Procalcitonin is useful in identifying bacteraemia among children with pneumonia

Empirical antibiotic use is prescribed in managing children with pneumonia worldwide. We assessed the usefulness of procalcitonin (PCT) and interferon-alpha (IFN-alpha) in differentiating viral from bacterial pneumonia. Among 159 hospitalized children, pneumonia was diagnosed based on clinical complaints plus pulmonary infiltrate. Aetiology was investigated for 9 viruses and 4 atypical and 3 typical bacteria. PCT and IFN-alpha were measured in the serum sample collected on admission. Eight patients had bacteraemic infections, 38 had non-bacteraemic typical infections, and 19 patients had atypical bacterial infections. Viral and unknown aetiology was established in 57 (36%) and 34 (21%) cases, respectively. Three patients with bacterial infection without collected blood culture were excluded. IFN-alpha (IU/ml) was detectable in 20 (13%) cases. The difference among median PCT values of the bacteraemic (4.22; 1.56-7.56), non-bacteraemic typical bacterial (1.47; 0.24-4.07), atypical bacterial (0.18; 0.06-1.03) and only viral (0.65; 0.11-2.22) subgroups was significant (p = 0.02). PCT was >= 2 ng/ml in 52 (33%) cases. The presence of IFN-alpha was associated with PCT <2 ng/ml (90% vs. 64%, p = 0.02). The negative predictive value (95% confidence interval) of PCT >= 2 ng/ml was 95% (89-100%), 89% (78-100%), 93% (85-100%) for differentiation of bacteraemic from viral, atypical bacterial and non-bacteraemic typical bacterial infection, respectively, and 58% (49-68%) for differentiation between bacterial and viral infection. PCT may be useful in identifying bacteraemia among children hospitalized with community-acquired pneumonia. IFN-alpha was uncommonly detected.

Incid��ncia de infec����o por Legionella pneumophila em pacientes que internaram no HCPA com pneumonia adquirida na comunidade

