Epidemiological features of hospital purulent-septic infections in otolaryngological wards]

Prospective epidemiological observation in an otorhinolaryngological hospital has made it possible to distinguish the specific features of pyoseptic nosocomial infections. Such infections, appearing as cross re- and superinfections, are most frequently induced by staphylococci, as well as by Proteus and Pseudomonas aeruginosa. High risk groups include patients with purulent otitis and sinusitis, who have contacted infection through instruments in examination and dressing rooms. The main sources of infection are patients with pyoseptic infections of the ear and sinuses.     

Characteristics of the sources and routes of spread of a Pseudomonas aeruginosa infection in a trauma department

In the study of the epidemic process of P. aeruginosa infection in a traumatological hospital the leading role of patients with hospital septic infections as the sources of infection has been epidemiologically proved. Contamination has been shown to occur mostly in the pus dressing room.     

Characteristics of sources and means of spread of Pseudomonas aeruginosa infections in urology wards

Patients with purulent septic infections form the main source of infection in urological departments. The spread of infection from these patients occurs mainly by contact in dressing and cystoscopy rooms. The complex of measures, planned in accordance with the results of diagnosis, makes it possible to decrease morbidity rate in the purulent septic infections of the urinary tract.     

Cost-Effectiveness Analysis of a Transparent Antimicrobial Dressing for Managing Central Venous and Arterial Catheters in Intensive Care Units

Objective

To model the cost-effectiveness impact of routine use of an antimicrobial chlorhexidine gluconate-containing securement dressing compared to non-antimicrobial transparent dressings for the protection of central vascular lines in intensive care unit patients.

Design

This study uses a novel health economic model to estimate the cost-effectiveness of using the chlorhexidine gluconate dressing versus transparent dressings in a French intensive care unit scenario. The 30-day time non-homogeneous markovian model comprises eight health states. The probabilities of events derive from a multicentre (12 French intensive care units) randomized controlled trial. 1,000 Monte Carlo simulations of 1,000 patients per dressing strategy are used for probabilistic sensitivity analysis and 95% confidence intervals calculations. The outcome is the number of catheter-related bloodstream infections avoided. Costs of intensive care unit stay are based on a recent French multicentre study and the cost-effectiveness criterion is the cost per catheter-related bloodstream infections avoided. The incremental net monetary benefit per patient is also estimated.

Patients

1000 patients per group simulated based on the source randomized controlled trial involving 1,879 adults expected to require intravascular catheterization for 48 hours.

Intervention

Chlorhexidine Gluconate-containing securement dressing compared to non-antimicrobial transparent dressings.

Results

The chlorhexidine gluconate dressing prevents 11.8 infections /1,000 patients (95% confidence interval: [3.85; 19.64]) with a number needed to treat of 85 patients. The mean cost difference per patient of €141 is not statistically significant (95% confidence interval: [€-975; €1,258]). The incremental cost-effectiveness ratio is of €12,046 per catheter-related bloodstream infection prevented, and the incremental net monetary benefit per patient is of €344.88.

Conclusions

According to the base case scenario, the chlorhexidine gluconate dressing is more cost-effective than the reference dressing.

Trial Registration

This model is based on the data from the RCT registered with www.clinicaltrials.gov (NCT01189682).     

美皮康在骨科外固定架患者护理中的应用

目的:探讨美皮康应用于外固定架针孔换药方式的临床效果。方法:将骨科50例四肢骨折行外固定架固定的患者随机分成实验组24例和对照组26例。实验组以美皮康有边型敷料换药,对照组以临床常用的络合碘纱布条进行换药,比较两组每天更换敷料频次,外固定针孔及周围皮肤红肿、渗出情况,护士更换污染床单被套频次及护士满意度。结果:实验组每天更换敷料频次少于对照组(P<0.05),外固定针孔及周围皮肤红肿、渗出等情况,实验组均优于对照组(P<0.05),实验组中护士更换污染床单被套频次明显少于对照组(P<0.05),护士满意度高于对照组(P<0.05)。结论:美皮康对保护骨科外固定针孔的治疗效果优于传统络合碘纱布条换药,对预防外固定针道感染有效,同时减轻护士维持床单位整洁、减少床单被套的更换频次,提高护士的满意度。     

