Interventions to improve hand hygiene compliance in patient care

Four studies met the criteria for the review: two from the original review and two from the update. Two studies evaluated simple education initiatives, one using a randomized clinical trial design and the other a controlled before and after design. Both measured hand hygiene compliance by direct observation. The other two studies were both interrupted times series studies. One study presented three separate interventions within the same paper: simple substitutions of product and two multifaceted campaigns, one of which included involving practitioners in making decisions about choice of hand hygiene products and the components of the hand hygiene program. The other study also presented two separate multifaceted campaigns, one of which involved application of social marketing theory. In these two studies follow-up data collection continued beyond 12 months, and a proxy measure of hand hygiene compliance (product use) was recorded. Microbiological data were recorded in one study. Hand hygiene compliance increased for one of the studies where it was measured by direct observation, but the results from the other study were not conclusive. Product use increased in the two studies in which it was reported, with inconsistent results reported for one initiative. MRSA incidence decreased in the one study reporting microbiological data

Effect of the Novel Influenza A (H1N1) Virus in the Human Immune System

BACKGROUND: The pandemic by the novel H1N1 virus has created the need to study any probable effects of that infection in the immune system of the host. METHODOLOGY/PRINCIPAL FINDINGS: Blood was sampled within the first two days of the presentation of signs of infection from 10 healthy volunteers; from 18 cases of flu-like syndrome; and from 31 cases of infection by H1N1 confirmed by reverse RT-PCR. Absolute counts of subtypes of monocytes and of lymphocytes were determined after staining with monoclonal antibodies and analysis by flow cytometry. Peripheral blood mononuclear cells (PBMCs) were isolated from patients and stimulated with various bacterial stimuli. Concentrations of tumour necrosis factor-alpha, interleukin (IL)-1beta, IL-6, IL-18, interferon (FN)-alpha and of IFN-gamma were estimated in supernatants by an enzyme immunoassay. Infection by H1N1 was accompanied by an increase of monocytes. PBMCs of patients evoked strong cytokine production after stimulation with most of bacterial stimuli. Defective cytokine responses were shown in response to stimulation with phytohemagglutin and with heat-killed Streptococcus pneumoniae. Adaptive immune responses of H1N1-infected patients were characterized by decreases of CD4-lymphocytes and of B-lymphocytes and by increase of T-regulatory lymphocytes (Tregs). CONCLUSIONS/SIGNIFICANCE: Infection by the H1N1 virus is accompanied by a characteristic impairment of the innate immune responses characterized by defective cytokine responses to S.pneumoniae. Alterations of the adaptive immune responses are predominated by increase of Tregs. These findings signify a predisposition for pneumococcal infections after infection by H1N1 influenza

Guideline for management of septic arthritis in native joints (SANJO).

This clinical guideline is intended for use by orthopedic surgeons and physicians who care for patients with possible or documented septic arthritis of a native joint (SANJO). It includes evidence and opinion-based recommendations for the diagnosis and management of patients with SANJO

Osteosynthesis-associated infection of the lower limbs by multidrug-resistant and extensively drug-resistant Gram-negative bacteria: a multicentre cohort study