Introdu����o: O diagn��stico microbiol��gico da infec����o por Legionella �� complexo, pois a bact��ria n��o �� visualizada �� colora����o de Gram no escarro, e sua cultura n��o �� realizada na maioria dos laborat��rios cl��nicos. A imunofluoresc��ncia direta nas secre����es respirat��rias tem baixa sensibilidade, em torno de 40% e a t��cnica da ���PCR��� n��o �� ainda recomendada para o diagn��stico cl��nico (CDC, 1997). A detec����o de anticorpos no soro �� a t��cnica mais utilizada, e o crit��rio definitivo �� a soroconvers��o para no m��nimo 1:128, cuja sensibilidade �� de 70 a 80% (Edelstein, 1993). Como crit��rios diagn��sticos de poss��vel pneumonia por Legionella, eram utilizados: t��tulo ��nico de anticorpos a L pneumophila positivo na dilui����o 1:256, em paciente com quadro cl��nico compat��vel (CDC, 1990) e o achado de ant��geno a Legionella na urina (WHO, 1990). Nos ��ltimos anos, por��m, com o uso crescente do teste de antigen��ria, foram detectados casos de pneumonia por Legionella, que n��o eram diagnosticados por cultura ou sorologia, tornando-o m��todo diagn��stico de certeza para o diagn��stico de pneumonia por Legionella (CDC, 1997). Por sua f��cil execu����o, resultado imediato, e alta sensibilidade - de 86% a 98% (Kashuba & Ballow, 1986; Harrison & Doshi, 2001), tem sido recomendado para o diagn��stico das PAC que necessitam interna����o hospitalar (Mulazimoglu & Yu, 2001; Gupta et al., 2001; Marrie, 2001), especialmente em UTI (ATS, 2001). V��rios estudos documentaram baixo valor preditivo positivo do t��tulo ��nico positivo de 1:256, tornando-o sem valor para o diagn��stico da pneumonia por Legionella, exceto, talvez, em surtos (Plouffe et al., 1995). Outros detectaram alta preval��ncia de anticorpos positivos na dilui����o 1:256 na popula����o, em pessoas normais (Wilkinson et al., 1983; Nichol et al., 1991). A partir de 1996, o CDC de Atlanta recomendou que n��o seja mais utilizado o crit��rio de caso prov��vel de infec����o por Legionella pneumophila por t��tulo ��nico de fase convalescente ���1:256, por falta de especificidade(CDC, 1997). A pneumonia por Legionella �� raramente diagnosticada, e sua incid��ncia �� subestimada. Em estudos de PAC, a incid��ncia da pneumonia por Legionella nos EUA, Europa, Israel e Austr��lia, foi estimada entre 1% a 16% (Muder & Yu, 2000). Nos EUA, foi estimado que cerca de 8 000 a 23 000 casos de PAC por Legionella ocorrem anualmente, em pacientes que requerem hospitaliza����o (Marston et al., 1994 e 1977). No Brasil, a incid��ncia de PAC causadas por Legionella em pacientes hospitalizados �� tema de investiga����o pertinente, ainda n��o relatado na literatura. Objetivo: detectar a incid��ncia de pneumonias causadas por Legionella pneumophila sorogrupos 1 a 6, em pacientes que internaram no Hospital de Cl��nicas de Porto Alegre por PAC, por um ano. Material e M��todos: o delineamento escolhido foi um estudo de coorte (de incid��ncia), constitu��da por casos consecutivos de pneumonia adquirida na comunidade que internaram no HCPA de 19 de julho de 2000 a 18 de julho de 2001. Para a identifica����o dos casos, foram examinados diariamente o registro computadorizado das interna����es hospitalares, exceto as interna����es da pediatria e da obstetr��cia, sendo selecionados todos os pacientes internados com o diagn��stico de pneumonia e de insufici��ncia respirat��ria aguda. Foram exclu��dos aqueles com menos de 18 anos ou mais de 80 anos; os procedentes de institui����es, HIV-positivos, gestantes, pacientes restritos ao leito; e portadores de doen��a estrutural pulmonar ou traqueostomias. Foram exclu��dos os pacientes que tivessem tido alta hospitalar nos ��ltimos 15 dias, e aqueles j�� inclu��dos no decorrer do estudo. Os pacientes selecionados foram examinados por um pesquisador, e inclu��dos para estudo se apresentassem infiltrado ao RX de t��rax compat��vel com pneumonia, associado a pelo menos um dos sintomas respirat��rios maiores (temperatura axilar > 37,8��C, tosse ou escarro; ou dois sintomas menores (pleurisia, dispn��ia, altera����o do estado mental, sinais de consolida����o �� ausculta pulmonar, mais de 12 000 leuc��citos/mm3). O estudo foi previamente aprovado pela Comiss��o de ��tica em Pesquisa do HCPA. Os pacientes eram entrevistados por um pesquisador, dando seu consentimento por escrito, e ent��o seus dados cl��nicos e laboratoriais eram registrados em protocolo individual. N��o houve interfer��ncia do pesquisador, durante a interna����o, exceto pela coleta de urina e de sangue para exame laboratoriais espec��ficos da pesquisa. Os pacientes eram agendados, no