Clinical Characteristics Of Infection Research Articles

Clinical evolution of patients with infection associated with orthopedic devices in treatment with continuous negative pressure

To describe the use of negative pressure therapy with (TPNi) and without instillation (TPNs) as adjuvant treatment in the management of orthopedic device-associated infections (IADO). Analytic observational study of records of patients with IADO managed with TPNi and TPNs with 0.9% saline solution, in patients > 18 years, operated on in 2018-2021. Clinical characteristics of infection, infectious agent as well as sociodemographic variables were evaluated. TPN was performed with the V.A.C. VERAFLO™ system. Analysis with χ2, Fisher and t-Student. Statistically accepted value p < 0.05. Sample 40 patients. 75% male. Fractures 42.5% exposed and 57.5% closed. 92.5% applied prophylactic antibiotic (30-120 min). 35% plate implants, 12.5% centromedullary nail, 10% knee prosthesis and 12.5% hip. 47.5% bleeding < 500 ml. 72.5% surgical time of 2-4 hours. Previous hospitalization time, TPNs 3 weeks 55.9% and 4 weeks 26.5%; TPNi, 3 weeks 50% and 4 weeks 33.3%. Conservation of the implant 73.5% TPNs and 50% TPNi (p = 0.341). Wound closure 91.2% with TPNs and 100% with TPNi (p = 1.000). The use of TPNs and TPNi were useful as adjuvant treatments in the management of IADO, in addition they allowed to preserve the implant and wound closure in a large part of the patients.

Clinical characteristics and predictors of delayed discharge among children with SARS‑CoV‑2 Omicron variant infection.

The present study investigated the epidemiology and clinical characteristics of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant and determined the risk factors for delayed discharge or release from isolation for pediatric patients in Quanzhou, China in 2022. There were 145, 254 and 23 patients in the asymptomatic, mildly symptomatic and moderately symptomatic categories, respectively. The proportion of pediatric patients in the moderately symptomatic category increased with increasing age. No child aged <1 year and 9.02% of patients aged 13-18 years were in the moderately symptomatic category. The proportion of patients with asymptomatic infection did not differ significantly by vaccination status. The median days until the first negative conversion of viral RNA was 11 days, and the median hospitalization duration was 16 days. Most symptoms appeared in the upper respiratory tract. Notably, ~33.23% of patients showed elevated aspartate aminotransferase levels. C-reactive protein and interleukin-6 (IL-6) levels, and lymphocyte counts were consistently lower in asymptomatic patients than those in in symptomatic patients. Adjusted logistic regression analyses indicated that IL-6 levels and time to the first negative conversion of viral RNA were independent risk factors for delayed discharge. The area under the curve of the regression model for predicting delayed discharge was 0.760. In conclusion, these results could facilitate the formulation of global epidemic prevention policies for pediatric patients.

Changing character and waning impact of COVID-19 at a tertiary centre in Cape Town, South Africa.

The emergence of genetic variants of SARS-CoV-2 was associated with changing epidemiological characteristics throughout coronavirus disease 2019 (COVID-19) pandemic in population-based studies. Individual-level data on the clinical characteristics of infection with different SARS-CoV-2 variants in African countries is less well documented. To describe the evolving clinical differences observed with the various SARS-CoV-2 variants of concern and compare the Omicron-driven wave in infections to the previous Delta-driven wave. We performed a retrospective observational cohort study among patients admitted to a South African referral hospital with COVID-19 pneumonia. Patients were stratified by epidemiological wave period, and in a subset, the variants associated with each wave were confirmed by genomic sequencing. Outcomes were analysed by Cox proportional hazard models. We included 1689 patients were included, representing infection waves driven predominantly by ancestral, Beta, Delta and Omicron BA1/BA2 & BA4/BA5 variants. Crude 28-day mortality was 25.8% (34/133) in the Omicron wave period versus 37.1% (138/374) in the Delta wave period (hazard ratio [HR] 0.68 [95% CI 0.47-1.00] p = 0.049); this effect persisted after adjustment for age, gender, HIV status and presence of cardiovascular disease (adjusted HR [aHR] 0.43 [95% CI 0.28-0.67] p < 0.001). Hospital-wide SARS-CoV-2 admissions and deaths were highest during the Delta wave period, with a decoupling of SARS-CoV-2 deaths and overall deaths thereafter. There was lower in-hospital mortality during Omicron-driven waves compared with the prior Delta wave, despite patients admitted during the Omicron wave being at higher risk. This study summarises clinical characteristics associated with SARS-CoV-2 variants during the COVID-19 pandemic at a South African tertiary hospital, demonstrating a waning impact of COVID-19 on healthcare services over time despite epidemic waves driven by new variants. Findings suggest the absence of increasing virulence from later variants and protection from population and individual-level immunity.

