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Incidence study of nosocomial infection in pediatric trauma patients.

In this article we intend to describe the epidemiological profile of nosocomial infection in pediatric patients with multiple trauma. We conducted a prospective study from July to November 2003 in a pediatric teaching hospital in Barcelona. We used US Centers for Disease Control and Prevention standard criteria to define nosocomial infection. Of the 121 patients included in the study, 33% had at least one episode of nosocomial infection, with an incidence rate of 9.9 infections per 100 admissions and 1.1 infections per 100 patient-days. The most frequent episode of nosocomial infection was bacteremia. Coagulase-negative staphylococci were the most common pathogens. Nosocomial infection rates per 100 device-days were 3.2 for bacteremia, 1.6 for respiratory infection and 1.0 for urinary tract infection. These findings suggest the need to evaluate infection control measures aimed at reducing the morbidity associated with infections.

Bacteremia↗

Intensive care unit-acquired infections: incidence, risk factors and associated mortality in a Turkish university hospital.

In this prospective study, 93 intensive care unit (ICU)-acquired infections seen in 131 ICU patients were evaluated. Infection rates were found to be 70.9 in 100 patients and 56.2 in 1,000 patient-days. Pneumonia (35.4%) and bloodstream infections (18.2%) were the most common infections; Staphylococcus aureus (30.9%) and Acinetobacter spp. (26.8%) were the most frequently isolated microorganisms. The results of multivariate logistic regression analyses estimating the risk factors for ICU-acquired infections were as follows: length of stay in ICU (>7 days) (odds ratio [OR]: 7.02; 95% confidence interval [CI]: 2.80-17.56), respiratory failure as a primary cause of admission (OR: 3.7; 95% Cl: 1.41-9.70), sedative medication (OR: 3.34; 95% CI: 1.27-8.79) and operation (before or after admission to ICU) (OR: 2.56; 95% CI: 1.06-6.18). In logistic regression analyses, age (>60 years) (OR: 3.65; 95% CI: 1.48-9.0), APACHE II score >15 (OR: 4.67; 95% CI: 1.92-11.31), intubation (OR: 3.60; 95% CI: 1.05-12.39) and central venous catheterization (OR: 7.85; 95% CI: 1.61-38.32) were found to be significant risk factors for mortality. The difference in mortality rates between patients with ICU-acquired infection and uninfected patients was not statistically significant (mortality rates: 42.3 and 45.6%, respectively). A high incidence of nosocomial infections was found, and the risk factors for ICU-acquired infections and mortality were determined.

Adolescent↗

[Blind bifid ureter associated with duplicity and contralateral vesicoureteral reflux].

We report on a pediatric patient who was evaluated for recurrent episodes of urinary tract infection. Evaluation by IVP, cystography and retrograde ureteropyelography revealed a complete ureteral duplicity, grade II vesicoureteral reflux in the lower half of the left kidney and a blind bifid ureter arising at the distal third of the right ureter. This is an uncommon condition (about 150 cases have been reported) difficult to diagnose if undetected by conventional radiological evaluation and retrograde ureteropyelography may be required. It may be associated with urological or other types of malformations. It is generally asymptomatic and with scant consequences, thus treatment is initially conservative. Surgical excision of the blind bifid ureter is warranted only when complications present. In the present case, prophylactic antibiotic therapy was instituted. At one year follow up, the patient is asymptomatic and urine cultures are negative.

Abnormalities, Multiple↗

Quantitative-PCR assessment of Cryptosporidium parvum cell culture infection.

A quantitative TaqMan PCR method was developed for assessing the Cryptosporidium parvum infection of in vitro cultivated human ileocecal adenocarcinoma (HCT-8) cell cultures. This method, termed cell culture quantitative sequence detection (CC-QSD), has numerous applications, several of which are presented. CC-QSD was used to investigate parasite infection in cell culture over time, the effects of oocyst treatment on infectivity and infectivity assessment of different C. parvum isolates. CC-QSD revealed that cell culture infection at 24 and 48 h postinoculation was approximately 20 and 60%, respectively, of the endpoint 72-h postinoculation infection. Evaluation of three different lots of C. parvum Iowa isolate oocysts revealed that the mean infection of 0.1 N HCl-treated oocysts was only 36% of the infection obtained with oocysts treated with acidified Hanks' balanced salt solution containing 1% trypsin. CC-QSD comparison of the C. parvum Iowa and TAMU isolates revealed significantly higher levels of infection for the TAMU isolate, which agrees with and supports previous human, animal, and cell culture studies. CC-QSD has the potential to aid in the optimization of Cryptosporidium cell culture methods and facilitate quantitative evaluation of cell culture infectivity experiments.

