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Sample records for bloodstream forms

  1. Bloodstream form pre-adaptation to the tsetse fly in Trypanosoma brucei.

    Science.gov (United States)

    Rico, Eva; Rojas, Federico; Mony, Binny M; Szoor, Balazs; Macgregor, Paula; Matthews, Keith R

    2013-01-01

    African trypanosomes are sustained in the bloodstream of their mammalian hosts by their extreme capacity for antigenic variation. However, for life cycle progression, trypanosomes also must generate transmission stages called stumpy forms that are pre-adapted to survive when taken up during the bloodmeal of the disease vector, tsetse flies. These stumpy forms are rather different to the proliferative slender forms that maintain the bloodstream parasitaemia. Firstly, they are non proliferative and morphologically distinct, secondly, they show particular sensitivity to environmental cues that signal entry to the tsetse fly and, thirdly, they are relatively robust such that they survive the changes in temperature, pH and proteolytic environment encountered within the tsetse midgut. These characteristics require regulated changes in gene expression to pre-adapt the parasite and the use of environmental sensing mechanisms, both of which allow the rapid initiation of differentiation to tsetse midgut procyclic forms upon transmission. Interestingly, the generation of stumpy forms is also regulated and periodic in the mammalian blood, this being governed by a density-sensing mechanism whereby a parasite-derived signal drives cell cycle arrest and cellular development both to optimize transmission and to prevent uncontrolled parasite multiplication overwhelming the host. In this review we detail recent developments in our understanding of the molecular mechanisms that underpin the production of stumpy forms in the mammalian bloodstream and their signal perception pathways both in the mammalian bloodstream and upon entry into the tsetse fly. These discoveries are discussed in the context of conserved eukaryotic signaling and differentiation mechanisms. Further, their potential to act as targets for therapeutic strategies that disrupt parasite development either in the mammalian bloodstream or upon their transmission to tsetse flies is also discussed.

  2. Zinc finger nuclease technology: A stable tool for high efficiency transformation in bloodstream form T. brucei.

    Science.gov (United States)

    Schumann, Gabriela; Kangussu-Marcolino, Monica M; Doiron, Nicholas; Käser, Sandro; de Assis Burle-Caldas, Gabriela; DaRocha, Wanderson D; Teixeira, Santuza M; Roditi, Isabel

    2017-02-20

    In Trypanosoma brucei, the generation of knockout mutants is relatively easy compared to other organisms as transfection methods are well established. These methods have their limitations, however, when it comes to the generation of genome-wide libraries that require a minimum of several hundred thousand transformants. Double-strand breaks with the meganuclease ISce-I dramatically increase transformation efficiency, but are not widely in use as cell lines need to be generated de novo before each transfection. Here we show that zinc finger nucleases are a robust and stable tool that can enhance transformation in bloodstream forms by more than an order of magnitude.

  3. In vitro cultivation of Trypanosoma acomys: production of insect stages and bloodstream forms.

    Science.gov (United States)

    Maraghi, S; Wallbanks, K R; Molyneux, D H; Abdel-Hafez, S K

    1995-01-01

    When Trypanosoma acomys bloodstream forms were cultivated at 37 degrees C in Schneider's Drosophila medium supplemented with 20% (v/v) heat-inactivated foetal calf serum (FCS), with Microtus agrestis embryonic fibroblasts in RPMI 1640 medium supplemented with 20% FCS or in Baltz's medium supplemented with 10% FCS, the parasites transformed and largely remained as epimastigotes. Epimastigotes were also usually the commonest stage observed when the parasites were co-cultivated with a mosquito cell line at 27 degrees C. However, if these cultures were initiated with the supernatant suspensions from fibroblast cultures that had been cryopreserved, trypomastigotes, including bloodstream-like forms, were the predominant stage for the first 4 days of culture. It is suggested that the glycerol supplement or the temperature changes stimulated this unusual morphogenesis. At 27 degrees C, T. acomys was incapable of multiplying and died when cultured in fresh Schneider's Drosophila medium supplemented with 20% FCS, but co-cultivation with the mosquito cell lines or cultivation in cell-free supernatants from 1-week-old mosquito cell cultures was successful at this temperature; most of the parasites multiplied as epimastigotes.

  4. KREX2 is not essential for either procyclic or bloodstream form Trypanosoma brucei.

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    Jason Carnes

    Full Text Available BACKGROUND: Most mitochondrial mRNAs in Trypanosoma brucei require RNA editing for maturation and translation. The edited RNAs primarily encode proteins of the oxidative phosphorylation system. These parasites undergo extensive changes in energy metabolism between the insect and bloodstream stages which are mirrored by alterations in RNA editing. Two U-specific exonucleases, KREX1 and KREX2, are both present in protein complexes (editosomes that catalyze RNA editing but the relative roles of each protein are not known. METHODOLOGY/PRINCIPAL FINDINGS: The requirement for KREX2 for RNA editing in vivo was assessed in both procyclic (insect and bloodstream form parasites by methods that use homologous recombination for gene elimination. These studies resulted in null mutant cells in which both alleles were eliminated. The viability of these cells demonstrates that KREX2 is not essential in either life cycle stage, despite certain defects in RNA editing in vivo. Furthermore, editosomes isolated from KREX2 null cells require KREX1 for in vitro U-specific exonuclease activity. CONCLUSIONS: KREX2 is a U-specific exonuclease that is dispensable for RNA editing in vivo in T. brucei BFs and PFs. This result suggests that the U deletion activity, which is required for RNA editing, is primarily mediated in vivo by KREX1 which is normally found associated with only one type of editosome. The retention of the KREX2 gene implies a non-essential role or a role that is essential in other life cycle stages or conditions.

  5. Ribose 5-phosphate isomerase B knockdown compromises Trypanosoma brucei bloodstream form infectivity.

    Science.gov (United States)

    Loureiro, Inês; Faria, Joana; Clayton, Christine; Macedo-Ribeiro, Sandra; Santarém, Nuno; Roy, Nilanjan; Cordeiro-da-Siva, Anabela; Tavares, Joana

    2015-01-01

    Ribose 5-phosphate isomerase is an enzyme involved in the non-oxidative branch of the pentose phosphate pathway, and catalyzes the inter-conversion of D-ribose 5-phosphate and D-ribulose 5-phosphate. Trypanosomatids, including the agent of African sleeping sickness namely Trypanosoma brucei, have a type B ribose-5-phosphate isomerase. This enzyme is absent from humans, which have a structurally unrelated ribose 5-phosphate isomerase type A, and therefore has been proposed as an attractive drug target waiting further characterization. In this study, Trypanosoma brucei ribose 5-phosphate isomerase B showed in vitro isomerase activity. RNAi against this enzyme reduced parasites' in vitro growth, and more importantly, bloodstream forms infectivity. Mice infected with induced RNAi clones exhibited lower parasitaemia and a prolonged survival compared to control mice. Phenotypic reversion was achieved by complementing induced RNAi clones with an ectopic copy of Trypanosoma cruzi gene. Our results present the first functional characterization of Trypanosoma brucei ribose 5-phosphate isomerase B, and show the relevance of an enzyme belonging to the non-oxidative branch of the pentose phosphate pathway in the context of Trypanosoma brucei infection.

  6. Probing the metabolic network in bloodstream-form Trypanosoma brucei using untargeted metabolomics with stable isotope labelled glucose.

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    Darren J Creek

    2015-03-01

    Full Text Available Metabolomics coupled with heavy-atom isotope-labelled glucose has been used to probe the metabolic pathways active in cultured bloodstream form trypomastigotes of Trypanosoma brucei, a parasite responsible for human African trypanosomiasis. Glucose enters many branches of metabolism beyond glycolysis, which has been widely held to be the sole route of glucose metabolism. Whilst pyruvate is the major end-product of glucose catabolism, its transamination product, alanine, is also produced in significant quantities. The oxidative branch of the pentose phosphate pathway is operative, although the non-oxidative branch is not. Ribose 5-phosphate generated through this pathway distributes widely into nucleotide synthesis and other branches of metabolism. Acetate, derived from glucose, is found associated with a range of acetylated amino acids and, to a lesser extent, fatty acids; while labelled glycerol is found in many glycerophospholipids. Glucose also enters inositol and several sugar nucleotides that serve as precursors to macromolecule biosynthesis. Although a Krebs cycle is not operative, malate, fumarate and succinate, primarily labelled in three carbons, were present, indicating an origin from phosphoenolpyruvate via oxaloacetate. Interestingly, the enzyme responsible for conversion of phosphoenolpyruvate to oxaloacetate, phosphoenolpyruvate carboxykinase, was shown to be essential to the bloodstream form trypanosomes, as demonstrated by the lethal phenotype induced by RNAi-mediated downregulation of its expression. In addition, glucose derivatives enter pyrimidine biosynthesis via oxaloacetate as a precursor to aspartate and orotate.

  7. Evaluation of some organic compounds on bloodstream forms of Trypanosoma cruzi

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    João S. Silva

    1992-09-01

    Full Text Available Accidental transmission of Chagas' disease to man by blood transfusion is a serious problem in Latin-America. This paper describes the testing of several synthetic, semi-synthetic, and natural compounds for their activity against blood trypomastigotes in vitro at 4-C. The compounds embody several types of chemical structures: benzoquinone, naphthoquinone, anthracenequinone, phenanthrenequinone, imidazole, piperazine, quinoline, xanthene, and simple benzenic and naphthalenic derivates. Some of them are for the first time tested against Trypanosoma cruzi. The toxic effect these compounds on this parasite was done by two quite distinct sets of experiments. In one set, the compounds were added to infected blood as ethanolic solution. In this situation the most active one was a furan-1, 2-naphthoquinone, in the same range as gentian violet, a new fact to be considered in the assessment of structure-activity relationships in this class of compounds. In other set, we tentatively evaluated the biological activity of water insoluble compounds by adding them in a pure form without solvent into infected blood. In this way some appear to be very active and it was postulated that the effectiveness of such compounds must result from interactions between them and specific blood components.

  8. Mathematical modelling of polyamine metabolism in bloodstream-form Trypanosoma brucei: an application to drug target identification.

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    Xu Gu

    Full Text Available We present the first computational kinetic model of polyamine metabolism in bloodstream-form Trypanosoma brucei, the causative agent of human African trypanosomiasis. We systematically extracted the polyamine pathway from the complete metabolic network while still maintaining the predictive capability of the pathway. The kinetic model is constructed on the basis of information gleaned from the experimental biology literature and defined as a set of ordinary differential equations. We applied Michaelis-Menten kinetics featuring regulatory factors to describe enzymatic activities that are well defined. Uncharacterised enzyme kinetics were approximated and justified with available physiological properties of the system. Optimisation-based dynamic simulations were performed to train the model with experimental data and inconsistent predictions prompted an iterative procedure of model refinement. Good agreement between simulation results and measured data reported in various experimental conditions shows that the model has good applicability in spite of there being gaps in the required data. With this kinetic model, the relative importance of the individual pathway enzymes was assessed. We observed that, at low-to-moderate levels of inhibition, enzymes catalysing reactions of de novo AdoMet (MAT and ornithine production (OrnPt have more efficient inhibitory effect on total trypanothione content in comparison to other enzymes in the pathway. In our model, prozyme and TSHSyn (the production catalyst of total trypanothione were also found to exhibit potent control on total trypanothione content but only when they were strongly inhibited. Different chemotherapeutic strategies against T. brucei were investigated using this model and interruption of polyamine synthesis via joint inhibition of MAT or OrnPt together with other polyamine enzymes was identified as an optimal therapeutic strategy.

  9. Biosynthesis and uptake of thiamine (vitamin B1) in bloodstream form Trypanosoma brucei brucei and interference of the vitamin with melarsen oxide activity.

    Science.gov (United States)

    Stoffel, Sabine A; Rodenko, Boris; Schweingruber, Anne-Marie; Mäser, Pascal; de Koning, Harry P; Schweingruber, M Ernst

    2006-02-01

    Bloodstream forms of Trypanosoma brucei brucei were cultivated in the presence and absence of thiamine (vitamin B1) and pyridoxine (vitamin B6). The vitamins do not change growth behaviour, indicating that Trypanosoma brucei is prototrophic for the two vitamins even though in silico no bona-fide thiamine-biosynthetic genes could be identified in the T. brucei genome. Intracellularly, thiamine is mainly present in its diphosphate form. We were unable to detect significant uptake of [3H]thiamine and structural thiamine analogues such as pyrithiamine, oxithiamine and amprolium were not toxic for the bloodstream forms of T. brucei, indicating that the organism does not have an efficient uptake system for thiamine and its analogues. We have previously shown that, in the fission yeast Saccharomyces pombe, the toxicity of melarsen oxide, the pharmacologically active derivative of the frontline sleeping sickness drug melarsoprol, is abolished by thiamine and the drug is taken up by a thiamine-regulated membrane protein which is responsible for the utilization of thiamine. We show here that thiamine also has weak effects on melarsen oxide-induced growth inhibition and lysis in T. brucei. These effects were consistent with a low affinity of thiamine for the P2 adenosine transporter that is responsible for uptake of melaminophenyl arsenicals in African trypanosomes.

  10. Replacing paper data collection forms with electronic data entry in the field: findings from a study of community-acquired bloodstream infections in Pemba, Zanzibar

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    Thriemer Kamala

    2012-02-01

    Full Text Available Abstract Background Entering data on case report forms and subsequently digitizing them in electronic media is the traditional way to maintain a record keeping system in field studies. Direct data entry using an electronic device avoids this two-step process. It is gaining in popularity and has replaced the paper-based data entry system in many studies. We report our experiences with paper- and PDA-based data collection during a fever surveillance study in Pemba Island, Zanzibar, Tanzania. Methods Data were collected on a 14-page case report paper form in the first period of the study. The case report paper forms were then replaced with handheld computers (personal digital assistants or PDAs. The PDAs were used for screening and clinical data collection, including a rapid assessment of patient eligibility, real time errors, and inconsistency checking. Results A comparison of paper-based data collection with PDA data collection showed that direct data entry via PDA was faster and 25% cheaper. Data was more accurate (7% versus 1% erroneous data and omission did not occur with electronic data collection. Delayed data turnaround times and late error detections in the paper-based system which made error corrections difficult were avoided using electronic data collection. Conclusions Electronic data collection offers direct data entry at the initial point of contact. It has numerous advantages and has the potential to replace paper-based data collection in the field. The availability of information and communication technologies for direct data transfer has the potential to improve the conduct of public health research in resource-poor settings.

  11. Computer algorithms to detect bloodstream infections.

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    Trick, William E; Zagorski, Brandon M; Tokars, Jerome I; Vernon, Michael O; Welbel, Sharon F; Wisniewski, Mary F; Richards, Chesley; Weinstein, Robert A

    2004-09-01

    We compared manual and computer-assisted bloodstream infection surveillance for adult inpatients at two hospitals. We identified hospital-acquired, primary, central-venous catheter (CVC)-associated bloodstream infections by using five methods: retrospective, manual record review by investigators; prospective, manual review by infection control professionals; positive blood culture plus manual CVC determination; computer algorithms; and computer algorithms and manual CVC determination. We calculated sensitivity, specificity, predictive values, plus the kappa statistic (kappa) between investigator review and other methods, and we correlated infection rates for seven units. The kappa value was 0.37 for infection control review, 0.48 for positive blood culture plus manual CVC determination, 0.49 for computer algorithm, and 0.73 for computer algorithm plus manual CVC determination. Unit-specific infection rates, per 1,000 patient days, were 1.0-12.5 by investigator review and 1.4-10.2 by computer algorithm (correlation r = 0.91, p = 0.004). Automated bloodstream infection surveillance with electronic data is an accurate alternative to surveillance with manually collected data.

  12. Bloodstream infections in HIV-infected patients.

    Science.gov (United States)

    Taramasso, Lucia; Tatarelli, Paola; Di Biagio, Antonio

    2016-04-02

    In the combined antiretroviral therapy era, HIV-infected patients remain a vulnerable population for the onset of bloodstream infections (BSI). Worldwide, nontyphoid salmonellae, Streptococcus pneumoniae, Escherichia coli, Staphylococcus aureus and coagulase negative staphylococci are the most important pathogens. Intravenous catheter associated infection, skin-soft tissue infection and endocarditis are associated with Gram-positive bacteremia. Among the Gram-negative, nontyphoidal Salmonella have been previously correlated to sepsis. Other causes of BSI in HIV-infected patients are mycobacteria and fungi. Mycobacteria constitute a major cause of BSI in limited resource countries. Fungal BSI are not frequent and among them Cryptococcus neoformans is the most common life-threatening infection. The degree of immunosuppression remains the key prognostic factor leading to the development of BSI.

  13. Bloodstream Infections with Mycobacterium tuberculosis among HIV patients

    Centers for Disease Control (CDC) Podcasts

    2010-09-23

    This podcast looks at bloodstream infections with Mycobacterium tuberculosis and other pathogens among outpatients infected with HIV in Southeast Asia. CDC health scientist Kimberly McCarthy discusses the study and why bloodstream infections occur in HIV-infected populations.  Created: 9/23/2010 by National Center for Emerging and Zoonotic Infectious Diseases (NCEZID).   Date Released: 9/23/2010.

  14. When Prostate Cancer Circulates in the Bloodstream

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    Virginie Vlaeminck-Guillem

    2015-10-01

    Full Text Available Management of patients with prostate cancer is currently based on imperfect clinical, biological, radiological and pathological evaluation. Prostate cancer aggressiveness, including metastatic potential, remains difficult to accurately estimate. In an attempt to better adapt therapeutics to an individual (personalized medicine, reliable evaluation of the intrinsic molecular biology of the tumor is warranted, and particularly for all tumor sites (primary tumors and secondary sites at any time of the disease progression. As a consequence of their natural tendency to grow (passive invasion or as a consequence of an active blood vessel invasion by metastase-initiating cells, tumors shed various materials into the bloodstream. Major efforts have been recently made to develop powerful and accurate methods able to detect, quantify and/or analyze all these circulating tumor materials: circulating tumors cells, disseminating tumor cells, extracellular vesicles (including exosomes, nucleic acids, etc. The aim of this review is to summarize current knowledge about these circulating tumor materials and their applications in translational research.

  15. Genotypic analysis of Acinetobacter bloodstream infection isolates in a Turkish university hospital.

    NARCIS (Netherlands)

    Alp, E.; Esel, D.; Yildiz, O.; Voss, A.; Melchers, W.J.G.; Doganay, M.

    2006-01-01

    Acinetobacter baumannii is a significant pathogen of bloodstream infections in hospital patients that frequently causes single clone outbreaks. We aimed to evaluate the genetic relatedness and antimicrobial susceptibility of Acinetobacter spp. bloodstream isolates, in order to obtain insight into th

  16. The changing epidemiology of Staphylococcus aureus bloodstream infection

    DEFF Research Database (Denmark)

    Laupland, K B; Lyytikäinen, O; Søgaard, M;

    2012-01-01

    Clin Microbiol Infect ABSTRACT: Although the epidemiology of Staphylococcus aureus bloodstream infection (BSI) has been changing, international comparisons are lacking. We sought to determine the incidence of S. aureus BSI and assess trends over time and by region. Population-based surveillance...

  17. Prevention of nosocomial bloodstream infections in preterm infants

    NARCIS (Netherlands)

    K. Helder MScN (Onno)

    2013-01-01

    textabstractProtecting patients from harm is the overarching theme of the studies presented here. More precisely, this thesis places a focus on the prevention of nosocomial or hospitalacquired bloodstream infections in preterm infants, thus saving them from further harm. A nosocomial infection is an

  18. Neonatal bloodstream infections in a pediatric hospital in Vietnam

    DEFF Research Database (Denmark)

    Kruse, Alexandra Yasmin; Thieu Chuong, D.H.; Phuong, C.N.;

    2013-01-01

    Septicemia and bloodstream infections (BSIs) are major causes of neonatal morbidity and mortality in developing countries. We prospectively recorded all positive blood cultures (BSI) among neonates admitted consecutively to a tertiary pediatric hospital in Vietnam during a 12-month period. Among...

  19. Coordinated Molecular Cross-Talk between Staphylococcus aureus, Endothelial Cells and Platelets in Bloodstream Infection

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    Carolina D. Garciarena

    2015-12-01

    Full Text Available Staphylococcus aureus is an opportunistic pathogen often carried asymptomatically on the human body. Upon entry to the otherwise sterile environment of the cardiovascular system, S. aureus can lead to serious complications resulting in organ failure and death. The success of S. aureus as a pathogen in the bloodstream is due to its ability to express a wide array of cell wall proteins on its surface that recognise host receptors, extracellular matrix proteins and plasma proteins. Endothelial cells and platelets are important cells in the cardiovascular system and are a major target of bloodstream infection. Endothelial cells form the inner lining of a blood vessel and provide an antithrombotic barrier between the vessel wall and blood. Platelets on the other hand travel throughout the cardiovascular system and respond by aggregating around the site of injury and initiating clot formation. Activation of either of these cells leads to functional dysregulation in the cardiovascular system. In this review, we will illustrate how S. aureus establish intimate interactions with both endothelial cells and platelets leading to cardiovascular dysregulation.

  20. Central line-associated bloodstream infections: prevention and management.

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    Weber, David J; Rutala, William A

    2011-03-01

    Approximately 80,000 central venous line-associated bloodstream infections (CLA-BSI) occur in the United States each year. CLA-BSI is most commonly caused by coagulase-negative staphylococci, Staphylococcus aureus, Candida spp, and aerobic gram-negative bacilli. These organisms commonly gain entrance in into the bloodstream via the catheter-skin interface (insertion site) or via the catheter hub. Use of strict aseptic technique for insertion is the key method for the prevention of CLA-BSI. Various methods can be used to reduce unacceptably high rates of CLA-BSI, including use of an antiseptic- or antibiotic-impregnated catheter, daily chlorhexidine baths/washes, and placement of a chlorhexidine-impregnated sponge over the insertion site.

  1. Prosthetic valve endocarditis and bloodstream infection due to Mycobacterium chimaera.

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    Achermann, Yvonne; Rössle, Matthias; Hoffmann, Matthias; Deggim, Vanessa; Kuster, Stefan; Zimmermann, Dieter R; Bloemberg, Guido; Hombach, Michael; Hasse, Barbara

    2013-06-01

    Prosthetic valve endocarditis (PVE) due to fast-growing nontuberculous mycobacteria (NTM) has been reported anecdotally. Reports of PVE with slowly growing NTM, however, are lacking. We present here one case of PVE and one case of bloodstream infection caused by Mycobacterium chimaera. Randomly amplified polymorphic DNA (RAPD)-PCR indicated a relatedness of the two M. chimaera strains. Both patients had heart surgery 2 years apart from each other. A nosocomial link was not detected.

  2. Prosthetic Valve Endocarditis and Bloodstream Infection Due to Mycobacterium chimaera

    OpenAIRE

    Achermann, Yvonne; Rössle, Matthias; Hoffmann, Matthias; Deggim, Vanessa; Kuster, Stefan; Zimmermann, Dieter R.; Bloemberg, Guido; Hombach, Michael; Hasse, Barbara

    2013-01-01

    Prosthetic valve endocarditis (PVE) due to fast-growing nontuberculous mycobacteria (NTM) has been reported anecdotally. Reports of PVE with slowly growing NTM, however, are lacking. We present here one case of PVE and one case of bloodstream infection caused by Mycobacterium chimaera. Randomly amplified polymorphic DNA (RAPD)-PCR indicated a relatedness of the two M. chimaera strains. Both patients had heart surgery 2 years apart from each other. A nosocomial link was not detected.

  3. Endothelial JAM-A promotes reovirus viremia and bloodstream dissemination.

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    Lai, Caroline M; Boehme, Karl W; Pruijssers, Andrea J; Parekh, Vrajesh V; Van Kaer, Luc; Parkos, Charles A; Dermody, Terence S

    2015-02-01

    Viruses that cause systemic disease often spread through the bloodstream to infect target tissues. Although viremia is an important step in the pathogenesis of many viruses, how viremia is established is not well understood. Reovirus has been used to dissect mechanisms of viral pathogenesis and is being evaluated in clinical trials as an oncolytic agent. After peroral entry into mice, reovirus replicates within the gastrointestinal tract and disseminates systemically via hematogenous or neural routes. Junctional adhesion molecule-A (JAM-A) is a tight junction protein that serves as a receptor for reovirus. JAM-A is required for establishment of viremia and viral spread to sites of secondary replication. JAM-A also is expressed on the surface of circulating hematopoietic cells. To determine contributions of endothelial and hematopoietic JAM-A to reovirus dissemination and pathogenesis, we generated strains of mice with altered JAM-A expression in these cell types and assessed bloodstream spread of reovirus strain type 1 Lang (T1L), which disseminates solely by hematogenous routes. We found that endothelial JAM-A but not hematopoietic JAM-A facilitates reovirus T1L bloodstream entry and egress. Understanding how viruses establish viremia may aid in development of inhibitors of this critical step in viral pathogenesis and foster engineering of improved oncolytic viral vectors.

  4. Bloodstream-To-Eye Infections Are Facilitated by Outer Blood-Retinal Barrier Dysfunction.

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    Phillip S Coburn

    Full Text Available The blood-retinal barrier (BRB functions to maintain the immune privilege of the eye, which is necessary for normal vision. The outer BRB is formed by tightly-associated retinal pigment epithelial (RPE cells which limit transport within the retinal environment, maintaining retinal function and viability. Retinal microvascular complications and RPE dysfunction resulting from diabetes and diabetic retinopathy cause permeability changes in the BRB that compromise barrier function. Diabetes is the major predisposing condition underlying endogenous bacterial endophthalmitis (EBE, a blinding intraocular infection resulting from bacterial invasion of the eye from the bloodstream. However, significant numbers of EBE cases occur in non-diabetics. In this work, we hypothesized that dysfunction of the outer BRB may be associated with EBE development. To disrupt the RPE component of the outer BRB in vivo, sodium iodate (NaIO3 was administered to C57BL/6J mice. NaIO3-treated and untreated mice were intravenously injected with 108 colony forming units (cfu of Staphylococcus aureus or Klebsiella pneumoniae. At 4 and 6 days postinfection, EBE was observed in NaIO3-treated mice after infection with K. pneumoniae and S. aureus, although the incidence was higher following S. aureus infection. Invasion of the eye was observed in control mice following S. aureus infection, but not in control mice following K. pneumoniae infection. Immunohistochemistry and FITC-dextran conjugate transmigration assays of human RPE barriers after infection with an exoprotein-deficient agr/sar mutant of S. aureus suggested that S. aureus exoproteins may be required for the loss of the tight junction protein, ZO-1, and for permeability of this in vitro barrier. Our results support the clinical findings that for both pathogens, complications which result in BRB permeability increase the likelihood of bacterial transmigration from the bloodstream into the eye. For S. aureus, however, BRB

  5. Bloodstream-To-Eye Infections Are Facilitated by Outer Blood-Retinal Barrier Dysfunction

    Science.gov (United States)

    Coburn, Phillip S.; Wiskur, Brandt J.; Miller, Frederick C.; LaGrow, Austin L.; Astley, Roger A.; Elliott, Michael H.; Callegan, Michelle C.

    2016-01-01

    The blood-retinal barrier (BRB) functions to maintain the immune privilege of the eye, which is necessary for normal vision. The outer BRB is formed by tightly-associated retinal pigment epithelial (RPE) cells which limit transport within the retinal environment, maintaining retinal function and viability. Retinal microvascular complications and RPE dysfunction resulting from diabetes and diabetic retinopathy cause permeability changes in the BRB that compromise barrier function. Diabetes is the major predisposing condition underlying endogenous bacterial endophthalmitis (EBE), a blinding intraocular infection resulting from bacterial invasion of the eye from the bloodstream. However, significant numbers of EBE cases occur in non-diabetics. In this work, we hypothesized that dysfunction of the outer BRB may be associated with EBE development. To disrupt the RPE component of the outer BRB in vivo, sodium iodate (NaIO3) was administered to C57BL/6J mice. NaIO3-treated and untreated mice were intravenously injected with 108 colony forming units (cfu) of Staphylococcus aureus or Klebsiella pneumoniae. At 4 and 6 days postinfection, EBE was observed in NaIO3-treated mice after infection with K. pneumoniae and S. aureus, although the incidence was higher following S. aureus infection. Invasion of the eye was observed in control mice following S. aureus infection, but not in control mice following K. pneumoniae infection. Immunohistochemistry and FITC-dextran conjugate transmigration assays of human RPE barriers after infection with an exoprotein-deficient agr/sar mutant of S. aureus suggested that S. aureus exoproteins may be required for the loss of the tight junction protein, ZO-1, and for permeability of this in vitro barrier. Our results support the clinical findings that for both pathogens, complications which result in BRB permeability increase the likelihood of bacterial transmigration from the bloodstream into the eye. For S. aureus, however, BRB permeability is

  6. Bloodstream-To-Eye Infections Are Facilitated by Outer Blood-Retinal Barrier Dysfunction.

    Science.gov (United States)

    Coburn, Phillip S; Wiskur, Brandt J; Miller, Frederick C; LaGrow, Austin L; Astley, Roger A; Elliott, Michael H; Callegan, Michelle C

    2016-01-01

    The blood-retinal barrier (BRB) functions to maintain the immune privilege of the eye, which is necessary for normal vision. The outer BRB is formed by tightly-associated retinal pigment epithelial (RPE) cells which limit transport within the retinal environment, maintaining retinal function and viability. Retinal microvascular complications and RPE dysfunction resulting from diabetes and diabetic retinopathy cause permeability changes in the BRB that compromise barrier function. Diabetes is the major predisposing condition underlying endogenous bacterial endophthalmitis (EBE), a blinding intraocular infection resulting from bacterial invasion of the eye from the bloodstream. However, significant numbers of EBE cases occur in non-diabetics. In this work, we hypothesized that dysfunction of the outer BRB may be associated with EBE development. To disrupt the RPE component of the outer BRB in vivo, sodium iodate (NaIO3) was administered to C57BL/6J mice. NaIO3-treated and untreated mice were intravenously injected with 108 colony forming units (cfu) of Staphylococcus aureus or Klebsiella pneumoniae. At 4 and 6 days postinfection, EBE was observed in NaIO3-treated mice after infection with K. pneumoniae and S. aureus, although the incidence was higher following S. aureus infection. Invasion of the eye was observed in control mice following S. aureus infection, but not in control mice following K. pneumoniae infection. Immunohistochemistry and FITC-dextran conjugate transmigration assays of human RPE barriers after infection with an exoprotein-deficient agr/sar mutant of S. aureus suggested that S. aureus exoproteins may be required for the loss of the tight junction protein, ZO-1, and for permeability of this in vitro barrier. Our results support the clinical findings that for both pathogens, complications which result in BRB permeability increase the likelihood of bacterial transmigration from the bloodstream into the eye. For S. aureus, however, BRB permeability is

  7. Bloodstream infection caused by nontoxigenic Corynebacterium diphtheriae in an immunocompromised host in the United States.

    Science.gov (United States)

    Wojewoda, Christina M; Koval, Christine E; Wilson, Deborah A; Chakos, Mary H; Harrington, Susan M

    2012-06-01

    Corynebacterium species are well-known causes of catheter-related bloodstream infections. Toxigenic strains of Corynebacterium diphtheriae cause respiratory diphtheria. We report a bloodstream infection caused by a nontoxigenic strain of C. diphtheriae and discuss the epidemiology, possible sources of the infection, and the implications of rapid species identification of corynebacteria.

  8. Cytosolic peroxidases protect the lysosome of bloodstream African trypanosomes from iron-mediated membrane damage.

    Directory of Open Access Journals (Sweden)

    Corinna Hiller

    2014-04-01

    Full Text Available African trypanosomes express three virtually identical non-selenium glutathione peroxidase (Px-type enzymes which preferably detoxify lipid-derived hydroperoxides. As shown previously, bloodstream Trypanosoma brucei lacking the mitochondrial Px III display only a weak and transient proliferation defect whereas parasites that lack the cytosolic Px I and Px II undergo extremely fast lipid peroxidation and cell lysis. The phenotype can completely be rescued by supplementing the medium with the α-tocopherol derivative Trolox. The mechanism underlying the rapid cell death remained however elusive. Here we show that the lysosome is the origin of the cellular injury. Feeding the px I-II knockout parasites with Alexa Fluor-conjugated dextran or LysoTracker in the presence of Trolox yielded a discrete lysosomal staining. Yet upon withdrawal of the antioxidant, the signal became progressively spread over the whole cell body and was completely lost, respectively. T. brucei acquire iron by endocytosis of host transferrin. Supplementing the medium with iron or transferrin induced, whereas the iron chelator deferoxamine and apo-transferrin attenuated lysis of the px I-II knockout cells. Immunofluorescence microscopy with MitoTracker and antibodies against the lysosomal marker protein p67 revealed that disintegration of the lysosome precedes mitochondrial damage. In vivo experiments confirmed the negligible role of the mitochondrial peroxidase: Mice infected with px III knockout cells displayed only a slightly delayed disease development compared to wild-type parasites. Our data demonstrate that in bloodstream African trypanosomes, the lysosome, not the mitochondrion, is the primary site of oxidative damage and cytosolic trypanothione/tryparedoxin-dependent peroxidases protect the lysosome from iron-induced membrane peroxidation. This process appears to be closely linked to the high endocytic rate and distinct iron acquisition mechanisms of the infective

  9. Concentration of erythrocyte-based magnetic carriers in the bloodstream

    Energy Technology Data Exchange (ETDEWEB)

    Danilov, Y.N.; Il' ina, M.B.; Makharudov, S.Y.; Orekhov, A.N.; Rodchenko, S.A.; Samokhin, G.P.

    1986-04-01

    The writers postulated that magnetic erythrocytes (ME), injected into the bloodstream, may be concentrated in an assigned region of the vascular bed with the aid of the field of a permanent magnet. To test this hypothesis, erythrocytes ''loaded'' with colloidal magnetite were used, and concentrated in experiments in vitro and in vivo. For the experiments in vivo ME were labeled with sodium pertechnetate (Na /SUP 99n/ TcO4) was estimated in ME with a Rackgamma 1270 counter by determining radioactivity in the ME suspension and in the supernatant. For the experiment in vivo, a midline laparotomy was performed on a dog weighing 14 kg under intravenous hexobarbital anesthesia. The distribution of ME was recorded by means of a gamma-camera.

  10. Mortality in enterococcal bloodstream infections increases with inappropriate antimicrobial therapy

    DEFF Research Database (Denmark)

    Suppli, M.; Aabenhus, R.; Harboe, Z.B.;

    2010-01-01

    Enterococcus species are common in nosocomial bloodstream infections and their incidence is rising. Although well recognized in several serious bacterial infections, the influence of appropriate antimicrobial therapy in enterococcal bacteraemia has not been fully settled. The aim of the study...... in Denmark. Patients with growth of non-enterococcus co-pathogens apart from the enterococcal bacteraemia were also included, as were patients with repeated enterococcal bacteraemia. Time to appropriate antimicrobial therapy was counted from the first episode. Appropriate antibiotic therapy was defined...... as any therapy with documented clinical effect, in vitro activity and a minimum treatment length of 6 days. Multivariate regression models were built to determine the independent risk factors for mortality. We included 196 patients with enterococcal bacteraemia. Appropriate antibiotics for at least 6...

  11. Reducing bloodstream infection with a chlorhexidine gel IV dressing.

    Science.gov (United States)

    Jeanes, Annette; Bitmead, James

    The use of vascular access devices (VAD) is common in healthcare provision but there is a significant risk of acquiring an infection. Central venous catheters (CVC) are associated with the highest risk of intravenous catheter-related bloodstream infection (CRBSI). 3M™ Tegaderm™ CHG IV dressing is a semi-permeable transparent adhesive dressing with an integrated gel pad containing chlorhexidine gluconate 2%. This product was reviewed by the National Institute for Health and Care Excellence (NICE) in 2015, recommending that Tegaderm CHG could be used for CVC and arterial line dressings in high-dependency and intensive-care settings. This article discusses issues around CRBSI, interventions to reduce the risk of CRBSI, and the use of Tegaderm CHG dressing.

  12. Biofilm formation is a risk factor for mortality in patients with Candida albicans bloodstream infection—Scotland, 2012–2013

    Science.gov (United States)

    Rajendran, R.; Sherry, L.; Nile, C.J.; Sherriff, A.; Johnson, E.M.; Hanson, M.F.; Williams, C.; Munro, C.A.; Jones, B.J.; Ramage, G.

    2016-01-01

    Bloodstream infections caused by Candida species remain a significant cause of morbidity and mortality in hospitalized patients. Biofilm formation by Candida species is an important virulence factor for disease pathogenesis. A prospective analysis of patients with Candida bloodstream infection (n = 217) in Scotland (2012–2013) was performed to assess the risk factors associated with patient mortality, in particular the impact of biofilm formation. Candida bloodstream isolates (n = 280) and clinical records for 157 patients were collected through 11 different health boards across Scotland. Biofilm formation by clinical isolates was assessed in vitro with standard biomass assays. The role of biofilm phenotype on treatment efficacy was also evaluated in vitro by treating preformed biofilms with fixed concentrations of different classes of antifungal. Available mortality data for 134 patients showed that the 30-day candidaemia case mortality rate was 41%, with predisposing factors including patient age and catheter removal. Multivariate Cox regression survival analysis for 42 patients showed a significantly higher mortality rate for Candida albicans infection than for Candida glabrata infection. Biofilm-forming ability was significantly associated with C. albicans mortality (34 patients). Finally, in vitro antifungal sensitivity testing showed that low biofilm formers and high biofilm formers were differentially affected by azoles and echinocandins, but not by polyenes. This study provides further evidence that the biofilm phenotype represents a significant clinical entity, and that isolates with this phenotype differentially respond to antifungal therapy in vitro. Collectively, these findings show that greater clinical understanding is required with respect to Candida biofilm infections, and the implications of isolate heterogeneity. PMID:26432192

  13. Antimicrobial resistance predicts death in Tanzanian children with bloodstream infections: a prospective cohort study

    Directory of Open Access Journals (Sweden)

    Msangi Viola

    2007-05-01

    Full Text Available Abstract Background Bloodstream infection is a common cause of hospitalization, morbidity and death in children. The impact of antimicrobial resistance and HIV infection on outcome is not firmly established. Methods We assessed the incidence of bloodstream infection and risk factors for fatal outcome in a prospective cohort study of 1828 consecutive admissions of children aged zero to seven years with signs of systemic infection. Blood was obtained for culture, malaria microscopy, HIV antibody test and, when necessary, HIV PCR. We recorded data on clinical features, underlying diseases, antimicrobial drug use and patients' outcome. Results The incidence of laboratory-confirmed bloodstream infection was 13.9% (255/1828 of admissions, despite two thirds of the study population having received antimicrobial therapy prior to blood culture. The most frequent isolates were klebsiella, salmonellae, Escherichia coli, enterococci and Staphylococcus aureus. Furthermore, 21.6% had malaria and 16.8% HIV infection. One third (34.9% of the children with laboratory-confirmed bloodstream infection died. The mortality rate from Gram-negative bloodstream infection (43.5% was more than double that of malaria (20.2% and Gram-positive bloodstream infection (16.7%. Significant risk factors for death by logistic regression modeling were inappropriate treatment due to antimicrobial resistance, HIV infection, other underlying infectious diseases, malnutrition and bloodstream infection caused by Enterobacteriaceae, other Gram-negatives and candida. Conclusion Bloodstream infection was less common than malaria, but caused more deaths. The frequent use of antimicrobials prior to blood culture may have hampered the detection of organisms susceptible to commonly used antimicrobials, including pneumococci, and thus the study probably underestimates the incidence of bloodstream infection. The finding that antimicrobial resistance, HIV-infection and malnutrition predict fatal

  14. Cefotaxime resistance and outcome of Klebsiella spp bloodstream infection.

    Science.gov (United States)

    Ortega, M; Marco, F; Soriano, A; Almela, M; Martínez, J A; López, J; Pitart, C; Mensa, J

    2011-12-01

    We attempt to describe the epidemiology and outcome associated with cefotaxime-resistant (CTX-R) Klebsiella spp bacteraemia. Klebsiella spp bloodstream infection episodes prospectively collected through a blood culture surveillance programme from January 1991 to December 2008 in a single institution were analysed. A total of 910 monomicrobial episodes of Klebsiella spp bacteraemia were identified during the study period. The most important sources were from urinary tract infection, unknown sources, billiary focus and catheter related infection. There were 112 (12%) CTX-R isolates. Out of 112 isolates, 98 were CTX-R by Extended-Spectrum β-Lactamase production. Shock on presentation and mortality were significantly more frequent in CTX-R than in CTX susceptible isolates. Inappropriate empirical therapy was received in 50 (45%) cases in the CTX-R Klebsiella spp group (13 cases of death, 26%). Predictive factors associated with CTX-R Klebsiella spp isolate were: previous β-lactam therapy (OR = 4.16), nosocomial acquired bacteraemia (OR = 1.93), solid organ trasplantation (OR = 2.09) and shock (OR = 1.90). Independent risk factors associated with mortality in Klebsiella spp bacteraemia were: age (OR = 1.03), liver cirrhosis (OR = 2.63), ultimately or rapidly fatal prognosis of underlying disease (OR = 2.44), shock (OR = 8.60), pneumonia (OR = 4.96) or intraabdominal (OR = 3.85) source of bacteraemia and CTX-R isolate (OR = 4.63). Klebsiella spp is an important cause of bloodstream infection. CTX-R isolates have been increasing since 2000. CTX-R is an independent factor associated with mortality in Klebsiella spp bacteraemia.

  15. Catheter Removal versus Retention in the Management of Catheter-Associated Enterococcal Bloodstream Infections

    Directory of Open Access Journals (Sweden)

    Jonas Marschall

    2013-01-01

    Full Text Available BACKGROUND: Enterococci are an important cause of central venous catheter (CVC-associated bloodstream infections (CA-BSI. It is unclear whether CVC removal is necessary to successfully manage enterococcal CA-BSI.

  16. Bacillus Cereus Catheter Related Bloodstream Infection in a Patient with Acute Lymphoblastic Leukemia

    OpenAIRE

    N Gurler; Oksuz, L; M Muftuoglu; Sargin, FD; Besisik, SK

    2012-01-01

    Bacillus cereus infection is rarely associated with actual infection and for this reason single positive blood culture is usually regarded as contamination . However it may cause a number of infections, such catheter-related bloodstream infections. Significant catheter-related bloodstream infections (CRBSI) caused by Bacillus spp. are mainly due to B. cereus and have been predominantly reported in immunocompromised hosts. Catheter removal is generally advised for management of infection. In t...

  17. Elimination of central line-associated bloodstream infections: application of the evidence.

    Science.gov (United States)

    Posa, Patricia J; Harrison, Denise; Vollman, Kathleen M

    2006-01-01

    Central line-associated bloodstream infections are considered to be an avoidable complication of care delivery. In addition to considerable morbidity and use of resources, central line-associated bloodstream infections carry an attributable morality between 12% and 25%. The estimated cost per infection is approximately 25,000 US dollars. Research over the last decade has focused on a number of care activities that have been shown to reduce the incidence of bloodstream infections related to central line placement in the critically ill patient. A significant reduction or elimination of central line-associated bloodstream infections can occur with implementation of a comprehensive central line-associated bloodstream infection prevention program that includes staff education, hand hygiene, use of maximal sterile barrier precautions, chlorhexidine gluconate skin antisepsis, avoidance of femoral lines, empowerment of staff to stop the procedure if sterile technique is broken, and daily assessment of the continued need for a central line. This article focuses on strategies for implementing a comprehensive central line-associated bloodstream infections prevention program and a tool and process for defect analysis as part of a statewide collaborative in Michigan.

  18. Epidemiology, surveillance, and prevention of bloodstream infections in hemodialysis patients.

    Science.gov (United States)

    Patel, Priti R; Kallen, Alexander J; Arduino, Matthew J

    2010-09-01

    Infections cause significant morbidity and mortality in patients undergoing hemodialysis. Bloodstream infections (BSIs) are particularly problematic, accounting for a substantial number of hospitalizations in these patients. Hospitalizations for BSI and other vascular access infections appear to have increased dramatically in hemodialysis patients since 1993. These infections frequently are related to central venous catheter (CVC) use for dialysis access. Regional initiatives that have shown successful decreases in catheter-related BSIs in hospitalized patients have generated interest in replicating this success in outpatient hemodialysis populations. Several interventions have been effective in preventing BSIs in the hemodialysis setting. Avoiding the use of CVCs in favor of access types with lower associated BSI risk is among the most important. When CVCs are used, adherence to evidence-based catheter insertion and maintenance practices can positively influence BSI rates. In addition, facility-level surveillance to detect BSIs and stimulate examination of vascular access use and care practices is essential to a comprehensive approach to prevention. This article describes the current epidemiology of BSIs in hemodialysis patients and effective prevention strategies to decrease the incidence of these devastating infections.

  19. Bloodstream Infections in a Neonatal Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Mehmet Sah Ižpek

    2016-09-01

    Full Text Available Aim: To determine the pattern of bloodstream infections (BSIs and antimicrobial susceptibility of pathogens in a neonatal intensive care unit (NICU.Material and Method: Positive hemoculture of neonates diagnosed with nosocomial sepsis from March 2011 to March 2014 in the NICU of Diyarbakir Maternity and Children%u2019s Hospital, in the southeastern region of Anatolia, Turkey, were retrospectively reviewed. Results: A total of 148 pathogens were isolated in 142 neonates. The most common microorganisms isolated were Klebsiella pneumoniae (40.5% and Acinetobacter baumannii (29.7% which was a result of a hospital outbreak. Multi-drug resistant (MDR strains accounted for 20.0% of K. pneumoniae isolates and 93.2% of A. baumannii isolates. The sepsis-attributable mortality rate was higher in cases infected with MDR strains than in cases infected without MDR strains or Candida spp (24% vs. 9.7%, p=0.032. Discussion: In our unit, BSIs were more often caused by Gram negative bacteria. BSIs caused by MDR strains were associated with a higher rate of sepsis-attributable mortality.

  20. Central venous catheter-related bloodstream infection caused by Staphylococcus aureus: microbiology and risk factors

    Directory of Open Access Journals (Sweden)

    Geraldo Sadoyma

    2006-04-01

    Full Text Available Although central vascular catheters (CVC are indispensable in modern medicine, they are an important risk factor for primary bacteremias. We examined the incidence and risk factors associated with catheter-related bloodstream infection (CR-BSI caused by Staphylococcus aureus in surgical patients. A prospective study was carried out in the Hospital das Clínicas da Universidade Federal de Uberlândia (HC-UFU from September 2000 to December 2002. The skin insertion site, catheter tip, and blood were microbiologically analyzed. Demographics and risk factors were recorded for each patient, and cultures were identified phenotypically. Staphylococcus aureus was the most frequent pathogen, with an incidence rate of 4.9 episodes of CR-BSIs per 1,000 catheter/days. Based on logistic regression, the independent risk factors were: colonization on the insertion site =200 colony forming units (CFU/20 cm² (p=0.03; odds ratio (OR =6.89 and catheter tip (p=0.01; OR=7.95. The CR-BSI rate was high; it was mainly associated with S. aureus, and skin colonization at the insertion site and on the catheter tip were important risk factors for CR-BSI.

  1. Candida bloodstream infections in intensive care units: analysis of the extended prevalence of infection in intensive care unit study

    NARCIS (Netherlands)

    Kett, D.H.; Azoulay, E.; Echeverria, P.M.; Vincent, J.L.; Pickkers, P.

    2011-01-01

    OBJECTIVES: To provide a global, up-to-date picture of the prevalence, treatment, and outcomes of Candida bloodstream infections in intensive care unit patients and compare Candida with bacterial bloodstream infection. DESIGN: A retrospective analysis of the Extended Prevalence of Infection in the I

  2. Isolation and characterization of kinetoplast DNA from the bloodstream form of Trypanosoma brucei.

    NARCIS (Netherlands)

    A.H. Fairlamb; P.O. Weislogel; J.H.J. Hoeijmakers (Jan); P. Borst (Piet)

    1978-01-01

    textabstractWe have used restriction endonucleases PstI, EcoRI, HapII, HhaI, and S1 nuclease to demonstrate the presence of a large complex component, the maxi-circle, in addition to the major mini-circle component in kinetoplast DNA (kDNA) networks of Trypanosoma brucei (East African Trypanosomiasi

  3. Involvement of lysosomes in the uptake of macromolecular material by bloodstream forms of Trypanosoma brucei.

    Science.gov (United States)

    Opperdoes, F R; Van Roy, J

    1982-09-01

    To investigate whether the lysosomes of Trypanosoma brucei are capable of uptake of macromolecules after internalization by the cell, we used Triton WR-1339, a non-digestible macromolecular compound, which is known to cause a marked decrease in the density of hepatic lysosomes due to massive intralysosomal storage. Intraperitoneal administration of 0.4 g/kg Triton WR-1339 to rats infected with T. brucei led to the development of a large vacuole in the trypanosomes between nucleus and kinetoplast within 22 h. Higher doses (2 g/kg) led to the disappearance of the trypanosomes from the blood and resulted in permanent cures (greater than 100 days). Lysosomes isolated from the trypanosomes of animals treated with a sub-curative dose showed a decrease in equilibrium density of 0.03 g/cm3 in sucrose gradients. These lysosomes were partly damaged as evidenced by a reduction in latency and an increase in the non-sedimentable part of lysosomal enzymes. We conclude that acid proteinase and alpha-mannosidase-containing organelles of T. brucei take up exogenous macromolecules and must therefore be considered as true lysosomes and that Triton WR-1339 acts in T. brucei as a true lysosomotropic drug. Its trypanocidal action probably results from an interference with lysosomal function.

  4. Alkaloids Induce Programmed Cell Death in Bloodstream Forms of Trypanosomes (Trypanosoma b. brucei

    Directory of Open Access Journals (Sweden)

    Michael Wink

    2008-10-01

    Full Text Available The potential induction of a programmed cell death (PCD in Trypanosoma b. brucei by 55 alkaloids of the quinoline, quinolizidine, isoquinoline, indole, terpene, tropane, steroid, and piperidine type was studied by measuring DNA fragmentation and changes in mitochondrial membrane potential. For comparison, the induction of apoptosis by the same alkaloids in human leukemia cells (Jurkat APO-S was tested. Several alkaloids of the isoquinoline, quinoline, indole and steroidal type (berberine, chelerythrine, emetine, sanguinarine, quinine, ajmalicine, ergotamine, harmine, vinblastine, vincristine, colchicine, chaconine, demissidine and veratridine induced programmed cell death, whereas quinolizidine, tropane, terpene and piperidine alkaloids were mostly inactive. Effective PCD induction (EC50 below 10 µM was caused in T. brucei by chelerythrine, emetine, sanguinarine, and chaconine. The active alkaloids can be characterized by their general property to inhibit protein biosynthesis, to intercalate DNA, to disturb membrane fluidity or to inhibit microtubule formation.

  5. Bacillus cereus catheter related bloodstream infection in a patient with acute lymphoblastic leukemia.

    Science.gov (United States)

    Gurler, N; Oksuz, L; Muftuoglu, M; Sargin, Fd; Besisik, Sk

    2012-01-01

    Bacillus cereus infection is rarely associated with actual infection and for this reason single positive blood culture is usually regarded as contamination . However it may cause a number of infections, such catheter-related bloodstream infections. Significant catheter-related bloodstream infections (CRBSI) caused by Bacillus spp. are mainly due to B. cereus and have been predominantly reported in immunocompromised hosts. Catheter removal is generally advised for management of infection. In this report, catheter-related bacteremia caused by B. cereus in a patient with acute lymphoblast c leukemia (ALL) in Istanbul Medical Faculty was presented.

  6. Diverse effects on mitochondrial and nuclear functions elicited by drugs and genetic knockdowns in bloodstream stage Trypanosoma brucei.

    Directory of Open Access Journals (Sweden)

    Christal Worthen

    Full Text Available BACKGROUND: The options for treating the fatal disease human African trypanosomiasis are limited to a few drugs that are toxic or facing increasing resistance. New drugs that kill the causative agents, subspecies of Trypanosoma brucei, are therefore urgently needed. Little is known about the cellular mechanisms that lead to death of the pathogenic bloodstream stage. METHODOLOGY/PRINCIPAL FINDINGS: We therefore conducted the first side by side comparison of the cellular effects of multiple death inducers that target different systems in bloodstream form parasites, including six drugs (pentamidine, prostaglandin D(2, quercetin, etoposide, camptothecin, and a tetrahydroquinoline and six RNAi knockdowns that target distinct cellular functions. All compounds tested were static at low concentrations and killed at high concentrations. Dead parasites were rapidly quantified by forward and side scatter during flow cytometry, as confirmed by ethidium homodimer and esterase staining, making these assays convenient for quantitating parasite death. The various treatments yielded different combinations of defects in mitochondrial potential, reactive oxygen species, cell cycle, and genome segregation. No evidence was seen for phosphatidylserine exposure, a marker of apoptosis. Reduction in ATP levels lagged behind decreases in live cell number. Even when the impact on growth was similar at 24 hours, drug-treated cells showed dramatic differences in their ability to further proliferate, demonstrating differences in the reversibility of effects induced by the diverse compounds. CONCLUSIONS/SIGNIFICANCE: Parasites showed different phenotypes depending on the treatment, but none of them were clear predictors of whether apparently live cells could go on to proliferate after drugs were removed. We therefore suggest that clonal proliferation assays may be a useful step in selecting anti-trypanosomal compounds for further development. Elucidating the genetic or

  7. Using real time process measurements to reduce catheter related bloodstream infections in the intensive care unit

    OpenAIRE

    Wall, R; Ely, E; Elasy, T; Dittus, R; Foss, J.; Wilkerson, K; Speroff, T

    2005-01-01

    

Problem: Measuring a process of care in real time is essential for continuous quality improvement (CQI). Our inability to measure the process of central venous catheter (CVC) care in real time prevented CQI efforts aimed at reducing catheter related bloodstream infections (CR-BSIs) from these devices.

  8. Patients with Central Lines - What You Need to Know to Avoid a Bloodstream Infection PSA (:60)

    Centers for Disease Control (CDC) Podcasts

    2011-03-01

    This 60 second PSA is based on the March, 2011 CDC Vital Signs report which indicates bloodstream infections in patients with central lines are largely preventable when healthcare providers use CDC-recommended infection control steps.  Created: 3/1/2011 by Centers for Disease Control and Prevention (CDC).   Date Released: 3/1/2011.

  9. Routine Surveillance for Bloodstream Infections in a Pediatric Hematopoietic Stem Cell Transplant Cohort: Do Patients Benefit?

    Directory of Open Access Journals (Sweden)

    Heather Rigby

    2007-01-01

    Full Text Available BACKGROUND: Hematopoietic stem cell transplant (HSCT recipients are at a high risk for late bloodstream infection (BSI. Controversy exists regarding the benefit of surveillance blood cultures in this immunosuppressed population. Despite the common use of this practice, the practical value is not well established in non-neutropenic children following HSCT.

  10. Secular Trends in Nosocomial Bloodstream Infections : Antibiotic-Resistant Bacteria Increase the Total Burden of Infection

    NARCIS (Netherlands)

    Ammerlaan, H. S. M.; Harbarth, S.; Buiting, A. G. M.; Crook, D. W.; Fitzpatrick, F.; Hanberger, H.; Herwaldt, L. A.; van Keulen, P. H. J.; Kluytmans, J. A. J. W.; Kola, A.; Kuchenbecker, R. S.; Lingaas, E.; Meessen, N.; Morris-Downes, M. M.; Pottinger, J. M.; Rohner, P.; dos Santos, R. P.; Seifert, H.; Wisplinghoff, H.; Ziesing, S.; Walker, A. S.; Bonten, M. J. M.

    2013-01-01

    Background. It is unknown whether rising incidence rates of nosocomial bloodstream infections (BSIs) caused by antibiotic-resistant bacteria (ARB) replace antibiotic-susceptible bacteria (ASB), leaving the total BSI rate unaffected. Methods. We investigated temporal trends in annual incidence densit

  11. Severe Community-Acquired Bloodstream Infection with Acinetobacter ursingii in Person who Injects Drugs.

    Science.gov (United States)

    Salzer, Helmut J F; Rolling, Thierry; Schmiedel, Stefan; Klupp, Eva-Maria; Lange, Christoph; Seifert, Harald

    2016-01-01

    We report a community-acquired bloodstream infection with Acinteobacter ursingii in an HIV-negative woman who injected drugs. The infection was successfully treated with meropenem. Species identification was performed by using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Improved identification of Acinetobacter spp. by using this method will help identify clinical effects of this underdiagnosed pathogen.

  12. Bloodstream Infections in Very Low Birth Weight Infants with Intestinal Failure

    NARCIS (Netherlands)

    Cole, Conrad R.; Hansen, Nellie I.; Higgins, Rosemary D.; Bell, Edward F.; Shankaran, Seetha; Laptook, Abbot R.; Walsh, Michele C.; Hale, Ellen C.; Newman, Nancy S.; Das, Abhik; Stoll, Barbara J.

    2012-01-01

    Objective To examine pathogens and other characteristics associated with late-onset bloodstream infections (BSIs) in infants with intestinal failure (IF) as a consequence of necrotizing enterocolitis (NEC). Study design Infants weighing 401-1500 g at birth who survived for >72 hours and received car

  13. Early oral switch therapy in low-risk Staphylococcus aureus bloodstream infection (SABATO) : Study protocol for a randomized controlled trial

    NARCIS (Netherlands)

    Kaasch, Achim J.; Fätkenheuer, Gerd; Prinz-Langenohl, Reinhild; Paulus, Ursula; Hellmich, Martin; Weiß, Verena; Jung, Norma; Rieg, Siegbert; Kern, Winfried V.; Seifert, Harald; Lewalter, Karl; Lemmen, Sebastian; Stijnis, Cornelis; Van der Meer, Jan; Soriano, Alex; Ruiz, Laura Morata; Arastéh, Keikawus; Stocker, Hartmut; Kluytmans, Jan; Veenemans, Jacobien; Brodt, Hans Reinhard; Stephan, Christoph; Wolf, Timo; Kessel, Johanna; Joost, Insa; Sinha, Bhanu; van Assen, Sander; Wilting, Kasper; Tobias Welte, Welte; Christiane Mölgen, Mölgen; Julia Freise, Freise; Brunkhorst, Frank; Pletz, Mathias; Hagel, Stefan; Becker, Christian; Frieling, Thomas; Kösters, Katrin; Reuter, Stefan; Hsiao, Mikai; Rupp, Jan; Dalhoff, Klaus; Turner, David; Snape, Susan; Crusz, Shanika; Venkatesan, Pradhib; Salzberger, Bernd; Hanses, Frank; Rodriguez-Baño, Jesùs; Méndez, Adoración Valiente; López-Cortés, Luis Eduardo; Cisneros, José Miguel; Navarro-Amuedo, Maria Dolores; Bonten, Marc; Oosterheert, Jan Jelrik; Ekkelenkamp, Miquel

    2015-01-01

    Background: Current guidelines recommend that patients with Staphylococcus aureus bloodstream infection (SAB) are treated with long courses of intravenous antimicrobial therapy. This serves to avoid SAB-related complications such as relapses, local extension and distant metastatic foci. However, in

  14. [A retrospective study of the relationship between bacterial numbers from central venous catheter tip cultures and blood cultures for evaluating central line-associated bloodstream infections].

    Science.gov (United States)

    Ohtaki, Hirofumi; Ohkusu, Kiyofumi; Nakayama, Asami; Yonetamari, Jun; Ando, Kohei; Miyazaki, Takashi; Ohta, Hirotoshi; Furuta, Nobuyuki; Watanabe, Tamayo; Ito, Hiroyasu; Murakami, Nobuo; Seishima, Mitsuru

    2014-01-01

    Catheter-related bloodstream infection (CRBSI) is an infectious disease requiring special attention. It is a common cause of nosocomial infections; catheter insertion into the central veins particularly increases the risk of infection (CLA-BSI: central line-associated bloodstream infection). We examined the relationship between the number of bacterial colonies cultured from shredded central venous catheter (CVC) tips and from blood cultures in our hospital from 2011 to 2012. Coagulase-negative staphylococci topped the list of microbe isolated from the CVC tip culture, followed by Pseudomonas aeruginosa, Staphylococcus aureus, and Candida spp. S. aureus and Candida spp., with growth of over 15 colony-forming units in the CVC tip culture, were also detected at high rates in the blood culture. However, gramnegative bacilli (Enterobacteriaceae and P. aeruginosa) did not show a similar increase in colony number in the CVC tip culture. Because microbes adhering to shredded catheter tips are readily detected by culture, this method is useful as a routine diagnostic test. In addition, prompt clinical reporting of the bacterial number of serious CLA-BSI-causing S. aureus and Candida spp. isolated from CVC tips could contribute to earlier CLA-BSI diagnosis.

  15. The krebs cycle enzyme α-ketoglutarate decarboxylase is an essential glycosomal protein in bloodstream African trypanosomes.

    Science.gov (United States)

    Sykes, Steven; Szempruch, Anthony; Hajduk, Stephen

    2015-03-01

    α-Ketoglutarate decarboxylase (α-KDE1) is a Krebs cycle enzyme found in the mitochondrion of the procyclic form (PF) of Trypanosoma brucei. The bloodstream form (BF) of T. brucei lacks a functional Krebs cycle and relies exclusively on glycolysis for ATP production. Despite the lack of a functional Krebs cycle, α-KDE1 was expressed in BF T. brucei and RNA interference knockdown of α-KDE1 mRNA resulted in rapid growth arrest and killing. Cell death was preceded by progressive swelling of the flagellar pocket as a consequence of recruitment of both flagellar and plasma membranes into the pocket. BF T. brucei expressing an epitope-tagged copy of α-KDE1 showed localization to glycosomes and not the mitochondrion. We used a cell line transfected with a reporter construct containing the N-terminal sequence of α-KDE1 fused to green fluorescent protein to examine the requirements for glycosome targeting. We found that the N-terminal 18 amino acids of α-KDE1 contain overlapping mitochondrion- and peroxisome-targeting sequences and are sufficient to direct localization to the glycosome in BF T. brucei. These results suggest that α-KDE1 has a novel moonlighting function outside the mitochondrion in BF T. brucei.

  16. Current strategies for the prevention and management of central line-associated bloodstream infections

    Directory of Open Access Journals (Sweden)

    Zhuolin Han

    2010-11-01

    Full Text Available Zhuolin Han, Stephen Y Liang, Jonas MarschallDivision of Infectious Diseases, Washington University School of Medicine in St Louis, St Louis, MO, USAAbstract: Central venous catheters are an invaluable tool for diagnostic and therapeutic purposes in today’s medicine, but their use can be complicated by bloodstream infections (BSIs. While evidence-based preventive measures are disseminated by infection control associations, the optimal management of established central line-associated BSIs has been summarized in infectious diseases guidelines. We prepared an overview of the state-of-the-art of prevention and management of central line-associated BSIs and included topics such as the role of antibiotic-coated catheters, the role of catheter removal in the management, and a review of currently used antibiotic compounds and the duration of treatment.Keywords: central venous catheters, bloodstream infections, guidelines, prevention

  17. Cluster of Candida parapsilosis primary bloodstream infection in a neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Silva Carmem Lúcia P. da

    2001-01-01

    Full Text Available Candida parapsilosis is an increasingly important bloodstream pathogen in neonatal intensive care units (NICU. We investigated a cluster of bloodstream infections in a NICU to determine whether nosocomial transmission occurred. During a 3-day period, 3 premature infants hospitalized in the same unit presented with sepsis caused by C. parapsilosis. Electrophoretic karyotype of the organisms was performed by using pulsed field gel electrophoresis in a countour-clamped homogeneous electric field system. The isolate from 1 newborn could not be typed, and the isolates from the remaining 2 infants had identical patterns. All 3 cases are described. We conclude that nosocomial transmission of C. parapsilosis occurred and that neonates under intensive care may represent a risk group for this pathogen.

  18. Tsukamurella catheter-related bloodstream infection in a pediatric patient with pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Kristen A. Wendorf

    2010-03-01

    Full Text Available Catheter-related bloodstream infections (CR-BSI are important complications in patients with long-term indwelling central venous catheters. In this report, we present the case of a 14-year-old male with pulmonary hypertension treated with continuous treprostinil infusion, who presented with a CR-BSI caused by a Tsukamurella species. This case highlights the potential for this unusual organism to cause infection in immunocompetent patients.

  19. Enterococcal bloodstream infection. Design and validation of a mortality prediction rule

    OpenAIRE

    Perez-Garcia, Alejandra; Landecho, Manuel; Beunza Nuin, Juan Jose; Conde-Estévez, D; Horcajada, J.P.; Grau, S.; Gea Sánchez, Alfredo; E. Mauleón; Sorli, L.; Gómez, J.; Terradas, R.; Lucena, J.F. (Juan F.); Alegre Garrido, Félix; A. Huerta; Pozo, José Luis del

    2016-01-01

    To develop a prediction rule to describe the risk of death as a result of enterococcal bloodstream infection. A prediction rule was developed by analysing data collected from 122 patients diagnosed with enterococcal BSI admitted to the Clínica Universidad de Navarra (Pamplona, Spain); and validated by confirming its accuracy with the data of an external population (Hospital del Mar, Barcelona). According to this model, independent significant predictors for the risk of death were being diabet...

  20. Risk of vancomycin-resistant enterococci bloodstream infection among patients colonized with vancomycin-resistant enterococci

    Directory of Open Access Journals (Sweden)

    Ahu Kara

    2015-02-01

    Full Text Available Background:Vancomycin-resistant enterococci colonization has been reported to increase the risk of developing infections, including bloodstream infections.Aim:In this study, we aimed to share our experience with the vancomycin-resistant enterococci bloodstream infections following gastrointestinal vancomycin-resistant enterococci colonization in pediatric population during a period of 18 months.Method:A retrospective cohort of children admitted to a 400-bed tertiary teaching hospital in Izmir, Turkey whose vancomycin-resistant enterococci colonization was newly detected during routine surveillances for gastrointestinal vancomycin-resistant enterococci colonization during the period of January 2009 and December 2012 were included in this study. All vancomycin-resistant enterococci isolates found within 18 months after initial detection were evaluated for evidence of infection.Findings: Two hundred and sixteen patients with vancomycin-resistant enterococci were included in the study. Vancomycin-resistant enterococci colonization was detected in 136 patients (62.3% while they were hospitalized at intensive care units; while the remaining majority (33.0% were hospitalized at hematology-oncology department. Vancomycinresistant enterococci bacteremia was present only in three (1.55% patients. All these patients were immunosuppressed due to human immunodeficiency virus (one patient and intensive chemotherapy (two patients.Conclusion:In conclusion, our study found that 1.55% of vancomycin-resistant enterococcicolonized children had developed vancomycin-resistant enterococci bloodstream infection among the pediatric intensive care unit and hematology/oncology patients; according to our findings, we suggest that immunosupression is the key point for developing vancomycinresistant enterococci bloodstream infections.

  1. Efficacy of an infection control programme in reducing nosocomial bloodstream infections in a Senegalese neonatal unit.

    Science.gov (United States)

    Landre-Peigne, C; Ka, A S; Peigne, V; Bougere, J; Seye, M N; Imbert, P

    2011-10-01

    Neonatal nosocomial infections are public health threats in the developing world, and successful interventions are rarely reported. A before-and-after study was conducted in the neonatal unit of the Hôpital Principal de Dakar, Senegal to assess the efficacy of a multi-faceted hospital infection control programme implemented from March to May 2005. The interventions included clustering of nursing care, a simple algorithm for empirical therapy of suspected early-onset sepsis, minimal invasive care and promotion of early discharge of neonates. Data on nosocomial bloodstream infections, mortality, bacterial resistance and antibiotic use were collected before and after implementation of the infection control programme. One hundred and twenty-five infants were admitted immediately before the programme (Period 1, January-February 2005) and 148 infants were admitted immediately after the programme (Period 2, June-July 2005). The two groups of infants were comparable in terms of reason for admission and birth weight. After implementation of the infection control programme, the overall rate of nosocomial bloodstream infections decreased from 8.8% to 2.0% (P=0.01), and the rate of nosocomial bloodstream infections/patient-day decreased from 10.9 to 2.9/1000 patient-days (P=0.03). Overall mortality rates did not differ significantly. The proportion of neonates who received antimicrobial therapy for suspected early-onset sepsis decreased significantly from 100% to 51% of at-risk infants (Pnosocomial bloodstream infections, and the efficacy of these interventions was long-lasting. Such interventions could be extended to other low-income countries.

  2. Second-Generation central venous catheter in the prevention of bloodstream infection: a systematic review 1

    Science.gov (United States)

    Stocco, Janislei Gislei Dorociaki; Hoers, Hellen; Pott, Franciele Soares; Crozeta, Karla; Barbosa, Dulce Aparecida; Meier, Marineli Joaquim

    2016-01-01

    Abstract Objective: to evaluate the effectiveness and safety in the use of second-generation central venous catheters impregnated in clorhexidine and silver sulfadiazine when compared with other catheters, being them impregnated or not, in order to prevent the bloodstream infection prevention. Method: systematic review with meta-analysis. Databases searched: MEDLINE, EMBASE, CINAHL, LILACS/SciELO, Cochrane CENTRAL; search in Congress Proceedings and records from Clinical Trials. Results: 1.235 studies were identified, 97 were pre-selected and 4 were included. In catheter-related bloodstream infection, there was no statistical significance between second-generation impregnated catheter compared with the non-impregnated ones, absolute relative risk 1,5% confidence interval 95% (3%-1%), relative risk 0,68 (confidence interval 95%, 0,40-1,15) and number needed to treat 66. In the sensitivity analysis, there was less bloodstream infection in impregnated catheters (relative risk 0,50, confidence interval 95%, 0,26-0,96). Lower colonization, absolute relative risk 9,6% (confidence interval 95%, 10% to 4%), relative risk 0,51 (confidence interval 95% from 0,38-0,85) and number needed to treat 5. Conclusion: the use of second-generation catheters was effective in reducing the catheter colonization and infection when a sensitivity analysis is performed. Future clinical trials are suggested to evaluate sepsis rates, mortality and adverse effects. PMID:27508901

  3. Cost-Effectiveness of Surveillance for Bloodstream Infections for Sepsis Management in Low-Resource Settings.

    Science.gov (United States)

    Penno, Erin C; Baird, Sarah J; Crump, John A

    2015-10-01

    Bacterial sepsis is a leading cause of mortality among febrile patients in low- and middle-income countries, but blood culture services are not widely available. Consequently, empiric antimicrobial management of suspected bloodstream infection is based on generic guidelines that are rarely informed by local data on etiology and patterns of antimicrobial resistance. To evaluate the cost-effectiveness of surveillance for bloodstream infections to inform empiric management of suspected sepsis in low-resource areas, we compared costs and outcomes of generic antimicrobial management with management informed by local data on etiology and patterns of antimicrobial resistance. We applied a decision tree model to a hypothetical population of febrile patients presenting at the district hospital level in Africa. We found that the evidence-based regimen saved 534 more lives per 100,000 patients at an additional cost of $25.35 per patient, resulting in an incremental cost-effectiveness ratio of $4,739. This ratio compares favorably to standard cost-effectiveness thresholds, but should ultimately be compared with other policy-relevant alternatives to determine whether routine surveillance for bloodstream infections is a cost-effective strategy in the African context.

  4. National Bloodstream Infection Surveillance in Switzerland 2008-2014: Different Patterns and Trends for University and Community Hospitals.

    Science.gov (United States)

    Buetti, Niccolò; Marschall, Jonas; Atkinson, Andrew; Kronenberg, Andreas

    2016-09-01

    OBJECTIVE To characterize the epidemiology of bloodstream infections in Switzerland, comparing selected pathogens in community and university hospitals. DESIGN Observational, retrospective, multicenter laboratory surveillance study. METHODS Data on bloodstream infections from 2008 through 2014 were obtained from the Swiss infection surveillance system, which is part of the Swiss Centre for Antibiotic Resistance (ANRESIS). We compared pathogen prevalences across 26 acute care hospitals. A subanalysis for community-acquired and hospital-acquired bloodstream infections in community and university hospitals was performed. RESULTS A total of 42,802 bloodstream infection episodes were analyzed. The most common etiologies were Escherichia coli (28.3%), Staphylococcus aureus (12.4%), and polymicrobial bloodstream infections (11.4%). The proportion of E. coli increased from 27.5% in 2008 to 29.6% in 2014 (P = .04). E. coli and S. aureus were more commonly reported in community than university hospitals (34.3% vs 22.7%, P<.001 and 13.9% vs 11.1%, P<.001, respectively). Fifty percent of episodes were community-acquired, with E. coli again being more common in community hospitals (41.0% vs 32.4%, P<.001). The proportion of E. coli in community-acquired bloodstream infections increased in community hospitals only. Community-acquired polymicrobial infections (9.9% vs 5.6%, P<.001) and community-acquired coagulase-negative staphylococci (6.7% vs 3.4%, P<0.001) were more prevalent in university hospitals. CONCLUSIONS The role of E. coli as predominant pathogen in bloodstream infections has become more pronounced. There are distinct patterns in community and university hospitals, potentially influencing empirical antibiotic treatment. Infect Control Hosp Epidemiol 2016;37:1060-1067.

