Common Microbial Cause Research Articles

URINARY TRACT INFECTION IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA ADMITTED FOR PROSTATECTOMY

   Urinary Tract Infection (UTI) in patients with Benign Prostatic Hyperplasia (BPH) causes UTI related complication before and after prostatectomy, reduction in their health-related quality of life and overall well-being, thus the knowledge of UTI may play a complementary role in management.The aim of this research was to study the prevalence of urinary tract infection (UTI), its causative organism and antibiotic susceptibility. All BPH patients who were admitted for prostatectomy were included to the study. Information on age, presence of an indwelling catheter, other factors related to UTI and antibiotic susceptibility results were obtained and analyzed using IBM SPSS version 26. Three hundred twenty six patients were studied. The age range of study participants was 51 to 89 years and displayed a median of 70 year (IQR=12). More than half of study participants 168 (51.5%) were between 61 to 70 years. Bacterial isolates were noted in 96 (29.4%) patients. Escherichia Coli noted in (25.3%) specimens was the most common organism isolated. The bacterial isolates were mostly sensitive to imipenem, meropenem, and fosfomycin, but showed greater resistance to cefotaxime, ceftazideme and cefazulin accordingly. The age of study participants was significantly greater for those who had bacteriuria (Mdn = 70) years than those who did not have bacteriuria (Mdn = 67), U = 9569, P = 0.048. The same it was significant for PSA level (P = 0.000) but were not significant for prostate size (P = 0.558). Less than one third of BPH patients had UTI (29.4%), E. Coli was the most common microbial cause of UTI in study participants it was the cause in one fourth of cases (25%), Imipenem group of antibiotic was the most sensitive antibiotics in study participants (93.9%), Cefotaxime was the most resistant antibiotics (66.7%)

Development and characterization of a new swine model of invasive pneumococcal pneumonia.

Streptococcus pneumoniae is the most common microbial cause of community-acquired pneumonia. Currently, there are no available models of severe pneumococcal pneumonia in mechanically ventilated animals to mimic clinical conditions of critically ill patients. We studied endogenous pulmonary flora in 4 healthy pigs and in an additional 10 pigs in which we intra-bronchially instilled S. pneumoniae serotype 19 A, characterized by its resistance to penicillin, macrolides and tetracyclines. The pigs underwent ventilation for 72 h. All pigs that were not challenged with S. pneumoniae completed the 72-h study, whereas 30% of infected pigs did not. At 24 h, we clinically confirmed pneumonia in the infected pigs; upon necropsy, we sampled lung tissue for microbiological/histological confirmation of pneumococcal pneumonia. In control pigs, Streptococcus suis and Staphylococcus aureus were the most commonly encountered pathogens, and their lung tissue mean ± s.e.m. concentration was 7.94 ± 20 c.f.u./g. In infected pigs, S. pneumoniae was found in the lungs of all pigs (mean ± s.e.m. pulmonary concentration of 1.26 × 105 ± 2 × 102 c.f.u./g). Bacteremia was found in 50% of infected pigs. Pneumococcal pneumonia was confirmed in all infected pigs at 24 h. Pneumonia was associated with thrombocytopenia, an increase in prothrombin time, cardiac output and vasopressor dependency index and a decrease in systemic vascular resistance. Upon necropsy, microbiological/histological pneumococcal pneumonia was confirmed in 8 of 10 pigs. We have therefore developed a novel model of penicillin- and macrolide-resistant pneumococcal pneumonia in mechanically ventilated pigs with bacteremia and severe hemodynamic compromise. The model could prove valuable for appraising the pathogenesis of pneumococcal pneumonia, the effects associated with macrolide resistance and the outcomes related to the use of new diagnostic strategies and antibiotic or complementary therapies.

