Days In Patients Research Articles

Implantation of Row One Needles 1-2 mm Anterior to the Posterior Margin of the Prostate Gland Results in Excellent PSA Control and Minimal Rectal Toxicity After I-125 Brachytherapy

Positioning of the posterior-most row of seeds (row 1) during prostate brachytherapy (PB) determines dose coverage to both the cancer-prone posterior peripheral zone and the anterior rectal wall and therefore impacts cure rates as well as the incidence of late rectal toxicity. Studies correlating row 1 position of needles and seeds and clinical outcomes after PB are lacking. Thus we undertook this analysis to demonstrate the safety and efficacy of our practice of positioning row 1 in patients during PB. We randomly selected 50 patients for this study who had a minimum 4 year follow-up from the 350 patients who have undergone I-125 PB at our institution. PB was performed with loose I-125 seeds to deliver a minimum peripheral dose of 144 Gy using a modified uniform loading technique. In all patients, row 1 on the template was positioned at a distance of 1-2 mm anterior to the posterior margin of the prostate gland from base to apex by angulating the rectal probe posteriorly to match the curvature of the prostate gland. Median patient age was 67 years, eight (16%) had diabetes, 12 (24%) were on blood thinners, one patient had ulcerative colitis. Patient records were evaluated for biochemical relapse free survival (RFS) and late rectal toxicity according to the RTOG criteria. Each patient's day 1 post-implant CT scan was reviewed for prostate quadrant dosimetry and various measures of rectal dosimetry including V100%, V100 Gy, rectal wall surface area dosimetry and seed number/distance from the rectal wall. After median follow-up of 63.5 months (range, 48-96 months) biochemical RFS was 100%. The median V100% of the anterior and posterior quadrants of the prostate was 91.8% and 90.9%, respectively. Median number of seeds < 5 mm, < 3 mm and < 1 mm from the rectal wall was 8 (0-26), 2 (0-17), and 0 (0-4), respectively. Median rectal V100% was 0.94 cc and rectal V100 Gy was 3.67 cc. Median rectal surface area receiving at least 100 Gy, 200 Gy and 100% of the prescription dose was 10.22 cm2, 0.80 cm2 and 4.88 cm2, respectively. The rate of RTOG grade 1 late rectal toxicity was 9/50 (18%). No patients had grade 2 or higher late toxicity. On multivariate analysis late grade 1 rectal toxicity was significantly associated with the presence of any seeds located < 5 mm from the anterior rectal wall (OR 1.19, p = 0.046) and the rectal surface area receiving at least 100 Gy (OR 1.32, p = 0.049). These results confirm the long-term safety and efficacy of implanting row 1 needles at a distance of 1-2 mm anterior to the posterior margin of the prostate gland during PB. This practice can provide good dosimetric coverage of the posterior peripheral zone with excellent biochemical RFS and minimal rectal toxicity in spite of the localized delivery of high radiation doses to the anterior rectal wall.

What do we know about cognitive functioning in adult congenital heart disease?

With the advent of improved medical and surgical care in congenital heart disease, there has been an increase in the number of patients who survive into adulthood, giving rise to a new patient population 'Adults with congenital heart disease'. In the past, morbidity and mortality were the primary concerns for this group. However, with improvements in outcome attention has shifted to other factors such as psychosocial and cognitive functioning. This paper reviews the literature on the cognitive functioning in adult congenital heart disease patients. A total of five relevant articles were retrieved via electronic searches of six databases, including MEDLINE, EMBASE, CINAHL, AMED, PsychINFO, and PubMed. The results displayed a consensus on the presence of some cognitive difficulties in adult congenital heart disease patients. The aetiology of cognitive dysfunctions appears to be multifactorial. The literature is limited by the very small number of studies looking at adults with congenital heart disease, with the majority focusing on cognitive functioning among children with congenital heart disease. However, the presence of cognitive dysfunctions and the resulting impact on the patient's day to day lives warrant for a more detailed and prospective research to enhance the understanding of its aetiology and impact.

DGI-005 Analysis of Levofloxacin Use in Geriatric Units at a University Hospital

Background Overuse of antibiotics, such as fluoroquinolones and third-generation cephalosporins, is a major cause of the emergence of extended-spectrum beta lactamase producing enterobacteriaceae. The use of levofloxacin in elderly inpatients...

