Molecular genetics of mating recognition in basidiomycete fungi

Patients with critical illnesses requiring aggressive medical intervention are at risk of acquiring serious nosocomial infection that may lead to increases in medical expenditures, morbidity, and mortality. Infection control in this population entails continuous surveillance for hospital-acquired infection, with investigation of outbreaks. Policies for effective antibiotic utilization, disinfection of medical devices and hospital environment, and patient isolation may limit nosocomial infection in this population. Finally, an effective infection control program should protect the health care worker from hospital-acquired infections through educational programs, routine health surveillance, vaccinations, and post-exposure care.     

Hospital-acquired pneumonia: perspectives for the healthcare epidemiologist

Nosocomial pneumonia is defined as an infection of lung parenchyma that was neither present nor incubating at the time of the patient's admission to the hospital. In the United States, hospital-acquired pneumonia is the second most common nosocomial infection and accounts for the most deaths from nosocomial infection. We describe how infection control personnel can use targeted surveillance to identify clusters of cases and to prevent pneumonia. We also discuss common pathogens that cause nosocomial pneumonia; ventilator-associated pneumonia; and strategies for prevention of hospital-acquired pneumonia.     

Atypical hand infections

The diagnosis and treatment of an atypical hand infection present a distinctive challenge for the hand surgeon. Infections caused by these uncommon organisms occur more often in immunocompromised patients. This article emphasizes the salient features of mycobacterial, nocardial, and fungal infections of the hand. With an accurate and timely diagnosis, appropriate surgical and pharmacologic treatment may eradicate these unusual infections.     

Effect of cytokines on anticryptococcal activity of human microglial cells

Since blood is a biologic product, it is unlikely that the risk for transfusion-transmitted infection will ever be reduced to zero. The approach to emerging infections associated with transfusion of blood and blood products includes assessing the transmissibility of the agent by this route; developing effective prevention strategies, including screening tests and donor deferral policies; improving viral and bacterial inactivation procedures; and surveillance for known, as well as emerging and poorly characterized, transfusion-transmitted agents. Vigilance is needed to help ensure proper balance between safety and the availability of blood. Finally, vigilance needs to extend to the developing world, where the basic elements to reduce transfusion-transmitted infections and systems of disease surveillance are often not available.     

Evidence-based practice in pressure sore reduction

A two-year project at Chase Farm Hospitals NHS Trust to promote evidence-based practice in pressure sore prevention resulted in a steady reduction in the number of hospital-acquired pressure sores. The pooling of resources by a wide variety of staff with a diverse range of knowledge and experience resulted in a truly multiprofessional project. The knowledge that working together to implement change can succeed strengthens the chances of success in future work and has brought direct benefits to patient care.     

The history of hand infections

The current approach to hand infections is a culmination of information gained from centuries of medical teaching by the ancient Greeks, nineteenth-century anatomists, and twentieth-century microbiologists and surgeons. Although many individuals have contributed to our knowledge through their teachings and writings, the contemporary treatment of hand infections has evolved quite rapidly. Several landmark scientific discoveries have drastically changed not only the manner in which hand infections are treated, but the ultimate clinical results obtained. This brief review of the history of hand infections highlights the major contributions that have influenced the contemporary medical and surgical approach to infections of the hand.     

Quantifying changes in retinal circulation: the generation of parametric images from fluorescein angiograms

Critical care unit patients show a higher risk of developing a bloodstream infection than ward patients. The urinary tract is the main source of hospital-acquired secondary bloodstream infection. Nosocomial urinary tract infection is promoted by bladder catheterization in the vast majority of cases. Aerobic gram-negative bacilli are the prevalent agents of bloodstream infection secondary to a nosocomial urinary tract infection. Sepsis and septic shock are severe complications of these infections in the critical care patient. Management of patients with a septic process of urinary source calls for the combination of adequate life-supporting care, an appropriate antibiotic therapy, and innovative adjunctive measures. Accurate catheter care is the best measure to adopt for the prevention of urosepsis.     

