Effect of Duplicate Isolates of Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus on Antibiogram Data

This is the published version, also available here: http://www.dx.doi.org/10.1128/JCM.41.10.4611-4616.2003

Nationwide antibiogram analysis using NCCLS M39-A guidelines

This is the published version, also available here: http://dx.doi.org/10.1128/JCM.43.6.2629-2634.2005.Lack of standardization in antibiogram (ABGM) preparation (the overall profile of antimicrobial susceptibility results of a microbial species to a battery of antimicrobial agents) has not been addressed until recently. The objective of this study was to analyze current antibiograms using the recently published NCCLS M39-A guidelines for preparation of antibiograms to identify areas for improvement in the reporting of antibiogram susceptibility data. Antibiograms from across the United States were obtained by various methods, including direct mailings, Internet searches, and professional contacts. Each ABGM collected was analyzed using prospectively defined elements from the M39-A guidelines. Additionally, seven quality indicators were also evaluated to look for the reporting of any atypical or inappropriate susceptibility data. The 209 antibiograms collected from 149 institutions showed at least 85% compliance to 5 of the 10 M39-A elements analyzed. Clinically relevant elements not met included annual analysis, duplicate isolate notation, and the exclusion of organisms with fewer than 10 isolates. As for the quality indicators evaluated, unexpected results included the 7% of antibiograms that reported 0% ampicillin susceptibility for Klebsiella pneumoniae. These findings suggest that antibiograms should be reviewed thoroughly by infectious disease specialists (physicians and pharmacists), clinical microbiologists, and infection control personnel for identification of abnormal findings prior to distribution

Acute Viral Hepatitis A – Clinical, Laboratory and Epidemiological Characteristics

Background and Aims: Infection with hepatitis A virus is still one of the most common causes of hepatitis worldwide. The clinical manifestation of acute hepatitis A (AHA) in adults can vary greatly, ranging from asymptomatic infection to severe and fulminant hepatitis. The aim of this study was to describe the demographic, clinical characteristics, laboratory features and hospital outcome of adult patients with AHA over a consecutive period of 4 years within an area from Eastern European country. Methods: Two hundred and two adult patients diagnosed with AHA were retrospective, observational and analytic analized over a period of 4 years. Based on prothrombin time less than 50, the study group was stratified in medium (79.2%) and severe forms (20.8%). We investigated the clinical, laboratory and epidemiological features. Statistical analysis were applied to compare the medium and severe forms of AHA. Results: Most patients (72.7%) were younger than 40 years. The main symptoms included: dyspepsia (72.07%), jaundice (86.63%), asteno-adynamia (86.72%), and flu-like symptoms (53.46%). The hemorrhagic cutaneous-mucous manifestations (6.93%) associated with the severe forms of AHA (OR =12.19, 95%CI -3.59 - 41.3, p =0.001). We found statistically significant differences for PT (p <0.001), INR (p <0.001), TQ (p <0.001), ALAT (p <0.001), ASAT (p <0.001), ALP (p <0.001) and platelets (p =0.009) between severe and medium AHA forms. We found that TQ, INR, ALAT and ASAT have the highest diagnostic values, statistically significant (p <0.05 ) for severe AHA forms with AUC (0.99, 0.99, 0.72, 0.70) at values of sensitivity (95%, 90.5%, 89%, 95%) and specificity (98%, 99%, 88%,94%). Conclusions Medium severity AHA forms were found in most of the study group patients (79.2%). The severe AHA forms were associated with hemorrhagic cutaneous-mucous manifestations (OR =12.19, p =0.001). The univariate analysis proved a negatively statistically significant correlation between IP and ALAT, ASAT. The present study revealed that TQ, INR and ALAT have the highest diagnostic values and are statistically significant for severe AHA forms

A fotonszámláló detektoros CT működési alapelve, előnyei és jelentősége a klinikai gyakorlatban = Photoncounting-detector CT: Basic principles, advantages and implications in clinical practice

Az elmúlt évtizedben fizikai és preklinikai vizsgálatokkal igazolták az alapjaiban új típusú, fotonszámláló komputertomográfiás (CT) detektor kiváló képalkotási tulajdonságait, míg napjainkban a páréves klinikai felhasználás egyre szélesebb körű tapasztalatait veszik számba. A klinikai gyakorlatban elterjedt, hagyományos CT-berendezésekben energiaintegráló detektorok (EID) találhatók, melyek indirekt konverziós technológiával alakítják át a röntgenfotonok energiáját elektromos jellé. Ezzel ellentétben a fotonszámláló CT detektorai (PCD) közvetlenül és magasabb hatásfokkal képesek elektromos jellé alakítani a röntgenfotonok energiáját, megszámlálni az egyes röntgenfotonok által létrehozott töltéseket és mérni azok energiaszintjét. Az új PCD-technológia számos előnyt nyújt a hagyományos EID-technológiával összevetve: egyrészt kisebb sugárterhelés mellett jobb térbeli felbontású, kedvezőbb jel/zaj arányú, kevesebb sugárkeményedési („beam-hardening”) műterméket tartalmazó és alacsonyabb elektronikus zajjal terhelt CT-képeket hoz létre, másrészt lehetővé teszi a spektrális képalkotást, valamint csökkentett dózisú kontrasztanyag alkalmazására is lehetőséget ad. Összefoglaló közleményünk a PCD-CT műszaki és fizikai alapelveit ismerteti, valamint áttekintést nyújt annak előnyeiről és a klinikai gyakorlatban való felhasználásáról. | Over the last decade, an esentially new type of computed tomography (CT) detector, namely the photoncounting detector has demonstrated its superior capabilities over traditional CT detectors in both physical and preclinical evaluations, while is now at the stage of early clinical experiences. Conventional CT scanners available today for routine clinical practice use energy integrated detectors (EID) which rely on indirect conversion technology. In contrary, the newly-introduced photon-counting detectors (PCD) utilize a direct conversion method allowing to count the number of x-ray photons and carry detailed information about the energy level of each individual x-ray photon. Due to the fundamental changes in the physical mechanisms responsible for photon detection and signal creation, PCDs have several benefits over traditional CT detectors. In comparison to current CT technology, PCDCT can produce better spatial resolution, reduced electronic noise with a higher contrast-to-noise ratio, reduced beam-hardening and metal artifacts. Furthermore, from the spectral information, this new technology is capable to reconstruct virtual monoenergetic images and optimize iv. contrast agent dose. In our current review article, technical principles and physics of PCDs and, in addition, early clinical experiences with their applications are summarized

