Compliance with international prevention guidelines for central-line-associated bloodstream infections in neonatal intensive care units in Belgium: a national survey.

BACKGROUND: Central-line-associated bloodstream infections (CLABSIs) are a preventable cause of morbidity among patients in neonatal intensive care units (NICUs). AIMS: To assess compliance with international guidelines for prevention of CLABSIs in Belgian NICUs, and to study unit characteristics contributing to CLABSIs. METHODS: A survey was undertaken to measure the adherence of various NICUs to the CLABSI prevention guidelines related to catheter insertion, catheter maintenance and quality control measurements. A Poisson regression model was used to estimate the CLABSI adjusted relative risk for each prevention guideline item implemented. Multi-variable linear regression was used to estimate associations between guideline compliance rate and facility characteristics and the incidence of CLABSIs for 2015-2016. FINDINGS: In Belgium, the overall CLABSI incidence density was 8.48/1000 central-line-days, and was higher in larger NICUs: 10.87‰ vs 6.69‰ (P<0.05). Adherence was highest for prevention items at catheter insertion (64%), and low for catheter maintenance and quality control items (47% and 50%, respectively). Superior adherence to insertion items (P=0.051) and quality performance items (P=0.004) was associated with decreased risk of CLABSIs, but this was not found for maintenance prevention items (P=0.279). After adjustment for guideline adherence, the size of the NICU was found to be an independent determinant for CLABSIs (P=0.002). CONCLUSIONS: In Belgium, the adherence of NICUs to international CLABSI prevention guidelines is moderate to poor. Compliance of NICUs with the guidelines is significantly associated with decreased CLABSI rates. The reasons for the gap between current practice in Belgian NICUs and international prevention guidelines need further investigation.

[Twin pregnancy and polymalformative syndrome by Enterovirus]. / Grossesse gémellaire et syndrome polymalformatif infectieux à Entérovirus.

Prenatal diagnosed congenital infection by Enterovirus is rarely described in the literature. A few casereports describe severe abnormalities observed by ultrasound that have led to spontaneous intrauterine demise or early death of the newborn. We report the case of a dichorionic diamniotic twin pregnancy. At 24 weeks of gestation, the second trimester ultrasound examination shows cardiac, brain and abdominal abnormalities in one of the fetuses. The other fetus has a normal appearance. "Standard" serological tests conducted on the mother are negative and amniocentesis reveals no genetic abnormality. After birth, Reverse Transcription Polymerase Chain Reaction (PCR) on samples of blood, ascites and stool reveals to be positive for Enterovirus in both newborns. Both are viable and exhibit severe brain abnormalities with severe neurological sequelae such as cerebral palsy, visual and hearing impairment. This case report illustrates the difficulty of prenatal diagnosis of congenital Enterovirus infection and informs about its possible neurological sequelae.

L'infection foetale précoce à Entérovirus (EV) est peu décrite dans la littérature. De rares cas rapportent de sévères anomalies vues à l'échographie qui conduisent à la mort foetale in utero ou au décès postnatal précoce. Nous présentons le cas d'une patiente présentant une grossesse gémellaire bichoriale biamniotique. L'échographie morphologique réalisée à 24 semaines d'aménorrhée révèle chez l'un des foetus des anomalies cardiaques, cérébrales et abdominales. Le second foetus présente un développement organique normal. Les sérologies «standards¼ réalisées chez la mère sont négatives et la ponction de liquide amniotique ne met pas en évidence d'anomalie génétique. A la naissance, une recherche d'Entérovirus par «Reverse Transcription Polymerase Chain Reaction¼ (RTPCR) se révèle positive pour les deux enfants. Ces derniers sont viables, mais présentent de sévères anomalies cérébrales causant des lourdes séquelles neurologiques. Ce cas clinique illustre la difficulté du diagnostic de l'infection congénitale à Entérovirus ainsi que ses conséquences potentielles.