The Most Common Microbial agents of Urinary Infection and Pattern of Antibiotical Sensitivity in Patients Referred to the Central Laboratory of ShahreKord

Urinary tract infections (UTI) are the second common infections, worldwide after respiratory infections. So understanding causes and treatment of these infections is necessary to prevent complications. The aim of this study was to investigate common microbial causes of UTI and antibiotic sensitivity pattern of patients referred to the central laboratory of ShahreKord city during 2020. This study was as descriptive and cross-sectional. Data collection was based on the data of the registry of positive samples of urinary tract infections and based on the studies performed in the laboratory, in terms of the type of pathogen and the type of antibiotic. Data were based on name, age, sex, test result, type of bacteria, and pattern of drug resistance or susceptibility. Finally, SPSS software (version 22) was applied for analyzing. Results showed that 8.2% tests were positive. More positive tests were in the summer season. Escherichia coli had the highest frequency. The lowest resistance was related to gentamicin and the highest resistance was related to ampicillin. Therefore, it is vital that ampicillin consumption should be decreased in urinary infection caused by Escherichia coli in ShahreKord.

S0219 It Takes a Village to Bend the Curve for HO-CDI: A Quality Improvement Initiative

Introduction: In 2015, the Centers for Disease Control (CDC) reported that Clostridium difficile infections (CDI) had become the most common microbial cause of health care-associated infections in the US. There are three types of C Diff infection for surveillance purposes: Healthcare facility-onset HO-CDI; Community-onset, healthcare facility–associated (CO-HCFA) CDI Community-associated (CA) CDI The Memphis VAMC has high rates of HO-CDI at 8.5/10,000 patient days in June 2019, which was double as compared to the national and local rates at other hospitals in the Memphis area. Methods: To combat the high rates of HO-CDI, a quality improvement (QI) CDI Prevention team was formed in June 2019 to work on a QI project to decrease the rates of HO-CDI at the Memphis VAMC. Highlights of the QI Project: Problem Statement: High rates of HO- CDI at the Memphis VAMC @ 8.5/10000 patient days as compared to national and local standards. Aim Statement: Decrease the rates of HO-CDI by 50 percentage in 6 months by December 2019 Core Metrics to be followed: Monthly HO-CDI rates Monthly rates of C Diff PCR orders Gap Analysis and Interventions: As showed in the GAP analysis table attached with the submission Results: Rates of HO CDI: Decrease in HO-CDI rates from 8.5/10,000 patient days to 2.3/10,0000 patient days in December 2019 as shown by the U chart with the submission. Number of C diff PCR tests ordered per month: Average of 81.5 tests/month in the preintervention period Average of 43.8 tests/month, a decrease by 46% as shown by the run chart in the submission. Conclusion: It really took a village and a combined effort from all the different departments as depicted in the gap analysis table to obtain the results that we were able to achieve. Electronic algorithms and protocols can be bypassed very easily, hence compliance monitoring with the note template is necessary even after completion of the QI Project. We all understand the importance of antibiotic stewardship, but the concept of diagnostic stewardship is equally important when you have a test with high sensitivity like the PCR for C.diff toxin.Table 1.: Gap Analysis TableFigure 1.: U chart showing the monthly rates of HO-CDI with the control limits.Figure 2.: Run chart showing the monthly number of C. Diff PCR tests ordered.

Spinal Epidural Abscess.

Spinal Epidural Abscess.

