内毒素和降钙素原在妇科术后尿路感染中的鉴别诊断价值

目的评价中段尿内毒素和血清降钙素原在妇科术后不同种类细菌尿路感染中的鉴别诊断价值。方法收集临床1205例妇科术后患者中段尿进行细菌培养及内毒素检测,同时对患者进行血清降钙素原检测,比较结果对尿路感染的鉴别诊断价值。结果1205份标本中尿培养出阳性350例,感染率为29．04％,其中298例为均存在留置导尿管,而在剩余400例尿培养阴性的患者中仅仅120例留置导尿管。两组之间差异有统计学意义（χ2=26．78,P〈0．05）。其中革兰阴性杆菌189例（54％）,革兰阳性菌112例（32％）,真菌49例（14％）。在三组患者中,中段尿内毒素在革兰阴性菌引起的术后尿路感染较革兰阳性菌和真菌的患者中明显升高,差异均有统计学意义（P〈0．05）。而对于血清降钙素原在革兰阴性菌和革兰阳性菌感染的患者明显高于真菌尿路感染的患者,差异均有统计学意义（P〈0．05）。而在革兰阴性菌和革兰阳性菌感染的患者中差异无统计学意义（P〉0．05）。结论妇科术后尿路感染与留置导尿管密切相关,革兰阴性菌是引起妇科术后尿路感染的主要致病菌,中段尿内毒素有助于鉴别诊断出革兰阴性菌引起尿路感染,而血清PCT升高时则有助于排除真菌尿路感染。     

Anaerobic infections of the soft tissue and bones

Severe soft tissue infections, usually necrotizing, are associated with a mortality of 40-60% and with amputations where the bones and joints are involved. The anaerobic bacteria associated with these infections are usually present in patients with underlying predisposing conditions (diabetes, vascular problems, immunosuppression). They are in the majority polymicrobial, endogenous or exogenous. There are many clinical and laboratory characteristics to establish the diagnosis of the different forms of these infections. Treatment of necrotizing soft tissue and bone infections requires early and aggressive surgical debridment. Timing of diagnosis and surgery influence essentially the outcome. Colostomy can be helpful in cases of perineal involvement. Antibiotic covering (broad spectrum) is mandatory as well as the systemic support of the patient.     

Opportunistic zygomycotic infections

This is a literature review of 361 opportunistic fungal infections caused by the Zygomycetes. The clinical and laboratory diagnosis, pathogenesis, management, treatment, and outcome of infection are discussed. The Zygomycetes are a group of opportunistic fungi (orders Mucorales and Entomophthorales) which cause severe infections which may be fatal. Early clinical recognition, prompt diagnostic procedures, control of underlying disease and treatment with high doses of amphotericin B and aggressive surgery increases survival in an otherwise lethal infection.     

Nasal surgery complications

This study examines the incidence of serious complications in nasal surgery and discusses the diagnosis and management of these complications. The authors review 259 consecutive cases performed between January 1, 1983, and August 31, 1988. One-hundred and ninety-five patients had septorhinoplasties, 29 had septoplasties, and 35 had rhinoplasties. Thirteen of these cases involved serious complications as follows: hemorrhage (5), perforation (4), infections (3), and pneumocephalus (1). All the patients with these serious complications had associated septal and/or turbinate surgery. The diagnosis and management of these complications will be discussed. In this small series of nasal surgery patients, the incidence of serious complications was 5.0 percent, with no fatalities reported. The higher incidence of serious complications occurred when associated septal and/or turbinate surgery was required. Awareness of these complications is essential because of the increasing number of patients presenting to plastic surgeons for nasal surgery in whom associated septal and/or turbinate surgery is necessary.     

Rare Invasive Fungal Infections: Epidemiology, Diagnosis and Management

Rare yeast and filamentous fungi belonging to hyalohyphomycetes (e.g., Scedosporium, Fusarium), zygomycetes and dematiaceous (e.g., Alternaria, Bipolaris) are implicated in human infections ranging from colonization and localized infections in immunocompetent individuals to fungemias and disseminated diseases in immunocompromised patients and accounting <10 % of all isolated fungal pathogens. The diagnosis of yeast, Fusarium and Scedosporium infections is based on blood cultures and of filamentous fungal infections on histopathology, direct microscopy and culture of infected tissues. The panfungal marker 1,3-b-D glucan test as well as cross reaction with antigen tests for other fungi can be used; whereas, PCR assays have been developed for direct detection of these fungi in blood and in tissues. Amphotericin B is the drug of choice for most rare yeast infections except for Trichosporon infections where voriconazole is used. The management of the other infections includes surgery combined with antifungal therapy mainly with amphotericin B for zygomycetes, voriconazole or amphotericin B for hyalohyphomycetes, and itraconazole or amphotericin B for dematiaceous fungi.     

