Annual Infection Rate Research Articles

Catheter-associated bloodstream infection in the pediatric intensive care unit

Catheter-associated bloodstream infections have been reported to occur in 3% to 8% of all central venous catheters inserted and are the predominant cause of hospital-acquired infection in intensive care units. Decreasing the pediatric intensive care unit rate of catheter-associated bloodstream infections became a high priority in 2008 for all members of the intensive care unit team affiliated with central venous catheter insertion and maintenance. Through a series of multidisciplinary initiatives, the annual average catheter-associated bloodstream infection rate in the pediatric intensive care unit fell from 7.9 infections per 1000 central catheter days in 2007 to 1.3 infections per 1000 central catheter days in 2009, a decrease of 83%. We attribute this success to the implementation of several key interventions, adherence to published insertion and maintenance bundles, and collaboration among pediatric intensive care unit physicians and nurses in all aspects of central catheter care. Statistically significant interventions included improvements to central venous catheter insertion practices, the development of a dedicated central catheter team, and regular collaborative discussion of central venous catheter necessity. In this 24-month period, this equates to 50 catheter-associated infections avoided, six potential deaths prevented, and an estimated cost savings of $1.45 million (based on $29,000 per infection). While implementation of these and other interventions has shown a positive impact, this project will continue into the future to assure sustainable successes and continued best practice improvements.

Improving Safety Culture Results in Rhode Island ICUs: Lessons Learned from the Development of Action-Oriented Plans

The Rhode Island (RI) Intensive Care Unit (ICU) Collaborative was designed to improve patient safety and clinical outcomes in adult ICUs through a unit-based patient safety program and evidenced-based practices. Few studies have shown how to draw on a strong safety culture to improve clinical outcomes. A study was conducted to (1) examine the impact of a Safety Attitudes Questionnaire Action Plan (SAQAP) on the 2008 Safety Attitudes Questionnaire (SAQ) and (2) determine the impact of an SAQAP on ICU central line-associated blood stream infections (CLABSIs) and ventilator-associated pneumonia (VAP) rates. The SAQ was administered at 23 ICUs in 11 hospitals in fall 2007 and 2008. Units were surveyed as to whether they completed an SAQAP on the basis of 2007 SAQ results. Annual rates of infection were submitted as unadjusted monthly CLABSI infections per 1,000 line days and VAP infections per 1,000 ventilator days for 2007 and 2008. SAQAPs were completed on 9 (39%) of the 23 units. Units that developed SAQAPs demonstrated higher improvement rates in all domains of the SAQ except working conditions. Improvements were close to statistical significance for teamwork climate (+18.4% in SAQAP units versus -6.4%, p = .07) and job satisfaction (+25.9% increase in SAQAP units versus +7.3%, p = .07). Units with SAQAPs decreased the CLABSI rates by 10.2% in 2008 compared with 2007, while those without SAQAP had a 2.2% decrease in rates (p = .59). Similarly, VAP rates decreased by 15.2% in SAQAP units, while VAP rates increased by 4.8% in units without SAQAP (p = .39). Teams that developed SAQAPs improved their unit culture and clinical outcomes. An active, targeted intervention in culture can translate into improved outcomes for patients.

Incidence of Influenza in Healthy Adults and Healthcare Workers: A Systematic Review and Meta-Analysis

BackgroundWorking in healthcare is often considered a risk factor for influenza; however, this risk has not been quantified. We aimed to systematically review evidence describing the annual incidence of influenza among healthy adults and healthcare workers (HCWs).Methods and FindingsWe searched OVID MEDLINE (1950 to 2010), EMBASE (1947 to 2010) and reference lists of identified articles. Observational studies or randomized trials reporting full season or annual influenza infection rates for healthy, working age adult subjects and HCWs were included. Influenza infection was defined as a four-fold rise in antibody titer, or positive viral culture or polymerase chain reaction.From 24,707 citations, 29 studies covering 97 influenza seasons with 58,245 study participants were included. Pooled influenza incidence rates (IR) (95% confidence intervals (CI)) per 100 HCWs per season and corresponding incidence rate ratios (IRR) (95% CI) as compared to healthy adults were as follows. All infections: IR 18.7 (95% CI, 15.8 to 22.1), IRR 3.4 (95% CI, 1.2 to 5.7) in unvaccinated HCWs; IR 6.5 (95% CI, 4.6 to 9.1), IRR 5.4 (95% CI, 2.8 to 8.0) in vaccinated HCWs. Symptomatic infections: IR 7.5 (95% CI, 4.9 to 11.7), IRR 1.5 (95% CI, 0.4 to 2.5) in unvaccinated HCWs, IR 4.8 (95% CI, 3.2 to 7.2), IRR 1.6 (95% CI, 0.5 to 2.7) in vaccinated HCWs.ConclusionsCompared to adults working in non-healthcare settings, HCWs are at significantly higher risk of influenza.