Genomic and clinical characterization of Klebsiella pneumoniae carrying the pks island.

The pks island and its production of the bacterial secondary metabolite genotoxin, colibactin, have attracted increasing attention. However, genomic articles focusing on pks islands in Klebsiella pneumoniae, as well as comparative genomic studies of mobile genetic elements, such as prophages, plasmids, and insertion sequences, are lacking. In this study, a large-scale analysis was conducted to understand the prevalence and evolution of pks islands, differences in mobile genetic elements between pks-negative and pks-positive K. pneumoniae, and clinical characteristics of infection caused by pks-positive K. pneumoniae. The genomes of 2,709 K. pneumoniae were downloaded from public databases, among which, 1,422 were from NCBI and 1,287 were from the China National GeneBank DataBase (CNGBdb). Screening for virulence and resistance genes, phylogenetic tree construction, and pan-genome analysis were performed. Differences in mobile genetic elements between pks-positive and pks-negative strains were compared. The clinical characteristics of 157 pks-positive and 157 pks-negative K. pneumoniae infected patients were investigated. Of 2,709 K. pneumoniae genomes, 245 pks-positive genomes were screened. The four siderophores, type VI secretion system, and nutritional factor genes were present in at least 77.9% (191/245), 66.9% (164/245), and 63.3% (155/245) of pks-positive strains, respectively. The number and fragment length of prophage were lower in pks-positive strains than in pks-negative strains (p < 0.05). The prevalence of the IS6 family was higher in pks-negative strains than in pks-positive strains, and the prevalence of multiple plasmid replicon types differed between the pks-positive and pks-negative strains (p < 0.05). The detection rate of pks-positive K. pneumoniae in abscess samples was higher than that of pks-negative K. pneumoniae (p < 0.05). The pks-positive strains had abundant virulence genes. There were differences in the distribution of mobile genetic elements between pks-positive and pks-negative isolates. Further analysis of the evolutionary pattern of pks island and epidemiological surveillance in different populations are needed.

Clinical Characteristics and Nomogram Model of Nosocomial Infection in Patients with Newly Diagnosed Multiple Myeloma

To explore the clinical characteristics of nosocomial infection in newly diagnosed multiple myeloma(NDMM) patients, and establish a predictive nomogram model. The clinical data of 164 patients with MM who were treated in Shanxi Bethune Hospital from January 2017 to December 2021 were retrospectively analyzed. The clinical characteristics of infection were analyzed. Infections were grouped as microbiologically defined infections and clinically defined infections. Univariate and multivariate regression models were used to analyze the risk factors of infection. A nomogram was established. 164 patients with NDMM were included in this study, and 122 patients (74.4%) were infected. The incidence of clinically defined infection was the highest (89 cases, 73.0%), followed by microbial infection (33 cases, 27.0%). Among 122 cases of infection, 89 cases (73.0%) had CTCAE grade 3 or above. The most common site of infection was lower respiratory in 52 cases (39.4%), upper respiratory tract in 45 cases (34.1%), and urinary system in 13 cases (9.8%). Bacteria(73.1%) were the main pathogens of infection. Univariate analysis showed that ECOG ≥2, ISS stage Ⅲ, C-reactive protein ≥10 mg/L, serum Creatinine ≥177 μmol/L had higher correlation with nosocomial infection in patients with NDMM. Multivariate regression analysis showed that C-reactive protein ≥10 mg/L (P＜0.001), ECOG ≥2 (P=0.011) and ISS stage Ⅲ （P=0.024） were independent risk factors for infection in patients with NDMM. The nomogram model established based on this has good accuracy and discrimination. The C-index of the nomogram was 0.779（95%CI: 0.682-0.875）. Median follow-up time was 17.5 months, the median OS of the two groups was not reached (P=0.285). Patients with NDMM are prone to bacterial infection during hospitalization. C-reactive protein ≥10 mg/L, ECOG ≥2 and ISS stage Ⅲ are the risk factors of nosocomial infection in NDMM patients. The nomogram prediction model established based on this has great prediction value.

