2012 July 13

Escherichia coli clonal group A causing bacteraemia of urinary tract origin.

Clin Microbiol Infect Start a Discussion »

Jul 132012

Escherichia coli clonal group A causing bacteraemia of urinary tract origin.

Clin Microbiol Infect. 2012 Jun 9;

Authors: Skjøt-Rasmussen L, Olsen SS, Jakobsen L, Ejrnaes K, Scheutz F, Lundgren B, Frimodt-Møller N, Hammerum AM

Abstract

Clin Microbiol Infect ABSTRACT: Escherichia coli clonal group A (CgA) causes disease in humans. This is the first study investigating the prevalence of CgA among E. coli from non-urine, extraintestinal infections in a northern European country. E. coli blood (n?=?196) and paired urine (n?=?195) isolates from the same patients with bacteraemia of urinary tract origin were analysed. The isolates were collected from January 2003 through May 2005 at four hospitals in Copenhagen, Denmark. Pulsed-field gel electrophoresis (PFGE) patterns, antimicrobial resistance and patient characteristics were determined for all CgA isolates; presence of virulence-associated genes (VAGs) and serotypes were determined for the blood CgA isolates. Thirty blood isolates (15%) belonged to CgA. CgA blood isolates were associated with female patients and sulfamethoxazole-trimethoprim resistance and they harboured a distinctive VAG profile. The blood and urine isolates from each pair were found to be related in 26 of 27 CgA blood/urine pairs, confirming a urinary tract origin of infection. Furthermore, a relationship between the PFGE patterns of CgA blood/urine isolates and CgA isolates from UTI patients in general practice and a CgA isolate from a community-dwelling human reported previously, was found, suggesting a community origin of CgA. The finding of CgA strains in 15% of the E. coli bloodstream infections with a urinary tract origin in Denmark suggests that CgA constitutes an important clonal lineage among extraintestinal pathogenic E. coli. A reservoir of this pathogenic E. coli group in the community causing not only UTI but also more severe infections such as bacteraemia has implications for public health.

PMID: 22784317 [PubMed - as supplied by publisher]

Link to Article at PubMed

Seasonality in Gram-negative and healthcare-associated infections.

Clin Microbiol Infect Start a Discussion »

Jul 132012

Seasonality in Gram-negative and healthcare-associated infections.

Clin Microbiol Infect. 2012 Jul 9;

Authors: Richet H

Abstract

Clin Microbiol Infect ABSTRACT: To assess seasonal variations in Gram-negative and healthcare-associated infections (HCAIs), a literature search was performed with combinations of the keywords 'seasonality', 'seasonal variations', 'Gram-negative bacilli', 'infections', 'nosocomial infections', and 'health care associated infections', to retrieve articles published in English in peer-reviewed journals from 1 January 1970 to 29 February 2012. Seasonality was demonstrated for infections, mostly bloodstream infections (BSIs), caused by Acinetobacter spp., Escherichia coli, Enterobacter cloacae, Klebsiella spp., and Pseudomonas aeruginosa, with higher rates of infection during the summer months in North America, Europe, the Middle East, Australia, and Asia. Correlations were observed between temperature increase and rates of BSI for Acinetobacter spp., P. aeruginosa, E. coli, Klebsiella pneumoniae, and extended-spectrum ?-lactamase-producing Enterobacteriaceae. A significant correlation between lower urinary tract infections and higher temperature and decreased relative humidity could explain the seasonality of some BSIs. Regarding HCAI, seasonality is intrinsically present in most viral respiratory and gastrointestinal infections, because viruses are introduced into hospitals during seasonal community outbreaks. Other HCAIs subject to seasonal variations include surgical wound infections, with winter peaks in the USA and summer peaks in Finland, central-line-associated BSIs in haematology/oncology paediatric outpatients, and dialysis-associated peritonitis. In summary, seasonal variations have been shown for infections caused by many Gram-negative bacilli, as well as for a few HCAIs, but many studies remain to be performed in order to better understand the mechanisms of these variations.

