Association between the use of anticholinergic agents and asymptomatic bacteriuria.
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Adult↗
Biomedical subjects
M Eveillard
Publications and source records attributed to M Eveillard.
Association between institutionalization and carriage of multiresistant bacteria in the elderly at the time of admission to a general hospital.
The impact of institutionalization on the carriage of multiresistant bacteria among the elderly was assessed prospectively by comparing the carriage rate in institutionalized patients over 70 years of age to the carriage rate in patients over 70 living at home (58 patients/group). Nares, skin, and rectal swabs were obtained within 24 h of admission to the hospital. Among the 20 carriers identified, 75% came from institutions. Significantly, institutionalized patients were incontinent (P < 0.001), less autonomous than those living at home (P < 10(-6)), and had taken antibiotics recently (P < 0.02). The primary characteristics associated with bacterial colonization were institutional living (P < 0.02), having at least one underlying disease (P < 0.001), dependence (Karnofsky index < or = 50; P < 0.02), recent treatment with antibiotics (P < 0.02), and the presence of skin lesions (P < 0.02). Among the risk factors identified, institutionalization can be readily determined upon admission; systematic communication of carrier status of transfer patients would improve overall patient care.
Aged↗
[Seroprevalence of hepatitis B and C viruses in a psychiatric institution].
Many patients admitted to psychiatric institutions have a history of risk factors for contamination with the hepatitis B and C viruses (HBV and HCV). Immunization policies for psychiatric institution patients are not widely know. A study conducted in a 600-bed psychiatric institution in Paris, France, to evaluate the proportion of potentially contaminating patients at admission, as well as immunization use in HBV-negative patients. Serologic markers for the HBV and HCV were looked for prospectively in all patients admitted over a two-month period. Immunization use was evaluated in the patients who had a first serologic test in 1995 or 1996 and follow-up tests until the end of 1997. The prospective part of the study demonstrated preadmission exposure to the HBV in 23.0 +/- 6.0% of patients. This proportion was larger in men (26.0%) than in women (14.8%), although the difference was not statistically significant (P = 0.10). Four patients (2.0%) tested positive for the HbS Ag. Among the HBV-negative patients, 13.0% received the vaccine; all had protective antibody levels. These patients were younger and more likely to be first-time admissions (18.4% vs 3.6%, P < 0.01). HCV seroprevalence was 6.0%. Serologic tests for the HBV were requested for 327 patients between January 1995 and december 1996. Among the patients who were seronegative at admission and received follow-up at the study hospital, only 13.8% were immunized at this hospital. Of the HCV-positive subjects, 63.3% were also HBV-positive. None of the HCV-positive HBV-negative subjects received immunization subsequently. Six to eight per cent of patients admitted to the study hospital are potentially contaminating for the HBV or HCV. The level of hepatitis B vaccine use is too low, particularly in high-risk patients. These data indicate a need for policies aimed at effectively preventing HBV and HCV transmission (information, education, immunization campaigns), both during the psychiatric institution stay and after discharge.
Adult↗
[Multidrug resistant bacteria in a psychiatric milieu].
Isolation rates of multiple-drug resistant (MDR) bacteria were evaluated retrospectively in a psychiatric care facility. Over the six-year study period, 66 MDR bacterial strains were found. Methicillin-resistant Staphylococcus aureus contributed half of all MDR strains and 31% of all S. aureus strains. Among Pseudomonas aeruginosa strains, 22% were resistant to ticarcillin or imipenem, and among Enterobacteriaceae, 4.1% were MDR strains (production of a derepressed cephalosporinase or of an extended-spectrum beta-lactamase). Although most MDR strains were probably acquired during hospitalizations in short-term care facilities outside our institution, patient-to-patient transmission, either direct or via other individuals, cannot be ruled out. These data indicate that psychiatric care facilities should adopt the MDR strain monitoring strategies already used in other hospitals.
Bacteria↗
[Specific features of nosocomial infections in the elderly at a general hospital center. 5 surveys of annual prevalence].