  5. Treatment and Outcomes in Carbapenem-resistant Klebsiella pneumoniae Bloodstream Infections

    Science.gov (United States)

    Neuner, Elizabeth A.; Yeh, Jun-Yen; Hall, Gerri S.; Sekeres, Jennifer; Endimiani, Andrea; Bonomo, Robert A.; Shrestha, Nabin K.; Fraser, Thomas G.; van Duin, David

    2010-01-01

    Carbapenem-resistant K. pneumoniae (CR-Kp) is an emerging multi-drug resistant nosocomial pathogen. This is a retrospective chart review describing the outcomes and treatment of 60 cases of CR-Kp bloodstream infections. All CR-Kp isolated from blood cultures were identified retrospectively from the microbiology laboratory from January 2007 to May 2009. Clinical information was collected from the electronic medical record. Patients with 14 day-hospital mortality were compared to those who survived 14 days. The all-cause in-hospital and 14-day mortality for all 60 CR-Kp bloodstream infections was 58.3% and 41.7%, respectively. In this collection, 98% of tested isolates were susceptible in vitro to tigecycline, compared to 86% to colistimethate, 45% to amikacin and 22% to gentamicin. Nine patients died prior to cultures being finalized, and received no therapy active against CR-Kp. In the remaining 51 patients, those who survived to day14 (n=35) were compared to non-survivor at day 14 (n=16). These patients were characterized by both chronic disease and acute illness. The 90-day readmission rate for hospital survivors was 72%. Time to active therapy was not significantly different between survivors and non-survivors, and hospital mortality was also similar regardless of therapy chosen. Pitt bacteremia score was the only significant factor associated with mortality in Cox regression analysis. In summary, CR-Kp bloodstream infections occur in patients who are chronically and acutely ill. They are associated with high 14-day mortality and poor outcomes regardless of tigecycline or other treatment regimens were selected. PMID:21396529

  6. Epidemic increase in Salmonella bloodstream infection in children, Bwamanda, the Democratic Republic of Congo.

    Science.gov (United States)

    Phoba, M-F; De Boeck, H; Ifeka, B B; Dawili, J; Lunguya, O; Vanhoof, R; Muyembe, J-J; Van Geet, C; Bertrand, S; Jacobs, J

    2014-01-01

    Salmonella enterica is the leading cause of bloodstream infection in children in sub-Saharan Africa, but few data are available from Central-Africa. We documented during the period November 2011 to May 2012 an epidemic increase in invasive Salmonella bloodstream infections in HGR Bwamanda, a referral hospital in Equateur Province, DR Congo. Salmonella spp. represented 90.4 % (103 out of 114) of clinically significant blood culture isolates and comprised Salmonella Typhimurium (54.4 %, 56 out of 103), Salmonella Enteritidis (28.2 %, 29 out of 103) and Salmonella Typhi (17.5 %, 18 out of 103), with Salmonella Enteritidis accounting for most of the increase. Most (82 out of 103, 79.6 %) isolates were obtained from children infected with Salmonella Typhimurium and Salmonella Enteritidis were 14 months (14 days to 64 years) and 19 months (3 months to 8 years) respectively. Clinical presentation was non-specific; the in-hospital case fatality rate was 11.1 %. More than two thirds (69.7 %, 53 out of 76) of children infection. Most (83/85, 97.6 %) non-typhoid Salmonella isolates as well as 6/18 (33.3 %) Salmonella Typhi isolates were multidrug resistant (i.e. resistant to the first-line oral antibiotics amoxicillin, trimethoprim-sulfamethoxazole and chloramphenicol), one (1.0 %) Salmonella Typhimurium had decreased ciprofloxacin susceptibility owing to a point mutation in the gyrA gene (Gly81Cys). Multilocus variable-number tandem-repeat (MLVA) analysis of the Salmonella Enteritidis isolates revealed closely related patterns comprising three major and four minor profiles, with differences limited to one out of five loci. These data show an epidemic increase in clonally related multidrug-resistant Salmonella bloodstream infection in children in DR Congo.

  7. Control method exploration of nosocomial bloodstream infection and its effect evaluation

    Institute of Scientific and Technical Information of China (English)

    CHAI Wen-zhao; WANG Xiao-ting; ZHOU Jiong; LI Xin; LUO Hong-bo; LIU Da-wei

    2012-01-01

    Background Currently,slightly more than 50% of bloodstream infections (BSIs) are hospital acquired.When these infections occur in patients in intensive care units,they are associated with a high mortality rate,additional hospital days and excess hospital costs.Because of multifactor of nosocomial BSIs,measurements of control nosocomial BSIs are wide variety and lead to some confusion in practice.The aim of this study was to explore special way in accordance with self-hospital base on common principle.Methods In one ward of the Intensive Care Unit,Peking Union Medical College Hospital,at first,we divided the all operation about bloodstream way into three sections used as keypoints.By surveying keypoints respectively,some operation faults of blood way were discovered.For decreasing the mobidity of nosocomial BSls,some intervention measurements were executed.The rate of nosocomial BSIs was analyzed by chi-square test.Results According to the statistics from January to June,we received and cured 618 patients in total; among them,there were 13 cases of nosocomial BSI and the average occurrence was 2.3 cases/month.After intervention measurements from July to December 2011,we received and cured 639 patients in total with seven cases of nosocomial BSI,and the average occurrence was 1.2 cases/month (P <0.05).From January to April 2012,no nosocomial BSI occurred in the investigated ward.Conclusion Removing the operation faults of bloodstream way might decrease the nosocomial BSI rapidly and efficiently by utilizing a key point survey.

  8. Bacillus cereus Bloodstream Infection in a Preterm Neonate Complicated by Late Meningitis

    Directory of Open Access Journals (Sweden)

    Toshinobu Horii

    2012-01-01

    Full Text Available Central nervous system infections caused by Bacillus cereus have rarely been reported in infants. In this paper, the case of a 2-month-old low-birth-weight female who developed meningitis 45 days after resolution of a bloodstream infection (BSI is described. The pulsed-field gel electrophoresis results revealed that the patterns of both B. cereus isolates responsible for the acute meningitis and for the prior bacteraemic episode were closely related. Although the source of the infection from within the patient was not clear, it is suggested that the B. cereus BSI developed in the neonate was complicated by acute meningitis.

  9. Taurolidine is effective in the treatment of central venous catheter-related bloodstream infections in cancer patients.

    Science.gov (United States)

    Koldehoff, M; Zakrzewski, J L

    2004-11-01

    Taurolidine is an antimicrobial agent that was originally used in the local treatment of peritonitis and was shown to be effective in the prevention of catheter-related bloodstream infections (CR-BSI). In this pilot study, we used taurolidine solution as an intravenous (i.v.) lock into the totally implantable intravascular devices of 11 consecutive oncological patients with catheter-related bloodstream infections not responding to systemic antimicrobial chemotherapy. All patients recovered completely from the infection. No adverse drug effects were seen. Three patients were successfully retreated for a recurrent infection. Our data suggest a beneficial role of taurolidine i.v. lock for the therapy of catheter-related bloodstream infections in oncological patients. Taurolidine i.v. lock application is feasible and could especially be useful in infections resistant to antibiotic chemotherapy.

  10. Muscle Releases Alpha-Sarcoglycan Positive Extracellular Vesicles Carrying miRNAs in the Bloodstream.

    Directory of Open Access Journals (Sweden)

    Michele Guescini

    Full Text Available In the past few years, skeletal muscle has emerged as an important secretory organ producing soluble factors, called myokines, that exert either autocrine, paracrine or endocrine effects. Moreover, recent studies have shown that muscle releases microRNAs into the bloodstream in response to physical exercise. These microRNAs affect target cells, such as hormones and cytokines. The mechanisms underlying microRNA secretion are poorly characterized at present. Here, we investigated whether muscle tissue releases extracellular vesicles (EVs, which carry microRNAs in the bloodstream under physiological conditions such as physical exercise. Using density gradient separation of plasma from sedentary and physically fit young men we found EVs positive for TSG101 and alpha-sarcoglycan (SGCA, and enriched for miR-206. Cytometric analysis showed that the SGCA+ EVs account for 1-5% of the total and that 60-65% of these EVs were also positive for the exosomal marker CD81. Furthermore, the SGCA-immuno captured sub-population of EVs exhibited higher levels of the miR-206/miR16 ratio compared to total plasma EVs. Finally, a significant positive correlation was found between the aerobic fitness and muscle-specific miRNAs and EV miR-133b and -181a-5p were significantly up-regulated after acute exercise. Thus, our study proposes EVs as a novel means of muscle communication potentially involved in muscle remodeling and homeostasis.

  11.   Bloodstream Bacterial Pathogens and their Antibiotic Resistance Pattern in Dhahira Region, Oman

    Directory of Open Access Journals (Sweden)

    PP Geethanjali

    2011-07-01

    Full Text Available Objectives: To describe the epidemiological, clinical, microbiological characteristics and antimicrobial resistance pattern of Bloodstream infections in Dhahira region, Oman.Methods: Clinical data was collected from all patients with positive blood cultures for two years period. Standard laboratory methods were used for blood culture. Antibiotic sensitivity was tested using Kirby-Bauer disc diffusion method.Results: Of the 360 bacterial pathogens isolated from 348 patients, 57.8�0were gram-positive and 42.2�0were gram-negative. The common isolates were: Streptococcus species 76 (21.1� coagulase-negative Staphylococci 75 (20.8� Escherichia coli 43 (11.9� Staphylococcus aureus 41 (11.4� Overall, mortality was 21.3�0(74/348. Staphylococcus species (Staphylococcus aureus and CoNS were more commonly resistant to Trimethoprim/ Sulphamethoxazole (35.3�20and Penicillin (25.9� Streptococcus species were resistant to Trimethoprim/Sulphamethoxazole (39.1�20and Erythromycin (19.6�Conclusion: Bloodstream infections are important causes of morbidity and mortality in our patients, especially among chronically ill elderly adult males. Prescription of proven resistant antibiotics to suspected bacteremic patients needs attention in Dhahira region.

  12. Risk factors for nosocomial bloodstream infection caused by multidrug resistant gram-negative bacilli in pediatrics

    Directory of Open Access Journals (Sweden)

    Mariana V. Arnoni

    2007-04-01

    Full Text Available The aim of this study was to identify the risk factors for nosocomial bloodstream infections by multidrug resistant Gram-negative bacilli. From November 2001 to December 2003, in the Pediatric Department of the Santa Casa de São Paulo, a retrospective case-control study was developed concerning patients who had nosocomial bloodstream infection caused by Gram-negative bacilli. Patients with multidrug resistant infections were designated as case patients, and control patients were those with an infection that did not meet the criteria for multidrug resistance. Previous use of central venous catheter and previous use of vancomycin plus third generation cephalosporins were associated to a higher chance of infections by multidrug resistant Gram-negative bacilli (Odds ratio - 5.8 and 5.2, respectively. Regarding sensitivity of the isolated agents, 47.8% were multidrug resistant, 54.2% were Klebsiella spp. ESBL producers and 36.4% were imipenem resistant Pseudomonas aeruginosa. The lethality rate was 36.9% in the studied cases and this rate was significantly higher in the group of patients with multidrug resistant infections (p=0.013. Risk factor identification as well as the knowledge of the susceptibility of the nosocomial infectious agents gave us the possibility to perform preventive and control strategies to reduce the costs and mortality related to these infections.

  13. Exchange of peripherally inserted central catheters is associated with an increased risk for bloodstream infection.

    Science.gov (United States)

    McCoy, Michael; Bedwell, Susan; Noori, Shahab

    2011-06-01

    It is not uncommon that the peripherally inserted central catheter (PICC) needs to be replaced either due to blockage or migration to a peripheral position. In such circumstances, there are two methods of PICC placement: new-site insertion and exchange by using the old PICC as a guide wire. Our objective was to investigate risk of infection associated with the exchange method. In this retrospective study, data on all PICC insertions in the neonatal intensive care unit in 2004 to 2008 were obtained. In the population who needed removal of existing PICC and insertion of a new one, we compared central line-associated bloodstream infection (CLABSI) within 1 week of insertion between the two insertion methods. Of 1148 PICC insertions reviewed, 164 (103 new-site and 61 exchange insertions) were performed after removal of a blocked/malpositioned PICC and therefore comprised the study population. The rate of CLABSI was higher in the exchange method (9.8% versus 1%, P exchange method (odds ratio 25.2, 95% confidence interval: 2.17 to 292.98; P = 0.01). In infants, insertion of PICCs using the exchange method carries an increased risk of bloodstream infection.

  14. Algorithm for pre-emptive glycopeptide treatment in patients with haematologic malignancies and an Enterococcus faecium bloodstream infection

    NARCIS (Netherlands)

    Zhou, Xuewei; Arends, Jan P; Span, Lambert Fr; Friedrich, Alexander W

    2013-01-01

    INTRODUCTION: Nowadays Enterococcus faecium has become one of the most emerging and challenging nosocomial pathogens. The aim of this study was to determine risk factors in haematology patients who are at risk of an Enterococcus faecium bloodstream infection (BSI) and should be considered for pre-em

  15. The Resistance Phenotype and Molecular Epidemiology of Klebsiella pneumoniae in Bloodstream Infections in Shanghai, China, 2012–2015

    Science.gov (United States)

    Xiao, Shu-zhen; Wang, Su; Wu, Wen-man; Zhao, Sheng-yuan; Gu, Fei-fei; Ni, Yu-xing; Guo, Xiao-kui; Qu, Jie-ming; Han, Li-zhong

    2017-01-01

    Klebsiella pneumoniae (K.pneumoniae) is a common nosocomial pathogen causing bloodstream infections. Antibiotic susceptibility surveillance and molecular characterization will facilitate prevention and management of K. pneumoniae bloodstream infections. K. pneumoniae isolates causing bloodstream infections were consecutively collected between January 2012 and December 2015 in Shanghai. Eighty isolates (20 per year) were randomly selected and enrolled in this study. Drug susceptibility were determined by the disk diffusion method. Polymerase chain reaction (PCR) was employed to detect extended-spectrum β-lactamases (ESBLs), carbapenemases, and seven housekeeping genes of K. pneumoniae. eBURST was used for multi-locus sequence typing (MLST). More than 50% isolates were resistant to cefuroxime, ampicillin-sulbactam, and piperacillin, while carbapenems had lower resistant rates than other antibiotics. Of the 80 isolates, 22 produced ESBLs, and 14 were carbapenemase producers. In the ESBL-producing K. pneumoniae isolates, the most common ESBL genes were blaSHV and blaCTX−M. Thirteen carbapenemase producers harbored blaKPC−2 and one other carried blaNDM−5. ST11 (14/80) was the most frequent sequence type (ST), followed by ST15 (7/80) and ST29 (4/80). Our data revealed high prevalence of antibiotic resistant K. pneumoniae isolates from bloodstream infections but their genetic diversity suggested no clonal dissemination in the region. Also, one K. pneumoniae isolate harbored blaNDM−5 in this study, which was firstly reported in Shanghai. PMID:28280486

  16. Patients with Central Lines — What You Need to Know to Avoid a Bloodstream Infection

    Centers for Disease Control (CDC) Podcasts

    2011-03-01

    This podcast is based on the March, 2011 CDC Vital Signs report which indicates bloodstream infections in patients with central lines are largely preventable when healthcare providers use CDC-recommended infection control steps.  Created: 3/1/2011 by Centers for Disease Control and Prevention (CDC).   Date Released: 3/1/2011.

  17. Bacterial etiology of bloodstream infections and antimicrobial resistance in Dhaka, Bangladesh, 2005–2014

    Directory of Open Access Journals (Sweden)

    Dilruba Ahmed

    2017-01-01

    Full Text Available Abstract Background Bloodstream infections due to bacterial pathogens are a major cause of morbidity and mortality in Bangladesh and other developing countries. In these countries, most patients are treated empirically based on their clinical symptoms. Therefore, up to date etiological data for major pathogens causing bloodstream infections may play a positive role in better healthcare management. The aim of this study was to identify the bacterial pathogens causing major bloodstream infections in Dhaka, Bangladesh and determine their antibiotic susceptibility pattern. Methods From January 2005 to December 2014, a total of 103,679 single bottle blood samples were collected from both hospitalized and domiciliary patients attending Dhaka hospital, icddrb, Bangladesh All the blood samples were processed for culture using a BACT/Alert blood culture machine. Further identification of bacterial pathogens and their antimicrobial susceptibility test were performed using standard microbiological procedures. Results Overall, 13.6% of the cultured blood samples were positive and Gram-negative (72.1% bacteria were predominant throughout the study period. Salmonella Typhi was the most frequently isolated organism (36.9% of samples in this study and a high percentage of those strains were multidrug-resistant (MDR. However, a decreasing trend in the S. Typhi isolation rate was observed and, noticeably, the percentage of MDR S. Typhi isolated declined sharply over the study period. An overall increase in the presence of Gram-positive bacteria was observed, but most significantly we observed the percentage of MDR Gram-positive bacteria to double over the study period. Overall, Gram positive bacteria were more resistant to most of the commonly used antibiotics than Gram-negative bacteria, but the MDR level was high in both groups. Conclusions This study identified the major bacterial pathogens involved with BSI in Dhaka, Bangladesh and also revealed their

  18. Taurolidine lock is superior to heparin lock in the prevention of catheter related bloodstream infections and occlusions.

    Directory of Open Access Journals (Sweden)

    Evelyn D Olthof

    Full Text Available BACKGROUND AND AIMS: Patients on home parenteral nutrition (HPN are at risk for catheter-related complications; mainly infections and occlusions. We have previously shown in HPN patients presenting with catheter sepsis that catheter locking with taurolidine dramatically reduced re-infections when compared with heparin. Our HPN population therefore switched from heparin to taurolidine in 2008. The aim of the present study was to compare long-term effects of this catheter lock strategy on the occurrence of catheter-related bloodstream infections and occlusions in HPN patients. METHODS: Data of catheter-related complications were retrospectively collected from 212 patients who received HPN between January 2000 and November 2011, comprising 545 and 200 catheters during catheter lock therapy with heparin and taurolidine, respectively. We evaluated catheter-related bloodstream infection and occlusion incidence rates using Poisson-normal regression analysis. Incidence rate ratios were calculated by dividing incidence rates of heparin by those of taurolidine, adjusting for underlying disease, use of anticoagulants or immune suppressives, frequency of HPN/fluid administration, composition of infusion fluids, and duration of HPN/fluid use before catheter creation. RESULTS: Bloodstream infection incidence rates were 1.1/year for heparin and 0.2/year for taurolidine locked catheters. Occlusion incidence rates were 0.2/year for heparin and 0.1/year for taurolidine locked catheters. Adjusted incidence ratios of heparin compared to taurolidine were 5.9 (95% confidence interval, 3.9-8.7 for bloodstream infections and 1.9 (95% confidence interval, 1.1-3.1 for occlusions. CONCLUSIONS: Given that no other procedural changes than the catheter lock strategy were implemented during the observation period, these data strongly suggest that taurolidine decreases catheter-related bloodstream infections and occlusions in HPN patients compared with heparin.

  19. APPROACH OF IMPROVING PRECISION IN ULTRASONIC DOPPLER BLOODSTREAM SPEED MEASUREMENT BY CHAOS-BASED FREQUENCY DETECTING

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    It is critical for cerebral vascular disease diagnosis through Doppler to detect the maximum and the minimum of the carotid blood flow speed accurately. A kind of Duffing system under an external periodic power with dump is introduced in the letter, numerical analysis is carried out by four-order Runge-Kutta method. An oscillator array is designed according to the frequency of the ultrasonic wave. When the external signals are inputted, computational algorithm is used to scan the array in turn and analyze the result, and the frequency can be determined. Based on the methods above, detecting the carotid blood flow speed accurately is realized. The Signal-to-Noise Ratio (SNR) of-20.23dB is obtained by the result of experiments. In conclusion, the SNR has been improved and the precision of the measured bloodstream speed has been increased,which can be 0.069% to 0.13%.

  20. Evidence-based measures to prevent central line-associated bloodstream infections: a systematic review

    Directory of Open Access Journals (Sweden)

    Daniele Cristina Perin

    Full Text Available ABSTRACT Objective: to identify evidence-based care to prevent CLABSI among adult patients hospitalized in ICUs. Method: systematic review conducted in the following databases: PubMed, Scopus, Cinahl, Web of Science, Lilacs, Bdenf and Cochrane Studies addressing care and maintenance of central venous catheters, published from January 2011 to July 2014 were searched. The 34 studies identified were organized in an instrument and assessed by using the classification provided by the Joanna Briggs Institute. Results: the studies presented care bundles including elements such as hand hygiene and maximal barrier precautions; multidimensional programs and strategies such as impregnated catheters and bandages and the involvement of facilities in and commitment of staff to preventing infections. Conclusions: care bundles coupled with education and the commitment of both staff and institutions is a strategy that can contribute to decreased rates of central line-associated bloodstream infections among adult patients hospitalized in intensive care units.

  1. Healthcare-associated Gram-negative bloodstream infections: antibiotic resistance and predictors of mortality.

    Science.gov (United States)

    Ergönül, Ö; Aydin, M; Azap, A; Başaran, S; Tekin, S; Kaya, Ş; Gülsün, S; Yörük, G; Kurşun, E; Yeşilkaya, A; Şimşek, F; Yılmaz, E; Bilgin, H; Hatipoğlu, Ç; Cabadak, H; Tezer, Y; Togan, T; Karaoğlan, I; İnan, A; Engin, A; Alışkan, H E; Yavuz, S Ş; Erdinç, Ş; Mulazimoglu, L; Azap, Ö; Can, F; Akalın, H; Timurkaynak, F

    2016-12-01

    This article describes the prevalence of antibiotic resistance and predictors of mortality for healthcare-associated (HA) Gram-negative bloodstream infections (GN-BSI). In total, 831 cases of HA GN-BSI from 17 intensive care units in different centres in Turkey were included; the all-cause mortality rate was 44%. Carbapenem resistance in Klebsiella pneumoniae was 38%, and the colistin resistance rate was 6%. Multi-variate analysis showed that age >70 years [odds ratio (OR) 2, 95% confidence interval (CI) 1.22-3.51], central venous catheter use (OR 2.1, 95% CI 1.09-4.07), ventilator-associated pneumonia (OR 1.9, 95% CI 1.1-3.16), carbapenem resistance (OR 1.8, 95% CI 1.11-2.95) and APACHE II score (OR 1.1, 95% CI 1.07-1.13) were significantly associated with mortality.

  2. Achromobacter Xylosoxidans Bloodstream Infection in Elderly Patient with Hepatocellular Carcinoma: Case Report and Review of Literature.

    Science.gov (United States)

    Raghuraman, Kausalya; Ahmed, Nishat H; Baruah, Frincy K; Grover, Rajesh K

    2015-01-01

    Achromobacter xylosoxidansis a nonfermentative Gram-negative organism, known to cause opportunistic infection in humans. We report a case of septicemia in a 76-year-old male patient with underlying hepatocellular carcinoma due to A. xylosoxidans, which showed a different antimicrobial susceptibility pattern from what is usually reported. From aerobic blood culture of the patient, A. xylosoxidans was isolated which was found to be sensitive to amoxicillin-clavulanic acid, piperacillin-tazobactam, ceftazidime, cefoperazone-sulbactam, meropenem, minocycline, tigecycline, and trimethoprim/sulfamethoxazole. The patient recovered with amoxicillin-clavulanic acid treatment, which was given empirically to the patient. The present case highlights the possible role of amoxicillin-clavulanic acid for treatment of bloodstream infection with A. xylosoxidans.

  3. Achromobacter Xylosoxidans bloodstream infection in elderly patient with Hepatocellular Carcinoma: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Kausalya Raghuraman

    2015-01-01

    Full Text Available Achromobacter xylosoxidansis a nonfermentative Gram-negative organism, known to cause opportunistic infection in humans. We report a case of septicemia in a 76-year-old male patient with underlying hepatocellular carcinoma due to A. xylosoxidans, which showed a different antimicrobial susceptibility pattern from what is usually reported. From aerobic blood culture of the patient, A. xylosoxidanswas isolated which was found to be sensitive to amoxicillin-clavulanic acid, piperacillin-tazobactam, ceftazidime, cefoperazone-sulbactam, meropenem, minocycline, tigecycline, and trimethoprim/sulfamethoxazole. The patient recovered with amoxicillin-clavulanic acid treatment, which was given empirically to the patient. The present case highlights the possible role of amoxicillin-clavulanic acid for treatment of bloodstream infection with A. xylosoxidans.

  4. Positive deviance as a strategy to prevent and control bloodstream infections in intensive care

    Directory of Open Access Journals (Sweden)

    Francimar Tinoco de Oliveira

    Full Text Available Abstract OBJECTIVE To describe the application of positive deviance as a strategy to prevent and control bloodstream infections. METHOD An intervention study with nursing and medical team members working in an intensive care unit in a university hospital, between June and December 2014. The four steps of the positive defiance methodology were applied: to define, to determine, to discover and to design. RESULTS In 90 days, 188 actions were observed, of these, 36.70% (n=69 were related to catheter dressing. In 81.15% (n=56 of these dressings, the professionals most adhered to the use of flexible sterile cotton-tipped swabs to perform antisepsis at catheter entry sites and fixation dressing. CONCLUSION Positive deviance contributed to the implementation of proposals to improve work processes and team development related to problems identified in central venous catheter care.

  5. JVG9, a benzimidazole derivative, alters the surface and cytoskeleton of Trypanosoma cruzi bloodstream trypomastigotes

    Science.gov (United States)

    Díaz-Chiguer, Dylan L; Hernández-Luis, Francisco; Nogueda-Torres, Benjamín; Castillo, Rafael; Reynoso-Ducoing, Olivia; Hernández-Campos, Alicia; Ambrosio, Javier R

    2014-01-01

    Trypanosoma cruzi has a particular cytoskeleton that consists of a subpellicular network of microtubules and actin microfilaments. Therefore, it is an excellent target for the development of new anti-parasitic drugs. Benzimidazole 2-carbamates, a class of well-known broad-spectrum anthelmintics, have been shown to inhibit the in vitro growth of many protozoa. Therefore, to find efficient anti-trypanosomal (trypanocidal) drugs, our group has designed and synthesised several benzimidazole derivatives. One, named JVG9 (5-chloro-1H-benzimidazole-2-thiol), has been found to be effective against T. cruzi bloodstream trypomastigotes under both in vitro and in vivo conditions. Here, we present the in vitro effects observed by laser scanning confocal and scanning electron microscopy on T. cruzi trypomastigotes. Changes in the surface and the distribution of the cytoskeletal proteins are consistent with the hypothesis that the trypanocidal activity of JVG9 involves the cytoskeleton as a target. PMID:25317703

  6. Port central venous catheters-associated bloodstream infection during outpatient-based chemotherapy.

    Science.gov (United States)

    Mauri, Davide; Roumbkou, Sofia; Michalopoulou, Stella; Tsali, Lamprini; Spiliopoulou, Anastasia; Panou, Charalampos; Valachis, Antonis; Panagopoulos, Angelos; Polyzos, Nikolaos P

    2010-12-01

    Central venous catheters (CVCs) are commonly used for the administration of intravenous chemotherapy in outpatient setting. Nevertheless, outbreaks of catheter-associated bloodstream infections had been reported from oncology centers. We describe a large outbreak of CVCs-associated Klebsiella oxytoca bloodstream infection, occurring in an oncology chemotherapy outpatient unit of northern Greece between October 2006 and May 2007. The outbreak involved approximately 10% of the patients with CVCs who were receiving home-based chemotherapy, and it represents the second larger outbreak of CVCs-associated BSIs due to Klebsiella oxytoca in oncology outpatient centers. We retrospectively analyzed the chain of investigations and prophylactic/diagnostic measures taken to eradicate the infection: (1) patients' chart audit, (2) estimation of the infection among asymptomatic patients, (3) implementation of the level of awareness of medical and paramedical personnel, (4) collection of samples from environment, medications and infusion materials, (5) critical appraisal of chemotherapeutical schemes and (6) cooperation with peripheral institutions. The isolation of Klebsiella oxytoca in a chemotherapy solution (infusional 5-FU in dextrose 5% solution within a 48 h pump) from a peripheral General Hospital and the prompt transmission of the data to the chemotherapy center played a key role for the management of the infection cluster. This is the first report that evidenced the detection of Klebsiella oxytoca within a chemotherapeutical preparation. Data transmission from peripheral hospitals to the central institution resulted in an important feedback that allowed a better estimation of the infection cluster and more tailored actions for the eradication of the infection.

  7. Bloodstream infection among children presenting to a general hospital outpatient clinic in urban Nepal.

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    Rahul Pradhan

    Full Text Available BACKGROUND: There are limited data on the etiology and characteristics of bloodstream infections in children presenting in hospital outpatient settings in South Asia. Previous studies in Nepal have highlighted the importance of murine typhus as a cause of febrile illness in adults and enteric fever as a leading bacterial cause of fever among children admitted to hospital. METHODS: We prospectively studied a total of 1084 febrile children aged between 2 months and 14 years presenting to a general hospital outpatient department in Kathmandu Valley, Nepal, over two study periods (summer and winter. Blood from all patients was tested by conventional culture and by real-time PCR for Rickettsia typhi. RESULTS: Putative etiological agents for fever were identified in 164 (15% patients. Salmonella enterica serovar Typhi (S. Typhi was identified in 107 (10%, S. enterica serovar Paratyphi A (S. Paratyphi in 30 (3%, Streptococcus pneumoniae in 6 (0.6%, S. enterica serovar Typhimurium in 2 (0.2%, Haemophilus influenzae type b in 1 (0.1%, and Escherichia coli in 1 (0.1% patient. S. Typhi was the most common organism isolated from blood during both summer and winter. Twenty-two (2% patients were PCR positive for R. typhi. No significant demographic, clinical and laboratory features distinguished culture positive enteric fever and murine typhus. CONCLUSIONS: Salmonella infections are the leading cause of bloodstream infection among pediatric outpatients with fever in Kathmandu Valley. Extension of immunization programs against invasive bacterial disease to include the agents of enteric fever and pneumococcus could improve the health of children in Nepal.

  8. Bloodstream infections in intensive care unit patients: distribution and antibiotic resistance of bacteria

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    Russotto V

    2015-08-01

    Full Text Available Vincenzo Russotto,1 Andrea Cortegiani,1 Giorgio Graziano,2 Laura Saporito,2 Santi Maurizio Raineri,1 Caterina Mammina,2 Antonino Giarratano1 1Department of Biopathology and Medical Biotechnologies (DIBIMED, Section of Anaesthesia, Analgesia, Intensive Care and Emergency, Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy; 2Department of Sciences for Health Promotion and Mother-Child Care, University of Palermo, Palermo, Italy Abstract: Bloodstream infections (BSIs are among the leading infections in critically ill patients. The case-fatality rate associated with BSIs in patients admitted to intensive care units (ICUs reaches 35%–50%. The emergence and diffusion of bacteria with resistance to antibiotics is a global health problem. Multidrug-resistant bacteria were detected in 50.7% of patients with BSIs in a recently published international observational study, with methicillin resistance detected in 48% of Staphylococcus aureus strains, carbapenem resistance detected in 69% of Acinetobacter spp., in 38% of Klebsiella pneumoniae, and in 37% of Pseudomonas spp. Prior hospitalization and antibiotic exposure have been identified as risk factors for infections caused by resistant bacteria in different studies. Patients with BSIs caused by resistant strains showed an increased risk of mortality, which may be explained by a higher incidence of inappropriate empirical therapy in different studies. The molecular genetic characterization of resistant bacteria allows the understanding of the most common mechanisms underlying their resistance and the adoption of surveillance measures. Knowledge of epidemiology, risk factors, mechanisms of resistance, and outcomes of BSIs caused by resistant bacteria may have a major influence on global management of ICU patients. The aim of this review is to provide the clinician an update on BSIs caused by resistant bacteria in ICU patients. Keywords: bloodstream infections, multidrug resistant

  9. 肾移植患者血流感染死亡的危险因素分析%Analysis of the risk factors for death in patients with bloodstream infections after renal transplantation

    Institute of Scientific and Technical Information of China (English)

    蒋欣; 曲青山; 李明; 邢利; 苗书斋

    2014-01-01

    OBJECTIVE To investigate the risk factors for death in patients with bloodstream infections after renal transplantation ,to provide the basis for prevention of bloodstream infections and clinical evaluation of patient prognosis .METHODS The clinical data of 217 patients with bloodstream infections after renal transplantation were retrospectively analyzed .The general information ,clinical data and related laboratory results of the patients were collected through the self-made survey form .The risk factors for death were analyzed by single factor analysis and multi factor analysis with the establishment of database .Data were analyzed by SPSS 17 .0 .RESULTS Totally 78 .80% of bloodstream infections after renal transplantation was nosocomial infections ,29 .95% were due to non-standard use of antibiotics .There were 72 cases of death in the 217 patients ,the mortality was 33 .18% .The main type of primary disease was chronic glomerulonephritis (66 .82% ) .The multivariate analysis showed that septic shock and platelet count <50 × 109/L were the independent risk factors for death in patients with blood-stream infections after renal transplantation .CONCLUSION Septic shock and platelet count <50 × 109/L are inde-pendent risk factors for death in patients with bloodstream infection after renal transplantation ,the clinical preven-tion measures should be adopted ,as soon as possible to avoid blood infection and reduce mortality in patients with renal transplantation .%目的:探讨肾移植患者血流感染死亡的危险因素,为临床评估患者预后和预防血流感染的发生提供依据。方法回顾性分析自2002年6月-2013年6月接受肾移植发生血流感染的217例患者临床资料,通过自制的调查表格收集患者的一般信息、临床资料和相关的实验室检查结果,建立数据库后通过单因素分析和多因素分析探讨肾移植患者并发血流感染死亡危险因素,数据采用SPSS 17.0进行分析。

  10. Teaching Form as Form

    DEFF Research Database (Denmark)

    Keiding, Tina Bering

    2012-01-01

    understanding of form per se, or, to use an expression from this text, of form as form. This challenge can be reduced to one question: how can design teaching support students in achieving not only the ability to recognize and describe different form-related concepts in existing design (i.e. analytical...... means that form serves both as the connective value and as the concept for reflection. In other words, form is observed as form, not anything else. The didactical challenge of teaching form as form is accentuated by students’ everyday-based pre-orientation towards function at the expense of form....... In general, students enter design education as far more skilled observers with regards to function than form. They are, in other words, predisposed to observe objects asking ‘what is?’, rather than ‘how is?’. This habit has not only cognitive implications. It is closely intertwined with a rudimentary...

  11. Equipe interdisciplinar reduz infecção sanguínea relacionada ao cateter venoso central em Unidade de Terapia Intensiva Pediátrica Interdisciplinary task-force reduces catheter-related bloodstream infection in a Pediatric Intensive Care Unit

    Directory of Open Access Journals (Sweden)

    Ricardo Vilela

    2010-12-01

    Full Text Available OBJETIVO: Avaliar o impacto de intervenções interdisciplinares nos indicadores de infecção de corrente sanguínea relacionada ao cateter venoso central e microrganismos isolados, em uma Unidade de Terapia Intensiva Pediátrica. MÉTODOS: Estudo de intervenção do tipo antes e depois. Foi criado um programa educativo e constituída uma equipe interdisciplinar de intervenção composta por médicos e enfermeiros da unidade e do Serviço de Controle de Infecção Hospitalar. As intervenções foram compostas por medidas diretas e indiretas educativas e processuais. O período pré-intervenção (Fase 1, de junho de 2003 a maio de 2004, foi comparado ao período pós-intervenção nas Fases 2 (junho de 2004 a maio de 2005 e 3 (junho de 2005 a maio de 2006. As taxas de infecção foram comparadas por ANOVA, sendo significante pOBJECTIVE: To determine the impact of interdisciplinary interventions on central venous catheter-related bloodstream infections rates in a Pediatric Intensive Care Unit (PICU and on the bloodstream infection organisms. METHODS: Interventional study type before-and-after. An educational program was performed and an interdisciplinary team of interventions was created. This team was formed by nurses and doctors of the PICU and of the Infection Control Committee. The interventions were composed by direct and indirect educational and procedural measures. Task-force interventions were developed from Jun/2003 to May/2004. This pre-intervention period (Phase 1 was compared with two post-intervention periods: Phases 2 (Jun/2004 to May/2005 and 3 (Jun/2005 to May/2006. Central venous catheter-related bloodstream infection rates during the three periods were compared by ANOVA, being significant p<0.05. RESULTS: 1,234 patients were studied from June 1st 2003 to May 31, 2006. The number of central venous catheter-related bloodstream infections was 22.72 per 1,000 catheter-days in Phase 1, and 6.81 and 5.87 in Phases 2 and 3

  12. Delay in the administration of appropriate antimicrobial therapy in Staphylococcus aureus bloodstream infection : A prospective multicenter hospital-based cohort study

    NARCIS (Netherlands)

    Kaasch, A. J.; Rieg, S.; Kuetscher, J.; Brodt, H. -R.; Widmann, T.; Herrmann, M.; Meyer, C.; Welte, T.; Kern, P.; Haars, U.; Reuter, S.; Huebner, I.; Strauss, R.; Sinha, B.; Brunkhorst, F. M.; Hellmich, M.; Faetkenheuer, G.; Kern, W. V.; Seifert, H.

    2013-01-01

    Early broad-spectrum antimicrobial treatment reduces mortality in patients with septic shock. In a multicenter, prospective observational study, we explored whether delayed appropriate antimicrobial therapy (AAT) influences outcome in Staphylococcus aureus bloodstream infection (SAB). Two hundred an

  13. Genome-wide expression profiling of in vivo-derived bloodstream parasite stages and dynamic analysis of mRNA alterations during synchronous differentiation in Trypanosoma brucei

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    Ghazal Peter

    2009-09-01

    Full Text Available Abstract Background Trypanosomes undergo extensive developmental changes during their complex life cycle. Crucial among these is the transition between slender and stumpy bloodstream forms and, thereafter, the differentiation from stumpy to tsetse-midgut procyclic forms. These developmental events are highly regulated, temporally reproducible and accompanied by expression changes mediated almost exclusively at the post-transcriptional level. Results In this study we have examined, by whole-genome microarray analysis, the mRNA abundance of genes in slender and stumpy forms of T.brucei AnTat1.1 cells, and also during their synchronous differentiation to procyclic forms. In total, five biological replicates representing the differentiation of matched parasite populations derived from five individual mouse infections were assayed, with RNAs being derived at key biological time points during the time course of their synchronous differentiation to procyclic forms. Importantly, the biological context of these mRNA profiles was established by assaying the coincident cellular events in each population (surface antigen exchange, morphological restructuring, cell cycle re-entry, thereby linking the observed gene expression changes to the well-established framework of trypanosome differentiation. Conclusion Using stringent statistical analysis and validation of the derived profiles against experimentally-predicted gene expression and phenotypic changes, we have established the profile of regulated gene expression during these important life-cycle transitions. The highly synchronous nature of differentiation between stumpy and procyclic forms also means that these studies of mRNA profiles are directly relevant to the changes in mRNA abundance within individual cells during this well-characterised developmental transition.

  14. Pathogens and antimicrobial susceptibility profiles in critically ill patients with bloodstream infections: a descriptive study

    Science.gov (United States)

    Savage, Rachel D.; Fowler, Robert A.; Rishu, Asgar H.; Bagshaw, Sean M.; Cook, Deborah; Dodek, Peter; Hall, Richard; Kumar, Anand; Lamontagne, François; Lauzier, François; Marshall, John; Martin, Claudio M.; McIntyre, Lauralyn; Muscedere, John; Reynolds, Steven; Stelfox, Henry T.; Daneman, Nick

    2016-01-01

    Background: Surveillance of antimicrobial resistance is vital to guiding empirical treatment of infections. Collating and reporting routine data on clinical isolate testing may offer more timely information about resistance patterns than traditional surveillance network methods. Methods: Using routine microbiology testing data collected from the Bacteremia Antibiotic Length Actually Needed for Clinical Effectiveness retrospective cohort study, we conducted a descriptive secondary analysis among critically ill patients in whom bloodstream infections had been diagnosed in 14 intensive care units (ICUs) in Canada. The participating sites were located within tertiary care teaching hospitals and represented 6 provinces and 10 cities. More than 80% of the study population was accrued from 2011-2013. We assessed the epidemiologic features of the infections and corresponding antimicrobial susceptibility profiles. Susceptibility testing was done according to Clinical Laboratory Standards Institute guidelines at accredited laboratories. Results: A total of 1416 pathogens were isolated from 1202 patients. The most common organisms were Escherichia coli (217 isolates [15.3%]), Staphylococcus aureus (175 [12.4%]), coagulase-negative staphylococci (117 [8.3%]), Klebsiella pneumoniae (86 [6.1%]) and Streptococcus pneumoniae (85 [6.0%]). The contribution of individual pathogens varied by site. For 13 ICUs, gram-negative susceptibility rates were high for carbapenems (95.4%), tobramycin (91.2%) and piperacillin-tazobactam (90.0%); however, the proportion of specimens susceptible to these agents ranged from 75.0%-100%, 66.7%-100% and 75.0%-100%, respectively, across sites. Fewer gram-negative bacteria were susceptible to fluoroquinolones (84.5% [range 64.1%-97.2%]). A total of 145 patients (12.1%) had infections caused by highly resistant microorganisms, with significant intersite variation (range 2.6%-24.0%, χ2 = 57.50, p < 0.001). Interpretation: We assessed the epidemiologic

  15. Clinical and microbiological characterization of carbapenem-resistant Acinetobacter baumannii bloodstream infections.

    Science.gov (United States)

    Song, Joon Young; Cheong, Hee Jin; Choi, Won Suk; Heo, Jung Yeon; Noh, Ji Yun; Kim, Woo Joo

    2011-05-01

    The incidence of carbapenem-resistant Acinetobacter baumannii infection is increasing, which might be associated with high morbidity and mortality among critically ill patients with limited therapeutic options. This study was conducted to evaluate the clinical and microbiological features of carbapenem-resistant A. baumannii bacteraemia. The medical records of 28 adult patients with this bacteraemia admitted to Korea University Guro Hospital, from January 2005 through December 2010, were reviewed. Using the 28 bloodstream isolates, we intended to detect genes encoding carbapenemases, and investigate the inoculum effect on each of the antimicrobial agents rifampicin, imipenem, colistin and tigecycline. With one blood isolate from a patient with pneumonia, rifampicin-inducible resistance was examined using the experimental mouse pneumonia model. Out of 28 carbapenem-resistant A. baumannii bloodstream infections (BIs), the most common primary focus was the central venous catheter (35.7 %) and then the lung (32.1 %). The 30 day overall mortality was 53.6 %; in most cases (80 %) the patients died within 10 days after the onset of the bacteraemia. By univariate analysis, inappropriate antimicrobial therapy (73.3 vs 30.8 %, P = 0.02), mechanical ventilation (53.3 vs 15.4 %, P = 0.04) and a high Pitt bacteraemia score (4.9±1.9 vs 2.2±1.2, P<0.01) were statistically significant risk factors for mortality, while only a high Pitt bacteraemia score (odds ratio 2.6; 95 % confidence interval 1.1-6.5) was independently associated with 30 day mortality by multivariate analysis. All 28 isolates had the bla(OXA-51)-like gene with upstream ISAbaI, 2 of which additionally had the bla(OXA-58)-like gene and the bla(OXA-23)-like gene. Inoculum effect and rifampicin inducible resistance were not detected. Considering the rapid progression to death in carbapenem-resistant A. baumannii BIs, early empirical antibiotic therapy would be warranted based on the local

  16. Bacillus Cereus catheter related bloodstream infection in a patient in a patient with acute lymphblastic leukemia

    Directory of Open Access Journals (Sweden)

    Lütfiye Öksüz

    2012-01-01

    Full Text Available Bacillus cereus infection is rarely associated with actual infection and for this reason single positive blood culture is usually regarded as contamination . However it may cause a number of infections, such catheter-related blood stream infections. Significant catheter-related bloodstream infections (CRBSI caused by Bacillus spp. are mainly due to B.cereus and have been predominantly reported in immunocompromised hosts1 . Catheter removal is generally advised for management of infection. In this report, catheter-related bacteremia caused by B.cereus in a patient with acute lymphoblastıc leukemia (ALL in Istanbul Medical Faculty was presented.A 44-year old man presented with fatigue, weight loss, epistaxis and high fever. A double-lumen Hickman–catheter (Bard 12.0 Fr, Round Dual Lumen was inserted by surgical cut-down to access the right subclavian vein which would be necessary for allogeneic stem cell transplantation. Three weeks later the patient presented with high fever and headache. Bacillus spp. was isolated from the cathether while blood culture obtained from the peripheral vein remained negative. The bacterial identification was confirmed as B.cereus using VITEK identification system It has been reported Bacillus cereus septicemia may be fatal in immunocompromised hosts despite broad-spectrum appropriate treatment10. Catheter removal is essential for prevention of recurrent bacteremia. Long-term cathater salvage should be reserved for appropriate patient group.

  17. Molecular differentiation and antifungal susceptibilities of Candida parapsilosis isolated from patients with bloodstream infections.

    Science.gov (United States)

    Tay, Sun Tee; Na, Shiang Ling; Chong, Jennifer

    2009-02-01

    The genetic heterogeneity and antifungal susceptibility patterns of Candida parapsilosis isolated from blood cultures of patients were investigated in this study. Randomly amplified polymorphic DNA (RAPD) analysis generated 5 unique profiles from 42 isolates. Based on the major DNA fragments of the RAPD profiles, the isolates were identified as RAPD type P1 (29 isolates), P2 (6 isolates), P3 (4 isolates), P4 (2 isolates) and P5 (1 isolate). Sequence analysis of the internal transcribed spacer (ITS) gene of the isolates identified RAPD type P1 as C. parapsilosis, P2 and P3 as Candida orthopsilosis, P4 as Candida metapsilosis, and P5 as Lodderomyces elongisporus. Nucleotide variations in ITS gene sequences of C. orthopsilosis and C. metapsilosis were detected. Antifungal susceptibility testing using Etests showed that all isolates tested in this study were susceptible to amphotericin B, fluconazole, ketoconazole, itraconazole and voriconazole. C. parapsilosis isolates exhibited higher MIC(50) values than those of C. orthopsilosis for all of the drugs tested in this study; however, no significant difference in the MICs for these two Candida species was observed. The fact that C. orthopsilosis and C. metapsilosis were responsible for 23.8 and 4.8 % of the cases attributed to C. parapsilosis bloodstream infections, respectively, indicates the clinical relevance of these newly described yeasts. Further investigations of the ecological niche, mode of transmission and virulence of these species are thus essential.

  18. Effectiveness of oral antibiotics for definitive therapy of Gram-negative bloodstream infections.

    Science.gov (United States)

    Kutob, Leila F; Justo, Julie Ann; Bookstaver, P Brandon; Kohn, Joseph; Albrecht, Helmut; Al-Hasan, Majdi N

    2016-11-01

    There is paucity of data evaluating intravenous-to-oral antibiotic switch options for Gram-negative bloodstream infections (BSIs). This retrospective cohort study examined the effectiveness of oral antibiotics for definitive treatment of Gram-negative BSI. Patients with Gram-negative BSI hospitalised for antibiotics were included in this study. The cohort was stratified into three groups based on bioavailability of oral antibiotics prescribed (high, ≥95%; moderate, 75-94%; and low, antibiotics were prescribed to 106, 179 and 77 patients, respectively, for definitive therapy of Gram-negative BSI. Mean patient age was 63 years, 217 (59.9%) were women and 254 (70.2%) had a urinary source of infection. Treatment failure rates were 2%, 12% and 14% in patients receiving oral antibiotics with high, moderate and low bioavailability, respectively (P = 0.02). Risk of treatment failure in the multivariate Cox model was higher in patients receiving antibiotics with moderate [adjusted hazard ratio (aHR) = 5.9, 95% CI 1.6-38.5; P = 0.005] and low bioavailability (aHR = 7.7, 95% CI 1.9-51.5; P = 0.003) compared with those receiving oral antimicrobial agents with high bioavailability. These data demonstrate the effectiveness of oral antibiotics with high bioavailability for definitive therapy of Gram-negative BSI. Risk of treatment failure increases as bioavailability of the oral regimen declines.

  19. Changes in plasma protein levels as an early indication of a bloodstream infection

    Science.gov (United States)

    Joenväärä, Sakari; Kaartinen, Johanna; Järvinen, Asko; Renkonen, Risto

    2017-01-01

    Blood culture is the primary diagnostic test performed in a suspicion of bloodstream infection to detect the presence of microorganisms and direct the treatment. However, blood culture is slow and time consuming method to detect blood stream infections or separate septic and/or bacteremic patients from others with less serious febrile disease. Plasma proteomics, despite its challenges, remains an important source for early biomarkers for systemic diseases and might show changes before direct evidence from bacteria can be obtained. We have performed a plasma proteomic analysis, simultaneously at the time of blood culture sampling from ten blood culture positive and ten blood culture negative patients, and quantified 172 proteins with two or more unique peptides. Principal components analysis, Orthogonal Projections to Latent Structures Discriminant Analysis (OPLS-DA) and ROC curve analysis were performed to select protein(s) features which can classify the two groups of samples. We propose a number of candidates which qualify as potential biomarkers to select the blood culture positive cases from negative ones. Pathway analysis by two methods revealed complement activation, phagocytosis pathway and alterations in lipid metabolism as enriched pathways which are relevant for the condition. Data are available via ProteomeXchange with identifier PXD005022. PMID:28235076

  20. Nosocomial bloodstream infections: organisms, risk factors and resistant phenotypes in the Brazilian University Hospital

    Directory of Open Access Journals (Sweden)

    Rosineide M. Ribas

    2007-06-01

    Full Text Available Bacteremia is one of the most frequent and challenging hospital-acquired infection and it is associated with high attributable morbidity and mortality and additional use of healthcare resources. The objective of this work was to determine the frequencies of its occurrence, organisms and resistance phenotypes associated to nosocomial acquired bloodstream infections. A total number of 51 nosocomial bacteremia by Gram-negative and 99 by Gram-positive were evaluated and compared during a 15-month period. The risk factors associated with these bacteremias were analyzed and antibiotic use and surgery were associated with bacteremia by Gram-negative and > 2 invasive devices with Gram-positive. The resistance phenotypes ESBL (extended-spectrum beta-lactamases (23.5% and AmpC/others (17.6% correspond to 41.2 % with predominance of E. agglomerans among AmpC (44.4% and K. pneumoniae among ESBLs (38.5%. Among S. aureus bacteremia, approximately 40% were associated to MRSA (methicillin-resistant Staphylococcus aureus.

  1. Risk Factors and Outcomes for Bloodstream Infections Secondary to Clostridium difficile Infection.

    Science.gov (United States)

    Falcone, Marco; Russo, Alessandro; Iraci, Federica; Carfagna, Paolo; Goldoni, Paola; Vullo, Vincenzo; Venditti, Mario

    2015-10-19

    We determined the incidence, risk factors, and outcomes of bloodstream infections (BSI) subsequent to Clostridium difficile infection (CDI). We performed a retrospective study of all patients with definite diagnosis of CDI admitted from January 2014 to December 2014 in two large hospitals in Rome. Two groups of patients were analyzed: those with CDI and subsequent BSI (CDI/BSI(+)) and those with CDI and no evidence of primary BSI (CDI/BSI(-)). Data about clinical features, microbiology, treatments, and mortality were obtained. Overall, 393 cases of CDI were included in the final analysis: 72 developed a primary nosocomial BSI, while 321 had CDI without microbiological and clinical evidence of BSI. Etiologic agents of BSI were Candida species (47.3%), Enterobacteriaceae (19.4%), enterococci (13.9%), and mixed infections (19.4%). In multivariate analysis, ribotype 027 status (odds ratio [OR], 6.5), CDI recurrence (OR, 5.5), severe CDI infection (OR, 8.3), and oral vancomycin at >500 mg/day (OR, 3.1) were recognized as factors independently associated with the development of nosocomial BSI. Thirty-day mortality from CDI diagnosis was higher for patients of the CDI/BSI(+) group than for the controls (38.9 versus 13.1%; P nosocomial BSI. Candida species and enteric bacteria appear to be the leading causative pathogens and are associated with poor outcomes.

  2. Haemodialysis catheter-related bloodstream infections: current treatment options and strategies for prevention.

    Science.gov (United States)

    Saxena, Anil K; Panhotra, Bodh R

    2005-03-05

    Regardless of the repeated reservations raised by countless researchers with reference to the use of catheters as vascular access for haemodialysis (HD), central venous catheters (CVCs) remain irreplaceable tools of the modern dialysis delivery system as a reliable option for the clinical situations requiring instant access to circulation, for various reasons. Patients on long-term haemodialysis are therefore at a significantly high risk for catheterrelated bloodstream infections (CRBSI) and ensuing serious complications. Although early systemic antibiotic treatment should include the coverage for Staphylococcus aureus, the pathogen with most devastating consequences including bacterial endocarditis; optimal treatment of CRBSI while preserving the catheter site, remains contentious. Nonetheless, catheter exchange over a guide wire and antimicrobial-anticoagulant "locks" have shown promising results as novel access salvage techniques. Despite the fact that a number of novel potentially useful strategies for the prevention of CRBSI are in the pipeline; equally essential however, remains the role of rigorous implementation of standard infection control measures for hygiene and aseptic handling of CVCs in long-term HD patients. The policy of increasing the AVF (arteriovenous fistula) prevalence beyond 50% while minimising the use of CVCs, dependent largely upon the timely referrals and prudently implemented pre-ESRD program - ought to have a positive impact on long-term HD outcomes.

  3. Seasonal trend and clinical presentation of Bacillus cereus bloodstream infection: association with summer and indwelling catheter.

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    Kato, K; Matsumura, Y; Yamamoto, M; Nagao, M; Ito, Y; Takakura, S; Ichiyama, S

    2014-08-01

    Bacillus cereus, an opportunistic pathogen, can cause fatal infection. However, B. cereus bloodstream infections (BSIs) have not been well characterised. From 2008 to 2013, B. cereus isolates from all of the specimens and patients with B. cereus BSIs were identified. Environmental samples were collected to detect B. cereus contamination. We also characterised the clinical presentation of B. cereus BSI through analyses of risk factors for BSI and mortality. A total of 217 clinical B. cereus isolates was detected. Fifty-one patients with nosocomial infections were diagnosed as B. cereus BSI, and 37 had contaminated blood cultures. The number of B. cereus isolates and BSI patients was significantly greater from June to September than from January to April (4.9 vs. 1.5 per month and 1.2 vs. 0.2, respectively). All BSIs were nosocomial and related to central or peripheral vascular catheter. Urinary catheter [odds ratio (OR) 6.93, 95% confidence interval (CI) 2.40-20.0] was the independent risk factor associated with BSI patients when compared to patients regarded as contaminated. In-hospital mortality among BSI patients was 20% and was associated with urinary catheter (OR 34.7, 95 % CI 1.89-63.6) and higher Charlson index (OR 1.99, 95 % CI 1.26-3.12). The number of B. cereus isolates and BSI increased during summer. Inpatients with indwelling vascular or urinary catheters should be carefully monitored for potential B. cereus BSIs.

  4. Bacterial bloodstream infections in liver transplantation: etiologic agents and antimicrobial susceptibility profiles.

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    Sganga, G; Spanu, T; Bianco, G; Fiori, B; Nure, E; Pepe, G; D'inzeo, T; Lirosi, M C; Frongillo, F; Agnes, S

    2012-09-01

    Liver transplantation (OLT) is a lifesaving procedure for the treatment of many end-stage liver diseases, but infection and acute rejection episodes still remain the main causes of morbidity and mortality. Bloodstream infections (BSIs), particularly, are the major cause of mortality among these patients. BSIs in OLT, are from intra-abdominal, biliary, respiratory, urinary, wound and/or central venous catheter sources. A certain percentage are of unknown origin. Using the computerized database of our microbiology laboratory, we analyzed all BSIs in 75 consecutive adult liver transplant patients in a single center between January 2008 and July 2011. BSIs occurred in 21/75 (28%) patients. Thirteen subjects had a single; two, two episodes, and the other six patients each >4 episodes. All episodes occurred in the first 60 days following OLT; the majority (74%), in the first month. Among 44 microorganisms recovered, 52.3% were gram-negative, the most frequent being Pseudomonas aeruginosa and Klebsiella pneumoniae; 47.7% were gram-positive, the most frequent being coagulase-negative staphylococci, particularly Staphylococcus epidermidis. Overall 65.9% of the isolates were resistant to several antibiotics: 40.9% displayed the multiding-resistant and 25% the panding-resistant phenotype. There was a high incidence of gram-negative and most importantly, resistant bacteria, which required appropriate therapy. These data showed that it is imperative to promote strategies to prevention and contain antimicrobial resistance.

  5. Risk factors and outcomes of imipenem-resistant Acinetobacter bloodstream infection in North-eastern Malaysia

    Institute of Scientific and Technical Information of China (English)

    Zakuan Zainy Deris; Mohd Nazri Shafei; Azian Harun

    2011-01-01

    Objective: To determine the risk factors and outcomes of imipenem-resistant Acinetobacterbaumannii (IRAB) bloodstream infection (BSI) cases, since there is very little publication on Acinetobacter baumannii infections from Malaysia. Methods: A cross sectional study of 41 cases (73.2%) of imipenem-sensitive Acinetobacter baumanii (ISAB) and 15 cases (26.8%) of IRAB was conducted in a teaching hospital which was located at North-Eastern state of Malaysia. Results:There was no independent risk factor for IRAB BSI identified but IRAB BSI was significantly associated with longer bacteraemic days [OR 1.23 (95% CI 1.01, 1.50)]. Although prior use of carbepenems and cephalosporin were higher among IRAB than ISAB group, statistically they were not significant. There was no significant difference in term of outcomes between the two groups. Conclusions: Although statistically not significant, this analysis compliments previous publication highlighting the importance of appropriate empiric antibiotic usage in hospital especially carbepenems and need further evaluation with bigger subjects.

  6. Species distribution and antifungal susceptibility profile of Candida spp. bloodstream isolates from Latin American hospitals

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    Godoy Patrício

    2003-01-01

    Full Text Available From March 1999 to March 2000, we conducted a prospective multicenter study of candidemia involving five tertiary care hospitals from four countries in Latin America. Yeast isolates were identified by classical methods and the antifungal susceptibility profile was determined according to the National Committee for Clinical Laboratory Standards microbroth assay method. During a 12 month-period we were able to collect a total of 103 bloodstream isolates of Candida spp. C. albicans was the most frequently isolated species accounting for 42% of all isolates. Non-albicans Candida species strains accounted for 58% of all episodes of candidemia and were mostly represented by C. tropicalis (24.2% and C. parapsilosis (21.3%. It is noteworthy that we were able to identify two cases of C. lusitaniae from different institutions. In our casuistic, non-albicans Candida species isolates related to candidemic episodes were susceptible to fluconazole. Continuously surveillance programs are needed in order to identify possible changes in the species distribution and antifungal susceptibility patterns of yeasts that may occurs after increasing the use of azoles in Latin American hospitals.

  7. Magnet® Hospital Recognition Linked to Lower Central Line-Associated Bloodstream Infection Rates.

    Science.gov (United States)

    Barnes, Hilary; Rearden, Jessica; McHugh, Matthew D

    2016-04-01

    Central-line-associated bloodstream infections (CLABSI) are among the deadliest heathcare-associated infections, with an estimated 12-25% mortality rate. In 2014, the Centers for Medicare and Medicaid Services (CMS) began to penalize hospitals for poor performance with respect to selected hospital-acquired conditions, including CLABSI. A structural factor associated with high-quality nursing care and better patient outcomes is The Magnet Recognition Program®. The purpose of this study was to explore the relationship between Magnet status and hospital CLABSI rates. We used propensity score matching to match Magnet and non-Magnet hospitals with similar hospital characteristics. In a matched sample of 291 Magnet hospitals and 291 non-Magnet hospitals, logistic regression models were used to examine whether there was a link between Magnet status and CLABSI rates. Both before and after matching, Magnet hospital status was associated with better (lower than the national average) CLABSI rates (OR = 1.60, 95%CI: 1.10, 2.33 after matching). While established programs such as Magnet recognition are consistently correlated with high-quality nursing work environments and positive patient outcomes, additional research is needed to determine whether Magnet designation produces positive patient outcomes or rewards existing excellence.

  8. Antifungal susceptibility survey of 2,000 bloodstream Candida isolates in the United States.

    Science.gov (United States)

    Ostrosky-Zeichner, Luis; Rex, John H; Pappas, Peter G; Hamill, Richard J; Larsen, Robert A; Horowitz, Harold W; Powderly, William G; Hyslop, Newton; Kauffman, Carol A; Cleary, John; Mangino, Julie E; Lee, Jeannette

    2003-10-01

    Candida bloodstream isolates (n = 2,000) from two multicenter clinical trials carried out by the National Institute of Allergy and Infectious Diseases Mycoses Study Group between 1995 and 1999 were tested against amphotericin B (AMB), flucytosine (5FC), fluconazole (FLU), itraconazole (ITR), voriconazole (VOR), posaconazole (POS), caspofungin (CFG), micafungin (MFG), and anidulafungin (AFG) using the NCCLS M27-A2 microdilution method. All drugs were tested in the NCCLS-specified RPMI 1640 medium except for AMB, which was tested in antibiotic medium 3. A sample of isolates was also tested in RPMI 1640 supplemented to 2% glucose and by using the diluent polyethylene glycol (PEG) in lieu of dimethyl sulfoxide for those drugs insoluble in water. Glucose supplementation tended to elevate the MIC, whereas using PEG tended to decrease the MIC. Trailing growth occurred frequently with azoles. Isolates were generally susceptible to AMB, 5FC, and FLU. Rates of resistance to ITR approached 20%. Although no established interpretative breakpoints are available for the candins (CFG, MFG, and AFG) and the new azoles (VOR and POS), they all exhibited excellent antifungal activity, even for those strains resistant to the other aforementioned agents.

  9. Closed Catheter Access System Implementation in Reducing Bloodstream Infection Rate in Low Birth Weight Preterm Infants

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    Lily eRundjan

    2015-03-01

    Full Text Available Background Bloodstream infection (BSI is one of the significant causes of morbidity and mortality encountered in a neonatal intensive care unit (NICU, especially in developing countries. Despite the implementation of infection control practices, such as strict hand hygiene, the BSI rate in our hospital is still high. The use of a closed catheter access system to reduce BSI related to intravascular catheter has hitherto never been evaluated in our hospital. Objective To determine the effects of closed catheter access system implementation in reducing the BSI rate in preterm neonates with low birth weight.Methods Randomized clinical trial was conducted on 60 low birth weight preterm infants hospitalized in the neonatal unit at Cipto Mangunkusumo Hospital, Jakarta, Indonesia from June to September, 2013. Randomized subjects either received a closed or non-closed catheter access system. Subjects were monitored for 2 weeks for the development of BSI based on clinical signs, abnormal infection parameters, and blood culture. Results Closed catheter access system implementation gave a protective effect towards the occurrence of culture-proven BSI (relative risk 0.095, 95% CI 0.011 to 0.85, p=0.026. Risk of culture-proven BSI in the control group was 10.545 (95% CI 1.227 to 90.662, p=0.026. BSI occurred in 75% of neonates without risk factors of infection in the control group compared to none in the study group.Conclusions The use of a closed catheter access system reduced the BSI in low birth weight preterm infants. Choosing the right device design, proper disinfection of device and appropriate frequency of connector change should be done simultaneously.

  10. Bacillus Cereus catheter related bloodstream infection in a patient in a patient with acute lymphblastic leukemia

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    Lütfiye Öksüz

    2012-01-01

    Full Text Available

    Bacillus cereus infection is rarely associated with actual infection and for this reason single positive blood culture is usually regarded as contamination . However it may cause a number of infections, such catheter-related blood stream infections. Significant catheter-related bloodstream infections (CRBSI caused by Bacillus spp. are mainly due to B.cereus and have been predominantly reported in immunocompromised hosts1 . Catheter removal is generally advised for management of infection. In this report, catheter-related bacteremia caused by B.cereus in a patient with acute lymphoblastıc leukemia (ALL in Istanbul Medical Faculty was presented.A 44-year old man presented with fatigue, weight loss, epistaxis and high fever. A double-lumen Hickman–catheter (Bard 12.0 Fr, Round Dual Lumen was inserted by surgical cut-down to access the right subclavian vein which would be necessary for allogeneic stem cell transplantation. Three weeks later the patient presented with high fever and headache. Bacillus spp. was isolated from the cathether while blood culture obtained from the peripheral vein remained negative. The bacterial identification was confirmed as B.cereus using VITEK identification system

    It has been reported Bacillus cereus septicemia may be fatal in immunocompromised hosts despite broad-spectrum appropriate treatment10. Catheter removal is essential for prevention of recurrent bacteremia. Long-term cathater salvage should be reserved for appropriate patient group.

  11. Molecular epidemiology and antimicrobial resistance of methicillin-resistant Staphylococcus aureus bloodstream isolates in Taiwan, 2010.

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    Chih-Jung Chen

    Full Text Available The information of molecular characteristics and antimicrobial susceptibility pattern of methicillin-resistant Staphylococcus aureus (MRSA is essential for control and treatment of diseases caused by this medically important pathogen. A total of 577 clinical MRSA bloodstream isolates from six major hospitals in Taiwan were determined for molecular types, carriage of Panton-Valentine leukocidin (PVL and sasX genes and susceptibilities to 9 non-beta-lactam antimicrobial agents. A total of 17 genotypes were identified in 577 strains by pulsotyping. Five major pulsotypes, which included type A (26.2%, belonging to sequence type (ST 239, carrying type III staphylococcal chromosomal cassette mec (SCCmec, type F (18.9%, ST5-SCCmecII, type C (18.5%, ST59-SCCmecIV, type B (12.0%, ST239-SCCmecIII and type D (10.9%, ST59-SCCmecVT/IV, prevailed in each of the six sampled hospitals. PVL and sasX genes were respectively carried by ST59-type D strains and ST239 strains with high frequencies (93.7% and 99.1%, respectively but rarely detected in strains of other genotypes. Isolates of different genotypes and from different hospitals exhibited distinct antibiograms. Multi-resistance to ≥3 non-beta-lactams was more common in ST239 isolates (100% than in ST5 isolates (97.2%, P = 0.0347 and ST59 isolates (8.2%, P<0.0001. Multivariate analysis further indicated that the genotype, but not the hospital, was an independent factor associated with muti-resistance of the MRSA strains. In conclusion, five common MRSA clones with distinct antibiograms prevailed in the major hospitals in Taiwan in 2010. The antimicrobial susceptibility pattern of invasive MRSA was mainly determined by the clonal distribution.

  12. Prevalence and Antimicrobial Resistance of Microbes Causing Bloodstream Infections in Unguja, Zanzibar.

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    Annette Onken

    Full Text Available Bloodstream infections (BSI are frequent and cause high case-fatality rates. Urgent antibiotic treatment can save patients' lives, but antibiotic resistance can render antibiotic therapy futile. This study is the first to collect epidemiological data on BSI from Unguja, Zanzibar.Clinical data and blood for culturing and susceptibility testing of isolated microbes were obtained from 469 consecutively enrolled neonates, children and adults presenting with signs of systemic infections at Mnazi Mmoja Hospital (MMH, Zanzibar.Pathogenic bacteria were recovered from the blood of 14% of the patients (66/469. The most frequently isolated microbes were Klebsiella pneumoniae, Escherichia coli, Acinetobacter spp. and Staphylococcus aureus. Infections were community-acquired in 56 patients (85% and hospital-acquired in 8 (12% (data missing for 2 patients. BSI caused by extended-spectrum beta-lactamase (ESBL producing Enterobacteriaceae (E. coli, K. pneumoniae was found in 5 cases, of which 3 were community-acquired and 2 hospital-acquired. Three of these patients died. Six of 7 Salmonella Typhi isolates were multidrug resistant. Streptococcus pneumoniae was found in one patient only.This is the first report of ESBL-producing bacteria causing BSI from the Zanzibar archipelago. Our finding of community-acquired BSI caused by ESBL-producing bacteria is alarming, as it implies that these difficult-to-treat bacteria have already spread in the society. In the local setting these infections are virtually impossible to cure. The findings call for increased awareness of rational antibiotic use, infection control and surveillance to counteract the problem of emerging antimicrobial resistance.

  13. Outbreak of Pantoea agglomerans Bloodstream Infections at an Oncology Clinic-Illinois, 2012-2013.

    Science.gov (United States)

    Yablon, Brian R; Dantes, Raymund; Tsai, Victoria; Lim, Rachel; Moulton-Meissner, Heather; Arduino, Matthew; Jensen, Bette; Patel, Megan Toth; Vernon, Michael O; Grant-Greene, Yoran; Christiansen, Demian; Conover, Craig; Kallen, Alexander; Guh, Alice Y

    2017-03-01

    OBJECTIVE To determine the source of a healthcare-associated outbreak of Pantoea agglomerans bloodstream infections. DESIGN Epidemiologic investigation of the outbreak. SETTING Oncology clinic (clinic A). METHODS Cases were defined as Pantoea isolation from blood or catheter tip cultures of clinic A patients during July 2012-May 2013. Clinic A medical charts and laboratory records were reviewed; infection prevention practices and the facility's water system were evaluated. Environmental samples were collected for culture. Clinical and environmental P. agglomerans isolates were compared using pulsed-field gel electrophoresis. RESULTS Twelve cases were identified; median (range) age was 65 (41-78) years. All patients had malignant tumors and had received infusions at clinic A. Deficiencies in parenteral medication preparation and handling were identified (eg, placing infusates near sinks with potential for splash-back contamination). Facility inspection revealed substantial dead-end water piping and inadequate chlorine residual in tap water from multiple sinks, including the pharmacy clean room sink. P. agglomerans was isolated from composite surface swabs of 7 sinks and an ice machine; the pharmacy clean room sink isolate was indistinguishable by pulsed-field gel electrophoresis from 7 of 9 available patient isolates. CONCLUSIONS Exposure of locally prepared infusates to a contaminated pharmacy sink caused the outbreak. Improvements in parenteral medication preparation, including moving chemotherapy preparation offsite, along with terminal sink cleaning and water system remediation ended the outbreak. Greater awareness of recommended medication preparation and handling practices as well as further efforts to better define the contribution of contaminated sinks and plumbing deficiencies to healthcare-associated infections are needed. Infect Control Hosp Epidemiol 2017;38:314-319.