ambulat��rio de pesquisa, num prazo de 4 a 12 semanas ap��s sua inclus��o no estudo, quando realizavam nova coleta de sangue, RX de t��rax de controle, e outros exames que se fizessem necess��rios para esclarecimento diagn��stico.Todos os pacientes foram acompanhados por 1 ano, ap��s sua inclus��o no estudo.Foram utilizadas a t��cnica de imunofluoresc��ncia indireta para detec����o de anticorpos das classes IgG, IgM e IgA a Legionella pneumophila sorogrupos 1 a 6 no soro, em duas amostras, colhidas, respectivamente, na 1�� semana de interna����o e depois de 4 a 12 semanas; e a t��cnica imunol��gica por teste ELISA para a detec����o do ant��geno de Legionella pneumophila sorogrupo 1 na urina, colhida na primeira semana de interna����o. As urinas eram armazenadas, imediatamente ap��s sua coleta, em freezer a ���70��C, e depois descongeladas e processadas em grupos de cerca de 20 amostras. A imunofluoresc��ncia foi feita no laborat��rio de doen��as Infecciosas da Universidade de Louisville (KY, EUA), em amostras de soro da fase aguda e convalescente, a partir da dilui����o 1:8; e a detec����o do ant��geno de Legionella pneumophila sorogrupo 1, nas amostras de urina, foi realizada no laborat��rio de pesquisa do HCPA, pelos investigadores, utilizando um kit comercial de teste ELISA fabricado por Binax (Binax Legionella Urinary Enzyme Assay, Raritan, EUA). As urinas positivas eram recongeladas novamente, para serem enviadas para confirma����o no mesmo laborat��rio americano, ao fim do estudo. Foram adotados como crit��rios definitivos de infec����o por Legionella pneumophila sorogrupos 1 a 6, a soroconvers��o (eleva����o de 4 vezes no t��tulo de anticorpos s��ricos entre o soro da fase aguda e da fase convalescente para no m��nimo 1:128); ou o achado de ant��geno de L pneumophila sorogrupo 1 na urina n��o concentrada, numa raz��o superior a 3, conforme instru����es do fabricante e da literatura.Os pacientes foram classificados, de acordo com suas caracter��sticas cl��nicas, em 1��) portadores de doen��as cr��nicas (doen��as pulmonares, card��acas, diabete mellitus, hepatopatias e insufici��ncia renal); 2��) portadores de doen��as subjacentes com imunossupress��o; 3��) pacientes h��gidos ou com outras doen��as que n��o determinassem insufici��ncia org��nica. Imunossupress��o foi definida como esplenectomia, ser portador de neoplasia hematol��gica, portador de doen��a auto-imune, ou de transplante; ou uso de medica����o imunossupressora nas 4 semanas anteriores ao diagn��stico (Yu et al., 2002b); ou uso de prednisolona 10 mg/dia ou equivalente nos ��ltimos 3 meses (Lim et al., 2001). As caracter��sticas cl��nicas e laboratoriais dos pacientes que evolu��ram ao ��bito por pneumonia foram comparados ��quelas dos pacientes que obtiveram cura. Para a an��lise das vari��veis categ��ricas, utilizou-se o teste qui-quadrado de Pearson ou teste exato de Fisher. Para as vari��veis num��ricas cont��nuas, utilizou-se o teste ���t��� de Student. Um valor de p< 0,05 foi considerado como resultado estatisticamente significativo (programas SPSS, vers��o 10). Foi calculada a freq����ncia de mortes por pneumonia na popula����o estudada, adotando-se a alta hospitalar como crit��rio de cura. Foi calculada a incid��ncia cumulativa para pneumonia por Legionella pneumophila sorogrupos 1 a 6, em um hospital geral, no per��odo de 1 ano. Resultados: durante um ano de estudo foram examinados 645 registros de interna����o, nos quais constavam, como motivo de baixa hospitalar, o diagn��stico de pneumonia ou de insufici��ncia respirat��ria aguda; a maioria desses diagn��sticos iniciais n��o foram confirmados. Desses 645 pacientes, foram inclu��dos no estudo 82 pacientes, nos quais os crit��rios cl��nicos ou radiol��gicos de pneumonia foram confirmados pelos pesquisadores. Durante o acompanhamento desses pacientes, por��m, foram exclu��dos 23 pacientes por apresentarem outras patologias que mimetizavam pneumonia: DPOC agudizado (5), insufici��ncia card��aca (3), tuberculose pulmonar (2), colagenose (1), fibrose pulmonar idiop��tica (1), edema pulmonar em paciente com cirrose (1), somente infec����o respirat��ria em paciente com sequelas pulmonares (4); ou por apresentarem crit��rios de exclus��o: bronquiectasias (4), HIV positivo (1), pneumatocele pr��via (1). Ao final, foram estudados 59 pacientes com pneumonia adquirida na comunidade, sendo 20 do sexo feminino e 39 do sexo masculino, com idade entre 24 e 80 anos (m��dia de 57,6 anos e desvio padr��o de ��10,6). Tivemos 36 pacientes com doen��as subjacentes classificadas como ���doen��as cr��nicas���, dos quais 18 