Global Infection Rate Research Articles

Parasitisme interne du mouton de race Ouled Djellal en zone semi-aride d’Algérie

Une étude du parasitisme interne a été réalisée chez des ovins de race Ouled Djellal infestés naturellement dans une région semi-aride d’Algérie (Tiaret). Des coproscopies effectuées pendant l’année 2004 sur 423 ovins ont révélé un taux global d’infestation de 78,9 p. 100 et ont permis d’identifier des cestodes (Moniezia spp., Avitellina sp.), des coccidies (Eimeria spp.) et des nématodes dont des strongles respiratoires (Dictyocaulus sp., Muellerius sp., Protostrongylus sp.). Le parasitisme a été saisonnier pour tous les parasites. Les coccidies ont été plus présentes chez les jeunes (n = 164), avec une prévalence de 44,5 p. 100. Chez les brebis (n = 240), l’infestation par les strongles digestifs a été la plus élevée (70,4 p. 100), avec un pic en mars et en novembre. Les strongles suivants ont été identifiés : Trichuris ovis (5,8 p. 100), Marshallagia marshalli (28,3 p. 100) et Nematodirus spp. (27 p. 100). Les autres strongles, dont certains genres/espèces ont été identifiés par coproculture, ont eu une prévalence de 56,6 p. 100. M. marshalli et Nematodirus spp. ont eu une évolution remarquablement similaire, mais d’un niveau plus faible que celle des autres strongles. L’excrétion des oeufs de strongles par gramme de fèces (opg) a présenté deux pics dont le plus élevé (moyenne de 1 081 opg) s’est produit en novembre (période d’agnelage), en raison, probablement, du phénomène d’augmentation des opg lors du péripartum. Globalement, le parasitisme lié aux strongles a été modéré, malgré sa prédominance. La prévalence des opg individuels inférieurs à 500 a été de 74,1 p. 100, celle des opg supérieurs ou égaux à 1 000 n’a été que de 14 p. 100 et la moyenne mensuelle d’opg n’a dépassé ce seuil qu’en novembre. Outre les conditions climatiques, l’implication de certains facteurs, tels que la nature du couvert végétal de la région et la race ovine, mérite investigation. Pour la prophylaxie, deux traitements anthelminthiques au cours de l’année (printemps et automne) doivent être suffisants.

Relations between undernutrition and nosocomial infections in elderly patients

Hospital-acquired infections and malnutrition are of major concern in public health in elderly patients. However, the interactions between these two entities are not well established. To determine the incidence of nosocomial infections (NI) and its association with malnutrition. 185 hospitalised older adults aged 81.6+/-0.6 years old were nutritionally assessed on admission by measurement of anthropometric variables, serum nutritional proteins and evaluation of dietary intake. During hospitalisation, patients' progress was closely monitored, particularly for the detection of nosocomial infections. The incidence rate of NI was 59% and the global infection rate was 7.6/1,000 bed days. The most common infection site was the urinary tract (n=63). The nutritional status of the population was studied by comparing three groups defined according to the absence (group I, n=116), presence of one infection (group II, n=38) or presence of more than one infection (group III, n=31). All but one anthropometric parameters varied among the three groups. Total energy intake also varied among the three groups. The group I had higher daily nutrient intake than the other two groups (respectively P=0.004 and P<0.0001). Albumin, transthyretin, and C-reactive protein levels differed significantly among the three groups (respectively P<0.0001, P<0.0001 and P=0.0003). Age, energy intake, length of hospital stay and the presence of a urinary catheter were independent risk factors of nosocomial infection. Our findings show that patients with multiple NI were older, showed an altered nutritional status, a prolonged recovery, more frequently had urinary catheters and more discharge placement.

¿Es aplicable el sistema de vigilancia epidemiológica de las infecciones intrahospitalarias que recomienda el CDC- americano (sistema NNIS) en un hospital chileno?

The National Nosocomial Infections Surveillance System (NNIS system) is the method for surveying nosocomial infections used by the Centers for Disease Control (CDC). This strategy allows the comparison of different hospitals, using rate adjustments. In Chile, this system is not used. To report the application of this system in a tertiary reference hospital in Chile. We performed a six months prospective cohort study. The active surveillance was carried out by using the intensive care unit and surgery components of the NNIS system. Tabulation and analysis of the data were done according to the NNIS system. In a parallel prevalence study, we determined the NNIS system sensitivity to detect nosocomial infections. A total of 492 patients were followed with a global nosocomial infection rate of 14%, for discharged patients. The calculated sensitivity and specificity of the system was 84.2 and 97% respectively. In the intensive care unit, 45 of 169 patients had nosocomial infections, with an adjusted rate of 2.8% for mean hospitalization time and severity of illness. In the cardiovascular and thoracic surgical units, 216 and 107 procedures were surveyed, respectively. The global rates of nosocomial infections were 7.4 and 7.5%, respectively. The adjusted rates according to risk factors were 0.9 and 2.3%, respectively. These data indicate that the surgical units had surgical site infections rates similar to those reported by the CDC. Nosocomial infections rates in Chile can be compared with rates observed in other countries. The epidemiological data collected can be useful to focus intervention or preventive strategies.

