Incidence Of Total Infections Research Articles

Sternal wound closure in patients undergoing open-heart surgery: a prospective randomized study comparing intracutaneous and zipper techniques

A prospective, randomized study was undertaken to compare a non-invasive surgical zipper to intracutaneous suture closure in open-heart surgery with respect to postoperative wound infection rate and cosmetic results. A total number of 300 patients were included in the study, of which 150 had their skin wound closed with zipper and 150 with intracutaneous suture. The end-points were superficial and deep sternal wound infections within 6 weeks postoperatively. The incidence of total infection after 6 weeks was equal in the two groups (6.7 vs. 6.7%) (P=0.94). The superficial infection rate was 5.3% in the zipper group vs. 6.0% in the intracutaneous, and the deep infection rate was 1.4% in the zipper group and 0.7% in the intracutaneous. There was no statistically significant difference between the groups. Only the cosmetic result differed. On a visual scale from 1 (poorest) to 10 (best), an average score of 8.2 was obtained in the intracutaneous group versus 8.9 in the zipper group (P<0.01). The wound infection rate was equal for the intracutaneous group compared with the zipper group; however, the cosmetic result was judged better by the patients in the zipper group.

Parasitism of asymmetrical pelvic phenotypes in stickleback

Subtle departures from bilateral symmetry in morphological traits result from environmental and genetic stresses and may signal an inferior genetic background. Because one correlate of an inferior genome is reduced resistance to infection, such asymmetry may provide a phenotypic signal of susceptibility to parasitism. I tested this hypothesis in a population of threespine stickleback (Gasterosteus aculeatus) with cestode and nematode infections and bilateral asymmetry of the pelvis. Seventeen percent of the fish had an asymmetrical pelvis and, of these, 78% had greater expression on the left side; this directionality suggests a genetic influence. Females had consistently greater left-side asymmetry than did males. The incidence of total infection (all parasite species) in the largest adult fish (&gt; 60 mm body length) was greater in asymmetrical phenotypes, and this occurred in both sexes and for each parasite species (Schistocephalus solidus, Cyathocephalus truncatus, Eustrongylides spp.), even when multiple-species infections were excluded. Contrary to prediction, however, in juvenile fish (&lt; 20 mm) and yearlings (20–40 mm) but not subadults and adults (40–60 mm), asymmetrical phenotypes had significantly lower infection rates than symmetrical fish. This pattern occurred in both sexes, but the extent of the association varied over the 14 years of sampling. Consequently, if the directional asymmetry of the pelvis is under genetic control, asymmetry would be favoured during early ontogeny but selected against during the adult stages. The data support the hypothesis that asymmetry is a phenotypic signal of parasitism, but the unexpected bidirectionality of the association within a single population suggests increased complexity of the processes coupling asymmetry and genetic background.

Infectious complications and immunodeficiency in patients with human T-cell lymphotropic virus I-associated adult T-cell leukemia/lymphoma.

Adult T-cell leukemia/lymphoma (ATL) is a malignancy of mature T-cells occurring in patients infected with the human T-cell lymphotropic virus-I. These patients frequently develop a variety of infections throughout their disease course. Charts and autopsy reports were reviewed for 41 patients with ATL with follow-up varying from 2 to 120 months. Infectious episodes were identified and documented. Analyses of humoral and cell-mediated immunity were performed. Cell-mediated immunity was assessed in vivo with the Merieux multitest skin test panel. Humoral immunity was assessed by quantitative immunoglobulin levels, by determining human antimouse antibody after murine monoclonal antibody infusion and by an in vitro immunoglobulin biosynthesis coculture system. A total of 112 infectious episodes were documented. Fifty-seven serious infections were identified. The incidence of total infections was 1.40/patient-year and for serious infections was 0.71/patient-year. The mean serum IgG and IgA levels were within normal range, the mean IgM level was at the lower limit of normal. Peripheral blood mononuclear cells from all patients studied failed to make meaningful amounts of IgG, M, or A when activated. Peripheral blood mononuclear cells of all of the 13 patients studied suppressed production of immunoglobulin by cocultured normal PBMC. Twenty-three of the 27 patients tested were anergic. ATL is a profoundly immunosuppressing malignancy. This is manifested by an extremely high incidence of infectious episodes/patient-year. The incidence of infection appears to be greater than for mycosis fungoides, Hodgkin's lymphoma and non-Hodgkin's lymphoma.

