Incidence and clinical implication of nosocomial infections associated with implantable biomaterials - catheters, ventilator-associated pneumonia, urinary tract infections

Health care associated infections, the fourth leading cause of disease in industrialised countries, are a major health issue. One part of this condition is based on the increasing insertion and implantation of prosthetic medical devices, since presence of a foreign body significantly reduces the number of bacteria required to produce infection. The most significant hospital-acquired infections, based on frequency and potential severity, are those related to procedures e.g. surgical site infections and medical devices, including urinary tract infection in catheterized patients, pneumonia in patients intubated on a ventilator and bacteraemia related to intravascular catheter use. At least half of all cases of nosocomial infections are associated with medical devices.Modern medical and surgical practices have increasingly utilized implantable medical devices of various kinds. Such devices may be utilized only short-time or intermittently, for months, years or permanently. They improve the therapeutic outcome, save human lives and greatly enhance the quality of life of these patients. However, plastic devices are easily colonized with bacteria and fungi, able to be colonized by microorganisms at a rate of 0.5 cm per hour. A thick biofilm is formed within 24 hours on the entire surface of these plastic devices once inoculated even with a small initial number of bacteria.The aim of the present work is to review the current literature on causes, frequency and preventive measures against infections associated with intravascular devices, catheter-related urinary tract infection, ventilator-associated infection, and infections of other implantable medical devices. Raising awareness for infection associated with implanted medical devices, teaching and training skills of staff, and establishment of surveillance systems monitoring device-related infection seem to be the principal strategies used to achieve reduction and prevention of such infections. The intelligent use of suitable antiseptics in combination with medical devices may further support reduction and prevention of such infections. In addition to reducing the adverse clinical outcomes related with these infections, such reduction may substantially decrease the economic burden caused by device-related infection for health care systems.     

Assessment of serological evidence for mumps virus infection in vaccinated children

It is estimated that at least one-third of mumps virus infections in non-vaccinated individuals are asymptomatic. Little information is available whether this proportion is the same among those vaccinated. We validated a commercial oral fluid mumps IgG-specific Enzyme Immunoassays (EIA) with vaccinated control groups to identify symptomatic and asymptomatic mumps virus infections in vaccinated individuals during a mumps outbreak in The Netherlands. A vaccinated control group was required to define a new cutoff value for the assay, because of the presence of low but significant levels of IgG antibodies in oral fluid as a result of mumps vaccination in the past. With a new cutoff, calculated using receiver operator characteristic analysis, we identified an attack rate of 7-10% compared to 2.7% based on clinical symptoms among vaccinated children. This finding has important implications when studying transmission patterns, strain virulence, as well as mumps vaccine effectiveness to protect from infection rather than disease.     

云南省德宏州无抗病毒治疗史的成年HIV感染者机会性感染相关症状发生及其处理

目的 了解云南省德宏州无抗病毒治疗史的成年HIV感染者机会性感染相关症状发生及处理.方法 回顾性调查德宏州≥18岁无抗病毒治疗史的HIV感染者于2012年1～9月间机会性感染相关症状发生及处理.结果 共有1 416例参加调查,以男性(75.3％)、≤40岁(74.2％)、少数民族(70.1％)、小学及以下文化程度(70.0％)为主;经性传播及静脉吸毒传播感染HIV者各占约50％;CD4细胞计数平均为478个/μL.133例(9.4％)调查对象观察期间至少出现过一种机会性感染相关症状,以呼吸系统症状罹患率最高(6.0％,85例).其中,85例(63.9％)仅出现1个系统症状,26例(19.5％)出现2个系统症状,22例(16.5％)则出现≥3个系统症状.多因素Logistic回归分析显示,CD4细胞计数＞200个/μl的患者机会性感染相关症状罹患率低于CD4细胞计数较低者.大多数出现机会性感染相关症状患者自购药物处理或不做任何处理.结论 德宏州无抗病毒治疗成年HIV感染者特别是CD4细胞计数水平低的患者机会性感染发生率较高,应加强机会性感染防治.     

