Nosocomial pneumonia

A unique, symmetrical onychodystrophy is described in 18 dogs. A rather sudden onset of onychomadesis is followed by chronic onychodystrophy affecting all claws. Pain and lameness are recognized in half of the patients, but the dogs are healthy otherwise. Histopathologically, this disorder is characterized by hydropic and lichenoid interface dermatitis. Nine dogs were treated with a commercial, fatty-acid supplement and had good-to-excellent responses. Due to the clinicopathological characteristics of this disorder, the authors propose the name "symmetrical lupoid onychodystrophy."     

Nosocomial zoonoses

There is a significant lack of knowledge in relation to the identification and management of infected wounds. More attention should be given in nurse education to knowing when and how to obtain would swabs. Wound swabbing practices should be standardised.     

Nosocomial ornithosis

Ornithosis is an occupational hazard to workers in the poultry industry, zoonosis. Own sporadic unusual case is appearing under the hospital circumstances as a nosocomial atypical pneumonia.     

Nosocomial parotitis

A total of 22 cases of acute suppurative parotitis are reviewed. The causative factors were severe primary disease with salivary gland hyposecretion related to age (77 years), dehydration, oral inactivity and drugs (19 patients). The oral hygiene was poor and permitted ascending canalicular invasion of resistant staphylococci. The mortality was 27%. The treatment, including preferably cloxacilline and incision, is discussed. To stress the importance of prophylaxis the name "nosocomial parotitis" is suggested.     

Nosocomial infections in hand surgery

The active and experienced hand surgeon should have enough knowledge to recognize both common and uncommon hand infections. Control of hospital-acquired infections, including surgical site infections, requires a knowledge of potential personal risk factors and ongoing surveillance systems to aid in prevention and early detection. Current national trends may soon require that surgical-site infections be diagnosed by specific criteria that will allow comparisons of data from various locations. Although most hand surgery procedures are now performed on an ambulatory basis, it is important for the hand surgeon to be aware of current methodologies for the prevention, control, surveillance, and treatment of hospital-acquired infections. These intriguing aspects of hospital-acquired infections are reviewed in this article.     

Nosocomial transmission of opportunistic infections

Immunocompromised patients are at high risk for opportunistic infections. Traditionally, these infections were thought to arise from endogenous reactivation of previously acquired latent infections, and nosocomial transmission therefore was deemed to be so unlikely that no special infection control interventions were needed to prevent transmission in healthcare settings. However, new data have challenged this view and suggest that some opportunistic pathogens are transmissible from one immunosuppressed patient to another. Epidemiological investigations, molecular genotyping, animal studies, and air-sampling experiments lend support to the hypothesis that reinfection with opportunistic pathogens does occur, that airborne transmission is possible, and that nosocomial spread is a plausible explanation for case clusters. Taken together, these observations support the view that some opportunistic infections are exogenous in origin and that additional epidemiological investigations are needed to define the true risk of nosocomial spread and need for isolation.     

Nosocomial infection in Auckland Healthcare hospitals

AIM: To determine the prevalence of nosocomial infection in Auckland Healthcare hospitals. BACKGROUND: Nosocomial infections cause patient morbidity and prolong hospital stay. Reporting surveillance results to staff has been shown to reduce nosocomial infection rates. METHOD: Point prevalence study for all patients in Auckland, Green Lane and National Women's hospitals. Standard definitions for nosocomial infections were used. RESULTS: One hundred and ten (12%) of 932 patients had 129 nosocomial infections: 27 (20%) surgical site infections; 25 (19%) lower respiratory tract infections; 23 (18%) skin/ soft tissue infections; 19 (15%) urinary tract infections; 14 (11%) bloodstream infections; and 21 (17%) other infections. Predominant organisms were: Staphylococcus aureus (29%), Escherichia coli (21%), other gram negative bacilli (14%), Pseudomonas aeruginosa (6%), streptococci (6%) and Candida albicans (6%). The prevalence of nosocomial infection was lower in National Women's Hospital (5%) than either Green Lane or Auckland hospitals (15% and 14% respectively), p < 0.01. The prevalence of nosocomial infection was the same in medical and surgical patients, 53 of 394 (14%) and 42 of 297 (14%), respectively. The highest prevalence was in intensive care unit patients, 7 of 31 (23%). The prevalence of nosocomial infection increased with patient age, 17-50 yr (8%) vs > 50 yr (14%), p < 0.01, and duration of hospitalisation 2% for < 2 days, 6% for 2-7 days vs 22% for > 7 days, p < 0.01. Risk factors for nosocomial infection were present in many patients: 339 (36%) had intravenous catheters in place; 268 (29%) patients had undergone surgery during their current admission; 122 (13%) had urinary catheters in place; and 122 (13%) had other invasive devices in situ. CONCLUSION: Our results are comparable with hospitals of similar size overseas. This study provides a base line for future studies which will enable the monitoring of trends over time and the impact of focused infection control initiatives.     

Postoperative pneumonia

Thoracic surgical patients are susceptible to pneumonia because of impaired systemic and lung host defenses. The incidence of pneumonia is higher with more extensive lung resections. Current prophylactic antibiotic therapy is based primarily on general surgical experience with emphasis on wound infection, not pneumonia. With expansion of indications for lung resection to include higher risk patients, there is a need to render antibiotic prophylaxis more specific to bacteria causative of pneumonia.     