Report Card on Surgical Care Improvement Project (SCIP): Nationwide Inpatient Sample Infection Data 2001–2006

The administration of appropriate antibiotics in a timely fashion with discontinuation post-operatively is the first of the Surgical Care Improvement Project (SCIP) initiatives and was expected to reduce post-operative infections significantly. This study aimed at determining whether SCIP has had an effect on surgical site infections (SSIs). A retrospective cohort study was conducted to evaluate the infection rates of adult patients (age≥18 years) having elective cholecystectomies, laparoscopic cholecystectomies, and colectomies from 2001-2006 using the Nationwide Inpatient Sample (NIS) database. The population consisted of all patients older than 18 years who had colon resection or cholecystectomy and were discharged from a hospital included in the NIS. Annual infection rates were determined for each of the operations. Post-operative infections rose steadily and significantly (p<0.0001) in colon surgery from 2001 to 2006. A significant increase in SSIs also was seen in open (p=0.0001) and laparoscopic (p<0.0001) cholecystectomy from 2001 to 2006. Length of stay was significantly longer in infected than in non-infected patients. The factors that contributed to the observed increase in the infection rate should be identified to improve the SCIP initiatives.

P1-255 Trends of brucellosis (malta fever) in Iran during the period 1991–2008

IntroductionBrucellosis (Malta fever) is a bacterial zoonotic infectious disease. This study reviews the brucellosis trend in Iran during 1991–2008, provides the distribution maps related to the patient and assays the...