Comparative effectiveness of initial computed tomography and invasive coronary angiography in women and men with stable chest pain and suspected coronary artery disease: multicentre randomised trial

To assess the comparative effectiveness of computed tomography and invasive coronary angiography in women and men with stable chest pain suspected to be caused by coronary artery disease

Effect of Duplicate Isolates of Methicillin-Susceptible and Methicillin-Resistant Staphylococcus aureus on Antibiogram Data

Duplicate Staphylococcus aureus isolates were analyzed to determine the impact of multiple isolates from the same patient on annual antibiogram data. During a 6-year period (1996 to 2001), 3,227 patients with 4,844 S. aureus isolates were evaluated. A total of 39% of patients with methicillin-resistant S. aureus (MRSA) (n = 860) and 23% of patients with methicillin-susceptible S. aureus (MSSA) (n = 2,367) infections had duplicate isolates. Cumulative data show that 91% of the patients during this 6-year period with duplicate isolates (2 to 13 duplicates/year) did not switch between MSSA and MRSA but retained the original S. aureus strain whether it was MSSA or MRSA. Rates of MRSA were calculated for each year by using all isolates and then eliminating duplicates. The impact of duplicate MRSA and MSSA isolates was evaluated by using the ratio of isolates per patient such that ratios of >1.0 indicate >1 isolate per patient. The 6-year ratio for MRSA was 1.90 isolates/patient, and the ratio for MSSA was 1.35. A significant difference (P < 0.05) was noted in the MRSA rates in 4 of 6 years when duplicate isolates were removed. Common phenotypic antibiogram patterns were compared for all MRSA isolates during the 6-year period, and 64% were of a single antibiogram phenotype. Eighty-eight percent of patients with duplicate MRSA isolates had phenotypically identical multiple isolates. The rate of MRSA differs when duplicate isolates are removed from the antibiogram data

Nationwide Antibiogram Analysis Using NCCLS M39-A Guidelines

Lack of standardization in antibiogram (ABGM) preparation (the overall profile of antimicrobial susceptibility results of a microbial species to a battery of antimicrobial agents) has not been addressed until recently. The objective of this study was to analyze current antibiograms using the recently published NCCLS M39-A guidelines for preparation of antibiograms to identify areas for improvement in the reporting of antibiogram susceptibility data. Antibiograms from across the United States were obtained by various methods, including direct mailings, Internet searches, and professional contacts. Each ABGM collected was analyzed using prospectively defined elements from the M39-A guidelines. Additionally, seven quality indicators were also evaluated to look for the reporting of any atypical or inappropriate susceptibility data. The 209 antibiograms collected from 149 institutions showed at least 85% compliance to 5 of the 10 M39-A elements analyzed. Clinically relevant elements not met included annual analysis, duplicate isolate notation, and the exclusion of organisms with fewer than 10 isolates. As for the quality indicators evaluated, unexpected results included the 7% of antibiograms that reported <100% vancomycin susceptibility for Staphylococcus aureus, 24% that had inconsistent beta-lactam susceptibility for Staphylococcus aureus, 20% that reported <100% imipenem susceptibility for Escherichia coli, and 37% that reported >0% ampicillin susceptibility for Klebsiella pneumoniae. These findings suggest that antibiograms should be reviewed thoroughly by infectious disease specialists (physicians and pharmacists), clinical microbiologists, and infection control personnel for identification of abnormal findings prior to distribution

Toxoplasmosis Screening during Pregnancy in a Romanian Infectious Diseases Tertiary Center: Results of a 15 Years Follow-Up Program

Maternal infection with Toxoplasma gondii during pregnancy may have serious consequences for the fetus. In Romania, screening for toxoplasmosis is included in the first antenatal visit. A retrospective study was performed on all toxoplasmosis antenatal screening patients between May 2008 and February 2023. Twenty-seven thousand one hundred sixty-nine (27,169) pregnant women presented for prenatal screening once (22,858) or several times: during the same pregnancy (209) or during multiple pregnancies (4102). Thirty-one thousand six hundred fifty-eight (31,658) tests for IgM and IgG antibodies were performed. Nine thousand eighty-three (9083) tests (28.69%), corresponding to 7911 women (29.12%), were positive for IgG antibodies. The seroprevalence increased with patients’ age, decreased in time intervals, and was more frequently associated with rural residence. At risk for acquiring the infection during the pregnancy were women with negative anti-Toxoplasma IgG antibodies (70.88%), but only 0.9% of them presented for rescreening during the same pregnancy. Acute Toxoplasma infection (ATI) was suspected in 44 patients (0.16%) due to IgG seroconversion and/or low or borderline IgG avidity. A questionnaire follow-up interview was performed, and no congenital toxoplasmosis was identified in children born from mothers with probable ATI. Our study demonstrates poor compliance with the screening program in the Romanian population