Hospital-acquired infection in elderly patients

Increasing numbers of elderly people are being treated in hospitals and are at particular risk of acquiring infections. The incidence, risk factors and types of hospital-acquired infection (HAI) in the elderly are reviewed. Special reference is made to urinary tract infections, respiratory tract infections, gastrointestinal infections including Clostridium difficile, bacteraemia, skin and soft tissue infections and infections with antibiotic-resistant organisms.     

Hospital-acquired pneumonia: epidemiology, etiology, and treatment

Despite improvements in diagnosis, treatment, and prevention, hospital-acquired pneumonia (HAP) remains the number one cause of nosocomial mortality. This article reviews the current knowledge regarding the incidence, epidemiology, and causes of HAP, with the appreciation that the available information is incomplete and that controversies are common, and thus the authors provide a rational approach to the initial management of HAP in immunocompetent adults. A discussion of therapy and what to do with patients who do not respond to the empiric therapy are included. The American Thoracic Society (ATS) statement on HAP has served as a foundation for this review but has been supplemented by newer literature that was not available when the ATS statement was developed.     

Open antireflux surgery]

A prospective study was conducted following 1364 major operations at the 450-bed Hungvuong Obstetric and Gynaecological Hospital in HoChiMinh City, Vietnam, from 1 May to 30 September 1997 to characterize postoperative hospital-acquired infections. These infections were identified by ward rounds, review of laboratory results and patient follow-up until 30 days after discharge. During the study period, 194 infections were identified, yielding a rate of 14.2 infections per 100 operations. The most common sites were surgical wound and urinary tract, contributing together 95.9% of all hospital-acquired infections. The four most common pathogens were Staphylococcus aureus (29.6%), Escherichia coli (20.4%), Enterococci (16.7%) and Staphylococcus epidermidis (14.8%).     

Acute blood pressure elevations with caffeine in men with borderline systemic hypertension

It has been shown that the problem of nosocomial infections is different in each specialist hospital division, and it is important to be aware of the local situation and to identify the specific problems. In order to set up an effective prevention programme and in the setting of a general system of control of nosocomial infection, we studied the incidence of infections and correlated the pathogenic organisms appearing during hospitalization in patients admitted to our Pneumology Division and Intermediate Intensive Care Unit over a period of 12 months. A nosocomial infections incidence of 13% was observed and 75% of these were respiratory, 21% urinary and 4% other infections. Seventy two percent of pathogenic agents were Gram-negative bacilli and 28% Gram-positive cocci. The site-specific rates of infections observed are related to intrinsic (host dependent) and extrinsic (non-host-dependent) risk factors that have not been exhaustively evaluated in the present study. However, the data so far collected will allow us to redirect the resources used in the control of nosocomial infections by targeting efforts at the surveillance of better defined groups of patients and by achieving data more suitable for comparisons between hospitals.     

Impending malunions of the hand. Treatment of subacute, malaligned fractures

Malunions of the hand present a challenging problem to the orthopaedic surgeon. Angular and rotational deformities, and shortening and articular incongruity, can lead to significant functional impairment or dysesthetic appearance. The prevention of malunion should remain a primary goal. When displaced fractures of the metacarpals or phalanges present within the first or second weeks, properly performed closed or open reduction with percutaneous pinning or internal fixation are excellent options with predictable results. Malaligned fractures that present later frequently cannot be readily reduced. Once fully united, treatment options have included corrective osteotomy if function is significantly impaired or if appearance is objectionable; for patients who are not suitable for surgery for medical or other reasons, or for whom appearance is acceptable, intensive occupational therapy to maximize function may yield sufficiently serviceable clinical results. During the past several years, the senior author (BL) has chosen to be more proactive in the prevention of malunions of the hand. In the authors' experience, results of aggressive surgical treatment of subacute, malaligned fractures in selected patients have produced results comparable with or superior to those reported for later reconstructive procedures. With the proliferation of managed care, there has been an increasing frequency of delayed referral patterns for fracture treatment by hand specialists. Definitive treatment of these "impending malunions" is preferable to passive treatment delay and secondary reconstructive procedures, offering both earlier correction of alignment and earlier opportunity for return of function.     

