Nosocomial Candidemia in Non-Neutropenic Patients at an Italian Tertiary Care Hospital

 In a retrospective study conducted in an Italian tertiary care hospital, the incidence of nosocomial candidemia was evaluated together with causative pathogens, treatment, and risk factors for death. Over a 6-year period (1992–1997), a total of 189 episodes of candidemia occurred in 189 patients (mean age 58±19 years), accounting for an average incidence of 1.14 episodes per 10,000 patient-days per year. The most common reasons for hospitalization were solid neoplasia (21%), trauma (17%), abdominal diseases requiring surgery (13%), and cardiovascular diseases (13%). No patient was neutropenic within 3 weeks prior to the onset of candidemia. One hundred thirty patients were hospitalized in intensive care units, 47 patients in surgical wards, and 12 patients in medical wards. Candida albicans was the most frequently isolated pathogen, accounting for 54% of fungal isolates, followed by Candida parapsilosis (23%), Candida glabrata (7%), Candida tropicalis (5%), Candida pelliculosa (4%), Candida lusitaniae (1%), Candida humicula (1%), and other non-albicans Candida spp. (5%). Seventy-six (41%) patients received adequate antifungal therapy. Seventy-one (58%) of the 123 evaluable patients with central venous catheters underwent line removal; 51 of them had catheter-related candidemia. The 30-day crude mortality rate was 45%. Older age, hospitalization in an intensive care unit, a longer duration of candidemia, retention of central lines, and inadequate antifungal therapy were significantly associated with poor outcome. In the present study, nosocomial candidemia was a frequent and relatively underestimated illness. Adequate antifungal therapy and central line removal independently reduced the high mortality of the disease.     

Simultaneous Nosocomial SARS-CoV-2 Outbreaks with Different Patterns of Occurrence in Two General Wards; Experience in a Tertiary Care Hospital in Korea

A nosocomial outbreak of severe acute respiratory syndrome-coronavirus-2 occurred in two general wards. One outbreak had pre-symptomatic transmission and was linked epidemiologically with an index case. The other outbreak was associated with early detection failure in a crowded room. Notably, adherence to appropriate mask wearing was not confirmed in the hospital outbreak. Confirmed cases were moved into isolation rooms, and contacts were quarantined. Quarantined cases were tested regularly and facilitated early termination of the hospital outbreak.     

Candidemia in a Tertiary Care Hospital: Epidemiology and Factors Influencing Mortality

The present study was conducted in order to assess the epidemiology and clinical course of candidemia and to identify the risk factors associated with mortality. A total of 143 episodes of nosocomial candidemia were identified during a 5-year period, and these were included in the study. The majority of candidemic episodes were due to Candida albicans (63, 44%), followed by Candida parapsilosis (32, 22%). The overall mortality was 45%. The following independent prognostic factors for mortality were identified: bacterial sepsis, rapidly fatal illness, chronic obstructive lung disease, presence of a central venous catheter, candidemia due to Candida albicans, and lack of antifungal therapy. Electronic Publication     

Comorbidities are Frequent in Patients with Gastroesophageal Reflux Disease in a Tertiary Health Care Hospital

INTRODUCTION

Several aspects of gastroesophageal reflux disease (GERD) have been studied, but the frequency of comorbidities is not yet fully understood.

OBJECTIVES

To study the prevalence of GERD comorbidities in a tertiary care hospital.

METHODS

We prospectively studied 670 consecutive adult patients from the outpatient department of our facility. A diagnosis was established using clinical, endoscopic and/or pHmetry-related findings. Each patient’s medical file was reviewed with respect to the presence of other medical conditions and diagnoses.