Airborne Microorganisms in Broiler Processing Plants

Concentrations of total aerobic bacteria, molds, yeasts, coliforms, enterococci, and psychrophiles were determined in the air of two poultry processing plants with Andersen samplers and a mobile power supply. Total aerobic bacterial counts were highest in the dressing room, with diminishing numbers in the shackling, eviscerating, and holding rooms, when sampling was carried out during plant operation. The average counts per ft³ of air in these four rooms were 2,200; 560; 230; and 62, respectively. (Each value is the average of 36 observations.) The number of organisms increased in the shackling and dressing rooms once processing was begun. Average total aerobic bacterial counts increased from 70 to 870 to 3,000 in the shackling room and from 310 to 4,900 to 7,000 in the dressing room when sampling was carried out at 5:00 am (before plant operations), 9:00 am, and 2:00 pm, respectively. (Each value is the mean of 12 observations.) Airborne molds might originate from a source other than the poultry being processed.     

Effect of a Synthetic Dressing Formed on a Burn Wound in Rats: a Comparison of Allografts, Collagen Sheets, and Polyhydroxyethylmethacrylate in the Control of Wound Infection

Allograft dressings to control Pseudomonas wound infections in rats were studied on surgical wounds and escharectomized burn wounds. The effects of allografts were compared with a collagen sheet (Aviderm) and a synthetic dressing, polyhydroxyethylmethacrylate (Hydron), formed on the wound by mixing the polymer and the solvent. The results indicated that infections in surgical wounds were more easily controlled by dressings than similar contaminations in burn wounds. A procedure was described for the formation of a synthetic dressing directly on the wound from a mixture of polymer and solvent. This type of preparation completely filled the wound area and sealed the edges, preventing further contamination, and gave excellent coverage of the wound. With 24 h of coverage of escharectomized burn wounds, allografts provided the best dressing for reduction of wound organisms. At 96 h of coverage, Hydron and Aviderm produce significant reductions in the Pseudomonas resident in the burn wound. The results support the thesis that suitable dressings promote local host defense processes which kill the contaminating bacteria.     

Radioimmunoassay for plasma betamethasone 17-benzoate.

A sensitive radioimmunoassay for plasma betamethasone 17-benzoate has been developed. The antiserum used was obtained by immunizing rabbits with betamethasone 17-benzoate-21-hemisuccinate-bovine-serum-albumin conjugate. All of the endogenous steroids tested cross reacted less than 0.10%. A standard curve was established with a useful range from 0.05-5 ng. Reliability criteria were satisfactory. Measurement of plasma concentrations of betamethasone 17-benzoate was performed in patients and in rabbits following occlusive dressing of betamethasone 17-benzoate cream and gel base.     

Outbreak of systemic Candida albicans in intensive care unit caused by cross infection.

The first documented outbreak of systemic candidosis shown to be due to cross infection with a particular strain of Candida albicans is reported. Over nine months in an intensive care unit 13 patients developed definite and one probable systemic candidosis. Twenty five further patients had superficial candidal infections. The strain that caused the outbreak (serotype A, morphotype A1, biotype 0/(1)5 5/7) was responsible for all the cases of systemic candidosis acquired in the intensive care unit, 11 (44%) of the superficial candidal infections in the unit, and 17% of candidal infections outside the unit but in the same hospital. The strain was also isolated from oral swabs taken from four nurses working in the unit and the hands of one of these nurses. Two out of 17 nurses were shown to have acquired the strain on their hands when examined immediately after nursing systemically infected patients. No environmental source could be identified. The strain also showed enhanced survival in handwashing experiments and was relatively resistant to Hibiscrub. Management of patients with systemic candidosis might include measures to prevent cross infection and handwashing with disinfectants that are active against candida.     