Infectious Complications Following Chimeric Antigen Receptor T-Cell Therapy for Hematologic Malignancy

BackgroundCAR T-cell therapy has shown remarkable efficacy for the treatment of hematologic malignancy. However, this novel adoptive cell therapy is associated with toxicities such as cytokine release syndrome (CRS), CAR-T related encephalopathy syndrome (CRES/ICANS) and infection. While as one of the most common toxicities after CAR T-cell therapy in the first month, infectious complications have not been systematically studied. we aim to explore the incidence, clinical and microbiological characteristics and identify high risk factors for infection in patients with ALL, NHL, and MM. The trial was registered on the Chinese Clinical Trial Registry (ChiCTR-OIC-17011180; ChiCTR1800018143).Methods72 patients with ALL, 56 patients with NHL and 42 patients with MM from January 2016 to December 2020 are involved in the cohort and the baseline data and the clinical characteristics of infection are retrospectively analyzed within 28 days. Infections were defined as a microbiologic, histopathologic, corroborating laboratory, radiographic or clinical diagnosis, and classified as bacterial (bacteremia or site infection), viral (respiratory or other), or fungal (proven or probable). Infection severity was classified as mild, moderate, severe, life-threatening, or fatal. (Young et al.Biol Blood Marrow Transplant 2016; 22:359-70.)CRS was graded by ASTCT. We used univariate and stepwise multivariable Poisson regression to identify associations between baseline clinical characteristics and infection density, and Cox proportional hazards regression to assess high-risk factors for infection.ResultsAmong 170 patients, a total of 119 infections occurred in 99 patients within 28 days, with a cumulative infection rate of 58.2%. The incidence of infection in ALL patients is higher than that of MM and NHL patients. Among 72 ALL patients, 46 (63.9%) patients developed infections, and among 42 MM patients, 24 patients (53.1%) developed infections. The difference in infections between these two groups of patients was statistically significant (Chi-Square test, P=0.038<0.05). There was no significant difference in infection between the ALL and NHL groups, and the MM patients and NHL groups had no significant difference in infection (Chi-square test: ALL vs NHL P=0.168; NHL vs MM P=0.497) .78 patients had 98 bacterial infections and the cumulative incidence of bacterial infection was 45.9%. The cumulative incidence of viral infection was 8.24%, and fungal infection was 4.12%. Bacterial infections are the main types of infections in patients with different tumors, followed by viral infections, and finally fungal infections. There was no statistic significant difference in the severity of infection among different tumors, whether it was the number of patients or events (Kruskal-Wallis test, P=0.646 ,P=0.605）75 infection events occurred in patients who were agranulocytosis, and 90% of patients with bloodstream infections had neutropenia at the time of infection. When agranulocytosis lasted for 28 days, the cumulative infection rate was 38.8%. 91 patients had both CRS and infection. The cumulative incidence of CRS and infection was 68.8% and 58.2%, respectively. Among patients with grade 3-4 CRS, 18 of 30 infections (60%) occurred after the peak of CRS.The adjusted baseline characteristic model showed that ALL patients, previous 30 days of infection history, refractory disease, ANC<0.5×10 9/L before infusion and≥4 prior antitumor treatment regimens had a higher infection density within 28 days; Grade 3 or 4 CRS was the only high-risk factor related to infection after infusion in the multivariate analysis.ConclusionsInfection is one of the common complications of CAR-T cell therapy in patients with hematological malignancy. Bacterial infections occur in most patients regardless of the type of disease. ALL patients, previous 30 days of infection history，refractory disease, ANC<0.5×10 9/L before infusion and Grade 3 or 4 CRS are risk factors for infection.Keywords：chimeric antigen receptor t cell；hematological malignancy；bacterial infection [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Incidence Rates, Household Infection Risk, and Clinical Characteristics of SARS-CoV-2 Infection Among Children and Adults in Utah and New York City, New York