pacientes apresentavam mais de uma co-morbidade, por ordem de preval��ncia: doen��as pulmonares, card��acas, diabete mellitus, hepatopatias e insufici��ncia renal; neoplasias ocorreram em 9 pacientes, sendo s��lidas em 7 pacientes e hematol��gicas em 2. Dos 59 pacientes, 61% eram tabagistas e 16,9%, alcoolistas. Do total, 10 pacientes apresentavam imunossupress��o. Dos demais 13 pacientes, somente um era previamente h��gido, enquanto os outros apresentavam tabagismo, sinusite, anemia, HAS, gota, ou arterite de Takayasu. A apresenta����o radiol��gica inicial foi broncopneumonia em 59,3% dos casos; pneumonia alveolar ocorreu em 23,7% dos casos, enquanto ambos padr��es ocorreram em 15,2% dos pacientes. Pneumonia intersticial ocorreu em somente um caso, enquanto broncopneumonia obstrutiva ocorreu em 5 pacientes (8,5%). Derrame pleural ocorreu em 22% dos casos, e em 21 pacientes (35%) houve comprometimento de mais de um lobo ao RX de t��rax. Foram usados beta-lact��micos para o tratamento da maioria dos pacientes (72,9%9). A segunda classe de antibi��ticos mais usados foi a das fluoroquinolonas respirat��rias, que foram receitadas para 23 pacientes (39,0%), e em 3�� lugar, os macrol��deos, usados por 11 pacientes (18,6%). Apenas 16 pacientes n��o usaram beta-lact��micos, em sua maioria recebendo quinolonas ou macrol��deos. Dos 43 pacientes que usaram beta-lact��micos, 25 n��o usaram nem macrol��deos, nem quinolonas. Em 13 pacientes as fluoroquinolonas respirat��rias foram as ��nicas drogas usadas para o tratamento da pneumonia. Do total, 8 pacientes foram a ��bito por pneumonia; em outros 3 pacientes, o ��bito foi atribu��do a neoplasia em est��gio avan��ado. Dos 48 pacientes que obtiveram cura, 33 (68,7%) estavam vivos ap��s 12 meses. Os resultados da compara����o realizada evidenciaram tend��ncia a maior mortalidade no sexo masculino e em pacientes com imunossupress��o, por��m essa associa����o n��o alcan��ou signific��ncia estat��stica. Os pacientes que usaram somente beta-lact��micos n��o apresentaram maior mortalidade do que os pacientes que usaram beta-lact��micos associados a outras classes de antibi��ticos ou somente outras classes de antibi��ticos. Examinando-se os pacientes que utiizaram macrol��deos ou quinolonas em seu regime de tratamento, isoladamente ou combinados a outros antibi��ticos, observou-se que tamb��m n��o houve diferen��a dos outros pacientes, quanto �� mortalidade. Os pacientes com padr��o radiol��gico de pneumonia alveolar tiveram maior mortalidade, e essa diferen��a apresentou uma signific��ncia lim��trofe (p= 0,05). Nossa mortalidade (11,9%) foi similar �� de Fang et al. (1990), em estudo cl��ssico de 1991 (13,7%); foi tamb��m similar �� m��dia de mortalidade das PAC internadas n��o em UTI (12%), relatada pela ATS, no seu ��ltimo consenso para o tratamento emp��rico das PAC (ATS, 2001). Foram detectados 3 pacientes com pneumonia por Legionella pneumophila sorogrupo 1 na popula����o estudada: 2 foram diagnosticados por soroconvers��o e por antigen��ria positiva, e o 3�� foi diagnosticado somente pelo crit��rio de antigen��ria positiva, tendo sorologia negativa, como alguns autores (McWhinney et al., 2000). Dois pacientes com PAC por Legionella n��o responderam ao tratamento inicial com beta-lact��micos, obtendo cura com levofloxacina; o 3�� paciente foi tratado somente com betalact��micos, obtendo cura. Conclus��es: A incid��ncia anual de PAC por Legionella pneumophila sorogrupos 1 a 6, no HCPA, foi de 5,1%, que representa a incid��ncia anual de PAC por Legionella pneumophila sorogrupos 1 a 6 em um hospital geral universit��rio. Coment��rios e Perspectivas: H�� necessidade de se empregar m��todos diagn��sticos espec��ficos para o diagn��stico das pneumonias por Legionella em nosso meio, como a cultura, a sorologia com detec����o de todas as classes de anticorpos, e a detec����o do ant��geno urin��rio, pois somente com o uso simult��neo de t��cnicas complementares pode-se detectar a incid��ncia real de pneumonias causadas tanto por Legionella pneumophila, como por outras esp��cies. A detec����o do ant��geno de Legionella na urina �� o teste diagn��stico de maior rendimento, sendo recomendado seu uso em todas as PAC que necessitarem interna����o hospitalar (Mulazimoglu & Yu, 2001; Gupta et al., 2001); em todos os pacientes com PAC que apresentarem fatores de risco potenciais para legionelose (Marrie, 2001); e para o diagn��stico etiol��gico das pneumonias graves (ATS, 2001). Seu uso �� indicado, com unanimidade na literatura, para a pesquisa de legionelose nosocomial e de surtos de legionelose na comunidade.

