Krankenhausinfektionen

Nosocomial infections (NI) are dependent on risk factors related to the patient himself and to further conditions during his treatment. Based on different data 30,000 death result from 1.3 Mio NI which ca be calculated for Germany. NI are both one of the greatest problems for health care policy and for the society as a whole.     

Fatal disseminated Trichosporon asahii fungemia in a child with acute lymphoblastic leukemia and a morbilliform eruption

Trichosporonosis is a rare, life‐threatening, opportunistic fungal infection that affects immunocompromised individuals with neutropenia, particularly those with underlying hematologic malignancies. We present the case of a 10‐year‐old boy with acute lymphoblastic leukemia who developed a diffuse, morbilliform eruption in the setting of fever and pancytopenia. He was found to have Trichosporon asahii fungemia with widespread visceral dissemination, and his condition rapidly deteriorated despite treatment. It is important to consider trichosporonosis in the evaluation of a critically ill individual with neutropena and a rash, because the initial cutaneous presentation may appear benign and delayed therapy results in death.     

Identification of a methicillin-resistant Staphylococcus aureus inhibitory compound isolated from Serratia marcescens

In this study, we identified an antimicrobial compound produced by the Gram-negative bacterium Serratia marcescens. Colonies of S. marcescens inhibited the growth of nine different methicillin-resistant Staphylococcus aureus (MRSA) isolates and several other tested Gram-positive bacterial species, but not Gram-negative bacteria. Genetic analysis revealed the requirement for the swrW gene which codes for a non-ribosomal peptide synthetase that generates the cyclodepsipeptide antibiotic serratamolide, also known as serrawettin W1. This is the first report describing the anti-MRSA properties of serratamolide.     

2017—2019年浙江省温州市经性传播感染的HIV/AIDS感染来源及特征分析

目的 分析2017—2019年浙江省温州市经性传播感染的HIV/AIDS感染来源和特征,为艾滋病综合防治措施的调整提供依据。 方法 以2017—2019年温州市鹿城区和永嘉县新发现的经性传播感染的HIV/AIDS为研究对象,调查收集其人口学、性行为、流动情况等信息,并采血检测首次CD4⁺T淋巴细胞计数,运用Epi Data 3.1和SAS大学版软件进行数据整理和统计分析。 结果 342名调查对象以男性、25～59岁年龄段为主,未婚、初中及以下文化程度、外地迁入者居多。经感染来源判定,新感染比例为22.42%,本地感染比例为71.00%。15~24岁以下年龄组、未婚病例新感染比例高,分别为33.33%和31.54%;60岁及以上年龄组、教师/干部/退休等职业、大专及以上文化程度病例本地感染比例高,分别为94.74%、87.80%和81.43%;新感染病例曾发生非商业临时异性性行为、固定性伴同性性行为的比例分别为60.87%和39.53%,高于既往感染病例(χ²=3.967,P=0.047;χ²=4.314,P=0.038);本地感染病例曾发生非商业临时同性性行为比例为98.26%,高于外地感染病例(P=0.036)。 结论 2017—2019年温州市经性传播感染的HIV/AIDS以既往感染和本地感染为主,青年、老年及高知人群不容忽视,应加强对非商业临时性行为的干预。     

Clinical significance of variations in levels of Epstein-Barr Virus (EBV) antigen and adaptive immune response during chronic active EBV infection in children