[EARLY ENTEROVIRUS NEONATAL INFECTION: WHEN SHOULD WE THINK ABOUT IT?]. / INFECTION NÉONATALE PRÉCOCE À ENTÉROVIRUS : QUAND FAUT-IL Y PENSER? Cas cliniques et revue de la literature.

Enterovirus (EV) may cause a broad spectrum of clinical syndromes and even cause a sepsis-like picture. Although they are responsible for high morbidity and mortality rates, viral testing does not appear in the algorithms for the evaluation of neonatal infections. During the month of June 2013, we identified 3 cases of EV meningitis in our unit of neonatology. All three infants had fever during the first week of life and their clinical examination revealed an irritability. The EV infection was detected by Real-Time Polymerase Chain Reaction (RT-PCR) EV on the cerebrospinal fluid (CSF). Two of the patients also had a positive RT-PCR EV in the blood. The 3 newborns were discharged from the hospital after a few days with no adverse outcome. Our clinical observations and the literature review suggest that EV infections in neonates ought to be identified as soon as possible by an early RT-PCR EV on the blood, and on the CSF if a lumbar puncture is indicated. This could help reduce the administration of antibiotics and the length of hospital stay.

[Value of the "Bacterial Meningitis Score" (BMS) for the differential diagnosis of bacterial versus viral meningitis]. / Utilité du "Bacterial Meningitis Score" (BMS) dans le diagnostic différentiel des méningites bactériennes et virales.

The "Bacterial Meningitis Score" (BMS) has been designed to identify children at low (BMS = 0) or high (BMS > or = 2) risk of bacterial meningitis (M). Its calculation is simple; it is based on 5 different items: Gram stain, seizure at or before presentation, peripheral white blood cell count (WBC), cerebrospinal fluid (CSF) WBC and CSF protein concentration. As of today, it has been validated in one single study in the United States. The purpose of this study is to evaluate the BMS performance in children hospitalized for M over a 5 years period. The medical records of 277 patients diagnosed with M, aged 29 days to 15 years and hospitalized in the Department of Pediatrics of the CHR Citadelle Hospital in Liège between 1999 and 2003 were analysed. Among the 277 hospitalised cases, there were 29 bacterial (10,5%) and 248 viral (89,5%) M. For patients whose BMS < 2, we found 100% of viral M. For those with BMS > or = 2, 59,3% had a bacterial M and 40,7% had a viral M. 23% of the children with BMS < 2 were treated with antibiotics; 17% of children with BMS = 2 were not been treated on admission. The BMS is an easily applicable method that could allow reduce the unnecessary use of antibiotics.

[Tyrosine-protein kinase activity in breast neoplasm. Comparison with activity obtained in benign diseases and in normal tissues]. / Actividad de tirosina-protein-quinasas en cáncer de mama. Comparación con la actividad obtenida en patologías benignas y en tejidos normales.

Tyrosine protein kinase (TPK) activity is associated to malignant cellular transformation. This work compares TPK activity in 27 surgical biopsy samples of mammary carcinoma, 10 samples of fibroadenomas, 13 samples of fibrocystic breast disease and 27 samples of normal mammary tissue. TPK activity was determined in tissue homogenates using (Val5) angiotensin II as exogenous substrate. In samples of mammary carcinoma, TPK activity was 33.86 +/- 31.98 pmol P32/mg protein/30 min. This value was significantly higher that those observed in fibrocystic disease (3.92 +/- 2.35), fibroadenomas (13.86 +/- 10.9) and normal tissue (3.56 +/- 3.02).

[Radiologic visibility of breast fibroadenomas]. / Visibilidad radiológica de los fibroadenomas mamarios.

