Antifungal Susceptibilities of Cryptococcus neoformans

Susceptibility profiles of medically important fungi in less-developed countries remain uncharacterized. We measured the MICs of amphotericin B, 5-flucytosine, fluconazole, itraconazole, and ketoconazole for Cryptococcus neoformans clinical isolates from Thailand, Malawi, and the United States and found no evidence of resistance or MIC profile differences among the countries

Secular trends in hospital-acquired Clostridium difficile disease in the United States, 1987-2001

We reviewed Clostridium difficile–associated disease (CDAD) data from the intensive care unit (ICU) and hospital-wide surveillance components of the National Nosocomial Infections Surveillance System hospitals during 1987–2001. ICU CDAD rates increased significantly only in hospitals with 1500 beds ( ) andP!.01 correlated with the duration of ICU stay ( ;). Hospital-wide (non-ICU) rates increased only inrp 0.82 P!.05 hospitals with!250 beds ( ) and in general medicine patients versus surgery patients (). CDADP!.01 P!.0001 predominated in general hospitals versus other facility types, and rates were significantly higher during winter versus nonwinter months (). Thus, prevention efforts should be targeted to high-risk groups in theseP!.01 settings. Clostridium difficile–associated disease (CDAD) is the major hospital-acquired gastrointestinal infection in the United States [1]. Risk factors associated with hospital-acquired CDAD include antimicrobial use, advanced age, laxative use, antineoplastic chemotherapeutic agent use, bowel colonization with C. difficile, production of toxin A, renal insufficiency, or gastrointestinal surgery or procedures [1, 2]. Over the past several years, a wide variety of reports have been published of outbreaks or perceived or real increases in the incidence of CDAD in the United States. Therefore, we conducted this study to determine secular trends in the incidence of CDAD in National Nosocomial Infections Surveillance System (NNIS) hospitals

Blood Culture Contamination in Tanzania, Malawi, and the United States: a Microbiological Tale of Three Cities

We conducted retrospective, comparative analyses of contamination rates for cultures of blood obtained in the emergency rooms of Muhimbili National Hospital (MNH) in Dar es Salaam, Tanzania; Lilongwe Central Hospital (LCH) in central Malawi; and the Duke University Medical Center (DUMC) in the United States. None of the emergency room patients had indwelling intravascular devices at the time that the blood samples for cultures were obtained. In addition, we reviewed the contamination rates for a cohort of patients already hospitalized in the DUMC inpatient medical service, most of whom had indwelling intravascular devices. The bloodstream infection rates among the patients at MNH (n = 513) and LCH (n = 486) were similar (∼28%); the contamination rates at the two hospitals were 1.3% (7/513) and 0.8% (4/486), respectively. Of 54 microorganisms isolated from cultures of blood collected in the DUMC emergency room, 26 (48%) were identified as skin contaminants. Cultures of blood collected in the DUMC emergency room were significantly more likely to yield growth of contaminants than the cultures of blood collected in the emergency rooms at MNH and LCH combined (26/332 versus 11/1,003; P < 0.0001) or collected in the DUMC inpatient medical service (26/332 versus 7/283; P < 0.01). For the MNH and LCH blood cultures, lower contamination rates were observed when skin was disinfected with isopropyl alcohol plus tincture of iodine rather than isopropyl alcohol plus povidone-iodine. In conclusion, blood culture contamination was minimized in sub-Saharan African hospitals with substantially limited resources through scrupulous attention to aseptic skin cleansing and improved venipuncture techniques. Application of these principles when blood samples for culture are obtained in U.S. hospital emergency rooms should help mitigate blood culture contamination rates and the unnecessary microbiology workup of skin contaminants

Tropical diabetic hand syndrome: Risk factors in an adult diabetes population

AbstractObjectives: To determine risk factors for the tropical diabetic hand syndrome, a condition associated with significant morbidity and mortality in Africa.Methods: This was a case-control study of a Tanzanian diabetes population presenting with the syndrome during February 1998 to March 2000. A case patient was defined as any patient with diabetes presenting with hand cellulitis, ulceration, or gangrene. Control patients were randomly selected patients with diabetes who had no hand symptoms.Results: Thirty-one case patients and 96 control patients were identified. The median age of case patients was 52 years (range, 28–76 y); 58% were male; 4 patients (16%) died. Precipitating events included papule (n = 6), insect bites (n = 6), boils (n = 5), burns (n = 2), or trauma (n = 3). Case and control patients were similar for presence of micro- and macrovascular disease and occupation. On logistic regression analysis, independent risk factors were body mass index of 20 or less (odds ratio [OR] = 18.0; 95% confidence interval [CI] = 4.3−97.0; P < 0.001), peripheral neuropathy (OR = 23.0; 95% Cl = 5.3−124.0; P < 0.001), or type I diabetes, (OR = 6.7; 95% Cl = 2.0−24.0, P < 0.01).Conclusion: The major risk factors for the tropical diabetic hand syndrome are intrinsically related to the underlying disease. Thus, prevention of hand infections may require aggressive glucose control, and education on hand care and the importance of seeing a doctor promptly at the onset of symptoms

Disseminated Nocardia beijingensis Masquerading as Pulmonary Tuberculosis in a Patient With Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome

Case of disseminated Nocardia beijingensis , initially diagnosed and treated by health department as tuberculosis, presented with worsening symptoms and new lesions. Adjustment to antinocardial treatment resulted in significant clinical and radiographic improvement. Maintain a high index of suspicion for Nocardia in patients diagnosed with tuberculosis with worsening lesions despite therapy