Fungal endophthalmitis

Fungal endophthalmitis occurs secondary to trauma, as a complication of intraocular surgery, or as an extension of an adjacent or distant focus of fungal infection. In the United States, Candida species are the most common pathogens isolated, followed by Aspergillus species. Candida infections show a predilection towards vitreous involvement, whereas Aspergillus infections usually manifest as hemorrhagic infarcts of the retinal or choroidal vessels or as infiltration of the subretinal and subretinal pigment epithelial spaces. Endogenous Aspergillus endophthalmitis is associated with a high mortality rate, underscoring the severity of systemic infection. The prognosis of fungal endophthalmitis depends on the virulence of the organism, extent of intraocular involvement, and the timing and mode of interventions. Prompt therapy following early diagnosis helps to reduce significant visual loss. Despite the introduction of new-generation triazoles and echinocandins into clinical practice, successful therapy is limited by the delay in diagnosis and a lack of broad-spectrum antifungals with good intravitreal penetration that lack systemic toxicity.     

Enhancement of antitoxic immunity in newborn infants by peroral administration of donor antistaphylococcal immunoglobulin

The possibility of enhancing specific immunity by the oral administration of homologous antistaphylococcal immunoglobulin in a dose of 50 I. U./kg b. w. before the first feeding was shown in 75 newborn infants with a high risk of staphylococcal infection. 24 hours after the first administration of Ig the titer of staphylococcal anti-alpha toxin in the blood rose from 0.68 +/- 0.05 I. U./ml to 2.9 +/- 0.14 I. U/ml, on day 7 this titer persisted at the level of 2.86 +/- 0.12 I. U./ml, and 3 months later the titer was 1.5 +/- 0.05 I. U./ml. No side effects were observed. In the reference group (50 infants) antitoxic titers remained low. No suppurative-septic diseases were observed in the test group within 3 months, while in the controls, focal forms of staphylococcal infection (12 cases) and sepsis (1 case) were registered.     

Diagnosis of pseudomembranous colitis.

Twenty-eight patients with histologically proved pseudomembranous colitis have been seen in one hospital since July 1975. All patients with the disease had received antibiotics, six for infections not requiring operations; the other 22 cases all occurred after major surgery. All the patients had diarrhoea; six patients also had fever with clinical signs of sepsis, and three had abdominal pain thought to be due to anastomotic dehiscence after colonic resection. Pseudomembranous colitis was associated with white blood counts over 15 000/mm3 in 17 patients and albumin concentrations of less than 30 g/1 in 18. Pseudomembranous colitis was an incidental finding at necropsy in two of six patients who had not had an operation. Of the 22 patients who had had major surgery, nine died from this complication; in all except two of these cases the diagnosis was made only at necropsy. If pseudomembranous colitis is suspected on clinical grounds or if there is an unexplained complication after colorectal surgery repeat sigmoidoscopy and testing for faecal toxins should be carried out to establish the diagnosis so that prompt supportive treatment can be given.     

Schizophillum commune Causing Sinusitis with Nasal Polyposis in the Sub-Himalayan Region: First Case Report and Review

Schizophillum commune is an environmental fungus rarely causing human infections of diverse nature. Sinusitis occurs in immunocompromised persons and seldom in healthy subjects. Though easily isolated, the lack of awareness of its virulence is a bottleneck in the diagnosis of this infection. We report the first case of S. commune sinusitis with nasal polyps in an immunocompetent male from the sub-Himalayan region. The computerized tomography scan findings established the clinical diagnosis, and causative agent was confirmed as S. commune. A white, woolly mold with septate, hyaline hyphae and characteristic spicules but unclamped connections suggested a monokaryotic isolate. Patient was treated successfully with fiberoptic endoscopic sinus surgery, and no antifungal therapy was instituted. There was no recurrence at review after 1 year.     

