An outbreak of Pseudomonas aeruginosa urinary tract infections following cystoscopy traceable to a malfunctioning drying cabinet.

Background: Pseudomonas aeruginosa is an important bacterial pathogen, particularly as a cause of nosocomial infections in hospitalized patients. Only few reports exist in which cystoscopes were implicated as an outbreak source. We describe an investigation into the cause of a sudden increase in the number of urinary tract infections (UTI) with P. aeruginosa in patients after cystoscopy. In addition, we share the lessons learned and measures taken to reduce the risk of similar infections in the future. Presentation of Case: Over a period of two weeks the urology outpatient department noticed a UTI in four patients following cystoscopy. An investigation was started for a common source of the outbreak in the urological treatment room. Additional screening of patients revealed a total of eleven males with P. aeruginosa UTI following cystoscopy. The infections were found to be due to a defective drying cabinet, which lacked an alarm signaling in case of loss of airflow. Amplified fragment length polymorphism (AFLP) analysis revealed that P. aeruginosa isolates from three patients and six isolates from environmental cultures (including cystoscopes from the drying cabinet) genotypically belonged to one strain. Discussion: The AFLP results suggest that contaminated cystoscopes caused P. aeruginosa UTI in 11 patients, with the drying cabinet as site of transfer of the infective strain. To our knowledge, this is the first report describing a malfunctioning drying cabinet as source of an outbreak following cystoscopy. Conclusion: In case of concomitant P. aeruginosa infections, cystoscopes and drying cabinets should be suspected as a potential source. Molecular techniques are helpful in investigating the epidemiology of an outbreak.

Quantitative ultrasound does not identify patients with an inflammatory disease at risk of vertebral deformities.

BACKGROUND: Previous studies from our group have shown that a high prevalence of vertebral deformities suggestive of fracture can be found in patients with an inflammatory disease, despite a near normal bone mineral density (BMD). As quantitative ultrasound (QUS) of the heel can be used for refined assessment of bone strength, we evaluated whether QUS can be used to identify subjects with an inflammatory disease with an increased chance of having a vertebral fracture. METHODS: 246 patients (mean age: 44 +/- 12.4 years) with an inflammatory disease (sarcoidosis or inflammatory bowel disease (IBD)) were studied. QUS of the heel and BMD of the hip (by dual X-ray absorptiometry (DXA)) were measured. Furthermore lateral single energy densitometry of the spine for assessment of vertebral deformities was done. Logistic regression analysis was performed to assess the strength of association between the prevalence of a vertebral deformity and BMD and QUS parameters, adjusted for gender and age. RESULTS: Vertebral deformities (ratio of <0.80) were found in 72 vertebrae of 54 subjects (22%). In contrast to the QUS parameters BUA (broadband ultrasound attenuation) and SOS (speed of sound), T-score of QUS and T-scores of the femoral neck and trochanter (DXA) were lower in the group of patients with vertebral deformities. Logistic regression analysis showed that the vertebral deformity risk increases by about 60 to 90% per 1 SD reduction of BMD (T-score) determined with DXA but not with QUS. CONCLUSION: Our findings imply that QUS measurements of the calcaneus in patients with an inflammatory condition, such as sarcoidosis and IBD, are likely of limited value to identify patients with a vertebral fracture.

Bone turnover and hip bone mineral density in patients with sarcoidosis.

BACKGROUND AND AIM OF THE WORK: Sarcoidosis is a chronic inflammatory T-cell-driven disease that can also affect bone. We evaluated bone remodelling and bone mineral density (BMD) in patients with sarcoidosis and their dependency of disease-related and treatment-related factors. METHODS: In 124 patients BMD of the hip (DXA) and markers of bone resorption (ICTP) and formation (PINP) were evaluated. Furthermore a lateral DXA of the spine for morphometric assessment of vertebral deformities was performed in 87 patients. Potential predictors of bone markers, BMD and determinants of prevalent vertebral deformities were assessed using multiple and logistic regression analysis. RESULTS: The population studied comprised untreated patients (n=51), patients that previously used glucocorticoids (n=31) and patients currently using glucocorticoids (n=42). In all these groups the age- and gender corrected Z-scores of the hip were normal, except in untreated patients, which revealed an increased Z-score at the trochanter (p = 0.004). In all but the patients currently on glucocorticoids the Z-scores for PINP and ICTP were increased (p < 0.05). In patients currently on glucocorticoids the Z-ICTP was also increased (p < 0.05), but the Z-PINP decreased (p < 0.01 compared to untreated patients). In 20.6% of patients one or more morphometric vertebral deformities were found. CONCLUSIONS: Hip BMD is normal in patients with sarcoidosis, despite an increased bone turnover. This may imply that in sarcoidosis mechanisms are involved that compensate for the well-known effects of cytokines in inflammatory diseases on osteoclastogenesis and bone resorption. Nonetheless, vertebral deformities suggestive of fracture were found in a significant number of patients which indicates that patients with sarcoidosis still have a relevant fracture risk.