1438 FLUOROQUINOLONES ARE STILL EFFECTIVE PROPHYLAXIS IN TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY

You have accessJournal of UrologyInfections/Inflammation of the Genitourinary Tract: Prostate & Genitalia1 Apr 20111438 FLUOROQUINOLONES ARE STILL EFFECTIVE PROPHYLAXIS IN TRANSRECTAL ULTRASOUND GUIDED PROSTATE BIOPSY Bing-Juin Chiang, Chao-Yuan Huang, Kuo-How Huang, Yeong-Shiau Pu, Hui-Ching Tai, Ming-Kuen Lai, Shuo-Meng Wang, Shr-Chyan Chen, Jun Chen, Hong-Jeng Yu, Ho-Shiang Huang, Yuan-Ju Lee, Ju-Ton Hsieh, Shih-Ping Liu, and Hong-Chiang Chang Bing-Juin ChiangBing-Juin Chiang Taipei, Taiwan More articles by this author , Chao-Yuan HuangChao-Yuan Huang Taipei, Taiwan More articles by this author , Kuo-How HuangKuo-How Huang Taipei, Taiwan More articles by this author , Yeong-Shiau PuYeong-Shiau Pu Taipei, Taiwan More articles by this author , Hui-Ching TaiHui-Ching Tai Taipei, Taiwan More articles by this author , Ming-Kuen LaiMing-Kuen Lai Taipei, Taiwan More articles by this author , Shuo-Meng WangShuo-Meng Wang Taipei, Taiwan More articles by this author , Shr-Chyan ChenShr-Chyan Chen Taipei, Taiwan More articles by this author , Jun ChenJun Chen Taipei, Taiwan More articles by this author , Hong-Jeng YuHong-Jeng Yu Taipei, Taiwan More articles by this author , Ho-Shiang HuangHo-Shiang Huang Taipei, Taiwan More articles by this author , Yuan-Ju LeeYuan-Ju Lee Taipei, Taiwan More articles by this author , Ju-Ton HsiehJu-Ton Hsieh Taipei, Taiwan More articles by this author , Shih-Ping LiuShih-Ping Liu Taipei, Taiwan More articles by this author , and Hong-Chiang ChangHong-Chiang Chang Taipei, Taiwan More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1350AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES American Urological Association Update Series suggested fluoroquinolone prophylaxis in transrectal ultrasound guided prostate biopsy (TRUSBP). EAU guidelines on prostate cancer also documented “quinolones are the drug of choice”. But increase in infectious complications and fluoroquinolone resistance were reported in recent years. Thus we reassessed the efficacy of antibiotics prophylaxis including pipemidic acid (a member of nonfluorinated quinolones) and levofloxacin. METHODS We conducted a retrospective study by reviewing medical records of TRUSBP in a single institution between 2002 and 2009. From 2002 to 2004, patients receiving oral pipemidic acid 500 mg twice daily for three days with or without pre-operative intravenous cefazolin 1gm injection were enrolled (group A). From 2005 to 2009, patients receiving levofloxacin 500mg single dose on the morning before biopsy were enrolled (group B). We compared the infection rate in different antibiotics prophylaxis and years. The spectrums and susceptibility of pathogens were also evaluated. Furthermore, we provided recommendations of treatment regimens in post-biopsy infection. RESULTS 1313(35.5%) patients were enrolled in group A. 2381(64.5%) patients were enrolled in group B. There was significant difference in infection rate (p <0.001) between group A and B (3.7% vs. 1.0%). The annual infection rates (%) were 3.6, 3.9, 3.5, 1.5, 0.7, 0.6, 1.2, and 1.2, since 2002 to 2009 respectively. Out-patient clinic setting (p=0.613), biopsy core number (p=0.34), age (p=0.67), PSA level (p=0.281), pathology of prostate cancer (p=0.10) and pathology of chronic inflammation (p=0.35) could not predict infective complications. Of the 72 patients with infectious complication, those receiving levofloxacin prophylaxis tended to harbor fluoroquinolone resistant pathogens (p<0.001). E. coli was the most common pathogen in both groups. 87.5% of E. coli yielded in group B were resistant to fluoroquinolones. Of the E. coli in group A, susceptibility to piperacillin/tazobactam, gentamycin, amikacin, and imipenem were 100%. Of the E. coli in group B, susceptibility to amikacin and imipenem were 100%. CONCLUSIONS To our knowledge, this is the largest retrospective study to evaluate the efficacy of levofloxacin prophylaxis in TRUSBP. Levofloxacin appears still effective and superior to pipemidic acid. EAU guidelines should be revised. Empirical treatment of piperacillin/tazobactam, aminoglycosides, and imipenem were suggested in patients with infectious complication after levofloxacin prophylaxis and TRUSBP. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e576 Peer Review Report Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Bing-Juin Chiang Taipei, Taiwan More articles by this author Chao-Yuan Huang Taipei, Taiwan More articles by this author Kuo-How Huang Taipei, Taiwan More articles by this author Yeong-Shiau Pu Taipei, Taiwan More articles by this author Hui-Ching Tai Taipei, Taiwan More articles by this author Ming-Kuen Lai Taipei, Taiwan More articles by this author Shuo-Meng Wang Taipei, Taiwan More articles by this author Shr-Chyan Chen Taipei, Taiwan More articles by this author Jun Chen Taipei, Taiwan More articles by this author Hong-Jeng Yu Taipei, Taiwan More articles by this author Ho-Shiang Huang Taipei, Taiwan More articles by this author Yuan-Ju Lee Taipei, Taiwan More articles by this author Ju-Ton Hsieh Taipei, Taiwan More articles by this author Shih-Ping Liu Taipei, Taiwan More articles by this author Hong-Chiang Chang Taipei, Taiwan More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Characterization of Onthophagus sellatus as the major intermediate host of the dog esophageal worm Spirocerca lupi in Israel

Spirocerca lupi is a parasitic nematode of dogs, that causes significant morbidity and mortality. Its intermediate hosts in Israel have never been described. The aim of this study was therefore to identify the intermediate hosts of S. lupi in Israel and to describe their abundance and annual infection rate with the nematode, in different microenvironments (i.e., the effects of irrigation and shade) in an endemic area. Dog dung pads were collected every 2 months from two different public parks for 1 year. Dung beetles were identified to the species level in infested dog feces and were examined for the presence of S. lupi larvae through dissection. The Scarabid beetle Onthophagus sellatus was the most abundant dung beetle species in dog dung pads and the only one infected with S. lupi larvae. The minimal period for development of the S. lupi L3 infective stage was 7 days. Significant differences were observed between the two different microenvironments and along the year. The highest risk for infection of dogs with the nematode was during the summer, in an irrigated, shady microenvironment.

