Microbiological characterization of the causative agents of hospital infection in urological patients

The analysis of the etiological structure of hospital infection in 52 urological patients has been carried out. The sensitivity of the causative agents of this infection to different antibiotics has been studied and recommendations on rational antibacterial therapy are given.     

Evaluation of the probability of the infection of medical personnel with Crimean-Congo hemorrhagic fever virus in cases of introduction of the infective agent to a non-endemic territory of Russia

The data on the secondary cases of infection with Crimean-Congo hemorrhagic fever (CHF) virus during the period of 1960 - 2002 have been analyzed and the probability of the infection of medical personnel with this virus has been evaluated. The data obtained in this study may be used in the development of the mathematical model of CHF epidemics (outbreaks), taking into account not only the transmission of the infective agent, but also hospital infection, as well as for calculating the number medical personnel, necessary for the liquidation of CHF epidemics (outbreaks).     

Prevention of varicella in immunocompromised patients on unpredictable occurrence of the disease in a children's ward: vaccine-boostered immune whole blood transfusion (VIB) method

For prevention of secondary varicella infection in patients whose immunities were extremely impaired by intensive chemotherapy or immunosuppressive agents, we have been using the vaccine-boostered immune whole blood transfusion (VIB) method when there was an unpredictable case of varicella in the children's ward. By this method passive transfer of humoral and cellular immunity is achieved. There have been 25 unpredictable occurrences of varicella or herpes-zoster in the ward of our children's hospital between April 1977 and May 1983 and during these episodes 16 patients, mostly with malignant diseases, have been treated by this method. There has been no case of secondary varicella infection among these patients and no serious troubles associated with the VIB method.     

Model of the spreading dynamics of a hospital infection

The article deals with the epidemiological model and the corresponding mathematical model of the spread of hospital infection. The mathematical apparatus of Markov's heterogeneous chain is used. The model may be used for the analysis and planning of antiepidemic measures, as well as for the evaluation of their effectiveness. The conditions for the possibility of the application of the newly developed mathematical model have been formulated. The method for calculating the parameters of the model on the basis of data on morbidity in different forms of hospital infection is presented. An example of using the above model for the analysis of the data of observation is considered in detail.     

Using models to identify routes of nosocomial infection: a large hospital outbreak of SARS in Hong Kong

Two factors dominated the epidemiology of severe acute respiratory syndrome (SARS) during the 2002-2003 global outbreak, namely super-spreading events (SSE) and hospital infections. Although both factors were important during the first and the largest hospital outbreak in Hong Kong, the relative importance of different routes of infection has not yet been quantified. We estimated the parameters of a novel mathematical model of hospital infection using SARS episode data. These estimates described levels of transmission between the index super-spreader, staff and patients, and were used to compare three plausible hypotheses. The broadest of the supported hypotheses ascribes the initial surge in cases to a single super-spreading individual and suggests that the per capita risk of infection to patients increased approximately one month after the start of the outbreak. Our estimate for the number of cases caused by the SSE is substantially lower than the previously reported values, which were mostly based on self-reported exposure information. This discrepancy suggests that the early identification of the index case as a super-spreader might have led to biased contact tracing, resulting in too few cases being attributed to staff-to-staff transmission. We propose that in future outbreaks of SARS or other directly transmissible respiratory pathogens, simple mathematical models could be used to validate preliminary conclusions concerning the relative importance of different routes of transmission with important implications for infection control.     

The epidemiology of neonatal meningitis

The epidemiological features of meningitides in newborns have been studied and criteria making it possible to distinguish the cases of intrauterine and postnatal infection have been proposed. The overwhelming majority of these infections has been found to occur due to hospital infections caused by enterobacteria and nonfermenting bacteria. In meningitides of this etiology the sources of infection are newborns colonized by these microorganisms. Infection is transmitted through everyday contacts through the hands of the medical staff. Besides, moist environmental objects serve as the additional reservoir of infection.     

240例住院患者痰液分离菌的回顾性分析

目的 了解我院住院患者痰液分离菌种类,探讨有效预防和控制呼吸道感染的措施。方法 对我院2005年1～12月住院患者所发生的240例住院感染细菌进行回顾性分析。结果 痰液的病原菌主要有大肠埃希菌、白假丝酵母、肺炎克雷伯菌、铜绿假单胞菌、鲍氏不动杆菌、金黄色葡萄球菌等;除大肠埃希菌的检出率(23．94％)较高外,真菌也有较高的检出率(22．54％);真菌已成为基层医院呼吸道感染的重要致病菌。结论 加强基层医院医务人员医院感染管理知识的培训,高度重视病原学监测,合理使用抗生素是当前预防基层医院呼吸道真菌感染的关键。     

综合性医院重症监护病房病原菌分离情况分析

目的探讨重症监护病房（Icu）医院内感染的临床特点及病原菌种类、分布情况,为临床合理使用抗菌药物、预防和控制医院感染提供参考和依据。方法采用前瞻性监测与回顾性调查相结合的方法,对ICU患者的临床资料进行统计分析。结果ICU病人标本中分离出病原菌593株,得出菌种分布与感染情况。结论重症监护病房医院内感染发生率高,以呼吸道感染为主,主要病原菌以革兰阴性非发酵菌为主,加强ICU患者感染的控制,可减少ICU医院内感染的发生。     