Animals↗

[Recurrent respiratory infection in children: its clinical and laboratory evaluation].

Respiratory infections comprise the main cause of medical consultations, and one of two of the first causes of morbidity and mortality in children under five in developing countries. Epidemiological studies have shown that preschool children contract between four and six respiratory infections in the course of a year without this causing any alarm as a deviation from "normality". Yet, the general practitioner and the pediatrician are frequently faced with the dilemma of deciding whether the child who is "always ill" the use of the recurrent infections is, normal or has predisposing conditions to the infections. Among the predisposing conditions for recurrent respiratory infections in children are several host factors, such as immune defense mechanisms and non-immune mechanisms as well as the infections agent and/or the environment. This article is an overview of the clinical and laboratory evaluation findings of children with recurrent respiratory infections.

Child↗

CT in the evaluation of spine infection.

Little experience of computed tomography (CT) evaluation of spinal infection has been reported. We collected 20 patients with spinal infection studied with CT. Fifteen patients had pyogenic infections, four had tubercular lesions, and one infection was fungal. Predisposing factors for spinal infection were present in ten of 20 patients. Metrizamide was injected into the subarachnoid space prior to CT in nine of 20 patients. CT detected bony destruction in all patients with osseous involvement. In addition, CT diagnosed prevertebral abscess formation and/or extension of the process into the spinal canal (and its level) in 12 of 15 patients with pyogenic infection in these sites. All tubercular infections showed prevertebral soft tissue involvement, one was associated with an epidural block. In our experience, CT can combine information provided by conventional tomography and myelography in one imaging modality, and offers the unique ability to provide direct evidence of spread of infection into the soft tissues.

Adolescent↗

Quantification of infectious HIV-1 plasma viral load using a boosted in vitro infection protocol.

Methods currently used for HIV-1 viral load measurements are very sensitive, but cannot distinguish between infectious and noninfectious particles. Here we describe the development of a novel, sensitive, and highly reproducible method that allows rapid isolation and quantification of infectious particles from patient plasma. By immobilizing HIV-1 particles in human plasma to platelets using polybrene, we observed a 10- to 1000-fold increase in infectivity over infection protocols using free virus particles. Using this method, we evaluated infectivity in plasma from 52 patients at various disease stages. At plasma viral loads of 1000-10000 HIV-1 RNA copies/ml 18%, at 10,000-50,000 copies/ml 73%, at 50,000-100,000 copies/ml 90%, and above 100,000 copies 96% of cultures were positive. We found that infectious titers among patients vary distinctively but are characteristic for a patient over extended time periods. Furthermore, we demonstrate that by evaluating infectious titers in conjunction with total HIV RNA loads, subtle effects of treatment intervention on viremia levels can be detected. The immobilization procedure does not interfere with viral entry and does not restore the infectivity of neutralized virus. Therefore, this assay system can be utilized to investigate the influence of substances that specifically affect virion infectivity such as neutralizing antibodies, soluble CD4, or protease inhibitors. Measuring viral infectivity may thereby function as an additional, useful marker in monitoring disease progression and evaluating efficacy of antivirals in vivo.

Adult↗

Anti-HIV activity of amphotericin B-cholesteryl sulfate colloidal dispersion in vitro.