227 A Retrospective Evaluation of Compliance to Clostridium difficile Treatment Guidelines

INTRODUCTION: Nearly half a million Americans suffered from Clostridium difficile (C. diff.) infections in a single year according to a study released by the Centers for Disease Control and Prevention (CDC). Studies indicate that C. diff. has become the most common microbial cause of Healthcare-Associated Infections found in U.S. hospitals driving up healthcare costs in acute care facilities alone. Our goal with this study is to investigate via retrospective chart review over the past 12 months to find out how often proper treatment was administered for patients admitted with a diagnosis of C. diff. infection. METHODS: This study is a retrospective chart review on patients admitted between Feb 2018–Feb 2019 at Franciscan Health St James Olympia Fields. Subjects were randomly selected with ICD-10 code for CDI. Age, gender, comorbidities, admission laboratory values, admission and discharge dates, and clinical course were obtained from EMR. The compliance to guidelines was assessed at initial treatment and as subjects further stratified into the categories non-severe, severe and fulminant disease. Compliance to guidelines was determined by type and duration of therapy. Secondary endpoints such as clinical outcomes such as 90-day mortality, therapy escalation and clinical cure which were also evaluated. RESULTS: A total of 118 patients were included in this study. This study shows that physician adherence to evidence-based guidelines for treatment of CDI was poor (50%). The study also found that compliance was lower in subjects with severe and fulminant disease. Overall, mortality associated with Clostridium Difficile treatment was 19.4% across all patients diagnosed with CDI regardless of severity of illness. CONCLUSION: CDI is a highly morbid condition and places a heavy burden on the healthcare system. Failing to adhere to the guidelines for treatment of Clostridium Difficile is detrimental to patients and results in worse clinical outcomes. This study identified that compliance to treatment guidelines is poor and barriers to compliance still exist despite education and guideline availability. To improve compliance to treatment guidelines in our hospital, we are currently developing an electronic order set through EPIC based on guidelines to allow for accurate treatment delivery and provide better outcomes.

Common microbial causes of significant bacteriuria and their antibiotic resistance pattern in the Isfahan Province of Iran

Urinary tract infections (UTIs) are considered the most common community-acquired infections worldwide, which have possible complications along with significant economic impact on national healthcare systems. The aim of this study was to identify the most common causes of significant bacteriuria and to assess their antimicrobial resistance pattern in the Isfahan province of Iran. In this cross-sectional study, 11,678 urine samples of the patients referred to Mahdieh Medical Diagnostic Centre Charity were examined over a period of 10 months (from September 2015 to June 2016). Among the cases, 6.85% were positive for bacteriuria (F/M = 11.3). Escherichia coli (62%) was the most frequently isolated bacteria, followed by Staphylococcus epidermidis (13.9%) and Staphylococcus aureus (6.8%). E. coli was more prevalent among patients with diabetes mellitus. E. coli isolates showed the highest resistance to nalidixic acid, Trimethoprim/Sulfamethoxazole and Cefixime. Our results revealed that broad-spectrum antibiotic resistance is frequent among isolated uropathogens in Isfahan, Iran.

EPOP-153 - Battling Hospital Acquired Clostridium Difficile with Innovative Infection Prevention Tools

Background: With the increase in antibiotic use in the United States, Clostridium difficile has become the most common microbial cause of healthcare associated infections. After seeing the number of Clostridium difficile cases double from 2015 to 2016, our community hospital faced a critical safety challenge for our patients. Using innovative techniques in standard prevention tools, our goal was to reduce our Clostridium difficile infection rate by 50%.

THE IMPACT OF UNDER KNEE PROSTHESIS ON VARIOUS DIMENSIONS OF LIFE QUALITY OF DISABLED INDIVIDUALS REFERRING TO REHABILITATION CENTER OF SHIRAZ RED CRESCENT IN 2017

