Overall Burden of Healthcare-Associated Infections Among Surgical Patients: Results of a National Study.

OBJECTIVE:: To assess the overall burden of healthcare-associated infections (HAIs) in patients exposed and nonexposed to surgery. BACKGROUND:: Targeted HAI surveillance is common in healthcare institutions, but may underestimate the overall burden of disease. METHODS:: Prevalence study among patients hospitalized in 50 acute care hospitals participating in the Swiss Nosocomial Infection Prevalence surveillance program. RESULTS:: Of 8273 patients, 3377 (40.8%) had recent surgery. Overall, HAI was present in 358 (10.6%) patients exposed to surgery, but only in 206 (4.2%) of 4896 nonexposed (P < 0.001). Prevalence of surgical site infection (SSI) was 5.4%. Healthcare-associated infections prevalence excluding SSI was 6.5% in patients with surgery and 4.7% in those without (P < 0.0001). Patients exposed to surgery carried less intrinsic risk factors for infection (age >60 years, 55.6% vs 63.0%; American Society of Anesthesiologists score >3, 5.9% vs 9.3%; McCabe for rapidly fatal disease, 3.9% vs 6.6%; Charlson comorbidity index >2, 12.3% vs 20.9%, respectively; all P < 0.001) than those nonexposed, but more extrinsic risk factors (urinary catheters, 39.6% vs 14.1%; central venous catheters, 17.8% vs 7.1%; mechanical ventilation, 4.7% vs 1.3%; intensive care stay, 18.3% vs 8.8%, respectively; all P < 0.001). Exposure to surgery independently predicted an increased risk of HAI (odds ratio 2.43; 95% CI 2.0-3.0). CONCLUSIONS:: Despite a lower intrinsic risk, patients exposed to surgery carried more than twice the overall HAI burden than those nonexposed; almost half was accountable to SSI. Extending infection control efforts beyond SSI prevention in these patients might be rewarding, especially because of the extrinsic nature of risk factors.

Utilização de penas de galinha para produção de queratinase por Aspergillus carbonarius

O objetivo deste trabalho foi estudar a produção de queratinase por Aspergillus carbonarius URM 1546, tendo-se como substrato penas de galinha, por meio de planejamento fatorial completo 2³. Todos os parâmetros estudados e as interações de segunda ordem foram estatisticamente significativos. A maior atividade queratinolítica (48,9 U mL-1) foi obtida com 120 rpm, 0,5% (p/v) de penas de galinha e sete dias de cultivo.

Réactualisation de la douzième conférence de consensus de la Société de réanimation de langue française (SRLF) : infections liées aux cathéters veineux centraux en réanimation [Updating of the 12th consensus conference of the Société de Réanimation de langue française (SRLF) : catheter related infections in Intensive Care unit]

Concerning catheter-related infections, many studies have been conducted until the last consensus conference of the Sociétéde réanimation de langue française (SRLF) in 1994. This text is the synthesis of the considerable amount of work performed by the experts of the society to review recent studies. The experts' texts as well as extensive bibliography are available at http://www.srlf.org.

HIV-1 elite controllers: beware of super-infections.

Super- and co-infection with HIV-1 are generally associated with accelerated disease progression. We report on the outcome of super-infection in two HIV-1 infected individuals previously known as elite controllers. Both presented an acute retroviral syndrome following super-infection and showed an immuno-virological progression thereafter. Host genotyping failed to reveal any of the currently recognized protective factors associated with slow disease progression. This report indicates that elite controllers should be informed of the risk of super-infection, and illustrates the complexity of mounting broad anti-HIV immunity.

Emerging viral infections after hematopoietic cell transplantation.

This overview summarizes recent data on emerging viruses after hematopoietic cell transplantation (HCT), including adenovirus, BK virus, human metapneumovirus (hMPV), and human herpesvirus (HHV) 6. The increased recognition of these infections is due to improved molecular detection methods, increased surveillance and more profound immunosuppression in the host. Adenovirus can cause serious disease especially in T-cell depleted transplant recipients. Adenovirus viremia is an important risk factor for disease in this setting. BK virus has been associated with hemorrhagic cystitis in HCT recipients. BK viremia is significantly associated with hemorrhagic cystitis. hMPV shows a seasonal distribution and can cause fatal pneumonia in HCT recipients. hMPV may be the etiology of some cases previously categorized as idiopathic pneumonia syndrome. HHV-6 commonly leads to viremia in HCT recipients. HHV-6 has been strongly associated with encephalitis and delayed platelet engraftment. Prospective studies are needed to further examine epidemiology, disease associations, and management strategies for these viruses.