Data about the risk of SARS-CoV-2 infection among children compared with adults are needed to inform COVID-19 risk communication and prevention strategies, including COVID-19 vaccination policies for children. To compare incidence rates and clinical characteristics of SARS-CoV-2 infection among adults and children and estimated household infection risks within a prospective household cohort. Households with at least 1 child aged 0 to 17 years in selected counties in Utah and New York City, New York, were eligible for enrollment. From September 2020 through April 2021, participants self-collected midturbinate nasal swabs for reverse transcription-polymerase chain reaction testing for SARS-CoV-2 and responded to symptom questionnaires each week. Participants also self-collected additional respiratory specimens with onset of COVID-19-like illness. For children unable to self-collect respiratory specimens, an adult caregiver collected the specimens. The primary outcome was incident cases of any SARS-CoV-2 infection, including asymptomatic and symptomatic infections. Additional measures were the asymptomatic fraction of infection calculated by dividing incidence rates of asymptomatic infection by rates of any infection, clinical characteristics of infection, and household infection risks. Primary outcomes were compared by participant age group. A total of 1236 participants in 310 households participated in surveillance, including 176 participants (14%) who were aged 0 to 4 years, 313 (25%) aged 5 to 11 years, 163 (13%) aged 12 to 17 years, and 584 (47%) 18 years or older. Overall incidence rates of SARS-CoV-2 infection were 3.8 (95% CI, 2.4-5.9) and 7.7 (95% CI, 4.1-14.5) per 1000 person-weeks among the Utah and New York City cohorts, respectively. Site-adjusted incidence rates per 1000 person-weeks were similar by age group: 6.3 (95% CI, 3.6-11.0) for children 0 to 4 years, 4.4 (95% CI, 2.5-7.5) for children 5 to 11 years, 6.0 (95% CI, 3.0-11.7) for children 12 to 17 years, and 5.1 (95% CI, 3.3-7.8) for adults (≥18 years). The asymptomatic fractions of infection by age group were 52%, 50%, 45%, and 12% among individuals aged 0 to 4 years, 5 to 11 years, 12 to 17 years, and 18 years or older, respectively. Among 40 households with 1 or more SARS-CoV-2 infections, the mean risk of SARS-CoV-2 infection among all enrolled household members was 52% (range, 11%-100%), with higher risks in New York City compared with Utah (80% [95% CI, 64%-91%] vs 44% [95% CI, 36%-53%]; P < .001). In this study, children had similar incidence rates of SARS-CoV-2 infection compared with adults, but a larger proportion of infections among children were asymptomatic.

Infectious complications following chimeric antigen receptor T-cell therapy for a hematologic malignancy within 28 days