Varicella breakthrough infection and vaccine effectiveness in Taiwan

We performed this nationwide retrospective investigation among the recipients of varicella vaccine to evaluate the breakthrough varicella infection rate, factors associated with breakthrough infection and the vaccine effectiveness. The recipients of these vaccinations were identified through Taiwan's National Immunization Information System and data on breakthrough infections among these recipients were collected by using Taiwan's National Health Insurance Claims Database. From 2000 to 2007, 1,057,345 persons received varicella vaccinations in Taiwan. Varicella breakthrough infection occurred among 22,640 (2.1%) vaccinees and 170 (0.016%) required hospitalization for varicella disease. Annual breakthrough infection rates ranged from 0.12% to 2.04%. The mean age of vaccination was 1.6 years (median 1.3 years) and the mean age at breakthrough infection was 3.9 years. The mean interval between vaccination and the breakthrough infection was 2.3 years. The rate was significantly lower in regions where free varicella vaccinations were available than in regions where they were not ( P < 0.001). Varicella breakthrough infection was significantly more likely to occur at 5 and 6 years of age among the vaccinees, who received vaccination between 12 months and 23 months of age ( P < 0.001). The vaccine effectiveness against varicella was 82.6% and against varicella-related hospitalization was 85.4% from 2000 to 2005.

Malaria infection and disease in an area with pyrethroid-resistant vectors in southern Benin

BackgroundThis study aimed to investigate baseline data on malaria before the evaluation of new vector control strategies in an area of pyrethroid-resistance of vectors. The burden of malaria was estimated in terms of infection (prevalence and parasite density) and of clinical episodes.MethodsBetween December 2007 and December 2008 in the health district of Ouidah - Kpomassè - Tori Bossito (southern Benin), a descriptive epidemiological survey of malaria was conducted. From 28 selected villages, seven were randomized from which a total of 440 children aged 0 to 5 years were randomly selected. Clinical and parasitological information was obtained by active case detection of malaria episodes carried out during eight periods of six consecutive days scheduled at six weekly intervals and by cross-sectional surveys of asymptomatic infection. Entomological information was also collected. The ownership, the use and the correct use of long-lasting insecticide-treated nets (LLINs) were checked over weekly-survey by unannounced visits at home in the late evening.ResultsMean parasite density in asymptomatic children was 586 P. falciparum asexual forms per μL of blood (95%CI 504-680). Pyrogenic parasite cut-off was estimated 2,000 P. falciparum asexual blood forms per μL. The clinical incidence of malaria was 1.5 episodes per child per year (95%CI 1.2-1.9). Parasitological and clinical variables did not vary with season. Anopheles gambiae s.l. was the principal vector closely followed by Anopheles funestus. Entomological inoculation rate was 5.3 (95%CI 1.1-25.9) infective bites per human per year. Frequency of the L1014F kdr (West) allele was around 50%. Annual prevalence rate of Plasmodium falciparum asymptomatic infection was 21.8% (95%CI 19.1-24.4) and increased according to age. Mean rates of ownership and use of LLINs were 92% and 70% respectively. The only correct use of LLINs (63%) conferred 26% individual protection against only infection (OR = 0.74 (95%IC 0.62-0.87), p = 0.005).ConclusionThe health district of Ouidah-Kpomassè-Tori Bossito is a mesoendemic area with a moderate level of pyrethroid-resistance of vectors. The used LLINs rate was high and only the correct use of LLINs was found to reduce malaria infection without influencing malaria morbidity.

Epidemiology and Risk Factors of Incident Hepatitis E Virus Infections in Rural Bangladesh

Hepatitis E virus (HEV) is the most common cause of acute viral hepatitis in the world. Most of South Asia is HEV endemic, with frequent seasonal epidemics of hepatitis E and continuous sporadic cases. This author group's epidemiologic work and clinical reports suggest that Bangladesh is HEV endemic, but there have been few population-based studies of this country's HEV burden. The authors calculated HEV infection rates, over an 18-month interval between 2003 and 2005, by following a randomly selected cohort of 1,134 subjects between the ages of 1 and 88 years, representative of rural communities in southern Bangladesh. Baseline prevalence of antibody to hepatitis E virus (anti-HEV) was 22.5%. Seroincidence was 60.3 per 1,000 person-years during the first 12 months and 72.4 per 1,000 person-years from >12 to 18 months (during the monsoon season), peaking by age 50 years and with low rates during childhood. Few of the seroconverting subjects reported hepatitis-like illness. Overall incidence was calculated to be 64 per 1,000 person-years, with 1,172 person-years followed. No significant associations were found between anti-HEV incidence and demographic or socioeconomic factors for which data were available. This is the first study to document annual HEV infection rates among "healthy" and very young to elderly subjects in a rural Bangladeshi population.