We examined whether the anti-HIV-1 activity of the polyene antibiotic Amphotericin B (AMB) is retained following incorporation into sterically stabilized 'Stealth' liposomes (L-AMB) with prolonged circulation in vivo, or cholesteryl sulfate colloidal dispersions (CD-AMB). The effects of the different preparations on acute infection of H9 cells with HIV-1IIIB, spreading of the virus from chronically infected H9/HTLV-IIIB cells to SupT1 cells, and HIV-1-induced syncytium formation were evaluated. Infection was monitored by p24 levels in culture supernatants. L-AMB did not affect HIV-1 infection. When present only during initial infection, AMB (3-20 microg/ml) reduced p24 levels by 70-80% after 7 and 10 days post-infection, while CD-AMB inhibited p24 production by approximately 30-40% at day 7 and 50-60% at day 10. The inhibitory effect of CD-AMB and AMB was enhanced by continuous treatment of acutely infected cells. The reduction of p24 production during continuous treatment was not due to cytotoxicity. During spreading of infection from infected to uninfected cells, AMB almost completely inhibited virus production while CD-AMB reduced both p24 production and the cytopathic effect in a dose-dependent manner. HIV-1 induced syncytium formation was slightly inhibited by AMB but not by CD-AMB. Because CD-AMB is considerably less cytotoxic than AMB, its ability to inhibit HIV infection in vivo needs to be evaluated further.

Amphotericin B↗

CT and MRI evaluation of musculoskeletal infection.

While the plain film and nuclear medicine bone scan are still the traditional imaging modalities used in the evaluation of musculoskeletal infection, the cross-sectional imaging modalities, computed tomography (CT) and magnetic resonance imaging (MRI), have become critical in the delineation of many types of musculoskeletal infection. In particular, the evaluation of soft tissue infections, including cellulitus, myositis, fasciitis, abscess, and septic arthritis are often best evaluated by MRI or CT due to their excellent anatomic resolution and soft tissue contrast. Even in osseous infection, CT and MRI can give better anatomic delineation of the extent of infection. In cases where the plain film and nuclear medicine bone scan findings are complicated due to previous surgery, trauma, or underlying illness, the anatomic resolution and soft tissue contrast provided by MRI and CT are often necessary to determine if underlying infection exists. MRI's visualization of the bone marrow allows for the sensitive detection of osteomyelitis, although specificity for the diagnosis of osteomyelitis is aided by other findings, including cortical destruction. The CT and MRI findings in the spectrum of musculoskeletal infections are discussed and contrasted, and pitfalls in their evaluation of musculoskeletal infection are described.

Abscess↗

Passive active prophylaxis against Hepatitis B in children with acute lymphoblastic leukemia.

The aim of this study was to assess the antibody response to combined passive active immunisation versus active immunisation along with interferon against Hepatitis B in 60 patients with acute lymphoblastic leukemia (ALL) between 1 and 21 years of age with negative Hepatitis B virus (HBV) serology at presentation. Thirty-one patients received combined passive active immunisation with human specific Hepatitis B immunoglobulin (HEPABIG-VHB Pharmaceuticals) and Hepatitis B vaccine (arm I) and 29 patients received active immunisation along with interferon (arm II). Protective antibody levels were detected in 89.6 and 21% patients, respectively, at the 6-month evaluation. Infection with HBV occurred in 17 and 59% patients, respectively, at the 6-month evaluation. Interferon, thus, failed to serve the role as a vaccine adjuvant. At the 9-month evaluation of patients who received immunoglobulin, protective antibody titers were lost in 8 out of 19 evaluable patients (42%) and of these, 3 patients became HBsAg reactive at this point of time. This study indicated that 47.3% patients undergoing aggressive chemotherapy responded to combined passive active prophylaxis with protective titers of antiHBs at the 9-month evaluation. However, the rate of HBV infection was greatly reduced to 27%. We suggest that usage of passive immunisation in the aggressive phase, followed by active immunisation after cessation of intense chemotherapy would be a better option to increase the rates of protective antibody levels in these immunocompromised patients with leukemia.

Acute Disease↗

Fulminant meningococcemia in a child with hereditary deficiency of the seventh component of complement and proteinuria.