儿童急性呼吸道多病原体混合感染的研究进展

急性呼吸道感染（ARTI）是儿童时期最常见的感染性疾病,其病原体包括病毒、细菌、真菌、支原体及衣原体等。近年来,随着病原检测手段的发展,急性呼吸道多病原体混合感染逐渐多见并引起重视,包括病毒与病毒、病毒与其他病原如细菌、支原体、衣原体等的混合感染。此文就儿童急性呼吸道多病原体混合感染的现状、感染特征、与疾病严重程度的关系等进行综述。     

Emerging tick-borne pathogens in the Nordic countries: A clinical and laboratory follow-up study of high-risk tick-bitten individuals

Despite the presence of several microorganisms, other than Borrelia burgdorferi sensu lato (Bbsl) and TBE virus, in Ixodes ricinus ticks from the Nordic countries, data is lacking on their pathogenic potential in humans. In this study, we wanted to investigate the aetiology and clinical manifestations of tick-transmitted infections in individuals seeking medical care following a tick-bite.The sampling frame was participants of a large-scale, prospective, multi-centre, follow-up study of tick-bitten volunteers recruited in Sweden, Finland and Norway in the years 2007–2015. Participants who sought medical care during the three-month follow-up period and from whom blood samples were collected during this healthcare visit (n = 92) were tested, using PCR, for exposure to spotted fever group (SFG) Rickettsia spp., Anaplasma phagocytophilum and Babesia spp. Moreover, 86 of these individuals had two serum samples, collected three months apart, tested serologically for six tick-borne microorganisms. The selected organisms – Bbsl, SFG rickettsiae, Anaplasma phagocytophilum, TBE virus, Babesia microti and Bartonella henselae – have all been detected in field-collected ticks from the Nordic countries. Medical records were reviewed and questionnaires were completed to determine clinical manifestations.We found Lyme borreliosis to be the most common tick-transmitted infection as seen in 46 (54%) of the 86 participants with available medical records. Among the 86 participants with paired sera, serological or molecular evidence of recent exposure to other microorganisms than Bbsl could be demonstrated in eight (9%). Five participants (6%) exhibited serological evidence of recent concomitant exposure to more than one tick-borne microorganism. Clinical presentations were mild with one exception (TBE).In conclusion, our data suggest a low risk of infection with tick-borne microorganisms, other than Bbsl, in immunocompetent tick-bitten persons from the examined regions, a low occurrence of co-infection and mostly mild or no overt clinical signs of infection in immunocompetent persons exposed to the studied agents.     

Hospital acquired infections surveillance and control in intensive care services. Results of an incidence study

Hospital acquired infections (HAI) continue to constitute a major health problem for hospital patients. Such a problem is particularly relevant in Intensive Care Wards. Here infections appear to be directly or indirectly related to the patients' death, and the patients, of course, represent a selected group of the most susceptible hosts in the whole hospital due to their immunosuppressed states, underlying diseases and the numerous and highly invasive diagnostic and therapeutic procedures to which they are submitted.This paper reports the results of a one-year surveillance incidence study carried out in four Intensive Care Wards at Padua Hospital by means of a daily visits to the wards and careful collection of the patients' data in a computerized sheet. Two-hundred-thirty-one of the 859 patients considered developed one or more HAI (HAI percentage 26.9%) for a total of 382 HAIs (Infections ratio 44.5%). Nosocomial pneumonias were the most frequent infections detected, whereas urinary tract infections, bacteremias and wound infections were less common in such patients. The study also confirmed the importance of invasive procedures and surgical operations in the predisposition to HAIs. In particular, the importance of the urinary catheter and of tracheal intubation was outlined. In addition, HAI appeared to be related to the duration of hospitalization and to the severity of the patients' illness. HAIs (especially nosocomial pneumonias) were also closely related to the patients' death. Pseudomonas aeruginosa, S. aureus, Acinetobacter and Streptococcus D were the most frequently isolated agents in the infected patients. Gram-negative agents accounted for 57% of all agents isolated and were particularly frequent in both pneumonias and urinary tract infections.Finally, this study underlined the necessity of particular and specific surveillance programs in Intensive Care Wards in order to obtain detailed data for a clear analysis of the problem.     