目的探讨血液肿瘤患者在回输嵌合抗原受体T细胞（CAR-T细胞）后28 d内感染的发生率、临床和微生物学特征及危险因素。方法回顾性分析2016年1月至2020年12月在华中科技大学同济医学院附属协和医院血液科成功接受CAR-T细胞输注的170例血液肿瘤患者基线资料以及回输后28 d内发生感染的临床与病原菌特征。使用泊松回归评估基线特征与感染密度的相关性，单因素和多因素Cox比例风险回归模型评估CAR-T细胞回输后感染的高危因素。结果170例患者中急性淋巴细胞白血病（ALL）72例、非霍奇金淋巴瘤（NHL）56例、多发性骨髓瘤（MM）42例，99例患者在28 d内共发生119次感染，累积感染发生率为（58.2±3.8）％；其中细菌感染98次（45.9％），总感染密度为2.01，首次感染发生的中位时间为回输后12（1～18）d。多因素泊松回归显示ALL患者、难治性疾病、既往30 d内感染病史、回输前ANC<0.5×109/L、前期治疗方案≥4种的患者在28 d内与感染密度有更高的相关性；多因素Cox回归显示≥3级细胞因子释放综合征（CRS）是发生感染的独立危险因素（HR＝3.74，95％CI 1.29～5.72，P<0.001）。结论感染是血液病患者CAR-T治疗后常见的并发症之一，不同肿瘤的感染发生率与类型有所差异，但均以细菌感染为主。ALL患者、难治性疾病、既往30天内感染病史、回输前ANC<0.5×109/L、前期治疗方案≥4种与感染密度相关；3级以上CRS是感染发生的独立危险因素。中国临床试验注册中心：ChiCTR-OIC-17011180、ChiCTR1800018143

Phenotypic and genotypic characteristics of Acinetobacter baumannii enrolled in the relationship among antibiotic resistance, biofilm formation and motility

Acinetobacter baumannii is an important pathogen in clinical. The factors of biofilm formation, antibiotic resistance and motility contribute great to A. baumannii in persisting in stressed environment, and further leads to nosocomial infections. 70 A. baumannii clinical isolates were investigated for their clinical characteristics of infection. Among the tested strains, 54 (77.1%) isolates were obtained from ICUs, with the frequency of multidrug-resistance (MDR) at 55.7%, and that of extensively drug-resistance (XDR) at 31.4%. 97.1% of the clinical isolates could form biofilms, in which 4.3% possessed weak biofilm formation ability, while 41.4% and 51.4% were moderate and strong biofilm producers, respectively. A strong correlation between antibiotic resistance and biofilm formation ability was found that all the resistant strains could form biofilms, with the majority in moderate and strong levels, but 2.9% sensitive isolates had no such ability. However, the sensitive strains that could produce biofilms showed stronger biofilm formation capacity in the early stage before 24 h compared to the resistant isolates, though they became weaker afterwards. 24 biofilm-related genes and two blaOXA genes were found in both biofilm-forming and non-biofilm-forming strains, but with higher prevalence in the strains that could produce biofilms. No correlation was detected between twitching motility with antibiotic susceptibility or biofilm formation. These results raised a viewpoint that examining timepoint is a key factor for determining the biofilm formation ability, and further highlighted the importance of the appropriate surveillance and control measures in preventing the emergence and transmission of MDR and XDR A. baumannii.

Desulfovibrio desulfuricans bacteremia: A case report and literature review

Desulfovibrio spp. are sulfate-reducing, anaerobic bacteria that are ubiquitously found in the environment. These organisms infrequently cause human infections, and the clinical characteristics of infection with Desulfovibrio spp. remain unclear. Here, we describe a case of Desulfovibrio desulfuricans bacteremia in an 88-year-old Japanese man with a past medical history of thoracic endovascular aortic repair (TEVAR). His chief complaint was hemoptysis for 2 weeks. A chest contrast-enhanced computed tomography demonstrated an enlarged thoracic aortic aneurysm surrounded by a ring-enhanced lesion, recognized as mediastinal abscess. Gram-negative spiral bacilli were detected in anaerobic blood culture. These bacteria could not be identified using conventional methods, but by analyzing a full base sequence of 16S rDNA, they were identified as D. desulfuricans subsp. desulfuricans. The patient underwent an emergent re-TEVAR, and the infection subsided after being treated with tazobactam/piperacillin and clindamycin, followed by metronidazole. A literature review of previous cases of D. desulfuricans bacteremia suggested that the pathogen was derived from bacterial translocation from the intestine in most cases. Desulfovibrio infection is presumably underestimated due to its infrequency, indolent growth, and difficulty in identification. Desulfovibrio spp. should be suspected when spiral rods are observed in anaerobic culture, and molecular analysis is required for accurate species-level differentiation of the pathogens. To better understand the pathogenicity of these fastidious organisms, further cases based on the exact bacterial identification should be investigated.