A previously healthy 14-year-old boy presented with fulminant meningococcemia. He was found to have a total deficiency of C7. His serum totally lacked bactericidal activity against Neisseria meningitidis. Addition of purified C7 restored the serum hemolytic and bactericidal activity. Susceptibility to disseminated Neisseria infections has previously been reported in 3 patients with C7 deficiency, as well as in a few patients with deficiency of C5, C6 and C8. These findings emphasize the importance of intact complement mediated bactericidal activity in host defense against disseminated Neisseria infections. Evaluation of the complement system in individuals with Neisseria infections appears mandatory.

Adolescent↗

The CC chemokine receptor 5 is important in control of parasite replication and acute cardiac inflammation following infection with Trypanosoma cruzi.

Infection of susceptible mice with the Colombiana strain of Trypanosoma cruzi results in an orchestrated expression of chemokines and chemokine receptors within the heart that coincides with parasite burden and cellular infiltration. CC chemokine receptor 5 (CCR5) is prominently expressed during both acute and chronic disease, suggesting a role in regulating leukocyte trafficking and accumulation within the heart following T. cruzi infection. To better understand the functional role of CCR5 and its ligands with regard to both host defense and/or disease, CCR5(-/-) mice were infected with T. cruzi, and the disease severity was evaluated. Infected CCR5(-/-) mice develop significantly higher levels of parasitemia (P < or = 0.05) and cardiac parasitism (P < or = 0.01) during acute infection that correlated with reduced survival. Further, we show that CCR5 is essential for directing the migration of macrophages and T cells to the heart early in acute infection with T. cruzi. In addition, data are provided demonstrating that CCR5 does not play an essential role in maintaining inflammation in the heart during chronic infection. Collectively, these studies clearly demonstrate that CCR5 contributes to the control of parasite replication and the development of a protective immune response during acute infection but does not ultimately participate in maintaining a chronic inflammatory response within the heart.

Acute Disease↗

Predisposing factors for infection in spine surgery: a survey of 850 spinal procedures.

A retrospective survey of 850 spinal procedures was conducted to determine risk factors for postoperative spinal infection. Some 574 posterior and 276 anterior procedures were evaluated. Infections were classed as early (within 19 weeks postoperatively) and late (> or = 20 weeks postoperatively), as well as deep and superficial infections. Previously postulated risk factors (i.e., diabetes, corticosteroid therapy, previous spinal surgery, obesity, chronic infection, and smoking) were investigated. Furthermore, it was hypothesized that three additional factors: extended preoperative hospitalization, prolonged operation duration, and high blood loss were risk factors not previously considered. A postoperative infection was evident in 22 of 850 procedures (19 early/three late infections, four superficial/18 deep infections). Most infections (n = 21) occurred with posterior instrumentation. Previously described factors were proven as risk factors. Extended preoperative hospitalization (p < 0.04), high blood loss (p < 0.01), and prolonged operation time (p < 0.001) were additionally determined as risk factors. The results suggest that routine prophylactic antibiotics might be unnecessary in anterior surgery, whereas extended prophylactics should be considered in posterior instrumentation, especially when risk factors are apparent.

Adolescent↗

Evaluating diabetic foot infection with magnetic resonance imaging: Kuwait experience.

OBJECTIVE: The aim of this study was to evaluate the capability of magnetic resonance imaging (MRI) to depict and characterize the changes seen in diabetic foot infections. SUBJECTS AND METHODS: MRI studies of 29 diabetic patients with suspected foot infection were evaluated. Sagittal and transverse T1-weighted images before and after intravenous gadolinium, and transverse fat-suppressed T2-weighted images were performed on the affected regions. The MRI findings were compared to subsequent clinical and/or histopathological findings. RESULTS: The MRI findings were: osteomyelitis in 14 patients, abscess in 5, cellulitis in 26, tenosynovitis in 4 and neuropathic joint in 8. Three cases were normal. Pathological confirmations were obtained in 19 patients. MRI and histological diagnosis were in concordance in 79% of osteomyelitis cases, 100% of neuropathy cases and 100% of cellulitis cases. The sensitivity and specificity of MRI in diagnosing osteomyelitis were 100 and 63%, respectively. The positive predictive and negative predictive values, and the accuracy were 79, 100 and 84%, respectively. MRI helped surgical planning for limb salvage procedures in 6 of the osteomyelitis cases and in a cellulitis case. CONCLUSION: The results indicate that MRI is a sensitive and accurate imaging modality for the evaluation of foot infections in diabetic patients and for planning proper treatment.