Prevalence of nosocomial infections in general surgery, orthopedic surgery and urological departments in the Czech Republic

Two prevalence studies of Nosocomial Infections carried out in 1987 (based on 4479 patients in 64 general surgery departments and 1603 patients in 29 orthopedic surgery departments) and in 1988 (based on 1263 patients in 32 urological departments) are summarized. The prevalence rate of nosocomial infections (NI) in general surgery departments was 14.0%, in orthopedic surgery departments 8.0% and in urological departments 20.9%. The highest degree of risk of acquiring NI was run by patients above 60 years of age in urological and general surgery departments. Surgical wound infections in departments of general surgery accounted for 60%, in orthopedic surgery departments for 47% and in urological departments for 37% of all NI. The prevalence of wound infections amongst general surgical patients was 8.4%, amongst orthopedic surgical patients 3.8% and in urological patients 7.7%. The prevalence of urinary tract infections in general surgery departments was 14.4%, in orthopedic surgery departments 18.6% and in urological departments 51.6%. The problems discussed include the role of intrinsic and in-hospital risk factors and the involvement of pathogens responsible for the onset of NI.     

The syndromal approach to the diagnosis of toxic food poisonings]

The authors criticize the nosological principle of the diagnosis of toxic infections and believe that in a vast majority of cases such diagnosis must be based on syndromes. The only exceptions are cases of mass outbreaks and hospital infections. The definition of alimentary toxic infection is given, the difficulties of their clinical diagnosis and the ways to overcome these difficulties are indicated.     

The association between farmers’ participation in herd health programmes and their behaviour concerning treatment of mild clinical mastitis

Background

Methicillin-resistant Staphylococcus aureus (MRSA) in animals is a rare finding in Sweden. In horses, MRSA was first detected in a screening survey in 2007. In 2008, six clinical cases occurred in an equine hospital, indicating an outbreak.

Method

All MRSA isolates detected, 11 spa-type t011 and one t064 (n = 12), in infected horses (n = 10) and screening of horses (n = 2) in Sweden from December 2007 to March 2010 were retrospectively analysed with pulsed-field gel electrophoresis (PFGE) using Cfr9I and ApaI restriction enzymes, to study relationship between the isolates. Medical records of infected horses and outbreak investigation notes were scrutinised to monitor the clinical outcome and other aspects of the outbreak.

Results

Eight of the 10 infected horses were linked to one equine hospital and two to another hospital in the same region. The six horses infected with MRSA in 2008 underwent surgery during the period 22 May-7 July in one of the hospitals. Four more infections linked to the two hospitals were notified between 2009 and March 2010. Nine of the 11 spa-type t011 isolates had identical Cfr9I and ApaI PFGE pattern. All six infected horses from 2008 presented with this MRSA. Two t011 isolates differed in one and two bands, respectively, in PFGE. Nine horses suffered from surgical site infections (SSI). No antimicrobials were used following the MRSA diagnosis and the infections cleared. The time from surgery to MRSA diagnosis differed greatly between the horses (range 15-52 days).

Conclusions

Association in time and space of six horses infected with an identical MRSA strain of spa-type t011 confirmed an outbreak. Two isolates found in 2009 and 2010 in the outbreak hospital were closely related to the outbreak strain, indicating one circulating strain. Both spa-type t011 and t064 have been reported in horses in Europe prior to these findings. The observation that the infections cleared although antimicrobials were not used is encouraging for future prudent use of antimicrobials. The time from surgery to bacteriological diagnosis was not acceptable in most cases, as contagious spread was a risk. Sampling when symptoms of infection are noticed and accurate analysis are thus important.     