A multi-centre study of efficacy and safety of Intratect®, a novel intravenous immunoglobulin preparation

We studied the efficacy, safety and pharmacokinetic profiles of Intratect®, a recently developed polyvalent intravenous immunoglobulin (IVIG) preparation. Fifty-one patients (aged 6-48 years) with primary immunodeficiencies (PID) and established replacement therapy using a licensed IVIG were enrolled and treated for 12 months with Intratect®. Retrospective patient data served as prestudy controls. The primary efficacy variable was the annual rate of acute serious bacterial infection (ASBI) per patient. Secondary parameters were annual rate of acute relevant infection (ARI), days with antibiotic use, fever, absence from school/work and hospitalization. The average IVIG dose was 0·49 g/kg, with an average infusion rate of 2·4 ml/kg/h. The annual ASBI rate/patient was 0·02 and ARIs were detected 128 times during the 630 adverse events in 40 patients, specified mainly as bronchitis, sinusitis, respiratory tract infection, rhinitis and pharyngitis. The annual rate of respiratory ARIs/patient was 2·0 and the rates/patient for days with fever >38°C, school/work absence and hospitalization were 1·81, 3·99 and 0·36, respectively. A total of 630 adverse events (AEs) were observed in 50 of 51 (98·0%) of patients. In 46 of 51 patients the AEs were not related to infusion. Pharmacokinetic studies after the first infusion revealed a mean elimination half-life of 50·8 ± 30·3 days. During this study, 19 of 649 (2·9%) IgG trough levels were below 6 g/l, better than that of reference IVIGs during the 6 months before study start (10 of 201). These data suggest that Intratect® is a well tolerated, safe and effective IgG concentrate for the treatment of patients with PID.

Epidemiological and genetic characteristics of norovirus outbreaks in long-term care facilities, 2003–2006

To identify the epidemiological and genetic characteristics of norovirus (NoV) outbreaks and estimate the impact of NoV infections in an older population, we analysed epidemiological and laboratory data collected using standardized methods from long-term care facilities (LTCFs) during 2003-2006. Faecal specimens were tested for NoV by real-time reverse transcriptase-polymerase chain reaction. NoV strains were genotyped by sequencing. Of the 234 acute gastroenteritis (AGE) outbreaks reported, 163 (70%) were caused by NoV. The annual attack rate of outbreak-associated NoV infection in LTCF residents was 4%, with a case-hospitalization rate of 3·1% and a case-fatality rate of 0·5%. GII.4 strains accounted for 84% of NoV outbreaks. Median duration of illness was longer for GII.4 infections than non-GII.4 infections (33 vs. 24 h, P<0·001). Emerging GII.4 strains (Hunter/2004, Minerva/2006b, Terneuzen/2006a) gradually replaced the previously dominant strain (Farmington Hills/2002) during 2004-2006. NoV GII.4 strains are now associated with the majority of AGE outbreaks in LTCFs and prolonged illness in Oregon.

Natural Japanese encephalitis virus infection among humans in west and east Japan shows the need to continue a vaccination program

Japanese encephalitis (JE) is a serious disease in Asia, but it can be prevented by vaccination. To evaluate the necessity for vaccination in areas with reduced numbers of vector mosquitoes, as well as patients, it is critical to understand the frequency of natural virus exposure. An antibody survey was recently conducted to estimate current natural infection rates in Japan, where the vaccination rate has dropped in recent years. Serum samples were collected in 2004–2008 from inhabitants of Kumamoto Prefecture in west Japan, and in 2004–2006 from the Tokyo Metropolitan area of east Japan. Average annual infection rates estimated from the prevalence of antibodies to the nonstructural 1 protein (NS1) of JE virus was 1.8% in Kumamoto and 1.3% in Tokyo. When estimated from percentages of populations with detectable neutralizing antibodies but with no vaccination history, the average annual infection rate was 2.6% in both survey areas. Thus, JE virus remains present and active in nature in Japan. Therefore, continuing a vaccination program is indispensable to prevent JE infection in humans.