Adult↗

Anaesthesia for the patient with acquired immune deficiency syndrome--a review.

Acquired immunodeficiency syndrome affects over 10 million persons worldwide. The disease represents an enormous cost to society in health care resources and in loss from the workforce. Although initially reported in 1980 as a disease affecting mainly homosexuals and intravenous drug abusers with a predominance in males, the male to female ratio was close to parity by 1992. The disease attacks all systems in the body. Preanaesthetic evaluation focuses on assessment of lung function and presence of infection, evaluation of endocarditis and treatment of congestive failure, rehydration and correction of electrolyte imbalances, transfusion and documentation of central nervous system manifestations. The Center for Disease Control and Prevention has produced guidelines to protect health care workers from transmission of the virus. Although the risk of infection is extremely low, these precautions should be routinely adopted.

Acquired Immunodeficiency Syndrome↗

Computed tomography for evaluation of puerperal infections.

Pelvic computed tomography was used to evaluate 74 women with persistent puerperal infection. There was at least one abnormal roentgenographic finding in 57, and these are correlated with clinical and surgical findings. In 16 women, a palpable pelvic mass was seen on tomography, however, masses not appreciated clinically were visualized in another 29 women, and in five, a clinically palpable mass was not visualized by tomography. In 12 women who had a normal pelvic examination, septic pelvic thrombophlebitis was diagnosed by tomography. Over-all, there was poor correlation with roentgenographic findings and uterine incisional necrosis and dehiscence. We conclude that pelvic tomography is useful to evaluate some women with persistent puerperal infection, but that these studies must be correlated with clinical findings.

Adolescent↗

[Incidence of genitourinary infection caused by Chlamydia trachomatis in a STD center calculated by direct antigen detection].

OBJECTIVE: Chlamydia trachomatis is one of the most common sexually transmitted agents which causes a wide spectrum of diseases including urethritis in men and endocervicitis in women. We analyzed patients with genitourinary C. trachomatis infections evaluating risk factors and the association with other sexually transmitted infections. MATERIAL AND METHODS: We processed 1,180 specimens from 913 patients (772 women and 141 men), attended at a Sexually Transmitted Diseases (STD) Center. The diagnostic of C. trachomatis infection was made by an enzyme-linked fluorescent immunoassay, Vidas Chlamydia test (bioMérieux). RESULTS: The incidence of C. trachomatis infection was 4.8% (57 cases) and was higher in women (70.1%) than in men (29.8%). The risk groups observed were: 26 prostitute, 7 contact with prostitute or risk partner, 5 homosexual, 5 promiscuous heterosexual and 14 without risk groups. Associated with this infection we observed other: 10 bacterial vaginosis, 8 Papillomavirus infection, 3 Trichomonas vaginalis infections, 2 Neisseria gonorrhoeae infections and 2 Candidiasis. The 53.4% of these patients didn't have any symptomatology at the consult moment. CONCLUSIONS: The control of patients with risk factors is important for the diagnostic of C. trachomatis and other sexually transmitted infections, because most of them were prostitutes and asymptomatic. Within men, homosexuality, contact with prostitute or risk partner were the practices with higher risk.

Antigens, Bacterial↗

Aztreonam-flucloxacillin double beta-lactam treatment as empirical therapy of serious infections in very elderly patients.

Aztreonam, the first monocyclic beta-lactam antibiotic with pure anti-Gram-negative activity, combined with flucloxacillin, a penicillinase resistant penicillin, was given as empirical treatment of 53 serious infections in very elderly people. Eighteen of the cases had positive blood cultures and 11 had a clinical picture of sepsis without positive blood cultures: Of 49 evaluable infections, 45 (92%) were cured. In 40% of the infections, antibiotic treatment could be narrowed after 72 hours to one antibiotic. Diarrhoea, mostly transitory, was the only side-effect. Aztreonam-flucloxacillin combination is a safe and effective empirical treatment regimen for serious infections in very elderly patients.

Aged↗