Prevalence of nosocomial infections and use of antibiotics in long-term care facilities in Norway, 2002 and 2003

There were 42900 institution-beds in long-term care facilities for elderly persons in Norway in 2000. This is twice as many as in 1984. Of those living in an elderly people's care institution 77% were above 80 years. To determine the magnitude and distribution of nosocomial infections in such institutions, the Norwegian Institute of Public Health initiated a surveillance system. The system is based on two annual one-day prevalence surveys recording the four most common nosocomial infections: urinary tract infections, lower respiratory tract infections, surgical-site infections and skin infections, as well as antibiotic use. All long-term care facilities were invited to participate in the four surveys in 2002 and 2003. The total prevalence of the four recorded nosocomial infections varied between 6.6 and 7.3% in the four surveys. Nosocomial infections occurred most frequently in the urinary tract (50%), followed by infections of the skin (25%), of the lower respiratory tract (19%) and of surgical sites (5%). The prevalence of nosocomial infections was highest in rehabilitation and short-term wards, whereas the lowest prevalence was found in special units for persons with dementia. In all the surveys the prevalence of the four recorded nosocomial infections was higher than the prevalence of patients receiving antibiotics. The frequency of nosocomial infections in such facilities highlights the need for nosocomial infection surveillance in this population and a need to implement infection control measures, such as infection control programmes including surveillance of nosocomial infections.     

Tuberculosis among healthcare workers in a tertiary-care hospital in South India

It is possible that tuberculosis is transmitted from patients to healthcare workers (HCWs). However, there are few data on this from developing countries. The object of this study was to document the incidence of tuberculosis among HCWs in the Christian Medical College (CMC), Vellore, India during a 10-year period (January 1992-December 2001). Data were collected from records maintained in the staff and students health services of CMC. A total of 125 cases were diagnosed during the period of study. The overall incidence of sputum positive cases was similar to that observed in the general population, during most years. However, it appears that focal outbreaks occur with transmission between HCWs. The chance of developing extra-pulmonary tuberculosis was higher in HCWs compared with the general population.     

Lenticulostriate echogenic vessels: clinical and sonographic study of 70 neonatal cases

Background Neonatal branching echogenic streaks in the basal ganglia or 'lenticulostriate vasculopathy' (LSV) has no clear comprehensive aetiology.Objective To provide some clinical evidence, possibly relevant to aetiology, by analysis of a large series.Materials and methods Seventy cases (9 deaths, 3 post mortem) identified between 1981 and 2000 out of 9,138 neonates with routine brain sonograms (578 in a protocol for neonates from HIV+ mothers). Review of maternal/neonatal charts for clinical data and serologic status. Retrospective analysis of sonograms for grading and time course of LSV and coexistent abnormalities.Results LSV was unilateral in 31 cases (22 right), bilateral in 39. Grading separated 8 major, 27 moderate and 35 minor patterns. In 42 cases, LSV was isolated, and in 28 it was mixed with peri-intraventricular haemorrhage grades I or II and/or leucomalacia. LSV was detected in the first postnatal week in 56 instances and appeared later in 13. Disappearance occurred mostly within 2 months. Perinatal circumstances: 13 recipient monochorionic twins (polycythaemia from twin-twin transfusion syndromes), 20 HIV+ mothers (possible immunological disturbances; only 2 infected neonates), 10 congenital anomalies, 1 toxoplasmosis, 1 postnatal cytomegalovirus infection, 25 miscellaneous conditions. Numerous maternal and neonatal factors were non-contributory.Conclusions These results do not support congenital toxoplasmosis, rubella, cytomegalovirus, and herpes (TORCH) infections as the main causative factor. Polycythaemia and various immunological disturbances may be involved, as well as infectious agents not appropriately screened by routine serodiagnoses.     

Effect of maternal antibiotic treatment on fetal periventricular white matter cell death in a rabbit intrauterine infection model

Aim: To evaluate the effects of maternal antibiotic treatment on fetal brain cell death in a rabbit intrauterine infection model. Methods: After Escherichia coli uterine-horn inoculation in 22 pregnant rabbits, followed at various times by ceftriaxone and caesarean section, cell death in white matter (histology and fragmented DNA staining) from fetuses killed at extraction was compared across groups using the Mantel-Haenszel test and Fisher's exact test for small numbers. Results: White matter cell death was consistently present at 48 h, with ceftriaxone initiation at 24 h (group 1), detectable at 84 but not 60 h, with ceftriaxone initiation at 12 h, and significantly reduced at 84 h with ceftriaxone initiation at 6 h (60% vs 100% in group 1, p 3 0.001, Fisher's exact test). Conclusion: Early maternal antibiotic therapy delays white matter cell death in rabbit fetuses exposed to intrauterine infection. This may provide a window for preventing white matter damage.     