Clinical and microbiological features of Clostridium difficile infections in France: The ICD-RAISIN 2009 national survey

IntroductionThe surveillance of Clostridium difficile infections (CDI) in France was reinforced after the emergence of the PCR-ribotype 027 epidemic clone in 2006; notification of case clusters or severe cases by healthcare facilities (HCF) became mandatory. The French Public Health Surveillance Institute (InVS) and the C. difficile National Reference Center (NRC) launched a national, prospective, multicentric survey to complete available data, in 2009. The survey had for objectives to assess CDI incidence and to characterize the strains responsible for CDI. Patients and methodsEvery month from March to August 2009, HCF notified the total number of new CDI cases, admissions, and patient-days (PD) to the InVS. A subset of participating HCF sent strains, isolated in March 2009 from CDI patients, to the NRC. ResultsOne hundred and five HCF with acute care wards and 95 with rehabilitation/long-term care (RLTC) wards participated in the 6-month epidemiological study. The incidence of CDI was 2.28 or 1.15 cases per 10,000 PD in acute care (n=1316 cases) or RLTC (n=295 cases), respectively. Seventy-eight HCF participated in the microbiological study. Two hundred and twenty-four (94.9%) of the 236 strains received by the NRC were toxigenic. The five major PCR-ribotypes were 014/020/077 (18.7%), 078/126 (12.1%), 015 (8.5%), 002 (8%), and 005 (4.9%). ConclusionThe incidence of CDI in 2009 in France remained lower than in other European countries, suggesting a successful impact of the 2006 recommendations for CDI control.

National multidrug-resistant bacteria (MDRB) surveillance in France through the RAISIN network: a 9 year experience

In the mid-1990s, the prevalence rate of multidrug-resistant bacteria (MDRB) in French hospitals was high and control of MDRB spread then became a major priority in the national infection control programme (ICP). To evaluate the impact of the ICP, a national coordination of MDRB surveillance was set up in 2002. Data were collected 3 months a year in healthcare facilities (HCFs) on a voluntary basis. All clinical specimens of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBLE) were prospectively included. Incidences per 1000 patient days (PDs) were calculated and trends in incidence from 2003 to 2010 were assessed. Participation in the surveillance increased from 478 HCFs in 2002 to 933 in 2010. In 2010, MRSA incidence was 0.40/1000 PDs: 1.14 in intensive care units (ICUs), 0.48 in acute care facilities (ACFs) and 0.27 in rehabilitation and long-term care facilities (RLTCFs). ESBLE incidence was 0.39/1000 PDs: 1.63 in ICUs, 0.46 in ACFs and 0.23 in RLTCFs. MRSA incidence significantly decreased from 0.72/1000 PDs in 2003 to 0.41/1000 PDs in 2010 (P<10(-3)); in contrast, ESBLE incidence significantly increased from 0.17/1000 PDs to 0.48/1000 PDs (P<10(-3)). The most prevalent ESBLE were Enterobacter aerogenes (34%) and Escherichia coli (25%) in 2003 and E. coli (60%) and Klebsiella pneumoniae (18%) in 2010. These results demonstrate the positive impact of the national ICP on MRSA rates. In contrast, ESBLE incidence, especially ESBL-producing E. coli, is increasing dramatically and represents a serious threat for hospitals and for the community that deserves specific control actions.

Patients’ interactions in an intensive care unit and their memories of intensive care: A mixed method study

The aim of this study was to describe the interaction between intensive care patients and the intensive care unit (ICU) environment from the perspective of the hospital bed and patients' memories of the ICU. Four adult patients in an intensive care unit were each recorded on DVD over a 24 hour period. The patients were also interviewed three months and six months after discharge from hospital. The data generated regarding their interactions with the ICU environment were then analysed using qualitative and quantitative content analysis. The ICU patient has short, direct and indirect contacts during treatment. In addition, the patient reacts to events in the ICU environment that do not include contact. Patients' memories were divided into two main categories: internal and external. Internal memories included physical and mental memories, which were experienced as surreal, unpleasant feelings or physical symptoms such as pain or the experience of being cold or thirsty. External experiences included events that the patient experienced through participation or observation, for example during nursing routines, or through hearing or observing other people, communication and the surroundings. The patient's day in ICU is occupied with episodes of brief contact with nursing staff in an environment that the patient experiences as confusing or incomprehensible. The day and night rhythm is disturbed while the patient's opportunities for rest or concentration are limited. Most interactions affect the patient and it is important for staff to be aware of the impact of potentially unsettling events.