2011—2015年北京西城区成人门诊腹泻患者诺如病毒与轮状病毒感染的流行病学特征

目的了解门诊腹泻病例中诺如病毒和轮状病毒感染现状,分析本辖区病毒感染性腹泻的流行特征。方法以2011—2015年在北京市西城区两所三甲医院成人肠道门诊就诊的腹泻病例作为监测对象,对其进行诺如病毒和轮状病毒检测及流行病学调查分析。结果调查检测腹泻病例共714例,200例检测阳性,总阳性率28.01%;其中轮状病毒检测阳性率为10.08%;诺如病毒检测阳性率为18.63%。诺如病毒检测阳性率显著高于轮状病毒阳性率(χ~2=7.211,P<0.05)。诺如病毒检测阳性病例中有腹泻10次以上、恶心、呕吐、水样便症状的病例百分比明显高于检测阴性病例;轮状病毒检测阳性病例中有腹痛症状的病例百分比明显低于检测阴性病例,腹泻10次以上的病例百分比明显高于检测阴性病例;诺如病毒及轮状病毒检测阳性病例中,便常规检查分别有白细胞和红细胞的病例百分比均显著低于检测阴性病例,差异有统计学意义。结论北京市西城区成人肠道门诊就诊的腹泻患者中诺如病毒和轮状病毒感染较为普遍,腹泻多次水样便、恶心、呕吐是诺如病毒感染的常见症状;次数较多的无腹痛腹泻是轮状病毒感染的常见表现。     

Quantifying Transmission of Clostridium difficile within and outside Healthcare Settings

To quantify the effect of hospital and community-based transmission and control measures on Clostridium difficile infection (CDI), we constructed a transmission model within and between hospital, community, and long-term care-facility settings. By parameterizing the model from national databases and calibrating it to C. difficile prevalence and CDI incidence, we found that hospitalized patients with CDI transmit C. difficile at a rate 15 (95% CI 7.2–32) times that of asymptomatic patients. Long-term care facility residents transmit at a rate of 27% (95% CI 13%–51%) that of hospitalized patients, and persons in the community at a rate of 0.1% (95% CI 0.062%–0.2%) that of hospitalized patients. Despite lower transmission rates for asymptomatic carriers and community sources, these transmission routes have a substantial effect on hospital-onset CDI because of the larger reservoir of hospitalized carriers and persons in the community. Asymptomatic carriers and community sources should be accounted for when designing and evaluating control interventions.     

Community-associated methicillin-resistant Staphylococcus aureus, Minnesota, 2000-2003

We compared characteristics of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) skin and soft tissue infections (SSTIs) and CA-MRSA invasive disease identified in Minnesota from 2000 through 2003. A total of 586 patients with SSTIs and 65 patients with invasive disease were identified. Patients with invasive disease were more likely to be smokers (p = 0.03), and report a history of immunosuppressive therapy (p = 0.03), emphysema (p = 0.011), or injection drug use (p = 0.020) than were SSTI patients. Invasive disease isolates were less likely to be susceptible to ciprofloxacin (p = 0.002) and clindamycin (p = 0.001) and more likely to have healthcare-associated pulsed-field gel electrophoresis subtypes than SSTI isolates (p<0.001). Patients with invasive disease may have had healthcare exposures that put them at risk of acquiring healthcare-associated MRSA and which were not exclusion criteria in the CA-MRSA case definition. Continued surveillance of MRSA is needed to better characterize CA-MRSA infections.     

武汉市农村留守妇女生殖道感染状况分析

目的分析农村留守妇女的性传播感染与生殖道感染状况及其影响因素,为改善其生活质量提供参考依据。方法采用整群抽样的方法,随机抽取武汉市某远城区2个村的留守妇女117人为研究对象,先在流动诊所内和村医务室内开展体检和采样,随后对其进行问卷调查。问卷内容主要包括一般状况、艾滋病知识知晓情况、与配偶和非固定性伴安全套使用情况、既往性病感染及就医情况等。结果农村留守妇女采取的避孕措施以结扎为主,而使用安全套的人很少,47.44%的妇女有过流产史,其艾滋病知识知晓率较低,共检测出2例梅毒螺旋体感染病例、9例沙眼衣原体感染病例、4例滴虫感染病例、14例霉菌感染病例,配偶外出打工组的生殖道感染风险均要高于配偶未外出打工组。结论加强对农村留守妇女的艾滋病防治及安全套使用知识的宣传教育,同时在城市加强对农民工的行为干预,有助于降低农村留守妇女生殖道感染的风险。     

肿瘤内科医院肺部真菌感染69例临床分析

目的 对肿瘤内科医院肺部真菌感染的临床资料进行总结分析,以提高治疗效果.方法 回顾性分析医院2002年9月-2011年3月收治的69例肿瘤患者真菌感染的诱因、诊治及预防情况.结果 共收治肿瘤患者1623例,肿瘤合并真菌感染患者69例,总感染率为4.25％;主要发生在＞50岁患者,占89.9％;69例患者中短期接受放化疗治疗者28例,手术者14例,广谱抗菌药物应用61例,长期接受免疫抑制剂治疗者3例,接受糖皮质激素治疗者10例;自住院后出现真菌感染症状时间为9～31 d,平均时间为(12.1±5.3)d;病例中基础病为:原发性肺癌37例感染率为4.56％,转移性肺癌10例为9.34％,纵隔肿瘤2例为2.32％,食管癌14例为4.50％,其他肿瘤6例为1.94％;经单因素方差分析显示,放疗与肺部真菌感染关系密切,放化疗与单一放疗感染无差异;69例患者共检出7种菌株,治疗结果,其中2例死于真菌性肺炎,其余67例中,54例痰菌转阴,治愈38例,复发5例.结论 肿瘤内科住院患者应注重对肺部真菌感染的引发因素进行预防,必要时进行药物预防.     