Abstract

Pediatric patients were recruited to analyze differences in Epstein-Barr virus (EBV) copy numbers and adaptive immune reactions in children with chronic active vs acute EBV infection (CAEBVI vs AEBVI), as well as to examine the relationship between these parameters and the pathogenesis of CAEBVI. Fluorescent qPCR was used to assess EBV-DNA levels, while ELISA, antibody affinity, flow cytometry, and heterophil agglutination (HA) assays were used to evaluate patient EBV-adaptive humoral and cellular immunity. Lastly, ELISPOT was employed to assess interferon (IFN)-γ secretory functions of EBV-specific cytotoxic T-lymphocytes (CTL) as a marker of subject EBV-specific adaptive cellular immunity. The results indicated that, compared with AEBVI patients or normal children, there was a dramatic elevation in viral copy levels, viral capsid antigen (VCA)-IgA, early antigen (EA)-IgA, and EA-IgG, but a lack of EBV nuclear antigen (EBNA)-IgG and a negative HA in CAEBVI patients (p?<?0.01). These subjects also had decreased CD4⁺, CD8⁺ (naïve), CD8⁺CD38⁺, and effective memory T-lymphocyte levels compared with AEBVI patients (p?<?0.01), and decreased EBV-specific CTL function compared with normal children (p?<?0.01). These results suggest that there is a disturbance in EBV antigen availability and in both the adaptive humoral and cellular immune responses in patients with CAEBVI, and that these outcomes may be associated with the chronic active re-infection process itself associated with CAEBVI.     

Leukocyte Esterase Versus ICM 2018 Criteria in the Diagnosis of Periprosthetic Joint Infection

BackgroundA leukocyte esterase (LE) test is inexpensive and provides real-time information about patients suspected of periprosthetic joint infections (PJIs). The 2018 International Consensus Meeting (ICM) recommends it as a diagnostic tool with a 2+ cutoff. There is still a lack of data revealing LE utility versus the ICM 2018 criteria for PJI.MethodsThis is a retrospective study of patients who underwent revision total hip and total knee arthroplasty at a single institution between March 2009 and December 2019. All patients underwent joint aspiration before the arthrotomy, and the LE strip test was performed on aspirated joint fluid. PJI was defined using the 2018 ICM criteria.ResultsAs per the 2018 ICM criteria, 78 patients were diagnosed with chronic PJI and 181 were not infected. An LE test with a cutoff of $\ge$1+ had a sensitivity of 0.744, a specificity of 0.906, a positive predictive value of 0.773, an accuracy of 0.825 (95% confidence interval 0.772-0.878), and a negative predictive value of 0.891. The positive likelihood ratio (LR+) was 7.917. Using an LE cutoff of 2 + had a sensitivity of 0.513, a specificity of 1.000, and an accuracy of 0.756 (95% confidence interval—0.812).ConclusionLE is a rapid and inexpensive test which can be performed at the bedside. Its performance is valuable as per ICM criteria. Based on the findings of this study and the given cohort, we suggest using the cutoff of LE1+ (result = negative or trace) as a point of care test to exclude infection, whereas LE at 2 + threshold has near absolute specificity for the diagnosis.     

Primary cutaneous aspergillosis at the site of cyanoacrylate skin adhesive in a neonate

Primary cutaneous aspergillosis is a rare but potentially life‐threatening disease. We present the case of a premature infant who developed primary cutaneous aspergillosis with Aspergillus niger at the site of a skin abrasion that had been treated with a purple‐colored cyanoacrylate product. The infection was treated successfully with gentle debridement of the cyanoacrylate product, followed by intravenous voriconazole and topical fluconazole. To our knowledge, this is the first reported case of primary cutaneous aspergillosis occurring at the site of cyanoacrylate‐based skin adhesive.     

小儿反复呼吸道感染危险因素分析

目的:探讨小儿反复呼吸道感染(RRTI)的危险因素,为降低儿童RRTI患病率制定相应的预防措施。方法:采用成组设计的病例对照研究方法,对RRTI病例及健康小儿各101例进行问卷调查,采用原子吸收法检测血微量元素(血锌、铜、铁、钙、镁)及血铅水平,采用免疫透射比浊法测定IgM、IgA、IgG、补体C3、补体C4的含量。应用Logistic回归模型控制混杂因素干扰。结果:儿童期不偏食、血锌为保护性因素。血铅含量偏高、主要看护人不是自己父母、户外活动时间短、既往佝偻病史为RRTI的可能危险因素。结论:运用科学的营养方式,杜绝偏食,坚持体育锻炼及户外活动,父母多看护儿女,定期检测微量元素,必要时补充锌或驱铅治疗,提高机体抵抗力,将会减少RRTI发生率。