Drugs of Last Resort? The Use of Polymyxins and Tigecycline at US Veterans Affairs Medical Centers, 2005–2010

Multidrug-resistant (MDR) and carbapenem-resistant (CR) Gram-negative pathogens are becoming increasingly prevalent around the globe. Polymyxins and tigecycline are among the few antibiotics available to treat infections with these bacteria but little is known about the frequency of their use. We therefore aimed to estimate the parenteral use of these two drugs in Veterans Affairs medical centers (VAMCs) and to describe the pathogens associated with their administration. For this purpose we retrospectively analyzed barcode medication administration data of parenteral administrations of polymyxins and tigecycline in 127 acute-care VAMCs between October 2005 and September 2010. Overall, polymyxin and tigecycline use were relatively low at 0.8 days of therapy (DOT)/1000 patient days (PD) and 1.6 DOT/1000PD, respectively. Use varied widely across facilities, but increased overall during the study period. Eight facilities accounted for three-quarters of all polymyxin use. The same statistic for tigecycline use was twenty-six VAMCs. There were 1,081 MDR or CR isolates during 747 hospitalizations associated with polymyxin use (1.4/hospitalization). For tigecycline these number were slightly lower: 671 MDR or CR isolates during 500 hospitalizations (1.3/hospitalization) (p = 0.06). An ecological correlation between the two antibiotics and combined CR and MDR Gram-negative isolates per 1000PD during the study period was also observed (Pearson’s correlation coefficient r = 0.55 polymyxin, r = 0.19 tigecycline). In summary, while polymyxin and tigecycline use is low in most VAMCs, there has been an increase over the study period. Polymyxin use in particular is associated with the presence of MDR Gram-negative pathogens and may be useful as a surveillance measure in the future.

Time-series analysis of the relationship of antimicrobial use and hand hygiene promotion with the incidence of healthcare-associated infections

We analyzed the effect of antimicrobial use and implementation of a hand hygiene program on the incidence of healthcare-associated infections (HAIs) and healthcare-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) infections at the Chung Shan Medical University Hospital (Taichung, Taiwan). Monthly data were retrospectively reviewed from January 2004 to December 2010. Use of antimicrobials and alcohol-based hand cleaner were separately regressed against the incidences of HAIs and HA-MRSA infections. Infection incidence was expressed as persons per 1000 patient days (PDs), monthly use of i.v. antibiotics was expressed as defined daily doses per 1000 PDs and monthly alcohol-based hand cleaner use was expressed as bottle per 1000 PDs. Multivariate analysis indicated that use of hand cleaner was associated with reduced incidence of HAIs (P=0.0001) and HA-MRSA infections (P<0.0001). Time-series analysis indicated that increased use of hand cleaner was significantly associated with significant decreases in the incidences of HAIs and HA-MRSA infections. Total antibiotic use had no significant effect on HAIs, but was associated with more HA-MRSA infections. In addition, the use of J01CR01 antibiotics (combinations of penicillins, including β-lactamase inhibitors) in particular was correlated with significantly increased incidence of HA-MRSA infections. Our forecasting model demonstrates the efficacy of a hand hygiene program and the need to limit the use of certain restricted antimicrobials in order to reduce the incidence of HAIs and HA-MRSA infections.

Fluoroquinolone use and fluoroquinolone-resistant Pseudomonas aeruginosa is declining in US academic medical centre hospitals

Fluoroquinolone use and fluoroquinolone-resistant Pseudomonas aeruginosa is declining in US academic medical centre hospitals

Ética y medicina: la experiencia del colegio médico del Perú

This article shows the work of the Peruvian Medical Association with respect to ethical disciplinary procedures, but also shows how, beyond the ethical control, the Order has promoted through a set of actions, a technically competent health care that respects the dignity and fundamental human rights. Part of these actions are the establishment of the Patient's Day, the emphasis in improving the quality and safety in the care of the users of the health services, the initiative to prevent and treat adverse events, the regulation and improvement of the physicians training both in pre as in post-graduate levels, and the demand for the establishment of an optimal health system and policies that will realize the right to health in the context of the principles of bioethics.