Catheter-associated Staphylococcus aureus bacteremia

The majority of cases of Staphylococcus aureus bacteremia are hospital-acquired, and most are associated with infected intravenous catheters. Preventive measures, early detection of infections, and strategies for effective treatment have become matters of increasing urgency.     

Infections following cesarean section

Postpartum endomyometritis and abdominal wound infection remain the most common infectious complications following childbirth. New information now suggests that incipient infection of the myometrium explains why patients develop postpartum endometritis despite antibiotic prophylaxis. Clinical predictors of postpartum endometritis continue to suffer from low sensitivity. However, use of a Gram stain of the amniotic fluid may be helpful in identifying a subset of women that may benefit from a therapeutic course of antibiotics initiated immediately after cesarean section. Broad-spectrum antimicrobial therapy is the mainstay of therapy for postpartum endometritis. Two newer extended spectrum cephalosporins, cefotetan and ceftizoxime, appear to be as effective as cefoxitin in the treatment of these infections. Abdominal wound infection is a common cause of antimicrobial failure in patients treated for post-cesarean endomyometritis. The genital mycoplasmas, usually resistant to the penicillins and cephalosporins, are commonly isolated from infected wounds following cesarean section. Wound infection surveillance has been shown to decrease infection incidence rates by providing feedback to the operating surgeon.     

Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors

Bacteria belonging to the genus Klebsiella frequently cause human nosocomial infections. In particular, the medically most important Klebsiella species, Klebsiella pneumoniae, accounts for a significant proportion of hospital-acquired urinary tract infections, pneumonia, septicemias, and soft tissue infections. The principal pathogenic reservoirs for transmission of Klebsiella are the gastrointestinal tract and the hands of hospital personnel. Because of their ability to spread rapidly in the hospital environment, these bacteria tend to cause nosocomial outbreaks. Hospital outbreaks of multidrug-resistant Klebsiella spp., especially those in neonatal wards, are often caused by new types of strains, the so-called extended-spectrum-beta-lactamase (ESBL) producers. The incidence of ESBL-producing strains among clinical Klebsiella isolates has been steadily increasing over the past years. The resulting limitations on the therapeutic options demand new measures for the management of Klebsiella hospital infections. While the different typing methods are useful epidemiological tools for infection control, recent findings about Klebsiella virulence factors have provided new insights into the pathogenic strategies of these bacteria. Klebsiella pathogenicity factors such as capsules or lipopolysaccharides are presently considered to be promising candidates for vaccination efforts that may serve as immunological infection control measures.     

Acinetobacter species as a cause of catheter-related infections

In recent years, Acinetobacter species have emerged as clinically important pathogens. Though these organisms are widely prevalent in nature, most human infections are hospital-acquired. Acinetobacter baumannii is the predominant species. Nosocomial Acinetobacter baumannii infections such as respiratory tract infections, urinary tract infections, meningitis following neurosurgical procedures, and bacteremia mainly affect patients with severe underlying disease in the ICU and often, in the setting of nosocomial outbreak. The occurrence of multiresistant strains often limits therapeutic options. A substantial part of Acinetobacter baumannii bacteremia cases represent catheter-related infections that usually carry a favorable prognosis. Acinetobacter species other than Acinetobacter baumannii are less frequently reported as a cause of infection in humans. Bacteremia due to these organisms is mostly sporadic and almost exclusively related to intravascular devices. The underlying diseases are often less severe than those of patients affected by Acinetobacter baumannii infections. The clinical course is usually benign and the infection responds readily to catheter removal irrespective of the appropriateness of antimicrobial therapy.     