Ehrlichiosis and Anaplasmosis among Transfusion and Transplant Recipients in the United States

Ehrlichiosis and anaplasmosis are emerging tickborne diseases that can also be transmitted through blood transfusions or organ transplants. Since 2000, ehrlichiosis and anaplasmosis cases in the United States have increased substantially, resulting in potential risk to transplant and transfusion recipients. We reviewed ehrlichiosis and anaplasmosis cases among blood transfusion and solid organ transplant recipients in the United States from peer-reviewed literature and Centers for Disease Control and Prevention investigations. We identified 132 cases during 1997–2020, 12 transfusion-associated cases and 120 cases in transplant recipients; 8 cases were donor-derived, and in 13 cases illness occurred <1 year after transplant. Disease in the remaining 99 cases occurred ≥1 year after transplant, suggesting donor-derived disease was unlikely. Severe illness or death were reported among 15 transfusion and transplant recipients. Clinicians should be alert for these possible infections among transfusion and transplant recipients to prevent severe complications or death by quickly treating them.     

头孢曲松治疗细菌性感染疗效观察

目的评价头孢曲松治疗细菌性感染的效果和安全性。方法以头孢曲松治疗下呼吸道感染、腹腔感染、胆道感染、尿道感染、肠道感染、软组织感染和变应性亚败血症等,给药方案为50～80mg/(kg·d),一次静滴或分两次静注,疗程3～12d。结果治疗细菌性感染总有效率80%;治疗肠道感染总有效率100%,明显高于对照组(P<0.01);不良反应率5%。结论头孢曲松治疗敏感细菌所致的下呼吸道感染、腹腔感染、胆道感染、尿道感染、肠道感染、软组织感染和变应性亚败血症等疗效确切,不良反应少见而轻微。     

人免疫缺陷病毒感染者辅助性T淋巴细胞因子变化及机会性感染的临床观察

目的观察人免疫缺陷病毒human immunodeficiency virus,HIV）感染者不同时期及其机会性感染者血清辅助性T淋巴细胞（helper T-Lymphocytes,Th）细胞因子水平的变化规律。方法正常对照组17例。研究组HIV阳性85例（A期17例,B期29例,C期39例）,其中机会性感染31例。用流式细胞仪检测血CD;T和CDs＋T细胞,用酶联免疫吸附技术（enzyme linked immunosorbent assay,ELISA）检测血清白介素-2（interleukin-2,IL-2）、1-干扰素（interferon-1,IFN-γ）、白介素-6（interleukin-6,IL-6）、白介素-10（interleukin-10,IL-10）,数据采用SPSS11．0软件进行统计。结果研究组CD4^＋T细胞（361．85±230．61）10^6／L低于对照组（772．41±161．56）10^6／L（t=6．992,P〈0．01）,IL-2（61．82±63．59）pg／ml低于对照组（111．25±66．14）pg／ml（t=2．907,P〈0．01）,研究组CD8^＋T细胞（713．36±317．59）10^6／L高于对照组（583．24±96．28）10^6／L（t=3．127,P〈0．01）、IL-10（1362．70±869．49）pg／ml高于对照组（818．54±276．22）pg／ml（t=4．704,P〈0．01）和IL-6（1883．14±1058．61）pg／ml高于对照组（1208．52±745．36）pg／ml（t=2．502,P〈0．05）。随着病程进展,IL-2逐渐下降,C期（51．72±62．28）pg／ml和B期（69．02±62．77）pg／m1分别低于对照组,而IL-6、IL-10逐渐上升,C期的IL-6（2040．27±1078．95）pg／ml、IL-10（1472．10±982．03）pg／ml均高于对照组;B期的IL-10（1347．35±780．95）pg／ml高于对照组（818．54±276．22）pg／ml。机会性感染组IL-6（2236．24±1052．42）pg／ml高于无机会性感染组（1680．43±1017．05）pg／ml（t=2．395,P〈0．05）。结论HIV感染者应动态检测血清IL-2、IL-6、IL-10的变化,同时可考虑上调IL-2和下调IL-6、IL-10,调整机体TH1／TI-L2细胞的平衡,以延缓疾病进展。     

Emergent strain of human adenovirus endemic in Iowa

We evaluated 76 adenovirus type 7 (Ad7) isolates collected in Iowa from 1992 to 2002 and found that genome type Ad7d2 became increasingly prevalent. By 2002, it had supplanted all other Ad7 genome types. The association of Ad7d2 with severe illness and death calls for heightened public health concern.     