Purpose: The purpose of this study was the clinical and therapeutic assessment of lower-limb osteosynthesis-associated infection (OAI) by multidrug-resistant (MDR) and extensively drug-resistant (XDR) Gram-negative bacteria (GNB), which have been poorly studied to date. Methods: A prospective multicentre observational study was conducted on behalf of ESGIAI (the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Implant-Associated Infections). Factors associated with remission of the infection were evaluated by multivariate and Cox regression analysis for a 24-month follow-up period. Results: Patients (n=57) had a history of trauma (87.7 %), tumour resection (7 %) and other bone lesions (5.3 %). Pathogens included Escherichia coli (n=16), Pseudomonas aeruginosa (n=14; XDR 50 %), Klebsiella spp. (n=7), Enterobacter spp. (n=9), Acinetobacter spp. (n=5), Proteus mirabilis (n=3), Serratia marcescens (n=2) and Stenotrophomonas maltophilia (n=1). The prevalence of ESBL (extended-spectrum β-lactamase), fluoroquinolone and carbapenem resistance were 71.9 %, 59.6 % and 17.5 % respectively. Most patients (n=37; 64.9 %) were treated with a combination including carbapenems (n=32) and colistin (n=11) for a mean of 63.3 d. Implant retention with debridement occurred in early OAI (66.7 %), whereas the infected device was removed in late OAI (70.4 %) (p=0.008). OAI remission was achieved in 29 cases (50.9 %). The type of surgery, antimicrobial resistance and duration of treatment did not significantly influence the outcome. Independent predictors of the failure to eradicate OAI were age &gt;60 years (hazard ratio, HR, of 3.875; 95 % confidence interval, CI95 %, of 1.540–9.752; p=0.004) and multiple surgeries for OAI (HR of 2.822; CI95 % of 1.144–6.963; p=0.024). Conclusions: Only half of the MDR/XDR GNB OAI cases treated by antimicrobials and surgery had a successful outcome. Advanced age and multiple surgeries hampered the eradication of OAI. Optimal therapeutic options remain a challenge.</p

Non-nosocomial healthcare-associated infective endocarditis in Taiwan: an underrecognized disease with poor outcome

<p>Abstract</p> <p>Background</p> <p>Non-nosocomial healthcare-associated infective endocarditis (NNHCA-IE) is a new category of IE of increasing importance. This study described the clinical and microbiological characteristics and outcome of NNHCA-IE in Taiwan.</p> <p>Methods</p> <p>A retrospective study was conducted of all patients with IE admitted to the Kaohsiung Veterans General Hospital in Kaohsiung, Taiwan over a five-year period from July 2004 to July 2009. The clinical and microbiological features of NNHCA-IE were compared to those of community-acquired and nosocomial IE. Predictors for in-hospital death were determined.</p> <p>Results</p> <p>Two-hundred episodes of confirmed IE occurred during the study period. These included 148 (74%) community-acquired, 30 (15%) non-nosocomial healthcare-associated, and 22 (11%) nosocomial healthcare-associated IE. <it>Staphylococcus aureus </it>was the most frequent pathogen. Patients with NNHCA-IE compared to community-acquired IE, were older (median age, 67 vs. 44, years, <it>p </it>< 0.001), had more MRSA (43.3% vs. 9.5%, <it>p </it>< 0.001), more comorbidity conditions (median Charlson comorbidity index [interquartile range], 4[2-6] vs. 0[0-1], <it>p </it>< 0.001), a higher in-hospital mortality (50.0% vs. 17.6%, <it>p </it>< 0.001) and were less frequently recognized by clinicians on admission (16.7% vs. 47.7%, <it>p </it>= 0.002). The overall in-hospital mortality rate for all patients with IE was 25%. Shock was the strongest risk factor for in-hospital death (odds ratio 7.8, 95% confidence interval 2.4-25.2, <it>p </it>< 0.001).</p> <p>Conclusions</p> <p>NNHCA-IE is underrecognized and carries a high mortality rate. Early recognition is crucial to provide optimal management and improve outcome.</p

Importance of the Collagen Adhesin Ace in Pathogenesis and Protection against Enterococcus faecalis Experimental Endocarditis

Ace is an adhesin to collagen from Enterococcus faecalis expressed conditionally after growth in serum or in the presence of collagen. Here, we generated an ace deletion mutant and showed that it was significantly attenuated versus wild-type OG1RF in a mixed infection rat endocarditis model (P<0.0001), while no differences were observed in a peritonitis model. Complemented OG1RFΔace (pAT392::ace) enhanced early (4 h) heart valve colonization versus OG1RFΔace (pAT392) (P = 0.0418), suggesting that Ace expression is important for early attachment. By flow cytometry using specific anti-recombinant Ace (rAce) immunoglobulins (Igs), we showed in vivo expression of Ace by OG1RF cells obtained directly from infected vegetations, consistent with our previous finding of anti-Ace antibodies in E. faecalis endocarditis patient sera. Finally, rats actively immunized against rAce were less susceptible to infection by OG1RF than non-immunized (P = 0.0004) or sham-immunized (P = 0.0475) by CFU counts. Similarly, animals given specific anti-rAce Igs were less likely to develop E. faecalis endocarditis (P = 0.0001) and showed fewer CFU in vegetations (P = 0.0146). In conclusion, we have shown for the first time that Ace is involved in pathogenesis of, and is useful for protection against, E. faecalis experimental endocarditis

