In situ bacteriologic diagnosis of total parenteral nutrition catheter infection.

An evaluation of the in situ bacteriologic status of a total parenteral nutrition (TPN) catheter, when the patient is pyretic but the cause of infection is not obvious, permits continued use of the catheter if the result is negative, as opposed to removal of the suspected catheter. To find a predictive value for the infection of the catheter, semiquantitative blood cultures taken through the TPN catheter were examined during the pyretic episodes. A total of 227 catheters from 204 patients were studied. Of these 149 were investigated during pyretic episodes. Twenty TPN catheters were removed because their semiquantitative blood cultures were positive, and in all cases the clinical conditions of the patients improved after removal of the catheters. The remaining 129 catheters investigated showed negative results and had predictive values of 100%. These catheters were left in place and all subsequently proved to be sterile on their removal at the end of the TPN. Thus 87% of the 149 suspected catheters were saved.

The national prevalence survey of nosocomial infections in Belgium, 1984.

A national one-day prevalence survey of nosocomial infections was carried out in March 1984 in 106 Belgian acute-care hospitals involving 8723 patients of whom 6130 had undergone surgery. Three infections were studied: surgical wound infection, bacteraemia and urinary-tract infection. One or more of these three infections was recorded in 9.3% of all patients and in 11.8% of surgical patients. Prevalences increased with increasing duration of hospital stay and with higher ages, but the association of HAI with age was no longer significant after correction for duration of hospital stay. Prevalences varied considerably in different specialties. After adjustment for age and duration of stay, there was no association between perioperative antibiotic prophylaxis and the prevalence of the infections studied, but bias due to selection of higher risk patients in the antibiotic group was probable. Larger hospitals had a higher overall prevalence, but populations differed according to the size of the hospital. Bacteraemia was strongly associated with the presence of an intravenous catheter, and urinary-tract infection with a urinary catheter.

Campylobacter fetus peritonitis followed by septicaemia in a patient on continuous ambulatory peritoneal dialysis.

A 62-year-old man being treated by continuous ambulatory peritoneal dialysis (CAPD) developed peritonitis due to Campylobacter fetus subspecies fetus (intestinalis), an organism seldom isolated in such circumstances. After appropriate and apparently effective antibiotic therapy, the patient relapsed 6 weeks later with septicaemia. Blood cultures yielded a similar organism, thereby suggesting a clinically silent metastatic infection during the episode of peritonitis, probably at an old arteriovenous fistula. Parenteral tobramycin followed by oral erythromycin achieved a complete cure of this unusual complication.

[Growth velocity and survival of full-term low birth weight infants in an African rural area (Burkina Faso)]. / Croissance pondérale et survie des enfants de petit poids de naissance nés à terme en milieu rural africain (Burkina Faso).

UNLABELLED: The objective of the study was to compare weight gain and mortality between full-term low birth weight (LBW) and normal birth weight (NBW) children. METHODS: One hundred and fifty-five full-term children born with LBW (<2500 g) and 280 NBW were recruited retrospectively in a rural health district of Burkina. Growth velocity, maternal characteristics and socio-economic status of families were investigated. RESULTS: Difference in weight means between the two groups decreased gradually from 3 months of age and did no more significantly differ from 8 months (P = 0.213). LBW, higher mother's BMI and number of antenatal care visits were associated with higher weight gain at 7 months. Lower weight gain was observed in children whose mothers had no education or high parity. Mortality risk was higher for LBW children (RR = 4.53; P = 0.005). LBW children's weight gain at 3 months was better than that of NBW infants. Nevertheless LBW children had a high mortality risk in the first year of life. CONCLUSION: Our results suggest that it could be interesting to focus early attention on LBW children without spontaneous catch up growth, to improve maternal nutritional status and girl's education.

Catheter infection caused by an unusual pathogen, Agrobacterium radiobacter.

The genus Agrobacterium is composed of several phytopathogenic species occurring worldwide in soils. One nontumorigenic species, Agrobacterium radiobacter, has occasionally been isolated from clinical specimens, but its pathogenic role in these cases has been difficult to ascertain since agrobacteria are usually isolated in association with other bacteria. We report the case of a central venous catheter infection and present the characteristics of A. radiobacter.

Pseudomonas stutzeri pneumonia and septicemia in a patient with multiple myeloma.

A case of septicemia caused by Pseudomonas stutzeri belonging to the unusual biotype Vb-3 in a patient with multiple myeloma is described. The origin of the septicemia was attributed to a community-acquired pneumonia. The bacteriology and pathogenicity of P. stutzeri are reviewed.