  14. Incidence, Clinical Characteristics and Attributable Mortality of Persistent Bloodstream Infection in the Neonatal Intensive Care Unit

    Science.gov (United States)

    Hsu, Jen-Fu; Chu, Shih-Ming; Lee, Chiang-Wen; Yang, Pong-Hong; Lien, Reyin; Chiang, Ming-Chou; Fu, Ren-Huei; Huang, Hsuan-Rong; Tsai, Ming-Horng

    2015-01-01

    Background An atypical pattern of neonatal sepsis, characterized by persistent positive blood culture despite effective antimicrobial therapy, has been correlated with adverse outcomes. However, previous studies focused only on coagulate-negative staphylococcus infection. Methods All episodes of persistent bloodstream infection (BSI), defined as 3 or more consecutive positive blood cultures with the same bacterial species, at least two of them 48 hours apart, during a single sepsis episode, were enrolled over an 8-year period in a tertiary level neonatal intensive care unit. These cases were compared with all non-persistent BSI during the same period. Results We identified 81 episodes of persistent BSI (8.5% of all neonatal late-onset sepsis) in 74 infants, caused by gram-positive pathogens (n=38, 46.9%), gram-negative pathogens (n=21, 25.9%), fungus (n=20, 24.7%) and polymicrobial bacteremia (n=2, 2.5%). Persistent BSI does not differ from non-persistent BSI in most clinical characteristics and patient demographics, but tends to have a prolonged septic course, longer duration of feeding intolerance and more frequent requirement of blood transfusions. No difference was observed for death attributable to infection (9.8% vs. 6.5%), but neonates with persistent BSI had significantly higher rates of infectious complications (29.6% vs. 9.2%, P < 0.001), death from all causes (21.6% vs. 11.7%, P = 0.025), and duration of hospitalization among survivors [median (interquartile range): 80.0 (52.5-117.5) vs. 64.0 (40.0-96.0) days, P = 0.005] than those without persistent BSI. Conclusions Although persistent BSI does not contribute directly to increased mortality, the associated morbidities, infectious complications and prolonged septic courses highlight the importance of aggressive treatment to optimize outcomes. PMID:25875677

  15. Using real time process measurements to reduce catheter related bloodstream infections in the intensive care unit

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    Wall, R; Ely, E; Elasy, T; Dittus, R; Foss, J; Wilkerson, K; Speroff, T

    2005-01-01

    

Problem: Measuring a process of care in real time is essential for continuous quality improvement (CQI). Our inability to measure the process of central venous catheter (CVC) care in real time prevented CQI efforts aimed at reducing catheter related bloodstream infections (CR-BSIs) from these devices. Design: A system was developed for measuring the process of CVC care in real time. We used these new process measurements to continuously monitor the system, guide CQI activities, and deliver performance feedback to providers. Setting: Adult medical intensive care unit (MICU). Key measures for improvement: Measured process of CVC care in real time; CR-BSI rate and time between CR-BSI events; and performance feedback to staff. Strategies for change: An interdisciplinary team developed a standardized, user friendly nursing checklist for CVC insertion. Infection control practitioners scanned the completed checklists into a computerized database, thereby generating real time measurements for the process of CVC insertion. Armed with these new process measurements, the team optimized the impact of a multifaceted intervention aimed at reducing CR-BSIs. Effects of change: The new checklist immediately provided real time measurements for the process of CVC insertion. These process measures allowed the team to directly monitor adherence to evidence-based guidelines. Through continuous process measurement, the team successfully overcame barriers to change, reduced the CR-BSI rate, and improved patient safety. Two years after the introduction of the checklist the CR-BSI rate remained at a historic low. Lessons learnt: Measuring the process of CVC care in real time is feasible in the ICU. When trying to improve care, real time process measurements are an excellent tool for overcoming barriers to change and enhancing the sustainability of efforts. To continually improve patient safety, healthcare organizations should continually measure their key clinical processes in real

  16. Clinical and microbiological characteristics of bloodstream infections in hematological cancer patients

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    V. N. Chebotkevich

    2016-01-01

    Full Text Available Introduction. Bloodstream infections (BSI are life-threatening illness for immunocompromised patients with hematological malignancies.The aim of the study was to compare epidemiology, causative pathogens and outcome of hospital-acquired BSI and clarifying the role of herpes group of viruses in their development.Materials and methods. During the period 1991–2013 438 bacterial strains obtained from 360 patients (pts with hematological malignancies wеre studied. All blood cultures were incubated in the continuous monitoring system for 7 days before discard. The real-time PCR was used for human herpesviruses DNA detection: Herpes simplex viruses types 1 and 2 (HSV 1, 2, Cytomegalovirus (CMV, Epstein–Barr virus(EBV and Herpesvirus 6 (HHV-6. In this study 64 hematological cancer patients with infectious complications who fulfilled criteria of systemic inflammatory response syndrome with positive peripheral blood cultures were investigated. All pts received empirical anti-infectious therapy with subsequent correction based on the bacteriological, virological and mycological analyses.Results and discussion. A total Gram-positive (G+ accounted for 69.2 % of BSI, Gram-negative (G– for 30.8 %. Among G+ BSI Coagulase Negative Staphylococci and Staphylococcus aureus were the most frequent pathogens (58.8 %, among G– BSI Escherichia coli (13.0 % was predominant. It is shown that the development of bacteremia were significantly more frequently occurs in the case of cytomegalovirusand the Epstein–Barr virus detection.Conclusion. Further epidemiological surveillance is warranted in order emerging resistant strains and related mortality. Reactivation of CMV and EBV is significantly associated with higher incidence of bacterial BSI.

  17. Hospital-wide multidisciplinary, multimodal intervention programme to reduce central venous catheter-associated bloodstream infection.

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    Walter Zingg

    Full Text Available Central line-associated bloodstream infection (CLABSI is the major complication of central venous catheters (CVC. The aim of the study was to test the effectiveness of a hospital-wide strategy on CLABSI reduction. Between 2008 and 2011, all CVCs were observed individually and hospital-wide at a large university-affiliated, tertiary care hospital. CVC insertion training started from the 3rd quarter and a total of 146 physicians employed or newly entering the hospital were trained in simulator workshops. CVC care started from quarter 7 and a total of 1274 nurses were trained by their supervisors using a web-based, modular, e-learning programme. The study included 3952 patients with 6353 CVCs accumulating 61,366 catheter-days. Hospital-wide, 106 patients had 114 CLABSIs with a cumulative incidence of 1.79 infections per 100 catheters. We observed a significant quarterly reduction of the incidence density (incidence rate ratios [95% confidence interval]: 0.92 [0.88-0.96]; P<0.001 after adjusting for multiple confounders. The incidence densities (n/1000 catheter-days in the first and last study year were 2.3/1000 and 0.7/1000 hospital-wide, 1.7/1000 and 0.4/1000 in the intensive care units, and 2.7/1000 and 0.9/1000 in non-intensive care settings, respectively. Median time-to-infection was 15 days (Interquartile range, 8-22. Our findings suggest that clinically relevant reduction of hospital-wide CLABSI was reached with a comprehensive, multidisciplinary and multimodal quality improvement programme including aspects of behavioural change and key principles of good implementation practice. This is one of the first multimodal, multidisciplinary, hospital-wide training strategies successfully reducing CLABSI.

  18. Bloodstream infection following 217 consecutive systemic-enteric drained pancreas transplants

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    Mark Walter

    2006-08-01

    Full Text Available Abstract Background Combined kidney pancreas transplantation (PTx evolved as excellent treatment for diabetic nephropathy. Infections remain common and serious complications. Methods 217 consecutive enteric drained PTxs performed from 1997 to 2004 were retrospectively analyzed with regard to bloodstream infection. Immunosuppression consisted of antithymocyteglobuline induction, tacrolimus, mycophenolic acid and steroids for the majority of cases. Standard perioperative antimicrobial prophylaxis consisted of pipercillin/tazobactam in combination with ciprofloxacin and fluconazole. Results One year patient, pancreas and kidney graft survival were 96.4%, 88.5% and 94.8%, surgical complication rate was 35%, rejection rate 30% and rate of infection 59%. In total 46 sepsis episodes were diagnosed in 35 patients (16% with a median onset on day 12 (range 1–45 post transplant. Sepsis source was intraabdominal infection (IAI (n = 21, a contaminated central venous line (n = 10, wound infection (n = 5, urinary tract infection (n = 2 and graft transmitted (n = 2. Nine patients (4% experienced multiple episodes of sepsis. Overall 65 pathogens (IAI sepsis 39, line sepsis 15, others 11 were isolated from blood. Gram positive cocci accounted for 50 isolates (77%: Coagulase negative staphylococci (n = 28, i.e. 43% (nine multi-resistant, Staphylococcus aureus (n = 11, i.e. 17% (four multi-resistant, enterococci (n = 9, i.e. 14% (one E. faecium. Gram negative rods were cultured in twelve cases (18%. Patients with blood borne infection had a two year pancreas graft survival of 76.5% versus 89.4% for those without sepsis (p = 0.036, patient survival was not affected. Conclusion Sepsis remains a serious complication after PTx with significantly reduced pancreas graft, but not patient survival. The most common source is IAI.

  19. Patterns and trends of pediatric bloodstream infections: a 7-year surveillance study.

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    Buetti, N; Atkinson, A; Kottanattu, L; Bielicki, J; Marschall, J; Kronenberg, A

    2017-03-01

    We characterize the epidemiology of pediatric bloodstream infections (BSIs) in Switzerland. We analyzed pathogen distribution and resistance patterns in monomicrobial and polymicrobial BSIs in children from 2008 to 2014 using data from the Swiss antibiotic resistance centre (ANRESIS). A confirmatory statistical analysis was performed comparing pathogens and resistance across 20 acute care hospitals. We identified 3,067 bacteremia episodes, of which 1,823 (59 %) were considered true BSI episodes. Overall, S. aureus (16.5 %, 300) was the most frequent pathogen, followed by E. coli (15.1 %, 276), coagulase-negative staphylococci (CoNS, 12.9 %, 235), S. pneumoniae (11.1 %, 202) and non-E. coli Enterobacteriaceae (8.7 %, 159). S. aureus and E. coli showed similar frequencies in all of the variables analyzed (e.g., hospital acquisition, hospital type, medical specialty). The proportion of these microorganisms did not change over time, resistance rates remained low (4.3 % methicillin resistance in S. aureus; 7.3 % third-/fourth-generation cephalosporin resistance in E. coli), and no significant resistance trends were observed. We observed a 50 % increase of CoNS BSIs from 2008 (9.8 %, 27) to 2014 (15.2 %, 46, p value for trend = 0.03). S. pneumoniae decreased from 17.5 % (48) to 6.6 % (20) during that timeframe (p for trend = 0.007). S. aureus and E. coli remained the most significant pathogens among pediatric BSIs in Switzerland, exhibiting low resistance rates. CoNS accounted for a greater proportion of BSIs over time. The decrease in bacteremic pneumococcal infections can likely be attributed to the introduction of the 13-valent conjugate vaccine in 2011.

  20. The Changing Epidemiology of Bloodstream Infections and Resistance in Hematopoietic Stem Cell Transplantation Recipients

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    Mücahit Yemişen

    2016-08-01

    Full Text Available Objective: Patients receiving hematopoietic stem cell transplantation (HSCT are exposed to highly immunosuppressive conditions and bloodstream infections (BSIs are one of the most common major complications within this period. Our aim, in this study, was to evaluate the epidemiology of BSIs in these patients retrospectively. Materials and Methods: The epidemiological properties of 312 patients with HSCT were retrospectively evaluated. Results: A total of 312 patients, followed between 2000 and 2011, who underwent autologous (62% and allogeneic (38% HSCT were included in the study. The most common underlying malignancies were multiple myeloma (28% and Hodgkin lymphoma (21.5%. A total of 142 (45% patients developed at least 1 episode of BSI and 193 separate pathogens were isolated from the blood cultures. There was a trend of increase in the numbers of BSIs in 2005-2008 and a relative increase in the proportion of gram-positive infections in recent years (2009-2011, and central venous catheter-related BSI was found to be most common source. Coagulase-negative staphylococci (49.2% and Acinetobacter baumannii (8.8% were the most common pathogens. Extended-spectrum beta-lactamase-producing strains were 23% and 22% among Escherichia coli and Klebsiella spp. isolates, respectively. Quinolone resistance was detected in 10% of Enterobacteriaceae. Resistance to carbapenems was not detected in Enterobacteriaceae, while it was seen at 11.1% and 23.5% in Pseudomonas and Acinetobacter strains, respectively. Conclusion: A shift was detected from gram-negative bacteria to gram-positive in the etiology over the years and central lines were the most common sources of BSIs.

  1. Risk factors and outcomes for patients with bloodstream infection due to Acinetobacter baumannii-calcoaceticus complex.

    Science.gov (United States)

    Chopra, Teena; Marchaim, Dror; Johnson, Paul C; Awali, Reda A; Doshi, Hardik; Chalana, Indu; Davis, Naomi; Zhao, Jing J; Pogue, Jason M; Parmar, Sapna; Kaye, Keith S

    2014-08-01

    Identifying patients at risk for bloodstream infection (BSI) due to Acinetobacter baumannii-Acinetobacter calcoaceticus complex (ABC) and providing early appropriate therapy are critical for improving patient outcomes. A retrospective matched case-control study was conducted to investigate the risk factors for BSI due to ABC in patients admitted to the Detroit Medical Center (DMC) between January 2006 and April 2009. The cases were patients with BSI due to ABC; the controls were patients not infected with ABC. Potential risk factors were collected 30 days prior to the ABC-positive culture date for the cases and 30 days prior to admission for the controls. A total of 245 case patients were matched with 245 control patients. Independent risk factors associated with BSI due to ABC included a Charlson's comorbidity score of ≥ 3 (odds ratio [OR], 2.34; P = 0.001), a direct admission from another health care facility (OR, 4.63; P < 0.0001), a prior hospitalization (OR, 3.11; P < 0.0001), the presence of an indwelling central venous line (OR, 2.75; P = 0.011), the receipt of total parenteral nutrition (OR, 21.2; P < 0.0001), the prior receipt of β-lactams (OR, 3.58; P < 0.0001), the prior receipt of carbapenems (OR, 3.18; P = 0.006), and the prior receipt of chemotherapy (OR, 15.42; P < 0.0001). The median time from the ABC-positive culture date to the initiation of the appropriate antimicrobial therapy was 2 days (interquartile range [IQR], 1 to 3 days). The in-hospital mortality rate was significantly higher among case patients than among control patients (OR, 3.40; P < 0.0001). BSIs due to ABC are more common among critically ill and debilitated institutionalized patients, who are heavily exposed to health care settings and invasive devices.

  2. Trypanosome Motion Represents an Adaptation to the Crowded Environment of the Vertebrate Bloodstream

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    Heddergott, Niko; Krüger, Timothy; Babu, Sujin B.; Wei, Ai; Stellamanns, Erik; Uppaluri, Sravanti; Pfohl, Thomas; Stark, Holger; Engstler, Markus

    2012-01-01

    Blood is a remarkable habitat: it is highly viscous, contains a dense packaging of cells and perpetually flows at velocities varying over three orders of magnitude. Only few pathogens endure the harsh physical conditions within the vertebrate bloodstream and prosper despite being constantly attacked by host antibodies. African trypanosomes are strictly extracellular blood parasites, which evade the immune response through a system of antigenic variation and incessant motility. How the flagellates actually swim in blood remains to be elucidated. Here, we show that the mode and dynamics of trypanosome locomotion are a trait of life within a crowded environment. Using high-speed fluorescence microscopy and ordered micro-pillar arrays we show that the parasites mode of motility is adapted to the density of cells in blood. Trypanosomes are pulled forward by the planar beat of the single flagellum. Hydrodynamic flow across the asymmetrically shaped cell body translates into its rotational movement. Importantly, the presence of particles with the shape, size and spacing of blood cells is required and sufficient for trypanosomes to reach maximum forward velocity. If the density of obstacles, however, is further increased to resemble collagen networks or tissue spaces, the parasites reverse their flagellar beat and consequently swim backwards, in this way avoiding getting trapped. In the absence of obstacles, this flagellar beat reversal occurs randomly resulting in irregular waveforms and apparent cell tumbling. Thus, the swimming behavior of trypanosomes is a surprising example of micro-adaptation to life at low Reynolds numbers. For a precise physical interpretation, we compare our high-resolution microscopic data to results from a simulation technique that combines the method of multi-particle collision dynamics with a triangulated surface model. The simulation produces a rotating cell body and a helical swimming path, providing a functioning simulation method for a

  3. A multicentre analysis of epidemiology of the nosocomial bloodstream infections in Japanese university hospitals.

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    Nagao, M

    2013-09-01

    Nosocomial bloodstream infections (BSIs) are an important cause of morbidity and mortality. The current study analysed data from a concurrent surveillance programme to examine the current epidemiological trends for nosocomial BSIs at 22 Japanese university hospitals from 1 April 2008 to 31 March 2012. The number of blood culture sets taken, the rate of multiple blood culture sets and the rates of antibiotic-resistant isolates among six major nosocomial BSI pathogens (Staphylococcus aureus, Enterococcus spp., Escherichia coli, Klebsiella spp., Pseudomonas aeruginosa, and Candida spp.) not including coagulase-negative staphylococci, were evaluated. The clinical characteristics of nosocomial BSIs caused by these pathogens were also collected for 2941 patients. The number of blood culture sets taken per bed increased during the 4-year study period (from 4.07 in 2008 to 5.37 in 2011), and the rates of multiple blood culture sets also increased (from 29.9% in 2008 to 50.0% in 2011). Methicillin resistance was detected in 50.2% of S. aureus isolates. The prevalence rates of extended-spectrum beta-lactamase-producing E. coli and Klebsiella spp. isolates increased annually during the study period, and the average prevalence rates were 12.3% and 5.8%, respectively. The overall crude mortality of nosocomial BSIs due to the six pathogens evaluated was 24.5% (43.2% in ICU settings and 20.5% in non-ICU settings). Thus, our multicentre study evaluated the current epidemiological trends for nosocomial BSIs, and we found that further efforts are needed to increase the use of multiple blood culture sets and improve the prognosis of nosocomial BSIs in Japanese university hospitals.

  4. Staphylococcus species and their Methicillin-Resistance in 7424 Blood Cultures for Suspected Bloodstream Infections

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    Ariana ALMAŞ

    2011-06-01

    Full Text Available Objectives: The aim of this study was to evaluate the distribution of Staphylococcus species in bloodstream infections and to assess their susceptibility to methicillin. Material and Methods: Between January 1st 2008 - December 31st 2010, 7424 blood culture sets were submitted to the Laboratory Department of the Hospital for Clinical Infectious Diseases in Cluj-Napoca, Romania. The blood cultures were performed using BacT/Alert until January 2010 and BacT/Alert 3D automated system (bioMérieux after that date. The blood culture bottles were incubated at 37°C in a continuously monitoring system for up to 7 days. The strain identifications were performed by conventional methods, ApiStaph galleries and Vitek 2 Compact system. Susceptibility to methicillin was determined by disk diffusion method with cefoxitin disk and by using Vitek 2 Compact system. Results: From the total number of performed blood cultures, 568 were positive with Staphylococcus species. From 168 bacteriemic episodes 103 were with Staphylococcus aureus. Among 65 coagulase-negative staphylococci isolates, Staphylococcus epidermidis was the most frequently isolated species (34, followed by Staphylococcus hominis (15, Staphylococcus haemolyticus (8, Staphylococcus saprophyticus (3, Staphylococcus cohnii (1, Staphylococcus auricularis (1, and 3 strains that were not identified at species level. Methicillin resistance was encountered in 53.40% of Staphylococcus aureus strains and in 80% of coagulase-negative staphylococci. Conclusions: An important percentage of blood cultures were contaminated with Staphylococcus species. The main species identified in true bacteriemia cases were Staphylococcus aureus and Staphylococcus epidermidis. The percentage of methicillin-resistance, proved to be high not only for coagulase-negative staphylococci but also for Staphylococcus aureus.

  5. Classification of positive blood cultures: computer algorithms versus physicians' assessment - development of tools for surveillance of bloodstream infection prognosis using population-based laboratory databases

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    Gradel Kim O

    2012-09-01

    Full Text Available Abstract Background Information from blood cultures is utilized for infection control, public health surveillance, and clinical outcome research. This information can be enriched by physicians’ assessments of positive blood cultures, which are, however, often available from selected patient groups or pathogens only. The aim of this work was to determine whether patients with positive blood cultures can be classified effectively for outcome research in epidemiological studies by the use of administrative data and computer algorithms, taking physicians’ assessments as reference. Methods Physicians’ assessments of positive blood cultures were routinely recorded at two Danish hospitals from 2006 through 2008. The physicians’ assessments classified positive blood cultures as: a contamination or bloodstream infection; b bloodstream infection as mono- or polymicrobial; c bloodstream infection as community- or hospital-onset; d community-onset bloodstream infection as healthcare-associated or not. We applied the computer algorithms to data from laboratory databases and the Danish National Patient Registry to classify the same groups and compared these with the physicians’ assessments as reference episodes. For each classification, we tabulated episodes derived by the physicians’ assessment and the computer algorithm and compared 30-day mortality between concordant and discrepant groups with adjustment for age, gender, and comorbidity. Results Physicians derived 9,482 reference episodes from 21,705 positive blood cultures. The agreement between computer algorithms and physicians’ assessments was high for contamination vs. bloodstream infection (8,966/9,482 reference episodes [96.6%], Kappa = 0.83 and mono- vs. polymicrobial bloodstream infection (6,932/7,288 reference episodes [95.2%], Kappa = 0.76, but lower for community- vs. hospital-onset bloodstream infection (6,056/7,288 reference episodes [83.1%], Kappa = 0.57 and

  6. Collaborative form(s)

    DEFF Research Database (Denmark)

    Gunn, Wendy

    Gunn asks us to consider beauty as collaborative forms of action generated by moving between design by means of anthropology and anthropology by means of design. Specifically, she gives focus to play-like reflexions on practices of designing energy products, systems and infrastructure. Design...

  7. In vivo observation of the hypo-echoic "black hole" phenomenon in rat arterial bloodstream: a preliminary Study.

    Science.gov (United States)

    Nam, Kweon-Ho; Paeng, Dong-Guk

    2014-07-01

    The "black hole," a hypo-echoic hole at the center of the bloodstream surrounded by a hyper-echoic zone in cross-sectional views, has been observed in ultrasound backscattering measurements of blood with red blood cell aggregation in in vitro studies. We investigated whether the phenomenon occurs in the in vivo arterial bloodstream of rats using a high-frequency ultrasound imaging system. Longitudinal and cross-sectional ultrasound images of the rat common carotid artery (CCA) and abdominal aorta were obtained using a 40-MHz ultrasound system. A high-frame-rate retrospective imaging mode was employed to precisely examine the dynamic changes in blood echogenicity in the arteries. When the imaging was performed with non-invasive scanning, blood echogenicity was very low in the CCA as compared with the surrounding tissues, exhibiting no hypo-echoic zone at the center of the vessel. Invasive imaging of the CCA by incising the skin and subcutaneous tissues at the imaging area provided clearer and brighter blood echo images, showing the "black hole" phenomenon near the center of the vessel in longitudinal view. The "black hole" was also observed in the abdominal aorta under direct imaging after laparotomy. The aortic "black hole" was clearly observed in both longitudinal and cross-sectional views. Although the "black hole" was always observed near the center of the arteries during the diastolic phase, it dissipated or was off-center along with the asymmetric arterial wall dilation at systole. In conclusion, we report the first in vivo observation of the hypo-echoic "black hole" caused by the radial variation of red blood cell aggregation in arterial bloodstream.

  8. The changing epidemiology of Acinetobacter spp. producing OXA carbapenemases causing bloodstream infections in Brazil: a BrasNet report.

    Science.gov (United States)

    Vasconcelos, Ana Tereza R; Barth, Afonso L; Zavascki, Alexandre P; Gales, Ana C; Levin, Anna S; Lucarevschi, Bianca R; Cabral, Blenda G; Brasiliense, Danielle M; Rossi, Flavia; Furtado, Guilherme H C; Carneiro, Irna Carla R S; da Silva, Juliana O; Ribeiro, Julival; Lima, Karla V B; Correa, Luci; Britto, Maria H; Silva, Mariama T; da Conceição, Marília L; Moreira, Marina; Martino, Marinês D V; de Freitas, Marise R; Oliveira, Maura S; Dalben, Mirian F; Guzman, Ricardo D; Cayô, Rodrigo; Morais, Rosângela; Santos, Sânia A; Martins, Willames M B S

    2015-12-01

    We evaluated the epidemiology of Acinetobacter spp. recovered from patients diagnosed with bloodstream infections in 9 tertiary hospitals located in all Brazilian geographic regions between April and August 2014. Although OXA-23-producing Acinetobacter baumannii clones were disseminated in most hospitals, it was observed for the first time the spread of OXA-72 among clonally related A. baumannii isolated from distinct hospitals. Interestingly, Acinetobacter pittii was the most frequent species found in a Northern region hospital. Contrasting with the multisusceptible profile displayed by A. pittii isolates, the tetracyclines and polymyxins were the only antimicrobials active against all A. baumannii isolates.

  9. A simple method to purify biologically and antigenically preserved bloodstream trypomastigotes of Trypanosoma cruzi using Deae-cellulose columns

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    Maria Auxiliadora de Sousa

    1983-09-01

    Full Text Available A method to purify trypanosomastigotes of some strains of Trypanosoma cruzi (Y, CL, FL, F, "Berenice", "Colombiana" and "São Felipe" from mouse blood by using DEAE-cellulose columns was standardized. This procedure is a modification of the Lanham & Godfrey methods and differs in some aspects from others described to purify T. cruzi bloodstream trypomastigotes, mainly by avoidance of prior purifications of parasites. By this method, the broad trypomastigotes were mainly isolated, accounting for higher recoveries obtained with strains having higher percentages of these forms: processing of infected blood from irradiated mice could be advantageous by increasing the recovery of parasites (percentage and/or total number and elution of more slender trypomastigotes. Trypomastigotes purified by this method presented normal morphology and motility, remained infective to triatomine bugs and mice, showing in the latter prepatent periods and courses parasitemia similar to those of control parasites, and also reproducing the polymorphism pattern of each strain. Their virulence and pathogenicity also remained considerably preserved, the latter property being evaluated by LD 50 tests, mortality rates and mean survival time of inoculated mice. Moreover, these parasites presented positive, clear and peripheral immunofluorescence reaction at titres similar to those of control organisms, thus suggesting important preservation of their surface antigens.Usando colunas de DEAE-cellulose foi padronizado um método para purificação de tripomastigotas de várias cepas de Trypanosoma cruzi (Y, CL, FL, F, "Berenice", "Columbiana" e "São Felipe" a partir do sangue de camundongos. Este método é uma modificação daqueles descritos por Lanham & Godfrey e difere em vários aspectos de outros descritos para purificar as formas sanguíneas deste parasita, particularmente na dispensa de pré-purificações. Por ele foram isolados principalmente os tripomastigotas largos

  10. Molecular Identification and Echinocandin Susceptibility of Candida parapsilosis Complex Bloodstream Isolates in Italy, 2007-2014.

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    Lovero, Grazia; Borghi, Elisa; Balbino, Stella; Cirasola, Daniela; De Giglio, Osvalda; Perdoni, Federica; Caggiano, Giuseppina; Morace, Giulia; Montagna, Maria Teresa

    2016-01-01

    The Candida parapsilosis group encompasses three species: C. parapsilosis, C. orthopsilosis, and C. metapsilosis. Here, we describe the incidence and echinocandin susceptibility profile of bloodstream isolates of these three species collected from patients admitted to an Italian university hospital from 2007 to 2014. Molecular identification of cryptic species of the C. parapsilosis complex was performed using polymerase chain reaction amplification of the gene encoding secondary alcohol dehydrogenase, followed by digestion with the restriction enzyme BanI. Minimum inhibitory concentrations were determined using the broth microdilution method according to European Committee for Antimicrobial Susceptibility Testing (EUCAST EDef 7.2) and Clinical Laboratory Standards Institute (CLSI M27-A3) guidelines, and the results were compared with those obtained using the E-test and Sensititre methods. Of the 163 C. parapsilosis complex isolates, 136 (83.4%) were identified as C. parapsilosis, and 27 (16.6%) as C. orthopsilosis. The species-specific incidences were 2.9/10,000 admissions for C. parapsilosis and 0.6/10,000 admissions for C. orthopsilosis. No resistance to echinocandins was detected with any of the methods. The percent essential agreement (EA) between the EUCAST and E-test/Sensititre methods for anidulafungin, caspofungin, and micafungin susceptibility was, respectively, as follows: C. parapsilosis, 95.6/97.8, 98.5/88.2, and 93.4/96.3; C. orthopsilosis, 92.6/92.6, 96.3/77.8, and 63.0/66.7. The EA between the CLSI and E-test/Sensititre methods was, respectively, as follows: C. parapsilosis, 99.3/100, 98.5/89.0, and 96.3/98.5; C. orthopsilosis, 96.3/92.6, 100/81.5, and 92.6/88.9. Only minor discrepancies, ranging from 16.9% (C. parapsilosis) to 11.1% (C. orthopsilosis), were observed between the CLSI and E-test/Sensititre methods. In conclusion, this epidemiologic study shows a typical C. parapsilosis complex species distribution, no echinocandin resistance, and it

  11. Molecular Identification and Echinocandin Susceptibility of Candida parapsilosis Complex Bloodstream Isolates in Italy, 2007–2014

    Science.gov (United States)

    Lovero, Grazia; Borghi, Elisa; Balbino, Stella; Cirasola, Daniela; De Giglio, Osvalda; Perdoni, Federica; Caggiano, Giuseppina; Morace, Giulia; Montagna, Maria Teresa

    2016-01-01

    The Candida parapsilosis group encompasses three species: C. parapsilosis, C. orthopsilosis, and C. metapsilosis. Here, we describe the incidence and echinocandin susceptibility profile of bloodstream isolates of these three species collected from patients admitted to an Italian university hospital from 2007 to 2014. Molecular identification of cryptic species of the C. parapsilosis complex was performed using polymerase chain reaction amplification of the gene encoding secondary alcohol dehydrogenase, followed by digestion with the restriction enzyme BanI. Minimum inhibitory concentrations were determined using the broth microdilution method according to European Committee for Antimicrobial Susceptibility Testing (EUCAST EDef 7.2) and Clinical Laboratory Standards Institute (CLSI M27-A3) guidelines, and the results were compared with those obtained using the E-test and Sensititre methods. Of the 163 C. parapsilosis complex isolates, 136 (83.4%) were identified as C. parapsilosis, and 27 (16.6%) as C. orthopsilosis. The species-specific incidences were 2.9/10,000 admissions for C. parapsilosis and 0.6/10,000 admissions for C. orthopsilosis. No resistance to echinocandins was detected with any of the methods. The percent essential agreement (EA) between the EUCAST and E-test/Sensititre methods for anidulafungin, caspofungin, and micafungin susceptibility was, respectively, as follows: C. parapsilosis, 95.6/97.8, 98.5/88.2, and 93.4/96.3; C. orthopsilosis, 92.6/92.6, 96.3/77.8, and 63.0/66.7. The EA between the CLSI and E-test/Sensititre methods was, respectively, as follows: C. parapsilosis, 99.3/100, 98.5/89.0, and 96.3/98.5; C. orthopsilosis, 96.3/92.6, 100/81.5, and 92.6/88.9. Only minor discrepancies, ranging from 16.9% (C. parapsilosis) to 11.1% (C. orthopsilosis), were observed between the CLSI and E-test/Sensititre methods. In conclusion, this epidemiologic study shows a typical C. parapsilosis complex species distribution, no echinocandin resistance, and it

  12. Molecular Identification and Echinocandin Susceptibility of Candida parapsilosis Complex Bloodstream Isolates in Italy, 2007-2014.

    Directory of Open Access Journals (Sweden)

    Grazia Lovero

    Full Text Available The Candida parapsilosis group encompasses three species: C. parapsilosis, C. orthopsilosis, and C. metapsilosis. Here, we describe the incidence and echinocandin susceptibility profile of bloodstream isolates of these three species collected from patients admitted to an Italian university hospital from 2007 to 2014. Molecular identification of cryptic species of the C. parapsilosis complex was performed using polymerase chain reaction amplification of the gene encoding secondary alcohol dehydrogenase, followed by digestion with the restriction enzyme BanI. Minimum inhibitory concentrations were determined using the broth microdilution method according to European Committee for Antimicrobial Susceptibility Testing (EUCAST EDef 7.2 and Clinical Laboratory Standards Institute (CLSI M27-A3 guidelines, and the results were compared with those obtained using the E-test and Sensititre methods. Of the 163 C. parapsilosis complex isolates, 136 (83.4% were identified as C. parapsilosis, and 27 (16.6% as C. orthopsilosis. The species-specific incidences were 2.9/10,000 admissions for C. parapsilosis and 0.6/10,000 admissions for C. orthopsilosis. No resistance to echinocandins was detected with any of the methods. The percent essential agreement (EA between the EUCAST and E-test/Sensititre methods for anidulafungin, caspofungin, and micafungin susceptibility was, respectively, as follows: C. parapsilosis, 95.6/97.8, 98.5/88.2, and 93.4/96.3; C. orthopsilosis, 92.6/92.6, 96.3/77.8, and 63.0/66.7. The EA between the CLSI and E-test/Sensititre methods was, respectively, as follows: C. parapsilosis, 99.3/100, 98.5/89.0, and 96.3/98.5; C. orthopsilosis, 96.3/92.6, 100/81.5, and 92.6/88.9. Only minor discrepancies, ranging from 16.9% (C. parapsilosis to 11.1% (C. orthopsilosis, were observed between the CLSI and E-test/Sensititre methods. In conclusion, this epidemiologic study shows a typical C. parapsilosis complex species distribution, no echinocandin

  13. Comparison of the systemic inflammatory response syndrome between monomicrobial and polymicrobial Pseudomonas aeruginosa nosocomial bloodstream infections

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    Wenzel Richard P

    2005-10-01

    Full Text Available Abstract Background Some studies of nosocomial bloodstream infection (nBSI have demonstrated a higher mortality for polymicrobial bacteremia when compared to monomicrobial nBSI. The purpose of this study was to compare differences in systemic inflammatory response and mortality between monomicrobial and polymicrobial nBSI with Pseudomonas aeruginosa. Methods We performed a historical cohort study on 98 adults with P. aeruginosa (Pa nBSI. SIRS scores were determined 2 days prior to the first positive blood culture through 14 days afterwards. Monomicrobial (n = 77 and polymicrobial BSIs (n = 21 were compared. Results 78.6% of BSIs were caused by monomicrobial P. aeruginosa infection (MPa and 21.4% by polymicrobial P. aeruginosa infection (PPa. Median APACHE II score on the day of BSI was 22 for MPa and 23 for PPa BSIs. Septic shock occurred in 33.3% of PPa and in 39.0% of MPa (p = 0.64. Progression to septic shock was associated with death more frequently in PPa (OR 38.5, CI95 2.9–508.5 than MPa (OR 4.5, CI95 1.7–12.1. Maximal SIR (severe sepsis, septic shock or death was seen on day 0 for PPa BSI vs. day 1 for MPa. No significant difference was noted in the incidence of organ failure, 7-day or overall mortality between the two groups. Univariate analysis revealed that APACHE II score ≥20 at BSI onset, Charlson weighted comorbidity index ≥3, burn injury and respiratory, cardiovascular, renal and hematologic failure were associated with death, while age, malignant disease, diabetes mellitus, hepatic failure, gastrointestinal complications, inappropriate antimicrobial therapy, infection with imipenem resistant P. aeruginosa and polymicrobial nBSI were not. Multivariate analysis revealed that hematologic failure (p Conclusion In this historical cohort study of nBSI with P. aeruginosa, the incidence of septic shock and organ failure was high in both groups. Additionally, patients with PPa BSI were not more acutely ill, as judged by APACHE II

  14. Systemic effects of locally injected platelet rich plasma in a rat model: an analysis on muscle and bloodstream.

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    Borrione, P; Grasso, L; Racca, S; Abbadessa, G; Carriero, V; Fagnani, F; Quaranta, F; Pigozzi, F

    2015-01-01

    Abundant evidence suggests that growth factors, contained in platelets alpha granules, may play a key role in the early stages of the muscle healing process with particular regard to the inflammatory phase. Although the contents of the platelet-rich plasma preparations have been extensively studied, the biological mechanisms involved as well as the systemic effects and the related potential doping implications of this approach are still largely unknown. The aim of the present study was to investigate whether local platelet-rich plasma administration may modify the levels of specific cytokines and growth factors both in treated muscle and bloodstream in rats. An additional aim was to investigate more deeply whether the local platelet-rich plasma administration may exert systemic effects by analyzing contralateral lesioned but untreated muscles. The results showed that platelet-rich plasma treatment induced a modification of certain cytokines and growth factor levels in muscle but not in the bloodstream, suggesting that local platelet-rich plasma treatment influenced directly or, more plausibly, indirectly the synthesis or recruitment of cytokines and growth factors at the site of injury. Moreover, the observed modifications of cytokine and growth factor levels in contralateral injured but not treated muscles, strongly suggested a systemic effect of locally injected platelet-rich plasma.

  15. Evaluation of Real-time PCR and Pyrosequencing for Screening Incubating Blood Culture Bottles from Adults with Suspected Bloodstream Infection

    Science.gov (United States)

    McCann, Chase D.; Moore, Miranda S.; May, Larissa S.; McCarroll, Matthew; Jordan, Jeanne A.

    2015-01-01

    Several molecular platforms can identify bacteria associated with bloodstream infections, but require positive culture bottles as starting material. Here we describe results of screening 1140 blood cultures at 8 hours post-inoculation, from 918 eligible adults being evaluated for bloodstream infection. DNA was extracted and analyzed by 16S and/or 23S rRNA real-time PCR/Pyrosequencing. Compared to culture, PCR/Pyrosequencing displayed 90.9% sensitivity, 99.6% specificity, 95.7% PPV, and 99.1% NPV. Overall concordance rate was 98.9% (1127/1140). In four cases with molecular-positive/culture-negative results, medical chart reviews provided evidence of identical bacteria from subsequent blood or concomitant urine/sputum cultures. Nine culture-positive/molecular-negative cases were associated with either polymicrobial growth, grew only in the anaerobic bottle of the clinical pair, and/or were detected by PCR/Pyrosequencing after 8 hours. In summary, this approach accurately detected and identified bacteria in ~91% of culture-confirmed cases significantly sooner than the phenotypic identification was available, having the potential to improve antibiotic stewardship. PMID:25534615

  16. Evaluation of real-time PCR and pyrosequencing for screening incubating blood culture bottles from adults with suspected bloodstream infection.

    Science.gov (United States)

    McCann, Chase D; Moore, Miranda S; May, Larissa S; McCarroll, Matthew G; Jordan, Jeanne A

    2015-03-01

    Several molecular platforms can identify bacteria associated with bloodstream infections but require positive culture bottles as starting material. Here, we describe results of screening 1140 blood cultures at 8h postinoculation, from 918 eligible adults being evaluated for bloodstream infection. DNA was extracted and analyzed by 16S and/or 23S rRNA real-time PCR/pyrosequencing. Compared to culture, PCR/pyrosequencing displayed 90.9% sensitivity, 99.6% specificity, 95.7% positive predictive value, and 99.1% negative predictive value. Overall concordance rate was 98.9% (1127/1140). In 4 cases with molecular-positive/culture-negative results, medical chart reviews provided evidence of identical bacteria from subsequent blood or concomitant urine/sputum cultures. Nine culture-positive/molecular-negative cases were associated with either polymicrobial growth, grew only in the anaerobic bottle of the clinical pair, and/or were detected by PCR/pyrosequencing after 8h. In summary, this approach accurately detected and identified bacteria in ~91% of culture-confirmed cases significantly sooner than the phenotypic identification was available, having the potential to improve antibiotic stewardship.

  17. Clonal distribution of bone sialoprotein-binding protein gene among Staphylococcus aureus isolates associated with bloodstream infections.

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    Wiśniewska, Katarzyna; Piórkowska, Anna; Kasprzyk, Joanna; Bronk, Marek; Świeć, Krystyna

    2014-11-01

    Staphylococcus aureus is a leading cause of bloodstream infections (BSI) and diseases that may be caused by hematogenous spread. The staphylococcal adhesin, for which the association with the infections emerging as a complication of septicemia has been well documented, is a bone sialoprotein-binding protein (Bbp). The aim of the study was to assess the prevalence of a bbp gene in S. aureus bloodstream isolates associated with BSI and to investigate to what degree the distribution of this gene is linked to the clonality of the population. Spa typing, used in order to explore the genetic population structure of the isolates, yielded 29 types. Six spa clusters and seven singletons were identified. The most frequent was spa clonal complex CC021 associated with MLST CC30 (38%). The bbp gene was found in 47% of isolates. Almost all isolates (95%) clustered in spa clonal complex CC021 were positive for this gene. All isolates carrying the bbp gene were sensitive to methicillin, and if clustered in the spa CC021, belonged to agr group III. Our study shows that Bbp is not strictly associated with BSI. However, one may conclude that for clonally related S. aureus strains most commonly causing BSI, the risk of Bbp-mediated complications of septicemia is expected to be higher than for other strains.

  18. Host Characteristics and Bacterial Traits Predict Experimental Virulence for Escherichia coli Bloodstream Isolates From Patients With Urosepsis.

    Science.gov (United States)

    Johnson, James R; Porter, Stephen; Johnston, Brian; Kuskowski, Michael A; Spurbeck, Rachel R; Mobley, Harry L T; Williamson, Deborah A

    2015-09-01

    Background.  Extraintestinal Escherichia coli infections are common, costly, and potentially serious. A better understanding of their pathogenesis is needed. Methods.  Sixty-seven E coli bloodstream isolates from adults with urosepsis (Seattle, WA; 1980s) underwent extensive molecular characterization and virulence assessment in 2 infection models (murine subcutaneous sepsis and moth larval lethality). Statistical comparisons were made among host characteristics, bacterial traits, and experimental virulence. Results.  The 67 source patients were diverse for age, sex, and underlying medical and urological conditions. The corresponding E coli isolates exhibited diverse phylogenetic backgrounds and virulence profiles. Despite the E coli isolates' common bloodstream origin, they exhibited a broad range of experimental virulence in mice and moth larvae, in patterns that (for the murine model only) corresponded significantly with host characteristics and bacterial traits. The most highly mouse-lethal strains were enriched with classic "urovirulence" traits and typically were from younger women with anatomically and functionally normal urinary tracts. The 2 animal models corresponded poorly with one another. Conclusions.  Host compromise, including older age and urinary tract abnormalities, allows comparatively low-virulence E coli strains to cause urosepsis. Multiple E coli traits predict both experimental and epidemiological virulence. The larval lethality model cannot be a substitute for the murine sepsis model.

  19. Identification, genotypic relation, and clinical features of colistin-resistant isolates of Acinetobacter genomic species 13BJ/14TU from bloodstreams of patients in a university hospital.

    Science.gov (United States)

    Lee, Seung Yeob; Shin, Jong Hee; Park, Kyung Hwa; Kim, Ju Hee; Shin, Myung Geun; Suh, Soon Pal; Ryang, Dong Wook; Kim, Soo Hyun

    2014-03-01

    Colistin resistance remains rare among clinical isolates of Acinetobacter species. We noted the emergence of colistin-resistant bloodstream isolates of the Acinetobacter genomic species (GS) 13BJ/14TU from patients at a university hospital between 2003 and 2011. We report here, for the first time, the microbiological and molecular characteristics of these isolates, with clinical features of Acinetobacter GS 13BJ/14TU bacteremia. All 11 available patient isolates were correctly identified as Acinetobacter GS 13BJ/14TU using partial rpoB gene sequencing but were misidentified using the phenotypic methods Vitek 2 (mostly as Acinetobacter baumannii), MicroScan (mostly as A. baumannii/Acinetobacter haemolyticus), and the API 20 NE system (all as A. haemolyticus). Most isolates were susceptible to commonly used antibiotics, including carbapenems, but all were resistant to colistin, for which it is unknown whether the resistance is acquired or intrinsic. However, the fact that none of the patients had a history of colistin therapy strongly suggests that Acinetobacter GS 13BJ/14TU is innately resistant to colistin. The phylogenetic tree of multilocus sequence typing (MLST) showed that all 11 isolates formed a separate cluster from other Acinetobacter species and yielded five sequence types. However, pulsed-field gel electrophoresis (PFGE) revealed 11 distinct patterns, suggesting that the bacteremia had occurred sporadically. Four patients showed persistent bacteremia (6 to 17 days), and all 11 patients had excellent outcomes with cleared bacteremia, suggesting that patients with Acinetobacter GS 13BJ/14TU-associated bacteremia show a favorable outcome. These results emphasize the importance of precise species identification, especially regarding colistin resistance in Acinetobacter species. In addition, MLST offers another approach to the identification of Acinetobacter GS 13BJ/14TU, whereas PFGE is useful for genotyping for this species.

  20. Five-Lumen Antibiotic-Impregnated Femoral Central Venous Catheters in Severely Burned Patients: An Investigation of Device Utility and Catheter-Related Bloodstream Infection Rates.

    Science.gov (United States)

    Friedman, Bruce C; Mian, Mohammad A H; Mullins, Robert F; Hassan, Zaheed; Shaver, Joseph R; Johnston, Krystal K

    2015-01-01

    The objective of this study is to determine the catheter-related bloodstream infection (CRBSI) rate in a severely burned patient population, many of whom required prolonged use of central venous catheters (CVCs). Between January 2008 and June 2012, 151 patients underwent placement of 455 five-lumen minocycline/rifampin-impregnated CVCs. CRBSI was defined as at least one blood culture (>100,000 colonies) and one simultaneous roll-plate CVC tip culture (>15 colony forming units) positive for the same organism. Most patients had accidental burns (81.5%) with a mean TBSA of 50%. A mean of three catheters were inserted per patient (range, 1-25). CVCs were inserted in the femoral vein (91.2%), subclavian vein (5.3%), and internal jugular vein (3.3%). Mean overall catheter indwell time was 8 days (range, 0-39 days). The overall rate of CRBSI per 1000 catheter days was 11.2; patients with a TBSA >60% experienced significantly higher rates of CRBSI than patients with a TBSA ≤60% (16.2 vs 7.3, P = .01). CVCs placed through burned skin were four times more likely to be associated with CRBSI than CVCs placed through intact skin. The most common infectious organism was Acinetobacter baumannii. Deep venous thrombosis developed in eleven patients (7%). The overall rate of CRBSI was 11.2, consistent with published rates of CRBSI in burn patients. Thus, femoral placement of 5-lumen CVCs did not result in increased CRBSI rates. These data support the safety of femoral CVC placement in burn patients, contrary to the Centers for Disease Control recommendation to avoid femoral CVC insertion.

  1. [Assessment of diagnostic methods for the catheter-related bloodstream infections in intensive care units].

    Science.gov (United States)

    Ataman Hatipoğlu, Ciğdem; Ipekkan, Korhan; Oral, Behiç; Onde, Ufuk; Bulut, Cemal; Demiröz, Ali Pekcan

    2011-01-01

    The majority of catheter-related bloodstream infections (CR-BSI) are associated with central venous catheters (CVCs) and most of them develop in patients staying at intensive care units (ICUs). The aim of this study was to assess the performance of different methods for the diagnosis of CR-BSI in neurology and neurosurgery ICUs of our hospital. This prospective study was carried out between January 2007 and January 2008 and all of the patients were followed daily for CR-BSI after the insertion of CVCs. Blood cultures were taken simultaneously from the catheter lumen and from at least one peripheral vein when there was a suspicion of CR-BSI. Additionally, from patients whose CVCs were removed, catheter tip cultures were taken and from patients with exit site infection, cultures of the skin surrounding the catheter entrance were taken. Catheter tip cultures were done by using quantitative and semiquantitative culture methods. Blood cultures taken from the catheter lumen and peripheral vein were incubated in the BACTEC 9050 (Becton Dickinson, USA) automated blood culture system. Gram and acridine orange (AO) staining were used for the smears prepared from the catheter tips and blood cultures. To evaluate the value of culture and staining methods in the diagnosis of CR-BSI; sensitivity, specificity, positive and negative predictive values (PPV and NPV, respectively) of each method were determined. A total of 148 patients (66 male, 82 female; age range: 1-94 years, mean age: 58.7 ± 21.8 years) were included in the study, of whom 67 (45.3%) were from neurology and 81 (54.7%) were from neurosurgery ICUs. One hundred ninety-nine CVC application performed in 148 patients were evaluated. Mean duration of catheterization was 8.5 ± 5.2 days. Thirty-two episodes of CR-BSI among 199 catheterizations (16%) in 29 patients among a total of 148 patients (19.6%) were determined. The most frequently isolated microorganisms were methicillin-resistant coagulase-negative staphylococci

  2. Impact of a modified Broviac maintenance care bundle on bloodstream infections in paediatric cancer patients

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    Furtwängler, Rhoikos

    2015-11-01

    Full Text Available Background: During intensive chemotherapy, bloodstream infection (BSI represents an important complication in paediatric cancer patients. Most patients carry a long-term central venous access device (CVAD. Improved maintenance care of these vascular catheters may decrease the risk of BSI.Methods: Intervention study (adapted CVAD prevention protocol with two observation periods (P1: 09-2009 until 05-2011; P2: 09-2011 until 05-2013; prospective surveillance of all laboratory confirmed BSIs. In P2, ready to use sterile NaCl 0.9% syringes were used for CVAD flushing and octenidine/isopropanol for the disinfection of catheter hubs and 3-way stopcocks. Results: During P1, 84 patients were included versus 81 patients during P2. There were no significant differences between the two patient populations in terms of median age, gender, underlying malignancy or disease status (first illness or relapse. Nearly all CVADs were Broviac catheters. The median duration from implantation to removal of the CVAD was 192 days (Inter-quartile-range (IQR; 110–288 days in P1 and 191 days (IQR; 103–270 days in P2. 28 BSI were diagnosed in 22 patients in P1 (26% of all patients experienced at least one BSI and 15 BSI in 12 patients in P2 (15% of all patients. The corresponding results for incidence density (ID were 0.44 (CI95 0.29–0.62 for P1 vs. 0.34 (0.19–0.53 BSI per 100 inpatient days for P2 and for incidence rate (IR 7.76 (5.16–10.86 in P1 vs. 4.75 (2.66–7.43 BSI per 1,000 inpatient CVAD utilization days. In P1, 9 BSI were caused by CoNS vs. only 2 in P2 (IR 2.49; CI95 0.17–4.17 vs. 0.63; CI95 0.08–1.72. In P1 two BSI (7% lead to early removal of the device. During P2 one CVAD was prematurely removed due to a Broviac-related BSI (6.7%.Conclusion: The preventive protocol investigated in this study led to a reduction of BSI in paediatric cancer patients. This result was clinically relevant but – due to insufficient power in a single centre observation

  3. DNA microarray genotyping and virulence and antimicrobial resistance gene profiling of methicillin-resistant Staphylococcus aureus bloodstream isolates from renal patients.

    LENUS (Irish Health Repository)

    McNicholas, Sinead

    2012-02-01

    Thirty-six methicillin-resistant Staphylococcus aureus (MRSA) bloodstream isolates from renal patients were genetically characterized by DNA microarray analysis and spa typing. The isolates were highly clonal, belonging mainly to ST22-MRSA-IV. The immune evasion and enterotoxin gene clusters were found in 29\\/36 (80%) and 33\\/36 (92%) isolates, respectively.

  4. DNA microarray genotyping and virulence and antimicrobial resistance gene profiling of methicillin-resistant Staphylococcus aureus bloodstream isolates from renal patients.

    LENUS (Irish Health Repository)

    McNicholas, Sinead

    2011-12-01

    Thirty-six methicillin-resistant Staphylococcus aureus (MRSA) bloodstream isolates from renal patients were genetically characterized by DNA microarray analysis and spa typing. The isolates were highly clonal, belonging mainly to ST22-MRSA-IV. The immune evasion and enterotoxin gene clusters were found in 29\\/36 (80%) and 33\\/36 (92%) isolates, respectively.

  5. Evaluation of the MALDI-TOF VITEK MS™ system for the identification of Candida parapsilosis, C. orthopsilosis and C. metapsilosis from bloodstream infections.

    Science.gov (United States)

    Nobrega de Almeida Júnior, João; de Souza, Letícia Bonato; Motta, Adriana Lopes; Rossi, Flávia; Romano Di Gioia, Thais Sabato; Benard, Gil; Del Negro, Gilda Maria Barbaro

    2014-10-01

    Twenty-nine Candida parapsilosis, seventeen Candida orthopsilosis and two Candida metapsilosis bloodstream isolates were submitted for identification by VITEK-MS™ mass spectrometer. Four isolates, two C. orthopsilosis and two C. metapsilosis, were not identified. Inclusion of Superspectra of both species in this database is required to improve its discrimination power.

  6. Burden of antimicrobial resistance in European hospitals : excess mortality and length of hospital stay associated with bloodstream infections due to Escherichia coli resistant to third-generation cephalosporins

    NARCIS (Netherlands)

    de Kraker, M. E. A.; Wolkewitz, M.; Davey, P. G.; Koller, W.; Berger, J.; Nagler, J.; Icket, C.; Kalenic, S.; Horvatic, J.; Seifert, H.; Kaasch, A.; Paniara, O.; Argyropoulou, A.; Bompola, M.; Smyth, E.; Skally, M.; Raglio, A.; Dumpis, U.; Kelmere, A. Melbarde; Borg, M.; Xuereb, D.; Ghita, M. C.; Noble, M.; Kolman, J.; Grabljevec, S.; Turner, D.; Lansbury, L.; Grundmann, H.

    2011-01-01

    This study determined excess mortality and length of hospital stay (LOS) attributable to bloodstream infection (BSI) caused by third-generation-cephalosporin-resistant Escherichia coli in Europe. A prospective parallel matched cohort design was used. Cohort I consisted of patients with third-generat

  7. Etiology and epidemiology of catheter related bloodstream infections in patients receiving home parenteral nutrition in a gastromedical center at a tertiary hospital in denmark

    DEFF Research Database (Denmark)

    Nielsen, Xiaohui Chen; Chen, Ming; Hellesøe, Anne-Marie Blok

    2012-01-01

    We conducted a retrospective epidemiologic study of catheter related bloodstream infections (CRBSI) in patients receiving long-term home parenteral nutrition (HPN) from January 2002 to December 2005. Our results showed that coagulase negative staphylococci (CoNS) were the most prevalent pathogens...

  8. Taurolidine lock is highly effective in preventing catheter-related bloodstream infections in patients on home parenteral nutrition: a heparin-controlled prospective trial.

    NARCIS (Netherlands)

    Bisseling, T.M.; Willems, M.C.M.; Versleijen, M.W.J.; Hendriks, J.C.M.; Vissers, R.K.; Wanten, G.J.A.

    2010-01-01

    BACKGROUND & AIMS: Catheter-related bloodstream infections remain the major threat for Home Parenteral Nutrition programs. Taurolidine, a potent antimicrobial agent, holds promise as an effective catheter lock to prevent such infections. Aim of the present study was to compare taurolidine with hepar

  9. Absence of microbial adaptation to taurolidine in patients on home parenteral nutrition who develop catheter related bloodstream infections and use taurolidine locks

    NARCIS (Netherlands)

    Olthof, E.D.; Rentenaar, R.J.; Rijs, A.J.M.M.; Wanten, G.J.A.

    2013-01-01

    BACKGROUND & AIMS: Some home parenteral nutrition (HPN) patients develop catheter related bloodstream infections (CRBSI) despite using an anti-microbial catheter lock solution taurolidine. The aim of this study was to assess whether long-term use of taurolidine leads to selective growth of microorga

  10. Effect of a vascular access team on central line-associated bloodstream infections in infants admitted to a neonatal intensive care unit : a systematic review

    NARCIS (Netherlands)

    Legemaat, Monique M; Jongerden, IP; van Rens, Roland M F P T; Zielman, Marjanne; van den Hoogen, Agnes

    2015-01-01

    OBJECTIVE: To review the effect of a vascular access team on the incidence of central line-associated bloodstream infections in infants admitted to a neonatal intensive care unit. DATA SOURCES: MEDLINE, CINAHL, Embase, Web-of-Science and the Cochrane Library were searched until December 2013. STUDY

  11. Draft Genome Sequence of Extremely Drug-Resistant Pseudomonas aeruginosa (ST357) Strain CMC_VB_PA_B22862 Isolated from a Community-Acquired Bloodstream Infection

    Science.gov (United States)

    Pragasam, Agila Kumari; Yesurajan, Francis; Doss C, George Priya; George, Biju; Devanga Ragupathi, Naveen Kumar; Walia, Kamini

    2016-01-01

    Extremely drug-resistant Pseudomonas aeruginosa strains causing severe infections have become a serious concern across the world. Here, we report draft genome sequence of P. aeruginosa with an extremely drug-resistant profile isolated from a patient with community-acquired bloodstream infection in India.

  12. Bloodstream infections during the onset of necrotizing enterocolitis and their relation with the pro-inflammatory response, gut wall integrity and severity of disease in NEC

    NARCIS (Netherlands)

    Heida, F. H.; Hulscher, J. B. F.; Schurink, M.; van Vliet, M. J.; Kooi, E. M. W.; Kasper, D. C.; Pones, M.; Bos, A. F.; Benkoe, T. M.

    2015-01-01

    Introduction: Bacterial involvement is believed to play a pivotal role in the development and disease outcome of NEC. However, whether a bloodstream infection (BSI) predisposes to NEC (e.g. by activating the pro-inflammatory response) or result from the loss of gut wall integrity during NEC developm

  13. Bloodstream infections during the onset of necrotizing enterocolitis and their relation with the pro-inflammatory response, gut wall integrity and severity of disease in NEC

    NARCIS (Netherlands)

    Heida, F.H.; Hulscher, J.B.; Schurink, M.; Vliet, M.J. van; Kooi, E.M.; Kasper, D.C.; Pones, M.; Bos, A.F; Benkoe, T.M.

    2015-01-01

    INTRODUCTION: Bacterial involvement is believed to play a pivotal role in the development and disease outcome of NEC. However, whether a bloodstream infection (BSI) predisposes to NEC (e.g. by activating the pro-inflammatory response) or result from the loss of gut wall integrity during NEC developm

  14. Etiological characteristics of 108 patients with secondary bloodstream infections%继发性血流感染108例病原学特点分析

    Institute of Scientific and Technical Information of China (English)

    黄仁刚; 杨兴祥; 喻华; 龙姗姗; 林健梅; 江南

    2015-01-01

    Objective To investigate the etiological characteristics of laboratory-confirmed bloodstream infections with identi-fied infective sources. Methods The data of the patients with laboratory-confirmed bloodstream infections and identified infective sources, who were treated at Sichuan Provincial People's Hospital from Jan. 2011 to Jun. 2013 were collected to analyze the etiological characteristics retrospectively. Results A total of 108 patients with identified infective sources were enrolled in this study, of whom 93 patients suffered from monomicrobial infection, and 15 patients suffered from polymicrobial infection. Bloodstream infections were com-monly found in urinary tract, abdominal cavity and respiratory tract. Infection with Escherichia coli. accounted for 75.8%and 42.4%in patients with bloodstream infections in urinary tract and abdominal cavity, respectively; Infection with Acinetobacter baumannii ac-counted for 62.5%in patients with bloodstream infections in respiratory tract, and Acinetobacter baumannii was resistant to carbapen-em antibiotics. The 30-day mortality of 108 patients with bloodstream infections was 19.4%. The patients with bloodstream infections in urinary tract had the lowest 30-day mortality rate (3.0%), while the patients with bloodstream infections in lower respiratory tract had the highest 30-day mortality rate (45.8%). The 30-day mortality rates of the patients with bloodstream infections with non-fermentation gram negative bacillus and fungi were 55.0%and 50.0%, respectively. Conclusions The pathogen distribution of the patients with different sources of bloodstream infections varies widely. Appropriate antibiotic therapy should take infective sources, types of bacteria and drug resistance into consideration.%目的 研究感染来源明确的血流感染患者的病原学特点. 方法 收集四川省人民医院2011年1月—2013年6月实验室确诊、感染来源明确的血流感染患者临床资料,回

  15. Incidence of colonization and bloodstream infection with carbapenem-resistant Enterobacteriaceae in children receiving antineoplastic chemotherapy in Italy.

    Science.gov (United States)

    Caselli, Desiree; Cesaro, Simone; Fagioli, Franca; Carraro, Francesca; Ziino, Ottavio; Zanazzo, Giulio; Meazza, Cristina; Colombini, Antonella; Castagnola, Elio

    2016-02-01

    Few data are available on the incidence of carbapenemase-producing Enterobacteriaceae (CPE) infection or colonization in children receiving anticancer chemotherapy. We performed a nationwide survey among centers participating in the pediatric hematology-oncology cooperative study group (Associazione Italiana Ematologia Oncologia Pediatrica, AIEOP). During a 2-year observation period, we observed a threefold increase in the colonization rate, and a fourfold increase of bloodstream infection episodes, caused by CPE, with a 90-day mortality of 14%. This first nationwide Italian pediatric survey shows that the circulation of CPE strains in the pediatric hematology-oncology environment is increasing. Given the mortality rate, which is higher than for other bacterial strains, specific monitoring should be applied and the results should have implications for health-care practice in pediatric hematology-oncology.

  16. Ten-year study of species distribution and antifungal susceptibilities of Candida bloodstream isolates at a Brazilian tertiary hospital.

    Science.gov (United States)

    Bonfietti, L X; Szeszs, M W; Chang, M R; Martins, M A; Pukinskas, S R B S; Nunes, M O; Pereira, G H; Paniago, A M M; Purisco, S U; Melhem, M S C

    2012-12-01

    To describe the incidence and susceptibility profile of Candida bloodstream infections in a tertiary-care hospital, we performed a retrospective observational study from 1998 to 2007. Comorbidities and risk factors were compiled from all cases. In vitro susceptibility testing to fluconazole, itraconazole, voriconazole, and amphotericin B was performed for 100 isolates, and caspofungin was tested for C. parapsilosis complex. In a ten-year evaluation of candidemias, 44 % were caused by C. albicans, and species of the C. parapsilosis complex were the second most frequent agents (37 %). Other species presented lower incidences (C. tropicalis, 13 %, C. glabrata, 5 %, and C. krusei, 1 %). Neither C. dubliniensis nor C. metapsilosis were observed in this study. C. orthopsilosis (3 %) and C. parapsilosis stricto sensu (34 %) were also found. Species distribution was independent of catheterization, mechanical ventilation, or previous use of antifungals or corticoids. Parenteral nutrition administration was strongly related to C. glabrata infection, and the highest mortality (80 %) was observed in patients infected by this species. All C. albicans isolates showed high susceptibility to all tested drugs. However, two C. parapsilosis stricto sensu isolates presented high minimum inhibitory concentration (MIC) (4 mg/L each) to fluconazole, and one exhibited voriconazole MIC of 0.25 mg/L, highlighting the cross-resistance to these azoles. All isolates of C. tropicalis and C. glabrata showed no resistance to any drug tested. No difference was noted between C. parapsilosis and C. orthopsilosis susceptibilities to caspofungin. Our results suggest that resistance to amphotericin B, fluconazole, voriconazole, itraconazole, and caspofungin in Brazilian Candida bloodstream isolates is still uncommon.

  17. Antimicrobial Resistance and Molecular Epidemiology of Escherichia coli Causing Bloodstream Infections in Three Hospitals in Shanghai, China.

    Directory of Open Access Journals (Sweden)

    Su Wang

    Full Text Available Escherichia coli (E. coli is one of the most frequent and lethal causes of bloodstream infections (BSIs. We carried out a retrospective multicenter study on antimicrobial resistance and phylogenetic background of clinical E. coli isolates recovered from bloodstream in three hospitals in Shanghai. E. coli isolates causing BSIs were consecutively collected between Sept 2013 and Sept 2014. Ninety isolates randomly selected (30 from each hospital were enrolled in the study. Antimicrobial susceptibility testing was performed by disk diffusion. PCR was used to detect antimicrobial resistance genes coding for β-lactamases (TEM, CTX-M, OXA, etc., carbapenemases (IMP, VIM, KPC, NDM-1 and OXA-48, and phylogenetic groups. eBURST was applied for analysis of multi-locus sequence typing (MLST. The resistance rates for penicillins, second-generation cephalosporins, fluoroquinolone and tetracyclines were high (>60%. Sixty-one of the 90 (67.8% strains enrolled produced ESBLs and no carbapenemases were found. Molecular analysis showed that CTX-M-15 (25/61, CTX-M-14 (18/61 and CTX-M-55 (9/61 were the most common ESBLs. Phylogenetic group B2 predominated (43.3% and exhibited the highest rates of ESBLs production. ST131 (20/90 was the most common sequence type and almost assigned to phylogenetic group B2 (19/20. The following sequence types were ST405 (8/90 and ST69 (5/90. Among 61 ESBL-producers isolates, B2 (26, 42.6% and ST131 (18, 29.5% were also the most common phylogenetic group and sequence type. Genetic diversity showed no evidence suggesting a spread of these antimicrobial resistant isolates in the three hospitals. In order to provide more comprehensive and reliable epidemiological information for preventing further dissemination, well-designed and continuous surveillance with more hospitals participating was important.

  18. Antimicrobial Resistance and Molecular Epidemiology of Escherichia coli Causing Bloodstream Infections in Three Hospitals in Shanghai, China.

    Science.gov (United States)

    Wang, Su; Zhao, Sheng-Yuan; Xiao, Shu-Zhen; Gu, Fei-Fei; Liu, Qing-Zhong; Tang, Jin; Guo, Xiao-Kui; Ni, Yu-Xing; Han, Li-Zhong

    2016-01-01

    Escherichia coli (E. coli) is one of the most frequent and lethal causes of bloodstream infections (BSIs). We carried out a retrospective multicenter study on antimicrobial resistance and phylogenetic background of clinical E. coli isolates recovered from bloodstream in three hospitals in Shanghai. E. coli isolates causing BSIs were consecutively collected between Sept 2013 and Sept 2014. Ninety isolates randomly selected (30 from each hospital) were enrolled in the study. Antimicrobial susceptibility testing was performed by disk diffusion. PCR was used to detect antimicrobial resistance genes coding for β-lactamases (TEM, CTX-M, OXA, etc.), carbapenemases (IMP, VIM, KPC, NDM-1 and OXA-48), and phylogenetic groups. eBURST was applied for analysis of multi-locus sequence typing (MLST). The resistance rates for penicillins, second-generation cephalosporins, fluoroquinolone and tetracyclines were high (>60%). Sixty-one of the 90 (67.8%) strains enrolled produced ESBLs and no carbapenemases were found. Molecular analysis showed that CTX-M-15 (25/61), CTX-M-14 (18/61) and CTX-M-55 (9/61) were the most common ESBLs. Phylogenetic group B2 predominated (43.3%) and exhibited the highest rates of ESBLs production. ST131 (20/90) was the most common sequence type and almost assigned to phylogenetic group B2 (19/20). The following sequence types were ST405 (8/90) and ST69 (5/90). Among 61 ESBL-producers isolates, B2 (26, 42.6%) and ST131 (18, 29.5%) were also the most common phylogenetic group and sequence type. Genetic diversity showed no evidence suggesting a spread of these antimicrobial resistant isolates in the three hospitals. In order to provide more comprehensive and reliable epidemiological information for preventing further dissemination, well-designed and continuous surveillance with more hospitals participating was important.

  19. Surveillance of Candida spp bloodstream infections: epidemiological trends and risk factors of death in two Mexican tertiary care hospitals.

    Directory of Open Access Journals (Sweden)

    Dora E Corzo-Leon

    Full Text Available INTRODUCTION: Larger populations at risk, broader use of antibiotics and longer hospital stays have impacted on the incidence of Candida sp. bloodstream infections (CBSI. OBJECTIVE: To determine clinical and epidemiologic characteristics of patients with CBSI in two tertiary care reference medical institutions in Mexico City. DESIGN: Prospective and observational laboratory-based surveillance study conducted from 07/2008 to 06/2010. METHODS: All patients with CBSI were included. Identification and antifungal susceptibility were performed using CLSI M27-A3 standard procedures. Frequencies, Mann-Whitney U test or T test were used as needed. Risk factors were determined with multivariable analysis and binary logistic regression analysis. RESULTS: CBSI represented 3.8% of nosocomial bloodstream infections. Cumulative incidence was 2.8 per 1000 discharges (incidence rate: 0.38 per 1000 patient-days. C. albicans was the predominant species (46%, followed by C. tropicalis (26%. C. glabrata was isolated from patients with diabetes (50%, and elderly patients. Sixty-four patients (86% received antifungals. Amphotericin-B deoxycholate (AmBD was the most commonly used agent (66%. Overall mortality rate reached 46%, and risk factors for death were APACHE II score ≥ 16 (OR = 6.94, CI95% = 2.34-20.58, p<0.0001, and liver disease (OR = 186.11, CI95% = 7.61-4550.20, p = 0.001. Full susceptibility to fluconazole, AmBD and echinocandins among C. albicans, C. tropicalis, and C. parapsilosis was observed. CONCLUSIONS: The cumulative incidence rate in these centers was higher than other reports from tertiary care hospitals from Latin America. Knowledge of local epidemiologic patterns permits the design of more specific strategies for prevention and preemptive therapy of CBSI.

  20. Surveillance of Candida spp Bloodstream Infections: Epidemiological Trends and Risk Factors of Death in Two Mexican Tertiary Care Hospitals

    Science.gov (United States)

    Corzo-Leon, Dora E.; Alvarado-Matute, Tito; Colombo, Arnaldo L.; Cornejo-Juarez, Patricia; Cortes, Jorge; Echevarria, Juan I.; Guzman-Blanco, Manuel; Macias, Alejandro E.; Nucci, Marcio; Ostrosky-Zeichner, Luis; Ponce-de-Leon, Alfredo; Queiroz-Telles, Flavio; Santolaya, Maria E.; Thompson-Moya, Luis; Tiraboschi, Iris N.; Zurita, Jeannete; Sifuentes-Osornio, Jose

    2014-01-01

    Introduction Larger populations at risk, broader use of antibiotics and longer hospital stays have impacted on the incidence of Candida sp. bloodstream infections (CBSI). Objective To determine clinical and epidemiologic characteristics of patients with CBSI in two tertiary care reference medical institutions in Mexico City. Design Prospective and observational laboratory-based surveillance study conducted from 07/2008 to 06/2010. Methods All patients with CBSI were included. Identification and antifungal susceptibility were performed using CLSI M27-A3 standard procedures. Frequencies, Mann-Whitney U test or T test were used as needed. Risk factors were determined with multivariable analysis and binary logistic regression analysis. Results CBSI represented 3.8% of nosocomial bloodstream infections. Cumulative incidence was 2.8 per 1000 discharges (incidence rate: 0.38 per 1000 patient-days). C. albicans was the predominant species (46%), followed by C. tropicalis (26%). C. glabrata was isolated from patients with diabetes (50%), and elderly patients. Sixty-four patients (86%) received antifungals. Amphotericin-B deoxycholate (AmBD) was the most commonly used agent (66%). Overall mortality rate reached 46%, and risk factors for death were APACHE II score ≥16 (OR = 6.94, CI95% = 2.34–20.58, p<0.0001), and liver disease (OR = 186.11, CI95% = 7.61–4550.20, p = 0.001). Full susceptibility to fluconazole, AmBD and echinocandins among C. albicans, C. tropicalis, and C. parapsilosis was observed. Conclusions The cumulative incidence rate in these centers was higher than other reports from tertiary care hospitals from Latin America. Knowledge of local epidemiologic patterns permits the design of more specific strategies for prevention and preemptive therapy of CBSI. PMID:24830654

  1. High prevalence of tuberculosis and serious bloodstream infections in ambulatory individuals presenting for antiretroviral therapy in Malawi.

    Directory of Open Access Journals (Sweden)

    Richard A Bedell

    Full Text Available BACKGROUND: Tuberculosis (TB and serious bloodstream infections (BSI may contribute to the high early mortality observed among patients qualifying for antiretroviral therapy (ART with unexplained weight loss, chronic fever or chronic diarrhea. METHODS AND FINDINGS: A prospective cohort study determined the prevalence of undiagnosed TB or BSI among ambulatory HIV-infected adults with unexplained weight loss and/or chronic fever, or diarrhea in two routine program settings in Malawi. Subjects with positive expectorated sputum smears for AFB were excluded. Investigations Bacterial and mycobacterial blood cultures, cryptococcal antigen test (CrAg, induced sputum (IS for TB microscopy and solid culture, full blood count and CD4 lymphocyte count. Among 469 subjects, 52 (11% had microbiological evidence of TB; 50 (11% had a positive (non-TB blood culture and/or positive CrAg. Sixty-five additional TB cases were diagnosed on clinical and radiological grounds. Nontyphoidal Salmonellae (NTS were the most common blood culture pathogens (29 cases; 6% of participants and 52% of bloodstream isolates. Multivariate analysis of baseline clinical and hematological characteristics found significant independent associations between oral candidiasis or lymphadenopathy and TB, marked CD4 lymphopenia and NTS infection, and severe anemia and either infection, but low positive likelihood ratios (<2 for all combinations. CONCLUSIONS: We observed a high prevalence of TB and serious BSI, particularly NTS, in a program cohort of chronically ill HIV-infected outpatients. Baseline clinical and hematological characteristics were inadequate predictors of infection. HIV clinics need better rapid screening tools for TB and BSI. Clinical trials to evaluate empiric TB or NTS treatment are required in similar populations.

  2. Regional variations in fluoroquinolone non-susceptibility among Escherichia coli bloodstream infections within the Veterans Healthcare Administration

    Directory of Open Access Journals (Sweden)

    Daniel J. Livorsi

    2016-10-01

    Full Text Available Abstract Objectives We sought to define regional variations in fluoroquinolone non-susceptibility (FQ-NS among bloodstream isolates of Escherichia coli across the Veterans Health Administration (VHA in the United States. Methods We analyzed a retrospective cohort of patients managed at 136 VHA hospitals who had a blood culture positive for E.coli between 2003 and 2013. Hospitals were classified based on US Census Divisions, and regional variations in FQ-NS were analyzed. Results Twenty-four thousand five hundred twenty-three unique E.coli bloodstream infections (BSIs were identified between 2003 and 2013. 53.9 % of these were community-acquired, 30.7 % were healthcare-associated, and 15.4 % were hospital-onset BSIs. The proportion of E.coli BSIs with FQ-NS significantly varied across US Census Divisions (p < 0.001. During 2003–2013, the proportion of E.coli BSIs with FQ-NS was highest in the West South-Central Division (32.7 % and lowest in the Mountain Division (20.0 %. Multivariable analysis showed that there were universal secular trends towards higher FQ-NS rates (p < 0.001 with significant variability of slopes across US Census Divisions (p < 0.001. Conclusion There has been a universal increase in FQ-NS among E.coli BSIs within VHA, but the rate of increase has significantly varied across Census Divisions. The reasons for this variability are unclear. These findings reinforce the importance of using local data to develop and update local antibiograms and antibiotic-prescribing guidelines.

  3. Does antimicrobial use density at the ward level influence monthly central line-associated bloodstream infection rates?