PMID: 22784293 [PubMed - as supplied by publisher]

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Clinical, radiological, and laboratory characteristics in pulmonary tuberculosis patients: comparative study of HIV-positive and HIV-negative inpatients at a referral hospital.

J Bras Pneumol Start a Discussion »

Jul 132012

Clinical, radiological, and laboratory characteristics in pulmonary tuberculosis patients: comparative study of HIV-positive and HIV-negative inpatients at a referral hospital.

J Bras Pneumol. 2011 Dec;37(6):768-75

Authors: Besen A, Staub GJ, Silva RM

Abstract

OBJECTIVE: To compare clinical, radiological, and laboratory characteristics of individuals with pulmonary tuberculosis co-infected or not with HIV.

METHODS: A cross-sectional study, in which signs and symptoms were assessed by anamnesis and physical examination in patients hospitalized with pulmonary tuberculosis. The results of sputum smear microscopy and culture for Mycobacterium tuberculosis, as well as hemoglobin levels and CD4+ T-cell counts, were obtained from medical records, and chest X-ray reports were consulted.

RESULTS: We included 50 pulmonary tuberculosis patients, who were divided into two groups (HIV-positive and HIV-negative; n = 25 per group). The mean age of the participants was 38.4 ± 10.5 years; 46 (92%) were males; and 27 (54%) were White. Expectoration was presented by 21 (84%) and 13 (52%) of the patients in the HIV-negative and HIV-positive groups, respectively (p = 0.016). Radiological findings of cavitation were present in 10 (43%) and 2 (10%) of the patients in the HIV-negative and HIV-positive groups, respectively (p = 0.016), whereas an interstitial pattern was observed in 18 (78%) and 8 (40%), respectively (p = 0.012). The mean hemoglobin level was 11.1 ± 2.9 g/dL and 9.3 ± 2.2 g/dL in the HIV-negative and HIV-positive groups, respectively (p = 0.015).

CONCLUSIONS: In our sample of tuberculosis patients, expectoration was less prevalent, hemoglobin levels were lower, and cavitation was less common, as was an interstitial pattern, among those co-infected with HIV than among those without HIV co-infection.

PMID: 22241034 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Risk stratification of spontaneous bacterial peritonitis in cirrhosis with ascites based on classification and regression tree analysis.

mol biol rep Start a Discussion »

Jul 132012

Risk stratification of spontaneous bacterial peritonitis in cirrhosis with ascites based on classification and regression tree analysis.

Mol Biol Rep. 2012 May;39(5):6161-9

Authors: Shi KQ, Fan YC, Ying L, Lin XF, Song M, Li LF, Yu XY, Chen YP, Zheng MH

Abstract

Risk stratification for spontaneous bacterial peritonitis (SBP) in patients with cirrhosis and ascites helps guide care. Existing prediction models, such as end-stage liver disease (MELD) score, are accurate but controversial in clinical practice. We developed and validated a practical user-friendly bedside tool for SBP risk stratification of patients with cirrhosis and ascites. Using classification and regression tree (CART) analysis, a model was developed for prediction of SBP in cirrhosis with ascites. The CART model was derived on data collected from 676 patients admitted from January 2007 to December 2009 retrospectively, and then was prospectively tested in another independent 198 inpatients between January 2010 and December 2010. The accuracy of CART model was evaluated using the area under the receiver operating characteristic curve. The performance of the model was further validated by comparing its predictive accuracy with that of the MELD score. Furthermore, the model was used to stratify SBP among patients with MELD scores under 15. CART analysis identified four variables for prediction of SBP: creatinine, total bilirubin, prothrombin time and white blood cell count, and three risk groups: low (2.0%), intermediate (27.5-33.3%) and high (60.6-86.4%) risk. The accuracy of CART model (0.881) exceeded that of MELD (0.791). Subjects in the intermediate risk and high risk groups had 22.21-fold (95% confident interval (CI), 9.98-49.45) and 173.50-fold (95% CI, 77.68-634.33) increased risk of SBP, respectively, comparing with the low risk group. Similar results were found when this risk stratification was applied to the validation cohort. Cirrhotic patients with ascites at low, intermediate, and high risk for SBP can be easily identified using CART model, which provides clinicians with a validated, practical bedside tool for SBP risk stratification.