G-CSF Induced Atypical Monocytic Proliferation Mimicking Acute Myelomonocytic Leukemia in Post-Induction Chemotherapy AML Patient

Abstract 4283 Introduction:Granulocyte colony-stimulating factor (G-CSF) is a major hematopoietic cytokine involved in control of neutrophil production, proliferation and survival.1 Nowadays, recombinant G-CSF is widely used in patients with hematopoietic malignanies receiving chemotherapy to increase leukocyte count.2 Studies have showed that G-CSF use in these settings is safe and does not increase relapse rate.3,4 However, A phenomena called transient atypical monocytosis, or pseudoleukemia, induced by G-CSF administration in AML patients with chemotherapy have been reported.5,6 This entity mimics recurrent/relapsed acute leukemia and causes confusion in pathologic diagnosis and potential problems in clinical management. The case presented in this report is an example of this entity. Pathology:A 55-year old male patient presented with leukocytosis and anemia. Peripheral blood smear examination revealed a blast population and monocytosis. Flow cytometry on the blood sample showed 37% blasts with expression of CD33, CD13, CD117, HLA-DR, CD34, CD14, CD15 and CD64. FISH study revealed a chromosomal abnormality of inversion 16. A diagnosis of acute myelomonocytic leukemia was established. The patient was treated with induction chemotherapy and was given Neupogen from day 6 through day 20. Bone marrow examination on the day 14th showed an aplastic marrow. However, examination of the patient's day 21 bone marrow revealed marked hypercellularity with sheets of large atypical monocytic cells and brisk mitotic figures. These cells showed round to ovoid nuclei, basophilic cytoplasm and prominent nucleoli, morphologically indistinguishable from blastic cells. Immunohistochemical studies confirmed that most of these atypical cells were lysozyme, CD163 and CD68 positive monocytes, some of them were positive for CD117. These findings raised concerns of recurrent/relapsed AML. However, FISH study was negative for inversion 16. These results indicate that the findings in the patient's day 21 marrow were most likely G-CSF-induced changes. The Neupogen was discontinued soon after. The patient was followed-up with periodic bone marrow examination and FISH study, which showed negative results. Currently, the patient is in complete remission. Discussion:We report one case of G-CSF induced atypical monocytic proliferation in an AML patient with induction chemotherapy. The findings could have created diagnostic problems if FISH study data had not available since those atypical cells were morphologically indistinguishable from blastic cells. Studies have shown that administration of recombinant G-CSF induces a rapid and sustained elevation in absolute peripheral neutrophil counts, and its use in leukemic patients during or after induction chemotherapy is safe and does not increase relapse rates.4 G-CSF shortens the transit time of developing granulocytes in bone marrow and accelerates the release of neutrophils that have undergone recent cell division.1 Our case of transient atypical monocytosis and a few similar cases reported in literatures showed an unusual response to G-CSF. This phenomenon was mostly seen in AML-M4, AML-M5 and AML-M3 cases7 and the mechanism is not entirely clear. A possible explanation is that G-CSF does not only act on neutrophils but also acts on progenitor hematopoietic cells including monocytes.8 One problem is that this entity can mimic recurrent AML causing confusion or potential misdiagnosis if clinical information or cytogenetic studies are not available. Therefore, it is important that both clinicians and pathologists be aware of this phenomenon in hematology/oncology settings. Appropriate discontinuation of G-CSF and following-up these patients with morphologic examination and cytogenetic studies is necessary. Meanwhile, a thorough understanding of exogenous G-CSF effects in cancer patients is essential to reduce any potential risks caused by its administration. Disclosures:No relevant conflicts of interest to declare.

Antibiotic use for presumed neonatally acquired infections far exceeds that for central line-associated blood stream infections: an exploratory critique

To assess antibiotic use as a complementary neonatal intensive care unit (NICU) infection measure to the central line-associated blood stream infection (CLABSI) rate. Patient days (PDs), line days, antibiotic (AB) use, CLABSI and other proven infections were analyzed in consecutive admissions to two NICUs over 3 and 6 months, respectively, from 1 January 2008 until discharge. An antibiotic course (AC) consisted of one or more uninterrupted antibiotic days (AD), classified as perinatal or neonatal, if started ≤3 d or ≥4 d post birth and as rule-out sepsis or presumed infection (PI) if treated ≤4 d or ≥5d, respectively. Events were expressed per 1000 PD and aggregated by conventional treatment categories and by clinical perception of infection certainty: possible, presumed or proven. The cohort included 754 patients, 18,345 PD, 6637 line days, 718 AC and 4553 AD. Of total antibiotic use, neonatal use constituted 39.2% of ACs, and 29.0% of ADs, When analyzed per 1000 PD, antibiotic use to treat PIs vs CLABSIs, was either 14 fold (CI 6.6-30) higher for ACs (5.40 vs 0.38/1000 PD, P<0.0001) or 8.8 fold (CI 7.1-11) higher for ADs (48.3 vs 5.5/1000 PD, P<0.0001). CLABSI rates, present a lower limit of NICU-acquired infections, whereas antibiotic-use measures, about 10-fold higher, may estimate an upper limit of that burden. Antibiotic-use metrics should be evaluated further for their ability to broaden NICU infection assessment and to guide prevention and antibiotic stewardship efforts.