Corinebacterium urealyticum: increased incidence of infection and encrusted uropathy

IntroductionCorynebacterium urealyticum (CU) affects patients who are immunosuppressed, chronically ill or have undergone numerous operations. Obstructive uropathy (OU) is a complication of infection. Study objectiveTo demonstrate the growing increase in cases of infection by CU and OU in the past 5 years. Material and methodsA descriptive study was conducted of urological patients with CU-positive urine cultures (January 2009–December 2014). We calculated the annual distribution and clinical characteristics of infection by CU and OU. Minimum follow-up: 6 months. We obtained the statistical means and ranges of clinical parameters pre/post-therapy. ResultsThe total number of patients with CU was 115 (men, 87; women, 28). The mean age was 67.9 years (range, 6–95 years), and the annual distribution of cases for 2009, 2010, 2011, 2012, 2013 and 2014 was 9 (7.8%), 13 (11.3%), 9 (7.8%), 20 (17.4%), 31 (27%) and 33 (28.7%), respectively. The increase in cases for 2009–2014 was 300%. Multiple urological surgeries were performed in 89 cases (77.3%), with surgical complications in 77 cases (66.9%). Eighteen (15.6%) patients had OU (men, 13; women, 5), 12 had pyelitis (66.7%), 3 had cystopathy (16.6%), 2 had prostatic capsule disease (11.2%) and 1 had mesh calcification (5.5%). The analysis of the 18 cases with OU showed pre/postantibiotic therapy urine pHs of 8 (r, 6–9) vs. 6 (r, 5–7). All postantibiotic cultures were negative. Acidifying solution was applied in 5 cases, and surgery was performed in 13 cases (72.2%). The results from before/after the multimodal therapy showed renal impairment in 12 (66.6%) vs. 9 cases (50%) and glomerular filtration rates (GFR) of 45.8 (r, 6 to >90) vs. 52.7 (r, 13 to >90). The improvement in GFR was 6.94 points (T Wilcoxon; p=.102). The radiology results (incrustations) showed improvement in 13 patients (72.2%) and no change in 5 (27.8%). There was no specific mortality for CU. ConclusionsThe prevalence of infection by CU and OU is increasing. Antibiotic treatment is highly effective. Acidifying solutions are an acceptable option for reducing calcifications.

In vitro biofilm production of Candida bloodstream isolates: any association with clinical characteristics?

Candida spp. are a leading cause of bloodstream infection (BSI) and are associated with high mortality rates. Biofilm production is a virulence factor of Candida spp., and has been linked with poor clinical outcome. The aim of our study was to assess biofilm production of Candida bloodstream isolates at our institute, and to determine whether in vitro biofilm production is associated with any clinical characteristics of infection. During the four-year study period, 93 cases of Candida BSI were analysed. The most frequently isolated species was C. albicans (66.7 %), followed by C. glabrata (9.7 %), C. parapsilosis (9.7 %), C. tropicalis (9.7 %) and C. krusei (4.3 %). Biofilm production was more prevalent among non-albicans Candida spp. (77.4 %) than C. albicans (30.6 %) (P = 0.02). Abdominal surgery was identified as a risk factor of BSI caused by biofilm producing non-albicans Candida isolates. No risk factors predisposing to bloodstream infection caused by a biofilm producing C. albicans isolate were identified. Biofilm production was not verified as a risk factor of mortality.