Objectives: Denture stomatitis (DS) is a benign condition, usually asymptomatic, that can affect denture wearer’s patients. The aim of this study was to describe the etiology of DS among Yemeni denture wearers and the risk factors of DS. A cross sectional study was carried out at Prothodontics Departments at the Faculty of Dentistry- Sana'a University, Sana’a city –Yemen. Methods: The study group consisted of 288 denture wearers' patients' contracting DS. The microbiological samples were collected by wiping sterile swabs on upper and lower denture fitting surfaces. Then, they were directly cultured for Candida in Chromomeric agar media and for bacteria in standard selective media, using standard bacteriological methods. Results: The most common microbial cause of DS was C. albicans (58.3%), followed by S. mutans (17%), while S. aureus (4.9%), lactobacillus (3.1%) and C. glabrata (4.2%) were less common. There was an association between male patients, older age group and longer period of denture wearers with high risk of contracting candidal DS and bacterial DS. Most of those patients were suffering from DS Type I and few from Type II, but no case of DS Type III was found. Ending, DS is a condition that commonly affects denture wearers, and should be treated even if asymptomatic. The condition requires a combined treatment approach from both patient and clinician, and the role of the patient must be stressed. Conclusion: Management of aetiological risk factors is key in order to prevent recurrence. Treatment modalities may include: treatment of any underlying systemic risk factors, improvement in the fit of existing dentures, replacement of existing dentures, improved denture hygiene and the use of antifungal agents. Whichever methods are employed, the main aim of treatment is to eradicate the biofilm from the patient’s dentures. Peer Review History: Received 11 March 2017; Revised 13 March; Accepted 14 March, Available online 15 March 2018 UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 4.5/10 Average Peer review marks at publication stage: 8.0/10 Reviewer(s) detail: Dr. Marwa A. A. Fayed, University of Sadat City, Egypt, maafayed@gmail.com Dr. Masoumeh Divar, Shiraz University, Shiraz, Iran, zhaledivar@gmail.com Similar Articles: RISK FACTORS OF PERIODONTAL DISEASES AMONG YEMENI YOUNG DENTAL PATIENTS SERO-PREVALENCE OF HEPATITIS C VIRUS AMONG DENTAL CLINIC WORKERS IN SANA’A CITY- YEMEN AND THE RISK FACTORS CONTRIBUTING FOR ITS INFECTION

Endophthalmitis: Then and Now

To report historically evolving strategies (then and now) in prevention and management of endophthalmitis. A perspective on relevant topics in the prophylaxis and management of endophthalmitis. This is an author-selected review of studies leading to changes in strategies for endophthalmitis management over the last 100 years. The current perspective discusses the trends and strategies over the past century. Historically, 3 endophthalmitis time-periods have existed and include the pre-antimicrobial era, the predominantly systemic antimicrobial era, and the current intravitreal antimicrobial era. The management of endophthalmitis from different etiologies, including endogenous, postinjection, post-cataract surgery, and other anterior segment-related (eg, post-penetrating keratoplasty), bleb-associated, glaucoma drainage device-associated, and open globe injury-associated, are discussed. Specific etiologies may predict most common microbial causes and may guide differing management strategies. Pars plana vitrectomy offers theoretical advantages but is generally reserved for patients with more advanced disease. Despite advances over the past 100 years, endophthalmitis is an important sight-threatening complication. Timely management with the appropriate use of antimicrobial agents may optimize visual outcomes.

Evaluation the Antibacterial Effects of Two Commercial Products of Eucalyptus globulus Against Common Microbial Causes of Respiratory Tract Infections

Background: Recently, antimicrobial activity of medicinal plants have attained once more importance due to drug resistance of microbial isolates to common antibiotics as well as fewer side effects and low cost of herbal products comparing to chemical drugs. Eucalyptus globules (E. globulus) has been widely applied as a natural remedy in respiratory tract infections. The present study focused on the evaluation of antibacterial effect of two commercial products of E. globulus against common microbial causes of respiratory tract infections. To this end, two commercial products of E. globules including inhaler and oral soft capsule with standard expiration date, (in three different batch numbers) were purchased from the pharmacy stores of Tabriz city. Methods: The antibacterial efficiency of these products were investigated using Minimum Inhibitory Concentration (MIC), Minimum Bactericidal Concentration (MBC) and disk diffusion methods against Staphylococcus aureus, Streptococcus pyogenes and Pseudomona aeruginosa. Results: Based on the obtained results, these commercial products of E. globules showed significant inhibitory effects against Gram-positive bacteria. The findings also indicated that the Eucalyptus inhaler products had more inhibitory effects than Eucalyptus oral soft capsule, however batch to batch variations were of concern. Conclusion: This research presents optimistic result on using the Eucalyptus as an alternative antibacterial agent against respiratory tract pathogenic microorganisms.