RESULTS

Of the 670 patients, 459 (68.6%) were female, and the mean age was 55.94 (17–80 years). We registered 316 patients (47.1%) with the erosive form of GERD and 354 patients (52.9%) with the non-erosive form. A total of 1,664 instances of comorbidities were recorded in 586 patients (87.5%), with the most common being arterial hypertension (21%), hypercholesterolemia (9%), obesity (9%), type II diabetes mellitus (5%) and depression (4%). Two or more comorbidities were present in 437 individuals (64.8%). The occurrence of comorbidities increased with age and was higher in patients with the non-erosive form of GERD.

CONCLUSIONS

In a tertiary referral population, comorbidities were very common, and these may have worsened the already impaired health-related quality of life of these patients. Clinicians caring for GERD patients in this setting must be aware of the likelihood and nature of comorbid disorders and their impact on disease presentation and patient management.     

Osteomyelitis of the Hip Joint Associated with Systemic Cat-Scratch Disease in an Adult

 Reported here is the case of a 29-year-old male with cervical lymphadenopathy, fever and weight loss, followed by acute painful osteomyelitis of the left hip joint due to cat-scratch disease. The diagnosis was established by detection of IgG antibodies to Bartonella henselae in serum and histologic examination of a lymph node including a positive polymerase chain reaction test. Treatment consisted of clarithromycin and cefotiam for 2 weeks. Four weeks after discharge, all of the patient's symptoms had completely resolved. Magnetic resonance imaging of the left hip joint showed marked regression of bone inflammation 4 months later and normalization after 8 months. Cat-scratch disease should be considered in the differential diagnosis of osteomyelitis in an adult, especially when lymphadenitis is present.     

Incidence,Epidemiology and Control of Clostridium difficile Infection in a Tertiary Care Private Hospital in India

Purpose: Clostridium difficile infection (CDI) is a serious healthcare-associated infection (HAI) now being increasingly reported from hospitals across India. However, there is a paucity of data on the incidence of and impact of control measures on CDI in India. Materials and Methods: This is a retrospective study conducted at a tertiary care hospital in Mumbai from January 2016 to December 2017. All patients with healthcare-onset diarrhoea were tested for C. difficile by glutamate dehydrogenase (GDH)/toxin assay or nucleic acid amplification test (NAAT). CDI was defined as either GDH and toxin positive or NAAT positive. The incidence of CDI was calculated per 1000 patient days. Demographic features of patients with CDI including age, sex, duration of hospitalisation before onset of CDI, antibiotic use and treatment administered were summarised. Results: A total of 67 patients had CDI in the study period with a mean incidence of 0.2/1000 patient days. A halving of the CDI incidence was seen after intensification of the CDI prevention bundle. The mean age of affected patients was 64 years and CDI occurred at a median duration of 2 weeks after hospitalisation. Eighty-seven per cent of the patients were on antibiotics at the time of diagnosis of CDI. The crude mortality rate was 22%. Conclusions: CDI is an emerging HAI in India. All hospitals need to set up policies for surveillance, testing, treatment and prevention of CDI based on recent international guidelines and local infrastructure/logistics.     

Intestinal Dysbiosis and Depletion of Butyrogenic Bacteria in Clostridium difficile Infection and Nosocomial Diarrhea

Clostridium difficile infection (CDI) causes nearly half a million cases of diarrhea and colitis in the United States each year. Although the importance of the gut microbiota in C. difficile pathogenesis is well recognized, components of the human gut flora critical for colonization resistance are not known. Culture-independent high-density Roche 454 pyrosequencing was used to survey the distal gut microbiota for 39 individuals with CDI, 36 subjects with C. difficile-negative nosocomial diarrhea (CDN), and 40 healthy control subjects. A total of 526,071 partial 16S rRNA sequence reads of the V1 to V3 regions were aligned with 16S databases, identifying 3,531 bacterial phylotypes from 115 fecal samples. Genomic analysis revealed significant alterations of organism lineages in both the CDI and CDN groups, which were accompanied by marked decreases in microbial diversity and species richness driven primarily by a paucity of phylotypes within the Firmicutes phylum. Normally abundant gut commensal organisms, including the Ruminococcaceae and Lachnospiraceae families and butyrate-producing C2 to C4 anaerobic fermenters, were significantly depleted in the CDI and CDN groups. These data demonstrate associations between the depletion of Ruminococcaceae, Lachnospiraceae, and butyrogenic bacteria in the gut microbiota and nosocomial diarrhea, including C. difficile infection. Mechanistic studies focusing on the functional roles of these organisms in diarrheal diseases and resistance against C. difficile colonization are warranted.     