    Directory of Open Access Journals (Sweden)

    Yoshida J

    2014-12-01

    Full Text Available Junichi Yoshida, Yukiko Harada, Tetsuya Kikuchi, Ikuyo Asano, Takako Ueno, Nobuo Matsubara Infection Control Committee, Shimonoseki City Hospital, Shimonoseki, Japan Abstract: The aim of this study was to elucidate risk factors, including ward antimicrobial use density (AUD, for central line-associated bloodstream infection (CLABSI as defined by the Centers for Disease Control and Prevention in a 430-bed community hospital using central venous lines with closed-hub systems. We calculated AUD as (total dose/(defined daily dose × patient days ×1,000 for a total of 20 drugs, nine wards, and 24 months. Into each line day data, we inputed AUD and device utilization ratios, number of central line days, and CLABSI. The ratio of susceptible strains in isolates were subjected to correlation analysis with AUD. Of a total of 9,997 line days over 24 months, CLABSI was present in 33 cases (3.3 ‰, 14 (42.4% of which were on surgical wards out of nine wards. Of a total of 43 strains isolated, eight (18.6% were methicillin-resistant Staphylococcus aureus (MRSA; none of the MRSA-positive patients had received cefotiam before the onset of infection. Receiver-operating characteristic analysis showed that central line day 7 had the highest accuracy. Logistic regression analysis showed the central line day showed an odds ratio of 5.511 with a 95% confidence interval of 1.936–15.690 as did AUD of cefotiam showing an odds ratio of 0.220 with 95% confidence interval of 0.00527–0.922 (P=0.038. Susceptible strains ratio and AUD showed a negative correlation (R2=0.1897. Thus, CLABSI could be prevented by making the number of central line days as short as possible. The preventative role of AUD remains to be investigated. Keywords: bloodstream infection, central line, antimicrobial use density

  4. Clinical and Microbiological Characteristics of Heteroresistant and Vancomycin-Intermediate Staphylococcus aureus from Bloodstream Infections in a Brazilian Teaching Hospital

    Science.gov (United States)

    da Costa, Thaina Miranda; Morgado, Priscylla Guimarães Migueres; Cavalcante, Fernanda Sampaio; Damasco, Andreia Paredes; Nouér, Simone Aranha; dos Santos, Kátia Regina Netto

    2016-01-01

    This study analyzed clinical and microbiological characteristics of heteroresistant (hVISA) and vancomycin-intermediate Staphylococcus aureus (VISA) from bloodstream infections (BSI) in a Brazilian teaching hospital, between 2011 and 2013. Minimum inhibitory concentrations (MIC) of antimicrobials were determined by broth microdilution method and SCCmec was detected by PCR. Isolates with a vancomycin MIC ≥ 2mg/L were cultured on BHI agar with 3, 4 or 6 mg/L (BHIa3, BHIa4 or BHIa6) of vancomycin and BHIa4 with casein (BHIa4ca). Macromethod Etest® and Etest® Glicopeptides Resistance Detection were also used. VISA and hVISA isolates were confirmed by the population analysis profile then typed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing. Medical data from the patients were obtained from their medical records. Among 110 consecutive isolates, 31 (28%) were MRSA and carried the SCCmec type II (15 isolates) or IV (16 isolates). Vancomycin MIC50 and MIC90 were 1 and 2 mg/L, respectively. MRSA isolates had increased non-susceptibility to daptomycin (p = 0.0003). Six (5%) isolates were VISA, four of which were MRSA, three SCCmec type II/USA100/ST5 and one type IV/USA800/ST3192. One MRSA SCCmec II isolate grew on agar BHIa3, BHIa4 and BHIa4ca, and it was confirmed as hVISA. Among the six VISA isolates, five (83%) grew on BHIa3 and three (50%) on BHI4ca. Four of the six VISA isolates and the one hVISA isolate were from patients who had undergone dialysis. Thus, a possible dissemination of the SCCmec II/USA100/ST5 lineage may have occurred in the hospital comprising the VISA, hVISA and daptomycin non-susceptible S. aureus Brazilian isolates from health care associated bloodstream infections. PMID:27575698

  5. Epidemiological characterization of Acinetobacter baumannii bloodstream isolates from a Chinese Burn Institute: A three-year study.

    Science.gov (United States)

    Huang, Guangtao; Yin, Supeng; Xiang, Lijuan; Gong, Yali; Sun, Kedai; Luo, Xiaoqiang; Zhang, Cheng; Yang, Zichen; Deng, Liuyang; Jiang, Bei; Jin, Shouguang; Chen, Jing; Peng, Yizhi

    2016-11-01

    Acinetobacter baumannii infection is a serious threat to burn patients. Bacteremia due to A. baumannii is becoming the most common cause of mortality following burn. However, the epidemiology of A. baumannii causing burn-related bloodstream infections has rarely been reported. We retrospectively collected 81 A. baumannii isolates from the bloodstream of burn patients over a three-year period. Antibiotic susceptibility tests, the prevalence of antibiotic-resistant genes and sequence typing (ST) were conducted to characterize these strains. Most of the isolates showed an extensive drug-resistant phenotype. The resistance frequencies to imipenem and meropenem were 94% and 91%, respectively. The blaOXA-23-like gene, AmpC, IS-AmpC, PER and SIM are the five most prevalent resistant genes, and their prevalence rates are 93% (75/81), 86% (70/81), 73% (59/81), 73% (59/81) and 52% (42/81), respectively. The 81 isolates were grouped into 10 known and 18 unknown ST types, with ST368 (38%) being the most prevalent. Except for ST457 and four new types (STn2, STn6, STn11 and STn14), the remaining 23 ST types belonged to one clonal complex 92, which is most common among clinical isolate in China. The above results indicated that ST368 isolates possessing both the blaOXA-23-like gene and ampC gene were the main culprits of the increasing nosocomial A. baumannii infection in this study. More attention should be paid to monitoring the molecular epidemiology of A. baumannii isolates from burn patients to prevent further distribution. Such information may help clinicians with therapeutic decisions and infection control in the Burns Institute.

  6. Bloodstream infections caused by Escherichia coli producing AmpC β-lactamases: epidemiology and clinical features.

    Science.gov (United States)

    Pascual, V; Alonso, N; Simó, M; Ortiz, G; Garcia, M C; Xercavins, M; Rivera, A; Morera, M A; Miró, E; Espejo, E; Navarro, F; Gurguí, M; Pérez, J; Rodríguez-Carballeira, M; Garau, J; Calbo, E

    2016-12-01

    The aim of the study was to investigate the epidemiology and clinical features of bloodstream infections due to Escherichia coli producing AmpC β-lactamases (AmpC-Ec-BSI). In a multi-centre case-control study, all third-generation-cephalosporin-resistant Escherichia coli BSI (3GC-Ec-BSI) isolates were analysed. Acquired bla AmpC (bla ac-AmpC) detection was done by polymerase chain reaction (PCR) and sequencing. Chromosomal bla AmpC (bla c-AmpC) expression was quantified by real-time PCR. Cases were patients with AmpC-Ec-BSI. Controls were patients with cephalosporin-susceptible E. coli BSI, matched 1:1 by sex and age. Demographics, comorbidities, intrinsic and extrinsic risk factors for antimicrobial resistance, clinical presentation and outcomes were investigated. Among 841 E. coli BSI, 17 were caused by AmpC-Ec (2 %). Eleven isolates (58.8 %) had bla ac-AmpC and six were bla c-AmpC overproducers. The mean age of cases was 66.2 years and 71 % were men. Cases were more frequently healthcare-related (82 vs. 52 % controls, p < 0.05) and presented more intrinsic and extrinsic risk factors. At least one risk factor was present in 94.1 % of cases vs. 41.7 % of controls (p = 0.002). Severity and length of stay (LOS) were higher among cases (mean Pitt Score 2.6 vs. 0.38 in controls, p = 0.03; LOS 17.5 days vs. 6 in controls, p = 0.02). Inappropriate empirical therapy (IET) was administered to 70.6 % of cases and 23.5 % of controls (p < 0.003). No differences were found in terms of cure rate at the 14th day and mortality. Bloodstream infections due to AmpC-Ec (mostly plasmid-mediated) are infrequent in our area. AmpC-Ec-BSI affects mainly patients with intrinsic risk factors and those with previous antibiotic exposure. A high proportion received IET.

  7. Clinical and Laboratory Characteristics of Patients with Nontuberculous Mycobacterium Bloodstream Infection in a Tertiary Referral Hospital in Beijing, China

    Institute of Scientific and Technical Information of China (English)

    Sai-Nan Bian; Li-Fan Zhang; Yue-Qiu Zhang; Qi-Wen Yang; Peng Wang; Ying-Chun Xu; Xiao-Chun Shi

    2016-01-01

    Background:Nontuberculous Mycobacterium (NTM) bloodstream infection (BSI) is relatively rare.We aimed in this study to evaluate the clinical characteristics,laboratory evaluation,and outcomes of patients with NTM BSI.Methods:We retrospectively reviewed the clinical records of inpatients with NTM BSI at our institution between January 2008 and January 2015 and recorded clinical parameters including age,gender,underlying disease,clinical manifestation,organs involved with NTM disease,species of NTM,laboratory data,treatment and outcome of these patients.We also reviewed the reported cases and case series ofNTM BSI by searching PubMed,EMBASE,and Wanfang databases.Data of normal distribution were expressed by mean ± standard deviation (SD).Data of nonnormal distribution were expressed by median and interquartile range (IQR).Results:Among the ten patients with NTM BSI,the median age was 51 years (IQR 29-57 years) and three patients were males.Eight patients were immunocompromised,with underlying diseases including human immunodeficiency virus (HIV) infection (one patient),rheumatic diseases (two patients),breast cancer (one patient),myelodysplastic syndrome (two patients),and aplastic anemia (two patients).Other organ(s) involved were lung (two patients),endocardium (two patients),brain,spinal cord,and soft tissue (one each patient).The median lymphocyte was 0.66 × 109/L (IQR 0.24-1.93 × 109/L).The median cluster of differentiation 4 (CD4) cell count was 179/ mm3 (IQR 82-619/mm3).Five patients died (three with hematological diseases,one with breast cancer,and one with rheumatic disease),three recovered,and two were lost to follow-up.Conclusions:We reported all cases in our hospital diagnosed with bloodstream NTM infection that was rarely reported.In this group of patients,patients usually had a high fever and could have multiple organ involvements.All patients with poor prognosis had underlying diseases.

  8. A Multinational, Preregistered Cohort Study of β-Lactam/β-Lactamase Inhibitor Combinations for Treatment of Bloodstream Infections Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae

    OpenAIRE

    Gutiérrez-Gutiérrez, Belén; Pérez-Galera, Salvador; Salamanca, Elena; de Cueto, Marina; Calbo, Esther; Almirante, Benito; Viale, Pierluigi; Oliver, Antonio; Pintado, Vicente; Gasch, Oriol; Martínez-Martínez, Luis; Pitout, Johann; Akova, Murat; Peña, Carmen; José MOLINA

    2016-01-01

    The spread of extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) is leading to increased carbapenem consumption. Alternatives to carbapenems need to be investigated. We investigated whether β-lactam/β-lactamase inhibitor (BLBLI) combinations are as effective as carbapenems in the treatment of bloodstream infections (BSI) due to ESBL-E. A multinational, retrospective cohort study was performed. Patients with monomicrobial BSI due to ESBL-E were studied; specific criteri...

  9. Nationwide German Multicenter Study on Prevalence of Antibiotic Resistance in Staphylococcal Bloodstream Isolates and Comparative In Vitro Activities of Quinupristin-Dalfopristin

    OpenAIRE

    Von Eiff, Christof; Reinert, Ralf René; Kresken, Michael; Brauers, Johannes; Hafner, Dieter; Peters, Georg

    2000-01-01

    Antibiotic-resistant gram-positive bacteria have become an increasing problem in the last two decades. In order to evaluate the prevalence of antibiotic resistance in staphylococcal bloodstream isolates in Germany, 2,042 staphylococci collected in 21 tertiary-care hospitals were investigated during a 3-year period (March 1996 to March 1999). Altogether, 1,448 S. aureus isolates and 594 coagulase-negative staphylococci (CoNS) that comprised 13 different species were included. Furthermore, the ...

  10. A 12-year review of Staphylococcus aureus bloodstream infections in haemodialysis patients: more work to be done.

    LENUS (Irish Health Repository)

    Fitzgerald, S F

    2012-02-01

    Staphylococcus aureus bloodstream infections (BSI) are a significant cause of morbidity and mortality in haemodialysis patients. This study describes a 12-year retrospective review of S. aureus BSI in a large haemodialysis centre in a tertiary referral hospital. The overall rate of S. aureus BSI was 17.9 per 100 patient-years (range 9.7-36.8). The rate of meticillin-resistant S. aureus (MRSA) BSI was 5.6 per 100 patient-years (range 0.9-13.8). Infective complications occurred in 11% of episodes, the most common being infective endocarditis (7.6%). Ten percent of patients died within 30 days of S. aureus being isolated from blood. Most cases of S. aureus BSI (83%) were related to vascular catheters. The provision of lower-risk vascular access, such as arteriovenous fistulae, and reduced use of intravascular catheters should be priorities in all haemodialysis units. Where alternative vascular access cannot be established, interventions to reduce the risk of catheter-related infections should be implemented to reduce morbidity and mortality in this vulnerable patient group.

  11. POLYCLONAL OUTBREAK OF BLOODSTREAM INFECTIONS CAUSED BY Burkholderia cepacia COMPLEX IN HEMATOLOGY AND BONE MARROW TRANSPLANT OUTPATIENT UNITS

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    Icaro Boszczowski

    2014-01-01

    Full Text Available Aim: The objective was to describe an outbreak of bloodstream infections by Burkholderia cepacia complex (Bcc in bone marrow transplant and hematology outpatients. Methods: On February 15, 2008 a Bcc outbreak was suspected. 24 cases were identified. Demographic and clinical data were evaluated. Environment and healthcare workers' (HCW hands were cultured. Species were determined and typed. Reinforcement of hand hygiene, central venous catheter (CVC care, infusion therapy, and maintenance of laminar flow cabinet were undertaken. 16 different HCWs had cared for the CVCs. Multi-dose heparin and saline were prepared on counter common to both units. Findings: 14 patients had B. multivorans (one patient had also B. cenopacia, six non-multivorans Bcc and one did not belong to Bcc. Clone A B. multivorans occurred in 12 patients (from Hematology; in 10 their CVC had been used on February 11/12. Environmental and HCW cultures were negative. All patients were treated with meropenem, and ceftazidime lock-therapy. Eight patients (30% were hospitalized. No deaths occurred. After control measures (multidose vial for single patient; CVC lock with ceftazidime; cleaning of laminar flow cabinet; hand hygiene improvement; use of cabinet to store prepared medication, no new cases occurred. Conclusions: This polyclonal outbreak may be explained by a common source containing multiple species of Bcc, maybe the laminar flow cabinet common to both units. There may have been contamination by B. multivorans (clone A of multi-dose vials.

  12. Candida albicans bloodstream isolates in a German university hospital are genetically heterogenous and susceptible to commonly used antifungals.

    Science.gov (United States)

    Huyke, Johanna; Martin, Ronny; Walther, Grit; Weber, Michael; Kaerger, Kerstin; Bougnoux, Marie-Elisabeth; Elias, Johannes; Kurzai, Oliver

    2015-10-01

    From an eight-year-span, 99 Candida bloodstream isolates were collected at the University Hospital Wuerzburg, Germany. In this study, all strains were analyzed using molecular and phenotypic typing methods. Confirmatory species identification revealed three isolates that were initially diagnosed as C. albicans to be actually C. dubliniensis. Two isolates contained a mixed culture of C. albicans and C. glabrata, in one of the specimens both species could be separated while it was not possible to recover C. albicans in the other sample. The remaining 95 C. albicans isolates were profiled by multilocus sequence typing (MLST). Phylogenetic analyses showed a highly heterogenous collection of strains, associated with many different clades and constituting a set of new diploid sequence types (DST). For all strains with identical DST, patient data were reviewed for potential nosocomial transmission. In addition, all isolates were tested for their susceptibility to amphotericin B, caspofungin, fluconazole, itraconazole, posaconazole and voriconazole. No clinically relevant resistance could be detected. Furthermore, these data underline that correlation between minimal inhibitory concentrations for caspofungin and anidulafungin is low.

  13. The impact of HIV infection on blood leukocyte responsiveness to bacterial stimulation in asymptomatic patients and patients with bloodstream infection

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    Michaëla A M Huson

    2016-05-01

    Full Text Available Introduction: HIV-induced changes in cytokine responses to bacteria may influence susceptibility to bacterial infections and the consequent inflammatory response. Methods: We examined the impact of HIV on whole blood responsiveness to bacterial stimulation in asymptomatic subjects and patients with bacterial bloodstream infection (BSI. Whole blood was stimulated ex vivo with two bacterial Toll-like receptor agonists (lipopolysaccharide and lipoteichoic acid and two pathogens (Streptococcus pneumoniae and non-typhoidal Salmonella, which are relevant in HIV-positive patients. Production of interferon-γ, tumour necrosis factor-α, interleukin-1β and interleukin-6 was used as a read-out. Results: In asymptomatic subjects, HIV infection was associated with reduced interferon-γ, release after stimulation and priming of the pro-inflammatory cytokine response to non-typhoidal Salmonella. In patients with BSI, we found no such priming effect, nor was there evidence for more profound sepsis-induced immunosuppression in BSI patients with HIV co-infection. Conclusions: These results suggest a complex effect of HIV on leukocyte responses to bacteria. However, in patients with sepsis, leukocyte responses were equally blunted in patients with and without HIV infection.

  14. The Antibiotic Resistance Profiles of Bacterial Strains Isolated from Patients with Hospital-Acquired Bloodstream and Urinary Tract Infections

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    Hamed Ghadiri

    2012-01-01

    Full Text Available Treatment of nosocomial infections is becoming difficult due to the increasing trend of antibiotics resistance. Current knowledge on antibiotic resistance pattern is essential for appropriate therapy. We aimed to evaluate antibiotic resistance profiles in nosocomial bloodstream and urinary tract pathogens. A total of 129 blood stream and 300 urinary tract positive samples were obtained from patients referring to Besat hospital over a two-year period (2009 and 2010. Antibiotic sensitivity was ascertained using the Kirby-Bauer disk diffusion technique according to CLSI guidelines. Patient's data such as gender and age were recorded. The ratio of gram-negative to gram-positive bacteria in BSIs was 1.6 : 1. The most prevalent BSI pathogen was Coagulase-Negative Staphylococci (CoNS. The highest resistance rate of CoNS was against penicillin (91.1% followed by ampicillin (75.6%, and the lowest rate was against vancomycin (4.4%. Escherichia coli was the most prevalent pathogen isolated from urinary tract infections (UTIs. Ratio of gram-negative to gram-positive bacteria was 3.2 : 1. The highest resistance rate of E. coli isolates was against nalidixic acid (57.7%. The present study showed that CoNS and E. coli are the most common causative agents of nosocomial BSIs and UTIs, and control of infection needs to be addressed in both antibiotic prescription and general hygiene.

  15. Erratum to: Seasonal trend and clinical presentation of Bacillus cereus bloodstream infection: association with summer and indwelling catheter.

    Science.gov (United States)

    Kato, K; Matsumura, Y; Yamamoto, M; Nagao, M; Ito, Y; Takakura, S; Ichiyama, S

    2016-05-01

    Bacillus cereus, an opportunistic pathogen, can cause fatal infection. However, B. cereus bloodstream infections (BSIs) have not been well characterised. From 2008 to 2013, B. cereus isolates from all of the specimens and patients with B. cereus BSIs were identified. Environmental samples were collected to detect B. cereus contamination. We also characterised the clinical presentation of B. cereus BSI through analyses of risk factors for BSI and mortality. A total of 143 clinical B. cereus isolates was detected. Fifty-one patients with nosocomial infections were diagnosed as B. cereus BSI, and 37 had contaminated blood cultures. The number of B. cereus isolates and BSI patients was significantly greater from June to September than from January to April (3.4 vs. 1.0 per month and 1.4 vs. 0.2, respectively). All BSIs were nosocomial and related to central or peripheral vascular catheter. Urinary catheter [odds ratio (OR) 6.93, 95 % confidence interval (CI) 2.40-20.0] was the independent risk factor associated with BSI patients when compared to patients regarded as contaminated. In-hospital mortality among BSI patients was 20 % and was associated with urinary catheter (OR 12.3, 95 % CI 0.67-225, p=0.045) and higher Charlson index (OR 1.99, 95 % CI 1.26-3.12). The number of B. cereus isolates and BSI increased during summer. Inpatients with indwelling vascular or urinary catheters should be carefully monitored for potential B. cereus BSIs.

  16. Risk factors for mortality in patients with bloodstream infections during the pre-engraftment period after hematopoietic stem cell transplantation

    Science.gov (United States)

    Karpov, Igor; Milanovich, Natalia; Uss, Anatoly; Iskrov, Igor

    2016-01-01

    Background Bloodstream infections (BSI) remain a frequent complication during the pre-engraftment period after hematopoietic stem cell transplantation (HSCT), resulting in high mortality rates. This study evaluated risk factors for mortality in hematopoietic stem cell transplant recipients with BSI in the pre-engraftment period. Methods This prospective case control study was performed at the Center of Hematology and Bone Marrow Transplantation in Minsk, Republic of Belarus. Data relating to patient age and gender, date and type of transplantation, conditioning chemotherapy regimen, microorganisms isolated from blood, and antibacterial therapy were prospectively collected from all hematopoietic stem cell recipients with microbiologically proven cases of BSI in the pre-engraftment period. The primary outcome was all-cause 30-day mortality after onset of febrile neutropenia. Results A total of 135 adult patients with microbiologically proven BSI after HSCT were studied, with 65.2% of cases caused by gram-negative microorganisms and 21.5% by non-fermenting bacteria. Inadequate empiric antibacterial therapy and isolation of carbapenem-resistant non-fermenting gram-negative bacteria (Acinetobacter baumannii and Pseudomonas aeruginosa) were independently associated with increased all-cause 30-day mortality in these patients. Conclusion The risk factors for mortality in adult patients with BSI in the pre-engraftment period after HSCT were inadequacy of empirical antibacterial therapy and isolation of carbapenem-resistant A. baumannii or P. aeruginosa. PMID:27382554

  17. Development of subsequent bloodstream infection in patients with positive Hickman catheter blood cultures and negative peripheral blood cultures.

    Science.gov (United States)

    Park, Ki-Ho; Cho, Oh-Hyun; Lee, Sang-Oh; Choi, Sang-Ho; Kim, Yang Soo; Woo, Jun Hee; Kim, Mi-Na; Kim, Dae-Young; Lee, Jung-Hee; Lee, Je-Hwan; Lee, Kyoo-Hyung; Lee, Dae Ho; Suh, Cheolwon; Kim, Sung-Han

    2011-05-01

    There are limited data on the incidence of subsequent bloodstream infection (BSI) and the effect of systemic antibiotics in patients who had positive catheter-drawn blood cultures (CBC) and negative peripheral blood cultures (PBC). We retrospectively reviewed all paired blood cultures from patients with Hickman catheter in the hematology-oncology ward between January 1997 and December 2008. There were 112 episodes with positive CBC and negative PBC. Nine episodes (8.0%; 95% CI, 3.0-13.1%) led to subsequent BSI within 28 days. Subsequent BSI developed in 6 of 31 episodes (19%) where empiric antibiotics were inappropriate but in 3 of 81 episodes (4%) where empiric antibiotics were appropriate (P = 0.01). Subsequent candidemia (50%, 2 of 4) was more common than subsequent bacteremia (6%, 7 of 108) (P = 0.03). In conclusion, for patients with positive CBC and negative PBC, the overall incidence of subsequent BSI was 8.0%, and inappropriate empiric antibiotics was associated with subsequent BSI.

  18. Carbapenemase-producing Klebsiella pneumoniae bloodstream infections: lowering mortality by antibiotic combination schemes and the role of carbapenems.

    Science.gov (United States)

    Daikos, George L; Tsaousi, Sophia; Tzouvelekis, Leonidas S; Anyfantis, Ioannis; Psichogiou, Mina; Argyropoulou, Athina; Stefanou, Ioanna; Sypsa, Vana; Miriagou, Vivi; Nepka, Martha; Georgiadou, Sarah; Markogiannakis, Antonis; Goukos, Dimitris; Skoutelis, Athanasios

    2014-01-01

    Carbapenemase-producing Klebsiella pneumoniae strains (CP-Kps) are currently among the most important nosocomial pathogens. An observational study was conducted during 2009 to 2010 in two hospitals located in a high-prevalence area (Athens, Greece). The aims were (i) to evaluate the clinical outcome of patients with CP-Kp bloodstream infections (BSIs), (ii) to identify predictors of mortality, and (iii) to evaluate the various antibiotic schemes employed. A total of 205 patients with CP-Kp BSIs were identified: 163 (79.5%) were infected with KPC or KPC and VIM, and 42 were infected with VIM producers. For definitive treatment, 103 patients received combination therapy (two or more active drugs), 72 received monotherapy (one active drug), and 12 received therapy with no active drug. The remaining 18 patients died within 48 h after the onset of bacteremia. The all-cause 28-day mortality was 40%. A significantly higher mortality rate was observed in patients treated with monotherapy than in those treated with combination therapy (44.4% versus 27.2%; P=0.018). The lowest mortality rate (19.3%) was observed in patients treated with carbapenem-containing combinations. In the Cox proportion hazards model, ultimately fatal disease (hazards ratio [HR], 3.25; 95% confidence interval [CI], 1.51 to 7.03; P=0.003), the presence of rapidly fatal underlying diseases (HR, 4.20; 95% CI, 2.19 to 8.08; Pcarbapenem-containing regimens.

  19. High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus

    Science.gov (United States)

    Viedma, Esther; Chaves, Fernando; Lalueza, Antonio; Fortún, Jesús; Loza, Elena; Pujol, Miquel; Ardanuy, Carmen; Morales, Isabel; de Cueto, Marina; Resino-Foz, Elena; Morales-Cartagena, Alejandra; Rico, Alicia; Romero, María P.; Orellana, María Ángeles; López-Medrano, Francisco; Fernández-Ruiz, Mario; Aguado, José María

    2016-01-01

    We investigated the prognostic role of high MICs for antistaphylococcal agents in patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection (MSSA CRBSI). We prospectively reviewed 83 episodes from 5 centers in Spain during April 2011–June 2014 that had optimized clinical management and analyzed the relationship between E-test MICs for vancomycin, daptomycin, oxacillin, and linezolid and development of complicated bacteremia by using multivariate analysis. Complicated MSSA CRBSI occurred in 26 (31.3%) patients; MICs for vancomycin and daptomycin were higher in these patients (optimal cutoff values for predictive accuracy = 1.5 μg/mL and 0.5 μg/mL). High MICs for vancomycin (hazard ratio 2.4, 95% CI 1.2–5.5) and daptomycin (hazard ratio 2.4, 95% CI 1.1–5.9) were independent risk factors for development of complicated MSSA CRBSI. Our data suggest that patients with MSSA CRBSI caused by strains that have high MICs for vancomycin or daptomycin are at increased risk for complications. PMID:27192097

  20. Comparison of severity of illness scoring systems for patients with nosocomial bloodstream infection due to Pseudomonas aeruginosa

    Directory of Open Access Journals (Sweden)

    Wenzel Richard P

    2006-08-01

    Full Text Available Abstract Background Several acute illness severity scores have been proposed for evaluating patients on admission to intensive care units but these have not been compared for patients with nosocomial bloodstream infection (nBSI. We compared three severity of illness scoring systems for predicting mortality in patients with nBSI due to Pseudomonas aeruginosa. Methods We performed a historical cohort study on 63 adults in intensive care units with P. aeruginosa monomicrobial nBSI. Results The Acute Physiology, Age, Chronic Health Evaluation II (APACHE II, Sequential Organ Failure Assessment (SOFA, and Simplified Acute Physiologic Score (SAPS II, were calculated daily from 2 days prior through 2 days after the first positive blood culture. Calculation of the area under the receiver operating characteristic (ROC curve confirmed that APACHE II and SAPS II at day -1 and SOFA at day +1 were better predictors of outcome than days -2, 0 and day 2 of BSI. By stepwise logistic regression analysis of these three scoring systems, SAPS II (OR: 13.03, CI95% 2.51–70.49 and APACHE II (OR: 12.51, CI95% 3.12–50.09 on day -1 were the best predictors for mortality. Conclusion SAPS II and APACHE II are more accurate than the SOFA score for predicting mortality in this group of patients at day -1 of BSI.

  1. Surveillance of bloodstream infections in pediatric cancer centers – what have we learned and how do we move on?

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    Simon, Arne

    2016-05-01

    Full Text Available Pediatric patients receiving conventional chemotherapy for malignant disease face an increased risk of bloodstream infection (BSI. Since BSI may represent an acute life-threatening event in patients with profound immunosuppression, and show further negative impact on quality of life and anticancer treatment, the prevention of BSI is of paramount importance to improve and guarantee patients’ safety during intensive treatment. The great majority of all pediatric cancer patients (about 85% have a long-term central venous access catheter in use (type Broviac or Port; CVAD. Referring to the current surveillance definitions a significant proportion of all BSI in pediatric patients with febrile neutropenia is categorized as CVAD- BSI. This state of the art review summarizes the epidemiology and the distinct pathogen profile of BSI in pediatric cancer patients from the perspective of infection surveillance. Problems in executing the current surveillance definition in this patient population are discussed and a new concept for the surveillance of BSI in pediatric cancer patients is outlined.

  2. Bloodstream infection after umbilical cord blood transplantation using reduced-intensity stem cell transplantation for adult patients.

    Science.gov (United States)

    Narimatsu, Hiroto; Matsumura, Tomoko; Kami, Masahiro; Miyakoshi, Shigesaburo; Kusumi, Eiji; Takagi, Shinsuke; Miura, Yuji; Kato, Daisuke; Inokuchi, Chiho; Myojo, Tomohiro; Kishi, Yukiko; Murashige, Naoko; Yuji, Koichiro; Masuoka, Kazuhiro; Yoneyama, Akiko; Wake, Atsushi; Morinaga, Shinichi; Kanda, Yoshinobu; Taniguchi, Shuichi

    2005-06-01

    Bloodstream infection (BSI) is a significant problem after cord blood transplantation (CBT). However, little information has been reported on BSI after reduced-intensity CBT (RI-CBT). We retrospectively reviewed the medical records of 102 patients. The median age of the patients was 55 years (range, 17-79 years). Preparative regimens comprised fludarabine 125 to 150 mg/m 2 , melphalan 80 to 140 mg/m 2 , or busulfan 8 mg/kg and total body irradiation 2 to 8 Gy. Prophylaxis against graft-versus-host disease comprised cyclosporin or tacrolimus. BSI developed within 100 days of RI-CBT in 32 patients. The cumulative incidence of BSI was 25% at day 30 and 32% at day 100. The median onset was day 15 (range, 1-98 days). Causative organisms included Pseudomonas aeruginosa (n = 12), Staphylococcus epidermidis (n = 11), Staphylococcus aureus (n = 6), Enterococcus faecium (n = 4), Enterococcus faecalis (n = 4), Stenotrophomonas maltophilia (n = 4), and others (n = 7). Of the 32 patients with BSI, 25 (84%) died within 100 days after RI-CBT. BSI was the direct cause of death in 8 patients (25%). Univariate analysis failed to identify any significant risk factors. BSI clearly represents a significant and fatal complication after RI-CBT. Further studies are warranted to determine clinical characteristics, identify patients at high risk of BSI, and establish therapeutic strategies.

  3. 成人原发血流感染494例临床分析%Clinical analysis of adult primary bloodstream infection

    Institute of Scientific and Technical Information of China (English)

    张黎; 刘正印; 徐英春; 李太生; 杨启文; 王爱霞

    2012-01-01

    Objective Evaluate the microbiological and epidemiological characteristics of primary bloodstream infections as well as the associated patients' clinical features at Peking Union Medical College Hospital.Method Microbiological and clinical data of the adult patients with primary bloodstream infections during January 1,2008 and December 31,2009 were retrospectively collected and evaluated.Pearson x2 test was used to compare the difference between proportions and Logistic regression was used in multivariate analysis.Result Five hundred and eighty-six strains of microbes were isolated from 494 adult patients with primary bloodstream infections.There were 80 patients with polymicrobial primary bloodstream infection of the 586 isolates,coagulase-negative staphylococci ( 175,29.9% ) was the most common,followed by Escherichia coli( 93,15.9% ),Enterococcus species ( 60,10.2% ),Streptococcus species ( 41,7.0% ),and Staphylococcus Aureus (39,6.7% ).Central-line was the leading suspected infective source among the suspected infective source involving 108 (18.4%) isolates. Excluded the 108 isolates with suspected sources,77 (45.3%) out of 167 patients with the primary bloodstream infections caused by coagulasc-negative staphylococci or Staphylococcus Aureus had a central-line,with a higher proportion of the patients with a central-line than the patients with bloodstream infection caused by other pathogens ( x2 =10.419,P =0.001 ).One hundred and fourteen patients died during hospitalization,with the crude mortality rate 23.0%.Fifty-nine patients (11.9%) died due to primary bloodstream infection.The patients with polymicrobial bloodstream infection were with a higher attributable mortality( OR =2.159 ;95% CI 1.165 -4.002 ;x2 =6.194,P =0.013 ).In the multivariate analysis,the independent risk factors of crude mortality rate to primary bloodstream infections were elderly patients,central neurological disorder,mechanical ventilation,and reservation a central

  4. A luciferase based viability assay for ATP detection in 384-well format for high throughput whole cell screening of Trypanosoma brucei brucei bloodstream form strain 427

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    Avery Vicky M

    2009-11-01

    Full Text Available Abstract Background Human African Trypanosomiasis (HAT is caused by two trypanosome species, Trypanosoma brucei rhodesiense and Trypanosoma brucei gambiense. Current drugs available for the treatment of HAT have significant issues related to toxicity, administration regimes with limited effectiveness across species and disease stages, thus there is a considerable need to find alternative drugs. A well recognised approach to identify new drug candidates is high throughput screening (HTS of large compound library collections. Results We describe here the development of a luciferase based viability assay in 384-well plate format suitable for HTS of T.b.brucei. The parameters that were explored to determine the final HTS assay conditions are described in detail and include DMSO tolerability, Z', diluents and cell inoculum density. Reference compound activities were determined for diminazene, staurosporine and pentamidine and compared to previously published IC50 data obtained. The assay has a comparable sensitivity to reference drugs and is more cost effective than the 96-well format currently reported for T.b.brucei. Conclusion Due to the reproducibility and sensitivity of this assay it is recommended for potential HTS application. As it is commercially available this assay can also be utilised in many laboratories for both large and small scale screening.

  5. Narrative form

    CERN Document Server

    Keen, Suzanne

    2015-01-01

    This revised and expanded handbook concisely introduces narrative form to advanced students of fiction and creative writing, with refreshed references and new discussions of cognitive approaches to narrative, nonfiction, and narrative emotions.

  6. Risk factors for bloodstream infections in 66 patients in ICU%ICU 66例血流感染患者危险因素分析

    Institute of Scientific and Technical Information of China (English)

    姚彬; 习慧明

    2012-01-01

    OBJECTIVE To investigate the risk factors for bloodstream infections in the intensive care unit (ICU), to analyze the distribution of pathogens and their drug resistance so as to provide basis for the prevention and treatment of bloodstream infections and reduce the incidence of bloodstream infections and the mortality. METHODS Totally 66 patients with bloodstream infections were investigated retrospectively in the ICU of Beijing Haidian Hospital between 2009 and 2011, the risk factors for bloodstream infections, the distribution of pathogens, and the drug resistance characteristics were analyzed. RESULTS A total of 70 strains of pathogens were isolated from 66 patients with bloodstream infections, including 32 (45. 7%) strains of gram-negative bacteria,28 (40. 0%) strains of gram-positive bacteria, and 10 (14.3%) strains of fungi; the main pathogens causing bloodstream infections were coagulase-negative Staphylococci (25. 7%), Acinetobacter baumannii (12.9%), Yeast (12. 9%), Burkholderia cepacia (10.0%), Enterococcus feces (8.6%), and Escherichia coli (8. 6%). Those patients with the bloodstream infections had poor prognosis and the mortality rate was high, up to 69. 23%. The chronic underlying disease, low immunity, invasive operation,and the abuse of antibiotics were risk factors of bloodstream infections. CONCLUSION The distribution of the gram-negative bacteria is as basically same as the gram-positive bacteria in the pathogens causing blood stream infections in the ICU during the three years. A. baumannii is the main species of gram-negative bacteria, and coagulase-negative Staphylococci was the predominant species of gram-positive bacteria. The strict aseptic operation, careful nursing of catheter, intensifying the blood culture, and reasonable use of antibiotics are the effective measures to prevent and treat the bloodstream infections.%目的 了解重症监护病房(ICU)血流感染的危险因素、病原菌分布特点及其耐药性,为更好地预防

  7. Comparison of pathogen DNA isolation methods from large volumes of whole blood to improve molecular diagnosis of bloodstream infections.

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    Anne J M Loonen

    Full Text Available For patients suffering from bloodstream infections (BSI molecular diagnostics from whole blood holds promise to provide fast and adequate treatment. However, this approach is hampered by the need of large blood volumes. Three methods for pathogen DNA isolation from whole blood were compared, i.e. an enzymatic method (MolYsis, 1-5 ml, the novel non-enzymatic procedure (Polaris, 1-5 ml, and a method that does not entail removal of human DNA (Triton-Tris-EDTA EasyMAG, 200 µl. These methods were evaluated by processing blood spiked with 0-1000 CFU/ml of Staphylococcus aureus, Pseudomonas aeruginosa and Candida albicans. Downstream detection was performed with real-time PCR assays. Polaris and MolYsis processing followed by real-time PCRs enabled pathogen detection at clinically relevant concentrations of 1-10 CFU/ml blood. By increasing sample volumes, concurrent lower cycle threshold (Ct values were obtained at clinically relevant pathogen concentrations, demonstrating the benefit of using larger blood volumes. A 100% detection rate at a concentration of 10 CFU/ml for all tested pathogens was obtained with the Polaris enrichment, whereas comparatively lower detection rates were measured for MolYsis (50-67% and EasyMAG (58-79%. For the samples with a concentration of 1 CFU/ml Polaris resulted in most optimal detection rates of 70-75% (MolYsis 17-50% and TTE-EasyMAG 20-36%. The Polaris method was more reproducible, less labour intensive, and faster (45 minutes (including Qiagen DNA extraction vs. 2 hours (MolYsis. In conclusion, Polaris and MolYsis enrichment followed by DNA isolation and real-time PCR enables reliable and sensitive detection of bacteria and fungi from 5 ml blood. With Polaris results are available within 3 hours, showing potential for improved BSI diagnostics.

  8. Bloodstream infection in patients with end-stage renal disease in a teaching hospital in central-western Brazil

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    Tamara Trelha Gauna

    2013-08-01

    Full Text Available Introduction Vascular access in patients undergoing hemodialysis is considered a critical determinant of bloodstream infection (BSI and is associated with high morbidity and mortality. The purpose of this study was to investigate the occurrence of BSI in patients with end-stage renal disease using central venous catheters for hemodialysis. Methods A cohort study was conducted in a public teaching hospital in central-western Brazil from April 2010 to December 2011. For every patient, we noted the presence of hyperemia/exudation upon catheter insertion, as well as fever, shivering, and chills during hemodialysis. Results Fifty-nine patients were evaluated. Thirty-five (59.3% patients started dialysis due to urgency, 37 (62.7% had BSI, and 12 (20% died. Hyperemia at the catheter insertion site (64.9% was a significant clinical manifestation in patients with BSI. Statistical analysis revealed 1.7 times more cases of BSI in patients with hypoalbuminemia compared with patients with normal albumin levels. The principal infective agents identified in blood cultures and catheter-tip cultures were Staphylococcus species (24 cases, non-fermentative Gram-negative bacilli (7 cases of Stenotrophomonas maltophilia and 5 cases of Chryseobacterium indologenes, and Candida species (6. Among the Staphylococci identified, 77.7% were methicillin-resistant, coagulase-negative Staphylococci. Of the bacteria isolated, the most resistant were Chryseobacterium indologenes and Acinetobacter baumannii. Conclusions Blood culture was demonstrated to be an important diagnostic test and identified over 50% of positive BSI cases. The high frequency of BSI and the isolation of multiresistant bacteria were disturbing findings. Staphylococcus aureus was the most frequently isolated microorganism, although Gram-negative bacteria predominated overall. These results highlight the importance of infection prevention and control measures in dialysis units.

  9. Differential Gel Electrophoresis (DIGE) Evaluation of Naphthoimidazoles Mode of Action: A Study in Trypanosoma cruzi Bloodstream Trypomastigotes

    Science.gov (United States)

    Brunoro, Giselle Villa Flor; Faça, Vitor Marcel; Caminha, Marcelle Almeida; Ferreira, André Teixeira da Silva; Trugilho, Monique; de Moura, Kelly Cristina Gallan; Perales, Jonas; Valente, Richard Hemmi; Menna-Barreto, Rubem Figueiredo Sadok

    2016-01-01

    Background The obligate intracellular protozoan Trypanosoma cruzi is the causative agent of Chagas disease, a neglected illness affecting millions of people in Latin America that recently entered non-endemic countries through immigration, as a consequence of globalization. The chemotherapy for this disease is based mainly on benznidazole and nifurtimox, which are very efficient nitroderivatives against the acute stage but present limited efficacy during the chronic phase. Our group has been studying the trypanocidal effects of naturally occurring quinones and their derivatives, and naphthoimidazoles derived from β-lapachone N1, N2 and N3 were the most active. To assess the molecular mechanisms of action of these compounds, we applied proteomic techniques to analyze treated bloodstream trypomastigotes, which are the clinically relevant stage of the parasite. Methodology/Principal Findings The approach consisted of quantification by 2D-DIGE followed by MALDI-TOF/TOF protein identification. A total of 61 differentially abundant protein spots were detected when comparing the control with each N1, N2 or N3 treatment, for 34 identified spots. Among the differentially abundant proteins were activated protein kinase C receptor, tubulin isoforms, asparagine synthetase, arginine kinase, elongation factor 2, enolase, guanine deaminase, heat shock proteins, hypothetical proteins, paraflagellar rod components, RAB GDP dissociation inhibitor, succinyl-CoA ligase, ATP synthase subunit B and methionine sulfoxide reductase. Conclusion/Significance Our results point to different modes of action for N1, N2 and N3, which indicate a great variety of metabolic pathways involved and allow for novel perspectives on the development of trypanocidal agents. PMID:27551855

  10. Nosocomial bloodstream infection in patients caused by Staphylococcus aureus: drug susceptibility, outcome, and risk factors for hospital mortality

    Institute of Scientific and Technical Information of China (English)

    CHEN Rong; YAN Zhong-qiang; FENG Dan; LUO Yan-ping; WANG Lei-li; SHEN Ding-xia

    2012-01-01

    Background Previous studies have different viewpoints about the clinical impact of methicillin resistance on mortality of hospital-acquired bloodstream infection (BSI) patients with Staphylococcus aureus (S.aureus).The objective of this study was to investigate the mortality of hospital-acquired BSI with S.aureus in a military hospital and analyze the risk factors for the hospital mortality.Methods A retrospective cohort study was performed in patients admitted to the biggest military tertiary teaching hospital in China between January 2006 and May 2011.All included patients had clinically significant nosocomial BSI with S.aureus.Multivariate Logistic regression analysis was used to identify the risk factors for hospital mortality of patients with S.aureus BSI.Results One hundred and eighteen patients of more than one year old were identified as clinically and microbiologically confirmed nosocomial bacteraemia due to S.aureus,and 75 out of 118 patients were infected with methicillin-resistant S.aureus (MRSA).The overall mortality of nosocomial S.aureus BSI was 28.0%.Methicillin resistance in S.aureus bacteremia was associated with significant increase in the length of hospitalization and high proportion of inappropriate empirical antibiotic treatment.After Logistic regression analysis,the severity of clinical manifestations (APACHE Ⅱ score) (odds ratio (OR) 1.22,95% confidence interval (CI) 1.12-1.34) and inadequacy of empirical antimicrobial therapy (OR 0.25,95% CI 0.09-0.69) remained as risk factors for hospital mortality.Conclusions Nosocomial S.aureus BSI was associated with high in-hospital mortality.Methicillin resistance in S.aureus has no significant impact on the outcome of patients with staphylococcal bacteremia.Proper empirical antimicrobial therapy is very important to the prognosis.

  11. Clinical and molecular characteristics of bloodstream infections caused by Candida albicans in children from 2003 to 2011.

    Science.gov (United States)

    Tsai, M-H; Wang, S-H; Hsu, J-F; Lin, L-C; Chu, S-M; Huang, H-R; Chiang, M-C; Fu, R-H; Lu, J-J; Huang, Y-C

    2015-11-01

    We investigated the clinical and molecular characteristics of Candida albicans bloodstream infection (BSI) in children from a tertiary-level medical centre in Taiwan over a 9-year period from January 2003 to December 2011. We performed multilocus sequence typing (MLST) to investigate the genetic relatedness of these C. albicans BSI isolates. A total of 79 episodes of C. albicans BSI in 76 paediatric patients were identified, including 41 (51.9%) from the paediatric intensive care unit, 24 (30.4%) from the neonatal intensive care unit and 14 (17.7%) from general wards. More than half (59.5%) of these patients had underlying chronic co-morbidities, and the majority (94.9%) had a catheter or some other artificial device. All the isolates were susceptible to the antifungal agents tested. Only 32.9% (26/79) received effective antifungal agents within 24 h of onset of candidaemia. Twenty-five (31.6%) patients had persistent candidaemia (>3 days after the start of antifungal treatment) and candidaemia-attributable mortality rate was 22.8% (18/79). The 72 isolates available for MLST yielded 53 unique diploid sequence types (DSTs). Forty-five DSTs were singletons and eight DSTs were shared by 27 (37.5%) isolates. Seventy-one (98.6%) isolates were clustered within previously known clades. Based on the definition of two or more strains with shared DST occurring within a period of 90 days, 10.1% of the infections were categorized as nosocomial clusters, most commonly identified in the intensive care units. Although cluster-associated candidaemia was not associated with a higher mortality rate, none of the clusters were identified by the hospital infection control team.

  12. Comparison of the clinical risk factors between Candida albicans and Candida non-albicans species for bloodstream infection.

    Science.gov (United States)

    Shigemura, Katsumi; Osawa, Kayo; Jikimoto, Takumi; Yoshida, Hiroyuki; Hayama, Brian; Ohji, Goh; Iwata, Kentaro; Fujisawa, Masato; Arakawa, Soichi

    2014-04-01

    The purpose of this study is to investigate the risk factors and susceptibilities to antifungal agents of Candida albicans and Candida non-albicans species (spp.) in candidemia cases in Kobe University Hospital. We investigated all consecutive patients with candida bloodstream infection (BSI) from 2008-2013 for whose full data were available for analyses, examining clinical factors such as gender, general complications, postoperative status or susceptibilities to antifungal agents. These factors were also compared between Candida albicans spp. and Candida non-albicans by univariate and multivariate analyses. Univariate analyses showed a significantly higher rate of Candida non-albicans species BSI patients cancer (odds ratio (OR) (95% confidence interval (CI))=2.29 (1.04-5.06) and P=0.040), chemotherapy (OR=4.35 (1.11-17.1) and P=0.035), fluconazole (FLCZ) resistance (OR=77.3 (4.51-1324) and P=0.003), and itraconazole (ITCZ) resistance (OR=15.6 (5.39-45.1) and PCandida albicans. Multivariate analyses demonstrated that Candida non-albicans spp. had significantly higher rate of chemotherapy (OR=4.44 (1.04-19.0) and P=0.045), FLCZ resistance (OR=5.87 (2.01-17.1) and P=0.001), and ITCZ resistance (OR=18.7(5.77-60.4) and PCandida albicans. In conclusion, this study revealed several risk factors for BSI with Candida albicans (underlying cardiovascular diseases and postoperative status) and Candida non-albicans spp. (cancer and chemotherapy), and demonstrated that Candida non-albicans spp. were more resistant to FLCZ and ITCZ than Candida albicans.

  13. Clinical and microbiological characteristics of bloodstream infections in a tertiary hospital in Maceió, Alagoas, Brazil

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    Maria Tereza Freitas Tenório

    2010-04-01

    Full Text Available We observed the clinical and microbiological characteristics of several stages of bloodstream infections (BSI, as well as the mortality attributed to it in a tertiary hospital in the northeast of Brazil (in the city of Maceió, Alagoas. A prospective cohort of 143 patients who had at least one positive blood culture was enrolled in the study. Their clinical evolution was followed up for 30 days from October 2005 to December 2006. The relation among the qualitative variables was verified through Chi-square test. The significance level was 5%. The statistical package adopted was SPSS 15.0 for Windows. Up to the thirtieth day, 30.1% of the patients presented bacteremia and 69.9% developed sepsis.Among these, 20.3% developed severe sepsis and 10.5% septic shock. The mortality attributed to it was 37.8%. In bacteremia, sepsis, severe sepsis, and septic shock conditions, mortality rates were 9.3%, 50%, 65.5%, and 84.6%, respectively. Respiratory (32.2% and urinary (14% sources and the ones related to central venous catheter (14% were prevalent. In the wards 55.12% of the cases developed sepsis, whereas in the intensive care units, the rate was 87.69% (p < 0.05. Chronic renal failure, diabetes melitus, and neuropathy were present in 21.7%, 26.6%, and 29.4% of the cases, respectively. Coagulase-negative Staphylococcus (25.9%, Staphylococcus aureus (21%, and Klebsiella pneumoniae (14% were the most present microorganism in the sample. The high morbidity and mortality rates in this study are attributed to the lack of knowledge on BSI characteristics and on instituted protocols for detection and treatment in early stages.

  14. EFFECT OF INFLIXIMAB ON PARAMETERS OF REMODELING OF ARTERIAL BLOODSTREAM, RANKL AND OSTEOPROTEGERIN LEVELS IN PATIENTS WITH RHEUMATOID ARTHRITIS

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    Larisa Aleksandrovna Knyazeva

    2013-01-01

    Full Text Available Objective. To study the effect of infliximab (INF on serum levels of RANKL and osteoprotegerin (OPG, as well as on structural and functional properties of the vascular wall in patients with rheumatoid arthritis (RA.Material and Methods. A total of 79 RA patients who corresponded to the classification criteria ACR (1987 or ACR/EULAR (2010 and were seronegative for IgM rheumatoid factor (RF were examined. The mean age of patients was 43.6±8.5 years. The serum levels of OPG and RANKL were determined by ELISA (Biomedica, Austria; the common carotid arteries (CCAs were visualized using an Acuson X/10 ultrasonic complex equipped with a 7 MHz linear sensor in the β-mode prior to therapy and after 12-month therapy with INF.Results and Discussion. An increased OPG level was observed mostly in patients with RA duration up to 1 year; an increase in RANKL level was pronounced stronger in patients with PA duration over 2 years. The disturbance of structural and functional properties of the arterial bloodstream was revealed, manifesting itself as an increase in the intimamedia complex thickness, diameter and rigidity index of CCA that were stronger pronounced in patients with late onset RA. A correlation analysis showed the presence of reliable relationship between the RANKL and OPG levels and CCA remodeling parameters. INF therapy showed high clinical effectiveness and correction effect on the RANKL/OPG system. In addition, it was accompanied by a reduction of signs of CCA remodeling, which was stronger pronounced in patients with early RA.Conclusion. The results prove the reasonability of using INF at early stages of RA in order to optimize the therapy and achieve more efficient control of cardiovascular complications.

  15. The Likelihood of Hospital Readmission among Patients with Hospital-Onset Central Line-Associated Bloodstream Infections

    Science.gov (United States)

    Khong, Carolyn; Baggs, James; Kleinbaum, David; Cochran, Ronda; Jernigan, John A.

    2015-01-01

    Objective We sought to determine whether central line-associated bloodstream infections (CLABSI) increase the likelihood of readmission. Design Retrospective matched cohort study for the years 2008–2009. Setting Acute care hospitals. Participants Medicare recipients. CLABSI and readmission status were determined by linking National Healthcare Safety Network surveillance data to the Centers for Medicare & Medicaid Services’ Medical Provider and Analysis Review in eight states. Frequency matching was used on ICD-9-CM procedure code category and intensive care unit status. Methods We compared the rate of readmission among patients with and without CLABSI during an index hospitalization. Cox proportional hazard analysis was used to assess rate of readmission (the first hospitalization within 30 days post-index discharge). Multivariate models included the following covariates: race, sex, length of index hospitalization stay central line procedure code, GAGNE co-morbidity score, and individual chronic conditions. Results Of the 8,097 patients, 2,260 were readmitted within 30 days (27.9%). The rate of first readmission was 7.1 events/person-year (PY) for CLABSI patients and 4.3 events/PY for non-CLABSI patients (p <0.001). The final model revealed a small but significant increase in the rate of 30 day readmissions for patients with a CLABSI compared to similar non-CLABSI patients. In the first readmission for CLABSI patients, we also observed an increase in diagnostic categories consistent with CLABSI including septicemia and complications of a device. Conclusions Our analysis found a statistically significant association between CLABSI status and readmission, suggesting that CLABSI may have adverse health impact that extends beyond hospital discharge. PMID:25990620

  16. Impact of Inadequate Empirical Therapy on the Mortality of Patients with Bloodstream Infections: a Propensity Score-Based Analysis

    Science.gov (United States)

    Retamar, Pilar; Portillo, María M.; López-Prieto, María Dolores; Rodríguez-López, Fernando; de Cueto, Marina; García, María V.; Gómez, María J.; del Arco, Alfonso; Muñoz, Angel; Sánchez-Porto, Antonio; Torres-Tortosa, Manuel; Martín-Aspas, Andrés; Arroyo, Ascensión; García-Figueras, Carolina; Acosta, Federico; Corzo, Juan E.; León-Ruiz, Laura; Escobar-Lara, Trinidad

    2012-01-01

    The impact of the adequacy of empirical therapy on outcome for patients with bloodstream infections (BSI) is key for determining whether adequate empirical coverage should be prioritized over other, more conservative approaches. Recent systematic reviews outlined the need for new studies in the field, using improved methodologies. We assessed the impact of inadequate empirical treatment on the mortality of patients with BSI in the present-day context, incorporating recent methodological recommendations. A prospective multicenter cohort including all BSI episodes in adult patients was performed in 15 hospitals in Andalucía, Spain, over a 2-month period in 2006 to 2007. The main outcome variables were 14- and 30-day mortality. Adjusted analyses were performed by multivariate analysis and propensity score-based matching. Eight hundred one episodes were included. Inadequate empirical therapy was administered in 199 (24.8%) episodes; mortality at days 14 and 30 was 18.55% and 22.6%, respectively. After controlling for age, Charlson index, Pitt score, neutropenia, source, etiology, and presentation with severe sepsis or shock, inadequate empirical treatment was associated with increased mortality at days 14 and 30 (odds ratios [ORs], 2.12 and 1.56; 95% confidence intervals [95% CI], 1.34 to 3.34 and 1.01 to 2.40, respectively). The adjusted ORs after a propensity score-based matched analysis were 3.03 and 1.70 (95% CI, 1.60 to 5.74 and 0.98 to 2.98, respectively). In conclusion, inadequate empirical therapy is independently associated with increased mortality in patients with BSI. Programs to improve the quality of empirical therapy in patients with suspicion of BSI and optimization of definitive therapy should be implemented. PMID:22005999

  17. Surveillance length and validity of benchmarks for central line-associated bloodstream infection incidence rates in intensive care units.

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    Patricia S Fontela

    Full Text Available INTRODUCTION: Several national and regional central line-associated bloodstream infections (CLABSI surveillance programs do not require continuous hospital participation. We evaluated the effect of different hospital participation requirements on the validity of annual CLABSI incidence rate benchmarks for intensive care units (ICUs. METHODS: We estimated the annual pooled CLABSI incidence rates for both a real regional (<100 ICUs and a simulated national (600 ICUs surveillance program, which were used as a reference for the simulations. We simulated scenarios where the annual surveillance participation was randomly or non-randomly reduced. Each scenario's annual pooled CLABSI incidence rate was estimated and compared to the reference rates in terms of validity, bias, and proportion of simulation iterations that presented valid estimates (ideal if ≥ 90%. RESULTS: All random scenarios generated valid CLABSI incidence rates estimates (bias -0.37 to 0.07 CLABSI/1000 CVC-days, while non-random scenarios presented a wide range of valid estimates (0 to 100% and higher bias (-2.18 to 1.27 CLABSI/1000 CVC-days. In random scenarios, the higher the number of participating ICUs, the shorter the participation required to generate ≥ 90% valid replicates. While participation requirements in a countrywide program ranged from 3 to 13 surveillance blocks (1 block = 28 days, requirements for a regional program ranged from 9 to 13 blocks. CONCLUSIONS: Based on the results of our model of national CLABSI reporting, the shortening of participation requirements may be suitable for nationwide ICU CLABSI surveillance programs if participation months are randomly chosen. However, our regional models showed that regional programs should opt for continuous participation to avoid biased benchmarks.

  18. Risk factors for catheter-related bloodstream infection: a prospective multicenter study in Brazilian intensive care units

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    Daniela Bicudo

    2011-08-01

    Full Text Available INTRODUCTION: Central venous catheters (CVC are devices of great importance in health care. The advantages gained from the use of catheters outweigh the complications that might result from their use, among which bloodstream infections (BSI. In spite of its importance, few national studies have addressed this issue. OBJECTIVE: The aim this study was to determine the incidence of BSI in patients with CVC, hospitalized in ICU, as well as the variables associated with this complication. METHODS: Multicentric cohort study carried out at ICUs of three hospitals at Universidade Federal de São Paulo complex. RESULTS: A total of 118 cases of BSI in 11.546 catheters day were observed: 10.22 BSI per 1,000 catheters day. On average, BSI was associated to seven additional days of hospital stay in our study (p < 0.001, with a significant difference between types of catheters. Concerning the place of insertion, there was no statistical difference in BSI rates. CONCLUSION: We concluded that a patient who uses a catheter for longer than 13 days presents a progressive risk for infection of approximately three times higher in relation to a patient who uses the catheter for less than 13 days (p < 0.001. The median duration of catheter use was 14 days among patients with BSI and 9 days in patients without infection (p < 0.001. There was higher prevalence of Gram-negative infections. The risk factors for BSI were utilization of multiple-lumen catheters, duration of catheterization and ICU length of stay.

  19. FACTORS ASSOCIATED WITH MORTALITY AMONG PATIENTS WITH CENTRAL VENOUS CATHETER-RELATED BLOODSTREAM INFECTION IN AN INTENSIVE CARE UNIT

    Directory of Open Access Journals (Sweden)

    Priscilla Roberta Silva Rocha

    2012-01-01

    Full Text Available Central venous catheterization is a common practice in the management of critically ill patients and is associated with various complications, such as Bloodstream Infections (BSI, which are major determinants of increased morbidity, mortality and healthcare expenses. Few studies have addressed factors that predict mortality in patients with this complication. The aim of this study was to investigate factors associated with mortality in patients with Central Venous Catheter (CVC-related BSI in an intensive care unit of a tertiary care hospital in the Federal District, Brazil. This was a retrospective and observational study, in which all CVC-related BSI that occurred between January 2008 and December 2010 were reviewed. We obtained demographic, clinical, biochemical and microbiological data from medical records and investigated its association with mortality during ICU stay. There were 4,504 ICU admissions during the study period and 68 were complicated by CVC-related BSI (4.09 per 1000 catheter-days, most due to gram-negative organisms (45.6%. Overall mortality was 59.7%. Death risk was significantly associated with mechanical ventilation (OR 27.8, 95% CI 3.28-250, p-1 in survivors vs. 73.9 mg dL-1 in non-survivors, p = 0.001. Mortality was not associated with other clinical or biochemical features, neither with microbiological variables, although lethality was high among patients with gram-positive infections (77% Vs 58.33% for fungi and 54.83% for gram-negative. CVC-related BSI was associated with high absolute mortality, which was predicted by mechanical ventilation and a higher number of invasive devices other than the CVC. Knowledge of local factors predictive of mortality is critical for planning strategies to reduce death risk associated with this complication.

  20. Fri form

    DEFF Research Database (Denmark)

    Jensen, Henrik

    2006-01-01

    Dette Kompendiun er lavet i forbindelse med en workshop i møbeldesign. En række af form-Z's værktøjer til konstruktion af dobbeltkrumme flader gennemgås. Kompendiet kan bruges til selvstudie.......Dette Kompendiun er lavet i forbindelse med en workshop i møbeldesign. En række af form-Z's værktøjer til konstruktion af dobbeltkrumme flader gennemgås. Kompendiet kan bruges til selvstudie....

  1. Admission to hospital with community-onset bloodstream infection during the 'after hours' is not associated with an increased risk for death.

    Science.gov (United States)

    Laupland, Kevin B

    2010-12-01

    Several studies conducted in diverse patient populations have found that patients presenting with acute illness during weekends or evening/nights are at increased risk for death. This study was conducted to examine whether patients with community-onset bloodstream infections who are admitted during evenings, nights, and weekends suffer increased mortality rates. All residents within the Calgary area who had first admissions with community-onset bloodstream infections during 2000-2008 were included. One thousand eight hundred and seventy-eight (27%) patients were admitted on a weekend. Among all admissions, 2753 (40%) were during the hours of 08:00-17:59, 1996 (29%) during 18:00-22:59, and 2174 (31%) during 23:00-07:59. More than two-thirds (n = 4867; 70%) of cases were admitted during the 'after hours' (evenings, nights, and/or weekends). The 30-day case-fatality rate was 13% (882/6923) and did not significantly vary between daytime (364/2753; 13%), evening (246/1996; 12%), and night (272/2174; 13%) admissions (p = 0.6), or with patients admitted on weekends as compared to weekdays (252/1878 (13%) vs. 630/5045 (12%); p = 0.3). Admission during the after hours (weekends and evenings/nights) was not associated with increased risk for death in logistic regression analysis (odds ratio 0.99, 95% confidence interval 0.83-1.16; p = 0.88). Admission with community-onset bloodstream infection during the after hours is not associated with adverse outcome in this region.

  2. Impact of changes in CLSI and EUCAST breakpoints for susceptibility in bloodstream infections due to extended-spectrum β-lactamase-producing Escherichia coli.

    Science.gov (United States)

    Rodríguez-Baño, J; Picón, E; Navarro, M D; López-Cerero, L; Pascual, A

    2012-09-01

    The impact of recent changes in and discrepancies between the breakpoints for cephalosporins and other antimicrobials, as determined by CLSI and European Committee on Antimicrobial Susceptibility Testing (EUCAST), was analysed in patients with bloodstream infections caused by extended-spectrum β-lactamase (ESBL) producing Escherichia coli in Spain, was analysed. We studied a cohort of 191 episodes of bloodstream infection caused by ESBL-producing E. coli in 13 Spanish hospitals; the susceptibility of isolates to different antimicrobials was investigated by microdilution and interpreted according to recommendations established in 2009 and 2010 by CLSI, and in 2011 by EUCAST. Overall, 58.6% and 14.7% of isolates were susceptible to ceftazidime, and 35.1% and 14.7% to cefepime using the CLSI-2010 and EUCAST-2009/2011 recommendations, respectively (all isolates would have been considered resistant using the previous guidelines). Discrepancies between the CLSI-2010 and the EUCAST-2011 recommendations were statistically significant for other antimicrobials only in the case of amikacin (98.4% versus 75.9% of susceptible isolates; p <0.01). The results varied depending on the ESBL produced. No significant differences were found in the percentage of patients classified as receiving appropriate therapy, following the different recommendations. Four out of 11 patients treated with active cephalosporins according to CLSI-2010 guidelines died (all had severe sepsis or shock); these cases would have been considered resistant according to EUCAST-2011. In conclusion, by using current breakpoints, extended-spectrum cephalosporins would be regarded as active agents for treating a significant proportion of patients with bloodstream infections caused by ESBL-producing E. coli.

  3. Cosmic Forms

    CERN Document Server

    Kleman, Maurice

    2011-01-01

    The continuous 1D defects of an isotropic homogeneous material in an Euclidean 3D space are classified by a construction method, the Volterra process (VP). We employ the same method to classify the continuous 2D defects (which we call \\textit{cosmic forms}) of a vacuum in a 4D maximally symmetric spacetime. These defects fall into three different classes: i)- $m$-forms, akin to 3D space disclinations, related to ordinary rotations and analogous to Kibble's global cosmic strings (except that being continuous any deficit angle is allowed); ii)- $t$-forms, related to Lorentz boosts (hyperbolic rotations); iii)- $r$-forms, never been considered so far, related to null rotations. A detailed account of their metrics is presented. Their inner structure in many cases appears as a non-singular \\textit{core} separated from the outer part by a timelike hypersurface with distributional curvature and/or torsion, yielding new types of geometrical interactions with cosmic dislocations and other cosmic disclinations. Whereas...

  4. Automorphic Forms

    DEFF Research Database (Denmark)

    von Essen, Flemming Brændgaard

    systems. For automorphic forms wrt. Hecke triangle groups and Fuchsian groups with no elliptic elements and genus 0, we show that some logarithms of multiplier systems can be interpreted as a linking number. Finally we show a "twisted" version of the prime geodesics theorem, and logarithms of multiplier...

  5. Use of Six Sigma strategies to pull the line on central line-associated bloodstream infections in a neurotrauma intensive care unit.

    Science.gov (United States)

    Loftus, Kelli; Tilley, Terry; Hoffman, Jason; Bradburn, Eric; Harvey, Ellen

    2015-01-01

    The creation of a consistent culture of safety and quality in an intensive care unit is challenging. We applied the Six Sigma Define-Measure-Analyze-Improve-Control (DMAIC) model for quality improvement (QI) to develop a long-term solution to improve outcomes in a high-risk neurotrauma intensive care unit. We sought to reduce central line utilization as a cornerstone in preventing central line-associated bloodstream infections (CLABSIs). This study describes the successful application of the DMAIC model in the creation and implementation of evidence-based quality improvement designed to reduce CLABSIs to below national benchmarks.

  6. Detection of mcr-1 encoding plasmid-mediated colistin-resistant Escherichia coli isolates from human bloodstream infection and imported chicken meat, Denmark 2015

    DEFF Research Database (Denmark)

    Hasman, H.; Hammerum, A. M.; Hansen, F.;

    2015-01-01

    The plasmid-mediated colistin resistance gene, mcr-1, was detected in an Escherichia coli isolate from a Danish patient with bloodstream infection and in five E. coli isolates from imported chicken meat. One isolate from chicken meat belonged to the epidemic spreading sequence type ST131. In addi....... In addition to IncI2*, an incX4 replicon was found to be linked to mcr-1. This report follows a recent detection of mcr-1 in E. coli from animals, food and humans in China....

  7. The decline of typhoid and the rise of non-typhoid salmonellae and fungal infections in a changing HIV landscape: bloodstream infection trends over 15 years in southern Vietnam.

    Science.gov (United States)

    Nga, Tran Vu Thieu; Parry, Christopher M; Le, Thuy; Lan, Nguyen Phu Huong; Diep, To Song; Campbell, James I; Hoang, Nguyen Van Minh; Dung, Le Thi; Wain, John; Dolecek, Christiane; Farrar, Jeremy J; Chau, Nguyen Van Vinh; Hien, Tran Tinh; Day, Jeremy N; Baker, Stephen

    2012-01-01

    The etiological spectrum of bloodstream infections is variable between industrialized and developing countries and even within a defined location over time. We investigated trends in bloodstream infections at an infectious disease hospital in Ho Chi Minh City, Vietnam, from 1994-2008. Amongst 66,111 blood cultures performed, a clinically relevant pathogen was isolated in 7645 episodes (positivity rate; 116/1000 cultures). Salmonella Typhi was the predominant pathogen until 2002; however, a considerable annual decline in the proportion of S. Typhi was observed (OR 0.6993, 95% CI [0.6885, 0.7103], pSalmonella (NTS), Cryptococcus neoformans and Penicillium marneffei, concurrent with increasing HIV prevalence. These data document a substantial longitudinal shift in bloodstream infection etiology in southern Vietnam. We propose such changes are related to increasing economic prosperity and HIV prevalence, and this pattern marks a substantial change in the epidemiology of invasive salmonellosis in Southeast Asia.

  8. Improved hospital-level risk adjustment for surveillance of healthcare-associated bloodstream infections: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Jones MA

    2009-09-01

    Full Text Available Abstract Background To allow direct comparison of bloodstream infection (BSI rates between hospitals for performance measurement, observed rates need to be risk adjusted according to the types of patients cared for by the hospital. However, attribute data on all individual patients are often unavailable and hospital-level risk adjustment needs to be done using indirect indicator variables of patient case mix, such as hospital level. We aimed to identify medical services associated with high or low BSI rates, and to evaluate the services provided by the hospital as indicators that can be used for more objective hospital-level risk adjustment. Methods From February 2001-December 2007, 1719 monthly BSI counts were available from 18 hospitals in Queensland, Australia. BSI outcomes were stratified into four groups: overall BSI (OBSI, Staphylococcus aureus BSI (STAPH, intravascular device-related S. aureus BSI (IVD-STAPH and methicillin-resistant S. aureus BSI (MRSA. Twelve services were considered as candidate risk-adjustment variables. For OBSI, STAPH and IVD-STAPH, we developed generalized estimating equation Poisson regression models that accounted for autocorrelation in longitudinal counts. Due to a lack of autocorrelation, a standard logistic regression model was specified for MRSA. Results Four risk services were identified for OBSI: AIDS (IRR 2.14, 95% CI 1.20 to 3.82, infectious diseases (IRR 2.72, 95% CI 1.97 to 3.76, oncology (IRR 1.60, 95% CI 1.29 to 1.98 and bone marrow transplants (IRR 1.52, 95% CI 1.14 to 2.03. Four protective services were also found. A similar but smaller group of risk and protective services were found for the other outcomes. Acceptable agreement between observed and fitted values was found for the OBSI and STAPH models but not for the IVD-STAPH and MRSA models. However, the IVD-STAPH and MRSA models successfully discriminated between hospitals with higher and lower BSI rates. Conclusion The high model goodness

  9. Characterization and Clinical Impact of Bloodstream Infection Caused by Carbapenemase-Producing Enterobacteriaceae in Seven Latin American Countries

    Science.gov (United States)

    Villegas, Maria Virginia; Pallares, Christian J.; Hernández-Gómez, Cristhian; Correa, Adriana; Álvarez, Carlos; Rosso, Fernando; Matta, Lorena; Luna, Carlos; Zurita, Jeannete; Mejía-Villatoro, Carlos; Rodríguez-Noriega, Eduardo; Seas, Carlos; Cortesía, Manuel; Guzmán-Suárez, Alfonso; Guzmán-Blanco, Manuel

    2016-01-01

    Introduction Infections caused by carbapenem-resistant Enterobacteriaceae are a public health problem associated with higher mortality rates, longer hospitalization and increased healthcare costs. We carried out a study to describe the characteristics of patients with carbapenemase-producing Enterobacteriaceae (CPE) and non-CPE bloodstream infection (BSI) from Latin American hospitals and to determine the clinical impact in terms of mortality and antibiotic therapy. Methods Between July 2013 and November 2014, we conducted a multicenter observational study in 11 hospitals from 7 Latin American countries (Argentina, Colombia, Ecuador, Guatemala, Mexico, Peru, Venezuela). Patients with BSI caused by Enterobacteriaceae were included and classified either as CPE or non-CPE based on detection of blaKPC, blaVIM, blaIMP, blaNDM and blaOXA-48 by polymerase chain reaction. Enrolled subjects were followed until discharge or death. Demographic, microbiological and clinical characteristics were collected from medical records. Both descriptive and inferential statistics were used to analyze the information. Results A total of 255 patients with Enterobacteriaceae BSI were included; CPE were identified in 53 of them. In vitro non-susceptibility to all screened antibiotics was higher in the patients with CPE BSI, remaining colistin, tigecycline and amikacin as the most active drugs. Combination therapy was significantly more frequent in the CPE BSI group (p < 0.001). The most common regimen was carbapenem + colistin or polymyxin B. The overall mortality was 37% (94/255). Overall and attributable mortality were significantly higher in patients with CPE BSI (p < 0.001); however, we found that patients with CPE BSI who received combination therapy and those who received monotherapy had similar mortality. After multivariate adjustment, CPE BSI (adjusted odds ratio [aOR] 4; 95% confidence interval [CI] 1.7–9.5; p = 0.002) and critical illness (aOR 6.5; 95% CI 3.1–13.7; p < 0

  10. Risk factors and prognosis of nosocomial bloodstream infections caused by extended-spectrum-beta-lactamase-producing Escherichia coli.