From a clinical point of view, all mammary fibroadenomas are similar. However some of them are not visible in mammograms, phenomenon probably related to glandular density. Aiming to elucidate whether the lack of visibility is caused by the glandular density or by tumor itself, a three stage study was performed. In 201 cases the mammographic visibility of fibroadenomas was determined and correlated with patient's age, the presence of fibrocystic disease and tumor histological type; after surgical excision, 18 fibroadenomas were sliced into 5 mm thick samples and X rayed to determine their visibility; finally 2 visible and 2 non visible tumors were calcinated at 550 degrees C and their ashes subjected to X-ray diffraction analysis. Twenty two percent of fibroadenomas were not visible on mammography, this percentage was higher for intracanalicular tumors, in younger women and in the presence of fibrocystic disease. Sixteen percent of excised and sliced tumors were not visible on X rays. Also, differences were found in X-ray diffraction studies between visible and invisible tumors, probably related to NaCl and KCl tumor content.

Causes of increasing pericardial pressure in experimental cardiac tamponade induced by ventricular perforation.

It has been shown that the intravenous infusion of saline solution in a dog with stabilized cardiac tamponade produced an increase in pericardial pressure. To demonstrate that this pressure increase is the result of bleeding into the pericardial sac, an experimental study was conducted, consisting of the injection of red cells marked with 51Cr during the intravenous infusion of saline solution in dogs with and without progressive tamponade. The results showed that in the dogs without progressive tamponade, both the pericardial pressure and the red cell count in the pericardial cavity remained stable during the infusion of saline solution, whereas in dogs with progressive tamponade, the numbers of marked cells and the pericardial pressure increased significantly, following a similar pattern.

Experimental cardiac tamponade with a myocardial wound: the effect of rapid intravenous infusion of saline.

In order to demonstrate that the evolution of cardiac tamponade from a ventricular wound is different from that without myocardial wounding, the effects of a rapid infusion of saline solution on hemodynamic behavior and pericardial pressure (PP) were evaluated in dogs with cardiac tamponade caused by ventricular perforation (group C), animals without cardiac tamponade (group A), and animals with cardiac tamponade induced by infusion of saline into the pericardium (group B). We found that blood pressure (BP) increased from 107.5 +/- 15.5 mm Hg to 126 +/- 4 mm Hg in group A; increased from 64.5 +/- 17.9 mm Hg to 117.5 +/- 22.17 mm Hg in group B; and increased from 60.75 +/- 46.5 mm Hg to 76 +/- 14.4 mm Hg in group C. Central venous pressure (CVP) increased from 3.75 +/- 0.96 cm H2O to 9.5 +/- 3.3 cm H2O in group A; increased from 8 +/- 2.4 cm H2O to 16.25 +/- 3.1 cm H2O in group B; and rose from 7.75 +/- 2.6 cm H2O to 20.66 +/- 5.03 cm H2O in group C. Cardiac output (CO) increased from 3.9 +/- 1.2 L/min to 18.93 +/- 3.96 L/min in group A; increased from 1.23 +/- 0.3 L/min to 5.4 +/- 1.7 L/min in group B; and increased from 1.8 +/- 0.66 L/min to 3.53 +/- 1.31 L/min in group C.(ABSTRACT TRUNCATED AT 250 WORDS)

Use of thermography in the differential diagnosis of phylloides tumour.

Thermography can be used as a method of diagnosing breast masses. We report our results of its use in the differential diagnosis of fibroadenoma from phylloides tumours (n = 47 and 20 respectively). Thermographic resolution (Th) and the difference in temperature between the tumour and a similar zone in the contralateral breast (delta 2) were compared. Thermograms were class Th1 (with a similar thermal pattern in both breasts without hypervascularization or hot points) and Th2 (with hypervascularization or a hot area with a thermal difference with the same area in the opposite breast (delta 2) of less than 2 degrees C) in most (95.7 per cent) of the patients with fibroadenoma and were class Th5 (having one or more pathological sign) in 85 per cent of the patients with phylloides tumours. Patients with phylloides tumours had a mean delta 2 of 2.99 degrees C whereas most of the patients with a fibroadenoma showed no difference in temperature. Their mean delta 2 was 0.2 degrees C (P less than 0.0005). We conclude that thermography helps in differential diagnosis between a fibroadenoma and a phylloides tumour.