The influence of hyperbaric conditions on haematologic parameters

The present study lasted for about three years and concerned ten healthy men ( mean age 26,7) who submitted for 30 min, the so called “ the dry test” of diving that is, going under pressure which correspond to 30m depth of sea water. The trial took place in a decompression champer on the installations of the Greek Navy in Salamina.The aim of this study was the detection of changes in haematologic parameters ( changes of general haematologic parameters as well as changes of the heamostatic mechanism), before, immediately afterwards and 30-45 min after the end of the assay. The haematologic parameters were as following:-haematocrit, haemoglobuln, white blood cell count,platelets, adhesiveness, prothrombin time, activated partial thromboplastin time ( APTT), fibrinogen levels, plasminogen levels, as-antiplasmin levels, Euglobulin clot lysis time ( ECLT), antithrombin III and Protein C levels. The investigation of the occurred changes was based on standardized laboratory methods according to the relative program o the European Union (European Concerted Action on Thrombosis-ECAT).The results of the whole trial could be briefly described as following:a) Increase of the WBC after then end of the assayb) Increase of platelets count after the end of the assayc) A slightly prolonged APTT which does not overcome the limits of the normal deviationd) Increase of fibrinogen immediately after the assay and gradual decrease of its level 30 min afterwardse) Decrease of plasminogen levels after the assay which gradually restore 30 min afterwardsf) Latent ( 30 min after the end of the assay) decrease of a2 antiplasmin levelsg) Increase of antithrombin III levels after the end of the assay which persist 30 min laterh) Latent ( 30 min after then end of the assay) decrease of protein C levelsi) Haematocrit, heamoglobulin, ECLT, Platelet adhesiveness, prothrombin time were not significantly affected in the present study.The above reported changes indicate that in hyperbaric conditions coagulation as well as fibrinolysis are slightly activated in a way that the mechanism of haemostasis is not affected and clinical manifestations are absent. More extended and systematic studies are needed to confirm this observationΗ παρούσα εργασία που διήρκεσε περίπου 3 χρόνια μελέτησε 10 υγιείς ενήλικες νέους άνδρες (μέση ηλικία 26,7 έτη) οι οποίοι υπεβλήθησαν στην λεγόμενη «ξηρά δοκιμασία» κατάδυσης, δηλαδή υπέστησαν πιέσεις που αντιστοιχούν σε πίεση σε 30m βάθος θαλασσινού νερού για 30 min.Η δοκιμασία έλαβε χώρα σε θάλαμο αποσυμπίεσης στις εγκαταστάσεις του Πολεμικού Ναυτικού στο Ναύσταθμο Σαλαμίνας. Σκοπός της εργασίας ήταν η ανεύρεση τυχόν μεταβολών στις αιματολογικές παραμέτρους που αφορούσαν στην γενική αιματολογική εικόνα και στις κύριες φάσεις του μηχανισμού της αιμόστασης, πριν τη δοκιμασία, αμέσως μετά και 45min μετά το πέρας της δοκιμασίας. ΟΙ ελεγχθέντες αιματολογικοί παράμετροι ήταν οι εξής: αιματοκρίτης, αιμοσφαιρίνη, αριθμός λευκών αιμοσφαιρίων, αριθμός αιμοπεταλίων, προσκολλητικότητα αιμοπεταλίων, χρόνος προθρομβίνης, χρόνος μερικής θρομβοπλαστίνης (ΑPTT) ,ινωδογόνο, πλασμινογόνο, α2 αντιπλασμίνη, ECLT (χρόνος λύσεως ευσφαιρινών), αντιθρομβίνη III και πρωτεΐνη C. Η διερεύνηση των τυχόν μεταβολών βασίστηκε σε προτυποποιημένες εργαστηριακές μεθόδους σύμφωνα με το σχετικό πρόγραμμα της Ευρωπαϊκής Ένωσης (European Concerted Action on Thrombosis-ECAT).