the study period. Centers for Disease Control and Prevention criteria were used as standard definitions for NI. Data including risk factors associated with NI were recorded. RESULTS: Sixty-five neonates had a total of 88 NI. The incidence rate of NI was 1.6 per 100 patient-days. The accumulative rate of NI was 32.7 per 100 admissions. Bacteremia (28.4%), conjunctivitis (19.5%), respiratory infection (10.2%), and urinary tract infection (7.9%) were the most common episodes observed. Gram-positive bacteria were the most commonly isolated germs (76.4%), with coagulase-negative Staphylococcus (72.5%) being the main pathogen. Intrinsic risk factors related to NI were low birth weight (<1000 g) and urinary catheter and peripheral venous catheter (P<.01). CONCLUSIONS: NI represent an important and frequent problem in neonates. Knowledge of the incidence of NI allows the targeting and implementation of preventive strategies for reducing morbidity and mortality related to NI in an NCU.     

Magnetic resonance imaging in pediatric hematology/oncology. Part I. Basic technology

Magnetic resonance imaging (MRI) is a promising new diagnostic modality that is well suited for the evaluation of children with hematological or oncological diagnosis. The side effects of ionizing radiation are avoided, the tomographic pathological anatomy in three orthogonal planes can be obtained, and differences between normal and abnormal tissues are often present. In order to present our preliminary clinical experience with MRI in pediatric hematology and oncology, the historical background of MRI, the technique, and possibilities for tissue characterization are reviewed.     

Nosocomial primary bloodstream infections in intensive care unit patients in a nonteaching community medical center: a 21-month prospective study.

All patients admitted to the medical and surgical intensive care units of a 500-bed nonteaching suburban hospital were followed prospectively for the occurrence of nosocomial primary bloodstream infections for 21 months. The incidence of primary bloodstream infection was 38 (1%) of 3163 patients; among patients with central venous catheters, it was 34 (4%) of 920 patients, or 4.0 infections per 1000 catheter-days. Ventilator-associated pneumonia, congestive heart failure, and each intravascular catheter inserted were independently associated with the development of a nosocomial primary bloodstream infection. Among infected patients, the crude mortality rate was 53%, and these patients had longer stays in intensive care units and the hospital than did uninfected patients. Bloodstream infection, however, was not an independent risk factor for death. The incidence, risk factors, and serious outcomes of bloodstream infections in a nonteaching community hospital were similar to those seen in tertiary-care teaching hospitals.     

Nosocomial infections in a neonatal intensive care unit: incidence and risk factors

BACKGROUND: Nosocomial infections (NIs) have become a matter of major concern in neonatal intensive care units (NICUs). The objectives of this study were to determine the incidence rate and the most frequent sites of infection in a Brazilian NICU from January 1999 to March 2000 and to study the risk factors for NIs. METHODS: A cohort study was carried out in which 225 neonates who remained at least 24 hours in the NICU were followed-up; neonates with NIs were identified, and the presence of risk factors was studied. Results were submitted to chi(2) distribution. RESULTS: The incidence rate and the incidence density rate were 50.7% and 62 infections per 1000 patient-days, respectively. In order of frequency, the sites of infection were: pneumonia (40.3%), primary bloodstream (16.7%), skin and soft tissue (14.9%), and meningitis (9.6%). The following risk factors were associated with NIs (P <.05): birth weight, gestational age, mechanical ventilation, total parenteral nutrition, umbilical catheter, use of antibiotics, and intubation in the delivery room. CONCLUSION: Risk factors were similar to those reported by other authors. However, incidence rates of infections in our NICU were much higher, possibly because of different methodologies and the adopted criteria for the classification of NIs.     