Polyclonal endemicity of Pseudomonas aeruginosa in a teaching hospital from Brazil: molecular typing of decade-old strains

Funda����o de Amparo �� Pesquisa do Estado de S��o Paulo (FAPESP)

Human respiratory syncytial virus in children hospitalized for acute lower respiratory infection

Funda����o de Amparo �� Pesquisa do Estado de S��o Paulo (FAPESP)

Molecular fingerprinting methods for the discrimination between C-albicans and C-dubliniensis

Opportunistic fungal pathogens are becoming increasingly important causes of both community-acquired and nosocomial infections. The most important fungal pathogens are yeast species belonging to the genus Candida. These species show differences in levels of resistance to antifungal agents and mortality. Consequently, it is important to correctly identify the causative organism to the species level. Identification of Candida dubliniensis in particular remains problematic because of the high degree of phenotypic similarity between this species and Candida albicans. However, as the differences between both are most pronounced at the genetic level, several studies have been conducted in order to provide a specific and rapid identification fingerprinting molecular test. In most candidal infectious, no single DNA fingerprinting technique has evolved as a dominant method, and each method has its advantages, disadvantages and limitations. Moreover, the current challenge of these techniques is to compile standardized patterns in a database for interlaboratory use and future reference. This review provides an overview of most common molecular fingerprinting techniques currently available for discrimination of C. albicans and C. dubliniensis.

Ocorr��ncia de infec����o urin��ria em pacientes de um hospital universit��rio

Infection in hospitals is a serious problem for the Public Health System. It is responsible for the increasing number of hospital deaths, as well as the longer time patients may have to stay in hospital, raising the costs of confinement more and more. The most common hospital infection is urinary tract infections (UTI), the use of the urinary catheter being the main risk factor. The aim of this study was to evaluate the profile of UTI among hospitalized patients in a University Hospital in Brazil, from October to December 2003. Out of 271 samples of urine checked, 51 were positive, 27 of these from patients having community-acquired UTI and 24 whose infection originated in the hospital. The community-acquired UTIs were more frequent in female patients (63%). The highest incidence of infection was caused by Escherichia coli (74%), especially in patients aged from 0 to 15 (37%). The episodes of hospital-acquired infection happened, in the main, in male patients aged above 50 (68%) who were using a lasting vesical catheter; in this group of patients the infection was frequently caused by E. coli (29.1%) and Klebsiella spp. (29.1%). E. coli and Klebsiella pneumoniae exhibited strong resistance (62.5%) to trimethoprim-sulfamethoxazole, as well as to ampicillin, showing that these drugs should not be used to cure UTIs in this institution.

Caracteriza����o da resist��ncia �� oxacilina em Staphylococcus aureus isolados de feridas de pacientes atendidos em Unidades B��sicas de Sa��de da cidade de Botucatu

Coordena����o de Aperfei��oamento de Pessoal de N��vel Superior (CAPES)

Isolamento e caracteriza����o de amostras comunit��rias Staphylococcus aureus resistente �� Meticilina (CA-MRSA) em uma popula����o carcer��ria no munic��pio de Avar��

Coordena����o de Aperfei��oamento de Pessoal de N��vel Superior (CAPES)

Compara����o da efic��cia cl��nica da associa����o amoxicilina e ��cido clavul��nico com oxacilina e ceftriaxone para tratamento hospitalar de pneumonia comunit��ria grave em crian��as: estudo cl��nico randomizado

Coordena����o de Aperfei��oamento de Pessoal de N��vel Superior (CAPES)

Infec����o viral respirat��ria comunit��ria e hospitalar em pacientes submetidos a transplante de c��lulas tronco hematopoi��ticas