Aspergillus osteochondritis after median sternotomy. Combined operative treatment and drug therapy with amphotericin B.

A case of Aspergillus fumigatus osteochondritis after median sternotomy for open heart surgery is presented. To the best of our knowledge, it is the second well documented case that has been reported in the literature. Successful healing was obtained with combined operative treatment (consisting of a large resection of the 8th, 9th and 10th right costal cartilages and surrounding soft tissues), and systemic drug therapy with Amphotericin B. Repeated serologic studies and bone scans were used for both the diagnosis and monitoring of the evolution of the infection; these 2 tools are recommended in cases of mycotic infections in that area.

Clinical and bacteriological evaluation of ceftazidime (GR 20263) as an antipseudomonal drug.

Ceftazidime was evaluated as an antipseudomonal drug, in a non-comparative study including 10 men and 4 women, at a daily dose of 3-6 g/day i.v. or i.m. for 4 days. Bacteriological eradication was initally obtained in 13 patients (93%), but 1 patient did not significantly improve, and 1 failure and 4 relapses occurred. Follow up was not adequate in 2 patients, so definite cure was obtained in 7/12 patients (58.3%). The drug was withdrawn in one case because of a severe rash; other side-effects were minimal and reversible. All the organisms were susceptible to ceftazidime (mean MIC 1.72 mg/l). Mean serum levels of ceftazidime were 2 mg/l at the trough and 55.7 mg/l (range 48-70) 30 min after iv injection, and after 1 g i.m. 5.1 mg/l (2-125) and 34.1 mg/l (18-48), respectively. A good correlation was generally observed between serum activity, serum values and MICs.

Detection of central venous catheter-associated sepsis.

To determine whether contamination of the catheter was the cause of pyrexis in patients receiving total parenteral nutrition through central venous catheters, semiquantitative culture of blood drawn through the line kept in place was performed. Eighty-three catheters from 75 patients were studied. The predictive value of a negative culture using this method was greater than 97%.

Flavobacterium multivorum septicemia in a hemodialyzed patient.

A case of Flavobacterium multivorum septicemia in a hemodialyzed patient is reported. Two blood cultures were positive at 48 h, and the patient became afebrile only after antimicrobial therapy. The origin of the septicemia could not be determined.

National study on the utilization of prophylactic antibiotics in surgery, Belgium, 1986.

During the last week of May 1986, a 1-week prospective study on antibiotic utilization in surgical patients was held in 104 (42%) of the 247 Belgian acute care hospitals. All surgical patients with a post-operative stay of at least 3 days were studied, involving 3112 patients. Each patient was observed for 7 days, starting from the day before surgery. Antibiotics were administered to 71.9% of all patients; 21.9% received therapeutic antibiotics and 52.9% prophylactic antibiotics; 2.9% received both. Of the 1285 patients undergoing a surgical procedure with no indication for antimicrobial prophylaxis, 50.7% nevertheless received prophylaxis; 92.8% of patients with a generally recognized indication for prophylaxis received antibiotic prophylaxis. Less than one fifth (17.1%) of all prophylactic courses were stopped on the day of the intervention whilst 26.3% were continued up to the fifth post-operative day or beyond. The most frequently prescribed drugs for this indication included first and second generation cephalosporins and nitroimidazoles. The number of different generic drugs utilized per hospital ranged from 1 to 18 (mean: 7.7).

Surgical prophylaxis in Belgian hospitals: estimate of costs and potential savings.

Between 1991 and 1995 the Belgian National Program for Surveillance of Hospital Infections (NSIH) collected data on perioperative antibiotic prophylaxis in 72 acute care hospitals. From the costs of prophylactic antibiotics for six categories of surgical procedure and from discharge summaries for hospitalization episodes nationwide, annual drug costs were estimated for 73% of Belgian surgical activity. Costs of antibiotics used in these surgical activities were estimated at 386-410 million Belgian francs (Bf) per year (US$12.1-12.9 million). After agreeing recommendations for best practice, the hypothetical costs of 'optimal' antimicrobial prophylaxis were calculated for the same selection of surgical procedures. It was calculated that savings of at least 194 million Bf (US$6.1 million) could be made if recommendations were followed closely. Only the costs borne by the National Health Insurance Institute for reimbursement of the dispensed drugs were considered in this study. Other direct costs, such as those related to drug storage, dispensing and administration, were not included.