Do HIV-seropositive patients become colonised with drug-resistant microorganisms?

The aim of the present study was to investigate whether HIV-infected patients, a group that is supposedly at risk for infection with antibiotic-resistant microbes, really does so, and to assess possible risk factors for acquiring these organisms. During the period from January 1998 to July 1999, samples of normal flora were obtained from 107 HIV-infected patients attending an outpatient clinic in Oslo, Norway. The samples were cultured for Streptococcus pneumoniae, Haemophilus influenzae, Escherichia coli, coagulase-negative staphylococci and Candida spp., and the resulting isolates were tested for antimicrobial susceptibility. The patients studied represented all stages of HIV infection, from recently infected to severely immunocompromised. Samples were taken at one, two or three time-points to determine whether antimicrobial resistance in colonising microorganisms increases over time. Antimicrobial resistance was linked primarily to antimicrobial prophylaxis, but it did not increase during the observation period. The level of a patient's immunodeficiency and the consequently intensified medical care was also of some importance. Even though about 50% of the patients were receiving antimicrobial agents at the time of sampling, the level of resistance found in these patients was very similar to that found in other patient groups in Norway; except for Candida albicans isolates, which were less susceptible to fluconazole. Overall, antimicrobial resistance was uncommon in the HIV-seropositive patients studied, a finding that is probably related to the overall low prevalence of antimicrobial resistance in the general population in Norway.

[Falciparum malaria in Oslo and Akerhus]. / Falciparummalaria i Oslo og Akershus.

BACKGROUND: Imported falciparum malaria in an increasingly frequent health problem in many areas in which it is not endemic. Complications are commonly seen, and reported case-fatality rates may exceed 3%. MATERIAL AND METHODS: The study is a medical chart-based retrospective study of all cases of falciparum malaria diagnosed in Oslo and Akershus counties, south-eastern Norway, 1988-1997. RESULTS: We identified 232 diagnosed cases; of these, records were available for 222 cases (95%). The incidence rate almost quadrupled during the study period. The two largest groups were immigrants visiting their country of origin (35%) and Norwegian tourists (29%). 95% of the cases were infected in Sub-Saharan Africa. There were no fatal cases, and only eight cases (3.6%) developed complicated falciparum malaria. In a statistical analysis, the following factors were found to be significantly associated with complicated disease: higher age, noncompliance to recommended chemoprophylaxis in assumed non-immune subjects, prolonged doctor's delay and prolonged diagnostic delay. INTERPRETATION: The study suggests that complications in imported falciparum malaria may largely be prevented by a high rate of chemoprophylaxis compliance in non-immune travellers and a high awareness of this possibility among physicians evaluating febrile travellers from endemic areas.

Home access to hospital discharge information on audiotape reduces sick leave and readmissions in patients with first-time myocardial infarction.

A prospective, randomized study was carried out to investigate whether repeated hospital discharge information on audiotape at home could improve knowledge and rehabilitation in patients with first-time myocardial infarction. The study comprised 50 patients (12 females and 38 males) of up to 75 years of age. At discharge, 26 patients were given tape recordings to use at home for one week, while 24 patients represented controls. High scores in patients' knowledge about their own disease were noted, as well as differences in long-term sick leave between the two groups and readmissions or need for emergency visits. No difference in knowledge was observed, but fewer patients in the tape group had long-term sick leave, readmissions or need for emergency visits. We found that baseline characteristics were similar in the two groups. Since acquired knowledge did not appear to differ between the groups, an effect of the taped information on the patients' family network is considered.

[Patient information on tape]. / Pasientinformasjon med båndspiller.

Giving patients access at home to tape recordings of their hospital discharge information was thought to improve the patient information. There could be an effect on their knowledge of their own disease and possibly also on clinical events. 50 patients with first time myocardial infarction were included; 26 received tape recordings and tape players. 24 patients were included as controls. The equipment was returned after one week, and the patients were followed up with a questionnaire after one, eight and 52 weeks. No difference in medical knowledge was observed. However, fewer patients in the tape group had long term sick leaves, and readmissions or need for emergency visits were less common. Baseline characteristics were almost the same in the two groups. Since acquired knowledge about their own disease did not appear to differ, an effect of the tape information upon the patient's family is considered.

Low frequency of complications in imported falciparum malaria: a review of 222 cases in south-eastern Norway.

We performed a retrospective study of 222 cases of falciparum malaria diagnosed in Oslo and Akerhus counties, Norway, from January 1988 to December 1997. Except for 12 cases, all had acquired the disease in sub-Saharan Africa. Sixty-four (28.8%) cases occurred in assumed non-immune individuals; of these, 41 (64.1%) were compliant to recommended antimalarial chemoprophylaxis. The mean time lag from first symptom to diagnosis (total diagnosis delay) was 4.6 d (median 3 d, range 0-30 d) and the mean time from presentation to diagnosis (doctor's delay) was 1.3 d (median 0 d, range 0-25 d). There were no fatal cases, and only 8 (3.6%) had a complicated course. The following factors were significantly associated with development of complicated disease: higher age, non-immunity combined with chemoprophylaxis non-compliance, prolonged doctor's delay and prolonged total diagnosis delay (p < or = 0.05). Our data suggest that complicated disease in imported falciparum malaria may largely be prevented by high chemoprophylaxis compliance rates in non-immune travellers and a high index of suspicion in physicians evaluating febrile travellers.