2001～2010年我院医院感染的调查和长期趋势分析

目的分析广西壮族自治区人民医院2001～2010年医院感染的发病率、感染部位分布、病原体的长期趋势,为深入开展医院感染监测工作提供依据。方法采用前瞻性与目标性监测相结合的调查方法监测该院2001～2010年的所有住院患者,对医院感染确认病例进行统计分析。结果 2001～2010年医院感染的总发生率为3.39%(2007～2008年呈上升趋势,P0.01)。常见感染部位为下呼吸道、泌尿道、胃肠道、上呼吸道及皮肤软组织;呼吸系统的感染率呈下降趋势(P0.01),但是下呼吸道构成比从2001年的27.9%上升到2010年的43.18%;泌尿系统、血液系统、腹部和消化系统、手术部位的医院感染发生率均呈上升趋势(P0.01)。重症监护病房、神经外科、老年病房、血液内科、肿瘤科的医院感染发生率长期处于前列。常见病原体有不动杆菌属、白色念珠菌、其它真菌、铜绿假单胞菌、大肠埃希菌、克雷白菌属、金黄色葡萄球菌。结论通过长期趋势分析表明,该院医院感染的重点科室为重症监护病房、神经外科等、重点感染部位为呼吸道、泌尿道及胃肠道等,重点病原体为不动杆菌、白色含珠菌等。应有针对性地重点加强这些科室、部位和病原体的目标性监测。     

Nosocomial viral respiratory infections: perennial weeds on pediatric wards

The frequency and importance of nosocomial infections of the respiratory tract in pediatrics have generally been underestimated. In part this has resulted from the emphasis on bacterial infections which occur primarily in select at-risk populations. Most respiratory infections in pediatric patients, hospital- and community-acquired, are viral and all patients are potentially susceptible The epidemiologic patterns of these viral respiratory agents on the ward mirror those seen in the community in terms of frequency, season, age affected and severity of illness. Hence, the most frequent nosocomial agents are the viruses that occur in outbreaks or epidemics and cause respiratory illness, epidemic respiratory viruses--respiratory syncytial virus, which causes the greatest morbidity and mortality; influenza, and the parainfluenza viruses. Their import, as exemplified by respiratory syncytial virus, results from (1) the severity of disease produced in young children, which is magnified in those hospitalized with certain underlying conditions; (2) the abundant and prolonged viral shedding, allowing easy spread; (3) the potential susceptibility of all patients and staff, since infections recur throughout life; and (4) the difficulty in controlling nosocomial spread.     

Nosocomial infections among HIV-positive and HIV-negative patients in a Brazilian infectious diseases unit

BACKGROUND: Some researchers observed that HIV-infected patients have a higher risk of acquiring nosocomial infections (NI). This study compared the incidence of NI among HIV-positive and HIV-negative inpatients. METHODS: Patients from an infectious diseases ward who were classified as positive and negative regarding their HIV status were followed-up for 21 months in a prospective cohort study. Daily surveillance was made with use of Centers for Disease Prevention and Control criteria for NI. RESULTS: NI per 1000 patients-day were 8.16 for HIV-positive patients and 3.94 for HIV-negative patients (P =.01). Central venous catheter (CVC) and urinary catheter utilization was significantly higher among HIV-positive patients than among HIV-negative patients (P <.001). Bloodstream infections (BSI) caused most of the NI, followed by urinary tract infections, vascular infections, and pneumonia. Overall, HIV-positive patients were more likely to have a BSI than were HIV-negative patients (P =.005). When only BSI was analyzed in patients with a CVC, there was no difference in the incidence of BSI between the 2 groups of patients (P =.24). HIV-positive patients were more likely to have an NI caused by Staphylococcus aureus than were HIV-negative patients (P =.04). Other important NI agents in both groups were Acinetobacter baumanii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and coagulase-negative Staphylococcus. CONCLUSIONS: In this study the HIV-positive patients were more likely to have NI than were the HIV-negative patients. Overall, HIV-positive patients are at increased risk for an NI caused either by S aureus or a BSI. Although HIV-positive patients had more CVC-days, there was no difference in the number of BSI among both groups, suggesting that the BSI incidence in the HIV-positive group is not exclusively related to the CVC.