    Science.gov (United States)

    Rodríguez-Baño, Jesús; Picón, Encarnación; Gijón, Paloma; Hernández, José Ramón; Cisneros, Jose M; Peña, Carmen; Almela, Manuel; Almirante, Benito; Grill, Fabio; Colomina, Javier; Molinos, Sonia; Oliver, Antonio; Fernández-Mazarrasa, Carlos; Navarro, Gemma; Coloma, Ana; López-Cerero, Lorena; Pascual, Alvaro

    2010-05-01

    Extended-spectrum-beta-lactamase (ESBL)-producing Escherichia coli (ESBLEC) is an increasing cause of community and nosocomial infections worldwide. However, there is scarce clinical information about nosocomial bloodstream infections (BSIs) caused by these pathogens. We performed a study to investigate the risk factors for and prognosis of nosocomial BSIs due to ESBLEC in 13 Spanish hospitals. Risk factors were assessed by using a case-control-control study; 96 cases (2 to 16% of all nosocomial BSIs due to E. coli in the participating centers) were included; the most frequent ESBL was CTX-M-14 (48% of the isolates). We found CTX-M-15 in 10% of the isolates, which means that this enzyme is emerging as a cause of invasive infections in Spain. By repetitive extragenic palindromic sequence-PCR, most isolates were found to be clonally unrelated. By multivariate analysis, the risk factors for nosocomial BSIs due to ESBLEC were found to be organ transplant (odds ratio [OR]=4.8; 95% confidence interval [CI]=1.4 to 15.7), the previous use of oxyimino-beta-lactams (OR=6.0; 95% CI=3.0 to 11.8), and unknown BSI source (protective; OR=0.4; 95% CI=0.2 to 0.9), and duration of hospital stay (OR=1.02; 95% CI=1.00 to 1.03). The variables independently associated with mortality were a Pitt score of >1 (OR=3.9; 95% CI=1.2 to 12.9), a high-risk source (OR=5.5; 95% CI=1.4 to 21.9), and resistance to more than three antibiotics, apart from penicillins and cephalosporins (OR=6.5; 95% CI=1.4 to 30.0). Inappropriate empirical therapy was not associated with mortality. We conclude that ESBLEC is an important cause of nosocomial BSIs. The previous use of oxyimino-beta-lactams was the only modifiable risk factor found. Resistance to drugs other than penicillins and cephalosporins was associated with increased mortality.

  11. Incidence, risk factors, microbiology of venous catheter associated bloodstream infections - A prospective study from a tertiary care hospital

    Directory of Open Access Journals (Sweden)

    M Kaur

    2015-01-01

    Full Text Available Purpose : Central venous catheters (CVCs though indispensable in current medical and intensive care treatment, also puts patients at risk of catheter related infection (CRI resulting in increased morbidity and mortality. We analysed the incidence, risk factors, bacteriological profile and antimicrobial susceptibility pattern of the isolates in central venous catheter associated bloodstream infection (CVC-BSI in the intensive care unit (ICU patients and studied the formation of biofilm in CVCs. Materials and Methods: The following case control study included 115 patients with CVC in situ. Quantitative blood cultures (QBC and catheter tip cultures were performed for the diagnoses. Direct catheter staining was done for an early diagnosis by acridine orange (AO and Gram staining methods. Biofilm production in catheters was detected by ′tissue culture plate′ (TCP method. The results were analysed using the computer-based program statistical package for the social sciences (SPSS. Results : In 25/115 patients, definite diagnosis of CVC-BSI was made. The mean age was 48.44 ± 17.34 years (cases vs 40.10 ± 18.24 years (controls and the mean duration of catheterisation was 25.72 ± 8.73 days (cases vs 11.89 ± 6.38 days (controls. Local signs of infection (erythema, tenderness and oozing were found more significantly in CVC-BSI cases. The AO staining was more sensitive and Gram staining of catheters showed higher specificity. Staphylococcus aureus followed by Pseudomonas aeruginosa and non-albicans Candida were common CVC-BSI pathogens. Multidrug-resistant (MDR strains were isolated in bacterial agents of CVC-BSI. Non-albicans Candida and Enterococcus faecalis showed strong biofilm production. Conclusion : The incidence of CVC-BSI was 21.73% and the rate was 14.59 per 1000 catheter days. Prolonged ICU stay and longer catheterisation were major risk factors. S. aureus was isolated most commonly in CVC-BSI cases. The menace of multidrug resistance and

  12. Analysis of bloodstream infection in children with severe hematopathy%重症血液病患儿血流感染的临床分析

    Institute of Scientific and Technical Information of China (English)

    张家源; 陈玉梅; 邹尧; 张丽; 阮敏; 陈晓娟; 刘晓明; 竺晓凡

    2014-01-01

    目的:探讨重症血液病患儿治疗过程中发生血流感染的原因、感染部位、病原菌分析及治疗对策。方法选择2007年1月-2009年9月住院治疗的血液病患儿2368例,对血液病患儿血流感染的发生率、感染部位与病原菌分布及相关因素进行分析,数据采用SPSS16.0统计软件进行处理,样本率的比较采用χ2检验。结果2368例住院治疗患儿中167例患儿发生血流感染,发生率7.1%;其中发生血流感染的急性淋巴细胞白血病患儿95例、急性髓性白血病患儿61例、重型再生障碍性贫血患儿9例、恶性淋巴瘤患儿2例,分别占56.9%、36.5%、5.4%、1.2%;感染部位以口腔黏膜与呼吸道为主,分别占12.6%与10.2%;经血培养检测,共分离出病原菌167株,其中革兰阴性杆菌90株占53.9%,革兰阳性球菌71株占42.5%,革兰阳性杆菌、真菌各3株,各占1.8%;急性淋巴细胞白血病患儿中应用糖皮质激素>2周及中性粒细胞绝对值<100/mm3与血流感染高度相关。结论急性髓性白血病较急性淋巴细胞白血病患儿易发生血流感染,血液病患儿中性粒细胞绝对值<100/mm3与血流感染的发生高度相关。%OBJECTIVE To explore the causes ,sites and pathogens of bloodstream infection in children with severe hematopathy and the method to decrease the mortality of bloodstream infection .METHODS Totally 2368 children with hematopathy were selected .The incidence rate ,infected sites ,pathogen distribution and related factors for bloodstream infection in children with hematopathy were analyzed . Data were processed by SPSS16 .0 , the comparison of sample rate was conducted with χ2 test .RESULTS There were 167 cases of bloodstream infection in the 2368 hospitalized children ,indicating the incidence was 7 .1% .The children who experienced bloodstream infection included 95 children with acute lymphoblastic

  13. Matrix-assisted laser desorption ionization time-of-flight mass spectrometry for the rapid identification of yeasts causing bloodstream infections.

    Science.gov (United States)

    Ghosh, A K; Paul, S; Sood, P; Rudramurthy, S M; Rajbanshi, A; Jillwin, T J; Chakrabarti, A

    2015-04-01

    Few studies have systematically standardised and evaluated matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) for identification of yeasts from bloodstream infections. This is rapidly becoming pertinent for early identification of yeasts and appropriate antifungal therapy. We used 354 yeast strains identified by polymerase chain reaction (PCR) sequencing for standardisation and 367 blind clinical strains for validation of our MALDI-TOF MS protocols. We also evaluated different sample preparation methods and found the on-plate formic acid extraction method as most cost- and time-efficient. The MALDI-TOF assay correctly identified 98.9% of PCR-sequenced yeasts. Novel main spectrum projections (MSP) were developed for Candida auris, C. viswanathii and Kodamaea ohmeri, which were missing from the Bruker MALDI-TOF MS database. Spectral cut-offs computed by receiver operating characteristics (ROC) analysis showed 99.4% to 100% accuracy at a log score of ≥ 1.70 for C. tropicalis, C. parapsilosis, C. pelliculosa, C. orthopsilosis, C. albicans, C. rugosa, C. guilliermondii, C. lipolytica, C. metapsilosis, C. nivariensis. The differences in the species-specific scores of our standardisation and blind validation strains were not statistically significant, implying the optimal performance of our test protocol. The MSPs of the three new species also were validated. We conclude that MALDI-TOF MS is a rapid, accurate and reliable tool for identification of bloodstream yeasts. With proper standardisation, validation and regular database expansion, its efficiency can be further enhanced.

  14. [Obesity as pathology of adipocytes: number of cells, volume of arterial bloodstream,local pools of circulation in vivo, natriuretic peptides and arterial hypertension].

    Science.gov (United States)

    Titov, V N; Dmitriev, V A

    2015-03-01

    The non-specific systemic biological reaction of arterial pressure from the level of organism. vasomotor center and proximal section of arterial bloodstream is appealed to compensate disorders of metabolism and microcirculation in distal section of arteries. This phenomenon occurs in several cases. The primarily local disorders of metabolism at autocrine level, physiological (aphysiological) death of cells, "littering" of intercellular medium become the cause of disorder of microcirculation in paracrin cenosises and deteriorate realization of biological functions of homeostasis, trophology, endoecology and adaptation. The local compensation of affected perfusion in paracrin cenosises at the expense of function of peripheral peristaltic pumps, redistribution of local bloodflow in biological reaction of endothelium-depended vaso-dilation has no possibility to eliminate disorders in realization of biological functions. The systemic increase of arterial pressure under absence of specific symptoms of symptomatic arterial hypertension is a test to detect disorder of biological functions of homeostasis, trophology, biological function of endoecology and adaptation. Allforms of arterial hypertension develop by common algorithm independently from causes of disorders of blood flow, microcirculation in distal section of arteries. The non-specific systemic compensation ofdisorders of metabolism from level of organism, in proximal section of arterial bloodstream always is the same one and results in aphysiological alterations in organs-targets. To comprehend etiological characteristics of common pathogenesis of arterial hypertension is possible in case of application of such technically complicated and still unclear in differential diagnostic of deranged functions modes of metabolomics.

  15. The current understanding of arterial-catheter related bloodstream infection%当前对动脉导管相关性血流感染的认识

    Institute of Scientific and Technical Information of China (English)

    王斌; 安友仲

    2016-01-01

    导管相关性血流感染(CRBSI)是重症加强治疗病房(ICU)中常见的严重感染之一,可增加患者的病死率,延长住院时间,增加住院费用.在CRBSI中,动脉导管相关性血流感染(AC-BSI)常被忽视或低估,目前的报道显示,AC-BSI的发生率接近甚至不低于中心静脉导管相关性血流感染(CVC-BSI).一旦怀疑AC-BSI,应在留取相关培养物培养后立即拔出动脉导管,并根据患者的情况实施抗感染治疗;预防是减少AC-BSI的关键.本文作者从AC-BSI的流行病学、病原学及发病机制、危险因素、诊断、治疗和预防等方面的进展进行综述,以期为临床处理提供帮助.%Catheter-related bloodstream infection (CRBSI) is one of the common severe infections in intensive care unit (ICU),which tends to increase the mortality of patients,the length of hospital stay and the cost of hospitalization.Arterial catheter-related bloodstream infection (AC-BSI) is often overlooked or underestimated.Some studies pointed out that the incidence of AC-BSI is close to or even higher than central venous catheter related bloodstream infection (CVC-BSI),which plays an important role in catheter-related infections.Once AC-BSI is suspected,arterial catheter should be removed immediately after bacterial culture and antibiotics should be prescribed according to severities of patients.Prevention is the key to reduce AC-BSI.The research progress of epidemiology,etiology,pathogenesis,risk factors,diagnosis,treatment and prevention of AC-BSI was reviewed to facilitate the clinical decision.

  16. 肿瘤重症患者合并血液感染后死亡的相关危险因素分析%Risk Factor Analysis of Mortality Following Bloodstream Infections of Cancer Patients in Intensive Care Unit

    Institute of Scientific and Technical Information of China (English)

    张青; 张文芳; 郑珊; 李丁; 张鹏

    2012-01-01

    Objective: The present study aims to analyze the bloodstream infection profiles and assess the risk factors associated with mortality of cancer patients in the intensive care unit ( ICU ) with bloodstream infections. Methods: Medical records of cancer patients with bloodstream infections, admitted to the Tianjin Medical University Cancer Institute and Hospital during January 2010 and June 2011, were retrospectively analyzed. Results: Microbiological data of 88 cases with bloodstream infections were recorded in our study ( 56 males, 32 females; 65.8 ± 24.2 years old ). Of the total patients, 45 survived and 43 died. The most commonly seen etiological agents of bloodstream infections were coagulase-negative staphylococci in 42 cases ( 37.8% ), Escherichia coli in 15 cases (13.5% ), and Candida albicans in 9 cases ( 8.1% ). Univariate analysis showed that risk factors included mechanical ventilation for more than 7 days and duration of central venous catheterization and higher APACHE II scores, of which, mechanical ventilation of more than 7 days was the independent mortality risk factor ( odds ratio: 6.8, 95%; CI: 2.5–18.4; P 7 d、中心静脉插管以及较高的APACHE Ⅱ评分是重症肿瘤患者合并血液感染后死亡的重要危险因子,其中机械通气>7 d为独立的死亡风险因子(OR=6.8,95%CI:2.5~18.4,P<0.001).结论:凝固酶阴性葡萄球菌是引起肿瘤患者血液感染的主要病原菌,临床应据此采取相应的预防控制措施,以减少重症肿瘤患者血液感染的发生发展.

  17. Contributors Form

    Directory of Open Access Journals (Sweden)

    Chief Editor

    2016-06-01

    to produce preprints or reprints and translate into languages other than English for sale or free distribution; and 4 the right to republish the work in a collection of articles in any other mechanical or electronic format. We give the rights to the corresponding author to make necessary changes as per the request of the journal, do the rest of the correspondence on our behalf and he/she will act as the guarantor for the manuscript on our behalf. All persons who have made substantial contributions to the work reported in the manuscript, but who are not contributors, are named in the Acknowledgment and have given me/us their written permission to be named. If I/we do not include an Acknowledgment that means I/we have not received substantial contributions from non-contributors and no contributor has been omitted.S NoAuthors' NamesContribution (IJCME Guidelines{1 substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; 2 drafting the article or revising it critically for important intellectual content; and 3 final approval of the version to be published. Authors should meet conditions 1, 2, and 3}.SignatureDate                              Note: All the authors are required to sign independently in this form in the sequence given above. In case an author has left the institution/country and whose whereabouts are not known, the senior author may sign on his/her behalf taking the responsibility.No addition/deletion/ or any change in the sequence of the authorship will be permissible at a later stage, without valid reasons and permission of the Editor.If the authorship is contested at any stage, the article will be either returned or will not be processed for publication till the issue is solved.Maximum up to 4 authors for short communication and up to 6 authors for original article.

  18. Large IncHI2-plasmids encode extended-spectrum β-lactamases (ESBLs) in Enterobacter spp. bloodstream isolates, and support ESBL-transfer to Escherichia coli.

    Science.gov (United States)

    Nilsen, E; Haldorsen, B C; Sundsfjord, A; Simonsen, G S; Ingebretsen, A; Naseer, U; Samuelsen, O

    2013-11-01

    We investigated the prevalence of extended-spectrum β-lactamases (ESBLs) in Enterobacter spp. bloodstream isolates from 19 hospital laboratories in Norway during 2011. A total of 62/230 (27%) isolates were resistant to third-generation cephalosporins and four (1.7%) were ESBL-positive; blaCTX -M-15 (n = 3) and blaSHV -12 (n = 1). This is comparable to the prevalence of ESBLs in clinical isolates of Escherichia coli and Klebsiella pneumoniae in Norway during the same period. All ESBL-positive isolates were multidrug resistant (MDR) and harboured plasmid-mediated quinolone resistance. Three isolates supported transfer of large IncHI2-plasmids harbouring ESBL- and MDR-encoding genes to E. coli recipients by in vitro conjugation.

  19. A 5-year survey of antimicrobial susceptibility profiles of methicillin-resistant Staphylococcus aureus (MRSA) isolated from patients with bloodstream infections in Northeast Italy.

    Science.gov (United States)

    Cojutti, Piergiorgio; Scarparo, Claudio; Sartor, Assunta; Coato, Paola; Rigoli, Roberto; Pea, Federico

    2015-01-01

    A 5-year survey (2009-2013) of antimicrobial susceptibility of methicillin-resistant Staphylococcus aureus (MRSA) isolated from patients with bloodstream infections was carried out in Northeast Italy. No upward creep of glycopeptides MICs was documented among 582 nonduplicate MRSA blood isolates, which were tested in accordance with broth microdilution and interpreted in accordance with EUCAST recommendations. Teicoplanin showed stably a lower MIC50 in comparison with vancomycin (0.25-0.5 versus 1 mg/L). The activities of newer anti-MRSA antibacterials stratified by glycopeptides MICs showed similar trends in MICs of either vancomycin or teicoplanin with those of daptomycin, linezolid, and tigecycline. We hypothesize that in centers with different distribution of glycopeptides MICs, downward for teicoplanin and upward for vancomycin, teicoplanin could be a more effective alternative to vancomycin for empirical treatment of MRSA-related bacteremia.

  20. Editorial on low-dose acetylsalicylic acid treatment and impact on short-term mortality in Staphylococcus aureus bloodstream infection: a propensity score-matched cohort study

    Science.gov (United States)

    Schoergenhofer, Christian; Schwameis, Michael; Lagler, Heimo

    2016-01-01

    The manuscript “Low-Dose Acetylsalicylic Acid Treatment and Impact on Short-Term Mortality in Staphylococcus aureus (S. aureus) Bloodstream Infection: A propensity Score-Matched Cohort Study” published in Critical Care Medicine by Osthoff et al. reported an association of aspirin intake with a reduced short-term mortality. Direct anti-microbial effects of aspirin and its metabolite salicylate were suggested in preclinical studies. Especially intriguing is the inclusion of a control group with Escherichia coli (E. coli) blood stream infections in this study, in which aspirin was not associated with an improved outcome. However, as other observational studies also reported benefits of aspirin in critically ill patients, randomized trials are needed to confirm the effects of low-dose aspirin. PMID:27294095

  1. Long-term, low-dose tigecycline to treat relapsing bloodstream infection due to KPC-producing Klebsiella pneumoniae after major hepatic surgery

    Directory of Open Access Journals (Sweden)

    Luca Morelli

    2015-07-01

    Full Text Available A 68-year-old male underwent a right hepatectomy, resection of the biliary convergence, and a left hepatic jejunostomy for a Klatskin tumour. The postoperative course was complicated by biliary abscesses with relapsing bloodstream infections due to Klebsiella pneumoniae carbapenemase (KPC-producing Klebsiella pneumoniae (KPC-Kp. A 2-week course of combination antibiotic therapy failed to provide source control and the bacteraemia relapsed. Success was obtained with a regimen of tigecycline 100 mg daily for 2 months, followed by tigecycline 50 mg daily for 6 months, then 50 mg every 48 h for 3 months. No side effects were reported.

  2. Carbapenems Versus Piperacillin-Tazobactam for Bloodstream Infections of Nonurinary Source Caused by Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae.

    Science.gov (United States)

    Ofer-Friedman, Hadas; Shefler, Coral; Sharma, Sarit; Tirosh, Amit; Tal-Jasper, Ruthy; Kandipalli, Deepthi; Sharma, Shruti; Bathina, Pradeep; Kaplansky, Tamir; Maskit, Moran; Azouri, Tal; Lazarovitch, Tsilia; Zaidenstein, Ronit; Kaye, Keith S; Marchaim, Dror

    2015-08-01

    A recent, frequently quoted study has suggested that for bloodstream infections (BSIs) due to extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL) Escherichia coli, treatment with β-lactam/β-lactamase inhibitors (BLBLIs) might be equivalent to treatment with carbapenems. However, the majority of BSIs originate from the urinary tract. A multicenter, multinational efficacy analysis was conducted from 2010 to 2012 to compare outcomes of patients with non-urinary ESBL BSIs who received a carbapenem (69 patients) vs those treated with piperacillin-tazobactam (10 patients). In multivariate analysis, therapy with piperacillin-tazobactam was associated with increased 90-day mortality (adjusted odds ratio, 7.9, P=.03). For ESBL BSIs of a non-urinary origin, carbapenems should be considered a superior treatment to BLBLIs.

  3. Recipient-born bloodstream infection due to extensively drug-resistant Acinetobacter baumannii after emergency heart transplant: report of a case and review of the literature.

    Science.gov (United States)

    Andini, Roberto; Agrusta, Federica; Mattucci, Irene; Malgeri, Umberto; Cavezza, Giusi; Utili, Riccardo; Durante-Mangoni, Emanuele

    2015-10-01

    Infections due to drug-resistant Gram-negative rods are an emerging risk factor for increased mortality after solid organ transplant. Extensively drug-resistant (XDR) Acinetobacter baumannii (Acb) is a major threat in several critical care settings. The limited available data on the outcome of XDR Acb infections in organ transplant recipients mostly comes from cases of donor-derived infections. However, recipients of life-saving organs are often critically ill patients, staying long term in intensive care units, and therefore at high risk for nosocomial infections. In this report, we describe our experience with the exceedingly complex management of a recipient-born XDR Acb bloodstream infection clinically ensued shortly after heart transplant. We also review the current literature on this mounting issue relevant for intensive care, transplant medicine and infectious diseases.

  4. Use of PCR coupled with electrospray ionization mass spectrometry for rapid identification of bacterial and yeast bloodstream pathogens from blood culture bottles.

    Science.gov (United States)

    Kaleta, Erin J; Clark, Andrew E; Johnson, Desiree R; Gamage, Dulini C; Wysocki, Vicki H; Cherkaoui, Abdessalam; Schrenzel, Jacques; Wolk, Donna M

    2011-01-01

    Sepsis is among the top 10 causes of mortality in the United States. Rapid administration of antibiotics is one of the most important contributors to patient survival, yet only a limited number of methods exist for rapid identification of microbes cultivated from bloodstream infections, which can lead to sepsis. While traditional single-target molecular methods have been shown to greatly improve survival for septic patients by enabling rapid deescalation of broad-spectrum antibiotics, multiplex methods offer even greater possibilities. A novel multiplex method, PCR coupled to electrospray ionization mass spectrometry (PCR/ESI-MS), was used to identify the genus and species of microorganisms found to cause human bloodstream infections. DNA was directly extracted from 234 BacT-Alert blood culture bottles, and results were compared to those obtained by clinical reference standard methods. The study results demonstrated 98.7% and 96.6% concordance at the genus and species levels, respectively. Mixtures of microbes were identified in 29 blood culture bottles, including mixed species of the same genus, as well as mixtures containing Gram-positive and Gram-negative organisms, exemplifying the PCR/ESI-MS capability to identify multiple organisms simultaneously without the need for cultivation. This study demonstrates high analytical accuracy in comparison to routine subculture of blood culture bottles and phenotypic identification of microbes. Without foreknowledge of the microorganisms potentially present, the PCR/ESI-MS methods can deliver accurate results in as little as 5 to 6 h after a positive alarm from the automated blood culture system; however, current batch mode testing limits the method's clinical utility at this time.

  5. Cessation of In-line Filters in Central Venous Catheters Does Not Significantly Influence the Incidence of Bloodstream Infections and Mortality in a Hospital Hematological Ward.

    Science.gov (United States)

    Tanaka, Hiroaki; Ambiru, Satoshi; Kawaguchi, Takeharu; Sugita, Yasumasa; Kawajiri, Chika; Nagao, Yuhei; Shimura, Takenori

    2016-01-01

    Objective The use of intravenous in-line filters is effective for the mechanical removal of large particles, precipitates, bacteria, fungi, large lipid globules, and air. However, the routine use of in-line filters remains controversial. Many patients with hematological diseases frequently suffer from bloodstream infections (BSIs) with fatal outcomes. Methods The year before cessation of an in-line filter was defined as the "filter period" and the year after its cessation was defined as the "non-filter period." The number of central line-associated bloodstream infections (CLABSIs), which are defined through surveillance, the catheter utilization rate, the number of patient deaths within 7 days after removal of the central venous catheters (CVCs), and the overall survival rate following CVC insertion were measured. Results During both periods, 84 patients had a total of 140 CVCs with a total number of catheter days of 3,407. There were 10 CVCs with CLABSIs, and the overall CLABSI rate was 2.9/1,000 catheter days, including 4 CVCs with CLABSIs (2.5/1,000 catheter days) during the filter period and 6 CVCs with CLABSIs (3.3/1,000 catheter days) during the non-filter period. The CLABSI rate, catheter utilization rate, and mortality did not differ significantly between the two periods. The only independent variable that was found to be significantly associated with the development of CLABSIs was a neutrophil count of line filters from CVCs does not significantly influence the incidence of BSIs and mortality in patients with hematological disease. To confirm our results, however, a large-scale randomized controlled study is warranted.

  6. 铜绿假单胞菌血流感染27例临床分析%Clinical analysis of bloodstream infections caused by Pseudomonas aeruginosa

    Institute of Scientific and Technical Information of China (English)

    丁艳苓; 姚婉贞; 宁永忠

    2013-01-01

    Objective To analyze the clinical characteristics and antimicrobial resistance of blood stream infections caused by P. aeruginosa. Methods The clinical data were retrospectively reviewed for the patients with P. aeruginosa bloodstream infection who were treated in Peking University Third Hospital from January 2006 to December 2009. Results A total of 27 patients were found with P. aeruginosa bloodstream infection. The Charlson scores of the patients were 4. 48 ± 2. 10. All patients had fever and increased or decreased white blood cell counts when their bloodstream infection was identified. Six patients were infected by multidrug-resistant (MDR) strains. Compared with the patients with non-MDR P. aeruginosa infection, the patients infected by MDR strains had significantly higher APACHE TJ scores and Sequential Organ Failure Assessment (SOFA) scores at admission, longer stay in Intensive Care Unit (RICU and SICU), higher prevalence of multiple (two or more) antibiotics use before positive blood culture after admission, and lower proprotion of patients with appropriate antibiotic therapy after blood culture. The Charlson scores, clinical manifestation, APACHE TJ scores and SOFA scores at the time of bloodstream infection, and in-hospital mortality were similar between the two groups of patients. Conclusions The patients with P. aeruginosa bloodstream infection showed severe clinical status and high mortality rate. The MDR strains-infected patients had more severe conditions than those infected by non-MDR strains, but their clinical manifestations were similar. Patients with bloodstream infection should subject to microbiological testing and be treated with appropriate active agents as soon as possible to reduce fatality rate.%目的 探讨铜绿假单胞菌血流感染的临床特点及细菌耐药性.方法 回顾性分析北京大学第三医院2006年1月-2009年12月铜绿假单胞菌血流感染患者的临床及微生物学资料.结果 27例患者纳入分

  7. Bloodstream Infections among AIDS Patients%艾滋病并发血流感染的临床分析

    Institute of Scientific and Technical Information of China (English)

    励峰; 朱翠云; 黄琴; 孙洪清

    2012-01-01

    Objective To analyze the bloodstream infections( BSI) among AIDS patients,and study its peripheral blood routine test,its pathogens distribution, and its influence to prognosis. Methods A retrospective cohort study was conducted among 144 AIDS inpa-tients from January 2011 to March 2012 in Shanghai Public health center of Fudan University. Results All of 144 cases, the incidence rate of BSI was 19.4% (28/144). The blood cultures contained 33 different pathogens, with 8 staphylococcus strains (24.2% ) ,6 fungi strains ( 18. 2% ) ,6 salmonella strains( 18. 2% ). The peripheral red blood cell count and haematoglobin were 3. 223 × 1012/L,98. 89g/L in patients with BSI and were 3.678 × 1012/L, 109. 94g/L in patients without BSI(f =0.016 and 0.049). The peripheral blood CD4 + lymphocyte counts were 78. 3 × 106/L in patients with BSI and were 98. 75 × 106/L in patients without BS1( P = 0. 422) . The mortality of BSI and non - BSI was 32. 1% and 12. 1% (X2 =6.772, P =0.009). Conclusion The AIDS patients with BSI had a lower red blood cell count and haematoglobin than non - BSI. The common pathogens of BSI were staphylococcus among AIDS patients in our hospital. AIDS patients with BSI had a high rate of mortality. It is necessary to prevent the happening of BSI.%目的 探讨艾滋病患者血流感染的病原菌分布,与外周血细胞的相关性及其对预后的影响.方法 回顾性分析2011年1月~2012年3月在上海市公共卫生临床中心感染科住院的艾滋病并发血流感染的发病率、病原菌分布、与外周血细胞、外周血淋巴细胞计数的相关性以及病死率.结果 144例艾滋病患者中确诊血流感染(血流感染组)有19.4% (28/144),无血流感染(无血流感染组)有80.6%(116/144).培养出33株病原菌,主要是葡萄球菌8株(24.2%);真菌6株(18.2%);沙门菌6株(18.2%).血流感染组平均红细胞计数及血红蛋白分别为3.223×1012/L、98.89g/L,无血流感染组分别为3.678×1012

  8. 金黄色葡萄球菌血流感染的临床特征分析%Clinical features of bloodstream infection caused by staphylococcus aureus

    Institute of Scientific and Technical Information of China (English)

    路明; 姚婉贞; 王筱宏; 刘振英

    2011-01-01

    OBJECTIVE To study the clinical characteristics and antimicrobial resistance of bloodstream infections caused by Staphylococcus aureus (SAU). METHODS Patients with bloodstream infections of SAU in our hospital from 2004 to 2008 were retrospectively reviewed. RESULTS All 28 patients had fever and 60. 7% with rigor. 18 cases had metastatic infection and lung was the most common metastasizing site. 85.7% of the patients had variety of vulnerable factors. 39% complicated by septic shock and the total mortality rate was 32.0%. 6 episodes were community acquired and 50. 0% of the primary infection site were from skin or soft tissues. All the six community-acquired SAU isolates were methicillin sensitive S. aureus (MSSA). The other 22 episodes were nosocomial infections, 45. 5% were related with central venous catheters, and 72. 0% of the SAU isolates were methicillin resistant S. aureus (MRSA). All the SAU isolates acquired from community and hospital were resistant to penicillin. CONCLUSION High fever with rigor and metastatic infection are common features of SAU bloodstream infection. MRSA isolates increased gradually with high mortality rate.%目的 了解金黄色葡萄球菌血流感染的临床特征及细菌耐药情况.方法 回顾分析医院2004-2008年由金黄色葡萄球菌所致血流感染患者的临床和微生物学资料.结果 共28例患者入选,均有发热,60.7%伴寒颤,18例有迁徙灶,肺受累最常见;85.7%的患者存在易感因素,39.0%合并感染性休克,死亡率32.0%;社区感染6例,多以皮肤为原发感染灶(50.0%),均为甲氧西林敏感金黄色葡萄球菌;医院内感染22例,多与中心静脉导管相关(45.5%),72.0%为耐甲氧西林金黄色葡萄球菌(MRSA);社区和医院内感染金黄色葡萄球菌株对青霉素100.0%耐药.结论 金黄色葡萄球菌血流感染多有高热、寒颤伴有迁徙灶,MRSA逐渐增多,导致很高的死亡率.

  9. Clinical Analysis of Catheter-Related Bloodstream Infection in ICU%ICU中心静脉置管患者血性感染的临床分析

    Institute of Scientific and Technical Information of China (English)

    吴敏

    2013-01-01

    目的 对ICU中心静脉导管患者发生医院血性感染的相关情况进行分析,探讨发生特点和危险因素.方法 对785例ICU中心静脉置管患者的一般情况和临床资料进行回顾性分析,包括患者的年龄、性别、自理能力、自身免疫性疾病、置管时间、置管部位和免疫抑制剂的使用等相关性感染因素.结果 785例患者相关血性感染共发生34例,发生率4.3%.34例病原菌共检出29株,阳性率85.3%.检出以革兰氏阴性菌为主,占总检出的48.3%,其次为革兰氏阳性菌,占41.4%,再次为真菌,占10.3%.ICU中心静脉导管患者发生医院血性感染与年龄、自理能力、自身免疫性疾病、置管时间和免疫抑制剂的使用相关.结论 积极治疗患者自身免疫性疾病,对置管时间进行控制,并减少免疫抑制剂的使用,是减少ICU中心静脉导管相关血性感染的重要措施.%Objective To investigate the bloodstream infection in patients with central venous catheter in ICU,explore the risk factors.Methods Totally 785 patients with central venous catheter were chosen and studied to analyze the risk factors which might cause bloodstream infection.The correlation factors were gender,age,self-help skills,autosomal disease,insertion time,catheter site,and application of immunosuppressive.Results 34 cases catheter-related bloodstream infection cases were detected in ICU(4.3%).29 cases were detected in 34 cases of pathogens,with the positive rate of 85.3%.The most common bacteria were Gram-negative bacteria,accounting for 48.3%,followed by Gram-positive bacteria which accounting for 41.4%,and Fungi which accounting for 10.3%.The analysis of 785 cases showed that the infection rate was closely related to age,self-help skills,autosomal disease,insertion time,and application of immunosuppressive.Conclusion It was effective to reduce the infection by treating the autosomal disease positively,controlling insertion time and using

  10. Taurolidine lock solutions for the prevention of catheter-related bloodstream infections: a systematic review and meta-analysis of randomized controlled trials.

    Directory of Open Access Journals (Sweden)

    Yong Liu

    Full Text Available BACKGROUND: Catheter-related bloodstream infections (CRBSIs are a significant cause of morbidity and mortality in critically ill patients, contributing to prolonged hospital stays and increased costs. Whether taurolidine lock solutions (TLS are beneficial for the prevention of CRBSIs remains controversial. In this meta-analysis, we aim to assess the efficacy of TLS for preventing CRBSIs. METHODS: We conducted a systematic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials. Eligible studies included randomized controlled trials that reported on the effects of TLS for preventing CRBSIs. The primary outcome in these studies was catheter-related bloodstream infections, with microbial distribution of CRBSI and catheter-associated thrombosis as secondary outcomes. Data were combined using random-effects models owing to significant clinical heterogeneity. RESULTS: Six randomized controlled trials (RCTs conducted from 2004 through 2013 involving 431 patients and 86,078 catheter-days were included in the review. TLS were significantly associated with a lower incidence of CRBSIs when compared to heparin lock solutions (Risk Ratio [RR], 0.34; 95% Confidence Interval [CI], 0.21-0.55. Use of TLS significantly decreased the incidence of CRBSIs from gram-negative (G- bacteria (P = 0.004; RR, 0.27; CI, 0.11-0.65, and was associated with a non-significant decrease in gram-positive (G+ bacterial infections (P = 0.07; RR, 0.41; CI, 0.15-1.09. No significant association was observed with TLS and catheter-associated thrombosis (RR, 1.99; CI, 0.75-5.28. CONCLUSIONS: The use of TLS reduced the incidence of CRBSIs without obvious adverse effects or bacterial resistance. However, the susceptibility of G+ and G- bacteria to taurolidine and the risk for catheter-associated thrombosis of TLS are indeterminate due to limited data. The results should be treated with caution due to the limited sample sizes and methodological deficiencies

  11. 抗感染中心静脉导管预防导管相关性血流感染的效果%Effect in prevention of catheter-related bloodstream infection using antiseptic impregnated central venous catheter

    Institute of Scientific and Technical Information of China (English)

    罗蕾; 秦英; 向亚娟

    2011-01-01

    Objective To evaluate the clinical effect in prevention of catheter-related bloodstream infection(CRBSI) using antiseptic impregnated central venous catheter. Methods The incidence of catheterrelated bloodstream infection was compared between 420 cases performed with antiseptic impregnated central venous catheter ( experimental group ) and 430 cases performed with general central venous catheter (control).Besides, the categories and characteristics of pathogenic bacteria which resulted in catheter-related bloodstream infection were analyzed. Results There were 66 cases of CRBSI in 850 cases, 25 cases were inserted antiseptic impregnated central venous catheter and 41 cases inserted general central venous catheter. No significant difference in the incidence between the two groups was found during 7 days(χ2 = 0. 06 ,P > 0. 05), however, the incidence of CRBSI was lower in the experimental group than of the control group after 7 days( χ2 = 3.91,4.30 ;P 0.05),7 d后实验组CRBSI感染率较对照组低,差异有统计学意义(χ2分别为3.91,4.30,P<0.05).实验组减少导管相关性血流感染的病原体主要为革兰阳性菌.结论 抗感染中心静脉导管可明显减少导管相关性血流感染的发生,有很大的临床价值.

  12. Comparison of E,E-Farnesol Secretion and the Clinical Characteristics of Candida albicans Bloodstream Isolates from Different Multilocus Sequence Typing Clades.

    Science.gov (United States)

    Jung, Sook-In; Shin, Jong Hee; Kim, Soo Hyun; Kim, Jin; Kim, Joo Hee; Choi, Min Ji; Chung, Eun-Kyung; Lee, Kyungwon; Koo, Sun Hoe; Chang, Hyun Ha; Bougnoux, Marie-Elisabeth; d'Enfert, Christophe

    2016-01-01

    Using multilocus sequence typing (MLST), Candida albicans can be subdivided into 18 different clades. Farnesol, a quorum-sensing molecule secreted by C. albicans, is thought to play an important role in the development of C. albicans biofilms and is also a virulence factor. This study evaluated whether C. albicans bloodstream infection (BSI) strains belonging to different MLST clades secrete different levels of E,E-farnesol (FOH) and whether they have different clinical characteristics. In total, 149 C. albicans BSI isolates from ten Korean hospitals belonging to clades 18 (n = 28), 4 (n = 23), 1 (n = 22), 12 (n = 17), and other clades (n = 59) were assessed. For each isolate, the FOH level in 24-hour biofilms was determined in filtered (0.45 μm) culture supernatant using high-performance liquid chromatography. Marked differences in FOH secretion from biofilms (0.10-6.99 μM) were observed among the 149 BSI isolates. Clade 18 isolates secreted significantly more FOH than did non-clade 18 isolates (mean ± SEM; 2.66 ± 0.22 vs. 1.69 ± 0.10 μM; P albicans BSI isolates belonging to the most prevalent MLST clade (clade 18) in Korea are characterized by increased levels of FOH secretion and less severe illness.

  13. A collaborative, systems-level approach to eliminating healthcare-associated MRSA, central-line-associated bloodstream infections, ventilator-associated pneumonia, and respiratory virus infections.

    Science.gov (United States)

    Henderson, Donna M; Staiger, Thomas O; Peterson, Gene N; Sinanan, Mika N; Angiulo, Cindy L; Makarewicz, Vanessa A; Wild, Lorie M; Whimbey, Estella E

    2012-01-01

    To achieve sustainable reductions in healthcare-associated infections (HAIs), the University of Washington Medical Center (UWMC) deployed a collaborative, systems-level initiative. With the sponsorship of senior leadership, multidisciplinary teams were established to address healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA), central-line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP), and respiratory virus infections. The goal of the initiative was to eliminate these four HAIs among medical center inpatients by 2012. In the first 24 months of the project, the number of healthcare-associated MRSA cases decreased 58%; CLABSI cases decreased 54%. Staff and provider compliance with infection prevention measures improved and remained strong, for example, 96% compliance with hand hygiene, 98% compliance with the recommended influenza vaccination program, and 100% compliance with the VAP bundle. Achieving these results required an array of coordinated, systems-level interventions. Critical project success factors were believed to include creating organizational alignment by declaring eliminating HAIs as an organizational breakthrough goal, having the organization's executive leadership highly engaged in the project, coordination by an experienced and effective project leader and manager, collaboration by multidisciplinary project teams, and promoting transparency of results across the organization.

  14. Risk factors and treatment outcomes of bloodstream infection caused by extended-spectrum cephalosporin-resistant Enterobacter species in adults with cancer.

    Science.gov (United States)

    Huh, Kyungmin; Kang, Cheol-In; Kim, Jungok; Cho, Sun Young; Ha, Young Eun; Joo, Eun-Jeong; Chung, Doo Ryeon; Lee, Nam Yong; Peck, Kyong Ran; Song, Jae-Hoon

    2014-02-01

    Treatment of Enterobacter infection is complicated due to its intrinsic resistance to cephalosporins. Medical records of 192 adults with cancer who had Enterobacter bacteremia were analyzed retrospectively to evaluate the risk factors for and the treatment outcomes in extended-spectrum cephalosporin (ESC)-resistant Enterobacter bacteremia in adults with cancer. The main outcome measure was 30-day mortality. Of the 192 patients, 53 (27.6%) had bloodstream infections caused by ESC-resistant Enterobacter species. Recent use of a third-generation cephalosporin, older age, tumor progression at last evaluation, recent surgery, and nosocomial acquisition were associated with ESC-resistant Enterobacter bacteremia. The 30-day mortality rate was significantly higher in the resistant group. Multivariate analysis showed that respiratory tract infection, tumor progression, septic shock at presentation, Enterobacter aerogenes as the culprit pathogen, and diabetes mellitus were independent risk factors for mortality. ESC resistance was significantly associated with mortality in patients with E. aerogenes bacteremia, although not in the overall patient population.

  15. Reduction of catheter-associated bloodstream infections through procedures in newborn babies admitted in a university hospital intensive care unit in Brazil

    Directory of Open Access Journals (Sweden)

    Daiane Silva Resende

    2011-12-01

    Full Text Available INTRODUCTION: Catheter-associated bloodstream infection (CA-BSI is the most common nosocomial infection in neonatal intensive care units. There is evidence that care bundles to reduce CA-BSI are effective in the adult literature. The aim of this study was to reduce CA-BSI in a Brazilian neonatal intensive care unit by means of a care bundle including few strategies or procedures of prevention and control of these infections. METHODS: An intervention designed to reduce CA-BSI with five evidence-based procedures was conducted. RESULTS: A total of sixty-seven (26.7% CA-BSIs were observed. There were 46 (32% episodes of culture-proven sepsis in group preintervention (24.1 per 1,000 catheter days [CVC days]. Neonates in the group after implementation of the intervention had 21 (19.6% episodes of CA-BSI (14.9 per 1,000 CVC days. The incidence of CA-BSI decreased significantly after the intervention from the group preintervention and postintervention (32% to 19.6%, 24.1 per 1,000 CVC days to 14.9 per 1,000 CVC days, p=0.04. In the multiple logistic regression analysis, the use of more than 3 antibiotics and length of stay >8 days were independent risk factors for BSI. CONCLUSIONS: A stepwise introduction of evidence-based intervention and intensive and continuous education of all healthcare workers are effective in reducing CA-BSI.

  16. Significance of yeasts in bloodstream infection: Epidemiology and predisposing factors of Candidaemia in adult patients at a university hospital (2010-2014).

    Science.gov (United States)

    Pongrácz, Júlia; Juhász, Emese; Iván, Miklós; Kristóf, Katalin

    2015-09-01

    The incidence of Candida bloodstream infection (BSI) has increased during the past decades. Species distribution is changing worldwide, and non-albicans Candida spp. are becoming more prevalent. Acquired resistance to antifungal agents has been documented in several reports. The aim of our study was to assess the epidemiology and antifungal susceptibility of Candida isolates from BSI at our institute. The incidence of Candida BSI increased during the first four years of our investigation, from 1.7 to 3.5 episodes / 10 000 admissions, then dropped to 2.66 episodes / 10 000 admissions in the last year. The most frequently isolated species was C. albicans (63%), followed by C. glabrata (13%), C. parapsilosis (10.2%), C. tropicalis (9.3%), and C. krusei (3.7%). One isolate each of C. kefyr, C. fabianii and C. inconspicua were detected. The percentage of C. albicans remained stable throughout the study period. The most frequent risk factors of Candida BSI in our patient population were intensive care treatment (60.4%), abdominal surgery (52.5%), and solid malignancy (30.7%). All isolates were wild-type organisms, no acquired antifungal resistance was detected.

  17. 艾滋病患者血流感染的研究%Study of bloodstream infection in HIV/AIDS patients

    Institute of Scientific and Technical Information of China (English)

    杨宗兴; 吴南屏

    2012-01-01

    血流感染(BSI)对艾滋病患者的预后有重要意义,即使在HAART时代,BSI在艾滋病患者的死亡原因中仍排在前三位.国外有较多针对艾滋病患者BSI的研究,而国内这方面的研究较少.此文就艾滋病患者BSI的发病率、病原体、诊断、预后和防治等问题作了综述.%Bloodstream infection(BSI) is of great importance to the prognosis of HIV/AIDS patients,which ranks among the first three causes of death of HIV/AIDS patients even in HAART(highly active antiretroviral therapy)era.Many studies of BSI aiming at HIV/AIDS patients have been conducted abroad,but there are few in China.Now,the studies of BSI of HIV/AIDS patients,the topics involving incidence,pathogens,diagnosis,prognosis,prevention and cure are reviewed in this article.

  18. High Incidence of Afebrile Bloodstream Infection Detected by Surveillance Blood Culture in Patients on Corticosteroid Therapy after Allogeneic Hematopoietic Stem Cell Transplantation.

    Science.gov (United States)

    Kameda, Kazuaki; Kimura, Shun-Ichi; Akahoshi, Yu; Nakano, Hirofumi; Harada, Naonori; Ugai, Tomotaka; Wada, Hidenori; Yamasaki, Ryoko; Ishihara, Yuko; Kawamura, Koji; Sakamoto, Kana; Ashizawa, Masahiro; Sato, Miki; Terasako-Saito, Kiriko; Nakasone, Hideki; Kikuchi, Misato; Yamazaki, Rie; Kanda, Junya; Kako, Shinichi; Tanihara, Aki; Nishida, Junji; Kanda, Yoshinobu

    2016-02-01

    Bloodstream infections (BSI) are still important complications after allogeneic hematopoietic stem cell transplantation (allo-SCT). Patients who are receiving corticosteroid therapy can develop BSI without fever. The utility of surveillance blood cultures in these situations is controversial. We retrospectively analyzed 74 patients who received a corticosteroid consisting of ≥.5 mg/kg prednisolone or equivalent after allo-SCT. In principle, we performed surveillance blood culture weekly for these patients. Sixteen patients (21.6%) developed definite BSI. In a multivariate analysis, a myeloablative conditioning regimen, high-risk disease status at allo-SCT, and the presence of a central venous catheter at the initiation of corticosteroid therapy were identified as independent significant risk factors for the development of definite BSI. At the first definite BSI episode, 7 patients (46.7%) were afebrile and diagnosed by surveillance blood culture. However, 6 of these 7 afebrile patients showed various signs that could be attributed to infection at the time of positive blood culture. In conclusion, patients receiving corticosteroid therapy after allo-SCT frequently develop afebrile BSI. Although surveillance blood culture might be beneficial in these situations, it also seems important to not miss the signs of BSI, even when patients are afebrile.

  19. The effect of comprehensive infection control measures on the rate of late-onset bloodstream infections in very low-birth-weight infants.

    Science.gov (United States)

    Wicker, Linda; Saslow, Judy; Shah, Sahil; Bhat, Vishwanath; Sannoh, Sulaiman; Brandon, Emma; Kemble, Nicole; Pyon, Kee; Stahl, Gary; Aghai, Zubair H

    2011-03-01

    Late-onset bloodstream infection (LOBI) is a significant problem in very low-birth-weight (VLBW) infants and can lead to increased mortality and morbidity. The incidence of LOBI in VLBW infants in our unit was >35% before 2004, much higher than 20% reported in other studies. A comprehensive infection control measure was introduced in our unit in 2005. Here we report the effects of comprehensive infection control measures on the rate of LOBI in VLBW infants. Infants in the preintervention group (born 2001 to 2004) were compared with the intervention group (born 2005 to 2008) for baseline demographics, risk factors for infection, and the rate of LOBI. LOBI was defined as a positive blood and/or cerebrospinal fluid culture after 3 days of life. Three hundred thirty-four VLBW infants were admitted to our unit during the preintervention period and 303 during the intervention period. There was no significant difference in baseline demographics and risk factors for LOBI between the two groups. The incidence of LOBI was significantly reduced from 38% before intervention to 23% after intervention ( P control measures significantly reduced the rate of LOBI in VLBW infants.

  20. Molecular epidemiology of extended-spectrum beta-lactamase (ESBL)-positive Klebsiella pneumoniae from bloodstream infections and risk factors for mortality.

    Science.gov (United States)

    Gürntke, Stephan; Kohler, Christian; Steinmetz, Ivo; Pfeifer, Yvonne; Eller, Christoph; Gastmeier, Petra; Schwab, Frank; Leistner, Rasmus

    2014-12-01

    The prevalence of extended-spectrum beta-lactamase (ESBL)-positive Klebsiella pneumoniae is growing worldwide. Infections with these bacteria are suspected to be related to increased mortality. We aimed to estimate the distribution of ESBL genotypes and to assess the impact on mortality associated with ESBL positivity in cases of bloodstream infection (BSI) due to K. pneumoniae. We performed a cohort study on patients with K. pneumoniae BSI between 2008 and 2011. Presence of ESBL genes was analyzed by PCR and sequencing. Risk factors for mortality were analyzed by Cox-proportional hazard regression. We identified 286 ESBL-negative (81%) and 66 (19%) ESBL-positive cases. 97% (n = 64) of the ESBL-positive isolates were susceptible for meropenem. The most common ESBL genotypes were CTX-M-15 (60%), SHV-5 (27%) and CTX-M-3 (5%). Significant risk factors for mortality were chronic pulmonary disease (HR 1.747) and moderate/severe renal disease (HR 2.572). ESBL positivity was not associated with increased mortality.

  1. Etiology, clinical course and outcome of healthcare-associated bloodstream infections in patients with hematological malignancies: a retrospective study of 350 patients in a Finnish tertiary care hospital.

    Science.gov (United States)

    Åttman, Emilia; Aittoniemi, Janne; Sinisalo, Marjatta; Vuento, Risto; Lyytikäinen, Outi; Kärki, Tommi; Syrjänen, Jaana; Huttunen, Reetta

    2015-01-01

    This retrospectively collected laboratory-based surveillance data includes 575 healthcare-associated bloodstream infections (BSIs) in 350 patients with hematological malignancy in Tampere University Hospital, Finland, during 1999-2001 and 2005-2010. The most common underlying diseases were acute myelogenous leukemia (n=283, 49%), followed by myeloma (n=87, 15%) and acute lymphocytic leukemia (n=76, 13%). The overall rate was 9.1 BSIs per 1000 patient-days. Gram-positive BSIs predominated and the most common pathogens were coagulase-negative staphylococci (23%), viridans streptococci (11%), enterococci (9%) and Escherichia coli (9%). Fungi caused 2% of BSIs. The 7-day and 28-day case fatalities were 5% and 10% and were highest in BSIs caused by P. aeruginosa (19% and 34%, respectively). The median age of patients with BSI has increased; it was 55.0 years during 1999-2001, compared to 59.0 years in 2005-2007 and 59.0 years in 2008-2010 (p<0.0001). Gram-positive bacteria predominated in this material. Case fatalities were low as compared to previous reports although the median age of patients increased.

  2. Nationwide German Multicenter Study on Prevalence of Antibiotic Resistance in Staphylococcal Bloodstream Isolates and Comparative In Vitro Activities of Quinupristin-Dalfopristin

    Science.gov (United States)

    von Eiff, Christof; Reinert, Ralf René; Kresken, Michael; Brauers, Johannes; Hafner, Dieter; Peters, Georg

    2000-01-01

    Antibiotic-resistant gram-positive bacteria have become an increasing problem in the last two decades. In order to evaluate the prevalence of antibiotic resistance in staphylococcal bloodstream isolates in Germany, 2,042 staphylococci collected in 21 tertiary-care hospitals were investigated during a 3-year period (March 1996 to March 1999). Altogether, 1,448 S. aureus isolates and 594 coagulase-negative staphylococci (CoNS) that comprised 13 different species were included. Furthermore, the antistaphylococcal activities of quinupristin-dalfopristin were compared with those of eight other compounds by the broth microdilution method. The rates of oxacillin resistance in Staphylococcus aureus, S. epidermidis, S. haemolyticus, and other CoNS were 13.5, 69, 90, and 34%, respectively. In oxacillin-resistant strains high rates of resistance (up to 100%) to erythromycin, clindamycin, ciprofloxacin, and gentamicin were also observed. However, no strain appeared to be resistant to vancomycin or quinupristin-dalfopristin. The streptogramin combination exhibited excellent in vitro activity against all staphylococcal species tested, regardless of the patterns of resistance to other drug classes. In terms of MICs at which 90% of the isolates are inhibited, quinupristin-dalfopristin was 2 times more active against S. aureus isolates, 4 to 16 times more active against S. haemolyticus, and 8 to 32 times more active against S. epidermidis than vancomycin or teicoplanin. PMID:10921933

  3. Hospital costs of central line-associated bloodstream infections and cost-effectiveness of closed vs. open infusion containers. The case of Intensive Care Units in Italy

    Directory of Open Access Journals (Sweden)

    Torbica Aleksandra

    2010-05-01

    Full Text Available Abstract Objectives The aim was to evaluate direct health care costs of central line-associated bloodstream infections (CLABSI and to calculate the cost-effectiveness ratio of closed fully collapsible plastic intravenous infusion containers vs. open (glass infusion containers. Methods A two-year, prospective case-control study was undertaken in four intensive care units in an Italian teaching hospital. Patients with CLABSI (cases and patients without CLABSI (controls were matched for admission departments, gender, age, and average severity of illness score. Costs were estimated according to micro-costing approach. In the cost effectiveness analysis, the cost component was assessed as the difference between production costs while effectiveness was measured by CLABSI rate (number of CLABSI per 1000 central line days associated with the two infusion containers. Results A total of 43 cases of CLABSI were compared with 97 matched controls. The mean age of cases and controls was 62.1 and 66.6 years, respectively (p = 0.143; 56% of the cases and 57% of the controls were females (p = 0.922. The mean length of stay of cases and controls was 17.41 and 8.55 days, respectively (p Conclusions CLABSI results in considerable and significant increase in utilization of hospital resources. Use of innovative technologies such as closed infusion containers can significantly reduce the incidence of healthcare acquired infection without posing additional burden on hospital budgets.

  4. Impact of ESKAPE bloodstream infection on prognosis of acute necrotizing pancreatitis%ESKAPE血流感染对急性坏死型胰腺炎预后的影响

    Institute of Scientific and Technical Information of China (English)

    杨双汇; 杨慧明; 黄耿文; 李宜雄

    2015-01-01

    目的:探讨ESKAPE血流感染对急性坏死性胰腺炎(ANP)患者预后及并发症的影响。  方法:回顾性分析2003年1月—2014年7月收治的有血培养结果的87例ANP患者,其中血培养阴性49例,阳性38例,分析血流感染,尤其是ESKAPE血流感染对ANP患者治疗结果的影响。  结果:在38例血培养阳性ANP患者的69份的病原学结果中,40.6%为ESKAPE,其中鲍曼不动杆菌占比50.0%,其余依次为屎肠球菌(14.3%)、肺炎克雷伯菌(10.7%),肠杆菌属(10.7%),金黄色葡萄球菌(7.1%)和铜绿假单胞菌(7.1%)。血流感染患者休克、呼吸衰竭、肾功能衰竭与消化道出血等并发症的发生率、病死率、住院费用及ICU住院天数均较非血流感染患者明显增高(均P  结论:血流感染明显增加ANP患者的并发症和病死率。ESKAPE是导致ANP患者血流感染的主要病原体,其与患者休克的发生密切相关。%Objective:To investigate the impact of ESAKPE bloodstream infection on the prognosis and complications in patients with acute necrotizing pancreatitis (ANP). Methods:Eighty-seven ANP patients admitted from January 2003 to July 2014 with blood culture results were retrospectively studied. Of the patients, 49 cases had negative and 38 cases had positive blood culture. hTe impact of bloodstream infection, especially ESKAPE bloodstream infection on therapeutic outcomes of these ANP patients was analyzed. Results:In the 69 pathogen test results from the 38 ANP patients with positive blood culture, 40.6%were ESAKPE pathogens that included Acinetobacter baumanni (50.0%), Enterococcus faecium (14.3%), Klebsiella pneumonia (10.7%), Enterobacter species (10.7%), Staphylococcus aureus (7.1%) and Pseudomonas aeruginosa (7.1%). Patients with bloodstream infection had significantly increased incidence of shock, respiratory failure, renal failure and digestive tract bleeding and mortality, as well as

  5. Careers (A Course of Study). Unit V: Forms, Forms, Forms.

    Science.gov (United States)

    Turley, Kay

    Designed to enable special needs students to understand and complete various job-related forms, this set of activities devoted to forms encountered before and after one obtains a job is the fifth in a nine-unit secondary level careers course intended to provide handicapped students with the knowledge and tools necessary to succeed in the world of…

  6. Clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections.

    LENUS (Irish Health Repository)

    de Kraker, Marlieke E A

    2011-04-01

    Antimicrobial resistance is threatening the successful management of nosocomial infections worldwide. Despite the therapeutic limitations imposed by methicillin-resistant Staphylococcus aureus (MRSA), its clinical impact is still debated. The objective of this study was to estimate the excess mortality and length of hospital stay (LOS) associated with MRSA bloodstream infections (BSI) in European hospitals. Between July 2007 and June 2008, a multicenter, prospective, parallel matched-cohort study was carried out in 13 tertiary care hospitals in as many European countries. Cohort I consisted of patients with MRSA BSI and cohort II of patients with methicillin-susceptible S. aureus (MSSA) BSI. The patients in both cohorts were matched for LOS prior to the onset of BSI with patients free of the respective BSI. Cohort I consisted of 248 MRSA patients and 453 controls and cohort II of 618 MSSA patients and 1,170 controls. Compared to the controls, MRSA patients had higher 30-day mortality (adjusted odds ratio [aOR] = 4.4) and higher hospital mortality (adjusted hazard ratio [aHR] = 3.5). Their excess LOS was 9.2 days. MSSA patients also had higher 30-day (aOR = 2.4) and hospital (aHR = 3.1) mortality and an excess LOS of 8.6 days. When the outcomes from the two cohorts were compared, an effect attributable to methicillin resistance was found for 30-day mortality (OR = 1.8; P = 0.04), but not for hospital mortality (HR = 1.1; P = 0.63) or LOS (difference = 0.6 days; P = 0.96). Irrespective of methicillin susceptibility, S. aureus BSI has a significant impact on morbidity and mortality. In addition, MRSA BSI leads to a fatal outcome more frequently than MSSA BSI. Infection control efforts in hospitals should aim to contain infections caused by both resistant and susceptible S. aureus.

  7. Prevention of Catheter-related Bloodstream Infection in ICU%ICU患者中心静脉导管相关性血流感染的预防

    Institute of Scientific and Technical Information of China (English)

    徐文

    2011-01-01

    Central venous catheter( CVC )is one of the most common technique for monitoring and treatment in ICU. But There is a risk of catheter-related bloodstream infection causing prolonged hospital stay and increased mortality. Positioning the CVC through the subclavian vein and using a antibiotic catheter can help to reduce the incidence of CRBSI. A bundle stratige is of a crucial role in CRBSI provention.It should include strict hand hygiene, sterilizing with mixture of 70% ethano and 2% chlorhexidine, maximal sterile barrier and regular dressing change. The efficiency of regular CVC replacement and of antibiotic based catheter lock solution are not clear, and are not recommended as a routine.%留置中心静脉导管是ICU中最常用的监测和治疗措施,但其同时存在发生导管相关性血流感染(CRBSI)的风险,从而导致患者住院时间延长和病死率升高.选择锁骨下穿刺径路、使用抗生素导管可减少CRBSI的发生.应用集束化预防措施进行置管及日常护理是预防CRBSI发生的重要措施,包括严格的手卫生、应用2%氯己定和70%乙醇混合液消毒皮肤、最大消毒屏障以及定期更换辅料.定期更换导管及使用抗生素封管对预防CRBSI效果不明确,不作为常规推荐.

  8. Meropenem for treating KPC-producing Klebsiella pneumoniae bloodstream infections: Should we get to the PK/PD root of the paradox?

    Science.gov (United States)

    Del Bono, Valerio; Giacobbe, Daniele Roberto; Marchese, Anna; Parisini, Andrea; Fucile, Carmen; Coppo, Erika; Marini, Valeria; Arena, Antonio; Molin, Alexandre; Martelli, Antonietta; Gratarola, Angelo; Viscoli, Claudio; Pelosi, Paolo; Mattioli, Francesca

    2017-01-02

    The objective of this study was to assess the achievement of pharmacokinetic/pharmacodynamic (PK/PD) targets of meropenem (MEM) in critically-ill patients with bloodstream infections (BSI) due to Klebsiella pneumoniae-carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) with MEM minimum inhibitory concentrations (MICs) ≥16 mg/L. Nineteen critically-ill patients with KPC-Kp BSI were given combination therapy including MEM, tigecycline, plus colistin or gentamicin (according to susceptibility testing). MEM was administered as an extended 3-hour infusion of 2 g every 8 hours, or adjusted according to renal function. MEM plasma concentrations were determined by high-performance liquid chromatography. PK/PD targets for MEM were defined as T > 40% 1×MIC and T > 40% 4×MIC. Possible synergisms between MEM and coadministered agents were assessed by time-kill assays based on plasma levels for MEM and on fixed plasma concentrations for the other agents. In none of 19 patients MEM reached any PK/PD target. The actual MEM MICs were 256, 512, and 1024 mg/L in 1, 3, and 15 isolates, respectively. However, theoretically, the PK/PD target of T > 40% 1×MIC could have been achieved in 95%, 68%, 32% and 0% of the isolates for MIC equal to 8, 16, 32, and 64 mg/L, respectively. No synergisms were observed between MEM and coadministered agents. In conclusion, high-dose MEM failed to reach PK/PD targets in 19 patients with BSI due to KPC-Kp with very high MEM MICs. On a theoretical basis, our results suggest a possible usefulness of MEM against resistant blood isolates with MICs up to 32 mg/L.

  9. Clinical and microbiological features of community-acquired and nosocomial bloodstream infections in the surgical department of a tertiary-care hospital in Beijing

    Institute of Scientific and Technical Information of China (English)

    L(U) You; GUO Peng; YE Ying-jiang; WANG Hui; SHEN Zhan-long; WANG Qi; ZHAO Chun-jiang

    2013-01-01

    Background Bloodstream infections (BSls) remain a major cause of morbidity and mortality in patients undergoing surgery.This study aimed at elucidating the clinical characteristics of community-acquired BSls (CABs) and nosocomial BSls (nBSls) in patients admitted to the surgical wards of a teaching hospital in Beijing,China.Methods This cross-sectional study compared 191 episodes of BSls in 4074 patients admitted to the surgical wards between January 2008 and December 2011.Cases of BSls were classified as CABs or nBSls,and the characteristics,relevant treatments,and outcomes of CABs and nBSls were compared.Results Of the 191 BSls,52 (27.2%) and 139 (72.8%) were CABs and nBSls,respectively.Eschedchia coli,coagulasenegative staphylococci,and Klebsiella spp,were the most frequently isolated microorganisms.There were significant differences between CABs and nBSls with respect to the use of hormonal drugs,ventilation,acute physiology and chronic health evaluation (APACHE) Ⅱ and American Society of Anesthesiologists scores,and prevalence of cancer (P <0.05).Empirical antibacterial therapy did not decrease the crude mortality,but multivariate analysis showed that high APACHE Ⅱ was independently associated with a risk of mortality (odds ratio =0.97,95% confidence interval:0.93-1.02 for APACHE Ⅱ).Conclusions We found significant differences in the clinical characteristics of surgical patients with CABs and nBSls.The outcome of patients seems to be related to high APACHE Ⅱ scores.

  10. Differential association of fluconazole dose and dose/MIC ratio with mortality in patients with Candida albicans and non-albicans bloodstream infection.

    Science.gov (United States)

    Brosh-Nissimov, T; Ben-Ami, R

    2015-11-01

    Targeting fluconazole therapy to achieve predefined pharmacodynamic goals has been suggested as a means of optimizing the treatment of patients with candidaemia. However, data regarding species-specific dosing targets are inconclusive. We retrospectively analysed a cohort of 75 adult patients with Candida bloodstream infection (BSI) who received initial treatment with fluconazole for ≥48 h (36 Candida albicans and 39 non-albicans Candida (NAC)). Fluconazole dose, the dose/MIC ratio and the 24-h area under the concentration-time curve (AUC24)/MIC ratio were determined for each patient, and classification and regression tree analysis was used to determine breakpoints for significant interactions with 30-day survival. Both fluconazole exposure parameters and patient-related and disease-related variables were assessed in univariable and multivariable survival models. The crude 30-day mortality rate was 32% (44% and 21% for C. albicans and NAC, respectively). An average fluconazole dose of >200 mg/day, a dose/MIC ratio of >400 and an AUC24/MIC ratio of >400 were associated with a higher 30-day survival rate and better microbiological response in patients with C. albicans BSI but not in those with NAC BSI. Baseline chronic kidney disease was a risk factor for fluconazole underdosing and mortality. Severity of sepsis (Sequential Organ Failure Assessment score) was the only significant predictor of death in patients with NAC BSI. We conclude that, although pharmacodynamic target-directed fluconazole dosing may help to optimize outcomes for patients with C. albicans BSI, additional studies are needed to define the role of fluconazole in the treatment of NAC BSI.

  11. Differences in characteristics between healthcare-associated and community-acquired infection in community-onset Klebsiella pneumoniae bloodstream infection in Korea

    Directory of Open Access Journals (Sweden)

    Jung Younghee

    2012-10-01

    Full Text Available Abstract Background Healthcare-associated (HCA infection has emerged as a new epidemiological category. The aim of this study was to evaluate the impact of HCA infection on mortality in community-onset Klebsiella pneumoniae bloodstream infection (KpBSI. Methods We conducted a retrospective study in two tertiary-care hospitals over a 6-year period. All adult patients with KpBSI within 48 hours of admission were enrolled. We compared the clinical characteristics of HCA and community-acquired (CA infection, and analyzed risk factors for mortality in patients with community-onset KpBSI. Results Of 553 patients with community-onset KpBSI, 313 (57% were classified as HCA- KpBSI and 240 (43% as CA-KpBSI. In patients with HCA-KpBSI, the severity of the underlying diseases was higher than in patients with CA-KpBSI. Overall the most common site of infection was the pancreatobiliary tract. Liver abscess was more common in CA-KpBSI, whereas peritonitis and primary bacteremia were more common in HCA-KpBSI. Isolates not susceptible to extended-spectrum cephalosporin were more common in HCA- KpBSI than in CA-KpBSI (9% [29/313] vs. 3% [8/240]; p = 0.006. Overall 30-day mortality rate was significantly higher in HCA-KpBSI than in CA-KpBSI (22% [70/313] vs. 11% [27/240]; p = 0.001. In multivariate analysis, high Charlson’s weighted index of co-morbidity, high Pitt bacteremia score, neutropenia, polymicrobial infection and inappropriate empirical antimicrobial therapy were significant risk factors for 30-day mortality. Conclusions HCA-KpBSI in community-onset KpBSI has distinctive characteristics and has a poorer prognosis than CA-KpBSI, but HCA infection was not an independent risk factor for 30-day mortality.

  12. Bloodstream infections among patients treated with intravenous epoprostenol or intravenous treprostinil for pulmonary arterial hypertension--seven sites, United States, 2003-2006.

    Science.gov (United States)

    2007-03-02

    Pulmonary arterial hypertension (PAH) is a life-threatening disorder characterized by elevated pulmonary artery pressure and pulmonary vascular resistance. Continuous infusion of a prostanoid, which acts as a vasodilator and anti-proliferative agent, is indicated in the treatment of patients with severe PAH. Two prostanoids are approved for intravenous (IV) use in the United States: epoprostenol (epoprostenol sodium [brand name Flolan], Gilead, Foster City, California) and treprostinil (treprostinil sodium [brand name Remodulin], United Therapeutics, Silver Spring, Maryland). These drugs are administered to PAH patients at hundreds of treatment centers in the United States. In September 2006, CDC received a report from a PAH specialist of a suspected increase in the number of gram-negative bloodstream infections (BSIs) among PAH patients treated with IV treprostinil. CDC conducted a retrospective investigation with the assistance of several state health departments and the cooperation of seven PAH treatment centers to determine the relative rates of BSI in a sample of patients treated with IV treprostinil and IV epoprostenol during 2003--2006. This report describes the results of that investigation, which indicated that, based on combined data from seven separate PAH treatment centers, pooled mean rates of BSI (primarily gram-negative BSI) were significantly higher for patients on treprostinil than for those on epoprostenol. The results do not suggest intrinsic contamination of IV treprostinil as a cause of the infections; the difference in rates might have been caused by differences in preparation and storage of the two agents, differences in catheter care practices, or differences in the anti-inflammatory activity of the agents. Health-care providers who care for PAH patients should be aware of these findings. Further investigation is needed to determine the causes of the different infection rates at centers where this was observed and to determine whether such a

  13. Implementation of central venous catheter bundle in an intensive care unit in Kuwait: Effect on central line-associated bloodstream infections.

    Science.gov (United States)

    Salama, Mona F; Jamal, Wafaa; Al Mousa, Haifa; Rotimi, Vincent

    2016-01-01

    Central line-associated bloodstream infection (CLABSIs) is an important healthcare-associated infection in the critical care units. It causes substantial morbidity, mortality and incurs high costs. The use of central venous line (CVL) insertion bundle has been shown to decrease the incidence of CLABSIs. Our aim was to study the impact of CVL insertion bundle on incidence of CLABSI and study the causative microbial agents in an intensive care unit in Kuwait. Surveillance for CLABSI was conducted by trained infection control team using National Health Safety Network (NHSN) case definitions and device days measurement methods. During the intervention period, nursing staff used central line care bundle consisting of (1) hand hygiene by inserter (2) maximal barrier precautions upon insertion by the physician inserting the catheter and sterile drape from head to toe to the patient (3) use of a 2% chlorohexidine gluconate (CHG) in 70% ethanol scrub for the insertion site (4) optimum catheter site selection. (5) Examination of the daily necessity of the central line. During the pre-intervention period, there were 5367 documented catheter-days and 80 CLABSIs, for an incidence density of 14.9 CLABSIs per 1000 catheter-days. After implementation of the interventions, there were 5052 catheter-days and 56 CLABSIs, for an incidence density of 11.08 per 1000 catheter-days. The reduction in the CLABSI/1000 catheter days was not statistically significant (P=0.0859). This study demonstrates that implementation of a central venous catheter post-insertion care bundle was associated with a reduction in CLABSI in an intensive care area setting.

  14. Are ciprofloxacin dosage regimens adequate for antimicrobial efficacy and prevention of resistance? Pseudomonas aeruginosa bloodstream infection in elderly patients as a simulation case study.

    Science.gov (United States)

    Cazaubon, Yoann; Bourguignon, Laurent; Goutelle, Sylvain; Martin, Olivier; Maire, Pascal; Ducher, Michel

    2015-12-01

    The aim of this work was to define the optimal dosage (OD) of ciprofloxacin in order to prevent the emergence of bacterial resistance of Pseudomonas aeruginosa in a geriatric population with a bloodstream infection. A thousand pharmacokinetic profiles were simulated with a ciprofloxacin pharmacokinetic model from the literature. Three dosing regimens were tested for five days: once daily (QD), twice daily (BID), and thrice daily (TID). First of all, effective dosages (ED) of ciprofloxacin were defined as those achieving a target AUC24 /MIC ≥ 125. Then, these ED were simulated in order to calculate the percentage of time spent within the mutant selection window (TMSW ) and to select optimal dosage (OD) defined as those achieving TMSW ≤ 20%. Based on the AUC24 /MIC, for low MICs (0.125 μg/mL), all dosing regimens recommended by French guidelines were effective. For intermediate MICs (0.25 and 0.5 μg/mL), simulated doses higher than those recommended were needed to achieve the efficacy target. About prevention of resistance for low MICs, dosages recommended were only effective in patients with creatinine clearance (CLCR ) ≥ 60 mL/min. For intermediate MICs, dosages higher than recommended were needed to achieve the optimality target. This study shows that current ciprofloxacin dosing guidelines have not been optimized to prevent the emergence of bacterial resistance, especially in geriatric patients with mild to severe renal impairment. To achieve both efficacy and prevention of resistance, ciprofloxacin dosages greater than those recommended would be needed. Tolerance of such higher doses needs to be evaluated in clinical studies.

  15. Rate and time to develop first central line-associated bloodstream infections when comparing open and closed infusion containers in a Brazilian Hospital

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    Margarete Vilins

    2009-10-01

    Full Text Available The objective of the study was to determine the effect of switching from an open (glass or semi-rigid plastic infusion container to a closed, fully collapsible plastic infusion container (Viaflex® on rate and time to onset of central lineassociated bloodstream infections (CLABSI. An open-label, prospective cohort, active healthcare-associated infection surveillance, sequential study was conducted in three intensive care units in Brazil. The CLABSI rate using open infusion containers was compared to the rate using a closed infusion container. Probability of acquiring CLABSI was assessed over time and compared between open and closed infusion container periods; three-day intervals were examined. A total of 1125 adult ICU patients were enrolled. CLABSI rate was significantly higher during the open compared with the closed infusion container period (6.5 versus 3.2 CLABSI/1000 CL days; RR=0.49, 95%CI=0.26- 0.95, p=0.031. During the closed infusion container period, the probability of acquiring a CLABSI remained relatively constant along the time of central line use (0.8% Days 2-4 to 0.7% Days 11-13 but increased in the open infusion container period (1.5% Days 2-4 to 2.3% Days 11-13. Combined across all time intervals, the chance of a patient acquiring a CLABSI was significantly lower (55% in the closed infusion container period (Cox proportional hazard ratio 0.45, p= 0.019. CLABSIs can be reduced with the use of full barrier precautions, education, and performance feedback. Our results show that switching from an open to a closed infusion container may further reduce CLABSI rate as well as delay the onset of CLABSIs. Closed infusion containers significantly reduced CLABSI rate and the probability of acquiring CLABSI.