PMID: 22205541 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Outcomes of tuberculosis treatment among inpatients and outpatients in the city of São Paulo, Brazil.

J Bras Pneumol Start a Discussion »

Jul 132012

Outcomes of tuberculosis treatment among inpatients and outpatients in the city of São Paulo, Brazil.

J Bras Pneumol. 2011 Dec;37(6):783-90

Authors: Perrechi MC, Ribeiro SA

Abstract

OBJECTIVE: To compare inpatient and outpatient treatment of tuberculosis, in terms of outcomes, in the city of São Paulo, Brazil, as well to determine which variables are most frequently associated with hospitalization.

METHODS: A prospective, longitudinal study carried out between January and December of 2007, at two large hospitals and at outpatient clinics, in two regions of the city of São Paulo. For inpatients, data were collected with a structured questionnaire. Additional data were obtained from the São Paulo State Department of Health Tuberculosis Database.

RESULTS: Of the 474 patients included in the study, 166 were inpatients, and 308 were outpatients. The multivariate analysis showed that hospitalization for tuberculosis was associated with hospital/emergency room diagnosis of tuberculosis (OR = 55.42), with HIV co-infection (OR = 18.57), with retreatment (OR = 18.51), and with having previously sought treatment at another health care facility (OR = 12.32). For the inpatient and outpatient groups, the overall cure rates were 41.6% and 78.3%, respectively, compared with 30.4% and 58.5% for those who were co-infected with HIV, whereas the overall mortality rates were 29.5% and 2.6%, respectively, compared with 45.7% and 9.8% for those who were co-infected with HIV.

CONCLUSIONS: Among inpatients, tuberculosis appears to be more severe and more difficult to diagnose, resulting in lower cure rates and higher mortality rates, than among outpatients. In addition, tuberculosis patients co-infected with HIV have less favorable outcomes.

PMID: 22241036 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Evaluation of Deep Vein Thrombosis With Reduced Radiation and Contrast Material Dose at Computed Tomography Venography.

Circ J Start a Discussion »

Jul 132012

Evaluation of Deep Vein Thrombosis With Reduced Radiation and Contrast Material Dose at Computed Tomography Venography.

Circ J. 2012 Jul 11;

Authors: Oda S, Utsunomiya D, Funama Y, Shimonobo T, Namimoto T, Itatani R, Hirai T, Yamashita Y

Abstract

Background:?Computed tomography venography (CTV) is clinically useful and widely available for the detection of deep vein thrombosis. Disadvantages of CTV are the need for a larger amount of i.v. contrast material (CM) and radiation exposure. A low-tube-voltage technique with iterative reconstruction may overcome this problem. The aim of this study was to investigate the effects of hybrid iterative reconstruction (HIR) on image quality at low-tube-voltage CTV. Methods and Results:?Forty patients (26 women, 14 men; mean age, 59.2±18.3 years) underwent CTV under an 80- or 120-kV protocol (CT dose index volume=10.3mGy vs. 14.9mGy, CM dose=540mgI/kg vs. 690mgI/kg) on a 64-detector CT. Quantitative parameters (ie, venous attenuation, image noise, and contrast-to-noise ratio [CNR]) were calculated and the image quality was scored on a 4-point scale. In step 1, the 80- and 120-kV protocols were compared under filtered back projection (FBP). In step 2, the 80-kV protocol with HIR was compared with the 120-kV protocol with FBP. In step 1, the visual scores were significantly higher under the 120-kV protocol; there was no significant difference in CNR between the protocols. In step 2, CNR was significantly higher under the 80-kV protocol with HIR than the 120-kV protocol with FBP. The visual scores of the 2 protocols were comparable. Conclusions:?The 80-kV CTV with HIR allows for a reduction in the radiation dose by 30% and the CM dose by 20% without image quality degradation.

PMID: 22784997 [PubMed - as supplied by publisher]

Link to Article at PubMed

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