Από τη μελέτη διαπιστώθηκαν τα παρακάτω:Σε συνθήκες δοκιμασίας «ξηράς κατάδυσης», νέοι υγιείς άνδρες παρουσίασαν στατιστικά σημαντικές μεταβολές που αφορούσαν τις αιματολογικές παραμέτρους ως εξής: α) αύξηση του αριθμού των λευκών αιμοσφαιρίων μετά το τέλος της δοκιμασίας β) Αύξηση του αριθμού των αιμοπεταλίων γ) Μικρή παράταση APTT πάντα μέσα στα όρια της φυσιολογικής διακύμανσης δ) Αύξηση του ινωδογόνου του πλάσματος και στη συνέχεια (30min αργότερα) σταδιακή μείωσή του ε) μείωση του πλασμινογόνου του πλάσματος και στη συνέχεια (μετά από 30min) επάνοδό του στα προ της δοκιμασίας επίπεδα στ) Καθυστερημένη (μετά 30 min) πτώση της τιμής της α2 αντιπλασμίνης ζ) Αύξηση της αντιθρομβίνης III του πλάσματος η οποία συνεχίζει να παραμένει αυξημένη 30min αργότερα η) Καθυστερημένη (μετά 30min) πτώση της τιμής της πρωτεΐνης C θ) οι τιμές του αιματοκρίτη, της αιμοσφαιρίνης, του χρόνου λύσεως ευσφαιρινών (ECLT) καθώς και η προσκολλητικότητα των αιμοπεταλίων και ο χρόνος προθρομβίνης δεν παρουσίασαν στατιστικά σημαντικές μεταβολές στην παρούσα μελέτη.Οι παραπάνω μεταβολές αποτελούν ένδειξη ότι σε συνθήκες υπερβαρικού stress, παρατηρείται μια μικρού βαθμού ενεργοποίηση τόσο του μηχανισμού πήξης όσο και του μηχανισμού ινωδόλυσης η οποία όμως εξισορροπείται και δεν οδηγεί σε παθολογικές μεταβολές. Εκτεταμένες μελέτες πιο συστηματικές απαιτούνται για την τεκμηρίωση αυτής της παρατήρησης

What is new in the management of skin and soft tissue infections in 2016?

Purpose of review Skin and soft tissue infections (SSTIs) are the most frequent infectious cause of referrals to emergency departments and hospital admissions in developed world, contributing to significant morbidity and healthcare expenditures. We sought to review recent literature covering epidemiology and management of SSTIs. Recent findings Incidence trends of SSTIs were increasing worldwide with Staphylococcus aureus and streptococci predominating and methicillin-resistant S. aureus (MRSA) posing additional challenges, because of high rates of treatment failure and relapse. Development of new antimicrobials was associated with an appraisal of regulatory definitions and endpoints. Prediction of clinical response can be very tricky, because of variable risk factors for recurrence or treatment failure, depending mostly on the host. Precise indications for new antimicrobials should be established; their integration into clinical practice algorithms may serve reduction of unnecessary admissions, overtreatment and total costs. Summary New antimicrobials with activity against MRSA have been recently launched. Long-acting agents, mainly oritavancin and dalbavancin, provide the opportunity of single-dose treatment and early discharge. Further outpatient treatment options include new per os antibiotics such as oxazolidinones. Validated assessment tools are urgently needed to support decision-making toward rational resource utilization and delivery of optimal treatment. © 2017 Wolters Kluwer Health, Inc