  16. Bloodstream infection caused by extensively drug-resistant Acinetobacter baumannii in cancer patients: high mortality associated with delayed treatment rather than with the degree of neutropenia.

    Science.gov (United States)

    Freire, M P; de Oliveira Garcia, D; Garcia, C P; Campagnari Bueno, M F; Camargo, C H; Kono Magri, A S G; Francisco, G R; Reghini, R; Vieira, M F; Ibrahim, K Y; Rossi, F; Hajjar, L; Levin, A S; Hoff, P M; Pierrotti, L C; Abdala, E

    2016-04-01

    This study aimed to describe severe infections with extensively drug-resistant Acinetobacter baumannii-calcoaceticus complex (XDR-ABC), as well as to investigate risk factors for mortality, in cancer patients. It was a retrospective study including all patients diagnosed with XDR-ABC bacteraemia during hospitalization in the intensive care unit of a cancer hospital between July 2009 and July 2013. Surveillance cultures were collected weekly during the study period, and clonality was analysed using pulsed field gel electrophoresis (PFGE). We analysed underlying diseases, oncology therapy, neutrophil counts, infection site and management of infection, in terms of their correlation with 30-day mortality. During the study period, 92 patients with XDR-ABC bacteraemia were identified, of whom 35 (38.0%) were patients with haematological malignancy. We identified XDR-ABC strains with four different profile patterns, 91.3% of patients harbouring the predominant PFGE type. Of the 92 patients with XDR-ABC bacteraemia, 66 (71.7%) had central line-associated bloodstream infections; infection occurred during neutropenia in 22 (23.9%); and 58 (63.0%) died before receiving the appropriate therapy. All patients were treated with polymyxin, which was used in combination therapy in 30 of them (32.4%). The 30-day mortality rate was 83.7%. Multivariate analysis revealed that septic shock at diagnosis of XDR-ABC infection was a risk factor for 30-day mortality; protective factors were receiving appropriate therapy and invasive device removal within the first 48 h. Among cancer patients, ineffective management of such infection increases the risk of death, more so than do features such as neutropenia and infection at the tumour site.

  17. Catheter related bloodstream infection (CR-BSI in ICU patients: making the decision to remove or not to remove the central venous catheter.

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    Rodrigo Octávio Deliberato

    Full Text Available BACKGROUND: Approximately 150 million central venous catheters (CVC are used each year in the United States. Catheter-related bloodstream infections (CR-BSI are one of the most important complications of the central venous catheters (CVCs. Our objective was to compare the in-hospital mortality when the catheter is removed or not removed in patients with CR-BSI. METHODS: We reviewed all episodes of CR-BSI that occurred in our intensive care unit (ICU from January 2000 to December 2008. The standard method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and a positive semi quantitative (>15 CFU culture of a catheter segment from where the same organism was isolated. The conservative method was defined as a patient with a CVC and at least one positive blood culture obtained from a peripheral vein and one of the following: (1 differential time period of CVC culture versus peripheral culture positivity of more than 2 hours, or (2 simultaneous quantitative blood culture with ≥ 5:1 ratio (CVC versus peripheral. RESULTS: 53 CR-BSI (37 diagnosed by the standard method and 16 by the conservative method were diagnosed during the study period. There was a no statistically significant difference in the in-hospital mortality for the standard versus the conservative method (57% vs. 75%, p = 0.208 in ICU patients. CONCLUSION: In our study there was a no statistically significant difference between the standard and conservative methods in-hospital mortality.

  18. Late onset sepsis in newborn babies: epidemiology and effect of a bundle to prevent central line associated bloodstream infections in the neonatal intensive care unit

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    Daiane Silva Resende

    2015-02-01

    Full Text Available Aim:We assessed late onset sepsis (LOS rates of neonates in a neonatal intensive care unit (NICU before and after implementing an evidence-based bundle to prevent these infections in a country with poor resources.Methods:We evaluate trends of LOS between October 2010 and August 2012 in a large tertiary hospital in Brazil. We designed a protocol based of CDC guidelines for insertion of maintenance of central venous catheter targeted to reduction of bloodstream infections. During this period two major events occurred: a great increase of LOS rates in January months and relocation of the unit to a provisory place. Additionally we evaluated the risk factors and etiology of these infections.Results:A total of 112 (20.3% cases defined as LOS were found. The overall incidence rate of LOS in the study was 16.1/1000 patient/days and 23.0/1000 CVC-days. Our monthly rates data of LOS/1000 patient-day reveal fluctuations over the studied period, with incidence rates of these infections in staff vacation period (January 2011 and 2012 significantly higher (59.6/1000 patients-days than compared with the other months rates (16.6/1000 patients-days (IRR = 3.59; p< 0.001. As opposite, the incidence rates of LOS during relocation period was lower (10.3/1000 patients-days when compared with baseline period 26.7/1000 patients-days (IRR = 2.59; p= 0.007. After the intervention period, these rates decreased in the post intervention period, when compared with preintervention 14.7/1000 patients-days and 23.4/1000 patients-days, respectively (IRR = 1.59; p= 0.04.Conclusion:Through simple infection control measures, LOS can be successfully controlled especially in NICUs of limited resources countries such as ours.

  19. Antifungal susceptibilities of bloodstream isolates of Candida species from nine hospitals in Korea: application of new antifungal breakpoints and relationship to antifungal usage.

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    Eun Jeong Won

    Full Text Available We applied the new clinical breakpoints (CBPs of the Clinical and Laboratory Standards Institute (CLSI to a multicenter study to determine the antifungal susceptibility of bloodstream infection (BSI isolates of Candida species in Korea, and determined the relationship between the frequency of antifungal-resistant Candida BSI isolates and antifungal use at hospitals. Four hundred and fifty BSI isolates of Candida species were collected over a 1-year period in 2011 from nine hospitals. The susceptibilities of the isolates to four antifungal agents were determined using the CLSI M27 broth microdilution method. By applying the species-specific CBPs, non-susceptibility to fluconazole was found in 16.4% (70/428 of isolates, comprising 2.6% resistant and 13.8% susceptible-dose dependent isolates. However, non-susceptibility to voriconazole, caspofungin, or micafungin was found in 0% (0/370, 0% (0/437, or 0.5% (2/437 of the Candida BSI isolates, respectively. Of the 450 isolates, 72 (16.0% showed decreased susceptibility to fluconazole [minimum inhibitory concentration (MIC ≥4 μg/ml]. The total usage of systemic antifungals varied considerably among the hospitals, ranging from 190.0 to 7.7 defined daily dose per 1,000 patient days, and fluconazole was the most commonly prescribed agent (46.3%. By Spearman's correlation analysis, fluconazole usage did not show a significant correlation with the percentage of fluconazole resistant isolates at hospitals. However, fluconazole usage was significantly correlated with the percentage of fluconazole non-susceptible isolates (r = 0.733; P = 0.025 or the percentage of isolates with decreased susceptibility to fluconazole (MIC ≥4 μg/ml (r = 0.700; P = 0.036 at hospitals. Our work represents the first South Korean multicenter study demonstrating an association between antifungal use and antifungal resistance among BSI isolates of Candida at hospitals using the new CBPs of the CLSI.

  20. Molecular epidemiology of CTX-M producing Enterobacteriaceae isolated from bloodstream infections in Rio de Janeiro, Brazil: emergence of CTX-M-15

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    Liliane Miyuki Seki

    2013-12-01

    Full Text Available OBJECTIVE: The present studywas designed to evaluate the molecular epidemiology of CTX-M producing Klebsiella pneumoniae, Enterobacter cloacae and Escherichia coli isolated from bloodstream infections at tertiary care hospitals in the State of Rio de Janeiro, Brazil. MATERIAL AND METHODS: A total of 231 nonduplicate Enterobacteriaceae were isolated from five Brazilian hospitals between September 2007 and September 2008. The antimicrobial susceptibility testing was performed by disk diffusion method according to the Clinical Laboratory Standard Institute. Isolates showing resistance to third-generation cephalosporins were screened for ESBL activity by the double-disk synergy test. The presence of blaCTX-M , blaCTX-M-15 and blaKPC genes was determined by Polymerase Chain Reaction (PCR amplification andDNA sequencing. The molecular typing of CTX-M producing isolateswas performed by pulsed-field gel electrophoresis (PFGE. RESULTS AND DISCUSSION: Ninety-three isolates were screened as ESBL positive and 85 (91% were found to carry CTX-M-type, as follows: K. pneumoniae 59 (49%, E. cloacae 15 (42%, and E. coli 11 (15%. Ten isolates resistant for carbapenems in K. pneumoniae were blaKPC-2 gene positive. Among CTX-M type isolates, CTX-M-15 was predominant in more than 50% of isolates for K. pneumoniae, E. coli, and E. cloacae. PFGE analysis of CTX-M producing isolates showed the predominance of CTX-M-15 in 10 of 24 pulsotypes in K. pneumoniae, 6 of 13 in E. cloacae and 3 of 6 in E. coli. CTX-M-15 was also predominant among KPC producing isolates. In conclusion, this study showed that CTX-M-15 was circulating in Rio de Janeiro state in 2007-2008. This data reinforce the need for continuing surveillance because this scenario may have changed over the years.

  1. Investigation of catheter-related bloodstream infections in ICU%ICU导管相关性血流感染调查研究

    Institute of Scientific and Technical Information of China (English)

    曾翠; 陈玉华; 贾会学; 李六亿; 吴安华

    2014-01-01

    OBJECTIVE To understand the utilization rate of central venous catheters in ICU and analyze the daily incidence of central venous catheter-related bloodstream infections so as to provide guidance for control of the central venous catheter-related bloodstream infections .METHODS The new definition of Central Line Associated Blood Stream Infection which was promulgated by the United States Centers for Disease Control in 2013 was viewed as the diagnostic criteria ,the patients who underwent central venous catheterization in 55 ICUs of 41 hospitals from Oct 1 , 2013 to Mar 31 , 2014 were monitored , and the baseline data , catheterization , and information of infections of the monitoring objects were completed ,and the statistical analysis was performed with the use of SPSS 10 .0 software .RESULTS A total of 4 256 patients were monitored ,with 51159 days of central venous catheter indwelling involved ;the infections occurred in 133 cases with the daily infection rate of 2 .60‰ , the daily infection rate was lowest in the ICUs of the cardiology department and the pediatric department .The daily infection rate was lowest in Guizhou province (0 .69‰) ,highest in general ICUs ( 2 .81‰) and Guangdong province (14 .22‰) .The average utilization rate of central venous catheter was 44 .12% ;the utilization rates was lowest in the ICUs of pediatric department (5 .91% ) and was lowest in Shandong province (26 .77% );the utilization rate was highest in the ICUs of surgery department (63 .21% ) and was highest in Guizhou province (90 .75% ) . CONCLUSION The average daily infection rate of central venous catheter-related bloodstream infections is slightly higher in those investigated hospitals than abroad and the rest parts of China .It is necessary to strengthen the operation training of the health care workers and pay attention to the maintenance of the catheters so as to ensure the safety of catheterization nursing of the patients .%目的:了解医院IC U中心静脉

  2. 恶性肿瘤患者铜绿假单胞菌血流感染的临床分析%Clinical analysis of cancer patients with Pseudomonas aeruginosa bloodstream infections

    Institute of Scientific and Technical Information of China (English)

    白长森; 李丁; 张文芳; 张青; 郑珊; 张鹏

    2014-01-01

    目的:分析恶性肿瘤患者合并铜绿假单胞菌血流感染的相关危险因素及耐药性情况。方法:回顾性分析天津医科大学肿瘤医院2010年1月至2012年12月30例合并铜绿假单胞菌血流感染及90例无铜绿假单胞菌血流感染的恶性肿瘤患者的临床资料;采用Whonet 5.6软件和SPSS 19.0对数据进行统计学分析。结果:感染组患者男20例,女10例,平均年龄(60.9±11.2)岁;对照组患者男60例,女30例,平均年龄(51.3±15.9)岁;多因素Logistic回归分析显示住院次数、合并其他部位感染和应用≥2种类型抗生素为恶性肿瘤患者合并铜绿假单胞菌血流感染的独立危险因素(P80%)。合并铜绿假单胞菌血流感染的恶性肿瘤患者的死亡率为60%。结论:恶性肿瘤患者合并铜绿假单胞菌血流感染死亡率高,在临床工作中必须采取综合防治的措施,减少铜绿假单胞菌血流感染的发生。%Objective:To analyze risk factors of cancer patients with Pseudomonas aeruginosa bloodstream infections and drug resistance. Methods:Clinical data of 30 cancer patients with P. aeruginosa bloodstream infection and 90 without infection who were ad-mitted in the Tianjin Medical University Cancer Institute and Hospital between January 2010 and December 2012 were retrospectively analyzed. Whonet 5.6 and SPSS19.0 software were used for statistical analysis of the data. Results:The infection group consisted of 20 male and 10 female patients with a mean age of 60.9±11.2 years. The control group consisted of 60 males and 30 females with a mean age of 51.3 ± 15.9 years. Multivariate logistic regression analysis showed that the number of hospitalization, combined with infection of other sites, and more than two types of antibiotics were independent risk factors of cancer patients with P. aeruginosa bloodstream infec-tions. P. aeruginosa showed high sensitivity(>80%) to carbapenems, ceftazidime, cefepime

  3. Modular Forms and Weierstrass Mock Modular Forms

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    Amanda Clemm

    2016-02-01

    Full Text Available Alfes, Griffin, Ono, and Rolen have shown that the harmonic Maass forms arising from Weierstrass ζ-functions associated to modular elliptic curves “encode” the vanishing and nonvanishing for central values and derivatives of twisted Hasse-Weil L-functions for elliptic curves. Previously, Martin and Ono proved that there are exactly five weight 2 newforms with complex multiplication that are eta-quotients. In this paper, we construct a canonical harmonic Maass form for these five curves with complex multiplication. The holomorphic part of this harmonic Maass form arises from the Weierstrass ζ-function and is referred to as the Weierstrass mock modular form. We prove that the Weierstrass mock modular form for these five curves is itself an eta-quotient or a twist of one. Using this construction, we also obtain p-adic formulas for the corresponding weight 2 newform using Atkin’s U-operator.

  4. Adaptive municipal electronic forms

    NARCIS (Netherlands)

    Kuiper, Pieter; Dijk, van Betsy; Bondarouk, Tanya; Ruël, Huub; Guiderdoni-Jourdain, Karine; Oiry, Ewan

    2009-01-01

    Adaptation of electronic forms (e-forms) seems to be a step forward to reduce the burden for people who fill in forms. Municipalities more and more offer e-forms online that can be used by citizens to request a municipal product or service or by municipal employees to place a request on behalf of a

  5. Factores de riesgo de infecciones del tracto sanguíneo asociadas a alimentación parenteral en pacientes pediátricos Risk factors of bloodstream infections associated with parenteral nutrition in pediatric patients

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    P. Balboa Cardemil

    2011-12-01

    Full Text Available Introducción: Una de las complicaciones de la nutrición parenteral (NP es la infección sanguínea (IS asociada a catéter, se desconoce los factores de riesgo más importantes en nuestro medio. Objetivo: Determinar los factores de riesgo de las IS asociadas a NP en pacientes pediátricos en hospitales de Santiago de Chile. Pacientes y métodos: En 2 hospitales públicos se analizaron retrospectivamente todos los recién nacidos (RN y niños que recibieron NP entre enero del 2002 y diciembre del 2005. El grupo estudio (GE son todos aquellos con hemocultivos (+ durante la administración de NP. El grupo control (GC correspondió a 2 controles por cada caso, niños con NP y hemocultivos (-. Para el análisis estadístico se usaron pruebas paramétricas, no paramétricas y regresión logística. Resultados: Se obtuvieron 58 casos y 130 controles. Los niños del GE recibieron NP por más tiempo que GC: 24 (7-934 vs 10 días (7-152 (p Introduction: One of the complications of parenteral nutrition (PN is bloodstream infection (BSI associated with catheter, unknown the most important risk factors in our country. Objective: To determine risk factors of BSI associated with PN in pediatric patients in public hospitals of Santiago, Chile. Patients and methods: In two public hospitals all newborns and children receiving PN were analyzed retrospectively, from January 2002 to December 2005. The study group (SG was formed by all those with blood cultures (+ during the administration of PN. We selected two controls for each case, children with PN and blood cultures (- (control group, CG. We used parametric, nonparametric and logistic regression to analyze data. Results: There were 58 cases and 130 controls. Children of the SG received PN for longer days than CG: 24 (7-934 vs. 10 days (7-152 (p < 0.001, presented a higher rate of malnutrition (44.4% vs. 31%, chi2, p < 0.05 and received more frequently PN by central venous catheter than peripheral catheter (GE

  6. A Multinational, Preregistered Cohort Study of β-Lactam/β-Lactamase Inhibitor Combinations for Treatment of Bloodstream Infections Due to Extended-Spectrum-β-Lactamase-Producing Enterobacteriaceae

    Science.gov (United States)

    Gutiérrez-Gutiérrez, Belén; Pérez-Galera, Salvador; Salamanca, Elena; de Cueto, Marina; Calbo, Esther; Almirante, Benito; Viale, Pierluigi; Oliver, Antonio; Pintado, Vicente; Gasch, Oriol; Martínez-Martínez, Luis; Pitout, Johann; Akova, Murat; Molina, José; Hernández, Alicia; Venditti, Mario; Prim, Nuria; Origüen, Julia; Bou, German; Tacconelli, Evelina; Tumbarello, Mario; Hamprecht, Axel; Giamarellou, Helen; Almela, Manel; Pérez, Federico; Schwaber, Mitchell J.; Bermejo, Joaquín; Lowman, Warren; Hsueh, Po-Ren; Mora-Rillo, Marta; Natera, Clara; Souli, Maria; Bonomo, Robert A.; Carmeli, Yehuda; Paterson, David L.; Pascual, Alvaro

    2016-01-01

    The spread of extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) is leading to increased carbapenem consumption. Alternatives to carbapenems need to be investigated. We investigated whether β-lactam/β-lactamase inhibitor (BLBLI) combinations are as effective as carbapenems in the treatment of bloodstream infections (BSI) due to ESBL-E. A multinational, retrospective cohort study was performed. Patients with monomicrobial BSI due to ESBL-E were studied; specific criteria were applied for inclusion of patients in the empirical-therapy (ET) cohort (ETC; 365 patients), targeted-therapy (TT) cohort (TTC; 601 patients), and global cohort (GC; 627 patients). The main outcome variables were cure/improvement rate at day 14 and all-cause 30-day mortality. Multivariate analysis, propensity scores (PS), and sensitivity analyses were used to control for confounding. The cure/improvement rates with BLBLIs and carbapenems were 80.0% and 78.9% in the ETC and 90.2% and 85.5% in the TTC, respectively. The 30-day mortality rates were 17.6% and 20% in the ETC and 9.8% and 13.9% in the TTC, respectively. The adjusted odds ratio (OR) (95% confidence interval [CI]) values for cure/improvement rate with ET with BLBLIs were 1.37 (0.69 to 2.76); for TT, they were 1.61 (0.58 to 4.86). Regarding 30-day mortality, the adjusted OR (95% CI) values were 0.55 (0.25 to 1.18) for ET and 0.59 (0.19 to 1.71) for TT. The results were consistent in all subgroups studied, in a stratified analysis according to quartiles of PS, in PS-matched cases, and in the GC. BLBLIs, if active in vitro, appear to be as effective as carbapenems for ET and TT of BSI due to ESLB-E regardless of the source and specific species. These data may help to avoid the overuse of carbapenems. (This study has been registered at ClinicalTrials.gov under registration no. NCT01764490.) PMID:27139473

  7. Presence of Mycoplasma fermentans in the bloodstream of Mexican patients with rheumatoid arthritis and IgM and IgG antibodies against whole microorganism

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    Salinas Salvador

    2009-08-01

    Full Text Available Abstract Background Increasing evidence incriminates bacteria, especially Mycoplasma fermentans, as possible arthritogenic agents in humans. The purpose of this study was to investigate M. fermentans in the bloodstream of patients with rheumatoid arthritis. Methods Two hundred and nineteen blood samples from patients with rheumatoid arthritis, systemic lupus erythematosus, antiphospholipid syndrome, and healthy individuals were screened by bacterial culture and direct PCR in order to detect mycoplasmas; IgM and IgG against M. fermentans PG18 were also detected by ELISA and Immunoblotting assays in patients with rheumatoid arthritis and healthy individuals. Results Blood samples from patients with antiphospholipid syndrome and healthy individuals were negative for mycoplasma by culture or direct PCR. In blood samples from patients with systemic lupus erythematosus were detected by direct PCR M. fermentans in 2/50 (2%, M. hominis in 2/50 (2% and U. urealyticum in 1/50 (0.5%. In patients with RA M. fermentans was detected by culture in 13/87 blood samples and in 13/87 by direct PCR, however, there was only concordance between culture and direct PCR in six samples, so M. fermentans was detected in 20/87(23% of the blood samples from patients with RA by either culture or PCR. Antibody-specific ELISA assay to M. fermentans PG18 was done, IgM was detected in sera from 40/87 patients with RA and in sera of 7/67 control individuals, IgG was detected in sera from 48/87 RA patients and in sera from 7/67 healthy individuals. Antibody-specific immunoblotting to M. fermentans PG18 showed IgM in sera from 35/87 patients with RA and in sera from 4/67 healthy individuals, IgG was detected in sera from 34/87 patients and in sera from 5/67 healthy individuals. Conclusion Our findings show that only M. fermentans produce bacteremia in a high percentage of patients with RA. This finding is similar to those reported in the literature. IgM and IgG against M

  8. Ethanol lock therapy (E-Lock in the prevention of catheter-related bloodstream infections (CR-BSI after major heart surgery (MHS: a randomized clinical trial.

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    María Jesús Pérez-Granda

    Full Text Available Lock-therapy with antimicrobials has been used for the treatment and prevention of catheter-related bloodstream infections (CR-BSI. Experiences with Ethanol-Locks (E-locks have included therapeutic interventions with variable results. Patients undergoing Major Heart Surgery (MHS are a high-risk population for CR-BSI.The aim of this study was to assess the efficacy and tolerance to E-Locks in the prevention of CR-BSI of patients undergoing MHS.This is an academic, prospective, randomized, non-blinded and controlled clinical trial assessing the incidence of CR-BSI of patients with E-locks (E-lock and the tolerance to the procedure in comparison with patients receiving conventional catheter-care (CCC. Patients undergoing MHS with intravascular catheters for more than 48 hours were randomly assigned into treatment or control group by a computer-generated list of randomly assigned numbers. In the treatment group, all their catheter lumens were locked with an ethanol solution at 70% for two hours, every three days (E-Locks. The control group received conventional catheter-care (CCC. Overall, 200 patients with 323 catheters were included in the study, which was stopped after 10 months due to adverse events. Of them, 179 catheters (113 patients had E-Locks and 144 catheters (87 patients were CCC. Euroscore Surgical Risk in both groups was 4.04 vs 4.07 p = 0.94 respectively. The results for the E-Locks and CCC were as follows: Incidence of CR-BSI/1000 days of exposure 2.1 vs 5.2 (p = 0.33, catheter tip colonization 14 (7.8% vs 6 (4.2% patients (p = 0.17, median length of hospital stay, 15 vs 16 days (p = 0.77. Seven patients (6.19%, all in the ethanol branch, had to discontinue the trial due to intolerance or adverse events.We do not recommend prophylaxis of CR-BSI with ethanol-lock on a routine basis in patients undergoing Major Heart Surgery.Clinical Trials.gov NCT01229592.

  9. Klebsiella variicola is a frequent cause of bloodstream infection in the stockholm area, and associated with higher mortality compared to K. pneumoniae.

    Directory of Open Access Journals (Sweden)

    Makaoui Maatallah

    Full Text Available Clinical isolates of Klebsiella pneumoniae are divided into three phylogroups and differ in their virulence factor contents. The aim of this study was to determine an association between phylogroup, virulence factors and mortality following bloodstream infection (BSI caused by Klebsiella pneumoniae. Isolates from all adult patients with BSI caused by K. pneumoniae admitted to Karolinska University Hospital, Solna between 2007 and 2009 (n = 139 were included in the study. Phylogenetic analysis was performed based on multilocus sequence typing (MLST data. Testing for mucoid phenotype, multiplex PCR determining serotypes K1, K2, K5, K20, K54 and K57, and testing for virulence factors connected to more severe disease in previous studies, was also performed. Data was retrieved from medical records including age, sex, comorbidity, central and urinary catheters, time to adequate treatment, hospital-acquired infection, and mortality, to identify risk factors. The primary end-point was 30- day mortality. The three K. pneumoniae phylogroups were represented: KpI (n = 96, KpII (corresponding to K. quasipneumoniae, n = 9 and KpIII (corresponding to K. variicola, n = 34. Phylogroups were not significantly different in baseline characteristics. Overall, the 30-day mortality was 24/139 (17.3%. Isolates belonging to KpIII were associated with the highest 30-day mortality (10/34 cases, 29.4%, whereas KpI isolates were associated with mortality in 13/96 cases (13.5%. This difference was significant both in univariate statistical analysis (P = 0.037 and in multivariate analysis adjusting for age and comorbidity (OR 3.03 (95% CI: 1.10-8.36. Only three of the isolates causing mortality within 30 days belonged to any of the virulent serotypes (K54, n = 1, had a mucoid phenotype (n = 1 and/or contained virulence genes (wcaG n = 1 and wcaG/allS n = 1. In conclusion, the results indicate higher mortality among patients infected with

  10. Klebsiella variicola is a frequent cause of bloodstream infection in the stockholm area, and associated with higher mortality compared to K. pneumoniae.

    Science.gov (United States)

    Maatallah, Makaoui; Vading, Malin; Kabir, Muhammad Humaun; Bakhrouf, Amina; Kalin, Mats; Nauclér, Pontus; Brisse, Sylvain; Giske, Christian G

    2014-01-01

    Clinical isolates of Klebsiella pneumoniae are divided into three phylogroups and differ in their virulence factor contents. The aim of this study was to determine an association between phylogroup, virulence factors and mortality following bloodstream infection (BSI) caused by Klebsiella pneumoniae. Isolates from all adult patients with BSI caused by K. pneumoniae admitted to Karolinska University Hospital, Solna between 2007 and 2009 (n = 139) were included in the study. Phylogenetic analysis was performed based on multilocus sequence typing (MLST) data. Testing for mucoid phenotype, multiplex PCR determining serotypes K1, K2, K5, K20, K54 and K57, and testing for virulence factors connected to more severe disease in previous studies, was also performed. Data was retrieved from medical records including age, sex, comorbidity, central and urinary catheters, time to adequate treatment, hospital-acquired infection, and mortality, to identify risk factors. The primary end-point was 30- day mortality. The three K. pneumoniae phylogroups were represented: KpI (n = 96), KpII (corresponding to K. quasipneumoniae, n = 9) and KpIII (corresponding to K. variicola, n = 34). Phylogroups were not significantly different in baseline characteristics. Overall, the 30-day mortality was 24/139 (17.3%). Isolates belonging to KpIII were associated with the highest 30-day mortality (10/34 cases, 29.4%), whereas KpI isolates were associated with mortality in 13/96 cases (13.5%). This difference was significant both in univariate statistical analysis (P = 0.037) and in multivariate analysis adjusting for age and comorbidity (OR 3.03 (95% CI: 1.10-8.36). Only three of the isolates causing mortality within 30 days belonged to any of the virulent serotypes (K54, n = 1), had a mucoid phenotype (n = 1) and/or contained virulence genes (wcaG n = 1 and wcaG/allS n = 1). In conclusion, the results indicate higher mortality among patients infected with

  11. Epidemiology and Burden of Bloodstream Infections Caused by Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae in a Pediatric Hospital in Senegal.

    Directory of Open Access Journals (Sweden)

    Awa Ndir

    Full Text Available Severe bacterial infections are not considered as a leading cause of death in young children in sub-Saharan Africa. The worldwide emergence of extended-spectrum beta-lactamase producing Enterobacteriaceae (ESBL-E could change the paradigm, especially in neonates who are at high risk of developing healthcare-associated infections.To evaluate the epidemiology and the burden of ESBL-E bloodstream infections (BSI.A case-case-control study was conducted in patients admitted in a pediatric hospital during two consecutive years. Cases were patients with Enterobacteriaceae BSI and included ESBL-positive (cases 1 and ESBL-negative BSI (cases 2. Controls were patients with no BSI. Multivariate analysis using a stepwise logistic regression was performed to identify risk factors for ESBL acquisition and for fatal outcomes. A multistate model was used to estimate the excess length of hospital stay (LOS attributable to ESBL production while accounting for time of infection. Cox proportional hazards models were performed to assess the independent effect of ESBL-positive and negative BSI on LOS.The incidence rate of ESBL-E BSI was of 1.52 cases/1000 patient-days (95% CI: 1.2-5.6 cases per 1000 patient-days. Multivariate analysis showed that independent risk factors for ESBL-BSI acquisition were related to underlying comorbidities (sickle cell disease OR = 3.1 (95%CI: 2.3-4.9, malnutrition OR = 2.0 (95%CI: 1.7-2.6 and invasive procedures (mechanical ventilation OR = 3.5 (95%CI: 2.7-5.3. Neonates were also identified to be at risk for ESBL-E BSI. Inadequate initial antibiotic therapy was more frequent in ESBL-positive BSI than ESBL-negative BSI (94.2% versus 5.7%, p<0.0001. ESBL-positive BSI was associated with higher case-fatality rate than ESBL-negative BSI (54.8% versus 15.4%, p<0.001. Multistate modelling indicated an excess LOS attributable to ESBL production of 4.3 days. The adjusted end-of-LOS hazard ratio for ESBL-positive BSI was 0.07 (95%CI, 0

  12. Epidemiology of bloodstream infections caused by Acinetobacter baumannii and impact of drug resistance to both carbapenems and ampicillin-sulbactam on clinical outcomes.

    Science.gov (United States)

    Chopra, Teena; Marchaim, Dror; Awali, Reda A; Krishna, Amar; Johnson, Paul; Tansek, Ryan; Chaudary, Khawar; Lephart, Paul; Slim, Jessica; Hothi, Jatinder; Ahmed, Harris; Pogue, Jason M; Zhao, Jing J; Kaye, Keith S

    2013-12-01

    Acinetobacter baumannii has become a leading cause of bloodstream infections (BSI) in health care settings. Although the incidence of infection with carbapenem- and ampicillin-sulbactam-resistant (CASR) A. baumannii has increased, there is a scarcity of studies which investigate BSI caused by CASR A. baumannii. A retrospective cohort study was conducted on adult patients with BSI caused by A. baumannii and who were admitted to the Detroit Medical Center between January 2006 and April 2009. Medical records were queried for patients' demographics, antimicrobial exposures, comorbidities, hospital stay, and clinical outcomes. Bivariate analyses and logistic regression were employed in the study. Two hundred seventy-four patients with BSI caused by A. baumannii were included in the study: 68 (25%) caused by CASR A. baumannii and 206 (75%) caused by non-CASR A. baumannii. In multivariate analysis, factors associated with BSI caused by CASR A. baumannii included admission with a rapidly fatal condition (odds ratio [OR] = 2.83, 95% confidence interval [CI] = 1.27 to 6.32, P value = 0.01) and prior use of antimicrobials (OR = 2.83, 95% CI = 1.18 to 6.78, P value = 0.02). In-hospital mortality rates for BSI caused by CASR A. baumannii were significantly higher than those for non-CASR A. baumannii-induced BSI (43% versus 20%; OR = 3.0, 95% CI = 1.60 to 5.23, P value < 0.001). However, after adjusting for potential confounders, the association between BSI caused by CASR A. baumannii and increased risk of in-hospital mortality was not significant (OR = 1.15, 95% CI = 0.51 to 2.63, P value = 0.74). This study demonstrated that CASR A. baumannii had a distinct epidemiology compared to more susceptible A. baumannii strains; however, clinical outcomes were similar for the two groups. Admission with a rapidly fatal condition was an independent predictor for both CASR A. baumannii and in-hospital mortality.

  13. Bloodstream infections in febrile neutropenic patients at a tertiary cancer institute in South India: A timeline of clinical and microbial trends through the years

    Directory of Open Access Journals (Sweden)

    K Govind Babu

    2016-01-01

    Full Text Available Introduction: Febrile neutropenia (FN is an oncological emergency. The choice of empiric therapy depends on the locally prevalent pathogens and their sensitivities, the sites of infection, and cost. The Infectious Diseases Society of America guidelines are being followed for the management of FN in India. Methods: This is a prospective observational study conducted at a tertiary care cancer centre from September 2012 to September 2014. Objectives: The objectives of this study were as follows: (1 To review the pattern of microbial flora, susceptibility pattern, and important clinical variables among bloodstream infections in febrile neutropenic patients with solid tumors and hematological malignancies. (2 As per the institutional protocol to periodically review the antibiotic policy and susceptibility pattern, and compare the findings with an earlier study done in our institute in 2010. This was a prospective study conducted from September 2012 to September 2014. Results: About 379 episodes of FN were documented among 300 patients. About 887 blood cultures were drawn. Of these, 137 (15% isolates were cultured. Isolates having identical antibiograms obtained from a single patient during the same hospitalization were considered as one. Hence, 128 isolates were analyzed. About 74 (58% cultures yielded Gram-negative bacilli, 51 (40% were positive for Gram-positive cocci, and 3 (2% grew fungi. Among Gram-negative organisms, Escherichia coli followed by Acinetobacter baumannii and Klebsiella pneumoniae accounted for 78% of the isolates. Among Gram-positive cocci, Staphylococcus species accounted for 84% of the isolates. We have noted a changing trend in the antibiotic sensitivity pattern over the years. Following the switch in empirical antibiotics, based on the results of the study done in 2010 (when the empirical antibiotics were ceftazidime + amikacin, the sensitivity to cefoperazone-sulbactam has plunged from about 80% to 60%%. Similar reduction in

  14. Prediction of central venous catheter-related bloodstream infections (CRBSIs) in patients with haematologic malignancies using a modified Infection Probability Score (mIPS).

    Science.gov (United States)

    Schalk, Enrico; Hanus, Lynn; Färber, Jacqueline; Fischer, Thomas; Heidel, Florian H

    2015-09-01

    The aim of this study was to predict the probability of central venous catheter-related bloodstream infections (CRBSIs) in patients with haematologic malignancies using a modified version of the Infection Probability Score (mIPS). In order to perform a prospective, mono-centric surveillance of complications in clinical routine due to short-term central venous catheters (CVCs) in consecutive patients receiving chemotherapy from March 2013 to September 2014, IPS was calculated at CVC insertion and removal (mIPSin and mIPSex, respectively). We used the 2012 Infectious Diseases Working Party of the German Society of Haematology and Medical Oncology (AGIHO/DGHO) criteria to define CRBSI. In total, 143 patients (mean 59.5 years, 61.4 % male) with 267 triple-lumen CVCs (4044 CVC days; mean 15.1 days, range 1-60 days) were analysed. CVCs were inserted for therapy of acute leukaemia (53.2 %), multiple myeloma (24.3 %) or lymphoma (11.2 %), and 93.6 % were inserted in the jugular vein. A total of 66 CRBSI cases (24.7 %) were documented (12 definite/13 probable/41 possible). The incidence was 16.3/1000 CVC days (2.9/3.1/10.1 per 1000 CVC days for definite/probable/possible CRBSI, respectively). In CRBSI cases, the mIPSex was higher as compared to cases without CRBSI (13.1 vs. 7.1; p < 0.001). The best mIPSex cutoff for CRBSI prediction was 8 points (area under the curve (AUC) = 0.77; sensitivity = 84.9 %, specificity = 60.7 %, negative predictive value = 92.4 %). For patients with an mIPSex ≥8, the risk for a CRBSI was high (odds ratio [OR] = 5.9; p < 0.001) and even increased if, additionally, CVC had been in use for about 10 days (OR = 9.8; p < 0.001). In case other causes of infection are excluded, a mIPSex ≥8 and duration of CVC use of about 10 days predict a very high risk of CRBSI. Patients with a mIPSex <8 have a low risk of CRBSI of 8 %.

  15. Prevalence of Resistant Gram-Negative Bacilli in Bloodstream Infection in Febrile Neutropenia Patients Undergoing Hematopoietic Stem Cell Transplantation: A Single Center Retrospective Cohort Study.

    Science.gov (United States)

    Wang, Ling; Wang, Ying; Fan, Xing; Tang, Wei; Hu, Jiong

    2015-11-01

    Bloodstream infection (BSI) is an important cause of morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT). To evaluate the causative bacteria and identify risk factors for BSI associated mortality in febrile neutropenia patients undergoing HSCT, we collected the clinical and microbiological data from patients underwent HSCT between 2008 and 2014 and performed a retrospective analysis. Throughout the study period, among 348 episodes of neutropenic fever in patients underwent HSCT, 89 episodes in 85 patients had microbiological defined BSI with a total of 108 isolates. Gram-negative bacteria (GNB) were the most common isolates (76, 70.3%) followed by gram-positive bacteria (GPB, 29, 26.9%) and fungus (3, 2.8%). As to the drug resistance, 26 multiple drug resistance (MDR) isolates were identified. Resistant isolates (n = 23) were more common documented in GNB, mostly Escherichia coli (9/36, 25%) and Klebsiella pneumonia (6/24, 25%). A total of 12 isolated were resistant to carbapenem including 4 K pneumoniae (4/24, 16.7%), 3 Stenotrophomonas maltophilia, and 1 Pseudomonas aeruginosa and other 4 GNB isolates (Citrobacter freumdii, Pseudomonas stutzeri, Acinetobacter baumanii, and Chryseobacterium indologenes). As to the GPB, only 3 resistant isolates were documented including 2 methicillin-resistant isolates (Staphylococcus hominis and Arcanobacterium hemolysis) and 1 vancomycin-resistant Enterococcus faecium. Among these 85 patients with documented BSI, 11 patients died of BSI as primary or associated cause with a BSI-related mortality of 13.1 ± 3.7% and 90-day overall survival after transplantation at 80.0 ± 4.3%. Patients with high-risk disease undergoing allo-HSCT, prolonged neutropenia (≥15 days) and infection with carbapenem-resistant GNB were associated with BSI associated mortality in univariate and multivariate analyses. Our report revealed a prevalence of GNB in BSI of neutropenic patients undergoing

  16. Maass Forms and Quantum Modular Forms

    Science.gov (United States)

    Rolen, Larry

    This thesis describes several new results in the theory of harmonic Maass forms and related objects. Maass forms have recently led to a flood of applications throughout number theory and combinatorics in recent years, especially following their development by the work of Bruinier and Funke the modern understanding Ramanujan's mock theta functions due to Zwegers. The first of three main theorems discussed in this thesis concerns the integrality properties of singular moduli. These are well-known to be algebraic integers, and they play a beautiful role in complex multiplication and explicit class field theory for imaginary quadratic fields. One can also study "singular moduli" for special non-holomorphic functions, which are algebraic but are not necessarily algebraic integers. Here we will explain the phenomenon of integrality properties and provide a sharp bound on denominators of symmetric functions in singular moduli. The second main theme of the thesis concerns Zagier's recent definition of a quantum modular form. Since their definition in 2010 by Zagier, quantum modular forms have been connected to numerous different topics such as strongly unimodal sequences, ranks, cranks, and asymptotics for mock theta functions. Motivated by Zagier's example of the quantum modularity of Kontsevich's "strange" function F(q), we revisit work of Andrews, Jimenez-Urroz, and Ono to construct a natural vector-valued quantum modular form whose components. The final chapter of this thesis is devoted to a study of asymptotics of mock theta functions near roots of unity. In his famous deathbed letter, Ramanujan introduced the notion of a mock theta function, and he offered some alleged examples. The theory of mock theta functions has been brought to fruition using the framework of harmonic Maass forms, thanks to Zwegers. Despite this understanding, little attention has been given to Ramanujan's original definition. Here we prove that Ramanujan's examples do indeed satisfy his

  17. 血流感染病原菌分布及耐药特性分析%The distribution and resistance characteristics analysis of pathogens from bloodstream infection

    Institute of Scientific and Technical Information of China (English)

    钟桥石; 胡龙华; 熊建球; 章白芩; 张黎明; 胡晓彦; 贾坤如

    2012-01-01

    目的 了解血流感染主要病原菌的分布特点及对常用抗菌药物的耐药情况,以指导临床合理用药.方法 对2006年1月—2011年6月期间本院临床各科室送检的血培养标本采用美国Bactec9120全自动血培养仪进行培养,Vitek-32型仪进行菌种鉴定,纸片扩散法测定菌株对抗菌药物的敏感性,头孢西丁法检测耐甲氧西林葡菌球菌,WHONET5.6软件分析数据.结果 共分离出598株病原菌,其中革兰阳性球菌282株,占47.2%;革兰阴性杆菌289株,占48.3%,真菌15株,占2.5%.最常见的感染菌分别为大肠埃希菌、表皮葡萄球菌、肺炎克雷伯菌、金黄色葡萄球菌、铜绿假单胞菌及鲍曼不动杆菌.金黄色葡萄球菌和表皮葡萄球菌中耐甲氧西林葡萄球菌检出率分别为63.9%和87.9%,其对青霉素耐药率均>95.0%,均未发现对万古霉素和替考拉宁耐药株.大肠埃希菌和肺炎克雷伯菌对碳青霉烯类抗生素耐药率最低,对氨苄西林耐药率分别为93.8%和100%.铜绿假单胞菌对亚胺培南耐药率为16.7%,而鲍曼不动杆菌对亚胺培南耐药率高达63.6%,鲍曼不动杆菌对其他抗菌药物的耐药率均>60%.结论 本单位血流感染以大肠埃希菌和葡萄球菌为主.表皮葡萄球菌较金黄色葡萄球菌耐药性严重,非发酵菌比肠杆菌科细菌耐药性严重,尤其是鲍曼不动杆菌引起的血流感染无经验抗菌药物可选,必须在药敏试验指导下用药.%Objective To investigate bacteria distribution characteristic and antimicrobial drug resistance of main pathogens of bloodstream infection in our hospital, and to guide the clinical treatment. Methods Various clinical departments blood cultures samples which were collected from January 2006 to June 2011 in the Second Affiliated Hospital of Nanchang University were incubated by Bactec9120 automated blood culture and identified by Vitek-32 automated microbial identified. Antimicrobial

  18. 氯己定醇皮肤消毒液在预防导管相关血流感染中的效果研究%Effect of chlorhexidine skin disinfectant on prevention of catheter-related bloodstream infections

    Institute of Scientific and Technical Information of China (English)

    吴晓琴; 李兰云; 郭晶; 何金; 李琳; 徐莉; 杜永川

    2014-01-01

    目的:探讨2%葡萄糖酸氯己定(CHG)醇皮肤消毒液对预防经外周静脉导入中心静脉置管(PICC)导管相关血流感染(CRBSI)的消毒效果。方法对2013年1-12月行PICC置管的肿瘤患者进行前瞻性随机对照研究,将64例PICC置管的患者进行随机分组,观察组34例使用2% CHG醇进行皮肤消毒,对照组30例使用5%聚维酮碘进行皮肤消毒,分别于各组患者进行PICC置管前及置管后48 h对置管周围部位的皮肤采样,进行细菌监测并比较两组间的差异。结果观察组在 PICC置管前和置管后较对照组48h皮肤菌落数低、干燥时间短(P<0.05),观察组总置管日2356 d ,无CRBSI发生;对照组总置管日1970 d ,CRBSI 4例,2% CHG醇消毒液能降低CRBSI的发生率(P<0.05)。结论2% CHG醇皮肤消毒液可降低PICC导管相关血流感染的发生率,并可减少皮肤表面的暂居菌,抑制其生长从而降低CRBSI风险。%OBJECTIVE To explore the effect of 2% chlorhexidine gluconate (CHG) on prevention of peripherally inserted central venous catheter-related bloodstream infections .METHODS The prospective randomized control study was conducted for the tumor patients who underwent PICC from Jan 2013 to Dec 2013;the 64 PICC patients were randomly divided into the observation group with 34 cases and the control group with 30 cases , the observation group was treated with 2% CHG for skin disinfection ,while the control group was given 5% povidone iodine for skin disinfection .The skins around the catheter insertion sites were respectively sampled before the PICC catheterization and at 48 hours after the PICC catheterization ;the bacterial species were monitored and compared between the two groups .RESULTS The bacterial colony counts in the skin were less in the observation group than in the control group before and after the PICC catheterization ,and the drying time of the observation group was shorter

  19. Forms of Arthritis

    Science.gov (United States)

    ... this page please turn Javascript on. Forms of Arthritis Past Issues / Fall 2006 Table of Contents Today, ... of Linda Saisselin Osteoarthritis (OA) — the form of arthritis typically occurring during middle or old age, this ...

  20. Fornemmelse for form

    DEFF Research Database (Denmark)

    Skude, Flemming

    2002-01-01

    Om den arkitektoniske forms afhængighed af aerodynamik, solens nedbrydning og optimering af materialers holdbarhed.......Om den arkitektoniske forms afhængighed af aerodynamik, solens nedbrydning og optimering af materialers holdbarhed....

  1. FORMS OF YOUTH TRAVEL

    OpenAIRE

    Moisã Claudia Olimpia

    2011-01-01

    Taking into account the suite of motivation that youth has when practicing tourism, it can be said that the youth travel takes highly diverse forms. These forms are educational tourism, volunteer programs and “work and travel”, cultural exchanges or sports tourism and adventure travel. In this article, we identified and analyzed in detail the main forms of youth travel both internationally and in Romania. We also illustrated for each form of tourism the specific tourism products targeting you...

  2. Method for forming ammonia

    Science.gov (United States)

    Kong, Peter C.; Pink, Robert J.; Zuck, Larry D.

    2008-08-19

    A method for forming ammonia is disclosed and which includes the steps of forming a plasma; providing a source of metal particles, and supplying the metal particles to the plasma to form metal nitride particles; and providing a substance, and reacting the metal nitride particles with the substance to produce ammonia, and an oxide byproduct.

  3. Mesonic Form Factors

    Energy Technology Data Exchange (ETDEWEB)

    Frederic D. R. Bonnet; Robert G. Edwards; George T. Fleming; Randal Lewis; David Richards

    2003-07-22

    We have started a program to compute the electromagnetic form factors of mesons. We discuss the techniques used to compute the pion form factor and present preliminary results computed with domain wall valence fermions on MILC asqtad lattices, as well as Wilson fermions on quenched lattices. These methods can easily be extended to rho-to-gamma-pi transition form factors.

  4. Forms in Space.

    Science.gov (United States)

    Moore, Paula

    1998-01-01

    Uses the work of M. C. Escher to instruct upper elementary students in the transformation of flat shape into three-dimensional form. Outlines the lesson as a series of sections: (1) reviewing form drawing; (2) creating three-dimensional effects; (3) imagining the forms in an inhabited world; and (4) using color and shading. (DSK)

  5. A 17-year study of bloodstream infection after liver transplantation: resistance rate, risk factor and mortality of enteroccal bloodstream infectious%肝移植术后肠球菌血行感染的耐药及危险因素分析

    Institute of Scientific and Technical Information of China (English)

    邰强; 郭志勇; 黄洁夫; 何晓顺; 胡安斌; 巫林伟; 鞠卫强; 朱晓峰; 马毅; 王东平; 王国栋

    2010-01-01

    Objective To explore the resistance rate, risk factor and mortality of enteroccal bloodstream infections (BSI) after liver transplantation. Methods From January 1993 to May 2010, a retrospective analysis of enteroccus in liver transplants were conducted. Results Fifty-eight BSI occurred in 53 of 695 patients. And a total of 30 enterocci were isolated. Linezolid and glycopeptide antibiotics were the most consistently active against the Enterococcus. The resistance rates to Enterococcus for erythromycin,clindamycin, imipenem, ciprofloxacin, gentamycin and ampicillin-clavulanic acid were all over 70%. The univariate analysis identified the following variables as the risk factors for enterococcal bacteremia:retransplantion ( P = 0. 03 ) and biliary duct complications ( P = 0. 02 ). Enterococcal bloodstream infection increased the mortality at Day 15. No significant difference was found in the mortality rate at Day 30 and 1 year after enterococcal bacteremia. Conclusion Enterococcus after liver transplantion is resistant to multiple agents but active to linezolid and glycopeptide antibiotics. The risk factors commonly associated with enteroccal BSI are retransplantion and biliary duct complications. Enterococcal BSI can increase the mortality at Day 15 after liver transplantation.%目的 了解肝移植术后血行感染中肠球菌的耐药、临床结果及危险因素,对肝移植术后血行感染的治疗提供参考依据.方法 1993年1月至2010年5月,回顾分析中山大学附属第一医院肝移植术后血行感染中肠球菌患者资料.结果 695例肝移植患者中,53例(7.6%)出现革兰阳性球菌血行感染,共有革兰阳性菌58株,以肠球菌(30株)最为常见.肠球菌对糖肽类、利奈唑胺均为敏感,对克林霉素、红霉素、阿莫西林/克拉维酸、亚胺培南、利福平、庆大霉素、环丙沙星耐药率都在70%以上.针对肝移植术后肠球菌血行感染的危险因素分析发现,再次移植(P=0.03)

  6. Micro metal forming

    CERN Document Server

    2013-01-01

    Micro Metal Forming, i. e. forming of parts and features with dimensions below 1 mm, is a young area of research in the wide field of metal forming technologies, expanding the limits for applying metal forming towards micro technology. The essential challenges arise from the reduced geometrical size and the increased lot size. In order to enable potential users to apply micro metal forming in production, information about the following topics are given: tribological behavior: friction between tool and work piece as well as tool wear mechanical behavior: strength and formability of the work piece material, durability of the work pieces size effects: basic description of effects occurring due to the fact, that the quantitative relation between different features changes with decreasing size process windows and limits for forming processes tool making methods numerical modeling of processes and process chains quality assurance and metrology All topics are discussed with respect to the questions relevant to micro...

  7. Cooperative Station History Forms

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Various forms, photographs and correspondence documenting the history of Cooperative station instrumentation, location changes, inspections, and...

  8. Electronic Capitalization Asset Form

    Data.gov (United States)

    Department of Transportation — National Automated Capitalization Authorization Form used by ATO Engineering Services, Logistics, Accounting for the purpose of identifying and capturing FAA project...

  9. Value of duplicate blood cultures in identifying bloodstream infection and discriminating contamination%双套血培养对提高血流感染检出率和鉴别污染的评价

    Institute of Scientific and Technical Information of China (English)

    王坚镪; 汤瑾; 庄亦晖; 陈瑜; 高锋

    2012-01-01

    Objective To evaluate the utility of duplicate blood cultures in identifying bloodstream infection and discriminating contamination. Methods The results of duplicate cultures during 20102011 were analyzed in terms of single or double positive findings. The ability of discriminating contamination was compared between single and double positive cultures. Results Duplicate blood cultures were conducted for 3 151 blood samples in our hospital during the period from 2010 through 2011 , about 71. 2% of all the blood cultures in these two years. There were 483 (15. 33%) positive cultures, including double-positive for 192 samples (192/3 151, 6.09%), single-positive for 291 (9.23%, 291/3 151) samples. Conclusions Duplicate blood cultures can improve the detection of bloodstream infection and discrimination of contamination. Duplicate blood cultures should be recommended for identifying bloodstream infection.%目的 评价双套血培养在提高血流感染检出率及鉴别污染的临床价值.方法 统计2010-2011年上海交通大学附属第六人民医院双套血培养的双次阳性率和单次阳性率,评价双次阳性和单次阳性在鉴别血培养污染中的差异.结果 我院2010-2011年共送检双套血培养3151例,占全年送检病例数的71.2%.共检出483例阳性,阳性率15.33%.其中双次阳性192例,阳性率6.09%;单次阳性291例,阳性率9.23%.结论 双套血培养能够提高血流感染检出率并能鉴别分离菌的定植或污染,建议临床在诊断血流感染时送检双套血培养.

  10. 重症患者中心静脉导管相关血流感染护理对策分析%Nursing countermeasures for bloodstream infection induced by central venous catheter in severe patients

    Institute of Scientific and Technical Information of China (English)

    兰艳萍; 葛凯杰

    2014-01-01

    Objective To analyze the nursing countermeasures for bloodstream infection induced by central venous catheter in severe patients, to provide reference for the control of infections in severe patients. Methods Divided 116 cases of central venous catheter in several patients randomly into group A, group B, 58 cases in each group, group A was given routine nursing care, group B was implemented the optimal nursing, observed nursing effect of the two groups.Results Catheter related bloodstream infection rates of group A and group B were 13.8% and 3.45%, indwelling catheter time was (12.5±3.4)d and (16.5±4.3)d, differences were statistically significant(P<0.05).Conclusion Optimal nursing for severe patients with central venous catheter can reduce catheter-related bloodstream infection, prolong indwelling time and improve the prognosis.%目的:分析重症患者中心静脉导管相关血流感染护理对策,为重症患者感染防止提供参考。方法将116例留置中心静脉导管的重症患者随机分为A、B两组,各58例, A组实施常规护理, B组实施优化护理,观察两组护理效果。结果A、B两组导管相关血流感染率分别为13.8%及3.45%,留置导管时间分别为(12.5±3.4)d及(16.5±4.3)d,差异均有统计学意义(P<0.05)。结论对留置中心静脉导管的重症患者进行优化护理后可减少导管相关血流感染、延长置管时间、改善预后。

  11. PowerForms

    DEFF Research Database (Denmark)

    Brabrand, Claus; Møller, Anders; Ricky, Mikkel

    2000-01-01

    All uses of HTML forms may benefit from validation of the specified input field values. Simple validation matches individual values against specified formats, while more advanced validation may involve interdependencies of form fields. There is currently no standard for specifying or implementing...

  12. Method of forming nanodielectrics

    Science.gov (United States)

    Tuncer, Enis [Knoxville, TN; Polyzos, Georgios [Oak Ridge, TN

    2014-01-07

    A method of making a nanoparticle filled dielectric material. The method includes mixing nanoparticle precursors with a polymer material and reacting the nanoparticle mixed with the polymer material to form nanoparticles dispersed within the polymer material to form a dielectric composite.

  13. Baryon form factors

    CERN Document Server

    Kubis, B; Meißner, Ulf G; Mei{\\ss}ner, Ulf-G.

    1999-01-01

    We calculate the form factors of the baryon octet in the framework of heavy baryon chiral perturbation theory. The calculated charge radius of the show that kaon loop effects can play a significant role in the neutron electric form factor. Furthermore. we derive generalized Caldi-Pagels relations between various charge radii which are free of chiral loop effects.

  14. Mastering HTML5 forms

    CERN Document Server

    Gupta, Gaurav

    2013-01-01

    This tutorial will show you how to create stylish forms, not only visually appealing, but interactive and customized, in order to gather valuable user inputs and information.Enhance your skills in building responsive and dynamic web forms using HTML5, CSS3, and related technologies. All you need is a basic understanding of HTML and PHP.

  15. A subset of two adherence systems, acute pro-inflammatory pap genes and invasion coding dra, fim, or sfa, increases the risk of Escherichia coli translocation to the bloodstream.

    Science.gov (United States)

    Szemiako, K; Krawczyk, B; Samet, A; Śledzińska, A; Nowicki, B; Nowicki, S; Kur, J

    2013-12-01

    An analysis of the phylogenetic distribution and virulence genes of Escherichia coli isolates which predispose this bacteria to translocate from the urinary tract to the bloodstream is presented. One-dimensional analysis indicated that the occurrence of P fimbriae and α-hemolysin coding genes is more frequent among the E. coli which cause bacteremia. However, a two-dimensional analysis revealed that a combination of genes coding two adherence factors, namely, P + Dr, P + S, S + Dr, S + fim, and hemolysin + one adherence factor, were associated with bacteremia and, therefore, with the risk of translocation to the vascular system. The frequent and previously unrecognized co-existence of pro-inflammatory P fimbriae with the invasion promoting Dr adhesin in the same E. coli isolate may represent high-risk and potentially lethal pathogens.

  16. 血液病粒细胞缺乏患者医院血流感染的回顾性临床分析%Nosocomial bloodstream infections in neutropenic hematological patients:a retrospective clinical study

    Institute of Scientific and Technical Information of China (English)

    汤丽苑; 俞康

    2012-01-01

    OBJECTIVE To investigate the risk factors of nosocomial bloodstream infections in hematological patients with neutropenia, and analyze the distribution and antibiotic resistance of the pathogenic bacteria so as to provide basis for reduling the in cidence of blood stream infections and the mortality. METHODS A retrospective analysis of neutropenic patients with nosocomial bloodstream infections was performed from 2009 to 2011. RESULTS 1:2 matched case-control study showed the immunosuppressive therapy(OR = 6. 967),neutrophi<0. 2 ×109/L(OR = 28. 306), the duration of neutropenia<7 days(OR = 4. 383),MASCC risk index<21 scores (Multinational Association of Supportive Care of Cancer risk index score, OR — &9. 002) were important risk factors of nosocomial bloodstream infections in hematological patients with neutropenia; of totally 62 strains of pathogens isolated, gram-negative bacteria accounted for 64. 5%. gram-positive bacteria accounted for 27. 4%, and fungi accounted for 8. 1% , the most common pathogenic organisms identified were Escherichia coli(30. 6%) , Klebsiella pneumoniae (21. 0%) and Staphylococcus aureus (8. 1%) s the detection rates of ESBLs-producing strains of E.coli and K. pneumoniae were 47. 4% and 30. 8%, respectively. CONCLUSION It is critical to take effective measures and monitor the local bacterial epidemiology to control or decrease the morbidity and mortality of nosocomial bloodstream infections in hematological patients with neutropenia.%目的 分析血液病粒细胞缺乏患者血流感染的危险因素、病原菌分布及耐药性,为减少其血流感染的发病率及病死率提供依据.方法 对医院2009-2011年61例血液科粒细胞缺乏患者并发医院血流感染进行回顾性临床分析.结果 免疫抑制剂应用、中性粒细胞<0.2×109/L、中性粒细胞缺乏时间<7 d及癌症支持疗法多国学会风险指数<21分是血液病粒细胞缺乏患者医院血流感染的

  17. Comparison of commercial methods and the CLSI broth microdilution to determine the antifungal susceptibility of Candida parapsilosis complex bloodstream isolates from three health institutions in Rio de Janeiro, Brazil.

    Science.gov (United States)

    Figueiredo-Carvalho, Maria Helena G; Barbedo, Leonardo S; Oliveira, Manoel M E; Brito-Santos, Fábio; Almeida-Paes, Rodrigo; Zancopé-Oliveira, Rosely M

    2014-08-01

    Two commercial methods, the Etest and Vitek 2, were compared with the Clinical and Laboratory Standards Institute broth microdilution method to determine the susceptibility of Candida parapsilosis complex to amphotericin B, caspofungin, fluconazole, voriconazole, and itraconazole. One-hundred bloodstream isolates of C. parapsilosis complex from three hospitals in Rio de Janeiro city, Brazil, between 1998 and 2006 were analyzed. C. parapsilosis sensu stricto (61 %) was the predominant species, followed by C. orthopsilosis (37 %) and C. metapsilosis (2 %). Most isolates were susceptible to the tested drugs. However, one C. parapsilosis sensu stricto isolate was considered resistant for amphotericin B. The essential agreement was 100 % between the methods, except for itraconazole (96.3 %). The categorical agreement varied for fluconazole and itraconazole by Etest and for amphotericin B and fluconazole by Vitek 2. This study reinforces the suitability of the commercial methods in routine clinical microbiology laboratories for antifungal susceptibility testing.

  18. Clinical efficacy of β-lactam/β-lactamase inhibitor combinations for the treatment of bloodstream infection due to extended-spectrum β-lactamase-producing Enterobacteriaceae in haematological patients with neutropaenia: a study protocol for a retrospective observational study (BICAR)

    Science.gov (United States)

    Gudiol, C; Royo-Cebrecos, C; Tebe, C; Abdala, E; Akova, M; Álvarez, R; Maestro-de la Calle, G; Cano, A; Cervera, C; Clemente, W T; Martín-Dávila, P; Freifeld, A; Gómez, L; Gottlieb, T; Gurguí, M; Herrera, F; Manzur, A; Maschmeyer, G; Meije, Y; Montejo, M; Peghin, M; Rodríguez-Baño, J; Ruiz-Camps, I; Sukiennik, T C; Carratalà, J

    2017-01-01

    Introduction Bloodstream infection (BSI) due to extended-spectrum β-lactamase-producing Gram-negative bacilli (ESBL-GNB) is increasing at an alarming pace worldwide. Although β-lactam/β-lactamase inhibitor (BLBLI) combinations have been suggested as an alternative to carbapenems for the treatment of BSI due to these resistant organisms in the general population, their usefulness for the treatment of BSI due to ESBL-GNB in haematological patients with neutropaenia is yet to be elucidated. The aim of the BICAR study is to compare the efficacy of BLBLI combinations with that of carbapenems for the treatment of BSI due to an ESBL-GNB in this population. Methods and analysis A multinational, multicentre, observational retrospective study. Episodes of BSI due to ESBL-GNB occurring in haematological patients and haematopoietic stem cell transplant recipients with neutropaenia from 1 January 2006 to 31 March 2015 will be analysed. The primary end point will be case-fatality rate within 30 days of onset of BSI. The secondary end points will be 7-day and 14-day case-fatality rates, microbiological failure, colonisation/infection by resistant bacteria, superinfection, intensive care unit admission and development of adverse events. Sample size The number of expected episodes of BSI due to ESBL-GNB in the participant centres will be 260 with a ratio of control to experimental participants of 2. Ethics and dissemination The protocol of the study was approved at the first site by the Research Ethics Committee (REC) of Hospital Universitari de Bellvitge. Approval will be also sought from all relevant RECs. Any formal presentation or publication of data from this study will be considered as a joint publication by the participating investigators and will follow the recommendations of the International Committee of Medical Journal Editors (ICMJE). The study has been endorsed by the European Study Group for Bloodstream Infection and Sepsis (ESGBIS) and the European Study Group

  19. Circle of Form

    DEFF Research Database (Denmark)

    Jaeger, Thomas Arvid

    2012-01-01

    a common professional language like in mathematics, colour and music. The result is a weaker professionalism in the aesthetic competences compared to the professionalism and competences in other areas. A research project [1] on contrasts or opposites in form investigated the phenomenon in the fields...... by this model, and using the knowledge gathered from the other areas, especially perception psychology, it showed to be a possible way to organize contrasts in form, a system of 4 different opposites, geometric, organic, mass and structure: The Circle of Form....

  20. Forms of matter and forms of radiation

    CERN Document Server

    Kleman, Maurice

    2009-01-01

    The theory of defects in ordered and ill-ordered media is a well-advanced part of condensed matter physics. Concepts developed in this field also occur in the study of spacetime singularities, namely: i)- the topological theory of quantized defects (Kibble's cosmic strings) and ii)- the Volterra process for continuous defects, used to classify the Poincar\\'e symmetry breakings. We reassess the classification of Minkowski spacetime defects in the same theoretical frame, starting from the conjecture that these defects fall into two classes, as on they relate to massive particles or to radiation. This we justify on the empirical evidence of the Hubble's expansion. We introduce timelike and null congruences of geodesics treated as ordered media, viz. 'm'-crystals of massive particles and 'r'-crystals of massless particles, with parallel 4-momenta in M^4. Classifying their defects (or 'forms') we find (i) 'm'- and 'r'- Volterra continuous line defects and (ii) quantized topologically stable 'r'-defects, these latt...

  1. Clinical analysis of 74 cases of bloodstream infections caused by multidrug-resist-ant Acinetobacter%多重耐药不动杆菌属血流感染74例临床分析

    Institute of Scientific and Technical Information of China (English)

    邹颖; 徐晓刚; 郭庆兰; 李光辉

    2014-01-01

    Objective To study the clinical characteristics,antimicrobial restistance of bloodstream infections (bacteremia) caused by multidrug-resistant Acinetobacter and analyze the outcomes of antibacterial therapy.Methods The clinical data were reviewed retrospectively for 74 patients with bloodstream infection caused by multidrug-resistant Acinetobacter who were trea-ted in HuaShan hospital from January 2005 to December 2011 .Results During the 6-year period,74 patients were diagnosed with multidrug-resistant Acinetobacter bacteremia,73 of which were nosocomial infections.The remaining one was community-acquired. Primary bloodstream infection accounted for 51 .4% (38/74),and secondary infection 48.6% (36/74), mainly secondary to pulmonary infections (23.0%,17/74). Solid tumor was the most common underlying disease (24.3%,18/74).Prior corticosteroid therapy,indwelling deep venous catheter,surgery and invasive procedures were predisposing factors of bacteremia. Acinetobacter-related bloodstream infections were associated with higher white blood cell count,increased neutrophil percentage,higher APACHE II score and lower serum albumin level.The bloodstream infection was caused by Acinetobacter baumannii in 65 pa-tients,Acinetobacter lwoffi in 7 patients,both Acinetobacter baumannii and Acinetobacter junii in one patient.The all-cause mortality rate was 27.0% (20/74).In vitro susceptibility testing showed that 20.0% (15/75 )of the Acinetobacter isolates were resistant to cefoperazone-sulbactam,which was the lowest among all the antibiotics tested.About 40.0% to 42.7% of the isolates were resistant to carbapenems.The outcome was related to the antimicrobial restistance.Carbapenem non-suscepti-ble Acinetobacter was associated with poorer outcome compared with carbapenem-susceptible Acinetobacter (mortality 46.9%vs 11 .9%,P <0.05 ).Cefoperazone-sulbactam non-susceptible Acinetobacter was also associated with poorer outcome com-pared with cefoperazone-sulbactam susceptible

  2. 肿瘤医院ICU血流感染病原菌致炎症反应的比较%Comparison of inflammatory reaction between pathogenic bacteria bloodstream infections in ICU of tumor hospital

    Institute of Scientific and Technical Information of China (English)

    吴莉; 方敏峰; 许华; 杨峰

    2013-01-01

    目的 比较肿瘤医院ICU血流感染病原菌炎症反应指标及引起的临床表现与炎症反应程度,以此指导ICU严重感染患者的早期经验性抗菌药物选择.方法 回顾性分析入住ICU 48 h后血培养阳性患者60例,根据血培养结果,分为革兰阳性菌血流感染组及革兰阴性菌血流感染组,比较两组患者的一般资料及临床炎症反应的各项指标.结果 两组患者体温、心率、白细胞计数、中性粒细胞计数、C反应蛋白及降钙素原比较,差异均无统计学意义;革兰阳性菌血流感染组与革兰阴性菌血流感染组严重脓毒症或脓毒症休克发生率分别为4.1%与22.0%(P<0.05),血清脑肽素值分别为(112.0±15.2)pg/ml与(812.0±25.3) pg/ml(P<0.05),行机械通气感染率分别为75.0%与94.4% (P=0.016);两组肾脏替代治疗例数、ICU住院时间、临床死亡率分别为10例与12例、(34.3±16.5)与(26.0±27.1)d及12.50%与22.20%,两组比较差异无统计学意义;共分离出病原菌60株,其中革兰阴性菌36株占60.0%,以大肠埃希菌、肺炎克雷伯菌为主,分别占25.0%、11.7%,革兰阳性菌24株占40.0%,以金黄色葡萄球菌、肠球菌属为主,分别占16.7%、13.3%.结论 肿瘤医院ICU血流感染中革兰阴性菌的发生率偏高,与革兰阳性菌血流感染患者相比较,革兰阴性菌血流感染患者的炎症反应较重,临床表现严重,预后差.%OBJECTIVE To compare the clinical manifestations and the inflammatory reaction degrees caused by the pathogens causing bloodstream infections in the ICU of a tumor hospital so as to guide the empirical use of antibiotics for the ICU patient with severe infections.METHODS A total of 60 blood culture-positive patients,who have been hospitalized in the ICU for 48 hours,were enrolled in the study and divided into two groups(the gram-negative bacteria bloodstream infection patients and gram-positive bacteria bloodstream infection

  3. NOAA Form 370 Database

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The data set contains information from submitted NOAA Form 370s, also known as the Fisheries Certificate of Origin, for imported shipments of frozen and/or processed...

  4. FORM, Diagrams and Topologies

    CERN Document Server

    Herzog, Franz; Ueda, Takahiro; Vermaseren, J A M; Vogt, Andreas

    2016-01-01

    We discuss a number of FORM features that are essential in the automatic processing of very large numbers of diagrams as used in the Forcer program for 4-loop massless propagator diagrams. Most of these features are new.

  5. VMS forms Output Tables

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — These output tables contain parsed and format validated data from the various VMS forms that are sent from any given vessel, while at sea, from the VMS devices on...

  6. Transplant Center Search Form

    Science.gov (United States)

    ... Share Your Story Give Us Feedback - A + A Transplant Center Search Form Welcome to the Blood & Marrow ... transplant centers for patients with a particular disease. Transplant Center login Username: * Password: * Request new password Join ...

  7. FormCalc 7

    CERN Document Server

    Agrawal, S; Mirabella, E

    2011-01-01

    We present additions and improvements in Version 7 of FormCalc, most notably analytic tensor reduction, choice of OPP methods, and MSSM initialization via FeynHiggs, as well as a parallelized Cuba library for numerical integration.

  8. MAPS Appraisal Report Form

    CERN Multimedia

    HR Department

    2005-01-01

    As announced in Weekly Bulletin 48/2004, from now onwards, the paper MAPS appraisal report form has been replaced by an electronic form, which is available via EDH (on the EDH desktop under Other Tasks / HR & Training) No changes have been made to the contents of the form. Practical information will be available on the web page http://cern.ch/ais/projs/forms/maps/info.htm, and information meetings will be held on the following dates: 18 January 2005: MAIN AUDITORIUM (500-1-001) from 14:00 to 15:30. 20 January 2005: AB AUDITORIUM II (864-1-D02) from14:00 to 15:30. 24 January 2005: AT AUDITORIUM (30-7-018) from 10:00 to 11:30. Human Resources Department Tel. 73566

  9. Getting in-formed

    DEFF Research Database (Denmark)

    Hansbøl, Mikala

    det vi undersøger på form gennem vores beskrivelser. Paperet tager afsæt i empiriske eksempler fra et postdoc projekt om et såkaldt 'serious game' - Mingoville. Projektet følger circuleringer og etableringer af Mingoville 'på en global markedsplads'. I paperet diskuteres hvordan vi som forskere samler....../performer de fænomener vi forsker i. Aktør-Netværks-Teoretiker Bruno Latour (2005) pointerer at enhver beskrivelse også er en form for forklaring. En form for forklaring, der putter ting ind i et skript og dermed også putter ting på form. Paperet diskuterer to tilgange til at gøre serious games og derved skabe viden om...... engagementer med disse fænomener i serious games forskning: experimentel og etnografisk....

  10. form-Z

    DEFF Research Database (Denmark)

    Jensen, Henrik

    2002-01-01

    Kompendiet gennemgår 3d-modellering, lyssætning og rendering med form-Z. Kurset er opbygget over CAD Clasic skabelonen (se min forskning). Kompendiet kan bruges til selvstudie.......Kompendiet gennemgår 3d-modellering, lyssætning og rendering med form-Z. Kurset er opbygget over CAD Clasic skabelonen (se min forskning). Kompendiet kan bruges til selvstudie....

  11. Achieving form in autobiography

    Directory of Open Access Journals (Sweden)

    Nicholas (Nick Meihuizen

    2014-06-01

    Full Text Available This article argues that, unlike biographies which tend to follow patterns based on conventional expectations, salient autobiographies achieve forms unique to themselves. The article draws on ideas from contemporary formalists such as Peter McDonald and Angela Leighton but also considers ideas on significant form stemming from earlier writers and critics such as P.N. Furbank and Willa Cather. In extracting from these writers the elements of what they consider comprise achieved form, the article does not seek to provide a rigid means of objectively testing the formal attributes of a piece of writing. It rather offers qualitative reminders of the need to be alert to the importance of form, even if the precise nature of this importance is not possible to define. Form is involved in meaning, and this continuously opens up possibilities regarding the reader’s relationship with the work in question. French genetic critic Debray Genette distinguishes between ‘semantic effect’ (the direct telling involved in writing and ‘semiological effect’ (the indirect signification involved. It is the latter, the article argues in summation, which gives a work its singular nature, producing a form that is not predictable but suggestive, imaginative.