Adult Celiac Disease Associated with HLA-DRw3 and -DRw7

Celiac disease (CD), which occurs in Europe with varying frequency, is known to be associated with HLA-B8 and even more strongly with HLA-Dw3 because of the high linkage disequilibrium between these two antigens. After typing for HLA-A, ∼B and -DR antigens in adult patients with CD, we can confirm the high prevalence of B8 (72.7%) and of DRw3 (63.7%). However we find that DRw7 is also significantly increased (54.5%); DRw3 and DRw7, taken together, represent 86% of our 22 patients.     

综合医院住院病人躯体形式障碍的临床特点

目的了解综合医院住院病人中躯体形式障碍(SD)的患病比率、临床特点及相关因素。方法采用自编调查表和ICD-10诊断标准对综合医院住院病人进行躯体形式障碍筛查及诊断,对SD患者与躯体病患者进行SCL-90量表测查。结果共筛查了1012例住院病人,诊断为SD者42例(4.15%),SD病人最常见症状为慢性疼痛、胃肠道及自主神经症状;与躯体病患者比较,SD患者年龄偏小(t=2.32,P<0.05),住院次数偏多(t=2.21,P<0.05),SCL-90总分、阳性项目数、躯体化、抑郁、焦虑及精神病性因子分高于普通躯体病患者(t=2.54~6.37,P<0.05~0.01)。结论综合医院中因躯体主诉而反复住院的SD病人并不少见,SD病人的心理状况差于普通躯体病患者。     

Clinico-Microbiological Analysis of Toxigenic Clostridium difficile from Hospitalised Patients in a Tertiary Care Hospital,Mangalore, Karnataka,India

Purpose: Prevalence of Clostridium difficile, an anaerobic, Gram-positive, spore-forming bacillus, is very much underestimated in India. The present study was intended to assess the burden of toxigenic C. difficile in hospitalised patients with clinically significant diarrhoea and analysis of their clinical picture. Materials and Methods: This cross-sectional study was conducted in a tertiary care teaching hospital, South India, from January 2012 to December 2014. Stool samples were collected consecutively from 563 inpatients from various wards. The prevalence of toxigenic C. difficile was determined by toxigenic culture and a two-step algorithm. The clinical spectrum of these patients was also analysed. Associated pathogens were identified using standard procedures. Statistical analysis was done by frequency, percentage, Chi-square test and z-test. Results: Out of the 563 stool samples analysed, the prevalence of toxigenic C. difficile was 12.79% and that of non-toxigenic C. difficile was 10.83%. The prevalence of toxigenic C. difficile among oncology patients was highly significant (HS). Antibiotic treatment, prolonged hospital stay and underlying diseases/conditions were the risk factors which were HS, and fever was the significant clinical feature among the patients. Escherichia coli was the predominant associated pathogen isolated (18.47%). Conclusion: The presence of toxigenic C. difficile in our locality is a matter of concern. Constant supervision, appropriate treatment and preventive measures are crucial in controlling C. difficile infection.     

Detection of a Rotavirus-Like Agent Associated with Diarrhea in an Infant

A rotavirus-like agent was detected in the feces of a child with diarrhea. Although morphologically indistinguishable from rotavirus, the agent was serologically distinct, and electrophoresis of its nucleic acid also showed that it was dissimilar.     