Community-acquired pneumonia

Within the scope of producing cartilage tissue in a three-dimensional culture design, the stability of the used delivery substance in-vitro tissue product has to be improved. For this, carrier materials consisting of bioresorbable polymers, e. g. poly(L[+]-lactic acid) and poly(glycolic acid) can be used. In respect of the biocompatibility of these polymers, the effect of degradation products on chondrocytes is of major interest. The available biomaterials were tested on chondrocytes in form of their monomers, glycolic acid and L(+)-lactic acid. Effects in regard of cell activity were determined with the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazoliumbromide( MTT)test. A non-pH-effect was examined by buffering with concentrated NaOH. In a short-term testing with increasing monomer concentrations as well as in a test over a twelve-day period, L(+)-lactic acid proved to have a lower cytotoxic effect on chondrocytes than glycolic acid. Similar results were obtained with buffered culture media. Therefore, poly(L[+]-lactic acid) can be recommended for the development of chondrocytes-polymer constructs for in-vitro engineering of cartilage tissue.     

Community-acquired pneumonia

Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality in all age groups, especially the elderly, which is a patient population that continues to grow. Recently the spectrum and clinical picture of pneumonia has been changing as a reflection of this aging population; this requires a reassessment of and a new approach to the patient with pneumonia. Currently, pneumonia patients are classified as having either community-acquired or hospital-acquired infection rather than typical versus atypical. Patients who have CAP are categorized by age, presence of a coexisting medical illness, and the severity of the pneumonia. The rationale behind categorizing patients is to stratify them in terms of mortality risk to help determine the location of therapy (e.g., outpatient, inpatient, intensive care unit) and focus the choice of initial antimicrobial therapy. Once the decision to hospitalize a patient with pneumonia is made, the next step is to decide on an appropriate diagnostic evaluation and antibiotic therapy. Both decisions have evolved over the last several years since the publication of the American Thoracic Society's CAP guidelines. The current approach to the diagnostic work-up of pneumonia stresses a limited role of diagnostic tests and procedures. The antimicrobial regimen has now evolved into one that is empiric in nature and based on the age of the patient, the presence of coexisting medical disease, and the overall severity of the pneumonia. This process is a dynamic once because bacterial resistance to commonly used antibiotics can further complicate the course of pneumonia therapy, but the impact of resistance on outcome is less clear. Resistance of Streptococcus pneumoniae to penicillin is a prime example of this growing problem, and adjustment to pneumonia therapy may be required. A difficult but not uncommon problem in pneumonia patients is slow recovery and delayed resolution of radiographic infiltrates. Factors that impact negatively on pneumonia resolution include advanced age and the presence of serious comorbid illnesses such as diabetes mellitus, renal disease, or chronic obstructive pulmonary disease. In addition, certain organism factors (e.g., intrinsic virulence) may interact with host factors and advanced age to delay pneumonia resolution. For example, 50% of patients with pneumococcal pneumonia have radiographic clearing at 5 weeks, and the majority clear within 2 to 3 months. Recent data demonstrate that radiographic resolution of CAP is most influenced by the number of lobes involved and the age of the patient. Radiographic clearance of CAP decreases by 20% per decade after age 20, and patients with multilobar infiltrates take longer to clear than those with unilobar disease. In general, when approaching slowly resolving infiltrates after pneumonia, bronchoscopic evaluation and lung biopsy are more likely to yield a specific diagnosis if the patient is a nonsmoker younger than 55 years old with multilobar disease. If the patients has either no identifiable factors associated with prolonged pneumonia resolution or the repeat chest radiograph at 1 month shows no appreciable change, further diagnostic testing is indicated. The route and duration of antibiotic therapy, another detail of the management of CAP patients that has changed recently, is complicated by the fact that the majority of patients with CAP have no pathogen identified. Therefore, in most instances the physician initiates empiric antibiotics on the basis of epidemiologic data. If an etiologic pathogen is identified (either initially or at a later time), then the antibiotic spectrum can be narrowed. When no pathogen is discovered, broad-spectrum empiric antibiotics are continued. (ABSTRACT TRUNCATED)     

Community-acquired pneumonia

This seminar reviews the aetiology, clinical presentation, approach to diagnosis, and management of immunocompetent adults with community-acquired pneumonia (CAP). Pneumonia is a common clinical entity, particularly among the elderly. A thorough understanding of the epidemiology and microbiology of CAP is essential for appropriate diagnosis and management. Although the microbiology of CAP has remained relatively stable over the last decade, there is new information on the incidence of atypical pathogens, particularly in patients not admitted to hospital, and new information on the incidence of pathogens in cases of severe CAP and in CAP in the elderly. Recent studies have provided new data on risk factors for mortality in CAP, which can assist the clinician in decisions about the need for hospital admission. The emergence of antimicrobial resistance in Streptococcus pneumoniae, the organism responsible for most cases of CAP, has greatly affected the approach to therapy, especially in those patients who are treated empirically. Guidelines for the therapy of CAP have been published by the American Thoracic Society, the British Thoracic Society, and, most recently, the Infectious Diseases Society of America. These guidelines differ in their emphasis on empirical versus pathogenic-specific management.