Corynebacterium urealyticum: aumento de la incidencia de infección y uropatía incrustante

IntroductionCorynebacterium urealyticum (CU) affects patients who are immunosuppressed, chronically ill or have undergone numerous operations. Obstructive uropathy (OU) is a complication of infection. Study objective: To demonstrate the growing increase in cases of infection by CU and OU in the past 5 years. Material and methodsA descriptive study was conducted of urological patients with CU-positive urine cultures (January 2009-December 2014). We calculated the annual distribution and clinical characteristics of infection by CU and OU. Minimum follow-up: 6 months. We obtained the statistical means and ranges of clinical parameters pre/post-therapy. ResultsThe total number of patients with CU was 115 (men, 87; women, 28). The mean age was 67.9 years (range, 6-95 years), and the annual distribution of cases for 2009, 2010, 2011, 2012, 2013 and 2014 was 9 (7.8%), 13 (11.3%), 9 (7.8%), 20 (17.4%), 31 (27%) and 33 (28.7%), respectively. The increase in cases for 2009–2014 was 300%. Multiple urological surgeries were performed in 89 cases (77.3%), with surgical complications in 77 cases (66.9%). Eighteen (15.6%) patients had OU (men, 13; women, 5), 12 had pyelitis (66.7%), 3 had cystopathy (16.6%), 2 had prostatic capsule disease (11.2%) and 1 had mesh calcification (5.5%). The analysis of the 18 cases with OU showed pre/postantibiotic therapy urine pHs of 8 (r, 6–9) vs. 6 (r, 5–7). All postantibiotic cultures were negative. Acidifying solution was applied in 5 cases, and surgery was performed in 13 cases (72.2%). The results from before/after the multimodal therapy showed renal impairment in 12 (66.6%) vs. 9 cases (50%) and glomerular filtration rates (GFR) of 45.8 (r, 6–>90) vs. 52.7 (r, 13–>90). The improvement in GFR was 6.94 points (T Wilcoxon; P=.102). The radiology results (incrustations) showed improvement in 13 patients (72.2%) and no change in 5 (27.8%). There was no specific mortality for CU. ConclusionsThe prevalence of infection by CU and OU is increasing. Antibiotic treatment is highly effective. Acidifying solutions are an acceptable option for reducing calcifications.

Surgical Burn Wound Infections and Their Clinical Implications

Typically, burn wound infections are classified by the organisms present in the wound within the first several days after injury or later by routine surveillance cultures. With universal acceptance of early excision and grafting, classification of burn wound colonization in unexcised burn wounds is less relevant, shifting clinical significance to open burn-related surgical wound infections (SWIs). To better characterize SWIs and their clinical relevance, the authors identified the pathogens responsible for SWIs, their impact on rates of regrafting, and the relationship between SWI and nosocomial infection (NI) pathogens. Epidemiologic and clinical data for 71 adult patients with ≥ 20% TBSA burn were collected. After excision and grafting, if a grafted site had clinical characteristics of infection, a wound culture swab was obtained and the organism identified. Surveillance cultures were not obtained. SWI pathogen, anatomic location, postburn day of occurrence, and need for regrafting were compiled. A positive culture obtained from an isolated anatomic location at any time point after excision and grafting of that location was considered a distinct infection. Pathogens responsible for NIs (urinary tract infections, pneumonia, bloodstream and catheter-related bloodstream infections, pseudomembranous colitis, and donor site infections) and their postburn day were identified. The profiles of SWI pathogens and NI pathogens were then compared. Of the 71 patients included, 2 withdrew, 6 had no excision or grafting performed, and 1 had incomplete data. Of the remaining 62 patients, 24 (39%) developed an SWI. In these 24 patients, 70 distinct infections were identified, of which 46% required regrafting. Candida species (24%), Pseudomonas aeruginosa (22%), Serratia marcescens (11%), and Staphylococcus aureus (11%) comprised the majority of pathogens. Development of an SWI with the need for regrafting increased overall length of stay, area of autograft, number of operative events, and was closely associated with the number of NIs. The %TBSA burn and depth of the burn were the main risk factors for SWI with need for regrafting. The SWI pathogen was identified as an NI pathogen 56% of the time, with no temporal correlation between shared SWI and NI pathogens. SWIs are commonly found in severely burned patients and are associated with regrafting. As a result, patients with SWIs are subjected to increased operative events, autograft placement, and increased length of hospitalization. In addition, the presence of an SWI may be a risk factor for development of NIs.