New methods for the detection of orthopedic and other biofilm infections

The detection and identification of bacteria present in natural and industrial ecosystems is now entirely based on molecular systems that detect microbial RNA or DNA. Culture methods were abandoned, in the 1980s, because direct observations showed that <1% of the bacteria in these systems grew on laboratory media. Culture methods comprise the backbone of the Food and Drug Administration-approved diagnostic systems used in hospital laboratories, with some molecular methods being approved for the detection of specific pathogens that are difficult to grow in vitro. In several medical specialties, the reaction to negative cultures in cases in which overt signs of infection clearly exist has produced a spreading skepticism concerning the sensitivity and accuracy of traditional culture methods. We summarize evidence from the field of orthopedic surgery, and from other medical specialties, that support the contention that culture techniques are especially insensitive and inaccurate in the detection of chronic biofilm infections. We examine the plethora of molecular techniques that could replace cultures in the diagnosis of bacterial diseases, and we identify the new Ibis technique that is based on base ratios (not base sequences), as the molecular system most likely to fulfill the requirements of routine diagnosis in orthopedic surgery.     

Enzyme immunoassays for the detection of microbial antigens and prospects for improved assays

The rapid diagnosis of viral infections is an important tool in the management of patients with infectious diseases. Solid-phase enzyme immunoassays have proved to be useful tools for the direct detection of the antigens of some viruses directly in clinical specimens. Such assays have been particularly useful in the diagnosis of viral infections in the gastrointestinal and respiratory tracts. However, standard solid-phase enzyme immunoassays often do not display sufficient sensitivity for the diagnosis of all cases of viral infections. Techniques which might be utilized to increase the sensitivity of solid-phase immunoassays include the use of monoclonal antibodies to maximize the efficiency of the antigen-antibody interactions and the use of high-turnover enzymes to increase the amount of signal generated by the ensuing enzyme-substrate reactions. In addition, techniques making use of nucleic acid hybridization have a great deal of potential for the accurate detection of viral nucleic acids in human body fluids. The successful application of these techniques to the diagnosis of viral infections could lead to a marked improvement in the care of patients with suspected infectious diseases as well as to a decrease in the transmission of viral infections to high-risk individuals.     

Endophthalmitis of probable endogenous origin caused by Scedosporium boydii: A case report

BackgroundMycotic ocular infections caused by the Scedosporium apiospermum species complex are challenging to treat because of the delayed diagnoses and poor responses to antifungal drugs and surgical treatment.Case reportA case of a 69-year-old male patient with a history of diabetes mellitus type 2 and prior surgery on the right femur is described. In the 10 days prior to the ophthalmic consultation he started with ocular pain, adding to a previous and progressive loss of visual acuity in his right eye. The diagnosis of endophthalmitis of probable endogenous origin was established. Despite medical treatment, the patient's condition worsened and, due to the imminent risks, an enucleation was performed. Smears of the enucleation tissue revealed fungal cells, and the cultures yielded a fungus belonging to the S. apiospermum species complex, which was identified as Scedosporium boydii by morphological characteristics and sequencing of a PCR amplicon.ConclusionsA diagnosis of endophthalmitis of probable endogenous origin in the right eye was based on a previous right femur surgery. Potential risk to the patient led to enucleation.     

A diagnosis of pneumococcal peritonitis secondary to pyo-salpinx in a young healthy female by culturing peritoneal pus

Pneumococcal intra-abdominal infections of female genital tract origin are rare. A 33-year-old woman with peritonitis due to Streptococcus pneumoniae serotype 3 was reported. The patient did not have any of the known predisposing conditions for intra-abdominal pneumococcal infection. The clinical presentation included signs of multiorgan failure. Peritoneal toilette, bilateral salpingectomy and antibiotic treatment were promptly administered. The patient remained febrile, developed respiratory failure and required a repeated laparotomy and a prolonged antimicrobial treatment. Penicillin susceptible S. pneumoniae was isolated from the pus collected at surgery. Thus, culturing of intra-operative specimens should never be neglected to establish the correct microbiologic diagnosis.     