Nosocomial Rhinocerebral Mucormycosis: Two Cases with a Temporal Relationship

Mucormycosis is an unusual fungal infection that usually affects immunosuppressed patients. Small outbreaks of mucormycosis have been previously reported. We present two clinical cases of fatal rhinocerebral mucormycosis with a close temporal relationship between them and a possible nosocomial transmission: case 1 was a 75-year-old male with diabetes and COPD, treated with antibiotics and systemic corticosteroids, who developed rhinocerebral mucormycosis. Case 2 was an 88-year-old woman who was treated with systemic antibiotics and corticosteroids and developed the same infection after insertion of a nasogastric tube. Both patients concurred at the same time in our hospital, and healthcare staff was common to both of them. These cases, along with previously reported cases, highlight that, although infrequent, transmission of the fungus in the hospital environment is a real possibility that should be taken into account in order to initiate contact and air isolation precautions that could avoid nosocomial transmission of this infection.     

某医院皮肤科就诊患者真菌感染的流行病学调查

目的探讨延安市某医院2006—2010年皮肤科门诊患者真菌感染的菌群分布、特点及变迁情况,为临床防治真菌感染提供研究依据。方法采用回顾性调查方法,收集5年来该院皮肤科门诊患者的所有真菌检查的病例资料,对标本来源、菌群分布及菌种变迁进行调查和分析。结果5年中真菌感染阳性率为9．98％-44．05％,男性感染率高于女性,浅部真菌感染率高于深部真菌,差异均有统计学意义（P〈0．005）;60岁以上患者占38．18％,感染以白假丝酵母菌为主但所占比例5年间下降了16．86％（P〈0．05）,而其他假丝酵母菌所占比例则呈上升趋势。结论5年来该院真菌感染菌群分布发生了变迁;真菌感染以老年男性为主,儿童真菌感染亦不容忽视,临床应加强对这些真菌感染的预防和监测,防止真菌感染。     

纤支镜导致呼吸机相关肺炎感染暴发的调查研究

目的调查分析疑似纤支镜清洗消毒不规范引起的医院感染暴发事件,为采取针对性控制措施提供依据。方法采用流行病学调查和病例对照研究的方法对医院感染病例进行分析,并提出综合干预措施。结果综合ICU使用呼吸机支持治疗患者,14天内发生的4例呼吸机相关肺炎患者均经纤支镜检查,4例患者痰标本中均培养出铜绿假单胞菌,纤支镜采样细菌培养出铜绿假单胞菌。结论使用不规范清洗消毒的纤支镜进行检查是引起综合ICU住院患者呼吸机相关肺炎感染的主要危险因素。重视医院感染控制,采取有效的消毒隔离措施,严格消毒灭菌技术操作,是预防和控制医院感染爆发的有效措施和途径。     

Clinical application of a live varicella vaccine (Oka strain) in a hospital

A total of 239 children, including 22 high-risk children and 55 non-high risk diseased children have been immunized with a live varicella vaccine (Oka strain) since June, 1978. No clinical reaction attributable to the vaccine has been observed. Of these children, 87 received emergency vaccination. Of 47 children receiving emergency vaccination because they had been in contact with varicella patients either in hospital, school or a playground, only 5 developed varicella and their symptoms were mild. Of 40 children receiving emergency vaccination because of exposure to varicella in their home, 10 developed mild varicella and 30 were protected. Clinical symptoms of varicella when seen seemed to be due to incomplete protection because the vaccine was given too late rather than to clinical reactions to the vaccine. During follow-up period of 6 to 66 months after vaccination, 8 children showed very mild rashes without fever as the result of exogenous varicella infection.     

Staphylococcus saprophyticus as a urinary pathogen: a six year prospective survey.

Over six years (1978-83, inclusive) weekly laboratory records of organisms causing urinary tract infection in women aged 15-25 not attending hospital were kept prospectively and analysed. The incidence of infection with Staphylococcus saprophyticus defined by age and sex was confirmed. This organism caused an increasing proportion of infections in young women over the six years studied, and these infections showed noticeable seasonality. All but four isolates of S saprophyticus were sensitive to all the commonly used antimicrobial agents that were tested. This might be because the organism is not often present in the body as a commensal and therefore not subject to the selection pressures exerted by such agents. As infection with S saprophyticus has different clinical connotations from infection with other coagulase negative staphylococci it should be differentiated from them in routine laboratory practice.     