A new dressing for laser-treated areas

Contemporary studies and observations have left no doubt that occlusive dressings are superior to open treatment after laser resurfacing. The currently available occlusive dressings, however, are time-consuming to apply, often dislodge shortly after application, and most require reapplication. The authors report a cross-sectional observational study of patients who were treated with a new dual silicone-based dressing (DiamondSeal) after full-face laser resurfacing, with or without rhytidectomy. Patients who previously underwent similar surgeries and who were treated with a popular occlusive tape dressing (Flexzan) acted as historic controls. A combination of two silicones produced a gel-like silicone admixture that was spread evenly over the laser-treated areas. The silicone gel solidified into a flexible membrane and remained on the patient's face for 5 days. Questionnaires were sent to patients who were treated with the silicone dressing and those who were treated with a currently popular occlusive dressing. When the attributes of these dressings were compared, the superiority of the silicone dressing approached statistical significance ( = 0.08). The majority of patients treated with the silicone dressing (71 percent) had a positive experience with this dressing, stating they would repeat the experience if necessary. Only 54 percent of patients with a tape dressing were willing to repeat their experience ( = 0.18). The major advantages of this dressing, noted from the surgeon's perspective, were the speed with which the mask was applied; the ease of application, without the need for templates; the acceptable cure duration, allowing spontaneous contouring of the silicone along facial contours; the simple tailoring of the dressing; the reduced need for and minimal time for reapplication; and the paucity of complications.     

Diagnosis of invasive candidosis by enzyme immunoassay of serum antigen.

Enzyme immunoassay was used to measure Candida albicans-related antigen in sera of rabbits and mice infected with C albicans. A range of heterologous antigens tested gave no cross reactions. Of the three patients who were investigated and gave positive reactions, two were confirmed as having deep candida infections. Enzyme immunoassay is efficient, simple, and sensitive, and may prove valuable in the early diagnosis of invasive candida infections.     

Bacterial cellulose: a versatile biopolymer for wound dressing applications

Although several therapeutic approaches are available for wound and burn treatment and much progress has been made in this area, room for improvement still exists, driven by the urgent need of better strategies to accelerate wound healing and recovery, mostly for cases of severe burned patients. Bacterial cellulose (BC) is a biopolymer produced by bacteria with several advantages over vegetal cellulose, such as purity, high porosity, permeability to liquid and gases, elevated water uptake capacity and mechanical robustness. Besides its biocompatibility, BC can be modified in order to acquire antibacterial response and possible local drug delivery features. Due to its intrinsic versatility, BC is the perfect example of a biotechnological response to a clinical problem. In this review, we assess the BC main features and emphasis is given to a specific biomedical application: wound dressings. The production process and the physical–chemical properties that entitle this material to be used as wound dressing namely for burn healing are highlighted. An overview of the most common BC composites and their enhanced properties, in particular physical and biological, is provided, including the different production processes. A particular focus is given to the biochemistry and genetic manipulation of BC. A summary of the current marketed BC-based wound dressing products is presented, and finally, future perspectives for the usage of BC as wound dressing are foreseen.     

Contemporaneous and successive mixed Plasmodium falciparum and Plasmodium vivax infections are associated with Ascaris lumbricoides: an immunomodulating effect?

Following an investigation suggesting a protective role for Ascaris against cerebral malaria, possibly through immunomodulation, we examined whether Ascaris had any impact on mixed Plasmodium falciparum and Plasmodium vivax infections. We studied a cross section of 928 patient files between 1991 and 1999. Forty patients had contemporaneous mixed infections and 40 patients had P. falciparum infections, followed by P. vivax infections. There was a significant association between Ascaris infection and risk of having both contemporaneous or successive mixed P. falciparum and P. vivax infections (adjusted odds ratios respectively 6 [2-18] P = 0.001 and 3.6 [1.2-11.1] P = 0.02). There was a positive linear trend between the burden of Ascaris and the risk of mixed infections P < 0.0001. These results suggested the possibility that pre-existing Ascaris infection may increase tolerance of the host to different Plasmodium spp., thus facilitating their coexistence.     

Microsurgical hypospadias repair

Successful primary hypospadias repair depends on careful execution of surgical principles, particularly during the urethroplasty portion of the procedure. These principles include careful tissue handling, development of well-vascularized flaps, and avoidance of placing sutures in the uroepithelial surface. Despite meticulous repair, the complication rate requiring secondary surgery is 15 to 30 percent. For the past year, the authors have utilized an operating room microscope, microsurgical instruments, a specially designed microsuture, and a Biooclusive dressing to decrease the postoperative morbidity and subsequent complications requiring secondary surgery (6.5 percent). A comparison of 50 hypospadias patients on whom no microsurgical repair had been used was made with 62 patients on whom microsurgical techniques were employed. The nonmicrosurgical group had 17 complications, 12 of which required reoperation (24 percent). The microsurgical group had 8 complications, 4 of which required reoperation (6.5 percent).     

