Current Issue : July - September Volume : 2013 Issue Number : 3 Articles : 7 Articles
Background: The incidence of fungal healthcare-associated infection (HAI) has increased in a major teaching\r\nhospital in the northern part of Taiwan over the past decade, especially in the intensive care units (ICUs). The\r\npurpose of this study was to determine the factors that were responsible for the outbreak and trend in the ICU.\r\nMethods: Surveillance fungal cultures were obtained from ââ?¬Å?sterileââ?¬Â objects, antiseptic solutions, environment of\r\ninfected patients and hands of medical personnel. Risk factors for comparison included age, gender, admission\r\nservice, and total length of stay in the ICU, Acute Physiology and Chronic Health Evaluation (APACHE) II scores at\r\nadmission to the ICU, main diagnosis on ICU admission, use of invasive devices, receipt of hemodialysis, total\r\nparenteral nutrition (TPN) use, history of antibiotic therapy before HAI or during ICU stay in no HAI group, and ICU\r\ndischarge status (ie, dead or alive). Univariable analysis followed by multiple logistic regression analysis was\r\nperformed to identify the independent risk factors for ICU fungal HAIs and ICU mortality.\r\nResults: There was a significant trend in ICU fungal HAIs from 1998 to 2009 (P < 0.001). A total of 516 episodes of\r\nICU fungal HAIs were identified; the rates of various infections were urinary tract infection (UTI) (54.8%), blood\r\nstream infection (BSI) (30.6%), surgical site infection (SSI) (6.6%), pneumonia (4.5%), other sites (3.5%). The fungi\r\nidentified were: yeasts (54.8%), Candida albicans (27.3%), Candida tropicalis (6.6%), Candida glabrata (6.6%), Candida\r\nparapsilosis (1.9%), Candida species (0.8%), and other fungi (1.9%). Candida albicans accounted for 63% of all\r\nCandida species. Yeasts were found in the environment of more heavily infected patients. The independent risk\r\nfactors (P < 0.05) of developing ICU fungal HAIs from all sites were TPN use, sepsis, surgical patients, mechanical\r\nventilation and an indwelling urinary catheter. The independent risk factors for ICU fungal UTI included TPN use,\r\nmechanical ventilation and an indwelling urinary catheter. The independent risk factors for ICU fungal BSI included\r\nTPN use, sepsis, and higher APACHE II score. The independent risk factors for ICU fungal pneumonia included TPN\r\nuse, surgical patients. The independent risk factors for ICU fungal SSI included surgical patients, and TPN use. The\r\nodds ratios of TPN use in various infection types ranged from 3.51 to 8.82. The risk of mortality in patients with ICU\r\nfungal HAIs was over 2 times that of patients without ICU HAIs in the multiple logistic regression analysis\r\n(P < 0.001)....
Background: Biofilm formation is a major virulence factor contributing to the chronicity of infections. To date few\r\nstudies have evaluated biofilm formation in infecting isolates of patients including both Gram-positive and\r\nGram-negative multidrug-resistant (MDR) species in the context of numerous types of infectious syndromes. Herein,\r\nwe investigated the biofilm forming capacity in a large collection of single patient infecting isolates and compared\r\nthe relationship between biofilm formation to various strain characteristics.\r\nMethods: The biofilm-forming capacity of 205 randomly sampled clinical isolates from patients, collected from\r\nvarious anatomical sites, admitted for treatment at Brooke Army Medical Center (BAMC) from 2004ââ?¬â??2011, including\r\nmethicillin-resistant/methicillin susceptible Staphylococcus aureus (MRSA/MSSA) (n=23), Acinetobacter baumannii\r\n(n=53), Pseudomonas aeruginosa (n=36), Klebsiella pneumoniae (n=54), and Escherichia coli (n=39), were evaluated for\r\nbiofilm formation using the high-throughput microtiter plate assay and scanning electron microscopy (SEM).\r\nRelationships between biofilm formation to clonal type, site of isolate collection, and MDR phenotype were\r\nevaluated. Furthermore, in patients with relapsing infections, serial strains were assessed for their ability to form\r\nbiofilms in vitro.\r\nResults: Of the 205 clinical isolates tested, 126 strains (61.4%) were observed to form biofilms in vitro at levels\r\ngreater than or equal to the Staphylococcus epidermidis, positive biofilm producing strain, with P. aeruginosa and S.\r\naureus having the greatest number of biofilm producing strains. Biofilm formation was significantly associated with\r\nspecific clonal types, the site of isolate collection, and strains positive for biofilm formation were more frequently\r\nobserved to be MDR. In patients with relapsing infections, the majority of serial isolates recovered from these\r\nindividuals were observed to be strong biofilm producers in vitro.\r\nConclusions: This study is the first to evaluate biofilm formation in a large collection of infecting clinical isolates\r\nrepresenting diverse types of infections. Our results demonstrate: (1) biofilm formation is a heterogeneous property\r\namongst clinical strains which is associated with certain clonal types, (2) biofilm forming strains are more frequently\r\nisolated from non-fluid tissues, in particular bone and soft tissues, (3) MDR pathogens are more often biofilm\r\nformers, and (4) strains from patients with persistent infections are positive for biofilm formation....