北京地区不同人群柯萨奇病毒A16型和肠道病毒71型感染状况调查

目的 了解北京地区不同人群柯萨奇病毒A16型（coxsachievirus A16,CoxA16）和肠道病毒71型（enterovirus 71,EV71）感染状况。方法 2012年对北京9区进行整群随机抽样,采集血样,开展血清流行病学调查。用酶联免疫吸附实验检测血清中抗CoxA16和抗EV71 免疫球蛋白G（immunoglobulin G,IgG）和免疫球蛋白M（immunoglobulin M,IgM）抗体。结果 2 140名被研究人群中,抗EV71 IgG和IgM阳性率分别为27.0%和1.6%,抗CoxA16 IgG和IgM的阳性率分别为48.5%和4.2%,抗EV71 IgM与抗CoxA16 IgM同时阳性阳性率为0.7%,抗EV71 IgG与抗CoxA16 IgG同时阳性阳性率为17.2%。各年龄组抗EV71 IgM、IgG阳性率、抗CoxA16 IgM、IgG阳性率、抗EV71 IgM 和抗CoxA16 IgM同时阳性的阳性率、抗EV71 IgG和抗CoxA16 IgG同时阳性阳性率差异均有统计学意义（均有P<0.05）。1～岁组抗EV71 IgM阳性率最高,5～岁组抗CoxA16 IgM阳性率最高,10～岁组抗EV71IgG 和20～岁组抗CoxA16 IgG阳性率最高。女性抗CoxA16 IgG阳性率高于男性。结论 低龄组儿童是手足口病防控的重点人群,手足口病防控措施制定应考虑地域分布因素。     

Short antibiotic prophylaxis for bacterial infections in a neonatal intensive care unit: a randomized controlled trial

We compared the effectiveness of a single dose and a three-day course of antibiotic prophylaxis in preventing bacterial infections in high-risk neonates. The study was a prospective, randomized controlled trial conducted in a 20-bed tertiary referral neonatal intensive care unit (NICU). A series of 130 neonates admitted consecutively to the NICU, fulfilling risk factors for infection, were assigned at random to receive intravenous antibiotic prophylaxis with ampicillin and netilmicin either in two daily doses for 72 h (three-day-administration group, 67 infants) or in a single bolus injection on admission (bolus group, 63 infants). Hospital-acquired infection, the main outcome measure, was defined as infection that developed at least 48 h after admission, and vertical infection (maternally transmitted) was considered to be present when clinical symptoms and abnormal laboratory findings became evident within 48 h of birth. Infections were considered as suspected when clinical and laboratory findings of infection were present, without positive cultures, and as confirmed when positive cultures were also present. No significant differences were found between the two groups of neonates studied in mean birth weight, gestational age or postnatal age on admission. The incidence of vertical infection was similar in the two groups (16/67, 23.9% vs. 14/63, 22.2%). Of the 130 newborns studied, 29 (22.3%) acquired at least one nosocomial infection during their NICU stay; total hospital-acquired infections, calculated as the incidence density of infection (the number of infective episodes divided by the number of days in the NICU), were less frequent among newborns who received the three-day course than the bolus (relative risk 0.69). This difference, although not statistically significant, depended on the different incidence density of confirmed nosocomial infections rather than on suspected infections (relative risk 0.59; 95% confidence interval 0.32-1.09; P=0.1). There were no significant differences between the two groups in overall mortality. A single bolus administration on admission is therefore likely to be as effective as a three-day course of antibiotic prophylaxis in preventing bacterial infection in high-risk infants admitted to an NICU.     

南通市某医院院内感染情况分析

对某三级医院三年半时间中所有出院病人院内感染的发生情况进行调查, 结果显示该院总的院内感染率为5.63% 。通过对院内感染情况进行了调查比较, 分析院内感染可能发生的原因, 提出了控制院内感染发生的方法措施