Surveillance of infection associated with external ventricular drains: proposed methodology and results from a pilot study

The insertion of external ventricular drains (EVDs) is necessary in some neurosurgical patients, but increases the risk of meningitis/ventriculitis. While there are well-recognized risk factors, the proportion of patients who develop meningitis/ventriculitis varies partly due to differences in definitions. A multi-disciplinary working group was established to agree definitions for EVD-associated meningitis/ventriculitis, and a surveillance system was piloted in four centres in the UK and Ireland. Definitions were agreed based on those published previously and on clinical and microbiological criteria. An agreed dataset was developed to monitor patients after the insertion of an EVD and until the EVD was removed and the microbial aetiology was recorded. Four neurosurgical centres participated, with 61-564 patients surveyed in each unit. The vast majority of drains were cranial. Intracranial haemorrhage was the most common indication for the EVD insertion. Between 6% and 35% of EVDs were inserted by consultants rather than junior doctors. The proportion of patients who developed meningitis/ventriculitis varied from 3% to 18% and from 4.8 to 12.7/1000 EVD-days. Coagulase-negative staphylococci were the most common microbial causes. Routine and ongoing monitoring of patients with an EVD in situ to detect meningitis/ventriculitis presents logistical difficulties, and few units do so. This pilot study suggests that a national system of surveillance with agreed definitions and a methodology to enable unit-to-unit comparisons of EVD meningitis/ventriculitis is both necessary and feasible. This will, in turn, inform quality improvement processes leading to the minimization of infection.

Listeria monocytogenes cross-contamination of cheese: risk throughout the food supply chain.

Listeria monocytogenes has been the most common microbial cause of cheese-related recalls in both the United States and Canada in recent years. Since L. monocytogenes is inactivated by pasteurization, the majority of these cases have been linked to environmental and cross-contamination of fresh-soft, soft-ripened, and semi-soft cheeses. Cross-contamination of foods with L. monocytogenes is a continuous risk throughout the food supply chain and presents unique challenges for subsequent illness and outbreak investigations. Reports on outbreaks of listeriosis attributed to cross-contamination downstream from primary processing help highlight the critical role of epidemiological investigation coupled with coordinated molecular subtyping and surveillance in the recognition and investigation of complex foodborne outbreaks. Despite their complexity, environmental sampling throughout the supply chain coupled with improved genotyping approaches and concomitant analysis of foodborne illness epidemiological exposure data are needed to help resolve these and similar cases more rapidly and with greater confidence.

The causative agents in infective endocarditis: a systematic review comprising 33,214 cases.

Infective endocarditis (IE) incidence remains high with considerable fatality rates; guidelines for prophylaxis against IE are currently under review in some settings which highlights the importance of maintaining up-to-date epidemiological estimates about the most common microbial causes. The objective of this systematic review, following PRISMA guidelines, was to identify the most common microbial causes of IE in recent years. Medline was searched from January 1, 2003 to March 31, 2013 for all articles containing the term "infective endocarditis". All relevant studies reporting diagnostic results were included. Special patient subpopulations were assessed separately. A total of 105 studies were included, from 36 countries, with available data on a total of 33,214 cases. Staphylococcus aureus was found to be the most common microorganism, being the most frequent in 54.3% of studies (N = 57) (and in 55.4% of studies using Duke's criteria for diagnosis [N = 51]). Viridans group streptococci (VGS), coagulase-negative staphylococci (CoNS), Enterococcus spp and Streptococcus bovis were among the most common causes. S. aureus was the most common pathogen in almost all population subgroups; however, this was not the case in patients with implantable devices, prosthetic valves, or immunocompromised non-HIV, as well as in the sub-group from Asia, emphasizing that a global one-size-fits-all approach to the management of suspected IE is not appropriate. This review provides an evidence-based map of the most common causative agents of IE, highlighting S. aureus as the leading cause in the 21st century. The changing epidemiology of IE in some patient sub-groups in the last decade and the very high number of microbiologically undiagnosed cases (26.6%) suggest the need to revisit IE prophylaxis and diagnostic strategies.

Rickettsioses as causes of CNS infection in southeast Asia.