P��s-gradua����o em Pesquisa e Desenvolvimento (Biotecnologia M��dica) - FMB

Streptococcus pneumoniae: susceptibility to penicillin and moxifloxacin

Objective: To determine the minimum inhibitory concentrations (MICs) of parenteral penicillin and moxifloxacin against Streptococcus pneumoniae strains isolated at a hospital center. Methods: In-vitro, prospective study involving 100 S. pneumoniae isolates collected from patients who had been treated, between October of 2008 and July of 2010, at the Hospital das Clinicas complex of the University of Sao Paulo School of Medicine, located in the city of Sao Paulo, Brazil. The isolates were obtained from respiratory tract cultures or blood samples unrelated to meningeal infections, and they were tested for penicillin and moxifloxacin susceptibility by E-test. The MIC category interpretations were based on updated standards. Results: All isolates were fully susceptible to parenteral penicillin (MIC &lt;= 2 mu g/mL), and, consequently, they were also susceptible to amoxicillin, ampicillin, third/fourth generation cephalosporins, and ertapenem. Of the S. pneumoniae strains, 99% were also susceptible to moxifloxacin, and only one strain showed an MIC = 1.5 mu g/mL (intermediate). Conclusions: Our results showed high susceptibility rates to parenteral penicillin and moxifloxacin among S. pneumoniae isolates unrelated to meningitis, which differs from international reports. Reports on penicillin resistance should be based on updated breakpoints for non-meningitis isolates in order to guide the selection of an antimicrobial therapy and to improve the prediction of the clinical outcomes.

Analysis of genetic lineages and their correlation with virulence genes in enterococcus faecalis clinical isolates from root canal and systemic infections

Introduction: Enterococcus faecalis is a member of the mammalian gastrointestinal microbiota but has been considered a leading cause of hospital-acquired infections. In the oral cavity, it is commonly detected from root canals of teeth with failed endodontic treatment. However, little is known about the virulence and genetic relatedness among E. faecalis isolates from different clinical sources. This study compared the presence of enterococcal virulence factors among root canal strains and clinical isolates from hospitalized patients to identify virulent clusters of E. faecalis. Methods: Multilocus sequence typing analysis was used to determine genetic lineages of 40 E. faecalis clinical isolates from different sources. Virulence clusters were determined by evaluating capsule (cps) locus polymorphisms, pathogenicity island gene content, and antibiotic resistance genes by polymerase chain reaction. Results: The clinical isolates from hospitalized patients formed a phylogenetically separate group and were mostly grouped in the clonal complex 2, which is a known virulent cluster of E. faecalis that has caused infection outbreaks globally. The clonal complex 2 group comprised capsule-producing strains harboring multiple antibiotic resistance and pathogenicity island genes. On the other hand, the endodontic isolates were more diverse and harbored few virulence and antibiotic resistance genes. In particular, although more closely related to isolates from hospitalized patients, capsuleproducing E. faecalis strains from root canals did not carry more virulence/antibiotic genes than other endodontic isolates. Conclusions: E. faecalis isolates from endodontic infections have a genetic and virulence profile different from pathogenic clusters of hospitalized patients��� isolates, which is most likely due to niche specialization conferred mainly by variable regions in the genome.

Prevention and control of surgical site infections: review of the Basel Cohort Study

INTRODUCTION: Surgical site infections (SSI) are the most common hospital-acquired infections among surgical patients, with significant impact on patient morbidity and health care costs. The Basel SSI Cohort Study was performed to evaluate risk factors and validate current preventive measures for SSI. The objective of the present article was to review the main results of this study and its implications for clinical practice and future research. SUMMARY OF METHODS OF THE BASEL SSI COHORT STUDY: The prospective observational cohort study included 6,283 consecutive general surgery procedures closely monitored for evidence of SSI up to 1 year after surgery. The dataset was analysed for the influence of various potential SSI risk factors, including timing of surgical antimicrobial prophylaxis (SAP), glove perforation, anaemia, transfusion and tutorial assistance, using multiple logistic regression analyses. In addition, post hoc analyses were performed to assess the economic burden of SSI, the efficiency of the clinical SSI surveillance system, and the spectrum of SSI-causing pathogens. REVIEW OF MAIN RESULTS OF THE BASEL SSI COHORT STUDY: The overall SSI rate was 4.7% (293/6,283). While SAP was administered in most patients between 44 and 0 minutes before surgical incision, the lowest risk of SSI was recorded when the antibiotics were administered between 74 and 30 minutes before surgery. Glove perforation in the absence of SAP increased the risk of SSI (OR 2.0; CI 1.4-2.8; p <0.001). No significant association was found for anaemia, transfusion and tutorial assistance with the risk of SSI. The mean additional hospital cost in the event of SSI was CHF 19,638 (95% CI, 8,492-30,784). The surgical staff documented only 49% of in-hospital SSI; the infection control team registered the remaining 51%. Staphylococcus aureus was the most common SSI-causing pathogen (29% of all SSI with documented microbiology). No case of an antimicrobial-resistant pathogen was identified in this series. CONCLUSIONS: The Basel SSI Cohort Study suggested that SAP should be administered between 74 and 30 minutes before surgery. Due to the observational nature of these data, corroboration is planned in a randomized controlled trial, which is supported by the Swiss National Science Foundation. Routine change of gloves or double gloving is recommended in the absence of SAP. Anaemia, transfusion and tutorial assistance do not increase the risk of SSI. The substantial economic burden of in-hospital SSI has been confirmed. SSI surveillance by the surgical staff detected only half of all in-hospital SSI, which prompted the introduction of an electronic SSI surveillance system at the University Hospital of Basel and the Cantonal Hospital of Aarau. Due to the absence of multiresistant SSI-causing pathogens, the continuous use of single-shot single-drug SAP with cefuroxime (plus metronidazole in colorectal surgery) has been validated.