Endometrial biopsy examination can be used to identify histopathological changes of endometrium and thus serve as a basis for prognostic evaluation of infertile animals. For the present study, fifty six endometrial biopsy samples were collected from infertile buffaloes for histopathological studies. Histopathologically, the lesions observed were acute, subacute, chronic, chronic suppurative and chronic catarrhal changes in 14.54%, 34.54%, 46.37%, 1.82% and 2.73% biopsies respectively. Acute endometritis cases revealed severe congestion and edema of endometrium, focal areas of denudation of epithelial lining and infiltration of polymorphonuclear cells and few lymphocytes. Moderate infiltration in sub epithelial zone of stratum compactum, moderate periglandular fibrosis, cystic dilation of endometrial glands in addition to stromal and glandular edema were noticed in sub acute endometritis. Diffuse infiltration of lymphocytes, plasma cells and macrophages in stratum compactum and stratum spongiosum, gland site masses with severe periglandular fibrosis were observed in chronic endometritis cases. Severe proliferation of fibroblasts, glandular sclerosis and hyalinization of blood vessels were also noticed in chronic endometritis. Chronic suppurative endometritis cases revealed periglandular fibrosis and infiltration of more polymorphonuclear cells in stratum compactum and stratum spongiosum.Chronic catarrhal endometritis cases revealed catarrhal changes in luminal epithelium and thick connective tissue stroma in endometrium....
Incidence of Chronic Respiratory Disease in Emu birds was recorded in Krishna District, Andhra Pradesh. Among the 258 Emu birds that were examined, 41 birds were found to be affected by CRD. Clinical signs in CRD affected birds were dyspnoea, moist rales, exudation from the nostrils, swollen face and infraorbital sinuses. Gross lesions recorded were catarrhal exudate in the nares and trachea, mild to severe congestion of tracheal mucosa, fibrinous exudation in the pleura and lungs, moderate to severe air sacculitis of all the air sacs characterized by moderate cloudiness of air sacs to caseous exudation that was attached to the walls of the airsacs. Serum plate agglutination test detected antibodies against M. gallisepticum in 68% of the ailing birds. Treatment of the ailing birds with Tylosin and Tiamulin was found to be effective....
Background: Aspergillus tubingensis is a black Aspergillus belonging to the Aspergillus section Nigri, which includes\r\nspecies that morphologically resemble Aspergillus niger. Recent developments in species determination have\r\nresulted in clinical isolates presumed to be Aspergillus niger being reclassified as Aspergillus tubingensis by\r\nsequencing. We present a report of a patient with an osteomyelitis of the maxillary bone with a probable invasive\r\nAspergillus tubingensis infection.\r\nCase presentation: We describe an immune compromised patient suffering from osteomyelitis of the maxillary\r\nbone after tooth extraction. The osteomyelitis probably resulted in dentogenic pansinusitis presenting as an acute\r\nethmoiditis. Histologic examination of biopsy samples showed osteomyelitis, and inflammation of the surrounding\r\nconnective tissue. Cultures of the alveolar wound grew Aspergillus tubingensis. The patient was treated with\r\nliposomal amphoterocin B, which was changed to oral treatment with voriconazole based on susceptibility testing\r\n(MIC for voriconazole was 1 �µg/ml).\r\nConclusion: This case shows that Aspergillus tubingensis may have the potential to cause severe invasive infections\r\nin immunocompromised hosts. A larger proportion of Aspergillus tubingensis isolates are less susceptible to azoles\r\ncompared to Aspergillus niger. Therefore, correct species identification and susceptibility testing is crucial for the\r\nchoice of anti-fungal treatment, screening of azole resistance, and characterization of the pathogenic potential of\r\nthe various species within Aspergillus section Nigri....