艰难梭菌毒素A/B、BD-PCR毒素基因及GDH检测对艰难梭菌相关性腹泻的诊断价值

目的探讨艰难梭菌毒素A/B及其相关毒素基因检测对艰难梭菌相关性腹泻的诊断价值。方法收集2015年1月至2015年10月我院ICU病房腹泻疑似艰难梭菌感染患者的粪便标本133例作为研究对象,分别采用艰难梭菌培养法、CDAB法、PCR毒素基因检测法及艰难梭菌毒素GDH检测法进行检测,以艰难梭菌培养法结果为金标准,计算各方法的诊断指标所包含有的特异度、敏感度、阴性预测值和阳性预测值等。结果本研究收集的133例粪便标本中,经过金标准粪便样本厌氧培养法检出阳性结果 20例,阴性结果 113例。CDAB法具有低敏感度(0.550)和高特异度(0.912),诊断符合率为0.932,BD-PCR毒素基因检测法具有高敏感度(0.950)和高特异度(0.929),诊断符合率为0.932,艰难梭菌毒素GDH检测法的高敏感度(0.900)和低特异度(0.779),诊断符合率为0.797。结论对于疑似艰难梭菌感染,可联合艰难梭菌GDH、艰难梭菌毒素A/B(CDAB)或进行荧光定量PCR毒素基因共同检测,有效降低检测时间,为临床医师及时提供准确的诊断依据,并制定行之有效的治疗措施。     

精神科开放与封闭病房护士心理健康状况调查

目的探讨精神科开放病房与封闭病房护士心理健康状况。方法在参考文献基础上自行设计一般状况调查表,应用症状自评量表（SCL-90）,对我院封闭病房109名护士和开放病房19名护士的心理状况进行对比研究。结果开放病房与封闭病房护士SCL-90评定结果比较,封闭病房护士在量表中的总分、阳性项目数、躯体化、人际关系、焦虑等方面,得分明显高于开放病房护士．结果具有统计学意义（P≤0．05）。结论精神科封闭病房护士心理健康状况相对较差,护理管理者应采取有效地干预措施。     

Prevalence,Toxin Gene Profile,Genotypes and Antibiotic Susceptibility of Clostridium difficile in a Tertiary Care Hospital in Taif,Saudi Arabia

Purpose: Clostridium difficile (C. difficile) is an important causative agent of nosocomial diarrhoea and has become a major worldwide public health concern. The current study was conducted to determine the prevalence of C. difficile infection (CDI) amongst patients with nosocomial diarrhoea in a large tertiary care hospital in Taif, Saudi Arabia, and to define molecular characteristics and antimicrobial sensitivity profiles of C. difficile strains isolated from those patients. Materials and Methods: Stool specimens were collected from 456 patients and were cultured for C. difficile isolation. The isolates were subjected to multiplex polymerase chain reaction (PCR) for detecting genes encoding the toxins (toxin A, toxin B and binary toxin [CDT]), genotyping by PCR ribotyping method and antimicrobial sensitivity testing using E test strips. Results: Seventy-four C. difficile strains were recovered, of which 44 (59.5%) were A⁺B⁺CDT⁻, 14 (18.9%) were A⁻B⁺CDT⁻, 4 (5.4%) were A⁺B⁺CDT⁺ and 12 (16.2%) were A⁻B⁻CDT⁻. Toxigenic strains, and hence CDI, were detected in 13.6% of the patients (62/456). Fourteen different ribotypes were distinguished amongst bacterial isolates, of which ribotypes 002, 001, 017, 014 and 020 were the most prevalent (20.3%, 18.9%, 18.9%, 9.5% and 8.1%, respectively). Four isolates (5.4%) belonged to ribotype 027. All bacterial isolates showed sensitivity to metronidazole, vancomycin and piperacillin-tazobactam. The isolates exhibited resistance to linezolid (2.7%), chloramphenicol (5.4%), rifampicin (13.5%), tetracycline (21.6%), moxifloxacin (48.6%), clindamycin (54%) and imipenem (83.8%). Multiple drug resistance was observed in 56.8% of the isolates. Conclusion: Further larger studies are required for an accurate understanding of CDI epidemiology in Saudi Arabia.     