Aspergillus protein degradation pathways with different secreted protease sets at neutral and acidic pH.

Aspergillus fumigatus grows well at neutral and acidic pH in a medium containing protein as the sole nitrogen source by secreting two different sets of proteases. Neutral pH favors the secretion of neutral and alkaline endoproteases, leucine aminopeptidases (Laps) which are nonspecific monoaminopeptidases, and an X-prolyl dipeptidase (DppIV). Acidic pH environment promotes the secretion of an aspartic endoprotease of pepsin family (Pep1) and tripeptidyl-peptidases of the sedolisin family (SedB and SedD). A novel prolyl peptidase, AfuS28, was found to be secreted in both alkaline and acidic conditions. In previous studies, Laps were shown to degrade peptides from their N-terminus until an X-Pro sequence acts as a stop signal. X-Pro sequences can be then removed by DppIV, which allows Laps access to the following residues. We have shown that at acidic pH Seds degrade large peptides from their N-terminus into tripeptides until Pro in P1 or P'1 position acts as a stop for these exopeptidases. However, X-X-Pro and X-X-X-Pro sequences can be removed by AfuS28 thus allowing Seds further sequential proteolysis. In conclusion, both alkaline and acidic sets of proteases contain exoprotease activity capable of cleaving after proline residues that cannot be removed during sequential digestion by nonspecific exopeptidases.

Les spirochètes dans tous leurs etats [A short journey through spirochetal infections]

Spirochetal infections present with a variety of clinical syndromes and epidemiologic features. Diagnosis remains challenging for the clinician because of the often protean clinical presentation and poor performance of stan-dard microbiological tests. We present 3 clinical cases, illustrating interesting or unusual features of these infections. First, we present a case of leptospirosis acquired in Switzerland after a rat bite. We then present a case of early disseminated Lyme disease with multiple erythema migrans, lymphopenia, thrombocytopenia and liver enzyme elevation. Finally, we present a case of secondary syphilis in an HIV-positive man, complicated by sensorineural deafness. For each case we highlight and discuss the specific epidemiological, clinical and therapeutic features.

Variáveis que influenciam a produção de celulases e xilanase por espécies de Aspergillus

O objetivo deste trabalho foi determinar as variáveis que influenciam a produção simultânea de celulases e xilanase por Aspergillus aculeatus URM 4953 e A. phoenicis URM 4924, com uso de bagaço de cana-de-açúcar como substrato. As variáveis avaliadas foram pH inicial, tempo de cultivo, concentração do substrato, agitação, concentração do inóculo, temperatura, tipo de bagaço de cana-de-açúcar e espécie de Aspergillus. Foi utilizado o planejamento fatorial fracionário 2(8-4), com três repetições no ponto central. Todas as variáveis analisadas influenciaram a produção de pelo menos uma das enzimas. As maiores atividades enzimáticas observadas foram: celulases totais, 0,45 UI mL-1; endoglucanase, 0,60 UI mL-1; exoglucanase, 0,17 U mL-1 ; celobiase 6,42 UI mL-1; e xilanase, 30,05 U mL-1. As melhores condições para produção das enzimas foram: pH 6,0; tempo de cultivo de 168 horas; bagaço de cana-de-açúcar residual como substrato; e A. aculeatus URM 4953, que produziu as celulases e a xilanase simultaneamente. As variáveis que influenciam a produção simultânea das celulases e xilanase são pH, tempo de cultivo, tipo de bagaço de cana-de-açúcar e espécie de Aspergillus.