Antimicrobial Activity of a Novel Vascular Access Film Dressing Containing Chlorhexidine Gluconate

Background

Covering insertion sites with chlorhexidine impregnated dressings has been proven to be clinically effective in reducing catheter related blood stream infections (CR-BSI). Two chlorhexidine gluconate (CHG)-impregnated dressings are commercially available, a polyurethane foam disk and a film dressing containing a chlorhexidine gluconate-impregnated gel pad. While both have demonstrated efficacy in clinical settings, the major drawback of high cost and impaired IV insertion site visibility limits their usage. A new, simple film dressing containing CHG within its adhesive layer is now available. The objective of this study was to test the in vitro antimicrobial efficacy of the new dressing in comparison to the CHG-impregnated gel dressing.

Methods

Quantitative aliquots of suspensions (concentration of 1.0x10⁶ to 5.0x10⁶ cfu/sample) of clinically relevant challenge organisms (Staphylococcus species, gram-negative bacilli, Candida albicans) were incubated in contact with the new CHG-containing film dressing, a placebo version of the same (negative control) and the commercially available CHG-impregnated gel dressing (positive control). Serial dilutions of the surviving organisms were quantified using the pour plate after 1, 3, 5, and 7 days of incubation in order to calculate an antimicrobial log₁₀ reduction for each organism/dressing combination at each point in time.

Results

The new CHG-containing film dressing delivered greater than 5.0 log₁₀ reduction throughout the 7 days on all aerobic gram-negative bacilli and Staphylococcus species tested. As of day 1 the CHG-containing film dressing provided greater than 5.0 log₁₀ reduction on Candida albicans. There were no statistically significant differences in the log₁₀ reduction between the two dressings tested.

Conclusion

The new CHG-containing film dressing was found to be as effective as the chlorhexidine gluconate-impregnated gel dressing on clinically relevant microbes.     

Fungal–bacterial interactions and their relevance in health

Cross‐kingdom interactions between bacteria and fungi are a common occurrence in the environment. Recent studies have identified various types of interactions that either can take the form of a synergistic relationship or can result in an antagonistic interplay with the subsequent destruction or inhibition of growth of bacteria, fungi or both. This cross‐kingdom communication is of particular significance in human health and disease, as bacteria and fungi commonly colonize various human surfaces and their interactions can at times alter the outcome of invasive infections. Moreover, mixed infections from both bacteria and fungi are relatively common among critically ill patients and individuals with weak immune responses. The purpose of this review is to summarize our knowledge on the type of interactions between bacteria and fungi and their relevance in human infections.     

Hierarchy of Dysfunction Related to Dressing Performance in Stroke Patients: A Path Analysis Study

Previous reports indicated that various dysfunctions caused by stroke affect the level of independence in dressing. These dysfunctions can be hierarchical, and these effects on dressing performance can be complicated in stroke patients. However, there are no published reports focusing on the hierarchical structure of the relationships between the activities of daily living and balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits. The purpose of this study was to elucidate the hierarchical and causal relationships between dressing performance and these dysfunctions in stroke patients. This retrospective study included 104 first-time stroke patients. The causal relationship between the dressing performance and age, time post stroke, balance function, motor and sensory functions of the affected lower limb, strength of the abdominal muscles and knee extension on the unaffected side, and visuospatial deficits were examined using path analysis. A hypothetical path model was created based on previous studies, and the goodness of fit between the data and model were verified. A modified path model was created that achieved an almost perfect fit to the data. Balance function and abdominal muscle strength have direct effects on dressing performance, with standardized direct effect estimates of 0.78 and 0.15, respectively. Age, motor and sensory functions of the affected lower limb, and strength of abdominal muscle and knee extension on the unaffected side have indirect effects on dressing by influencing balance function. Our results suggest that dressing performance depends strongly on balance function, and it is mainly influenced by the motor function of the affected lower limb.     