Consommation des antibiotiques rapportée via les bilans standardisés de lutte contre les infections nosocomiales et relation avec l’ICATB

Objective The study's objective was to describe the evolution of antibiotic consumption between 2006 and 2008 in French health care facilities (HCF) its relations with the national policy of good antibiotics use using the ICATB score. Method Data from standardized reports on infection control activities collected from 2006 to 2008 by the Ministry of Health (antibiotic consumptions and elements of antibiotic stewardship of every HCF) were analyzed with linear regression models to multilevel random intercept adjusted on HCF characteristics (public or private) and activity. Results The analysis was performed on 4062 (48,2%) observations after exclusion of HCF not concerned by the ICATB public reporting indicator (7.2% of observations), invalid or missing data (21,2% of observations) and irrelevant values (23.4%). The global antibiotic consumption was 343 defined daily doses (DDD) per 1000 patient-days (PD) and varied little between 2006 and 2008. However, the linear regression model showed an increase of 5.7 DDD per 1000 PDs per year ( P < 0.001). There was a positive association between antibiotic consumption and ICATB score, mainly concerning sub-scores ICATB-action and ICATB-organization. Conclusion The recent lack of decrease in antibiotic consumption in French HCF between 2006 and 2008 is coherent with other available national data, but exclusion of more than 50% of observations limits the impact of this analysis. The relationship between policy of good use and consumption of antibiotics remain difficult to specify, because of the short (three years) study length and because of the nature of ICATB, a composite indicator assessing only partly antibiotic policies.

Antibiotic use in 530 French hospitals: results from a surveillance network at hospital and ward levels in 2007

Antibiotic use in French hospitals is among the highest in Europe. A study was carried out to describe antibiotic consumption for inpatients at hospital and at ward levels. Data were voluntarily collected retrospectively by 530 hospitals accounting for approximately 40 million patient-days (PD) on the following: antibacterials for systemic use [J01 class of the WHO Anatomical Therapeutic Chemical (ATC) classification, defined daily doses (DDD) system, 2007], rifampicin and oral imidazole derivatives, expressed in number of DDD and number of PD in 2007. Consumption was expressed in DDD/1000 PD. Median antibiotic use ranged from 60 DDD/1000 PD in long-term care (LTC) and psychiatric hospitals to 633 DDD/1000 PD in teaching hospitals. Penicillins and beta-lactamase inhibitors combinations were the most frequently used antibiotics, accounting for 26% of total use in cancer hospitals to 40% in LTC/psychiatric hospitals. Glycopeptides and carbapenems were mostly used in cancer and teaching hospitals. Level of consumption and pattern of use differed according to clinical ward from 60 DDD/1000 PD in psychiatric wards up to 1466 DDD/1000 PD in intensive care units (ICUs). In medicine, surgery, ICU and rehabilitation wards, fluoroquinolones accounted for 13%-19% of the total use. This multicentre survey provided detailed information on antibiotic use in a large sample of hospitals and wards, allowing relevant comparisons and benchmarking. Analysis of consumption at the ward level should help hospitals to target practice audits to improve antibiotic use.

Selection of the optimal regimen of insulin therapy using spectral analysis

The offered method of indemnification improvement for saccharine diabetes in combination with the spectral glucose analysis allows to replace the protracted clinical selection process of the optimum insulinization mode on patient with relatively simple procedures removal of patient's day glycemic type and test on receptivity to insulin the results of which drawn on for finding of the optimum insulinization mode in numeral model experiments on PC with the mathematical dynamics modeling of the glucose level in blood and secretion of insulin by a pancreas, whereupon it remains only to conduct final optimum verification of the neat individual mode in the real terms. Use neat, near to physiology, for the management of insulin the automated metering device will allow the injections mode of insulin to promote the insulinization accordance of the patient's necessities.

