Rate of Transmission of Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae Without Contact Isolation

The estimated rate of spread of extended-spectrum beta-lactamaseproducing Enterobacteriaceae was low in a tertiary care university-affiliated hospital with high levels of standard hygiene precautions, challenging the routine use of contact isolation in a non-epidemic settin

第750回 千葉医学会例会・第2回 磯野外科例会 3.

<div><p>A broad spectrum of symptoms has been associated with <i>C</i>. <i>difficile</i> infection (CDI). Several studies indicate that toxin-production correlates with growth rates of <i>C</i>. <i>difficile</i>. This study aimed to correlate growth rates of <i>C</i>. <i>difficile</i> with disease severity and strain characteristics. From 01/2003 to 10/2011, strains from a prospective cohort of all inpatients with CDI at the University Hospital Basel, Switzerland were analyzed regarding binary toxin, presence of the tcdC deletion and ribotype. Isothermal microcalorimetry was performed to determine growth rates, quantified by the Gompertz function. Ordered logistic regression models were used to correlate disease severity with strain features and clinical characteristics. Among 199 patients, 31 (16%) were infected with binary toxin-producing strains, of which the tcdC gene-deletion nt117 was detected in 9 (4%). Disease severity was classified as mild in 130 patients (65.3%), as severe in 59 patients (29.7%) and as severe/complicated in 10 patients (5.0%). Growth rates were inversely associated with disease severity in univariable (OR 0.514, 95%CI 0.29–0.91, p = 0.023) and multivariable analyses (OR 0.51, 95%CI 0.26–0.97, p = 0.040). While none of the strain characteristics such as presence of the tcdC gene deletion or binary toxin predicted CDI severity, growth rates were inversely correlated with disease severity. Further investigations are needed to analyze growth-regulators and respective correlations with the level of toxin production in <i>C</i>. <i>difficile</i>, which may be important determinants of disease severity.</p></div

Are persons with fibromyalgia or other musculoskeletal pain more likely to report hearing loss? A HUNT study

Background Leading theories about the pathogenesis of fibromyalgia focus on central nervous dysregulation or sensitization, which can cause altered perception. There is growing evidence that fibromyalgia involves altered perception not only of pain, but also other sensory stimuli. On this basis, we investigated whether individuals with fibromyalgia are more likely to report subjective loss of hearing, adjusted for audiometrically measured loss of hearing, compared to persons without any musculoskeletal pain disorders. In addition, we studied persons with other musculoskeletal pain than fibromyalgia and persons who did not have any musculoskeletal pain. Methods The study includes 44 494 persons from the second health survey in Nord-Trøndelag (HUNT2) who had undergone audiometry and answered a comprehensive questionnaire that mapped fibromyalgia, musculoskeletal pain at various sites and subjective hearing loss. Respondents with other musculoskeletal pain problems than fibromyalgia were divided into two groups with respectively localized and widespread musculoskeletal pain. Data were analyzed with logistic regression models adjusting for age, education, anxiety, depression and hearing thresholds. Results In adjusted analysis, individuals with fibromyalgia had increased likelihood to report subjective hearing loss, compared to persons without fibromyalgia or other musculoskeletal pain (OR 4.578, 95% CI 3.622–5.787 and OR 4.523, 95% CI 3.077–6.647 in women and men). Furthermore, people with local and widespread musculoskeletal pain not diagnosed with fibromyalgia, also had increased likelihood to report subjective hearing loss, compared to people with no musculoskeletal pain. This relationship was greater for widespread pain than for localized pain (OR 1.915, 95% CI 1.627–2.255, and 1.796, 95% CI 1.590–2.029, in women and men with local musculoskeletal pain and OR 3.073, 95% CI 2.668-3.539, OR 3.618, 95% CI 3.225–4.058, in women and men with widespread pain, respectively). Conclusions Our findings are consistent with the hypothesis that fibromyalgia is related to a general dysregulation of the central nervous system. The same might also be the case for other local and, in particular, other widespread, musculoskeletal pain

Prospective Validation of Cessation of Contact Precautions for Extended-Spectrum β-Lactamase–Producing Escherichia coli

After contact precautions were discontinued, we determined nosocomial transmission of extended-spectrum β-lactamase (ESBL)–producing Escherichia coli by screening hospital patients who shared rooms with ESBL-producing E. coli–infected or –colonized patients. Transmission rates were 2.6% and 8.8% at an acute-care and a geriatric/rehabilitation hospital, respectively. Prolonged contact was associated with increased transmission

Analyses of growth rates according to different strain characteristics.

<p>Analyses of growth rates according to different strain characteristics.</p

Associations of strain characteristics with disease severity.

<p>Associations of strain characteristics with disease severity.</p