Vacuum assisted closure for the treatment of sternal wounds: the bridge between débridement and definitive closure

A method to refine the treatment of sternal wounds using Vacuum Assisted Closure (V.A.C.) therapy as the bridge between débridement and delayed definitive closure is described. A retrospective review of 35 consecutive patients with sternal wound complications over a 2-year period (March of 1999 to March of 2001) was performed. The treatment of sternal wounds with traditional twice-a-day dressing changes was compared with the treatment with the wound V.A.C. device. An analysis of the number of days between initial débridement and closure, number of dressing changes, number and types of flaps needed for reconstruction, and complications was performed. Eighteen patients were treated with traditional twice-a-day dressing changes and 17 patients were treated with V.A.C. therapy alone. The two groups were similar regarding age, sex, type of cardiac procedure, and type of sternal wound. The V.A.C. therapy group had a trend toward a shorter interval between débridement and closure, with a mean of 6.2 days, whereas the dressing change group had mean of 8.5 days. The V.A.C. therapy group had a significantly lower number of dressing changes, with a mean of three, whereas the twice-a-day dressing change group had a mean of 17 (p < 0.05). Reconstruction required an average of 1.5 soft-tissue flaps per patient treated with traditional dressing changes versus 0.9 soft-tissue flaps per patient for those treated with V.A.C. therapy (p < 0.05). Before closure, there was one death among patients undergoing dressing changes and three in the V.A.C. therapy group, all of which were unrelated to the management of the sternal wound. Patients with sternal wounds who have benefited from V.A.C. therapy alone have a significant decrease in the number of dressing changes and number of soft-tissue flaps needed for closure. Finally, the V.A.C. therapy group had a trend toward a decreased number of days between débridement and closure.     

Infectious Complications in Bone Marrow Transplant Patients

In 11 patients receiving transplants of allogeneic bone marrow, the graft was successful in six. Nine patients developed infections, and six died—five of septicaemia and one of Pneumocystis carinii pneumonia. Fifty individual infections occurred. Predisposing factors included severe underlying diseases, long-term exposure to resistant hospital organisms, heavy immunosuppressive therapy, and graft-versus-host disease. Gram-negative bacilli and Candida albicans were the most common causative organisms. In every instance of septicaemia identical organisms were isolated from blood cultures and simultaneously obtained stool cultures. Infection with exogenous organisms often occurred in patients occupying conventional isolation rooms. Isolation of one patient for 45 days in a laminar air flow room prevented infection with exogenous organisms.     

削痂植皮术后结合负压封闭引流在深度烧伤患者中的应用效果及对血清致痛因子及炎性因子的影响

摘要 目的：探讨削痂植皮术后结合负压封闭引流在深度烧伤患者中的应用效果及对血清致痛因子及炎性因子的影响,以此为临床治疗深度烧伤患者提供参考。方法：选取暨南大学附属第一医院在2018年1月至2022年1月期间收治的75例深度烧伤患者进行回顾性分析,所有患者均接受削痂植皮术治疗;按术后不同换药方法分为常规换药组和VSD组,其中常规换药组35例,术后常规换药;VSD组40例,术后采用VSD治疗。比较两组患者首次植皮成活率,术后1周、2周创面愈合率,创面愈合时间,疼痛程度及并发症发生率等,测定两组患者血清致痛因子、冲洗液炎性因子表达水平。结果：VSD组首次植皮成活率95.00%（38/40）,常规换药组首次植皮成活率71.43%（25/35）,差异有统计学意义（P<0.05）。VSD组术后1周、2周创面愈合率高于常规换药组,创面愈合时间、创面疼痛评分低于常规换药组,差异有统计学意义（P<0.05）。两组术后1周相关致痛因子表达较术前明显下降（P<0.05）,且VSD组致痛因子表达低于常规换药组,差异有统计学意义（P<0.05）。两组术后1周冲洗液炎性因子表达低于术前（P<0.05）,且VSD组冲洗液炎性因子表达与常规换药组比较下降明显,差异有统计学意义（P<0.05）。VSD组术后并发症发生率12.50%（5/40）低于常规换药组40.00%（14/40）,差异有统计学意义（P<0.05）。结论：削痂植皮术后结合负压封闭引流技术可提高深度烧伤患者创面愈合效果,增加首次植皮成活率,减少细菌生成、炎性因子的释放,减轻创面疼痛程度,值得临床进一步研究。