  12. FormFlavor Manual

    CERN Document Server

    Evans, Jared A

    2016-01-01

    This manual describes the usage and structure of FormFlavor, a Mathematica-based tool for computing a broad list of flavor and CP observables in general new physics models. Based on the powerful machinery of FeynArts and FormCalc, FormFlavor calculates the one-loop Wilson coefficients of the dimension 5 and 6 Standard Model effective Lagrangian entirely from scratch. These Wilson coefficients are then evolved down to the low scale using one-loop QCD RGEs, where they are transformed into flavor and CP observables. The last step is accomplished using a model-independent, largely stand-alone package called FFObservables that is included with FormFlavor. The SM predictions in FFObservables include up-to-date references and accurate current predictions. Using the functions and modular structure provided by FormFlavor, it is straightforward to add new observables. Currently, FormFlavor is set up to perform these calculations for the general, non-MFV MSSM, but in principle it can be generalized to arbitrary FeynArts...

  13. 导管相关血流感染临床分析%Clinical analysis of cathetei-related bloodstream infection

    Institute of Scientific and Technical Information of China (English)

    卓婕; 孙永昌; 李莉; 李然

    2011-01-01

    目的 分析我院2008年1月至2010年12月重症监护病房(ICU)和普通病房导管相关血流感染(CRBSI)的发生情况,为CRBSI的预防和治疗提供依据.方法 将我院131例CRBSI病例分为ICU组和普通病房组,对临床资料、病原菌、导管位置、预后等进行回顾性分析.结果 ICU组(88例)和普通病房组(43例)在年龄和性别构成上差异无统计学意义(P>0.05).ICU组患者APACHE Ⅱ评分高于普通病房组(P=0.039).CRBSI在股静脉置管的患者中发生率最高.两组患者共培养出致病菌株152株.ICU组106株,其中革兰阳性球菌43株(40.6%),革兰阴性杆菌41株(38.7%),真菌22株(20.7%);普通病房组46株,其中革兰阳性球菌29株(63.0%).革兰阴性杆菌13株(28.3%),真菌4株(8.7%).因CRBSI导致死亡病例ICU组16例(18.2%),普通病房组4例(9.3%)(P>0.05).混合感染患者死亡率显著高于单一菌株感染(P=0.004).死亡病例感染病原菌前三位分别为真菌(12株)、肠球菌(6株)、铜绿假单胞菌(3株).结论 CRBSI在ICU和普通病房患者中病原菌分布存在差异,是抗菌药物选择和预后判断中需要考虑的因素.%Objective To study the incidence and pathogenic etiology of catheter-related bloodstream infection (CRBSI) in intensive care unit (ICU) and general ward, and to provide basis for the prevention and therapy of CRBSI. Methods 131 cases of CRBSI were divided into ICU group and general ward group. The clinical data, pathogens, catheter location, and prognosis were analyzed retrospectively. Results There was no statistical significance on age and gender between ICU group (88 cases) and general ward group (43 cases) ( P >0. 05). APACHE Ⅱ score in ICU group was higher than that in general ward group ( P =0.039). The incidence of CRBSI in the femoral vein was the highest. There were 152 pathogenic strains isolated from the two groups. There were 106 strains in ICU group, in which 43 strains (40.6%) were gram-positive cocci, 41

  14. Comparative waste forms study

    Energy Technology Data Exchange (ETDEWEB)

    Wald, J.W.; Lokken, R.O.; Shade, J.W.; Rusin, J.M.

    1980-12-01

    A number of alternative process and waste form options exist for the immobilization of nuclear wastes. Although data exists on the characterization of these alternative waste forms, a straightforward comparison of product properties is difficult, due to the lack of standardized testing procedures. The characterization study described in this report involved the application of the same volatility, mechanical strength and leach tests to ten alternative waste forms, to assess product durability. Bulk property, phase analysis and microstructural examination of the simulated products, whose waste loading varied from 5% to 100% was also conducted. The specific waste forms investigated were as follows: Cold Pressed and Sintered PW-9 Calcine; Hot Pressed PW-9 Calcine; Hot Isostatic Pressed PW-9 Calcine; Cold Pressed and Sintered SPC-5B Supercalcine; Hot Isostatic pressed SPC-5B Supercalcine; Sintered PW-9 and 50% Glass Frit; Glass 76-68; Celsian Glass Ceramic; Type II Portland Cement and 10% PW-9 Calcine; and Type II Portland Cement and 10% SPC-5B Supercalcine. Bulk property data were used to calculate and compare the relative quantities of waste form volume produced at a spent fuel processing rate of 5 metric ton uranium/day. This quantity ranged from 3173 L/day (5280 Kg/day) for 10% SPC-5B supercalcine in cement to 83 L/day (294 Kg/day) for 100% calcine. Mechanical strength, volatility, and leach resistance tests provide data related to waste form durability. Glass, glass-ceramic and supercalcine ranked high in waste form durability where as the 100% PW-9 calcine ranked low. All other materials ranked between these two groupings.

  15. Methods for forming particles

    Energy Technology Data Exchange (ETDEWEB)

    Fox, Robert V.; Zhang, Fengyan; Rodriguez, Rene G.; Pak, Joshua J.; Sun, Chivin

    2016-06-21

    Single source precursors or pre-copolymers of single source precursors are subjected to microwave radiation to form particles of a I-III-VI.sub.2 material. Such particles may be formed in a wurtzite phase and may be converted to a chalcopyrite phase by, for example, exposure to heat. The particles in the wurtzite phase may have a substantially hexagonal shape that enables stacking into ordered layers. The particles in the wurtzite phase may be mixed with particles in the chalcopyrite phase (i.e., chalcopyrite nanoparticles) that may fill voids within the ordered layers of the particles in the wurtzite phase thus produce films with good coverage. In some embodiments, the methods are used to form layers of semiconductor materials comprising a I-III-VI.sub.2 material. Devices such as, for example, thin-film solar cells may be fabricated using such methods.

  16. Forms of Inattentiveness

    DEFF Research Database (Denmark)

    Knudsen, Morten

    2011-01-01

    and kept out of sight in the decision processes by looking at a specific case study involving the construction of a model intended to control, and render transparent, the quality of health services in Denmark. This paper outlines the forms of inattentiveness which make communication blind to information...... that could question the quality model. Five forms of inattentiveness are identified that function as answers to the question of how communication avoids actualizing relevant but also potentially destructive information. This study documents a considerable amount of blindness to potentially relevant themes...... and it points to activities that produce this blindness as they reduce the probability that potentially destructive subjects are actualized. Information is not only something organizations need, but may also be something they protect themselves against. In that case, the forms of inattentiveness may...

  17. Physical forms of MIPs.

    Science.gov (United States)

    Biffis, Andrea; Dvorakova, Gita; Falcimaigne-Cordin, Aude

    2012-01-01

    The current state of the art in the development of methodologies for the preparation of MIPs in predetermined physical forms is critically reviewed, with particular attention being paid to the forms most widely employed in practical applications, such as spherical beads in the micro- to nanometer range, microgels, monoliths, membranes. Although applications of the various MIP physical forms are mentioned, the focus of the paper is mainly on the description of the various preparative methods. The aim is to provide the reader with an overview of the latest achievements in the field, as well as with a mean for critically evaluating the various proposed methodologies towards an envisaged application. The review covers the literature up to early 2010, with special emphasis on the developments of the last 10 years.

  18. Incentive to Form

    DEFF Research Database (Denmark)

    Thomsen, Bente Dahl; Madsen, Klaus

    2011-01-01

    Projektet ’Incitament til Form' har identificeret en række tematiske angreb på formstudier - i stærkt papir – som skaber nye former, hvor af en eller flere ofte indeholder stærkere kvaliteter end udgangspunktet. Incitamenter er, i denne sammenhæng, former skabt ved foldning over variationer af lige...... af hans formstudierne gennem dialog og præsentation af incitamenter. Dialogen om form og læringsrums aktiviteter der var centrale for Lynges pædagogik. Dialogen og formeksperimenter kombineres med opfordringer til at søge inspiration i naturen og videnskabelige udredninger. De tematiske angreb er...

  19. Sixth form pure mathematics

    CERN Document Server

    Plumpton, C

    1968-01-01

    Sixth Form Pure Mathematics, Volume 1, Second Edition, is the first of a series of volumes on Pure Mathematics and Theoretical Mechanics for Sixth Form students whose aim is entrance into British and Commonwealth Universities or Technical Colleges. A knowledge of Pure Mathematics up to G.C.E. O-level is assumed and the subject is developed by a concentric treatment in which each new topic is used to illustrate ideas already treated. The major topics of Algebra, Calculus, Coordinate Geometry, and Trigonometry are developed together. This volume covers most of the Pure Mathematics required for t

  20. Many Forms of Culture

    Science.gov (United States)

    Cohen, Adam B.

    2009-01-01

    Psychologists interested in culture have focused primarily on East-West differences in individualism-collectivism, or independent-interdependent self-construal. As important as this dimension is, there are many other forms of culture with many dimensions of cultural variability. Selecting from among the many understudied cultures in psychology,…

  1. Forming of Thermoplastic Composites

    NARCIS (Netherlands)

    Haanappel, S.P.; Sachs, U.; Thije, ten R.H.W.; Rietman, A.D.; Akkerman, R.

    2012-01-01

    Design and production guidelines for UD reinforced thermoplastic composites are highly desirable. Therefore, forming experiments and simulations with a realistic complex shaped product were conducted. Thermoforming experiments with quasi-isotropic UD carbon/PEEK and 8HS woven glass/PPS composites sh

  2. On Quadratic Differential Forms

    NARCIS (Netherlands)

    Willems, J.C.; Trentelman, H.L.

    1998-01-01

    This paper develops a theory around the notion of quadratic differential forms in the context of linear differential systems. In many applications, we need to not only understand the behavior of the system variables but also the behavior of certain functionals of these variables. The obvious cases w

  3. eta ' transition form factors

    NARCIS (Netherlands)

    Amo Sanchez, del P.; Raven, H.G.; Snoek, H.; BaBar, Collaboration

    2011-01-01

    eta((')) transition form factors in the momentum-transfer range from 4 to 40 GeV(2). The analysis is based on 469 fb(-1) of integrated luminosity collected at PEP-II with the BABAR detector at e(+)e(-) center-of-mass energies near 10.6 GeV.

  4. Supercongruences via modular forms

    CERN Document Server

    Osburn, Robert

    2009-01-01

    We prove two supercongruences for the coefficients of power series expansions in t of modular forms where t is a modular function. As a result, we settle two recent conjectures of Chan, Cooper and Sica. Additionally, we provide a table of supercongruences for numbers which appear in similar power series expansions and in the study of integral solutions of Apery-like differential equations.

  5. Metal forming and lubrication

    DEFF Research Database (Denmark)

    Bay, Niels

    2000-01-01

    Lubrication is essential in most metal forming processes. The lubricant film has two basic functions, [1]: i. to separate the work piece and tool surfaces and ii. to cool the workpiece and the tool. Separation of the two surfaces implies lower friction facilitating deformation and lowering the tool...... deformation step to avoid overheating and breakdown of the lubricant....

  6. Measuring urban form

    NARCIS (Netherlands)

    Berghauser Pont, M.Y.

    2011-01-01

    For many, the notion of ‘measuring urban form’ will sound disturbing. Urban form is about visual images of cities, experiences, feelings, memories of place, thoughts and intellectual constructs anchored in the realm of the arts and the humanities. Anne Vernez Moudon however gives in the paper Urbani

  7. Geodiversity and land form

    Science.gov (United States)

    Gray, Murray

    2014-05-01

    The Earth's surface has a dynamic and topographically varied natural landscape. In some cases the resulting landforms are given generic names reflecting their form and/or origin, (e.g. sand dunes, eskers, ox-bow lakes) but in many cases the land surface has a more amorphous form and is less easily categorized other than at a landscape scale (e.g. dissected plateau, Chalk downland). Across much of Europe, while the natural vegetation has been removed or radically modified, the natural land form/topography remains in tact. In this context and in terms of geoconservation we ought to be: • allowing the dynamic natural processes that create, carve and modify landscapes to continue to operate; and • retaining natural topographic character and geomorphological authenticity in the face of human actions seeking to remodel the land surface. In this presentation examples of this approach to geoconservation of land form will be given from the UK and other parts of the world. This will include examples of both appropriate and inappropriate topographic modifications.

  8. 医院获得性铜绿假单胞菌血流感染的临床分析%Clinical analysis of hospital-acquired bloodstream infections due to Pseudomonas aeruginosa

    Institute of Scientific and Technical Information of China (English)

    文亚坤; 曹萌; 邹琳; 俞森洋; 孙宝君

    2013-01-01

    目的 分析医院获得性铜绿假单胞菌血流感染的临床特征及死亡相关因素,为临床诊治提供参考依据.方法 回顾性分析医院2010年1月-2011年12月由铜绿假单胞菌引起的医院获得性血流感染患者临床资料,根据是否暴露于危险因素进行死亡相关单因素及多因素分析,单因素分析分别比较不同危险因素之间死亡率的差异,多因素分析采用logistic回归分析.结果 51例血流感染患者98.0%出现发热,72.5%伴寒颤;31.4%有血液系统疾病,白细胞、中性粒细胞低于正常值,余患者中97.1%白细胞或(和)中性粒细胞升高;37.3%为导管相关性血流感染,35.3%发生感染性休克;病死率为29.4%,死亡相关单因素分析显示,年龄≥70岁、糖尿病、心脏疾病、肺部感染、血白蛋白< 30 g/L、血红蛋白<90 g/L、有创机械通气、血液透析、入住ICU与死亡相关;logistic回归分析显示,糖尿病、血红蛋白<90 g/L是死亡相关因素.结论 医院获得性铜绿假单胞菌血流感染多伴有发热、寒颤、白细胞或(和)中性粒细胞升高,糖尿病、血红蛋白<90 g/L为死亡相关因素.%OBJECTIVE To study the clinical characteristics and factors associated with mortality of nosocomial bloodstream infections due to Pseudomonas aeruginosa so as to provide reference for the clinical diagnosis and treatment. METHODS The clinical data of the patients with bloodstream infections caused by P. aeruginosa from Jan 2010 to Dec 2011 were analyzed retrospectively. According to the exposure to the risk factors, both the univariate factor analysis and the multivariate analysis were performed for the risk factors associated with the mortality. The univariate analysis was performed by comparing the mortality due to the various risk factors between the two groups, and logistic regression analysis was performed to analyze the multiple factors. RESULTS Of totally 51 patients with

  9. Clinical distribution and drug resistance of Staphylococcus aureus causing bloodstream infections%金黄色葡萄球菌血流感染的临床分布与耐药性分析

    Institute of Scientific and Technical Information of China (English)

    陈世平; 冯旰珠; 李彤; 杜兴冉; 胡慧敏

    2016-01-01

    OBJECTIVE To investigate the clinical distribution and drug resistance of Staphylococcus aureus causing bloodstream infections so as to provide guidance for reasonable clinical use of antibiotics .METHODS The related clinical data were collected from 76 patients with S .aureus bloodstream infections who were hospitalized from Jan 2009 to May 2015 . The clinical distribution and drug resistance of the strains were retrospectively analyzed . RESULTS The S .aureus bloodstream infection was prevalent in elderly patients and neonates ;among the patients with bloodstream infection ,35 .5% distributed in the renal disease department ,13 .2% in the neonatal depart‐ment ,13 .2% in the ICU .The drug resistance rate of the S .aureus to penicillin was the highest (94 .7% );the drug susceptibility rates to teicoplanin ,vancomycin ,and linezolid were 100% ;the drug susceptibility rate to fu‐sidic acid was 96 .1% .The detection rate of methicillin‐resistant S .aureus (MRSA) reached up to 40 .8% ;the drug susceptibility rates of the M RSA strains to gentamicin ,clindamycin ,levofloxacin ,and sulfamethoxazole‐tri‐methoprim were significantly lower than those of the methicillin‐sensitive S .aureus (MSSA) (P<0 .05) .There was no significant difference in the drug susceptibility rate to the commonly used antibiotics between the MRSA strains causing the community‐acquired infection and the MRSA strains causing the hospital‐acquired infection or between the MSSA strains causing the community‐acquired infection and the MSSA strains causing the hospital‐ac‐quired infection .CONCLUSION The clinical distribution of the patients with S .aureus bloodstream infections is rel‐atively concentrated ,the detection rate of the MRSA strains is relatively high .The strains are highly drug‐resist‐ant .It is necessary for the hospital to conduct the anti‐infection therapy as early as possible and reasonably use an‐tibiotics so as to avoid the emergence of drug resistance

  10. Early diagnostic value of combined inflammatory cytokines in bloodstream infection with different organisms%早期联合测定炎症因子对不同病原菌血流感染的鉴别诊断价值

    Institute of Scientific and Technical Information of China (English)

    陈炜; 牛素平; 臧学峰; 赵磊; 盛博

    2015-01-01

    Objective To investigate the expression of procalcitonin (PCT) and C-reactive protein (CRP),and endotoxin in bloodstream infection with different microorganisms,so as to assess the value of these inflammatory cytokines in early diagnosis of sepsis in bloodstream infections patients.Methods Data of 152 septic bloodstream infected patients with 90 male and 62 female aged from 62 to 102 years and 79.2 ± 16.3 years in average admitted from January 2012 to December 2013 were analyzed retrospectively.According to the results of blood culture,the microorganisms could be categorized into gram-negative bacteria,gram-positive bacteria and fungus groups,and the levels of serum CRP,PCT,and endotoxin were compared among these groups of bloodstream infections patients within 24 hours after admission.Results (1) A total of 152 strains of microorganisms were surveyed including 92 gram-negative strains (61.18%),43 gram-positive strains (28.29%),and 16 fungal strains (10.53%).In the gram-negative strains,Klebsiella pneumoniae (n =29),Acinetobacter baumannii (n =24),Escherichia coli (n =23),Burkholderia cepacia (n =9) and Pseudomonas aeruginosa (n =4) were the most common isolates.In the Gram-positive strains,13 strains of Staphylococcus aureus were isolated.(2) In the gram-negative bacterial bloodstream infections group,there were 60 (64.52%) patients with endotoxin positive,and there were no endotoxin positive cases with detected gram-positive bacteria and fungal bloodstream infections.The median levels of PCT were significantly different among the three groups [gram-negative strains group:7.760 (3.365,28.585) ng/mL,gram-positive strains group:0.705 (0.265,3.225) ng/mL,fungal infection group:1.245 (0.543,1.998) ng/mL].In the fungal bloodstream infection group,the mean level of CRP was higher than that in other two groups [gram-negative strains group:(126.01 ± 66.53) mg/L,gram-positive strains group:(77.58 ±54.21) mg/L,fungal infection group:(140.14 ±71.21) mg/L].(3) The

  11. The Form of Gentrification

    CERN Document Server

    Venerandi, Alessandro; Romice, Ombretta; Porta, Sergio

    2014-01-01

    Many socioeconomic studies have been carried out to explain the phenomenon of gentrification. Although results of these works shed light on the process around this phenomenon, a perspective which focuses on the relationship between city form and gentrification is still missing. With this paper we try to address this gap by studying and comparing, through classic methods of mathematical statistics, morphological features of five London gentrified neighbourhoods. Outcomes confirm that areas which have undergone gentrification display similar and recognizable morphological patterns in terms of urban type and geographical location of main and local roads as well as businesses. These initial results confirm findings from previous research in urban sociology, and highlight the role of urban form in contributing to shape dynamics of non-spatial nature in cities.

  12. Tube-Forming Assays.

    Science.gov (United States)

    Brown, Ryan M; Meah, Christopher J; Heath, Victoria L; Styles, Iain B; Bicknell, Roy

    2016-01-01

    Angiogenesis involves the generation of new blood vessels from the existing vasculature and is dependent on many growth factors and signaling events. In vivo angiogenesis is dynamic and complex, meaning assays are commonly utilized to explore specific targets for research into this area. Tube-forming assays offer an excellent overview of the molecular processes in angiogenesis. The Matrigel tube forming assay is a simple-to-implement but powerful tool for identifying biomolecules involved in angiogenesis. A detailed experimental protocol on the implementation of the assay is described in conjunction with an in-depth review of methods that can be applied to the analysis of the tube formation. In addition, an ImageJ plug-in is presented which allows automatic quantification of tube images reducing analysis times while removing user bias and subjectivity.

  13. Formed HIP Can Processing

    Energy Technology Data Exchange (ETDEWEB)

    Clarke, Kester Diederik [Los Alamos National Lab. (LANL), Los Alamos, NM (United States)

    2015-07-27

    The intent of this report is to document a procedure used at LANL for HIP bonding aluminum cladding to U-10Mo fuel foils using a formed HIP can for the Domestic Reactor Conversion program in the NNSA Office of Material, Management and Minimization, and provide some details that may not have been published elsewhere. The HIP process is based on the procedures that have been used to develop the formed HIP can process, including the baseline process developed at Idaho National Laboratory (INL). The HIP bonding cladding process development is summarized in the listed references. Further iterations with Babcock & Wilcox (B&W) to refine the process to meet production and facility requirements is expected.

  14. Parking and Urban Form

    OpenAIRE

    Brueckner, Jan K.; Franco, Sofia F.

    2015-01-01

    This paper analyzes the provision of residential parking in a monocentric city, with the ultimate goal of appraising the desirability and effects of regulations such as a minimum-parking requirement (MPR) per dwelling. The analysis considers three different regimes for provision of parking space: surface parking, underground parking, and structural parking, with the latter two regimes involving capital investment either in the form of an underground parking garage or an above-ground parking s...

  15. Nucleon Electromagnetic Form Factors

    Energy Technology Data Exchange (ETDEWEB)

    Kees de Jager

    2004-08-01

    Although nucleons account for nearly all the visible mass in the universe, they have a complicated structure that is still incompletely understood. The first indication that nucleons have an internal structure, was the measurement of the proton magnetic moment by Frisch and Stern (1933) which revealed a large deviation from the value expected for a point-like Dirac particle. The investigation of the spatial structure of the nucleon, resulting in the first quantitative measurement of the proton charge radius, was initiated by the HEPL (Stanford) experiments in the 1950s, for which Hofstadter was awarded the 1961 Nobel prize. The first indication of a non-zero neutron charge distribution was obtained by scattering thermal neutrons off atomic electrons. The recent revival of its experimental study through the operational implementation of novel instrumentation has instigated a strong theoretical interest. Nucleon electro-magnetic form factors (EMFFs) are optimally studied through the exchange of a virtual photon, in elastic electron-nucleon scattering. The momentum transferred to the nucleon by the virtual photon can be selected to probe different scales of the nucleon, from integral properties such as the charge radius to scaling properties of its internal constituents. Polarization instrumentation, polarized beams and targets, and the measurement of the polarization of the recoiling nucleon have been essential in the accurate separation of the charge and magnetic form factors and in studies of the elusive neutron charge form factor.

  16. 严重肝病伴糖尿病患者大肠埃希菌血流感染临床分析%Clinical analysis of bloodstream infections caused by Escherichia coli in severe liver diseases compared with diabetes

    Institute of Scientific and Technical Information of China (English)

    何卫平; 崔恩博; 蔡少平; 鲍春梅; 张文瑾; 范振平; 曲芬

    2014-01-01

    Objective To investigate the clinical characteristic and drug resistance of bloodstream infections caused by Escherichia coli (E.coli)in patients with severe liver diseases and diabetes,and to provide evidence for optimal therapy of antibiotics in clinical practice. Methods The clinical features and drug susceptibility of E.coli-caused bloodstream infections among inpatients with severe liver diseases and diabetes from 2009 to 2012 were analyzed retrospectively. Results A total of 47 strains of E. coli were isolated from those inpatients,among which 22 strains of extended-spectrumβ-lactamases (ESBLs)(46.81% )were positive. The overwhelming majority patients were liver cirrhosis with infection resulting from spontaneous bacterial peritonitis. The drug resistance of ESBLs-positive strains was higher than that of ESBLs-negative strains,with no statistical differences existed in age,sex,basic disease,infection source,peak temperature,white blood cell count and the percentage of neutrophils between ESBLs-positive strains and negative strains. Mortality rate in patients accompanied with septic shock was higher than that in patients without shock. Conclusion Due to the severity and bad prognosis of bloodstream infection,early identification and comprehensive treatment should be taken to reduce mortality.%目的:分析严重肝病伴糖尿病患者大肠埃希菌血流感染的临床特点及耐药性,为临床合理应用抗菌药物提供依据。方法回顾性分析2009年至2012年住院的严重肝病合并糖尿病血流感染大肠埃希菌患者的临床特点及药敏结果。结果严重肝病合并糖尿病血流感染大肠埃希菌患者共47例,基础疾病以肝硬化为主,感染来源以自发性细菌性腹膜炎为主,ESBL阳性22株,阳性率46.81%。ESBL阳性大肠埃希菌耐药性高于 ESBL 阴性大肠埃希菌,但两者在年龄、性别、基础疾病、原发病灶、体温峰值、白细胞计数及中性粒细胞百分比

  17. 78 FR 58605 - Proposed Collection; Comment Request for Form 8453-EMP, Form 8453-F, Form 8453-FE, Form 8879-F...

    Science.gov (United States)

    2013-09-24

    ... Internal Revenue Service Proposed Collection; Comment Request for Form 8453-EMP, Form 8453-F, Form 8453-FE, Form 8879-F, and 8879-EMP. AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice and request...- file Return; Form 8453-EMP, Employment Tax Declaration for an IRS e- file Return; Form 8879-EMP, IRS...

  18. 重症急性胰腺炎患者肠屏障功能障碍与血流感染的关系研究%Relationship between intestinal barrier dysfunction and bloodstream infection of patients with severe acute pancreatitis

    Institute of Scientific and Technical Information of China (English)

    陈力; 卢燕

    2015-01-01

    目的:研究重症急性胰腺炎患者肠屏障功能障碍与血流感染的关系。方法统计分析2012年5月至2015年5月本院收治的重症急性胰腺炎患者80例的临床资料。结果合并血流感染组患者的 APACHE Ⅱ评分显著高于非血流感染组(P<0.05),住 ICU 时间显著长于非血流感染组(P<0.05),4周病死率15.0%(6/40)显著低于非血流感染组5.0%(2/40)(P<0.05);合并血流感染组和非血流感染组患者入院后第1、3、7d 的 L/M 、ET 、累及器官数之间的差异均显著(P<0.05);合并血流感染组患者入院后第1、3、7d 的 L /M 、ET 均逐渐升高,非血流感染组患者入院后第1、3、7d 的 L/M 、ET 均逐渐降低,L /M 、ET 呈显著的正相关关系(P<0.05)。结论重症急性胰腺炎患者肠屏障功能障碍与血流感染密切相关,值得临床充分重视。%Objective To study the relationship between intestinal barrier dysfunction and bloodstream infec‐tion of patients with severe acute pancreatitis .Methods The clinical data of 80 cases of patients with severe acute pancreatitis in our hospital from May 2012 to May 2015 were statistically analyzed .Results The APACHE Ⅱ score of combined bloodstream infections group was significantly higher (P< 0 .05) ,the duration of ICU stay was signifi‐cantly longer (P< 0 .05) ,the 4‐week mortality rate 15 .0% (6 / 40) was significantly lower than non bloodstream in‐fection group 5 .0% (2/40) (P< 0 .05) ;The differences of L / M ,ET ,involving the number of organs after admis‐sion 1 ,3 ,7 d between the combined bloodstream infections group and non bloodstream infection group were signifi‐cant (P< 0 .05) ;The L / M ,ET after admission 1 ,3 ,7 d of the combined bloodstream infections group were gradual‐ly increased ,The L / M ,ET after admission 1 ,3 ,7d of the non bloodstream infection group decreased gradually ,L /M ,ET showed

  19. Impact of Cluster of Intervention Strategies on CRRT Central Venous Catheter-related Bloodstream Infections%集束化干预策略对CRRT中心静脉导管相关性血行感染的影响

    Institute of Scientific and Technical Information of China (English)

    陈刚; 黄晓铭; 陈鑫鑫

    2014-01-01

    Objective To explore the cluster intervention strategies for CRRT central venous catheter related bloodstream infections (hereinafter referred to as CRBIS). Methods Retrospective analysis of our department in August 2012-February 2013 lines of central venous catheter and conventional CRRT infection intervention measures of patients 150 cases (control group) and March 2013-September 2013 lines of central venous catheter and CRRT in 196 patients with cluster intervention strategies (observation group), compared two groups of patients the incidence of CRBIS, ICU hospitalization days and hospitalization expenses, etc. Results Cluster intervention strategies significantly reduce the rate of catheter-related bloodstream infection, which reduces the patients in ICU time, reduced the cost of patients. Conclusion Cluster intervention strategy can decrease the CRRT CRBIS rate of femoral vein, but need to improve the clinical compliance.%目的:探讨集束化干预策略对CRRT中心静脉导管相关性血流感染(以下简称 CRBIS)的影响。方法回顾性对比分析我科2012年8月~2013年2月行CRRT中心静脉导管并按常规实施感染干预措施的患者150例(对照组)与2013年3月~9月行CRRT中心静脉导管并按集束化干预策略患者196例(观察组),比较两组患者的CRBIS发生率、ICU 住院天数、住院费用等。结果集束化干预策略明显降低导管相关性血行感染,从而降低了患者入住 ICU时间,减少了患者费用。结论集束化干预策略可降低CRRT股静脉的CRBIS率,但需提高临床的依从性。

  20. ICU 导管相关性血流感染危险因素分析%Influential factors of central venous catheter-related bloodstream infections in ICU patients. Zong Zhihua

    Institute of Scientific and Technical Information of China (English)

    宗志华

    2013-01-01

      目的探讨 ICU 导管相关性血流感染(catheter-related blood stream infections, CRBSI)的风险因素,及其预防对策。方法回顾性分析2008年5月至2012年5月我院实 ICU 实施中心静脉置管的患者803例,其中发生 CRBSI 46例,分析发生的原因并制订相应的对策。结果46例患者发生 CRBSI 的原因与操作不当、导管的类型和材料、置管部位、时间及患者因素等有关;其中4例患者更换导管,7例拔除了导管,其余35例感染得到控制。结论患者、导管及置管因素均影响 CRBSI 的发生,通过纠正诱发因素,降低 CRBSI 发生率,有助于改善患者预后。%Objective To investigate the influential factors of central venous catheter-related bloodstream infections (CRBSI) in ICU, so as to develop appropriate countermeasures. Methods The clinical date of 803 ICU patients from May 2008 to May 2012 treated with central venous catheter were retrospectively reviewed to find 46 cases of catheter-related bloodstream infections. The influential factors were analyzed and the countermeasures were worked out. Results 46 cases of CRBSI were related with improper operation, tube type and materials, catheter site, time and patients and other relevant factors. 4 cases were treated with catheter replacement. 7 cases were removed of the catheter and 35 cases were controled stably. Conclusion it’s possible way to reduce the incidence of CRBSI and help to improve the prognosis of patients, from correcting factors, including patients, catheter and catheter factors, which influence the occurrence of CRBSI.

  1. Advanced forming technology

    Directory of Open Access Journals (Sweden)

    J. Kliber

    2016-10-01

    Full Text Available Forming is usually the final stage of metallurgical production of steel (90 % of the 1,7 billion tons of total steel production in the world and traditionally also largely of the products made of non-ferrous metals. Many procedures and methods exist and we will focus only on some of them. The aim is usually to achieve ultra-fine grained structure, the proper microstructure and (mechanical / electrical properties in innovative materials. The presented article mentions only some examples.

  2. Code Optimization in FORM

    CERN Document Server

    Kuipers, J; Vermaseren, J A M

    2013-01-01

    We describe the implementation of output code optimization in the open source computer algebra system FORM. This implementation is based on recently discovered techniques of Monte Carlo tree search to find efficient multivariate Horner schemes, in combination with other optimization algorithms, such as common subexpression elimination. For systems for which no specific knowledge is provided it performs significantly better than other methods we could compare with. Because the method has a number of free parameters, we also show some methods by which to tune them to different types of problems.

  3. [Adhesive cutaneous pharmaceutical forms].

    Science.gov (United States)

    Gafiţanu, E; Matei, I; Mungiu, O C; Pavelescu, M; Mîndreci, I; Apostol, I; Ionescu, G

    1989-01-01

    The adhesive cutaneous pharmaceutical forms aimed to local action release the drug substance in view of a dermatological, traumatological, antirheumatic, cosmetic action. Two such preparations were obtained and their stability, consistency and pH were determined. The "in vitro" tests of their bioavailability revealed the dynamics of calcium ions release according to the associations of each preparation. The bioavailability determined by evaluating the pharmacological response demonstrated the antiinflammatory action obtained by the association of calcium ions with the components extracted from poplar muds. The therapeutical efficiency of the studied preparations has proved in the treatment of some sport injuries.

  4. Do naked singularities form?

    CERN Document Server

    Vaz, C; Vaz, Cenalo; Witten, Louis

    1995-01-01

    A naked singularity is formed by the collapse of a Sine-Gordon soliton in 1+1 dimensional dilaton gravity with a negative cosmological constant. We examine the quantum stress tensor resulting from the formation of the singularity. Consistent boundary conditions require that the incoming soliton is accompanied by a flux of incoming radiation across past null infinity, but neglecting the back reaction of the spacetime leads to the absurd conclusion that the total energy entering the system by the time the observer is able to receive information from the singularity is infinite. We conclude that the back reaction must prevent the formation of the naked singularity.

  5. Bipolar pulse forming line

    Science.gov (United States)

    Rhodes, Mark A.

    2008-10-21

    A bipolar pulse forming transmission line module for linear induction accelerators having first, second, third, fourth, and fifth planar conductors which form an interleaved stack with dielectric layers between the conductors. Each conductor has a first end, and a second end adjacent an acceleration axis. The first and second planar conductors are connected to each other at the second ends, the fourth and fifth planar conductors are connected to each other at the second ends, and the first and fifth planar conductors are connected to each other at the first ends via a shorting plate adjacent the first ends. The third planar conductor is electrically connectable to a high voltage source, and an internal switch functions to short a high voltage from the first end of the third planar conductor to the first end of the fourth planar conductor to produce a bipolar pulse at the acceleration axis with a zero net time integral. Improved access to the switch is enabled by an aperture through the shorting plate and the proximity of the aperture to the switch.

  6. Nucleon Electromagnetic Form Factors

    Energy Technology Data Exchange (ETDEWEB)

    Marc Vanderhaeghen; Charles Perdrisat; Vina Punjabi

    2007-10-01

    There has been much activity in the measurement of the elastic electromagnetic proton and neutron form factors in the last decade, and the quality of the data has greatly improved by performing double polarization experiments, in comparison with previous unpolarized data. Here we review the experimental data base in view of the new results for the proton, and neutron, obtained at JLab, MAMI, and MIT-Bates. The rapid evolution of phenomenological models triggered by these high-precision experiments will be discussed, including the recent progress in the determination of the valence quark generalized parton distributions of the nucleon, as well as the steady rate of improvements made in the lattice QCD calculations.

  7. Pion form factor

    Energy Technology Data Exchange (ETDEWEB)

    Ryong Ji, C.; Pang, A.; Szczepaniak, A. [North Carolina State Univ., Raleigh, NC (United States)

    1994-04-01

    It is pointed out that the correct criterion to define the legal PQCD contribution to the exclusive processes in the lightcone perturbative expansion should be based on the large off-shellness of the lightcone energy in the intermediate states. In the lightcone perturbative QCD calculation of the pion form factor, the authors find that the legal PQCD contribution defined by the lightcone energy cut saturates in the smaller Q{sup 2} region compared to that defined by the gluon four-momentum square cut. This is due to the contribution by the highly off-energy-shell gluons in the end point regions of the phase space, indicating that the gluon four-momentum-square cut may have cut too much to define the legal PQCD.

  8. Paramodular Cusp Forms

    CERN Document Server

    Poor, Cris

    2009-01-01

    We classify Siegel modular cusp forms of weight two for the paramodular group K(p) for primes p< 600. We find that weight two Hecke eigenforms beyond the Gritsenko lifts correspond to certain abelian varieties defined over the rationals of conductor p. The arithmetic classification is in a companion article by A. Brumer and K. Kramer. The Paramodular Conjecture, supported by these computations and consistent with the Langlands philosophy and the work of H. Yoshida, is a partial extension to degree 2 of the Shimura-Taniyama Conjecture. These nonlift Hecke eigenforms share Euler factors with the corresponding abelian variety $A$ and satisfy congruences modulo \\ell with Gritsenko lifts, whenever $A$ has rational \\ell-torsion.

  9. The forms of prophecy

    Directory of Open Access Journals (Sweden)

    Rayco González

    2013-11-01

    Full Text Available The prophecy is a kind of text holding therefore its own textual marks, differing from other kinds of texts. In order to do a discursive analysis of it, we must bring a semiotic study of its own possible forms. It includes its intertextual connections, as well as the use of typical tropos and topoi. Our aim is to describe the features of a kind of text that seems to appear in every well-known culture. Our analysis is limited to religious prophecies, showing mainly several examples from Judeo-Christian tradition, but also from other cultures, according to our line of argument. Amongst its features we find the use of allusion, forcing to any addressee to expand all possible interpretations. Likewise the prophecy seems to fulfill the double function of threat/promise, depending on each addressee.

  10. Le forme del fondo

    Directory of Open Access Journals (Sweden)

    Michel Maffesoli

    2004-12-01

    Full Text Available Non è vero che la natura ha paura del vuoto. Forse addirittura si completa. Il vuoto è anche una modalità dell'essere. È possibile nidificarvisi, avvolgersi pigramente e, così, proteggersi dall'angoscia del tempo che passa. Il vuoto delle apparenze è, in alcuni momenti, una delle forme d'espressione della vita sociale. Oltretutto occorre saperle riconoscere. Certamente, abbiamo tutti un'esistenza personale, ma siamo, ugualmente, i rappresentanti, a volte anche le vittime, di uno "spirito comune", forse anche di un "inconscio collettivo" che si è costituito di secolo in secolo. E, molto spesso, quando crediamo di esprimere le nostre idee, siamo soltanto dei portavoce, comparse di un vasto "theatrum mundi" dalle dimensioni infinite.

  11. Weird past tense forms.

    Science.gov (United States)

    Xu, F; Pinker, S

    1995-10-01

    It is often assumed that children go through a stage in which they systematically overapply irregular past tense patterns to inappropriate verbs, as in wipe-wope, bring-brang, trick-truck, walk-has walken. Such errors have been interpreted both as reflecting over-use of minor grammatical rules (e.g. 'change i to a'), and as reflecting the operation of a connectionist pattern associator network that superimposes and blends patterns of various degrees of generality. But the actual rate, time course, and nature of these errors have never been documented. We analysed 20,000 past tense and participle usages from nine children in the CHILDES database, looking for overapplications of irregular vowel-change patterns, as in brang, blends, as in branged, productive suffixations of -en, as in walken, gross distortions, as in mail-membled, and double-suffixation, as in walkeded. These errors were collectively quite rare; children made them in about two tenths of one per cent of the opportunities, and with few stable patterns: the errors were not predominantly word-substitutions, did not occur predominantly with irregular stems, showed no consistency across verbs or ages, and showed no clear age trend. Most (though not all) of the errors were based closely on existing irregular verbs; gross distortions never occurred. We suggest that both rule-theories and connectionist theories have tended to overestimate the predominance of such errors. Children master irregular forms quite accurately, presumably because irregular forms are just a special case of the arbitrary sound-meaning pairings that define words, and because children are good at learning words.

  12. Forming Spirals From Shadows

    Science.gov (United States)

    Kohler, Susanna

    2016-07-01

    What causes the large-scale spiral structures found in some protoplanetary disks? Most models assume theyre created by newly-forming planets, but a new study suggests that planets might have nothing to do with it.Perturbations from Planets?In some transition disks protoplanetary disks with gaps in their inner regions weve directly imaged large-scale spiral arms. Many theories currently attribute the formation of these structures to young planets: either the direct perturbations of a planet embedded in the disk cause the spirals, or theyre indirectly caused by the orbit of a planetary body outside of the arms.Another example of spiral arms detected in a protoplanetary disk, MWC 758. [NASA/ESA/ESO/M. Benisty et al.]But what if you could get spirals without any planets? A team of scientists led by Matas Montesinos (University of Chile) have recently published a study in which they examine what happens to a shadowed protoplanetary disk.Casting Shadows with WarpsIn the teams setup, they envision a protoplanetary disk that is warped: the inner region is slightly tilted relative to the outer region. As the central star casts light out over its protoplanetary disk, this disk warping would cause some regions of the disk to be shaded in a way that isnt axially symmetric with potentially interesting implications.Montesinos and collaborators ran 2D hydrodynamics simulations to determine what happens to the motion of particles within the disk when they pass in and out of the shadowed regions. Since the shadowed regions are significantly colder than the illuminated disk, the pressure in these regions is much lower. Particles are therefore accelerated and decelerated as they pass through these regions, and the lack of axial symmetry causes spiral density waves to form in the disk as a result.Initial profile for the stellar heating rate per unit area for one of the authors simulations. The regions shadowed as a result of the disk warp subtend 0.5 radians each (shown on the left

  13. Insight into the exoproteome of the tissue-derived trypomastigote form of Trypanosoma cruzi

    Science.gov (United States)

    Queiroz, Rayner; Ricart, Carlos; Machado, Mara; Bastos, Izabela; Santana, Jaime; Sousa, Marcelo; Roepstorff, Peter; Charneau, Sébastien

    2016-11-01

    The protozoan parasite Trypanosoma cruzi causes Chagas disease, one of the major neglected infectious diseases. It has the potential to infect any nucleated mammalian cell. The secreted/excreted protein repertoire released by T. cruzi trypomastigotes is crucial in host-pathogen interactions. In this study, mammalian tissue culture-derived trypomastigotes (Y strain) were used to characterize the exoproteome of the infective bloodstream life form. Proteins released into the serum-free culture medium after 3h of incubation were harvested and digested with trypsin. NanoLC-MS/MS analysis resulted in the identification of 540 proteins, the largest set of released proteins identified to date in Trypanosome spp. Bioinformatic analysis predicted most identified proteins as secreted, predominantly by non-classical pathways, and involved in host-cell infection. Some proteins possess predicted GPI-anchor signals, these being mostly trans-sialidases, mucin associated surface proteins and surface glycoproteins. Moreover, we enriched phosphopeptides and glycopeptides from tryptic digests. The majority of identified glycoproteins are trans-sialidases and surface glycoproteins involved in host-parasite interaction. Conversely, most identified phosphoproteins have no Gene Ontology classification. The existence of various proteins related to similar functions in the exoproteome likely reflects this parasite’s enhanced mechanisms for adhesion, invasion and internalization of different host-cell types, and escape from immune defences.

  14. 鲍曼不动杆菌血流感染预后的危险因素分析%Analysis of risk factors on prognosis of Acinetobacter baumannii bloodstream infection

    Institute of Scientific and Technical Information of China (English)

    乔莉; 张劲松; 梅亚宁; 张华忠; 苏成磊

    2013-01-01

    Objective To explore the risk factors on prognosis of Acinetobacter baumannii bloodstream infection.Methods Clinical data from 78 patients with Acinetobacter baumannii bloodstream infection hospitalized in First Affiliated Hospital of Nanjing Medical University from January 2010 to November 2012 were analyzed retrospectively.According to the 28-day prognosis after admission,the patients were divided into non-survivors (n=40) and survivors (n=38).Data on demographic and clinical characteristics,wards,underlying diseases,treatments,invasive medical procedures,bacterial resistance to antibiotics,and acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score in the beginning were collected.The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis.The predictor value was concluded by comparing area under the receiver operating characteristic curve (ROC curve) of each index.Results Risk factors of mortality of Acinetobacter baumannii bloodstream infection goes as following,including intensive care unit admission [ICU,odds ratio (OR)=12.9,95% confidence interval (95% CI) 2.4-63.5,P=0.001],trachea intubationor tracheostomy (OR =6.2,95% CI 1.5-30.4,P=0.023),invasive mechanical ventilation (OR =5.1,95% CI 1.4-22.6,P=0.042),invasive medical procedure besides central venous catheter (including thoracentesis,bone marrow puncture,lumbar puncture,catheterization,bronchoalveolar lavage with bronchofibroscope,arteriovenous fistula plastic operation,OR =8.4,95%CI 1.7-37.8,P=0.011),APACHE Ⅱ score ≥ 19 in the beginning (OR=35.4,95%CI 3.8-318.6,P=0.001).With respect to APACHE Ⅱ score ≥ 19 as mortality cut-off point,an area under the receiver operating curve of 0.938 was statistically significant (P<0.05),with sensitivity 76.2% and specificity 94.1%.The relationship between prognosis and antibiotic resistance did not have statistically significance.Conclusion Invasive medical procedures and

  15. 鲍曼不动杆菌血流感染临床特征和死亡危险因素分析%Analysis of clinical manifestations and risk factors of mortality in Acinetobacter baumannii bloodstream infection

    Institute of Scientific and Technical Information of China (English)

    张银维; 周华; 蔡洪流; 杨青; 沈茜; 沈毅弘; 周建英

    2016-01-01

    Objective To explore the clinical manifestations,antimicrobial therapy,and risk factors of mortality in patients with Acinetobacter baumannii bloodstream infection.Methods Clinical data of 153 patients with Acinetobacter baumannii bloodstream infection hospitalized in First Affiliated Hospital of Zhejiang University from January 2013 to September 2014 were analyzed retrospectively.According to the 28-day survival after diagnosis,the patients were divided into death group (n =76) and survival group (n =77).Data related to demographic and clinical characteristics,underlying diseases,treatment,invasive procedures,bacterial resistance to antibiotics,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ)scores at onset,and antimicrobial therapy were collected.The index as an independent risk factor of mortality was demonstrated by multivariate logistic regression analysis.Results This study included 153 patients with Acinetobacter baumannii bloodstream infection.The 28-day mortality was 49.7%.The independent risk factors of mortality were APACHE Ⅱ score ≥22 at onset (OR =15.7,95% CI 5.1-48.1,P < 0.001),septic shock (OR =6.3,95 % CI 1.9-21.3,P =0.003),and administration of steroids (OR =3.6,95% CI 1.0-12.3,P =0.043).Compared with subjects treated with non-cefoperazone-sulbactam-based regimen,those treated with cefoperazone-sulbactam for multidrug-resistant Acinetobacter baumannii (MDR-AB) had significantly lower mortality on day7,day14 and day28 (8.9% vs 59.2%,31.1% vs 65.8%,44.4% vs 72.4% respectively).Conclusions The patients with Acinetobacter baumannii bloodstream infection have high mortality within one month.Administration of steroids and septic shock are associated with poor prognosis.APACHE Ⅱ score ≥ 22 at onset predicts adverse outcome.Cefoperazone-sulbactam-based antimicrobial therapy improves patients' survival.%目的 探讨鲍曼不动杆菌血流感染患者的临床特征、抗菌药物治疗

  16. 老年患者医院获得性血流感染的临床回顾性研究%Hospital-acquired bloodstream infections in geriatric wards: a retrospective clinical study

    Institute of Scientific and Technical Information of China (English)

    柏淑禹; 张伟

    2016-01-01

    目的 探讨老年病房医院感染血流感染病例的临床特点、病原学特征及其他相关因素,为临床诊疗提供科学依据.方法 对我院老年病房2010年6月至2015年10月医院获得性血流感染患者的相关因素及临床特征进行回顾性分析.结果 老年血流感染患者64例,基础疾病以恶性肿瘤(39.1%)及2型糖尿病(32.8%)为主;原发血流感染53例,占82.8%;继发性血流感染11例,占17.2%;原发感染病灶以呼吸道、泌尿道和肝胆系统为主.13例患者死亡,病死率高达20.3%.多因素条件Logistic逐步回归分析显示,中心静脉置管或输液港≥7 d(OR=49.51)、使用质子泵抑制剂药物≥3d(OR=13.63)是老年患者血流感染发生的独立危险因素;64例患者中,共检出66株病原菌.G+菌以凝固酶阴性葡萄球菌属最常见(18.2%);G-菌以埃希菌属(18.2%)和克雷伯菌属(15.2%)多见,二者产超广谱β-内酰胺酶株为54.5%.结论 血流感染严重影响老年患者的预后.减少侵袭性操作、积极防治肿瘤、改善内环境、保护重要脏器功能,是降低老年病房血流感染发生率的主要措施.%Objective To investigate the clinical and pathogenic features and other related factors of hospital-acquired bloodstream infections (HABSI) in geriatric wards,in order to provide the scientific basis for clinical diagnosis and therapy.Methods Clinical characteristics and other related factors of HABSI in patients admitted to the Department of Geriatrics of our hospital from June 2010 to October 2015 were retrospectively analyzed.Results Of the 64 elderly patients with HABSI,malignant tumor (39.1%) and type 2 diabetes mellitus (32.8%) were among the main disorders for their admission to the hospital.There were 53 cases of primary bloodstream infections and 11 cases of secondary bloodstream infections,accounting for 82.8% and 17.2%,respectively.Primary infections involved mostly the respiratory,urinary and

  17. [Trend of detection of cefotaxime-resistant Escherichia coli and clinical features of bloodstream infection due to extended-spectrum β-lactamase producing Escherichia coli in a general hospital].

    Science.gov (United States)

    Tarumoto, Norihito; Nobe, Masako; Uchida, Masatsugu; Maesaki, Shigefumi; Tanaka, Masahiko

    2014-12-01

    Recently, the community pandemic infections of cefotaxime (CTX)-M type extended-spectrum β-lactamase (ESBL) producing bacteria, which is mostly resistant to CTX, has been well-known as major problems. When the ESBL-confirmation test cannot be done, CTX-resistant Escherichia coli might be used as the alternation method of infectious control. We investigated tendency of third-generation cephalosporin resistant E. coli and the clinical features of bloodstream infections (BSI) due to ESBL producing E. coli in our hospital, which has no department of microbial examination. We examined the trend of detection of CTX-resistant E. coli isolates from clinical samples from January 2009 to November 2013, and antimicrobial use density (AUD) of third-generation cephalosporins in the same period, and the clinical features of BSI of ESBL-producing E. coli. As a result, the percentages of CTX-resistant E. coli in all E. coli were 5.4% in inpatient and 3.9% in outpatient in 2009, but 32.8% and 17.8% in 2013, respectively. Additionally, AUD had increased from 20.6 in 2009 to 28.9 in 2013. In BSI due to E. coli, the clinical features which were male, bedridden patient and using urethral catheter, central venous catheter, chronic renal failure were significantly in the cases of ESBL-producing E. coli (n=8), compared to non-ESBL producing E. coli (n=32).

  18. 失代偿期肝硬化患者大肠埃希菌血流感染临床及预后分析%Clinical and prognostic analysis of decompensated cirrhosis patients Escherichia coil bloodstream infections

    Institute of Scientific and Technical Information of China (English)

    何卫平; 杨柳; 鲍春梅; 张文瑾; 崔恩博; 蔡少平; 范振平; 曲芬

    2015-01-01

    Objective To investigate the clinical characteristic and drug resistance of decompensated cirrhosis patients bloodstream infections causing by Escherichia coli,and determine risk factors for mortality among patients with bloodstream infections.Methods The clinical data and drug susceptibility of decompensated cirrhosis patients Escherichia coli bloodstream infections from 2009 to 2012 in 302 hospital of PLA were retrospectively analyzed.Univariable and multivariable Logistic regression was used to identify independent risk factors for all-cause mortality.Results A total 211 strains of E.coli were isolated from decompensated cirrhosis inpatients,80 strains ESBLs detecting were positive,positive rate was 37.9%.Most of infection source were uncertain.The drug resistance of ESBLs positive strains was higher than ESBLs negative strains,but no statistical difference existed in age,sex,basic disease,infection source,peak temperature,white blood cell count,the percentage of neutrophils between ESBLs positive strains and negative strains.154 patients were survived and 57 patients were died after treatment,with a mortality of 27.01%.On multivariate analysis,independent risk factors for in-hospital mortality were old age [odds ratio (OR) =2.429],abnormal pulse (OR =2.977),liver failure (OR =11.159),hepatic encephalopathy(OR =2.524),septic shock (OR =8.837),acute kidney injury (OR =3.758),gastrointestinal bleeding(OR =4.118).Body temperature of > 39 ℃ (OR =0.301) had protective effect to lower mortality.A Logistic probobility model was created by adding points for each independent risk factor,and had a c-statistic of 0.898.Conclusions Due to decompensated cirrhosis patients Escherichia coli bloodstream infection severity and bad prognosis,early effective antimicrobial therapy and severe complication prevention should be taken to reduce mortality.%目的 分析失代偿期肝硬化患者大肠埃希菌血流感染的临床特点及耐药性,探讨影响疾

  19. Group valued differential forms revisited

    DEFF Research Database (Denmark)

    Kock, Anders

    We study the relationship between combinatorial group valued differential forms, and classical differential forms with values in the corresponding Lie algebra. In particular, we compare simplicial coboundary and exterior derivative for 1-forms. The results represent strengthenings of results...

  20. Moon (Form-Origin)

    Science.gov (United States)

    Tsiapas, Elias

    2016-04-01

    When the Earth was formed, it was in a state of burning heat. As time went by, temperature on the planet's surface was falling due to radiation and heat transfer, and various components (crusts) began taking solid form at the Earth's poles. The formation of crusts took place at the Earth's poles, because the stirring of burning and fluid masses on the surface of the Earth was significantly slighter there than it was on the equator. Due to centrifugal force and Coriolis Effect, these solid masses headed towards the equator; those originating from the North Pole followed a south-western course, while those originating from the South Pole followed a north-western course and there they rotated from west to east at a lower speed than the underlying burning and liquid earth, because of their lower initial linear velocity, their solid state and inertia. Because inertia is proportional to mass, the initially larger solid body swept all new solid ones, incorporating them to its western side. The density of the new solid masses was higher, because the components on the surface would freeze and solidify first, before the underlying thicker components. As a result, the western side of the initial islet of solid rocks submerged, while the east side elevated. . As a result of the above, this initial islet began to spin in reverse, and after taking on the shape of a sphere, it formed the "heart" of the Moon. The Moon-sphere, rolling on the equator, would sink the solid rocks that continued to descend from the Earth's poles. The sinking rocks partially melted because of higher temperatures in the greater depths that the Moon descended to, while part of the rocks' mass bonded with the Moon and also served as a heat-insulating material, preventing the descended side of the sphere from melting. Combined with the Earth's liquid mass that covered its emerging eastern surface, new sphere-shaped shells were created, with increased density and very powerful structural cohesion. During the

  1. Analysis of clinical distribution and drug resistance of bloodstream infections caused by Klebsiella pneumoniae%肺炎克雷伯菌血流感染的临床分布及耐药性分析

    Institute of Scientific and Technical Information of China (English)

    查翔远; 宋有良; 林建; 崔小玲; 潘晓龙; 倪世峰

    2015-01-01

    Objective To study the clinical distribution and antimicrobial resistance of bloodstream infections caused by Klebsiella pneumoniae .Methods Patients with bloodstream infection caused by Klebsiella pneumoniae in Tongling People's Hospital in Anhui province from January 2008 to December 2013 were retrospectively reviewed.Results A total of 71 cases were found with bloodstream infection caused by Klebsiella pneumoniae, the top three clinical distribution departments were infectious diseases department, ICU and oncology de-partment, and the top three complications were pulmonary infection, malignant tumor, biliary tract infection as well as diabetes mellitus. There were 24 strains of ESBLs-producing Klebsiella pneumoniae, accounting for 33.8%among 71 strains of Klebsiella pneumoniae isolated from the blood samples, in which 18 (52.9%) strains of ESBLs-producing Klebsiella pneumoniae among 34 hospital acquired infection cases and 6 ( 1 6 .2%) strains of ESBLs-producing Klebsiella pneumoniae among 3 7 community acquired infection cases;the positive rate of ESBLs-producing Klebsiella pneumoniae strains among hospital acquired infection cases was significantly higher than that of community acquired in-fection cases(χ2 =10.680, P=0.05).Among 71 strains of Klebsiella pneumoniae, no imipenem or meropenem-resistant isolate was found, and the resistance rates to amikacin, levofloxacin, ciprofIoxacin, cefoxitin, cefepime, cefoperazone/sulbactam and piperacillin/tazobactam were low(<20%) .The resistance rates of stains isolated from hospital acquired infection cases to piperaeillin, amoxicillin/clavulanate, cef-operazone/sulbactam, ampicillin/sulbactam, ticareillin/clavulanate, piperacillin/tazobactam, cefazolin, cefoperazone, cefuroxime, ceftazi-dime, ceftriaxone, cefotaxime and aztreonam were significantly higher than those of stains isolated from community acquired infection cases. The resistance rates of ESBLs-producing Klebsiella pneumoniae strains to 20 antimicrobial

  2. Tectonics: The meaning of form

    DEFF Research Database (Denmark)

    Christiansen, Karl; Brandt, Per Aage

    Tectonics – The meaning of form deals with one of the core topics of architecture: the relationship between form and content. In the world of architecture, form is not only made from brick, glass and wood. Form means something. When a material is processed with sufficient technical skill and insi......Tectonics – The meaning of form deals with one of the core topics of architecture: the relationship between form and content. In the world of architecture, form is not only made from brick, glass and wood. Form means something. When a material is processed with sufficient technical skill...

  3. Image forming apparatus

    DEFF Research Database (Denmark)

    2005-01-01

    An image H(x, y) for displaying a target image G(x, y) is displayed on a liquid-crystal display panel and illumination light from an illumination light source is made to pass therethrough to form an image on a PALSLM. Read light hv is radiated to the PALSLM and a phase-modulated light image alpha...... (x, y) read out of the PALSLM is subjected to Fourier transform by a lens. A phase contrast filter gives a predetermined phase shift to only the zero-order light component of Fourier light image alpha f(x, y). The phase-shifted light image is subjected to inverse Fourier transform by a lens...... to project an output image O(x, y) to an output plane. A light image O'(x, y) branched by a beam sampler is picked up by a pickup device and an evaluation value calculating unit evaluates conformity between the image O(x, y) and the image G(x, y).; A control unit performs feedback control of optical...

  4. Comparison of inflammatory reaction between gram-negative and gram-positive bloodstream infections in critical patients%革兰阴性菌和革兰阳性菌血流感染危重患者中致炎症反应的比较

    Institute of Scientific and Technical Information of China (English)

    吴志恒; 郭玉霞; 卜婧; 郭翠翠; 谢佳; 穆玉

    2012-01-01

    Objective To investigate the extent of inflammatory reaction induced by nosocomial gram-negative or gram-positive bloodstream infections through comparing some clinical indicators and levels of inflammatory mediators. Methods Prospective analysis was conducted in patients with positive blood culture obtained 48 h after admission to ICU, in terms of patient gender, age, APACHE Ⅱ and Sequential organ failure assessment (SOFA) scores, underlying diseases, severity of infection, total parenteral nutrition, receiving operation or surgical procedure, mechanical ventilation, blood purification therapy, mixed bacterial bloodstream infection, length of ICU stay and in hospital mortality. The parameters such as temperature, heart rate, WBC count, neutrophils, lymphocytes, levels of C-reactive protein, calcitonin, tumor necrosis factor-α (TNF-α), interleukin-lβ (IL-lβ) and interleukin-6 (IL-6) were also compared between the patients with gram-positive bloodstream infection and those with gram-negative bloodstream infection. Results The incidence of severe sepsis and septic shock was significantly higher in the patients with gram-negative bloodstream infection than in those with gram-positive bloodstream infection (88.9% vs. 73% , P= 0. 003). Blood levels of TNF-α (0. 97 ± 0. 54 vs. 0.75 ± 0. 32, P = 0.029), IL-1β (7.03 + 0.12 vs. 2.21 ± 0. 09, P = 0. 006) and IL-6 (10. 59 ± 2. 48 vs. 2.55 ± 0. 75, P= 0. 005) increased more in the patients with gram-negative bloodstream infection than in the patients in gram-positive bloodstream infection. Conclusions The patients with gram-negative bloodstream infection show more severe clinical condition and inflammatory reaction than the patients with gram-positive bloodstream infection. The pathogenic mechanism and extent of the host inflammatory response should be considered when treating bloodstream infections in clinical practice.%目的 比较医院感染革兰阴性菌血流感染和革兰阳性菌血流感染的炎性

  5. 血流感染脓毒症患者炎症因子水平与疾病严重程度相关性研究%Correlation between levels of inflammatory cytokines in sepsis patients with bloodstream infections and severity of disease

    Institute of Scientific and Technical Information of China (English)

    赵磊; 盛博; 李丽娟; 陈炜

    2015-01-01

    OBJECTIVE To explore the correlation between the levels of inflammatory cytokines in the sepsis pa‐tients with bloodstream infections such as procalcitonin (PCT) ,C‐reactive protein (CRP) ,and endotoxin and the severity of disease so as to provide guidance for diagnosis of disease .METHODS A total of 134 sepsis patients who were positive for blood culture were retrospectively analyzed .The levels of the inflammatory cytokines within 24 hours were compared between the patients with bloodstream infections caused by gram‐negative bacteria and the patients with bloodstream infections caused by gram‐positive bacteria ,and the correlations with APACHE Ⅱscores were observed .RESULTS The levels of CRP ,PCT ,and endotoxin in all the patients with bloodstream in‐fections and the subgroup patients were significantly correlated with the APACHE Ⅱ score ,the correlation with PCT was the highest in the patients with bloodstream infections caused by the gram‐negative bacteria ,and the cor‐relation with CRP was the highest in the patients with bloodstream infections caused by the gram‐positive bacteria . The levels of PCT and CRP of the subgroup patients with severe sepsis or septic shock were significantly higher than those of the subgroup patients with sepsis (P<0 .01) .However ,the levels of PCT ,CRP ,and endotoxin of the subgroup patients with severe sepsis or septic shock in the gram‐negative bacteria group were significantly higher than those of the subgroup patients with severe sepsis or septic shock in the gram‐positive bacteria . CONCLUSION The levels of the blood inflammatory cytokines in the sepsis patients with bloodstream infections caused by both the gram‐negative bacteria and the gram‐positive bacteria are positively correlated with the severity of disease .%目的:探讨降钙素原(PCT )、C‐反应蛋白(CRP)、内毒素等炎症因子在细菌性血流感染脓毒症患者中的水平及与疾病严重程度的相关性,

  6. Watching How Planets Form

    Science.gov (United States)

    2006-09-01

    Anatomy of a Planet-Forming Disc around a Star More Massive than the Sun With the VISIR instrument on ESO's Very Large Telescope, astronomers have mapped the disc around a star more massive than the Sun. The very extended and flared disc most likely contains enough gas and dust to spawn planets. It appears as a precursor of debris discs such as the one around Vega-like stars and thus provides the rare opportunity to witness the conditions prevailing prior to or during planet formation. "Planets form in massive, gaseous and dusty proto-planetary discs that surround nascent stars. This process must be rather ubiquitous as more than 200 planets have now been found around stars other than the Sun," said Pierre-Olivier Lagage, from CEA Saclay (France) and leader of the team that carried out the observations. "However, very little is known about these discs, especially those around stars more massive than the Sun. Such stars are much more luminous and could have a large influence on their disc, possibly quickly destroying the inner part." The astronomers used the VISIR instrument [1] on ESO's Very Large Telescope to map in the infrared the disc surrounding the young star HD 97048. With an age of a few million years [2], HD 97048 belongs to the Chameleon I dark cloud, a stellar nursery 600 light-years away. The star is 40 times more luminous than our Sun and is 2.5 times as massive. The astronomers could only have achieved such a detailed view due to the high angular resolution offered by an 8-metre size telescope in the infrared, reaching a resolution of 0.33 arcsecond. They discovered a very large disc, at least 12 times more extended than the orbit of the farthest planet in the Solar System, Neptune. The observations suggest the disc to be flared. "This is the first time such a structure, predicted by some theoretical models, is imaged around a massive star," said Lagage. ESO PR Photo 36/06 ESO PR Photo 36/06 A Flared Proto-Planetary Disc Such a geometry can only be

  7. [THE HUMORAL, NEUROHORMONAL VEGETATIVE AND HYDRAULIC REGULATION OF METABOLISM. THE DISTAL AND PROXIMAL SECTIONS OF ARTERIAL BLOODSTREAM. THE FATTY ACIDS AND METABOLIC ARTERIAL HYPERTENSION (A LECTURE)].

    Science.gov (United States)

    Titov, V N; Dmitriev V A

    2015-04-01

    The regulation of metabolism formed sequentially in phylogenesis at three levels separately: autocrine level--in cell; in paracrin cell cenosis--structural and functional units of organs; at organism level. The interrelated variants of regulation: humoral; neurohumoral; neurohormonal; vegetative-sympathetic; parasympathetic--conduction of nervous impulse is to be evaluated in consequence of becoming of stages of phylogenesis. The becoming of hydrodynamic regulation is early even. The impact by pressure (blood flow) in paracrin cell cenosis is implemented by local peristaltic pumps in open-ended system of lymph and blood circulation. In closed system of circulation occurred separation of arterial flow on two functional sections. Phylogenetically early distal with regulation of hydrodynamic pressure by arterioles of muscular type in paracrin cell cenosis and compensation of disorders of biological reaction metabolism-micro-circulation (MM). In later proximal section, arteries of elastic type arterial pressure forms heart as a central pump under sympathetic innervation at level of organism from vasomotor center. The physical factor--pressure--became regulator of reaction M M. Increasing of arterial pressure in proximal systemically increases blood pressure in distal and all paracrin cell cenosises compensating alteration of reaction M M. The systemic non-optimal increasing of hydrodynamic pressure invoke negative reaction of organs controlling hydrodynamics in local pools of intercellular medium: kidneys with pool of primary urine; brain with spinal fluid; lungs with pulmonary circulation; placenta with pool of amniotic medium. All of them tend to decrease blood flow in organs. The activation of synthesis of angiotensin-II forms pathologic compensation and their secondary damage as organs-targets. The sympathetic stimulation of heart forces it to work at full capacity. No humoral mediator or internal organ can regulate arterial pressure.

  8. 重症急性胰腺炎血行感染患者肠屏障功能障碍的研究%A study of intestinal barrier dysfunction in patients with severe acute pancreatitis and bloodstream infection

    Institute of Scientific and Technical Information of China (English)

    余杨梓; 傅强; 华鹂鹂

    2012-01-01

    Objective To investigate the relationship between the bloodstream infection and intestinal barrier dysfunction in patients with severe acute pancreatitis (SAP) . Methods [''ifty-five cases of SAP patients were divided into confirmed bloodstream infection group(group A, IS cases) and suspicious bloodstream infection or without bloodstream infection group (group B, 37 cases) by the positive or negative results of bilateral upper extremity venous double flask culture. According to the guide, the patients were diagnosed and conventional integrated traditional Chinese medicine and western medicine was used to treat them systemically. The acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores were calculated on the entrance into the groups. The lactulose/mannitol (L/M) ratio and the level of peripheral blood endotoxin (ET) was detected on the 1st, 3rd, 7th day after entrance into the groups ; the enterobacterial repetitive intergenic consensus (ERIC) fingerprint which reflected the composition of intestinal microflora characteristics from total DNA extraction of feces was obtained. The endogenous creatinine clearance rate (CCr), the number of involved organs, the length of stay in surgical intensive care unit (SI.CU) and in the hospital and mortality in 28 days were recorded. Results The length of stay in S1CU in group A (days ; 11.75±4.83 vs. 7.68±3.33) and the mortality in 28 days (16.67% vs. 5.40%) were significantly higher than those in group B. The general conditions of two groups had no significant difference on the first day and so did L/M ratio, ET, the number of involved organs, endogenous CCr (all P>0.05). Within a week, the L/M ratio and ET levels in group A were significantly increased, while in group B those were decreased obviously, and at each time point, the above indexes in A group were higher than those in group B (L/M ratio on the 3rd day; 3.83 ± 1.67 vs. 1.33±0.56, on the 7th day; 4.37± 1.95 vs. 0.95 ± 0.30 ; ET (kEU/L) on the

  9. 血流感染MRSA中的ST239克隆株快速检测与分析%Application of rapid detection of MRSA ST239 clones in bloodstream infections

    Institute of Scientific and Technical Information of China (English)

    姚杰; 杨凯; 刘周; 陈礼文; 周强; 管世鹤

    2015-01-01

    目的 评价多重PCR法对耐甲氧西林金黄色葡萄球菌(MRSA) ST239克隆株的快速检测及合肥地区血流感染MRSA的分子流行现状.方法 收集2008年至2013年安徽医科大学第一附属医院及第二附属医院临床分离的血流感染金黄色葡萄球菌的106株MRSA进行相关耐药性分析,并采用多重PCR技术对ST239型克隆株进行快速检测,同时运用多位点序列分型(MLST)加以确认及葡萄球菌染色体mec基因盒(SCCmec)分型分析.结果 106株血流感染金黄色葡萄球菌中MRSA有51株,占48.1%,MRSA均为多耐药菌,对红霉素、氨基糖苷类和喹诺酮类耐药率明显高于甲氧西林敏感金黄色葡萄球菌(MSSA),MRSA和MSSA对磺胺甲噁唑/甲氧苄啶的敏感率分别为86.3%和 94.5%;51株MRSA中有47株为ST239快速检测阳性,阳性率高达92.2%;随机选取20株ST239初筛阳性的MRSA经MLST验证和SCCmec分型后确认为MRSA-ST239-SCCmecⅢ型.结论 合肥地区血流感染MRSA近半数为多重耐药克隆MRSA-ST239-SCCmecⅢ型,运用多重PCR技术能够快速检测ST239克隆株.%Objective To evaluation the method of rapid detection of Methicillin-resistant Stphylococcus aureus (MRSA) ST239 clones with multiplex PCR assay and investigation of the epidemic status of MRSA blood stream infections in Hefei area.Methods Antibiotic susceptibility testing were applied to MRSA isolates from bloodstream infection,rapid screening and confirmation of MRSA ST239 clones by using multiplex PCR,Multilocus Sequence typing (MLST) and Staphyloccoccal Cassette Chromosome mec(SCCmec) typing.Results 51 of 106 clinic isolates Staphylococcus aureus were identified as MRSA,accounting for 48.1%.The resistance rate of MRSA to erythromycin,aminoglycosides and quinolone were significantly higher than Methicillin Sensitive Staphylococcus aureus (MSSA).Both MRSA and MSSA had a high sensitivity to cotrimoxazole,the sensivity rates were 86.3% and 94.5%,respectively; 47 of 51

  10. ICU患者血流感染鲍氏不动杆菌耐药性分析%Drug resistance of Acinetobacter baumannii causing bloodstream infections in ICU patients

    Institute of Scientific and Technical Information of China (English)

    杨莉; 李玉苹; 章红霞

    2015-01-01

    OBJECTIVE To understand the drug resistance of Acinetobacter baumannii causing bloodstream infec‐tions in intensive care units (ICUs) so as to provide guidance for clinical control of A .baumannii infection and for reasonable use of antibiotics .METHODS The positive blood culture specimens were submitted from the patients who were hospitalized the ICUs from Jan 2009 to Dec 2013 ,then the isolated A .baumannii strains were identified by using VITEK‐2 Compact automatic microorganism analyzer of BioMerieux ,France ,the drug susceptibility to the commonly used antibiotics was determined with the use of MIC method ,and all the data were statistically ana‐lyzed by using SPSS11 .0 software .RESULTS Of totally 35 829 blood culture specimens submitted from the ICUs from Jan 2009 to Dec 2013 ,the A .baumannii strains were cultured from 49 blood specimens ;with the positive rate of 0 .14% .The A .baumannii was most susceptible to polymyxin ,and the drug susceptibility rates to ampicil‐lin‐sulbactam ,aztreonam ,ciprofloxacin ,ceftriaxone ,and cefepime were very low .CONCLUSION The A .bauman‐nii strains tend to be multidrug‐resistant during the antibiotics therapy .As for the poor prognosis of the patients with A .baumannii bloodstream infections ,it is necessary for the hospital to reasonably use antibiotics ,strengthen the disinfection and isolation in the ICUs ,and cut the various possible transmission routes .%目的:了解重症监护病房(IC U )鲍氏不动杆菌血流感染的耐药性,指导临床控制鲍氏不动杆菌感染,合理使用抗菌药物。方法对2009年1月-2013年12月IC U住院患者送检血培养阳性标本,对检出的鲍氏不动杆菌采用法国生物梅里埃公司VITEK‐2 Compact全自动微生物分析仪进行鉴定,采用MIC法测定常用抗菌药物的敏感性,所有资料采用SPSS11.0软件进行统计分析。结果2009年1月-2013年12月ICU共送检血培养标本35829份,其中有49

  11. Risk factors for bloodstream infections in liver or kidney transplantation recipients%肝、肾移植患者并发血流感染的死亡危险因素分析

    Institute of Scientific and Technical Information of China (English)

    万齐全; 肖雪飞; 叶启发; 周建党

    2012-01-01

    Objective: To investigate the possible risk factors for death among liver or kidney recipients with bloodstream infections (BSIs).Methods: A retrospective study of 138 episodes of bloodstream infections documented in 103 patients was conducted to assess potential risk factors for mortality. The risk factors were identified by logistic regression analysis.Results: The mean age of the patients was 12-66 (42.3±12.7) years. The majority of infections were nosocomial (78.6%). The BSIs-related mortality rate was 39.8% (41/103). The following variables were identified as risk factors for BSIs-related mortality by univariate analysis: intra-abdominal/biliary focus (P=0.003), polymicrobial infection (P<0.00l), liver transplant (P<0.00l), platelet count < 50000/mm3 (P<0.00l), and septic shock (P<0.00l). Platelet count <50000/mm3 (P=0.002) and septic shock (P<0.00l) showed significantly difference between the mortality group and the survival groups in the multivariate logistic regression analysis. Conclusion: Decreased platelet count and septic shock are risk factors for increased mortality in liver or kidney tranplantation recipients with BSIs. The BSIs-related mortality rate is high. Attention should be paid to the prevention of BSIs in liver or kidney transplant patients.%目的:评价影响伴有血流感染的肝、肾移植患者生存率的可能危险因素.方法:回顾性研究103例肝、肾移植患者发生的138次血流感染,评估导致肝、肾移植术后患者死亡的危险因素.使用单变量分析和多元逻辑回归方法确定危险因素.结果:入选患者年龄12~66(42.3±12.7)岁.绝大多数为院内感染(78.6%),血流感染相关的死亡率为39.8%(41/103).单变量分析显示以下变量能预测血流感染相关的死亡:腹腔内或胆道感染(P=0.003),混合感染(P<0.001),肝移植(P<0.001),血小板计数<50000/mm3 (P<0.001),感染性休克(P<0.001).多元逻辑回归分析显示血小板计数<50000/mm3 (P=0

  12. Application of real-time PCR in rapid detection of bloodstream infection pathogens%实时定量PC R在血流感染病原体快速检测中的应用

    Institute of Scientific and Technical Information of China (English)

    范世珍; 林松青; 莫莉

    2016-01-01

    Objective To investigate the clinical application value of real‐time PCR in the detection of bloodstream infection pathogens .Methods A total of 92 blood samples from 80 patients in our hospital were collected for conducting real time PCR de‐tection and conventional blood culture .The sensitivity and specificity were compared between the two methods .Results Among 92 samples ,66 samples (71 .7% ) were negative in both assays .Ten different pathogens were detected by either blood culture system or real‐time PCR or by both methods .Seven positive samples were detected by both assays .The consistence of the two methods was 79 .3% .The negative predictive value of real‐time PCR was 0 .94 ,the sensitivity was 0 .64 and the specificity was 0 .82 .Among them ,15 samples were positive in real‐time PCR ,while negative in blood culture system ,4 samples were positive in the blood cul‐ture ,whereas were negative in the real‐time PCR .The pathogens cultured in 2 samples were not in the detection range of real time PCR ,moreover real time pCR could not detect Candida glabrata .Conclusion Real time PCR is a valuable method for rapidly detec‐tion the sample of bloodstream infection ,but cannot completely replace the blood culture test .%目的:探讨实时定量PCR在血流感染病原体检测中的临床应用价值。方法选取收治的80例患者共92份血液标本进行实时定量PCR检测,同时进行血液培养,比较两种方法的特异度和敏感度。结果在92份标本当中,两种方法共同阴性标本66份(71.7%),两种方法共检测出病原体10种。实时定量 PCR和血培养共同检出阳性标本7例,两种方法的一致性为79.3%。实时定量PCR的阴性预测值是0.94,敏感度是0.64,特异度是0.82。其中15份标本实时定量 PCR阳性而血培养阴性,4份标本血培养阳性而实时定量PCR阴性。其中2份标本所培养出的病原体不在实时定量 PCR的检测范围

  13. Analysis of Risk Factors of Central Venous Catheter-related Bloodstream Infection%中心静脉导管相关血流感染的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    吴庆华; 傅小云

    2012-01-01

    [Objective]To explore the risk factors and prevention points of central venous catheter(CVC)-related bloodstream infections(CVC-RBI). [Methods] Clinical data of 25 patients with catheter-related infection caused by central venipuncture in critical care medicine department of affiliated hospital of Zunyi medical college were analyzed retrospectively. The types and characteristics of pathogens of patients were analyzed by the culture at distal end of the catheter and blood culture or the secretion culture at outlet of the catheter. [Results ] Among 25 patients with catheter-related infection, 4 cases were infection at the tip of the catheter, 3 cases were infection at the outlet and 18 cases were catheter-related bloodstream infection. The patient's age and sex had no relation with the infection rate( P >0. 05). Catheter time was positively correlated to infection(R = 0. 32). When catheter time was less than one week, the infection rate was 0. When catheter time was less than or equal to one week and less than one month, the infection rate was 24%. When catheter time was less than or equal to one month, the infection rate was 76%. There were significant differences among groups( P <0. 05). [Conclusion]The incidence of CVC-BSI increases with the increasing of catheter time, and is related with various of operations and the patient's status.%[目的]探讨中心静脉导管(CVC)引发的导管相关性血流感染(CVC-RBI)的危险因素及预防要点.[方法]回顾性分析遵义医学院附属医院重症医学科25例中心静脉穿刺患者发生导管性感染的资料,并通过导管末端培养与血培养,或通过导管出口部位分泌物培养,分析患者病原菌种类和特点.[结果]25例导管相关性感染患者中,导管尖端部位感染4例,出口部位感染3例,导管相关性血流感染18例.患者的年龄和性别与感染率无关( P >0.05).置管时间与感染发生率呈正相关(R=0.32 ).置管时间<1周,感染发生率为0;≤1

  14. Mycobacterium tuberculosis L-forms

    OpenAIRE

    2011-01-01

    M. tuberculosis L-forms researches done in China during the recent years were reviewed in this article. M. tuberculosis L-forms could be produced spontaneously or induced by isoniazid or D-cyclic serine, that influenced the synthesis of cell walls. Among the acid-fast organisms isolated from the patients, more L-forms were found than vegetative forms. In extrapulmonary tuberculosis, M. tuberculosis disseminated through the blood mainly in L-forms, L-forms could adhere on the surface or harbor...