Use of ondansetron in the control of emesis in autologous peripheral blood stem cell transplant (APBSCT) for solid tumours

The authors describe several case-records where Garamycin Schwamm was used primarily to prevent infection in recent injuries of the hand. They mention also the possibility to administer it secondarily in the treatment of chronic infection. The high local gentamycin concentration, the haemostatic effect of the collagen carrier and its favourable influence on wound healing are found in particular in recent hand injuries with a highly contaminated wound. Secondarily Garamycin is used as a supplement of surgery in chronic infections of soft tissues or the skeleton. Treatment and prevention of infection in surgery of the hand is of major importance for the resulting function of the hand and minimalization of the number of reconstruction operations.     

N-acetylcysteine prevents development of the hyperdynamic circulation in the portal hypertensive rat

Infective endocarditis, defined as pathologically or clinically definite by the Duke criteria, was observed in 14 transplant recipients at our institutions. In addition, we reviewed 32 previously reported cases in solid organ transplant recipients. The spectrum of organisms causing infective endocarditis was clearly different in transplant recipients than in the general population; 50% of the infections were due to Aspergillus fumigatus or Staphylococcus aureus, but only 4% were due to viridans streptococci. Fungal infections predominated early (accounting for six of 10 cases of endocarditis within 30 days of transplantation), while bacterial infections caused most cases (80%) after this time. In 80% (37) of the 46 cases in transplant recipients, there was no underlying valvular disease. Seventy-four percent (34) of the 46 cases were associated with previous hospital-acquired infection, notably venous access device and wound infections. Three patients with S. aureus endocarditis had had an episode of S. aureus bacteremia > 3 weeks prior to the diagnosis of endocarditis and had received treatment for the initial bacteremia of < 14 days' duration. The overall mortality rate was 57% (26 of 46 patients died), with 58% (15) of the 26 fatal cases not being suspected during life. Endocarditis is an underappreciated sequela of hospital-acquired infection in transplant recipients.     

Spiral CT vs incremental CT: is spiral CT superior in imaging of the brain?

Historically, staphylococci, pseudomonads, and Escherichia coli have been the nosocomial infection troika; nosocomial pneumonia, surgical wound infections, and vascular access-related bacteremia have caused the most illness and death in hospitalized patients; and intensive care units have been the epicenters of antibiotic resistance. Acquired antimicrobial resistance is the major problem, and vancomycin-resistant Staphylococcus aureus is the pathogen of greatest concern. The shift to outpatient care is leaving the most vulnerable patients in hospitals. Aging of our population and increasingly aggressive medical and surgical interventions, including implanted foreign bodies, organ transplantations, and xenotransplantation, create a cohort of particularly susceptible persons. Renovation of aging hospitals increases risk of airborne fungal and other infections. To prevent and control these emerging nosocomial infections, we need to increase national surveillance, "risk adjust" infection rates so that interhospital comparisons are valid, develop more noninvasive infection-resistant devices, and work with health-care workers on better implementation of existing control measures such as hand washing.     

Epidemiology of severe hospital-acquired infections in patients with liver cirrhosis: effect of long-term administration of norfloxacin

We performed a 5-year retrospective study to evaluate the effect of long-term administration of norfloxacin on the epidemiology of severe hospital-acquired infections in patients with advanced cirrhosis. Sixty-seven episodes of spontaneous bacterial peritonitis and 60 episodes of bacteremia occurred in, respectively, 46 patients (group 1a) and 52 patients (group 1b) who did not receive norfloxacin, while 23 and 17 episodes occurred in 21 patients (group 2a) and 17 patients (group 2b) during or within 10 days after long-term administration of norfloxacin. Enterobacteriaceae were more prevalent in groups 1a and 1b than in the other two groups (P < .001 and P < .01, respectively); conversely, staphylococci were more prevalent in groups 2a and 2b (P < .001 and P < .05, respectively). The rate of staphylococcal resistance to methicillin was 53.6% in groups 1a and 1b and 77.3% in groups 2a and 2b. We conclude that long-term norfloxacin administration to cirrhotic patients reduces the risk of gram-negative infections but increases the risk of severe hospital-acquired staphylococcal infections and of high-level resistance to antibiotics.