Human Pythiosis: Emergence of Fungal-Like Organism

Pythiosis is an emerging infectious disease caused by the aquatic oomycete Pythium insidiosum, a fungal-like organism. It is believed that P. insidiosum’s zoospores, its infected form, play major role in pathogenesis. Vascular and ocular infections are the most common clinical manifestation in humans. It is difficult to establish the diagnosis given its relatively rarity and difficulty to distinguish P. insidiosum from other molds. Delay in diagnosis and treatment has been associated with poor outcomes. High index of suspicion is the key, particularly in thalassemia patients with arterial insufficiency and patients with fungal keratitis/endophthalmitis without improvement on antifungal therapy. Tissue culture and zoospore induction remain gold standard for diagnosis; however, DNA-based method should be performed simultaneously. The combination of radical surgery, antifungal agents, and immunotherapy has been recommended. It was previously believed that surgery with negative surgical margins was the essential to survive in vascular pythiosis; however, it was recently found that patients could have residual disease despite documented negative surgical margins as infected clot may be dislodged to proximal arterial sites prior to surgery. Serum β-d-glucan (BG) has been used to monitor disease response after treatment initiation in vascular pythiosis. A significant decrease in BG levels within 2 weeks after surgery is indicative of the absence of residual infection. Unfortunately, monitoring tools for ocular pythiosis are not yet available. Itraconazole plus terbinafine have generally been used in P. insidiosum-infected patients; however, antibacterial agents, including azithromycin and linezolid, have also been used with favorable outcomes in ocular disease. Recently, azithromycin or clarithromycin plus doxycyclin were used in two relapsed vascular pythiosis patients with good outcomes.

     

Prophylactic antibiotics in plastic and reconstructive surgery.

There is no consensus in the literature on the use of prophylactic antibiotics to prevent postoperative infection. This study was performed to investigate whether the use of prophylactic antibiotics has an effect on postoperative infection rates. A total of 1400 patients were classified into four groups based on their diagnosis. During the induction of anesthesia, half of each group received 2 g of a sulbactam-ampicillin combination and the other half received a placebo (saline solution) intravenously. Wound infection rates were observed in the postoperative period. Age, sex, and operative site of the patients with the same diagnosis were comparable in each group. The white blood cell count and the body temperature reading of each patient were recorded postoperatively. Wounds were observed daily in the postoperative period and graded according to a predetermined scale. Bacteriologic specimens were obtained from patients who had wound infections. According to our clinical experience, antibiotic prophylaxis is not necessary in plastic surgery. At the end of our 6-year study, a significant difference could not be found between the antibiotic prophylaxis and placebo groups.     

中国大陆地区接合菌病流行现状的回顾性分析

目的了解中国大陆地区近30 a接合菌病流行情况及诊治现状。方法通过CNKI和Pubmed数据库搜索1976年来中国大陆地区接合菌病相关文献,进行数据分析和总结。结果病例报告206篇,共428例患者。感染类型以胃溃疡基础上合并胃肠毛霉菌病为主,其他常见感染类型为肺部、鼻眶脑和皮肤软组织。继发于糖尿病、消化道溃疡、外伤手术烧伤和其他无基础疾病患者多见。病原学诊断主要依赖镜检、培养和病理,仅35株菌鉴定至种的水平,其中6例进行分子生物学鉴定。单独系统抗真菌药物治疗为主,体外药敏试验少,两性霉素B和两性霉素B脂质体为首选用药。428例患者中共死亡126例,占发病总人数的29.43%;其中以全身播散型感染死亡率最高,占此型感染人数的83.34%。结论中国大陆地区接合菌病感染率有上升趋势。感染类型以胃溃疡基础上合并胃肠毛霉菌病为主。应该提高形态学诊断水平,并积极开展分子鉴定,同时有条件情况下应进行菌种的体外药物敏感性检测,为临床提供更为准确的参考信息。     

Preoperative statin therapy and infectious complications in cardiac surgery

AimTo assess whether preoperative statin therapy is associated with the risk of postoperative infection in patients undergoing cardiac surgery.Methods520 patients undergoing cardiac surgery in 2010 were retrospectively examined. Data regarding statin and antibiotic use prior to and after surgery were available from the hospital pharmacy information system. Cultures and clinical data of patients on postoperative antibiotics other than standard prophylactic therapy were studied to identify postoperative infections up to 30 days from day of surgery.Results370 (71.2 %) patients were on preoperative statin therapy. Overall, 82 patients (15.8 %) suffered from postoperative infection of which 11 were surgical site infections. In multivariable regression analysis, statin therapy was associated with a reduced risk of postoperative infection (adjusted odds ratio: 0.329, 95 %: CI 0.19–0.57; P < 0.001).ConclusionsPreoperative statin use was associated with a considerable reduced risk of postoperative infections following cardiac surgery. Randomised controlled trials are required to clarify the role of statin therapy in the prevention of postoperative infections.