Respiratory syncytial virus infections in Central Australia.

Little is known about the epidemiology of respiratory syncytial virus (RSV) infection in arid desert regions and in the Aboriginal population. We describe the seasonality and epidemiology of RSV infection in Central Australia, an arid area with a large Aboriginal population. Five-year retrospective study from 2000 through 2004 of children less than 2 years old admitted to Alice Springs Hospital with documented RSV infection. RSV infection was documented in 173 children <2 years old admitted over a 5-year period, 165 community-acquired and 8 nosocomial. The annual incidence rate of community-acquired RSV infection in hospitalised Central Australian children <2 years old was 20.4 per 1000. The rate in Aboriginal children of 29.6 per 1000 children was significantly greater than in non-Aboriginal children of 10.9 per 1000 (P < 0.0001). Associated risk factors were common; 52% of infected children had at least one other comorbidity. Younger children had more severe illness and longer duration of hospital stay. RSV-related illness peaked in winter but infections occurred throughout the year, and the winter predominance was less marked than in temperate climates. In the arid, desert region of Central Australia, RSV infection occurs throughout the year, but is more frequent in winter and more common in Aboriginal children. These data are important for understanding RSV epidemiology in desert regions, and for planning active or passive RSV immunoprophylaxis in these and other similar populations.

Systems Initiatives Reduce Healthcare-Associated Infections: A Study of 22,928 Device Days in a Single Trauma Unit

"Implementation research" promotes the systematic conversion of evidence-based principles into routine practice to improve the quality of care. We hypothesized a system-based initiative to reduce nosocomial infection would lower the incidence of ventilator-associated pneumonia (VAP), urinary tract infection (UTI), and bloodstream infection (BSI). From January 2006 to April 2008, 7,364 adult trauma patients were admitted, of which 1,953 (27%) were admitted to the trauma intensive care unit and comprised the study group. Tight glycemic control was maintained using a computer algorithm for continuous insulin administration based on every 2-hour blood glucose testing. Centers for Disease Control and Prevention definitions of nosocomial infections were used. Evidence-based infection reduction strategies included the following: a VAP bundle (spontaneous breathing, Richmond Agitation-Sedation Scale, oral hygiene, bed elevation, and deep vein thrombosis/stress ulcer prophylaxis), UTI (expert insertion team and Foley removal/change at 5 days), and BSI (maximum barrier precautions, chlorhexidine skin prep, line management protocol). An electronic dashboard identified the at-risk population, and designated auditors monitored the compliance. Infection rates (events per 1,000 device days) were measured over time and compared annually using Fisher's exact test. The study group had 22,928 device exposure days: 6,482 ventilator days, 9,037 urinary catheter days, and 7,399 central line days. Patient acuity, demographics, and number of device days did not vary significantly year-to-year. Annual infection rates declined between 2006 and 2008, and decreases in UTI and BSI rates were statistically significant (p < 0.05). These decreases pushed UTI and BSI rates below Centers for Disease Control and Prevention norms. Over 28 months, a systems approach to reducing nosocomial infection rates after trauma decreased nosocomial infections: UTI (76.3%), BSI (74.1%), and VAP (24.9%). Our experience suggests that infection reduction requires (1) an evidence-based plan; (2) MD and staff education/commitment; (3) electronic documentation; and (4) auditors to monitor and ensure compliance.

Status of natural infection with Japanese encephalitis virus in Japan: Prevalence of antibodies to the nonstructural 1 protein among humans and horses

The literature on natural infections with Japanese encephalitis virus in Japan and subclinical:clinical infection rates was summarized. To detect natural infections, conventional serologic methods were used in the past, while nonstructural 1 protein-based methods have been used recently. Annual infection rates in humans and horses indicated the status of natural virus activity in Japan.