1report that scrub typhus caused by Orientia tsutsugamushi, murine typhus caused by Rickettsia typhi, and leptospirosis caused by various Leptospira species account for more than a third of CNS infections diagnosed over 8 years in Vientiane Hospital in Laos. The study is one more great contribution from this team in their investigation of undocumented syndromes, as well as in the public health challenge of rickettsial diseases in southeast Asia. The same investigators have previously reported that scrub typhus was the second most common microbial cause of fever of unknown origin in rural Laos (122 [15%] of 799 diagnosed cases). 2 In 2006, rickettsial infection was detected in 115 (27%) of 427 adults admitted to Vientiane Hospital for fever with negative blood culture. 3 The most common rickettsial agent was O tsutsugamushi followed by R typhi. Fewer data are available about the prevalence of these diseases in other southeast Asian countries. In Thailand, scrub and murine typhus has been reported 4 in 16% and 2%, respectively, of fever of unknown origin, with mortality of 3–17% for scrub typhus. Even if epidemiological data for the whole region are unavailable, the substantial presence of rickettsial infections is shown by frequent reports in travellers returning from this area. 5

Drug-resistant ventilator associated pneumonia in a tertiary care hospital in Saudi Arabia.

BACKGROUND:There is a wide geographic and temporal variability of bacterial resistance among microbial causes of ventilator-associated pneumonia (VAP). The contribution of multi-drug resistant (MDR) pathogens to the VAP etiology in Saudi Arabia was never studied. We sought to examine the extent of multiple-drug resistance among common microbial causes of VAP.MATERIALS AND METHODS:We conducted a retrospective susceptibility study in the adult intensive care unit (ICU) of King Abdulaziz Medical City, Riyadh, Saudi Arabia. Susceptibility results of isolates from patients diagnosed with VAP between October 2004 and June 2009 were examined. The US National Healthcare Safety Network definition of MDR was adopted.RESULTS:A total of 248 isolates including 9 different pathogens were included. Acinetobacter spp. was highly (60-89%) resistant to all tested antimicrobials, including carbapenems (three- and four-class MDR prevalence were 86% and 69%, respectively). Pseudomonas aeruginosa was moderately (13-31%) resistant to all tested antimicrobials, including antipseudomonal penicillins (three- and four-class MDR prevalence were 13% and 10%, respectively). With an exception of ampicillin (fully resistant), Klebsiella spp. had low (0-13%) resistance to other tested antimicrobials with no detected MDR. Staphylococcus aureus was fully susceptible to vancomycin with 42% resistance to oxacillin. There were significant increasing trends of MDR Acinetobacter spp. however not P. aeruginosa during the study. Resistant pathogens were associated with worse profile of ICU patients but not patients’ outcomes.CONCLUSION:Acinetobacter in the current study was an increasingly resistant VAP-associated pathogen more than seen in many parts of the world. The current finding may impact local choice of initial empiric antibiotics.

Underlying heart disease and microbiological spectrum of adult infective endocarditis in one Chinese university hospital: a 10‐year retrospective study

To identify the underlying heart disease and microbiological pathogen associated with infective endocarditis (IE) in Chinese patients in one university hospital over a 10-year period. We recruited 115 adult patients admitted to Peking University First Hospital from 2002 to 2011 who were diagnosed with definite IE. Statistical analysis was performed to analyse data on demographics, clinical and laboratory findings, as well as microbiological pathogens. The most common underlying heart diseases for IE were congenital heart disease (24.3%) followed by degenerative valvular disease (17.4%). Aortic (44.3%) and mitral (43.5%) valves were most frequently affected. The right-sided IE cases were all found in patients with congenital heart disease. The age of patients was younger in right-sided cases than that in left-sided ones (P = 0.001). There was no difference in the mortality among groups with different underlying heart disease (P = 0.841). Forty-four (38.3%) patients were infected with viridans group streptococci. The isolation rate of staphylococci in right-sided IE was higher than that in the left-sided IE group (P = 0.021). More than 85% of streptococci were susceptible to β-lactams. Congenital heart disease and degenerative valvular disease have overtaken rheumatic heart disease as the major underlying heart diseases associated with IE. Viridans group streptococci are the most common microbial cause of IE.