Passive avoidance response in mice infected with Schistosoma mansoni

Schistosomiasis is a parasitic disease of humans and rodents affecting more than 200 million people worldwide. Following the onset of infection, the worms induce granulomas around schistosome eggs in the liver, intestine and central nervous system (both brain and spinal cord), which are likely to cause changes in cognitive functions. In the present study, CD-1 female mice were percutaneously infected with 60 cercariae of Schistosoma mansoni and the effect on the mice's cognitive abilities were assessed by using the passive avoidance learning paradigm both in an early and a late phase of infection (independent groups). The results of the study show that infected animals without brain granulomas (early phase) had impairments in their passive avoidance response, whereas mice with brain granulomas (late phase) behaved as uninfected ones. Moreover, a decreased propensity to start exploration was observed in mice with granulomas in the brain. The results suggest that the murine model of infection may be a useful tool for studying human neuroschistosomiasis.     

急性坏死性胰腺炎合并念珠菌感染

目的 探讨急性坏死性胰腺炎(ANP)合并念珠菌感染的诊治方法。方法 回顾分析78例ANP患者的临床资料,诊断由手术发现或cT检查确定,其中62例接受预防性抗生素治疗,16例未接受。每例均行血、尿、便、痰和创口引流液的培养和涂片镜检,检出念珠菌。结果78例ANP中共有14例发生念珠菌感染,发病率17．9％,死亡4例,死亡率28．6％;使用预防性抗生素组发病率19．4％,死亡率25．0％;未用预防性抗生素组的发病率12．5％,死亡率50．0％。结论 资料证明ANP合并念珠菌感染是一个值得重视的临床问题,预防性使用抗生素治疗ANP可预防严重继发性感染的发牛．但也同时会合并念珠菌感染。     

Positive culture in allograft ACL-reconstruction: what to do?

The transmission of disease or infection from the donor to the recipient is always a risk with the use of allografts. We carried out a research study on the behavioural pattern of implanted allografts, which were initially stored in perfect conditions (all cultures being negative) but later presented positive cultures at the implantation stage. Because there is no information available on how to deal with this type of situation, our aim was to set guidelines on the course of action which would be required in such a case. We conducted a retrospective study of 181 patients who underwent an ACL reconstruction using BPTB allografts. All previous bone and blood cultures and tests for hepatitis B and C, syphilis and HIV were negative. An allograft sample was taken for culture in the operating theatre just before its implantation. The results of the cultures were obtained 3–5 days after the operation. We had 24 allografts with positive culture (13.25%) after the implantation with no clinical infection in any of these patients. Positive cultures could be caused by undetected contamination while harvesting, storing or during manipulation before implantation. The lack of clinical signs of infection during the follow-up of our patients may indicate that no specific treatment—other than an antibiotic protocol—would be required when facing a case of positive culture of a graft piece after its implantation.     

某镇工矿企业从业人员HBV感染状况分析

了解工矿企业从业人员 HBV感染状况及其乙肝 5项血清学标志物模式 ,对受检者进行 AL T和 HBs Ag检测 ,HBs Ag阳性者或阴性者均进一步做两对半检测。结果显示 HBs Ag阳性率低于全国平均水平 ,HBs Ag阳性率男性明显高于女性 (P<0 .0 1) ,感染模式以“小三阳”为主 ,“大三阳”居次     

Imaging in pancreatic infection

The most common cause of infection involving the pancreas is complicated pancreatitis. Infected necrosis, pancreatic abscess, and infection of pancreatic pseudocysts are seen. Diagnostic imaging, in particular, contrast-enhanced computed tomography, plays a large role in the identification of the complications seen in acute pancreatitis. The imaging findings of the infectious complications of pancreatitis is reviewed. Diagnostic imaging also plays a role in the diagnosis of infected necrosis and in the percutaneous management of pancreatic abscesses and pseudocysts. The imaging findings of pancreatic necrosis are usually not sensitive to the presence of co-existent infection. Image-guided needle aspiration of the necrotic pancreas can be crucial in the diagnosis of infected necrosis. Image-guided placement of percutaneous drainage catheters is a nonsurgical alternative for the management of pancreatic abscesses and pseudocysts. Image-guided catheter placement and the management of these catheters is discussed.