传染病医院血液净化中心的医院感染管理

目的：探讨传染病医院血液净化中心的医院感染管理方法。方法：我院血液净化中心自2010年1月～2012年1月加强医院感染管理,制定了相关的制度及规范,现对感染管理措施进行总结分析,并统计医院感染发生率。结果：通过加强血液净化中心的医院感染管理,可有效防止医院感染的发生,医院感染的发生率为11.68%。结论：完善医院管理制度和规范,制定严格的管理措施,提高医务人员风险意识等可有效提高医院感染的管理水平,预防医院感染的发生。     

Self-regulation of the epidemic process in Pseudomonas aeruginosa infection under hospital conditions

The dynamics of the epidemic process of P. aeruginosa urinary tract infection at a urological clinic has been studied from the viewpoint of the theory of self regulation. Such approach to the study of the epidemic process under hospital conditions permits the detection of the risk factors, most important under given conditions.     

Sources of infection in childhood tuberculosis in a region of east Croatia

Possible sources of tuberculosis (TBC) infection in children have been assessed in a retrospective epidemiological study covering a north-east region of Croatia in which the incidence of childhood tuberculosis has been increasing since the war in 1991-1995. During the past decade (1993-2003), 271 children up to 18 years of age have been referred for hospital care because of known contacts with tuberculosis (142 children, group A) or because of indicative clinical signs and symptoms (129 children, group B). Possible sources of infection were identified on the basis of medical documentation and field investigations. Frequencies of source identification for different age groups were compared. In group A, the exposure took place most often within the family (parents, grandparents, siblings, 129 of 142 children, 90.87%). Relatives, neighbors, friends and schoolmates accounted for 9.2%. In group B, possible sources of infection were identified for 44 of 129 children (34.1%) and were within the family for 16 of those 44 (36.4%). Evidenced contact with tuberculosis was more usual among younger children (0-9 years of age, 65.5%) in group A than among the older ones (10-18 years of age, 34.5%). In group B, contacts with tuberculosis were equally distributed (50.0%) among younger and older children. High proportion of unrecognized contacts in children having clinical signs and symptoms indicative of tuberculosis (group B, 85 of 129, 65.9%) opens the possibility that extra-familial exposure to tuberculosis occurs more often than expected regardless of the age of children.     

Nosocomial infection caused by vancomycin‐susceptible multidrug‐resistant Enterococcus faecalis over a long period in a university hospital in Japan

Compared with other developed countries, vancomycin‐resistant enterococci (VRE) are not widespread in clinical environments in Japan. There have been no VRE outbreaks and only a few VRE strains have sporadically been isolated in our university hospital in Gunma, Japan. To examine the drug susceptibility of Enterococcus faecalis and nosocomial infection caused by non‐VRE strains, a retrospective surveillance was conducted in our university hospital. Molecular epidemiological analyses were performed on 1711 E. faecalis clinical isolates collected in our hospital over a 6‐year period [1998–2003]. Of these isolates, 1241 (72.5%) were antibiotic resistant and 881 (51.5%) were resistant to two or more drugs. The incidence of multidrug resistant E. faecalis (MDR‐Ef) isolates in the intensive care unit increased after enlargement and restructuring of the hospital. The major group of MDR‐Ef strains consisted of 209 isolates (12.2%) resistant to the five drug combination tetracycline/erythromycin/kanamycin/streptomycin/gentamicin. Pulsed‐field gel electrophoresis analysis of the major MDR‐Ef isolates showed that nosocomial infections have been caused by MDR‐Ef over a long period (more than 3 years). Multilocus sequence typing showed that these strains were mainly grouped into ST16 (CC58) or ST64 (CC8). Mating experiments suggested that the drug resistances were encoded on two conjugative transposons (integrative conjugative elements), one encoded tetracycline‐resistance and the other erythromycin/kanamycin/streptomycin/gentamicin‐resistance. To our knowledge, this is the first report of nosocomial infection caused by vancomycin‐susceptible MDR‐Ef strains over a long period in Japan.     

Gnathostoma hispidum Infection in a Korean Man Returning from China

Human Gnathostoma hispidum infection is extremely rare in the world literature and has never been reported in the Republic of Korea. A 74-year-old Korean man who returned from China complained of an erythematous papule on his back and admitted to our hospital. Surgical extraction of the lesion and histopathological examination revealed sections of a nematode larva in the deep dermis. The sectioned larva had 1 nucleus in each intestinal cell and was identified as G. hispidum. The patient recalled having eaten freshwater fish when he lived in China. We designated our patient as an imported G. hispidum case from China.     

The evaluation of the vibriocidal antibody test in establishing a diagnosis of cholera or Vibrio carriage]

On the basis of the serological survey of cholera patients, vibrio carriers and persons having had contacts with the source or reservoir of Vibrio cholerae the conclusion has been made that the test for the presence of vibriocidal antibodies, together with the bacteriological study of the patient, is of diagnostic importance in the diagnosis of cholera or vibrio carriership. The detection of vibriocidal antibodies, especially in the study of paired sera, permits the detection of cholera cases which have not been bacteriologically confirmed due to various reasons; besides, it makes it possible to exclude the diagnosis of cholera made only on the basis of clinical data. Like bacteriological study, the determination of vibriocidal antibodies must be obligatory for persons hospitalized in a provisory hospital or an isolation ward; it will undoubtedly improve the quality of cholera diagnosis and permit taking timely antiepidemic measures in the focus of infection.