Editorial Commentary:Loperamide for the Treatment of Traveler’s Diarrhea: Broad or Narrow Usefulness?

by anaerobic bacteria in the intestine, is to give more-prolonged and higher drug concentrations in the intestinal lumen, with less absorption into the blood, potentially causing fewer systemic adverse effects, such as CNS depression, than when loperamide hydrochloride is administered. Clinical studies in the meta-analysis enrolled young US students or military personnel in prospective randomized trials in Mexico, Thailand, and Egypt. The most common microbial cause of diarrhea identified in study participants were enterotoxigenic Escherichia coli, followed by Shigella species, Campylobacter species, Salmonella species, enteroaggregative E. coli, Giardia lamblia, Entamoeba histolytica, and Cryptosporidium species. Pathogenesis of traveler’s diarrhea occurs at the epithelial cell surface of the intestine, where enterotoxins cause fluid production or invasive pathogens elicit inflammation. Neural signals are transmitted from this surface to smooth muscle to increase peristalsis, giving rise to symptoms of cramps and frequent bowel movements. Traveler’s diarrhea is unique for a high attack rate because of a low level of immunity in travelers against prevalent pathogens in the food and water from the visited countries. Travelers are also a selected population of usually young, healthy adults who develop mild or moderately severe nondehydrating

Molecular Assays for Detection of Human Metapneumovirus

The recent description of the respiratory pathogen human metapneumovirus (hMPV) has highlighted a deficiency in current diagnostic techniques for viral agents associated with acute lower respiratory tract infections. We describe two novel approaches to the detection of viral RNA by use of reverse transcriptase PCR (RT-PCR). The PCR products were identified after capture onto a solid-phase medium by hybridization with a sequence-specific, biotinylated oligonucleotide probe. The assay was applied to the screening of 329 nasopharyngeal aspirates sampled from patients suffering from respiratory tract disease. These samples were negative for other common microbial causes of respiratory tract disease. We were able to detect hMPV sequences in 32 (9.7%) samples collected from Australian patients during 2001. To further reduce result turnaround times we designed a fluorogenic TaqMan oligoprobe and combined it with the existing primers for use on the LightCycler platform. The real-time RT-PCR proved to be highly reproducible and detected hMPV in an additional 6 out of 62 samples (9.6%) tested during the comparison of the two diagnostic approaches. We found the real-time RT-PCR to be the test of choice for future investigation of samples for hMPV due to its speed, reproducibility, specificity, and sensitivity.

Long Term Trends in the Occurrence of Nosocomial Blood Stream Infection

To determine trends in the occurrence of nosocomial blood stream infection at the University of Alberta Hospital. A prospective survey of nosocomial blood stream infection was conducted; cases from August 1986 to December 1996 were reviewed. Cases were detected by a review of positive blood cultures reported by the microbiology laboratory. Centers for Disease Control and Prevention definitions of nosocomial infection were used to categorize isolates as nosocomial, community acquired or contaminant. There were 2389 cases; primary bacteremia was the most common source (57%), followed by urinary tract, respiratory tract and surgical site sources (10% each). The nosocomial blood steam infection rate rose progressively from 6.0/1000 admissions and 4.59/10,000 patient days in 1986 to 11.2/1000 admissions and 14.31/10,000 days in 1996 (P<0.01); 48% of the total increase in rate occurred between 1995 and 1996. Significant increases occurred between 1986 and 1996 in primary infections (from 3.2 to 7.5/1000 admissions, P<0.01) and infections from all secondary sources (from 2.5 to 3.8/1000 admissions, P=0.01). Coagulase-negative staphylococci (27%), Staphylococcus aureus (19%) and enterococci (9%) were the most common microbial causes. Aerobic Gram-negative bacilli accounted for 28% and candida for 6%. Coagulase-negative staphylococci, enterococci and candida all became more prevalent as causes of infection over the study period. The nosocomial blood stream infection rate in the hospital has nearly doubled in the past 10 years, largely due to increased primary bacteremia.