Produção de celulases por Aspergillus niger por fermentação em estado sólido

O objetivo deste trabalho foi avaliar a produção enzimática de celulases pelo fungo filamentoso Aspergillus niger por fermentação em estado sólido de diferentes substratos. Foram avaliados os substratos sólidos bagaço de cana-de-açúcar, farelo de soja, farelo de trigo e misturas entre os substratos. Em substrato com 90% de bagaço e 10% de farelo de soja, avaliaram-se os efeitos do conteúdo de umidade (60, 70 e 80%, base úmida) e da suplementação com os meios indutores da atividade enzimática: sacarose, Mandels & Weber básico, Mandels & Weber modificado, com acréscimo de carboximetilcelulose, e Czapeck Dox. As maiores atividades de celulase total e endoglucanase, em farelo de trigo, foram obtidas após 72 horas de cultivo: 0,4 e 21,0 UI g-1, respectivamente. Observou-se expressivo aumento nas atividades enzimáticas na medida em que se aumentou a proporção de farelos no substrato, em comparação à fermentação com bagaço de cana apenas. O conteúdo de umidade de 50% foi insuficiente para conseguir completa hidratação do bagaço de cana, e a umidade ideal varia de acordo com o meio utilizado para suplementação e encontra-se entre 70 e 80%. O meio de Mandels & Weber modificado apresenta o melhor resultado como indutor da atividade enzimática.

Prévention des infections chez les voyageurs immunosupprimés [Prevention of infection in immunocompromised travelers].

Every year there are more immunocompromised patients with a better quality of life and, therefore, that travel more frequently. While traveling, patients may be exposed to several infections, such as traveler's diarrhea or malaria, which can be associated with a high rate of complications in this population. An appropriate strategy for the prevention of travel-related infections is essential, including education about hygiene measures, vaccinations and prescription of a tailored antimicrobial prophylaxis/stand-by treatment, according to the type of immunosuppression. Potential drug interactions, particularly between antimalaric and immunosuppressive drugs, must also be considered for decision taking. Collaboration between the general practitioner and the travel medicine and infectious diseases specialists is highly recommended to improve the management of these patients.

Les infections endo-artérielles, complications redoutables des infections à salmonelles non typhi [Endarterial infections, redoubtable complications of non-typhi salmonella infections].

Three cases are reported of salmonella aortitis observed in three men aged 55, 60 and 48 years, the last of whom had a prosthetic aortic valve and ascending aorta. The microorganisms were S. typhi murium, S. paratyphi B, and S. wien. Despite antibiotic treatment two patients died of perforating aortitis. The third patient developed S. wien gastroenteritis a few days after surgical replacement of the aortic valve and the ascending aorta. Five years later he presented with several bacteremic episodes due to S. wien, which recurred despite several courses of cotrimoxazole treatment. He has now been asymptomatic for over one year under prolonged cotrimoxazole treatment. Since vascular infection may occur following non typhi salmonellosis in 5% of patients over 50, or who have underlying endothelial lesions, the question arises as to whether non typhi S. gastroenteritis should be treated with antibiotics in these high risk patients, in contrast to present recommendations.

Motivational brief intervention for the prevention of sexually transmitted infections in travelers: a randomized controlled trial.

Background: Sexually transmitted infections (STIs) are among the frequent risks encountered by travelers. Efficient interventions are needed to improve the understanding of the risks of STIs. We investigated the potential benefits of a motivational brief intervention (BI) and the provision of condoms on the engagement in unprotected casual sex.Methods: 3-arm randomized controlled trial performed among single travelers aged 18-44 years visiting a travel clinic in Switzerland. The main outcomes were the prevalence of casual unprotected sexual intercourse and their predictors.Results: 5148 eligible travelers were seen from 2006 to 2008. 1681 agreed to participate and 1115 subjects (66%) completed the study. 184/1115 (17%) had a casual sexual relationship abroad and overall 46/1115 (4.1%) had inconsistently protected sexual relations. Women (adjusted OR 2.7 [95% CI 1.4-5.6]) and travelers with a history of past STI (adjusted OR 2.8 [95% CI 1.1-7.4]) had more frequent casual sexual relationships without consistent protection. Regarding the effect of our intervention, the prevalence of subjects using condoms inconsistently was 28% (95% CI 16-40) in the motivational BI group, 24% (95% CI 10-37) in the condoms group and 24% (95% CI 14-33) in the control group (p = 0.7).Conclusion: This study showed that a motivational brief intervention and/or the provision of free condoms did not modify risky sexual behavior of young travelers. The rate of inconsistently protected sexual relationships during travel was however lower than expected

Infektionsprävention in der Physiotherapie = Prévention des infections en physiothérapie

Les règles d'hygiène de base doivent être respectées par tous les acteurs de la santé, dans les institutions de soins, mais aussi dans les cabinets. Elles constituent un des piliers de la sécurité et de la qualité du traitement.