Medications at the End of Life Care for Terminal Cancer Patients during Their Last Admission

Purpose: To evaluate medications at the end of life care for terminal cancer patients during their last admission. Methods: Medical records of terminal cancer patients during their last admission from July 2003 to April 2008 at a district academic hospital were evaluated. Patient's characteristics, therapeutic drug classification during their last admission and on the patient's day of death, and the administrated route and number of medications on the patient's day of death were analyzed. Results: Total 81 patients were included. The median patient age was 63 years. The median length of admission was 18 days (range: 1~101). 54% of the patients had more than one comorbidities. The most frequently prescribed drugs during the last admission were opioid analgesics (63%), followed by antibiotics (58%) and antacids (53%). On the day of death, common medications were antibiotics (59%), antacids (58%), and opioid analgesics (46%). Intravenous injection was given to 81% of the patients and intramuscular injection was given to 16% of the patients on the day of patient's death. Number of medications prescribed to patients was between 0 and 11 (median: 3) and 12% (10/81) of the patients took over 8 medications including intravenous and oral drugs on the day of death. 6% (5/81) of the patients took potentially futile medications, like multivitamin or statin until the day of death. Conclusion: This study suggests that potentially futile medications and uncomfortable care were given to terminal cancer patients. Multicenter-based studies are necessary to diminish futile medications by essential medication at the end of life care for terminal cancer patients.

Perioperative Predictive Factors Following Splenectomy for Complete Remission of Immune Thrombocytopenic Purpura

Perioperative Predictive Factors Following Splenectomy for Complete Remission of Immune Thrombocytopenic Purpura Introduction. Immune thrombocytopenic purpura (ITP) is one of the most commonly known and widely researched haematological diseases. ITP manifests as decrease in platelet count of various degrees, which can even cause fatal bleeding from 0.4 - 13% annually. Glucocorticoids (GC) and intravenous immunoglobulin (IgG) are used as the first line of treatment, 20-50% of drug therapy is ineffective and splenectomy is "the second stage" of treatment. Various sources of literature mention the range of ITP remission following splenectomy from 49 - 93%. Current studies are looking for prognostic factors, which would ensure complete ITP remission following splenectomy. Aim of the Study. To analyse possible perioperative prognostic factors in ITP patients for achieving remission following splenectomy. Materials and methods. The retrospective study included 13 patients diagnosed with immune thrombocytopenic purpura (ITP), who underwent surgery in the period from 2002 to 2009 at the Riga Eastern Clinical University Hospital "Linezers". From laboratory tests - full blood-count 1 - 2 days before the operation, on the 5th - 7th day following the operation, 1 month after the operation, one year after the operation and during the last follow-up found in the patient's out-patient file. The size of the spleen before the surgery was determined by ultrasonography. The access to the abdominal cavity and the spleen - conventional or laparoscopic surgery, the duration of the operation, perioperative blood loss, post-operative complications and the patient's day of discharge following the surgery was analysed. Results. In the period from January 2002 to January 2009 at RECUH clinic "Linezers" 13 ITP patients underwent surgery. As to the gender the average age for both genders was similar (men 39.0 ± 14.1 and women 39.0 ± 16.0). The mean value of the duration of the disease in women (8.0 ± 9.0 months) and men (68.1 ± 58.7 months) has a statistically significant difference, using the independent pair selection t-test (t = 2.38; p = 0.047). In one US case and in one CT case accessory spleens were detected. The pre-operative mean value of PLT count had increased in a statistically significant way in accordance with the independent pair selection t-test (t = 3.087; p = 0.009), and in accordance with Wilcoxon signed-rank test (z = 2,202; p = 0,028) compared to the mean value of PLT count, which was detected during the last follow-up visit on average 35.9 ± 35.9 months after the surgery. Analysis of variance (ANOVA) shows that the average age of cured patients 34.6 ± 9.8 is statistically less significant than for those patients, who continue treatment and whose disease has transformed (F = 7.327; p = 0.011). Conclusions. The performed research allows concluding that the decisive factors in successful ITP outcome after the operation are the following: 1) in patients, who have undergone the operation in a relatively younger age (34.6 ± 9.8 years) the disease outcome is more successful during the follow - up period - 35.9 ± 35.9 months (F = 7.327; p = 0.011); 2) the visualisation and removal of the accessory spleen decreases the probability of relapse.