Prospective survey of the incidence, risk factors and outcome of hospital-acquired infections in the elderly

Four hundred and thirty-six patient admissions to either an acute assessment or a rehabilitation ward for the care of the elderly were studied. A total of 113 episodes fitting the definition of a hospital-acquired infection (HAI) occurred in 81 (18·5%) of admissions. The global infection rate was 10·8 per 1000 patient bed days and did not differ between the wards. The chest and urinary tract were the commonest sites of infection, and 26 patients appeared to be infected at more than one site. The majority of first infections occurred within 14 days of admission. Median length of stay for patients with one or more infective episodes was significantly longer than for those who did not develop an HAI. The presence of an HAI, multiple-site infections and chest infections were significantly associated with fatal outcome. HAI occurs commonly in elderly patients and is associated with prolonged hospital stay and increased mortality.

Role of Culex quinquefasciatus in the transmission of bancroftian filariasis in the Federal Islamic Republic of Comoros (Indian Ocean)

In October 1988-January 1989, as a part of a malaria and filariasis control programme in Federal Islamic Republic of Comoros an entomological survey was carried out in 19 rural and urban localities of Grande Comore. Anjouan and Moheli Islands. The potential breeding places were examined and pyrethrum spray catches were made to evaluate the indoor resting densities of mosquitos. A total of 14.578 adult mosquitos potential vectors of filariasis was collected: 94.5% Culex quinquefasciatus, 3.5% Anopheles gambiae s. str. 1.9% A. funestus and 0.1% other anopheline species. A. funestus, uniformly spread in Moheli, was present only in the south-west coast of Anjouan and absent in Grande Comore. A. gambiae and Cx quinquefasciatus were present in Grande Comore. A. gambiae and Cx quinquefasciatus were present in the three islands with different densities in the villages. Only Cx quinquefasciatus specimens la maximum of 150 for each locality) were dissected to search filaria larvae being the Anopheles specimens used to evaluate the malaria transmission. The global infection rate (9.4%) and the infectivity rate (0.9%) observed in Cx quinquefasciatus are higher than indices reported in previous surveys. All the larvae in the third development instar (L3) were identified as Wuchereria bancrofti. The results suggest that in FIR of Comoros W. bancrofti is well adopted to local Cx quinquefasciatus population. Because of the presence of high mosquito density this species plays a prominent role in the transmission of lymphatic filariasis in that area. The high transmission levels calls for the implementation of a specific control program.

Septic complications of intramedullary locked nailing in traumatology in a series of 1.474 nails from 1974 to 1989

The authors present a computerized study of 1.474 locked nailings of fresh femoral and tibial fractures, carried out at the Strasbourg Traumatologic Center from 1974 to 1989. 70 septic complications were found, that is a global infection rate of 4.8%. 19 cases were superficial and 51 (3.4%) deep infections. The follow-up of 46 deep infections showed that in 32 cases the locked nailing remained stable and could be maintened until bone consolidation; in 14 cases of unstable nailing, a change of the method of treatment was necessary. 73% of the cases can be considered as benign infections, requiring no supplementary surgical operation except final removal of the nail. The 27% deep infections with severe osteitis and osteomyelitis, required repeated re-operations, with delayed recovery and permanent sequelae; however they only represent 1.1% of the total 1.474 nailings. During the study, two distinct periods can be differentiated: before 1984, period of perfecting the method, and after 1984, period of mastered operative technique, advent of systemic antibioprophylaxis and greater caution in the indications for nailing grade 3 open fractures. Between these two periods, the total infection rate went from 6.3% to 3.5%, the superficial infections from 2.2% to 0.6%, the infection rate in closed fractures from 4.3% to 2.2%, the deep infections in open femoral fractures from 5.9% to 2.2%. On contrary, the deep infection rate after nailing of open tibial fractures remained unchanged at 9% and increased dramatically with the grade of the soft-tissue lesions: 7.9% in 140 grade 1 open fractures, 15% in 99 grade 2 and 40% in 10 grade 3 open nailed tibial fractures. In conclusion, using the Gustilo classification, we recommend intramedullary locking nailing in fresh open grade 1, 2 and 3a femoral and tibial fractures, since it allows better bone and functional prognosis and ensures that infection risks are kept within reasonable limits. On the other hand, there is an absolute indication for primary external fixation in grade 3b and 3c open fractures especially of the tibia.

Hepatitis B: global importance and need for control

Hepatitis B is a disease of global importance, with greater than 300 million carriers of the virus world-wide. Hepatitis B virus (HBV) is the cause of up to 80% of cases of primary liver cancer, the single most important cause of mortality globally. In countries where HBV carrier rates reach 10%, HBV infection may account for 3% of total mortality, a level which exceeds polio-related mortality before the introduction of polio vaccine. The only means by which hepatitis B can be eventually eliminated is mass vaccination of infants with hepatitis B vaccine as part of the Expanded Programme on Immunization (EPI) in areas of the world where the HBV carrier rate exceeds 2.5%. With recent dramatic increases in hepatitis B vaccine production and decreases in per-dose price, there are grounds for optimism that global HBV infection rates may be reduced by as much as 90% over the next 10 years.

Nosocomial infections in long-term facilities.

We studied the incidence and prevalence of hospital-acquired infections in our intermediate-care units and the Nursing Home Care Unit at the Veterans Administration Medical Center, Johnson City, TN over a 4-year period (1980 through 1983). The global infection rate was 3.86 per 1,000 patient care days. The lower respiratory tract was the most common site of infection, followed by urinary tract infections, skin infections, bacteremia, wound infections, and infections at other sites. The prevalence study conducted by monthly visits over a 1-year period showed similar results. All of our patients were elderly males with multiple underlying diseases and poor performance status. The high incidence of nosocomial infections in chronic-care facilities relates to the poor functional assessment of the patients, which may increase the susceptibility of these patients to develop infections, mainly lower respiratory and cutaneous infections.