Antibodies to Recombinant Clostridium difficile Toxins A and B Are an Effective Treatment and Prevent Relapse of C. difficile-Associated Disease in a Hamster Model of Infection

Clostridium difficile causes antibiotic-associated diarrhea and colitis in humans through the actions of toxin A and toxin B on the colonic mucosa. At present, broad-spectrum antibiotic drugs are used to treat this disease, and patients suffer from high relapse rates after termination of treatment. This study examined the role of both toxins in pathogenesis and the ability of orally administered avian antibodies against recombinant epitopes of toxin A and toxin B to treat C. difficile-associated disease (CDAD). DNA fragments representing the entire gene of each toxin were cloned, expressed, and affinity purified. Hens were immunized with these purified recombinant-protein fragments of toxin A and toxin B. Toxin-neutralizing antibodies fractionated from egg yolks were evaluated by a toxin neutralization assay in Syrian hamsters. The carboxy-terminal region of each toxin was most effective in generating toxin-neutralizing antibodies. With a hamster infection model, antibodies to both toxins A and B (CDAD antitoxin) were required to prevent morbidity and mortality from infection. In contrast to vancomycin, CDAD antitoxin prevented relapse and subsequent C. difficile reinfection in the hamsters. These results indicate that CDAD antitoxin may be effective in the treatment and management of CDAD in humans.     

Factors Associated with Complications and Mortality in Adult Patients Hospitalized for Infectious Cellulitis

The aim of this study was to analyze medical outcomes, including risks for complications and mortality, in 332 adult patients hospitalized for cellulitis. The infection was documented microbiologically in 128 cases (39%). Staphylococcus aureus (46 cases) and Streptococcus pyogenes (22 cases) were the most frequent causative pathogens. Overall, 63 patients (19%) were discharged early (≤4 days) and 166 patients (50%) were hospitalized for more than 4 days without developing any complications. One hundred three patients (31%) had one or more complications or died. Of these, 78 required surgical debridement, 10 required plastic surgery, 7 underwent amputation, and 15 had shock on presentation. When comparing the three study groups (patients discharged early, patients hospitalized for ≤4 days without complications, and patients who developed 1 or more complication or who died), patients who were discharged early (low risk) were more frequently female and were less likely to have multiple comorbid conditions, hypoalbuminemia, renal insufficiency, and/or cutaneous necrosis at presentation. Overall mortality (<30 days) was 5% (16/332 patients). Factors associated with death were male sex, presence of multiple comorbid conditions, congestive heart failure, morbid obesity, hypoalbuminemia, renal insufficiency, shock, and Pseudomonas aeruginosa cellulitis. These findings can be used to stratify patients with acute cellulitis according to risks for complications and mortality and may be helpful when deciding the most appropriate means of care, i.e. outpatient treatment or hospitalization. Electronic Publication     

中山市慢性非传染性疾病相关危险因素调查分析

目的通过对慢性病相关危险因素的调查分析，探索中山市慢性病发病主要危险因素．为有针对性开展社区干预和防控措施提供依据。方法采用整群随机抽样的调查方法．并应用多因素分析的基本方法筛查危险因素。结果中山市社区人群高血压、慢性阻塞性肺病（COPD）、恶性肿瘤、冠心病、脑卒中、糖尿病的患病率分别为18．51％、6．65％、0．89％、2．79％、0．78％、2．07％；中山市社区慢性病主要危险因素为年龄、吸烟、超重和家族史。结论慢性病的防控与人们的生活方式和行为习惯关系密切，积极引导社区群众戒除不良的生活方式，调整饮食结构．可以有效降低慢性病的发病水平。