The dynamic relationship between antibiotic use and the incidence of vancomycin-resistant Enterococcus: time-series modelling of 7-year surveillance data in a tertiary-care hospital

The role of antibiotics in the epidemiology of vancomycin-resistant Enterococcus (VRE) has been studied extensively, but controversies remain as to which, and to what extent, antibiotics facilitate the emergence and dissemination of VRE in hospitals. Aggregate data on the use of several antibiotic classes in terms of defined daily doses (DDD) per 100 patient-days (PD), and VRE incidence rates in terms of clinical isolates per 1000 PD, were evaluated during a 7-year period at a tertiary-care hospital. Time-series analysis (autoregressive integrated moving average (ARIMA) and transfer function models) was used to quantify the temporal effect of antibiotic use on VRE incidence and estimate effect-delays. The incidence rate of VRE observed in a specific bimester was found to be a function of its value during the preceding bimester and of prior changes in the volume of use of four antibiotic classes. In particular, an increase of one DDD/100 PD in the use of glycopeptides, fluoroquinolones, extended-spectrum cephalosporins and beta-lactam-beta-lactamase inhibitor combinations resulted, independently, in average changes of +0.024, +0.015, + 0.020 and -0.010 isolates per 1000 PD in the incidence of VRE, with average delays of 2, 4, 2 and 6 months, respectively, which explained 56% of the observed variation in VRE rates over time. Efforts to reduce VRE cross-transmission should be supplemented by targeted antibiotic control policies. The use of glycopeptides, broad-spectrum cephalosporins and fluoroquinolones in high amounts should be the targets of such policies. Penicillin-beta-lactamase inhibitor combinations might be suitable substitutes for extended-spectrum cephalosporins.

Specific control measures for antibiotic prescription are related to lower consumption in hospitals: results from a French multicentre pilot study

In France, antibiotic consumption (ABC) is dramatically high in parallel with the high rate of multidrug-resistant bacteria. For the last few years, a nationwide policy has been implemented at the national level to control and monitor ABC. Since 2002, surveillance networks have been set up with voluntary hospitals to evaluate the antibiotic policy and consumption. The present study was conducted to identify whether specific control measures of the antibiotic policy could reduce ABC in hospitals. Based on the data from the Northern France surveillance system, local recommendations and antibiotic use were collected annually on a standardized questionnaire that had 21 items. ABC was expressed in defined daily doses (DDDs) per 1000 patient-days (PDs). The ABC indicator was the overall antibiotic consumption. A multivariate logistic regression analysis was performed using low (< or =75th percentile) and high (>75th percentile) ABC as the dependent variable. A total of 83/111 hospitals were included in the study. In 75% of the hospitals, total ABC was < or =669.5 DDDs/1000 PDs. The less frequent practices were educational antibiotic programmes (17%), authorization from an antibiotic specialist for selected antibiotics (26%) and systematic reassessment of AB treatment after 72 h (27%). In the multivariate analysis, three variables remained significantly and independently associated (P < 0.05) with ABC: the type of hospital, the proportion of non-acute-care beds and the nominative delivery form as the only antibiotic control measure. Total ABC was lower in hospitals having a nominative delivery form, compared with hospitals not having it. Conversely, ABC was significantly higher in public teaching hospitals compared with non-teaching hospitals. Similarly, ABC was higher in hospitals with a lowest proportion (i.e. < or =25%) of non-acute-care beds compared with hospitals where this proportion was >25%. Specific control measures could lower ABC. Sustained control efforts should focus on antibiotics with the highest potential for emerging bacterial resistance.

Infecção em idosos internados em instituição de longa permanência

To evaluate the occurrence of infection in elderly interned in long-term care facilities (LTCF) during 13 consecutive months. Fifty five elderly were evaluated according to infection and, reporting was standardized. The median age was 75 (66 81) years. The data set consisted of 20,896 patients-day (PD) of care during the period, with a total of 76 infections for a pooled mean rate of infections 3.20 per 1,000 PD of care. Patient infection rate was 63.6%. Prevalent topographies of infection were respiratory (50%), urinary tract (32%), skin and soft tissue (12%) and gastroenteritis (7%), with an infection rate for specific categories/1000 PD of 1.60, 1.01, 0.38, 0.21, respectively. Mortality infection rate was 5%. Microbiological agents were isolated in 30.5% of the infection episodes. Escherichia coli and Staphylococcus aureus were prevalent. Infection presented an elevated incidence in the elderly interned, but no unusual problem with infections was disclosed.