Specific features of nosocomial infections in patients aged 70 years or older admitted to a short-term care medical department in a 400-bed general hospital were studied to assist in designing nosocomial infection control programs for this population. Data from five annual prevalence surveys were evaluated retrospectively. The 517 patients aged 70 years or older were compared to the 1093 patients younger than 70 years. The older patients were more likely to have risk factors for nosocomial infections including severe disease (36.2% vs 19.1%; P < 10(-6)), referral from another department (24.6% vs 17.5%; P < 0.01), a long hospital stay duration (8.5 days vs 3.5 days), mechanical ventilation (4.3% vs 1.6%; P < 0.01), an indwelling urinary catheter (12.0% vs 4.0%; P < 10(-7)), and a long median duration of urinary catheterization (6 days vs 2 days). The prevalence of nosocomial infections was increased nearly two-fold in the older patients (10.3% vs 5.6%; P < 0.01), although the difference was statistically significant only for urinary tract infections (5.4% vs 1.4%; P < 10(-5)), particularly in patients without urinary catheters. After exclusion of all patients with urinary tract infections, the prevalence of nosocomial infections was similar in the older and younger patients (4.3% vs 3.7%) despite a persistently higher frequency of risk factors for nosocomial infection in the older group. These results indicate that urinary tract infection should be the main target of programs aimed at minimizing nosocomial infection in elderly patients admitted to short-term care facilities. Faultless technique is essential during urinary catheter insertion. High-quality nursing care contributes substantially to the prevention of urinary tract infection in noncatheterized patients with urinary incontinence or neurologic disorders.
Aged↗
[Dynamic viscosity and corneal endothelial protection with Healonid, Healon GV, Provisc and Viscoat during phacoemulsification].
PURPOSE: To demonstrate the utility of a viscoelastic substance which maintains high viscosity during phacoemulsification, we conducted a double study. METHODS: We compared in vitro the corneal endothelial protection offered by Healon, Healon GV, Provisc and Viscoat after < > phacoemulsification. Eight samples of ten to fifteen freshly enucleated pig eyes were operated; the first four groups were the controls, whereas the other four tested the different viscous solutions. In parallel, we determined the rheologic properties of the four viscoelastic substances in a physicS laboratory. To measure the percentage of corneal endothelial cell damage, we used the Janus Green spectrometric technique. RESULTS: Corneal endothelial cell damage averaged 31.67% in eyes in which no viscoelastic substance was used. Damage was 14.29% in specimens that received Healon, 12.85% with Healon GV, 2.48% in the Viscoat group and 15.43 in those that received Provisc. There is a significant difference (p <0.001) between the Viscoat group and all other samples. The values of the viscosity at different shear rates and the graph of viscosities as a function of shear rate of the four viscous solutions are given. CONCLUSION: Viscoat has a very high dynamic viscosity at high shear rate. This property and a poor cohesion provide a better corneal endothelial protection during in vitro phacoemulsification.
Animals↗
Identification and characterization of adhesive factors of Clostridium difficile involved in adhesion to human colonic enterocyte-like Caco-2 and mucus-secreting HT29 cells in culture.
Experiments reported in this communication showed that the highly toxinogenic Cd 79685, Cd 4784, and Wilkins Clostridium difficile strains and the moderately toxinogenic FD strain grown in the presence of blood adhere to polarized monolayers of two cultured human intestinal cell lines: the human colonic epithelial Caco-2 cells and the human mucus-secreting HT29-MTX cells. Scanning electron microscopy revealed that the bacteria interacted with well-defined apical microvilli of differentiated Caco-2 cells and that the bacteria strongly bind to the mucus layer that entirely covers the surface of the HT29-MTX cells. The binding of C. difficile to Caco-2 cells developed in parallel with the differentiation features of the Caco-2 cells, suggesting that the protein(s) which constitute C. difficile-binding sites are differentiation-related brush border protein(s). To better define this interaction, we tentatively characterized the mechanism(s) of adhesion of C. difficile with adherence assays. It was shown that heating of C. difficile grown in the presence of blood enhanced the bacterial interaction with the brush border of the enterocyte-like Caco-2 cells and the human mucus-secreting HT29-MTX cells. A labile surface-associated component was involved in C. difficile adhesion since washes of C. difficile grown in the presence of blood without heat shock decreased adhesion. After heating, washes of C. difficile grown in the presence of blood did not modify adhesion. Analysis of surface-associated proteins of C. difficile subjected to different culture conditions was conducted. After growth of C. difficile Cd 79685, Cd 4784, FD and Wilkins strains in the presence of blood and heating, two predominant SDS-extractable proteins with molecular masses of 12 and 27 kDa were observed and two other proteins with masses of 48 and 31 kDa disappeared. Direct involvement of the 12 and 27 kDa surface-associated proteins in the adhesion of C. difficile strains was demonstrated by using rat polycolonal antibodies pAb 12 and pAb 27 directed against the 12 and 27 kDa proteins. Indeed, adhesion to Caco-2 cell monolayers of C. difficile strains grown in the presence of blood, without or with heat-shock, was blocked. Taken together, our results suggest that C. difficile may utilize blood components as adhesins to adhere to human intestinal cultured cells.
Antibodies, Bacterial↗