On the Relationship between Age, Annual Rate of Infection, and Prevalence ofMycobacterium tuberculosisin a South African Township

On the Relationship between Age, Annual Rate of Infection, and Prevalence of<i>Mycobacterium tuberculosis</i>in a South African Township

Application of human immunodeficiency virus type 1 BED enzyme immunoassay on dried blood spots in India

Dried blood spots (DBSs) on filter paper are being used increasingly in population-based human immunodeficiency virus (HIV) studies. This study evaluated the application of a BED enzyme immunoassay (EIA) on DBSs to estimate HIV incidence in a population-based study in India. The Calypte HIV-1 BED Incidence EIA was performed on 224 HIV-1-positive DBS samples, after screening 12 617 individuals from a population-based sample in Guntur district in the southern Indian state of Andhra Pradesh. The number of recently infected HIV cases was identified using this BED assay and was used to estimate the annual HIV incidence rate based on calculations and adjustment formulae suggested by the Centers for Disease Control and Prevention (CDC). The updated BED data management software provided by the CDC was used for analyses. Of the 224 HIV-1 antibody-positive DBS samples, 29 (12.95 %) were estimated by the BED HIV-1 assay to have been infected within the past 155 days. After adjusting for age, gender and rural/urban distribution of the population, the annual incidence rate of HIV-1 infection was estimated to be 0.32 % (95 % confidence interval 0.20-0.44 %). This annual incidence was 18.6 % of the HIV prevalence of 1.72 % in this study. Thus, the BED assay revealed a higher incidence of HIV in this study than was expected from the prevalence. Correlation of the BED assay with panel testing and longitudinal incidence data in the Indian population is needed to calibrate it for use in India.

Tunel aorto-ventricular izquierdo: una rara entidad en cardiología pediátrica

Weekly home-based subcutaneous immunoglobulin (SCIg) therapy is an alternative to intravenous immunoglobulin (IVIg) in the treatment of patients with primary antibody deficiencies. The objective of this study was to investigate the efficacy, safety, related quality of life and cost effectiveness of SCIg in our area. Observational and descriptive study including paediatric patients with common variable immunodeficiency (CVID) receiving SCIg in our hospital (November 2006 to April 2008). Obtained data were compared with those from the last year with IVIg. Eleven patients with CVID were included. Median age was 15 years. The median trough serum IgG level was 622 mg/dl with IVIg. In patients in whom the SCIg dose was maintained or reduced compared to IVIg, the median trough serum IgG level was 850 mg/dl (p < 0.0005). Annual rate of infection was 2.22 per patient-year, without significant differences to IVIg (p = 0.212). There were 58 treatment-related adverse events (AE) reported with SCIg (45 local AE and 13 systemic AE). The most frequent treatment-related adverse event was infusion-site reaction. Switching to home-based subcutaneous IgG treatment led to significant improvements in quality of life and substantial cost savings. We conclude that subcutaneous administration of 16% SCIg is a safe and cost-effective alternative to IVIg for replacement therapy of primary antibody deficiencies. Median trough serum IgG levels were higher with SCIg. Local AE were common but mild and the incidence decreased over time. Quality of life is significantly improved.

Gammaglobulina subcutánea en inmunodeficiencia común variable. Primera experiencia en España

Introduction and aim Weekly home-based subcutaneous immunoglobulin (SCIg) therapy is an alternative to intravenous immunoglobulin (IVIg) in the treatment of patients with primary antibody deficiencies. The objective of this study was to investigate the efficacy, safety, related quality of life and cost effectiveness of SCIg in our area. Materials and methods Observational and descriptive study including paediatric patients with common variable immunodeficiency (CVID) receiving SCIg in our hospital (November 2006 to April 2008). Obtained data were compared with those from the last year with IVIg. Results Eleven patients with CVID were included. Median age was 15 years. The median trough serum IgG level was 622 mg/dl with IVIg. In patients in whom the SCIg dose was maintained or reduced compared to IVIg, the median trough serum IgG level was 850 mg/dl (p<0.0005). Annual rate of infection was 2.22 per patient-year, without significant differences to IVIg (p=0.212). There were 58 treatment-related adverse events (AE) reported with SCIg (45 local AE and 13 systemic AE). The most frequent treatment-related adverse event was infusion-site reaction. Switching to home-based subcutaneous IgG treatment led to significant improvements in quality of life and substantial cost savings. Conclusions We conclude that subcutaneous administration of 16% SCIg is a safe and cost-effective alternative to IVIg for replacement therapy of primary antibody deficiencies. Median trough serum IgG levels were higher with SCIg. Local AE were common but mild and the incidence decreased over time. Quality of life is significantly improved.