Incidence of infection and analysis of contributing factors in revision joint arthroplasty over a two‐year period

AbstractThis study examined the incidence of infection and the contributing factors in 166 patients undergoing total joint revision surgery. Of these 32 (19%) had organisms grown from material taken at the local site at the time of revision surgery. Six of the culture‐negative patients were clinically suspected of having an infection. With the inclusion of these six, the total incidence of infection in these revision patients was 23%. This is not the incidence of infection in total joint surgery. This is the incidence of infection in patients undergoing revision surgery for whatever reason. The cause of infection in 53% of the cases was either Staphylococcus aureus or coagulase‐negative Staphylococci. The Gram‐negative bacteria were implicated in only five (15%) of the cases. Many of these infections (31%) were in patients who had had the implant for greater than 7 years. Only 15% of the infections were in patients who had the implant for less than 6 months with an additional 9% being revised in the first year. There were no clinical symptoms or underlying conditions, including allergy, that distinguished the infected from the noninfected group. The infection rate was somewhat higher with the cobalt chromium alloys, somewhat less in the uncemented devices, and somewhat higher in the patients with total knee replacements than those with total hip replacements. The histopathologic analysis revealed that the presence of polymorphonuclear leukocytes (PMNS) was correlated with infection, but most patients with infection had lymphocytes rather than PMNS indicative of a chronic infection. Thus the diagnosis of infection on the basis of histopathology needs to be carefully evaluated. The presence of PMNS is diagnostic for infection, but has a high number of false negatives. The histopathologic data and the data on implantation time indicate that most of these infections are chronic infections. © 1994 John Wiley &amp; Sons, Inc.

Epidemiology of atypical mycobacterial infections in new south wales, 1980-88

Five hundred and seventy seven instances of probable disease caused by a typical Mycobacterium species were identified from isolates referred to the N.S.W. Mycobacterium Reference Laboratory during the period 1980-88. The annual figure rose rapidly from 1986, the increase being entirely due to cases of infection caused by organisms of the Mycobacterium avium-intra cellulare-scrofulaceum complex in patients with AIDS. Other atypical Mycobacterium spp. have not been isolated with increasing frequency from known HIV-antibody positive individuals. Despite the increasing numbers of patients with various kinds of immune deficiency or suppression, the total incidence of infection caused by these organisms appears otherwise not to have changed, nor has there been a rise in documented cases of infection caused by organisms traditionally regarded as saprophytic. Five hundred and seventy seven instances of probable disease caused by a typical Mycobacterium species were identified from isolates referred to the N.S.W. Mycobacterium Reference Laboratory during the period 1980-88. The annual figure rose rapidly from 1986, the increase being entirely due to cases of infection caused by organisms of the Mycobacterium avium-intra cellulare-scrofulaceum complex in patients with AIDS. Other atypical Mycobacterium spp. have not been isolated with increasing frequency from known HIV-antibody positive individuals. Despite the increasing numbers of patients with various kinds of immune deficiency or suppression, the total incidence of infection caused by these organisms appears otherwise not to have changed, nor has there been a rise in documented cases of infection caused by organisms traditionally regarded as saprophytic.

Histoplasmosis of lungs.

HISTOPLASMOSIS is an infectious disease of protean clinical manifestations for the reason that the causative organism, the fungus Histoplasma capsulatum, may affect practically any tissue of the body. The organs most commonly involved are the lymph nodes, liver, lungs, spleen, adrenal glands, bone marrow, kidneys, intestinal tract, oropharynx, larynx, and skin.1Up to the present time only about 200 cases of all varieties of histoplasmosis confirmed by cultural or histological methods have been reported in the world literature. In more than one-half of these patients there was definite evidence of histoplasmosis of the lungs, either as the sole manifestation of the disease or occurring in association with other organ involvement. INCIDENCE The paucity of authentic reports of histoplasmosis over the years by no means reflects the total incidence of infection or clinical disease due to H. capsulatum. Some of the factors which may have been responsible in the past for overlooking histoplasmosis were our limited knowledge of