Microbiology, time course and clinical characteristics of infection in critically ill patients receiving packed red blood cell transfusion

Packed red blood cell transfusion has been associated with increased infection in a variety of critically ill patient populations. We evaluated the microbiology and time course of infection in transfused patients in the intensive care unit (ICU) as no data exist on these parameters. We performed a retrospective review of data for all patients admitted to a 24-bed medical-surgical ICU at Cooper University Hospital from July 2003 to September 2006 and entered in the Project Impact database. A total of 2432 patients were admitted during the study period, of which 609 underwent transfusion. Transfused patients were more likely to develop a nosocomial infection (10.5% vs. 4.9%, P < 0.001). ICU and hospital length of stay were longer in the transfused group (P < 0.001 for both). Mortality was also greater (13.1% vs. 8.7%, P = 0.001). Transfused patients had a shorter time from hospital admission to first infection (P < 0.001) and ICU admission to first infection (P < 0.001). Multivariate analysis confirmed transfusion as an independent risk factor for infection, mortality, hospital and ICU length of stay. Methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus and Acinetobacter occurred more often in transfused patients. Acinetobacter accounted for a disproportionate share of infections among transfused patients (P < 0.001). Transfused ICU patients have a higher incidence of nosocomial infection and worse outcomes. Transfused patients had a shorter onset of infection. Acinetobacter infection appears to be particularly common among these patients. Further investigation is merited to better elucidate the mechanism for these findings and their therapeutic and clinical implications.

O.5.3 Clinical characteristics of infection with the newer human parechoviruses in children

O.5.3 Clinical characteristics of infection with the newer human parechoviruses in children

The human metapneumovirus: biology, epidemiological features, and clinical characteristics of infection

The human metapneumovirus: biology, epidemiological features, and clinical characteristics of infection

Central venous catheter infection in haemophiliacs undergoing prophylaxis or immune tolerance with clotting factor concentrate.

The risk of infection in individuals with haemophilia using central vascular access devices for administration of clotting factor concentrates for prophylaxis or immune tolerance is unknown. We conducted a survey of US haemophilia treatment centres to determine the incidence and clinical characteristics of infection associated with the use of central venous catheters. Seventy (38.3%) of 183 patients using central lines developed device-associated infection, including 30 (28.0%) on prophylaxis and 40 (52.6%) on immune tolerance, P < 0.005. Over half (54.8%) the infections occurred in those 3 years of age. Implanted/tunnelled devices (port catheters) were more likely to become infected in the first 30 days after insertion, 11 of 41 (26.8%), than external catheters (broviac/hickman), none of 29 (0%), P= 0.00003. The median time to infection from initial device placement, 124 days, varied with age, 57 days in those 2 years of age vs. 161 days in those > 2 years of age, P= 0.0008, but not with type of device or treatment. Staphylococcal infections were more common with implanted devices (ports), 30 (73.2%), than external catheters, 12 (41.4%), P < 0.01, and Gram-negative infections were more common with external catheters, 17 (58.6%), than tunnelled devices, 7 (17.1%), P < 0.005. In summary, the rate of infection with central venous access devices in haemophiliacs is high, and alternative approaches to venous access should be explored.

Hemophilus aphrophilus Endocarditis, with Cerebral Embolism, in an Alaskan Eskimo

Brief Communication1 April 1966Hemophilus aphrophilus Endocarditis, with Cerebral Embolism, in an Alaskan EskimoROBERT FORTUINE, M.D., FRED W. BELL JR., B.S.ROBERT FORTUINE, M.D.Search for more papers by this author, FRED W. BELL JR., B.S.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-64-4-873 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptIn 1940, Khairat (1) described from London a fatal case of endocarditis caused by an organism he named Hemophilus aphrophilus. A second case was reported by Toshach and Bain (2) in 1958 from Edmonton, Alberta, and a third in 1963 by Keith and Lyon (3) from Cincinnati. Witorsch and Gorden (4) of New Haven reviewed these cases and added three in 1964.We recently encountered a seventh case ofH. aphrophilusendocarditis, complicated by cerebral embolism, in a remote area of southwestern Alaska. We present this case to define further the clinical characteristics of infection with this little-known organism and...