Background: Carbapenemase producing Enterobacteriaceae are becoming a major public health concern globally,\r\nhowever, relatively little is known about the molecular and clinical epidemiology of these organisms in many parts\r\nof the world.\r\nMethods: As part of a laboratory surveillance programme, 96 carbapenem non-susceptible Enterobacteriaceae\r\nisolates from clinical samples from patients in seven hospitals were referred for investigation for carbapenemases.\r\nUsing polymerase chain reaction (PCR) to screen for a collection of genes encoding carbapenemases, 33 of 96\r\n(34.5%) isolates were confirmed as carbapenemase producers. NDM-1 producers were the most prevalent at 64%\r\n(21/33) whilst OXA-181 was the second most common carbapenemase constituting 24.5% (8/33) of the\r\ncarbapenemase producing isolates. Seven of these eight OXA-181 positive isolates underwent further\r\ncharacterisation with screening for other transmissible antimicrobial resistance determinants using PCR. Clonal\r\nrelatedness was explored using Multilocus sequence typing (MLST) and Pulsed Field Gel Electrophoresis (PFGE).\r\nPlasmid characterisation was performed including restriction analysis and transfer by conjugation or transformation.\r\nResults: In addition to the OXA-181 gene, all contained other transmissible resistance determinants including\r\nextended spectrum �Ÿ-lactamases, oxacillinases or 16S rRNA methylase genes, but none contained\r\nmetallo-�Ÿ-lactamases or serine carbapenemases. All isolates had a multidrug resistant phenotype with two isolates\r\nbeing resistant to every antibiotic tested including colistin. Multilocus sequence typing confirmed five isolates\r\nbelonged to ST17 and two to ST14, with those belonging to the same sequence type having identical PFGE\r\nprofiles. The OXA-181 gene was typically carried on large plasmids which were mostly non-conjugative.\r\nConclusions: OXA-181 carbapenemase appears to be an important and probably under-recognised cause of\r\ncarbapenem resistance in Enterobacteriaceae in Singapore. Further coordinated research into clinical and molecular\r\nepidemiology of carbapenemases is urgently required in Singapore and throughout Asia....
Background: Injection drug users (IDUs) represent a significant proportion of patients with chronic hepatitis C\r\n(CHC). The low treatment uptake among these patients results in a low treatment effectiveness and a limited public\r\nhealth impact. We hypothesised that a general practitioner (GP) providing an opioid maintenance treatment (OMT)\r\nfor addicted patients can achieve CHC treatment and sustained virological response rates (SVR) comparable to\r\npatients without drug dependency.\r\nMethods: Retrospective patient record analysis of 85 CHC patients who received OMT for more than 3 months in a\r\nsingle-handed general practice in Zurich from January 1, 2002 through May 31, 2008. CHC treatment was based on\r\na combination with pegylated interferon and ribavirin. Treatment uptake and SVR (undetectable HCV RNA 6 months\r\nafter end of treatment) were assessed. The association between treatment uptake and patient characteristics was\r\ninvestigated by multiple logistic regression.\r\nResults: In 35 out of 85 CHC patients (52 males) with a median (IQR) age of 38.8 (35.0-44.4) years, antiviral therapy\r\nwas started (41.2%). Median duration (IQR) of OMT in the treatment group was 55.0 (35.0-110.1) months compared\r\nto the group without therapy 24.0 (9.8-46.3) months (p<0.001). OMT duration remained a significant determinant\r\nfor treatment uptake when controlled for potential confounding. SVR was achieved in 25 out of 35 patients (71%).\r\nConclusion: In addicted patients a high CHC treatment and viral eradication rate in a primary care setting in\r\nSwitzerland is feasible. Opioid substitution seems a beneficial framework for CHC care in this ââ?¬Å?difficult to treatââ?¬Â\r\npopulation....
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