Population-based epidemiology of rotavirus hospitalisations in Switzerland

BACKGROUND: Rotaviruses (RV) are the most common cause of dehydrating gastroenteritis requiring hospitalisation in children <5 years of age. A new generation of safe and effective RV vaccines is available. Accurate data describing the current burden of RV disease in the community are needed to devise appropriate strategies for vaccine usage. METHODS: Retrospective, population-based analysis of RV hospitalisations in children <5 years of age during a 5-year period (1999-2003) in a both urban and rural area inhabited by 12% of the Swiss population. RESULTS: Of 406 evaluable cases, 328 were community-acquired RV infections in children <5 years of age. RV accounted for 38% of all hospitalisations for gastroenteritis. The overall hospitalisation incidence in the <5-year-old was 1.5/1000 child-years (peak incidence, 2.6/1000 child-years in children aged 13-24 months). The incidence of community-acquired RV hospitalisations was significantly greater in children of non-Swiss origin (3.0 vs. 1.1/1000 child-years, relative risk 2.7; 95% CI 2.2-3.4), who were younger, but tended to be less severely dehydrated on admission than Swiss children. In comparison with children from urban areas, RV hospitalisation incidence was significantly lower among those residing in the remote mountain area (0.71 vs. 1.71/1000 child years, relative risk 2.2, 95% CI 1.6-3.1). CONCLUSION: Population-based RV hospitalisation incidence was low in comparison with other European countries. Significantly greater hospitalisation rates among children living in urban areas and those from non-Swiss families indicate that factors other than the severity of RV-induced dehydration are important driving forces of hospital admission.

Nosocomial infection: A risk factor for a complicated course in children with respiratory syncytial virus infection - Results from a prospective multicenter German surveillance study

BACKGROUND: Nosocomially acquired respiratory syncytial virus infections (RSV-NI) may cause serious problems in hospitalized paediatric patients. Hitherto, prospectively collected representative data on RSV-NI from multicenter studies in Germany are limited. METHODS: The DMS RSV Ped database was designed for the prospective multicenter documentation and analysis of clinically relevant aspects of the management of inpatients with RSV-infection. The study covered six consecutive seasons (1999-2005); the surveillance took place in 14 paediatric hospitals in Germany. RESULTS: Of the 1568 prospectively documented RSV-infections, 6% (n=90) were NI and 94% (n=1478) were community acquired (CA). A significantly higher proportion in the NI group displayed additional risk factors like prematurity, chronic lung disease, mechanical ventilation (med. history), congenital heart disease, and neuromuscular impairment. Of all NI, 55% occurred in preterms (30.6% of all RSV-infections in preterms with severe chronic lung disease of prematurity were NI). Illness severity as well as the total mortality, but not the attributable mortality was significantly higher in the NI group. In the multivariate analysis, NI was significantly associated with the combined outcome 'complicated course of disease'. CONCLUSION: This is the first prospective multicenter study from Germany, which confirms the increased risk of a severe clinical course in nosocomially acquired RSV-infection. Of great concern is the high rate of (preventable) NI in preterms, in particular in those with severe chronic lung disease or with mechanical ventilation due to other reasons.