Hip bone mineral density, bone turnover and risk of fracture in patients on long-term suppressive L-thyroxine therapy for differentiated thyroid carcinoma.

OBJECTIVE: Untreated hyperthyroidism and treatment with high doses of thyroid hormone are associated with osteoporosis. However, their effect on bone turnover, their contribution to bone mineral density (BMD) in the context of other clinical risk factors for osteoporosis and the prevalence of vertebral fractures is not well documented. DESIGN: Cross-sectional study. METHODS: We studied 59 patients receiving L-thyroxine suppressive therapy for differentiated thyroid carcinoma (DTC). BMD of the hip was measured by dual X-ray absorptiometry (DXA) and lateral DXA pictures of the lumbar and thoracic vertebrae were performed. Bone resorption was measured by C-telopeptides of type I collagen (ICTP) and bone formation by procollagen type I N-propeptide (PINP). Clinical risk factors for osteoporosis were evaluated using a questionnaire. RESULTS: Z-scores of BMD were similar as the NHANES (National Health and Nutrition Examination Survey) III reference group in women and men, also after long-term (> 10 years) suppression therapy. Patients in the lowest and highest quartile of BMD showed significant differences in the presence of clinical risk factors. ICTP levels were significantly higher than in age-matched controls, PINP levels were not different. We found four patients with a prevalent vertebral fracture. CONCLUSIONS: We conclude that patients with well-differentiated thyroid carcinoma are not at increased risk of developing low bone mass nor have a higher prevalence of vertebral fracture at least when treated with relatively low doses of L-thyroxine.

Comorbidity in newly diagnosed thyroid cancer patients: a population-based study on prevalence and the impact on treatment and survival.

BACKGROUND: Comorbidity may be an important contributory factor to differences in the treatment and outcome of cancer, especially in older patients. It might also provide information on the aetiology of the cancer in cases of high or low frequency. The aim of this study was to describe the spectrum of comorbidity and the possible impact on treatment and survival in newly diagnosed thyroid cancer (TC). DESIGN: A population-based observational study. SETTING: The Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), the Netherlands. METHODS: Demographic, histological and treatment data on all 417 TC patients diagnosed between 1 January 1993 and 31 December 2002 were collected and followed up till 2004. An adapted version of the list of Charlson was used for registration of clinically relevant concomitant disorders. The prevalence of comorbidity at diagnosis was analysed according to gender, age, histological type and therapy. Crude 6-month and 1- and 5-year survival rates were determined. A regression analysis was performed to identify independent variables related to survival. RESULTS: Information on comorbidity was available for 378 patients (91%). Comorbidity was present in 32% of the patients; 23% had one and 12% had two or more concomitant diseases. The prevalence of comorbidity increased with age. Hypertension was the most frequent comorbidity (18%), followed by 'other cancers' (7%), cardiovascular diseases (6%) and diabetes mellitus (6%). The prevalence of hypertension was twice as high as expected at all age groups. Six patients > 60 years had had tuberculosis. Initial surgical treatment was negatively related to the presence of concomitant diseases in patients < 70 years (P = 0.02), but not in patients > or = 70 years. Comorbidity was not independently associated with crude survival up to 5 years. CONCLUSIONS: A previous diagnosis of hypertension was associated with TC. The use of external radiation for diagnostic and therapeutic procedures for tuberculosis probably explains the high prevalence of former tuberculosis in elderly TC patients. Treatment choices appeared to be influenced by the presence of comorbidity. Comorbidity did not affect survival up to 5 years; a study with a longer period of follow-up is needed.