  15. The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: a multicentre retrospective cohort study.

    Science.gov (United States)

    Stewardson, Andrew J; Allignol, Arthur; Beyersmann, Jan; Graves, Nicholas; Schumacher, Martin; Meyer, Rodolphe; Tacconelli, Evelina; De Angelis, Giulia; Farina, Claudio; Pezzoli, Fabio; Bertrand, Xavier; Gbaguidi-Haore, Houssein; Edgeworth, Jonathan; Tosas, Olga; Martinez, Jose A; Ayala-Blanco, M Pilar; Pan, Angelo; Zoncada, Alessia; Marwick, Charis A; Nathwani, Dilip; Seifert, Harald; Hos, Nina; Hagel, Stefan; Pletz, Mathias; Harbarth, Stephan

    2016-08-18

    We performed a multicentre retrospective cohort study including 606,649 acute inpatient episodes at 10 European hospitals in 2010 and 2011 to estimate the impact of antimicrobial resistance on hospital mortality, excess length of stay (LOS) and cost. Bloodstream infections (BSI) caused by third-generation cephalosporin-resistant Enterobacteriaceae (3GCRE), meticillin-susceptible (MSSA) and -resistant Staphylococcus aureus (MRSA) increased the daily risk of hospital death (adjusted hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.34-2.42, HR = 1.81; 95% CI: 1.49-2.20 and HR = 2.42; 95% CI: 1.66-3.51, respectively) and prolonged LOS (9.3 days; 95% CI: 9.2-9.4, 11.5 days; 95% CI: 11.5-11.6 and 13.3 days; 95% CI: 13.2-13.4, respectively). BSI with third-generation cephalosporin-susceptible Enterobacteriaceae (3GCSE) significantly increased LOS (5.9 days; 95% CI: 5.8-5.9) but not hazard of death (1.16; 95% CI: 0.98-1.36). 3GCRE significantly increased the hazard of death (1.63; 95% CI: 1.13-2.35), excess LOS (4.9 days; 95% CI: 1.1-8.7) and cost compared with susceptible strains, whereas meticillin resistance did not. The annual cost of 3GCRE BSI was higher than of MRSA BSI. While BSI with S. aureus had greater impact on mortality, excess LOS and cost than Enterobacteriaceae per infection, the impact of antimicrobial resistance was greater for Enterobacteriaceae.

  16. The health and economic burden of bloodstream infections caused by antimicrobial-susceptible and non-susceptible Enterobacteriaceae and Staphylococcus aureus in European hospitals, 2010 and 2011: a multicentre retrospective cohort study

    Science.gov (United States)

    Stewardson, Andrew J; Allignol, Arthur; Beyersmann, Jan; Graves, Nicholas; Schumacher, Martin; Meyer, Rodolphe; Tacconelli, Evelina; De Angelis, Giulia; Farina, Claudio; Pezzoli, Fabio; Bertrand, Xavier; Gbaguidi-Haore, Houssein; Edgeworth, Jonathan; Tosas, Olga; Martinez, Jose A; Ayala-Blanco, M Pilar; Pan, Angelo; Zoncada, Alessia; Marwick, Charis A; Nathwani, Dilip; Seifert, Harald; Hos, Nina; Hagel, Stefan; Pletz, Mathias; Harbarth, Stephan

    2016-01-01

    We performed a multicentre retrospective cohort study including 606,649 acute inpatient episodes at 10 European hospitals in 2010 and 2011 to estimate the impact of antimicrobial resistance on hospital mortality, excess length of stay (LOS) and cost. Bloodstream infections (BSI) caused by third-generation cephalosporin-resistant Enterobacteriaceae (3GCRE), meticillin-susceptible (MSSA) and -resistant Staphylococcus aureus (MRSA) increased the daily risk of hospital death (adjusted hazard ratio (HR) = 1.80; 95% confidence interval (CI): 1.34–2.42, HR = 1.81; 95% CI: 1.49–2.20 and HR = 2.42; 95% CI: 1.66–3.51, respectively) and prolonged LOS (9.3 days; 95% CI: 9.2–9.4, 11.5 days; 95% CI: 11.5–11.6 and 13.3 days; 95% CI: 13.2–13.4, respectively). BSI with third-generation cephalosporin-susceptible Enterobacteriaceae (3GCSE) significantly increased LOS (5.9 days; 95% CI: 5.8–5.9) but not hazard of death (1.16; 95% CI: 0.98–1.36). 3GCRE significantly increased the hazard of death (1.63; 95% CI: 1.13–2.35), excess LOS (4.9 days; 95% CI: 1.1–8.7) and cost compared with susceptible strains, whereas meticillin resistance did not. The annual cost of 3GCRE BSI was higher than of MRSA BSI. While BSI with S. aureus had greater impact on mortality, excess LOS and cost than Enterobacteriaceae per infection, the impact of antimicrobial resistance was greater for Enterobacteriaceae. PMID:27562950

  17. Successful Salvage of Central Venous Catheters in Patients with Catheter-Related or Central Line-Associated Bloodstream Infections by Using a Catheter Lock Solution Consisting of Minocycline, EDTA, and 25% Ethanol.

    Science.gov (United States)

    Raad, Issam; Chaftari, Anne-Marie; Zakhour, Ramia; Jordan, Mary; Al Hamal, Zanaib; Jiang, Ying; Yousif, Ammar; Garoge, Kumait; Mulanovich, Victor; Viola, George M; Kanj, Soha; Pravinkumar, Egbert; Rosenblatt, Joel; Hachem, Ray

    2016-06-01

    In cancer patients with long-term central venous catheters (CVC), removal and reinsertion of a new CVC at a different site might be difficult because of the unavailability of accessible vascular sites. In vitro and animal studies showed that a minocycline-EDTA-ethanol (M-EDTA-EtOH) lock solution may eradicate microbial organisms in biofilms, hence enabling the treatment of central line-associated bloodstream infections (CLABSI) while retaining the catheter in situ Between April 2013 and July 2014, we enrolled 30 patients with CLABSI in a prospective study and compared them to a historical group of 60 patients with CLABSI who had their CVC removed and a new CVC inserted. Each catheter lumen was locked with an M-EDTA-EtOH solution for 2 h administered once daily, for a total of 7 doses. Patients who received locks had clinical characteristics that were comparable to those of the control group. The times to fever resolution and microbiological eradication were similar in the two groups. Patients with the lock intervention received a shorter duration of systemic antibiotic therapy than that of the control patients (median, 11 days versus 16 days, respectively; P < 0.0001), and they were able to retain their CVCs for a median of 74 days after the onset of bacteremia. The M-EDTA-EtOH lock was associated with a significantly decreased rate of mechanical and infectious complications compared to that of the CVC removal/reinsertion group, who received a longer duration of systemic antimicrobial therapy. (This study has been registered at ClinicalTrials.gov under registration no. NCT01539343.).

  18. In vitro activities of tedizolid compared with other antibiotics against Gram-positive pathogens associated with hospital-acquired pneumonia, skin and soft tissue infection and bloodstream infection collected from 26 hospitals in China.

    Science.gov (United States)

    Li, Shuguang; Guo, Yu; Zhao, Chunjiang; Chen, Hongbin; Hu, Bijie; Chu, Yunzhuo; Zhang, Zhijie; Hu, Yunjian; Liu, Zhiyong; Du, Yan; Gui, Qiaodi; Ji, Ping; Zeng, Ji; Cao, Bin; Fu, Quan; Zhang, Rong; Wang, Zhongxin; Zhuo, Chao; Feng, Xianju; Jia, Wei; Jin, Yan; Xu, Xuesong; Liao, Kang; Ni, Yuxing; Yu, Yunsong; Xu, Xiuli; Hu, Zhidong; Lei, Jin-E; Yang, Qing; Wang, Hui

    2016-10-01

    To evaluate the in vitro antimicrobial activities of tedizolid, linezolid and other comparators against clinically significant Gram-positive cocci isolates from hospital-acquired pneumonia (HAP), skin and soft tissue infection (SSTI) and bloodstream infection (BSI), 2140 nonduplicate isolates (23.7 % isolated from HAP, 46.8 % from SSTI and 29.5 % from BSI) were consecutively collected in 26 hospitals in 17 cities across China during 2014. These pathogens included 632 methicillin-resistant Staphylococcus aureus, 867 methicillin-sensitive Staphylococcusaureus, 299 coagulase-negative Staphylococcus (CoNS), 104 Enterococcus faecalis, 99 Enterococcusfaecium, 13 Streptococcus pneumoniae, 23 α-haemolytic Streptococcus and 103 β-haemolytic Streptococcus. MICs of routine clinical antibiotics were determined by broth microdilution method according to the Clinical and Laboratory Standards Institute guidelines 2015. Tedizolid, linezolid, vancomycin, daptomycin, teicoplanin and tigecycline showed high in vitro activity against Gram-positive pathogens (≥98.0 % susceptible), and tedizolid exhibited four- to eight fold greater activity than linezolid against the pathogens tested, with MIC90s of methicillin-resistant Staphylococcus aureus, α-haemolytic Streptococcus and β-haemolytic Streptococcus (0.25 vs 2 µg ml-1); methicillin-sensitive Staphylococcu saureus, E. faecalis and E. faecium (0.5 vs 2 µg ml-1); methicillin-resistant CoNS and methicillin-sensitive CoNS (0.25 vs 1 µg ml-1); and Streptococcuspneumoniae (0.125 vs 0.5 µg ml-1). Tedizolid MIC90s associated with different infections did not show significant differences, and the drug exhibited excellent activity against surveyed Gram-positive pathogens associated with HAP, SSTI and BSI, including linezolid-nonsusceptible strains. These data suggest that tedizolid could be an alternative to linezolid for the treatment of infections caused by Gram-positive organisms.

  19. The clinical value of PCT levels in bacteria identification in ICU patients with bloodstream infection%血清降钙素原对ICU血流感染患者菌种鉴别中的应用研究

    Institute of Scientific and Technical Information of China (English)

    王建; 庄国华; 牛野; 李宏; 夏建萍

    2015-01-01

    目的 探讨血清降钙素原(PCT)水平测定在ICU血流感染患者菌种鉴别中的应用价值.方法 对本院ICU 2007年12月至2013年12月收治的540例血流感染患者的PCT水平进行检测并对患者标本分离的菌种进行鉴别,分析PCT水平在鉴别血流感染菌种的有效性.结果 540例血流感染患者中,G+菌感染患者比例最高(49.63%),G-菌感染患者比例次之(38.52%),真菌感染患者比例最低(11.85%),三者间差异有统计学意义(P<0.05).G-菌感染组PCT水平及阳性率均显著高于G+菌感染组和真菌感染组,差异有统计学意义(P<0.05),G+菌和真菌感染组之间差异无统计学意义(P>0.05).PCT界定为2.04 ng/ml时,血清PCT水平区分G-和G+的灵敏度和特异度分别为82.18%和76.09%;PCT界定为3.16 ng,/ml时,血清PCT水平鉴别血流感染G-菌与真菌种的灵敏度和特异度分别为59.42%和65.73%.结论 应用血清PCT水平鉴别G-菌与G+菌、真菌所致血流感染具有较高的临床价值,PCT水平≥2.04 ng/ml时,发生G-菌感染几率较大,PCT水平对G+菌与真菌的鉴别准确度较差.%Objective To investigate the clinical value of procalcitonin (PCT) levels in bacteria identification in intensive care unit (ICU) patients with bloodstream infection.Methods There were 540 cases of patients with bloodstream infection in our ICU between December 2007 and December 2013.The PCT levels and bacteria were identified.The application effectiveness of PCT levels in the bacteria identification was studied.Results The G+ bacteria infection rate was 49.63% (268/540),G-bacteria infection rate was 38.52% (208/540),and the fungal infection rate was 11.85% (64/540).The patients of G-bacteria had significant difference with G + bacteria and fungal infection (P < 0.05).The PCT average and positive rate of G-bacteria were significantly higher than G + bacteria and fungi group (P < 0.05),respectively.G+ bacteria and fungi infection did not

  20. Analysis of Pathogen Distribution and Drug Resistance in Diabetes Combined with Bloodstream Infection%糖尿病患者合并血流感染病原菌分布及耐药性分析

    Institute of Scientific and Technical Information of China (English)

    胡浩; 杨广涛

    2014-01-01

    目的:了解糖尿病合并血流感染患者病原菌分布及其对抗菌药的耐药情况。方法:回顾性分析我院内分泌科2008年1月-2014年6月100例糖尿病合并血流感染患者的血培养资料。结果:从糖尿病合并血流感染的患者中经血培养出大肠埃希菌57株(超广谱β-内酰胺酶(ESBL)阳性40株),肺炎克雷伯菌18株(ESBL7株),鲍曼不动杆菌13株,金黄色葡萄球菌12株(耐甲氧西林金黄色葡萄球菌(MRSA)6株);药敏试验中对革兰阴性杆菌敏感多为半合成青霉素加酶抑制剂、第三代头孢菌素加酶抑制剂、第三代以上喹诺酮类、氨基苷类、碳青酶烯类抗菌药;对革兰阳性球菌敏感多为万古霉素、复方新诺明、呋喃妥因。结论:2型糖尿病合并血流感染病原菌多为革兰阴性杆菌,尤其是大肠埃希菌。对革兰阴性菌敏感的抗菌药依次为:碳青酶烯类抗生素>半合成青霉素加酶抑制剂>氨基苷类>第三代头孢菌素加酶抑制剂>第三代以上头孢菌素类。由于糖尿病患者多合并肾脏病变,需谨慎使用氨基苷类及喹诺酮类,碳青酶烯类抗菌药、半合成青霉素加酶抑制剂及第三代头孢菌素加酶抑制剂抗菌谱广而且作用较强,可作为治疗的首选。%Objective: To understand the pathogen distribution and drug resistance in diabetes combined with blood-stream infection. Methods: A retrospective analysis wag made of the blood cultivation data of 100 diabetes with blood-stream infection in our hospital from January of 2008 to June of 2014. Results:Through blood cultivation test,the following pathogens were found from the diabetes complicated with infection: 57 strains of Escheriehia coli. (40 ESBL positive strains),18 strains of Klebsiella pneumoniae (7 ESBL positive sreains),13 strains of Acinetobacter baumannii and 12 strains of Staphylococcus aureus (6 MRSA positive strains). The susceptibility

  1. Clinical analysis of bloodstream infections caused by Escherichia coli in elderly patients with hepatobiliary disease%老年肝胆疾病患者大肠埃希菌血流感染的临床特点分析

    Institute of Scientific and Technical Information of China (English)

    王钱; 鲍春梅; 何卫平; 崔恩博; 张文瑾; 范振平; 曲芬

    2015-01-01

    Objective To investigate the clinical characteristics and drug resistance in elderly patients with hepatobiliary disease and blood-stream infections caused by Escherichia coli,and to provide a basis for clinical therapy.Methods A retrospective analysis was performed on the clinical characteristics and drug susceptibility of 57 elderly inpatients with hepatobiliary disease and bloodstream infections caused by Esch-erichia coli in our hospital from 2009 to 2012.Comparison of continuous data between the two groups was made by t test,and comparison of categorical data was made by chi -square test.Results The majority of patients had liver cirrhosis,and spontaneous bacterial peritonitis was the major infection source.A total of 57 strains of Escherichia coli were isolated from elderly patients with hepatobiliary disease,and 24 (42.1%)out of them were positive for extended -spectrum β-lactamase (ESBL).ESBL -positive strains had a significantly higher level of drug resistance than ESBL -negative strains (P 0.05).The case -fa-tality rate in patients with septic shock,hepatic encephalopathy,or acute kidney injury was significantly higher than that in patients with no com-plications (χ2 =9.541,7.622,9.733,respectively,P <0.05).Conclusion Elderly patients with hepatobiliary disease and bloodstream infections caused by ESBL -positive Escherichia coli had a high level of drug resistance and a poor prognosis for severe complications.Antibiotic therapy combined with prevention and control of severe complications should be taken as early as possible to reduce the case -fatality rate.%目的:分析老年肝胆疾病患者大肠埃希菌血流感染的临床特点及耐药性,为临床治疗提供依据。方法回顾性分析2009年-2012年于解放军三二医院住院的57例老年肝胆疾病患者血流感染大肠埃希菌的临床特点及药敏试验结果。计量资料组间比较采用 t 检验,计数资料组间比较采用χ2检验。结果57例老年肝

  2. ICU中心静脉导管相关性血流感染持续质量改进的成效分析%Assessment of effect of continuous quality improvement on catheter-related bloodstream infections in ICU

    Institute of Scientific and Technical Information of China (English)

    林娟; 钟既宁; 陈丽; 胡才宝; 蔡国龙

    2013-01-01

    OBJECTIVE To explore the effect of targeted surveillance and interventions on prevention and control of the catheter-related bloodstream infections in the intensive care unit (ICU) so as to reduce the incidence of infections.METHODS The patients with the central venous catheter-related infections,who were hospitalized the ICU from Jan 2009 to Dec 2010,were enrolled in the study,then the incidence of the central venous catheter-related infections was investigated by using the targeted monitoring method,the causes were analyzed,the continuous quality improvement was performed,the education and supervision of the medical staff was intensified,and the quality of maintenance of the catheter was improved after the catheterization.RESULTS Totally 147 patients with indwelling central venous catheters were included before the continuous quality improvement in 2009,with the mean catheterization duration of(33.84±30.89) days,4569 days in total,23 cases were diagnosed as the infections with the mean infection rate of 5.03 per 1000 catheter-days; totally 141 cases of patients underwent central venous catheterization after the continuous quality improvement in 2010,ith the mean catheterization duration of (36.78 ±43.54) days,5014 days in total,and 13 cases were diagnosed as infections with the mean infection rate of 2.59 per 1000 catheter-days.The mean catheterization duration of the patients with bloodstream infections was (47.23 ± 37.61) days,the incidence of catheter-related infections was 8.88 % in the patients with the catheterization duration no more than 7 days,58.3% in the patients with the catheterization duration more than 90 days,with the mean incidence rate of the central venous catheter-related blood stream infections dropping from 5.03‰ in 2009 to 2.59‰ in 2010.CONCLUSION The targeted monitoring combined with continuous quality improvement can effectively reduce the incidence of central venous catheter-related bloodstream infections in the ICU patients

  3. Visual perception of tree forms

    Energy Technology Data Exchange (ETDEWEB)

    Muederrisoglu, Haldun; Eroglu, Engin; OEzkan, Suekran; Ak, Kivanc [Department of Landscape Architecture, Faculty of Forestry, Abant Izzet Baysal University, 81000, Duzce (Turkey)

    2006-06-15

    This study, made in the cities of Adapazari, Duzce, and Bolu, has three fundamental goals. The first one is the evaluation of visual quality and strength of each tree form, second is the determination of visual quality and strength of different tree forms next to each other, and the third goal of this study is determining the effects of personal characteristics to the perception of tree forms. To reach these three goals the semantic differential method was used to evaluate graphical visions of tree forms. According to the findings, trees with pyramid forms have the most effective visual quality and strength. Pyramid-formed tree combinations have higher visual quality and strength than mixed combinations do. At the same time personal characteristics are effective on the visual perception of tree forms. A strong relationship between the amount of area per person in the cities the participants live in and their visual perception of tree forms has been found. (author)

  4. Matryoshka of Special Democratic Forms

    CERN Document Server

    Devchand, Chandrashekar; Weingart, Gregor

    2008-01-01

    Special p-forms are forms which have components \\phi_{\\mu_1...\\mu_p} equal to +1,-1 or 0 in some orthonormal basis. A p-form \\phi\\in \\Lambda^p R^d is called democratic if the set of nonzero components {\\phi_{\\mu_1...\\mu_p}} is symmetric under the transitive action of a subgroup of O(d,Z) on the indices {1,...,d}. Knowledge of these symmetry groups allows us to define mappings of special democratic p-forms in d dimensions to special democratic P-forms in D dimensions for successively higher P \\geq p and D \\geq d. In particular, we display a remarkable nested stucture of special forms including a U(3)-invariant 2-form in six dimensions, a G_2-invariant 3-form in seven dimensions, a Spin(7)-invariant 4-form in eight dimensions and a special democratic 6-form \\Omega in ten dimensions. The latter has the remarkable property that its contraction with one of five distinct bivectors, yields, in the orthogonal eight dimensions, the Spin(7)-invariant 4-form. We discuss various properties of this ten dimensional form.

  5. A 17-year study of bloodstream Escherichia coli infection after liver transplantation: resistance rate,risk factor and mortality%肝移植术后大肠埃希菌血行感染耐药及危险因素分析

    Institute of Scientific and Technical Information of China (English)

    邰强; 郭志勇; 黄洁夫; 何晓顺; 胡安斌; 巫林伟; 鞠卫强; 朱晓峰; 王东平; 王国栋; 马毅

    2011-01-01

    Objective To explore the resistance rate,risk factors and mortality of Escherichia coli bloodstream infections (BSI) after liver transplantation.Methods From January 1993 to May 2010,a retrospective analysis of Escherichia coli in liver transplants were conducted.Results A total of 88 BSI occurred in 83/695 patients and Escherichia coli ( n =23 ) was most commonly found.Carbapenem and piperacillin-tazobactam were the most consistently active against Escherichia coli while the resistance rate to enterococcus for ciprofloxacin,gentamycin,ampicillin-clavulanic acid was over 60%.Univariate analysis identified the following variables as risk factors for Escherichia coli bacteremia:cholangioenterostomy ( P <0.001 ) and ductal complications ( P < 0.001 ).Escherichia coli bloodstream infection could increase the mortality at 15 days after bloodstream infection.No significant difference in mortality occurred at 30 days and 1 year after enterococcal bacteremia.Conclusion Escherichia coli after liver transplantation is resistant to agents but commonly active to carbapenem and piperacillin-tazobactam.The risk factor associated with Escherichia coli bloodstream infections are cholangioenterostomy and ductal complications.Escherichia coli bloodstream infection can increase the mortality at 15 days after bloodstream infection.%目的 探讨肝移植术后血行感染中大肠埃希菌的耐药、临床结果及危险因素.方法 回顾分析1993年1月至2010年5月,中山大学附属第一医院移植科肝移植术后血行感染中大肠埃希菌患者资料,对患者的资料(如:抗生素耐药、术式及危险因素)进行分类统计.结果 695例肝移植患者中,83例(7.6%)88次出现革兰阴性球菌血行感染,以大肠埃希菌(23例)最为常见.大肠埃希菌对碳青酶烯类抗生素均为100%敏感,对哌拉西林/他唑巴坦耐药率在5%以下,而对环丙沙星、庆大霉素、氨苄西林/克拉维酸耐药率基本都在60%以上.针

  6. Investigation and analysis of postoperative cardiac venous catheter-related bloodstream infections in children with congenital heart disease%先天性心脏病患儿术后中心静脉导管相关性血流感染的调查分析

    Institute of Scientific and Technical Information of China (English)

    贾鹏; 黄睿; 李刚; 刘斌

    2015-01-01

    OBJECTIVE To investigate postoperative central venous catheter‐related bloodstream infections in children with congenital heart disease as well as the distribution of pathogenic bacteria ,so as to provide the basis for reducing infection rates .METHODS A total of 617 children with congenital heart disease who underwent surgical treatment in the cardiology center during May 2011 to Mar .2013 were enrolled .The targeted monitoring of central venous catheter‐related bloodstream infections was performed , and the infection incidence and the pathogen distribution were investigated .RESULTS Among the 617 children who underwent cardiac surgery and had indwelling central venous catheters ,12 cases of related bloodstream infections occurred ,the incidence was 1 .94% .Three cases (25 .00% ) had related bloodstream infections occurring in 7 days ,7 cases (58 .33% ) in 8 - 15 days and 2 cases (16 .67% ) after 15 days .Totally 21 pathogens were detected ,including 12 gram‐negative bacteria accounting for 57 .14% and 9 gram‐positive bacteria accounting for 42 .86% ,among which Acinetobacter baumannii ,Pseudomonas aeruginosa ,Staphylococcus aureus accounted for the top three .CONCLUSION The rate of postoperative central venous catheter‐related bloodstream infections in children with congenital heart disease is relatively high .In the course of treatment ,health care workers should be strictly in accordance with the instruc‐tion manual ,implement proactive measures to prevent infection in children ,reduce central venous catheter‐related bloodstream infections ,shorten hospital stay in children and reduce mortality .%目的:探讨先天性心脏病患儿术后中心静脉导管(CVC)相关性血流感染以及病原菌分布,为临床降低其感染率提供依据。方法选取2011年5月-2013年3月心脏病治疗中心收治的617例实施手术治疗的先天性心脏病患儿,进行中心静脉导管相关血流感染目标性监测,调查研究感

  7. Temporal form in interaction design

    DEFF Research Database (Denmark)

    Vallgårda, Anna; Winther, Morten Trøstrup; Mørch, Nina

    2015-01-01

    Interaction design is distinguished from most other design disciplines through its temporal form. Temporal form is the computational structure that enables and demands a temporal expression in the resulting design. Temporal form is what enables poetry. In music, temporal form is the composition...... of tones, pauses, and timbre arranged into harmonies and rhythms. In interaction design it is, for instance, the behaviors of pixels on a screen or the movements in shape-changing interfaces. In this paper we show the power of working explicitly with temporal form in designing computational things. We give...

  8. Impact of extended-spectrum β-lactamases production on mortality in Enterobacteriaceae bloodstream infection: a meta-analysis%产超广谱β内酰胺酶对肠杆菌科细菌血流感染病死率的影响:荟萃分析

    Institute of Scientific and Technical Information of China (English)

    张晓琳; 焦红梅; 刘新民

    2013-01-01

    Objective A meta-analysis was preformed to examine the impact of extended-spectrum p-lactamases (ESBLs) production on the mortality of Enterobacteriaceae bloodstream infections. Methods PubMed, CNKI and WanFangdata databases were searched with search terms "extended-spectrum beta-lactamase" or "ESBL" and "bacteremia", "bloodstream". Retrospective cohort studies were included, screened and the heterogeneity of studies was tested. Valid data were extracted and analyzed with Revman 5. 1 software. Results Nineteen studies met the inclusion criteria, a total of 3 218 subiects, including 994 patients and 2 224 controls. Meta-analysis of crude RRs demonstrated significantly increased mortality in ESBL-associated bloodstream infections (RR 1. 86, 95%CI 1. 50-2. 30, P<0. 001 ). Conclusions ESBL production is associated with increased mortality of Enterobacteriaceae bloodstream infections.%目的 通过荟萃分析,评价肠杆菌科细菌血流感染中产超广谱β内酰胺酶(ESBL)对病死率的影响.方法 检索PubMed、万方数据库、CNKI数据库,英文检索关键词为“ESBL”、“extended spectrum beta-lactamase”与“bacteremia”、“bloodstream”两组关键词一一组合,中文检索词为“超广谱β内酰胺酶”与“血流感染”、“菌血症”或“败血症”,获得比较ESBL及非ESBL肠杆菌科细菌血流感染预后的研究结果,对其进行筛选、异质性检验,纳入文献的研究设计均为回顾性队列研究,采用Revman5.1软件对提取的数据进行分析.结果 共有19篇文章符合标准,获得3 218例样本,其中病例组994例,对照组2 224例.荟萃分析结果显示,产ESBL肠杆菌科细菌血流感染病死率较非产ESBL的明显增高(RR 1.86,95% CI 1.50~2.30,P<0.001).结论 在肠杆菌科细菌血流感染中,产ESBL肠杆菌科细菌明显增加了病死率.

  9. Bloodstream infections among patients using central venous catheters in intensive care units Infección de corriente sanguínea en pacientes con catéter venosos central en unidades de cuidado intensivo Infecções da corrente sangüínea em pacientes em uso de cateter venoso central em unidades de terapia intensiva

    OpenAIRE

    2007-01-01

    Central Venous Catheters (CVC), widely used in Intensive Care Units (ICU) are important sources of bloodstream infections (BSI). This prospective cohort epidemiological analytical study, aimed to infer the incidence of BSI, the risk factors associated and evaluate the care actions related to the use of these catheters in seven ICU in the Federal District - Brasília, Brazil. From the 630 patients using CVC, 6.4% developed BSI (1.5% directly related to the catheter and 4.9% clinic BSI). The hos...

  10. Risk factors and prognosis of patients with bloodstream infection due to carbapenem-resistant Acinetobacter baumannii%耐碳青霉烯类鲍曼不动杆菌血流感染患者危险因素及预后

    Institute of Scientific and Technical Information of China (English)

    黄文治; 乔甫; 王妍潼; 尹维佳; 宗志勇

    2015-01-01

    Objective To explore the risk factors and prognosis of hospitalized patients with bloodstream infection due to carbapenem-resistant Acinetobacter baumannii (CRAB).Methods 163 patients with CRAB bloodstream in-fection from 2010 to 2013 were conducted retrospective case-control study,68 patients with bloodstream infection due to carbapenem-susceptible Acinetobacter baumannii (CSAB)during the same period were as control group. Results The independent risk factors for CRAB bloodstream infection were stay in intensive care unit(ICU)(OR, 1 .27[95%CI ,5.55-22.89])and emergency department(OR,3.57 [95%CI ,1 .67 -7.62])before infection.Pa-tients with CRAB bloodstream infection had lower 28-day survival rate than those with CSAB bloodstream infection (66.17% vs 96.95%,χ2 =15.71 ,P <0.001 ).The independent risk factors for influencing prognosis of Acineto-bacter baumannii bloodstream infection were infection of CRAB (HR 95% CI ,3.01 -67.28),blood disease(HR 95%CI ,3.77-25.97),cardiac insufficiency(HR 95%CI ,2.10-20.41),stay in ICU(HR 95%CI ,1 .01 -5.28), and age(HR 95%CI ,1 .01 -1 .04).Conclusion The independent risk factors for CRAB bloodstream infection are stay in ICU and emergency department before infection,CRAB bloodstream infection is risk factor for influencing prognosis of patients.%目的:探讨住院患者血流感染耐碳青霉烯类鲍曼不动杆菌(CRAB)的危险因素及预后。方法采用病例对照研究,回顾性收集某院2010—2013年 CRAB 血流感染患者163例,并以同期68例对碳青霉烯类敏感的鲍曼不动杆菌(CSAB)血流感染患者作为对照,进行危险因素及预后分析。结果 CRAB 血流感染的独立危险因素是感染前入住重症监护病房(ICU)[OR 及 OR95%CI :1.27(5.55~22.89)]及入住过急诊室[OR 及 OR95%CI :3.57(1.67~7.62)]。鲍曼不动杆菌(AB)血流感染患者28 d 生存率 CRAB 为66.17%,而 CSAB 为96.95%, CRAB

  11. Clinical diagnostic value of dual blood culture of procalcitonin and high sensitivity C-reactive protein for bloodstream infection%降钙素原、超敏C反应蛋白联合血培养对血流感染的临床诊断价值

    Institute of Scientific and Technical Information of China (English)

    黄丽君

    2016-01-01

    目的:探讨降钙素原、超敏C反应蛋白联合血培养对血流感染的临床诊断价值。方法82例血流感染患者作为观察组,82例非血流感染的局部感染患者作为对照组,收集两组患者的血液标本进行降钙素原、超敏C反应蛋白检测及血培养,对比观察三种检测方法对血流感染患者的临床诊断价值。结果观察组降钙素原阳性率为69.51%、超敏 C反应蛋白阳性率为96.34%,高于对照组的9.76%、48.78%(P0.05)。结论降钙素原、超敏C反应蛋白对血流感染的诊断特异性强,联合血培养检测可以提高诊断的准确性,尽早明确诊断,及时指导临床采取有效的治疗方案,改善患者的预后。%Objective To investigate clinical diagnostic value of dual blood culture of procalcitonin and high sensitivity C-reactive protein for bloodstream infection.Methods There were 82 bloodstream infection patients as observation group and 82 local infection patients without bloodstream infection as control group. Blood samples of both groups were taken for procalcitonin and high sensitivity C-reactive protein detection and blood culture. Clinical diagnostic values of the three detection ways were compared.Results The observation group had higher procalcitonin positive rate as 69.15% and high sensitivity C-reactive protein positive rate as 96.34% than 9.76% and 48.78% of the control group (P0.05).Conclusion Procalcitonin and high sensitivity C-reactive protein contain high specificity in diagnosis of bloodstream infection, and their dual blood culture can improve accuracy of diagnosis, so as to clarify early diagnosis, guide effective clinical treatment, and improve prognosis in patients.

  12. FormLink/FeynCalcFormLink : Embedding FORM in Mathematica and FeynCalc

    CERN Document Server

    Feng, Feng

    2012-01-01

    FORM, a symbolic manipulation system, has been widely used in a lot of calculations for High Energy Physics due to its high performance and fficient design. Mathematica, another computational software program, has also widely been used, but more for reasons of generality and user-friendliness than for speed. Especially calculations involving tensors and noncommutative operations like calculating Dirac traces can be rather slow in Mathematica, compared to FORM. In this article we describe FormLink and FeynCalcFormLink, two Mathematica packages to link Mathematica and FeynCalc with FORM. FormLink can be used without FeynCalc and FeynCalcFormLink, which is an extension loading FormLink and FeynCalc automatically. With these two packages the impressive speed and other special features of FORM get embedded into the generality of Mathematica and FeynCalc in a simple manner. FeynCalcFormLink provides a FORM-based turbo for FeynCalc, making it much more efficient. FormLink turns Mathematica into an editor and code or...

  13. Discussion on Form Focused Instruction

    Institute of Scientific and Technical Information of China (English)

    冯滢

    2007-01-01

    The pedagogy of language teaching has moved from one extreme-Grammar Translation Method to the other-Communicative Language Teaching.Today Form Focused Instruction(FFI)has emerged,intending to bring language forms instructionback to the communicative language classroom.Despite of the approval of this new approach,there is a hot dispute on its two types of application:Focus on Form or Focus on FormS.This article briefly analyzes FFI in recent research studies with focus on the choice between the two types of application.The tentative conclusion is FFI does show some explicit and reliable effects on accuracy and error elimination in language teaching;however,the investigation into its application is not simply either Focus on Form Or Focus on FormS,but focuses on the optimal combination of the two in teaching.

  14. Temporal form in interaction design

    DEFF Research Database (Denmark)

    Vallgårda, Anna; Winther, Morten Trøstrup; Mørch, Nina;

    2015-01-01

    Interaction design is distinguished from most other design disciplines through its temporal form. Temporal form is the computational structure that enables and demands a temporal expression in the resulting design. Temporal form is what enables poetry. In music, temporal form is the composition...... of tones, pauses, and timbre arranged into harmonies and rhythms. In interaction design it is, for instance, the behaviors of pixels on a screen or the movements in shape-changing interfaces. In this paper we show the power of working explicitly with temporal form in designing computational things. We give...... temporal forms by letting a series of expert designers reflect upon them. We borrow a framework from Boorstin’s film theory in which he distinguishes between the voyeuristic, the vicarious, and the visceral experience. We show how to use rhythms, complexity, gentle or forceful behavior, etc., to create...

  15. The semantics of biological forms.

    Science.gov (United States)

    Albertazzi, Liliana; Canal, Luisa; Dadam, James; Micciolo, Rocco

    2014-01-01

    This study analyses how certain qualitative perceptual appearances of biological forms are correlated with expressions of natural language. Making use of the Osgood semantic differential, we presented the subjects with 32 drawings of biological forms and a list of 10 pairs of connotative adjectives to be put in correlations with them merely by subjective judgments. The principal components analysis made it possible to group the semantics of forms according to two distinct axes of variability: harmony and dynamicity. Specifically, the nonspiculed, nonholed, and flat forms were perceived as harmonic and static; the rounded ones were harmonic and dynamic. The elongated forms were somewhat disharmonious and somewhat static. The results suggest the existence in the general population of a correspondence between perceptual and semantic processes, and of a nonsymbolic relation between visual forms and their adjectival expressions in natural language.

  16. Isometric Spacelike Immersions of Space Forms in Indefinite Space Forms

    Institute of Scientific and Technical Information of China (English)

    李海中; 吴岚

    2001-01-01

    Let M be a connected n-dimensional space form spacelike isometrically immersed in a (2n -1)-dimensional indefinite space form. If M is maximal, we prove that either M is totally geodesic or M is apiece of the n-dimensional hyperbolic cylinder in the (2n - 1)-dimensional pseudo-hyperbolic space.``

  17. Laser forming and welding processes

    CERN Document Server

    Yilbas, Bekir Sami; Shuja, Shahzada Zaman

    2013-01-01

    This book introduces model studies and experimental results associated with laser forming and welding such as laser induced bending, welding of sheet metals, and related practical applications. The book provides insight into the physical processes involved with laser forming and welding. The analytical study covers the formulation of laser induced bending while the model study demonstrates the simulation of bending and welding processes using the finite element method. Analytical and numerical solutions for laser forming and welding problems are provided.

  18. [Pseudotumor form of urinary tuberculosis].

    Science.gov (United States)

    Rabii, Redouane; Moufid, Kamal; Joual, Abdenbi; Maani, Ahmed; Bennani, Saad; el Mrini, Mohamed

    2002-12-01

    Urogenital tuberculosis is an increasingly frequent serious disease. The diagnosis is often delayed due to the marked clinical polymorphism, leading to serious sequelae. The diagnosis of typical forms is easy, but some forms are misleading and can lead to an incorrect diagnosis. The authors report a pseudoneoplastic form of urogenital tuberculosis in a young patient that was initially diagnosed as lymphoma. In the light of this case and a review of the literature, the authors emphasize the diagnostic difficulties of these forms and the treatment modalities.

  19. A compiler for variational forms

    CERN Document Server

    Kirby, Robert C; 10.1145/1163641.1163644

    2011-01-01

    As a key step towards a complete automation of the finite element method, we present a new algorithm for automatic and efficient evaluation of multilinear variational forms. The algorithm has been implemented in the form of a compiler, the FEniCS Form Compiler FFC. We present benchmark results for a series of standard variational forms, including the incompressible Navier-Stokes equations and linear elasticity. The speedup compared to the standard quadrature-based approach is impressive; in some cases the speedup is as large as a factor 1000.

  20. Discussion on Form Focused Instruction

    Institute of Scientific and Technical Information of China (English)

    冯滢

    2007-01-01

    The pedagogy of language teaching has moved from one extreme-Grammar Translation Method to the other-Communicative Language Teaching.Today Form Focused Instruction(FFI) has emerged,intending to bring language forms instruction back to the communicative language classroom.Despite of the approval of this new approach,there is a hot dispute on its two types of application:Focus on Form or Focus on FormS.This article briefly analyzes FFI in recent research studies with focus on the choice between the two types ...

  1. INFORMATIONAL EFFECT OF A FORM

    Directory of Open Access Journals (Sweden)

    Kovalenko V.F.

    2016-02-01

    Full Text Available The study was conducted by method of light scattering of laser emission. The influence of the form field, mutual influence of mental informational and form torsional fields as well as the following exposure of water samples in the form field after the cease of informational influence on water structure were examined. Paper forms of a pyramid, a cylinder, and a prism were used. The experimental findings show that mechanism of mutual influence on water structure of the form and informational torsional fields depended on the initial conditions of spin restructuring process – the configuration of a form, the type of the form field (internal and external ones, and the initial water structure. The influence of the form field on informational aftereffect was determined, the character of which was defined by ratio of intensities of torsional form field and an informational soliton. The phenomenon of the abnormally large amplification of the informational aftereffect in the internal field of a pyramid demonstrating the attributes of positive reverse connection between the informational soliton and torsional field of water structure and selection of generated cluster sizes were discovered.

  2. Research on BD BACTEC 9120 blood culture instrument combined with serum PCT in diagnosis of bloodstream infections%BD BACTEC 9120血培养仪联合血清降钙素原在血流感染诊断中的应用

    Institute of Scientific and Technical Information of China (English)

    郭盼; 马萍; 王海龙; 董彬; 尚晓泓

    2015-01-01

    目的:比较革兰阳性(G+)菌和革兰阴性(G-)菌血流感染(BSI)的血清降钙素原(PCT)水平,探讨血培养与PCT联合检测在临床诊断中的意义。方法:采用BD BACTEC9120型全自动血培养仪对199例住院发热患者的血液标本进行细菌培养,同时检测PCT水平,比较PCT浓度水平在血培养阳性与阴性之间以及革兰阳性细菌与阴性细菌之间的差异。结果:①筛选出检测PCT的99例血培养阳性标本中分别检出18种细菌,其中表皮葡萄球菌构成比最大(占17.2%);其余依次为大肠埃希菌(占16.2%)和鲍曼不动杆菌(占10.1%);②血培养阳性与血培养阴性标本PCT结果比较差异有统计学意义;③血培养革兰阳性菌与革兰阴性菌PCT结果比较无明显差异,但如果将革兰阳性菌组金黄色葡萄球菌的结果去除,再与革兰阴性菌相比差异有统计学意义。结论:PCT对革兰阴性菌与革兰阳性菌感染有一定的判别作用,配合血培养检测能辅助临床的快速诊断,提示临床初步抗生素的使用方向,减少用药的盲目性和耐药菌株的出现。%Objective: Compare gram-positive (G+)bacteria and gram-negative bacteria (G-) bloodstream infections of serum procalcitonin(PCT) original level, to explore the clinical significance of blood culture and PCT joint detection. Methods: One hundred and ninty nine cases were selected, by using BD BACTEC 9120 type automatic blood culture instrument to detect the bacterial culture and at the same time the PCT results, comparative PCT concentration in blood cultures between positive and negative results and gram-positive bacteria and gram-negative bacteria. Results:(1)Screening detection of PCT were detected in 99 cases of specimens of blood culture positive for 18 species of bacteria including staphylococcus epidermis form than most, by 17.2%;The second is the e. coli were 16.2%and 10.1%acinetobacter baumannii. (2)blood culture positive for

  3. 恶性血液病合并血流感染61例临床分析%Clinical Analysis of 61 Cases of Malignant Hematology with Bloodstream Infection

    Institute of Scientific and Technical Information of China (English)

    金凤波; 夏瑞祥; 金广霞; 吴炜; 刘飞

    2012-01-01

    的药物分别为亚胺培南、万古霉素及利奈唑胺.临床对该类患者及早正确使用敏感抗菌药物治疗,可有效控制感染,并可降低BSI导致恶性血液病患者的病死率.%Objective To study the characteristics,treatments and prognosis in the malignant hematology patients with bloodstream infection.Methods From January 2008 to December 2009,61 cases of malignant hematology with bloodstream infection patients,who were treated by department of blood transfusion in the First Affiliated Hospital of Anhui Medical University,were analyzed retrospectively.The antibiotic resistance rates and sensitivity rates of 72 non-duplicate pathogenic isolates were calculated,and the infection related factors and prognosis of malignant hematology with bloodstream infection patients were analyzed,through the issues of patients' neutrophil counts,days of hospitalization,age and initial antimicrobial treatment options.The x2 test was used to analyze the qualitative data,and the t-test was used to analyze the quantitative data.P<0.05 showed that the difference was statistically significant.Results The main pathogens of these 61 patients were Gram-negative bacterium.The total prevalence of extendedspectrum beta-lactamases (EBSLs)-producing strains in E.coli and Klebsiella isolates were 56.25% and 36.60%,respectively.The sensitive rates of ESBLs-producing strains of E.coli to Imipenem,Klebsiella to Imipenem,and Gram-positive cocci to Vancomycin and Linezolid were 100%.Compared with the patients whose neutrophils>0.5 × 109/L,the patients whose neutrophils<0.5 × 109/L were more susceptible to multiple infection (x2.455,P=0.02).Among the 60 patients,the multiple infection was significant different between hospitalization days <20 d and >20 d(x2 =7.576,P=0.006).The mortality was high in patients over the age of 60(x2=3.021,P=0.023).Before the blood culture results returning,the antimicrobial treatment average times of the 35 patients who had used

  4. Home Nursing of Continuous Improvement Prevention and Controlling Role of Tumor Patient with PICC Related Bloodstream Infection%居家护理持续改进在防控PICC相关性血流感染中的作用

    Institute of Scientific and Technical Information of China (English)

    高群英; 刘建红; 张柳柳; 陈传英; 张容; 孟爱凤; 朱敏; 朱娟芳

    2012-01-01

    目的 探讨居家护理持续改进在防控PICC( Parenterally Insersted Central-Catheters)相关性血流感染中的作用.方法 回顾性分析1年内265例PICC置管肿瘤患者中PICC相关性血流感染(PICC-BSIs)病例,针对因居家护理不当引起的PICC-BSIs,提出居家护理改进措施,①出院前加强PICC居家护理相关知识宣教;②发放自行设计的居家PICC日常维护单;③寻求家庭、社会支持系统;④建立维护网络;⑤通过电话回访提高患者出院后导管维护依从性.结果 在回顾性265例PICC置管肿瘤患者中有3例居家护理不当引起的PICC-BSIs,进行居家护理措施持续改进的252例PICC置管肿瘤患者因居家护理不当引起的PICC-BSIs为0.结论 对PICC置管的肿瘤患者进行居家护理措施持续改进,能有效防控PICC-BSIs的发生.%Objective Explore home nursing of continuous improvement prevention and controlling role of tumor patients with PICC related bloodstream infection ( PICC-BSIs) . Methods 265 cases in home nursing patients with tumor caused by PICC-BSIs cases for one year were analyzed retrospectively, and intervention measures were taken to improve home nursing care into the way. ①before discharge PICC strengthen knowledge education related to home nursing;②increase instructions of daily maintenance of home PICC; ③search for family and social support system; ④operate a PICC intervention system such as establish a PICC maintenance network in residential communities; ⑤through the telephone patients a better return after discharge tube maintenance compliance. Results 265 cases were analyzed retrospectively, three cases of PICC-BSIs were caused by improper home nursing in one year. For the continuous improvement of 252 home nursing patients with tumor PICC tube, PICC-BSIs cases were zero. Conclusion The tumor patients with PICC catheter can control and prevent PICC-BSIs by improving home nursing continuously.

  5. 实体器官移植术后并发败血症96例临床分析%A clinical anylasis of 96 patients with bloodstream infections after solid organ transplantation

    Institute of Scientific and Technical Information of China (English)

    万齐全; 明英姿; 马颖

    2012-01-01

    目的:探讨实体器官移植术后并发败血症的临床表现、病原体、综合治疗及结果.方法:回顾性分析96例实体器官移植术后并发败血症患者的临床资料、病原体构成和来源、综合处理手段及成败原因.结果:96例患者共发生134次败血症,患者平均年龄42.4岁.实体器官移植术后并发败血症病原体种类繁多,病原体耐药性强,临床表现无特异性,抗感染效果差.经减量或停用免疫抑制剂、抗感染等处理,57例存活,败血症相关病死率为40.6%.结论:果断停用实体器官移植术后并发败血症患者的免疫抑制剂,及早使用敏感抗生素,以及强有力营养及器官功能支持是救治成功的关键,预防感染发生尤为关键.%Objective: To evaluate clinical characteristics, pathogens, treatment regimens and outcomes in patients with bloodstream infections (BSIs) after solid organ transplantation.Methods: Clinical data of ninety six cases of BSI were analyzed retrospectively to identify the pathogens and the origin of infection, and to evaluate comprehensive treatment and the causes of success or failure.Results: All 96 patients underwent the comprehensive treatments, including suspending administration of immunosuppressants and starting administration of approprite antibiotics. The clinical characteristics of patients with BSIs after solid organ transplantation were atypical. The pathogens were various and seriously multi-drug resistant, which led to a high mortality. Among them 57 cases recovered, but the BSI-related mortality rate was 40.6%.Conclusion: Stopping the administration of immunosuppressants, reasonable use of antibiotics,nutritional support and protecting the function of organs as soon as possible were of the greatest importance among of the various treatment plan. Avoidance of all kinds of infection in the first place is most important.

  6. Cluster of Central Venous Catheter Related Bloodstream Infections Intervention Study%集束化干预中心静脉导管相关性血流感染的研究

    Institute of Scientific and Technical Information of China (English)

    黄彩云; 庞杰媚

    2014-01-01

    目的:探讨集束化护理方案在预防中心静脉导管相关性血流感染(C RBS I )的效果。方法:对2012年8月-2014年1月收住IC U的466例中心静脉置管患者制定及实施集束化护理策略。选择集束化干预前2011年3月-2012年8月同科室置中心静脉导管的403例患者作为对照。结果:采取集束化干预后导管的使用率从63.6%升到71.6%,导管的感染率从8.61‰降低到1.49‰,下降了82.7%,干预前、后感染率差异有统计学意义。结论:集束化护理能减少中心静脉导管感染的机会。%Objective :Discusses cluster care solutions in central venous catheter related bloodstream infection (CRBSI) prevention effect. Methods :In August 2012 to January 2014 of 466 patients with central venous catheter admitted to the ICU nursing strategy formulation and implementation of cluster. Before choosing cluster change intervention in March 2011 to August 2012 of 403 patients as control of central venous catheter. Results:Take the cluster is changed after the intervention catheter utilization rose from 63. 6% to 71. 6% ,catheter infection rate reduced from 8. 61‰ to 1. 49‰ ,de‐creased by 82. 7% ,infection rate difference was statistically significant before and after intervention. Conclusion:Cluster of central venous catheter infection nursing can reduce the opportunity.

  7. Another Form for LAMBDA Method

    Institute of Scientific and Technical Information of China (English)

    ZHOU Yangmei; LIU Jingnan

    2003-01-01

    The LAMBDA methodthat was proposed by Teunissen is introduced. Then, on the basis of both the back-sequential conditional LS technique and the upper-triangular Cholesky decomposition, another form for LAMBDA method is proposed.This new form for LAMBDA method has the same principle and calculation speed as the traditional LAMBDA method.

  8. Green Lubricants for Metal Forming

    DEFF Research Database (Denmark)

    Bay, Niels

    2010-01-01

    The increasing focus on legislation towards diminishing the impact on working environment as well as external environment has driven efforts to develop new, environmentally benign lubricants for metal forming. The present paper gives an overview of these efforts to substitute environmentally...... hazardous lubricants in cold, warm and hot forging as well as sheet forming and punching/blanking with new, less harmful lubricants....

  9. Identities between Modular Graph Forms

    CERN Document Server

    D'Hoker, Eric

    2016-01-01

    This paper investigates the relations between modular graph forms, which are generalizations of the modular graph functions that were introduced in earlier papers motivated by the structure of the low energy expansion of genus-one Type II superstring amplitudes. These modular graph forms are multiple sums associated with decorated Feynman graphs on the world-sheet torus. The action of standard differential operators on these modular graph forms admits an algebraic representation on the decorations. First order differential operators are used to map general non-holomorphic modular graph functions to holomorphic modular forms. This map is used to provide proofs of the identities between modular graph functions for weight less than six conjectured in earlier work, by mapping these identities to relations between holomorphic modular forms which are proven by holomorphic methods. The map is further used to exhibit the structure of identities at arbitrary weight.

  10. FormTracer - A Mathematica Tracing Package Using FORM

    CERN Document Server

    Cyrol, Anton K; Strodthoff, Nils

    2016-01-01

    We present FormTracer, a high-performance, general purpose, easy-to-use Mathematica tracing package which uses FORM. It supports arbitrary space and spinor dimensions as well as an arbitrary number of simple compact Lie groups. While keeping the usability of the Mathematica interface, it relies on the efficiency of FORM. An additional performance gain is achieved by a decomposition algorithm that avoids redundant traces in the product tensors spaces. FormTracer supports a wide range of syntaxes which endows it with a high flexibility. Mathematica notebooks that automatically install the package and guide the user through performing standard traces in space-time, spinor and gauge-group spaces are provided.

  11. 探讨ICU患者中心静脉导管相关性血流感染的集束化预防策略%Increase the bundle prevention strategies of central venous catheter-related bloodstream infection in patients of ICU

    Institute of Scientific and Technical Information of China (English)

    王艳菊; 陈奕文; 姜爱丽

    2014-01-01

    ICU收治急危重症患者,大多数患者需要使用中心静脉导管测压、输液等,但其同时存在发生导管相关性血流感染(CRBSI)的风险,从而导致患者住院时间延长和病死率升高等。选择最优的穿刺途径、严格的手卫生、消毒皮肤、最大消毒屏障以及定期更换辅料等,应用集束化预防措施进行置管及日常护理是预防导管相关性血流感染发生的重要措施。%In ICU,there are critically ill patients,and most patients require the use of central venous catheter manometer,infusion and so on.But at the same time,the occurrence of catheter-related bloodstream infection(CRBSI) risk,result in patients with prolonged hospitalization and mortality rate higher.The application of bundle preventive measures of catheter and daily care, including the selection of optimal puncture,strict hand hygiene,disinfection, the biggest disinfection and barrier regular replacement of accessories and so on,is an important measure to prevent occurrence of catheter-related bloodstream infection,.

  12. Quantum modular forms, mock modular forms, and partial theta functions

    Science.gov (United States)

    Kimport, Susanna

    Defined by Zagier in 2010, quantum modular forms have been the subject of an explosion of recent research. Many of these results are aimed at discovering examples of these functions, which are defined on the rational numbers and have "nice" modularity properties. Though the subject is in its early stages, numerous results (including Zagier's original examples) show these objects naturally arising from many areas of mathematics as limits of other modular-like functions. One such family of examples is due to Folsom, Ono, and Rhoades, who connected these new objects to partial theta functions (introduced by Rogers in 1917) and mock modular forms (about which there is a rich theory, whose origins date back to Ramanujan in 1920). In this thesis, we build off of the work of Folsom, Ono, and Rhoades by providing an infinite family of quantum modular forms of arbitrary positive half-integral weight. Further, this family of quantum modular forms "glues" mock modular forms to partial theta functions and is constructed from a so-called "universal" mock theta function by extending a method of Eichler and Zagier (originally defined for holomorphic Jacobi forms) into a non-holomorphic setting. In addition to the infinite family, we explore the weight 1/2 and 3/2 functions in more depth. For both of these weights, we are able to explicitly write down the quantum modular form, as well as the corresponding "errors to modularity," which can be shown to be Mordell integrals of specific theta functions and, as a consequence, are real-analytic functions. Finally, we turn our attention to the partial theta functions associated with these low weight examples. Berndt and Kim provide asymptotic expansions for a certain class of partial theta functions as q approaches 1 radially within the unit disk. Here, we extend this work to not only obtain asymptotic expansions for this class of functions as q approaches any root of unity, but also for a certain class of derivatives of these functions

  13. 血培养阳性时间在假丝酵母菌属血流感染中的诊断价值%Diagnostic value of positivity in candida bloodstream infection

    Institute of Scientific and Technical Information of China (English)

    王凯飞; 陈荣; 沈定霞; 叶丽艳; 王磊利

    2011-01-01

    OBJECTIVE To analyze the clinical characteristics of patients with candidemia and to assess the clinical value of the time to positivity (TTP) of blood cultures in patients of Candida bloodstream infection. METHODS The correlation of TTP with clinical parameters of 82 patients with candidemia was analyzed retrospectively. All statistical calculations were performed by using SPSS statistical software. RESULTS The average TTP in patients of C. Tropicalis bloodstream infection was the shortest (17. 0 ± 4. 9h), C. Glabrata was the longest (43. 6± 18. 9h), C. Albicans and C. Parapsilosis were (26. 6 ± 14. 3)h and (33. 7 ± 7. 8)h .respectively. Among the clinical parameters of patients of blood stream infection:78% of patients received long-term antibiotic therapy and 35% of patients underwent abdominal surgery. Among the first diagnosis in patients. 'tumor amounted to the highest percentage (20. 7%) and 35. 4% of patients suffered from respiratory infection at the same time. TTP were no significantly difference between survival group and death group. In the 30 candidemic patients with multiple blood cultures, the mortality of the patients with extended TTP was 16. 7% , which was significantly lower than that of the patients with shortened TTP (66. 7%). CONCLUSION More attention should be paid to the infection of Candida for patients rececing long-term antibiotic therapy, abdominal surgery, or with tumor and respiratory infection. The change of TTP is related to the prognosis of the patient.%目的 分析假丝酵母菌属血流感染的临床特征,探讨血培养的阳性时间(TTP)在假丝酵母菌属血流感染中的临床意义.方法 采用回顾性分析的方法,收集82例假丝酵母菌血培养阳性患者的TTP及其相关临床资料,将30 d内死亡的分为死亡组,未死亡的为生存组,并应用SPSS统计学软件进行数据分析.结果 热带假丝酵母菌TTP平均值最短,为(17.0±4.9)h,光滑假丝酵母菌TTP平均值最长,为(43.6±18

  14. 血清降钙素原与血培养联合检测对血流感染的诊断价值%Value of detection of serum procalcitonin combined with blood culture in diagnosis of bloodstream infections

    Institute of Scientific and Technical Information of China (English)

    方国华; 周赛军; 朱正国

    2015-01-01

    目的:分析血清降钙素原(PC T )与血培养联合检测对血液感染的诊断价值,为临床诊断治疗提供参考。方法选取2013年1-6月医院收治的120例肺炎发热患者为观察组,80例肿瘤发热患者为对照组,入院后对两组患者进行血清PC T测定及血培养,对比检测结果;对观察组患者分别在发热后12、24、48 h检测血清PC T并进行血液培养,对比结果。结果首次采血检测,血清PC T检测观察组阳性67例、对照组阳性8例,差异有统计学意义(χ2=43.02,P<0.01),血培养观察组阳性12例、对照组1例,差异有统计学意义(χ2=6.05,P<0.05);观察组患者发热后12、24 h ,血清PC T阳性61、68例,阳性率50.8%、56.7%,血培养阳性16、31例,阳性率13.3%、25.8%,差异均有统计学意义( P<0.01);发热后48 h ,血清PC T阳性71例,阳性率59.1%,血培养阳性68例,阳性率56.6%,差异无统计学意义。结论血清降钙素原联合血培养对于诊断血流感染有一定的价值,应在临床工作中加以推广。%OBJECTIVE To analyze the value of detection of serum procalcitonin (PCT) combined with blood culture in diagnosis of bloodstream infections so as to provide guidance for clinical diagnosis and treatment .METHODS To‐tally 120 pneumonia patients with fever who were treated in the hospital from Jan 2013 to Jun 2013 were chosen as the observation group ,and 80 tumor patients with fever were assigned as the control group .The serum PCT level was determined and the blood culture was performed for the two groups of patients after the admission to the hos‐pital ,and the results were compared .The levels of serum PCT of the patients in the observation group were detec‐ted at 12 ,24 ,and 48 hours after they had fever ,the blood culture was performed ,and the results were observed and compared .RESULTS The serum PCT was tested positive

  15. Effect of anaerobic blood culture on diagnosis and treatment of suspected bloodstream infections%厌氧血培养对疑似血流感染患者临床诊断治疗的影响

    Institute of Scientific and Technical Information of China (English)

    余世全; 周惠琴; 刘励军

    2012-01-01

    OBJECTIVE To study the effect of anaerobic blood culture on the positive rate of blood culture of the patients with suspected bloodstream infections so as to provide basis for the timely diagnosis and treatment. METHODS The blood sample were cultured by adopting two sets of aerobic and anaerobic blood culture bottles, the culture result was identified and analyzed by using VITEK-32 instrument and identification card after the detection with BACTEC-9120 full-automatic blood culture system. RESULTS Of 1744 blood culture samples submitted, there were 215 positive with the positive rate of 12. 33% , totally 80 strains of bacteria were isolated; there were 84 both aerobic and anaerobic culture positive, accounting for 39. 07%, and there were 111 aerobic culture positive with anaerobic culture negative, accounting for 51. 63%, and there were 20 aerobic culture negative with anaerobic culture positive, accounting for 9. 30% , as compared with the result of the aerobic and anaerobic blood cultures, the differences were statistically significant(^2 = 23. 536, P<0. 05); of the both aerobic and anaerobic blood culture positive samples, there were 5 strains of pathogens appeared as positive 2 days before the anaerobic blood culture, 2 strains as positive 1 day before the anaerobic blood culture. CONCLUSION The anaerobic blood culture can increase the positive rate of the blood culture of the patients with suspected bloodstream infections; two sets of aerobic and anaerobic blood culture mode can improve the positive rate of blood culture, ensure the acquirement of the culture result in the early stage, avoid the escaped examination, and diagnose and treat the diseases in a timely manner, which plays a significant role in improving the cure rate of the patients.%目的 探讨厌氧血培养对疑似血流感染患者血培养阳性率的影响,为临床及时正确的诊断及治疗提供依据.方法 血液标本采用双套需氧瓶加厌氧瓶血培养,用BACTEC-9120全自

  16. The epidemiology of bloodstream infections in Fuxing Hospital in 2012 in Beijing%首都医科大学附属复兴医院2012年住院患者血流感染分析

    Institute of Scientific and Technical Information of China (English)

    梁蓓; 姜利; 刘淑梅; 席修明

    2016-01-01

    目的 了解血流感染患者的临床特征、预后及病原菌种类.方法 收集首都医科大学附属复兴医院2012年1月1日至12月31日住院患者的阳性血培养结果,分析确诊为血流感染患者的临床资料和病原菌种类.结果 血流感染患者149例,占当年出院患者18 774例次的0.8%,即当年血流感染的发生率为0.8%.首次发生血流感染时,15例(10.1%)患者来自手术科室,83例(55.7%)患者来自非手术科室,51例(34.2%)患者来自ICU.33例(22.1%)患者表现为感染性休克.住院期间死亡68例,病死率为45.6%.共发生154例次血流感染,其中医院获得性血流感染125例次(81.2%),社区获得性血流感染29例次(18.8%).共分离出病原菌188株,其中革兰阴性菌106株(56.4%),革兰阳性菌67株(35.6%),真菌15株(8.0%).革兰阴性菌血流感染中,社区获得性血流感染更多为肠杆菌科细菌,而非发酵菌在医院获得性血流感染显著多于社区获得性血流感染.125例次医院获得性血流感染中分离出159株菌(84.6%).188株病原菌中,26株为中心静脉导管相关性血流感染.手术科室、非手术科室、ICU的非发酵菌和肠杆菌分布差异有统计学意义(P=0.049).结论 血流感染发生地点不同、患者所在科室不同,病原学分布差异较大.对本地区、本单位、本科室血流感染患者临床特征和病原菌分布及演变的及时了解,为临床医生经验性使用抗菌药物提供依据,以改善血流感染患者的预后.%Objective To investigate the etiology,clinical features and outcome of hospitalized patients with bloodstream infections (BSIs) in a tertiary hospital.Methods Positive blood cultures were obtained from the microbiological laboratory in Fuxing Hospital,Capital Medical University from January 1,2012 to December 31,2012.BSIS events were identified and the epidemiology data were collected.Results A total of 149 patients and 154 BSIs events were

  17. Application of cluster care in the catheter-related bloodstream infections%集束化护理在导管相关性血流感染中的应用

    Institute of Scientific and Technical Information of China (English)

    陈萍燕

    2016-01-01

    目的:探讨集束化护理在预防中心静脉导管相关性血流感染中的应用价值。方法从 ICU 收治的留置中心静脉导管的患者中选取200例为研究对象,采用随机数字表法分为研究组和对照组,每组各100例,对照组患者行常规护理,研究组患者行集束化护理。比较两组置管部位、置管时间、感染发生率。结果研究组中颈内静脉置管、锁下静脉置管、股静脉置管分别为82.00%(82/100)、14.00%(14/100)、4.00%(4/100),与对照组的79.00%(79/100)、15.00%(15/100)、6.00%(6/100)比较,差异均无统计学意义(均 P >0.05);研究组置管时间为(10.36±4.67)d,与对照组的(11.28±4.58)d 相当,组间差异无统计学意义(χ2=1.406,P >0.05)。研究组导管相关性血流感染发生率为1.00%(1/100),明显低于对照组的9.00%(9/100)(χ2=6.736,P =0.009)。结论集束化护理在留置中心静脉导管患者中的应用,较常规护理模式而言,可以显著降低中心静脉导管相关性血流感染发生率,是一种有效的护理干预模式。%Objective To explore the application value of cluster nursing care in preventing central venous catheter -related bloodstream infections.Methods 200 patients with indwelling central venous catheter in ICU were selected as the research subjects.They were randomly divided into study group and control group by digital table, 100 cases in each group.The patients in the control group received routine nursing.The patients in the study group was given cluster based nursing.The catheter site,catheterization time,infection rate were compared between two groups.Results In the study group,the rates of internal jugular vein set pipe and lock venous catheter and femoral vein set tube were 82.00%(82 /100),14.00%(14 /100),4.00%(4 /100),which in the control group were 79

  18. Surveillance and analysis of central venous catheter-associated bloodstream infections in children with congenital heart disease after cardiac surgery%小儿先天性心脏病手术后中心静脉导管相关性血流感染调查分析

    Institute of Scientific and Technical Information of China (English)

    胡梅英; 陈修文; 乐萍

    2013-01-01

    OBJECTIVE To investigate the incidence of the central venous catheter-associated bloodstream infections in the children with congenital heart disease (CHD) after cardiac surgery and observe the distribution of pathogens. METHODS The targeted surveillance was performed for 928 children with CHD who were treated in the cardiac ICU from Jan to Dec 2012, and the children with the indwelling catheter duration over 48 hours and the children with the extubation time less than 48 hours were selected as the study objects, then the incidence of the central venous catheter-related bloodstream infections and the isolation of pathogens were analyzed. RESULTS Totally 15 cases were diagnosed as the central venous catheter-related bloodstream infections with the incidence of 1. 62% and 3. 79/1. 000 catheter days; totally 23 strains of pathogens were isolated from peripheral vein blood and/or catheter tips, which were mainly the gram-egative bacteria, and the Acinetobacter baumannii, Pseudo-monas aeruginosa and Serratia marcescens were the top three species. CONCLUSION The children with CHD are at high risk of the central-venous catheter-related bloodstream infections, it is necessary to strengthen the surveillance of the central venous catheter-related bloodstream infections in the children after cardiac surgery and take interventions so as to reduce the incidence of nosocomial infections.%目的 探讨小儿先天性心脏病(先心病)患儿术后,中心静脉导管相关血流感染(CLA-BSI)发生水平及病原菌分布特点.方法 对2012年1-12月心脏病治疗中心手术治疗的928例先心病患儿进行CLA-BSI目标性监测,将中心静脉导管留置时间>48 h或拔除导管<48 h内的先心病术后患儿作为研究对象,对CLA-BSI发生水平和病原菌检出进行分析.结果 共诊断CLA-BSI病例15例,感染率为1.62%,每千个导管日感染为3.79%;经外周静脉血或(和)中心静脉导管尖端标本共检出病原菌23株,病原菌以革

  19. 血培养阳性报警时间对新生儿凝固酶阴性葡萄球菌血流感染的诊断研究%The alarm time of positive blood culture in diagnosing the neonatal bloodstream infection of coagulase negative Staphy lococcus

    Institute of Scientific and Technical Information of China (English)

    程宏; 陈彩云; 程波

    2014-01-01

    目的:评价血培养阳性报警时间(TTP)对新生儿凝固酶阴性葡萄球菌血流感染的诊断价值,为临床治疗提供参考依据。方法回顾性分析2007年1月-2012年12月血培养凝固酶阴性葡萄球菌阳性的346例新生儿,分为血流感染组145例和血培养污染组201例;对所有新生儿进行血培养分析,比较血流感染患者与血培养污染患者TTP的差异,计算TTP对血流感染组与血培养污染组鉴别诊断的灵敏度、特异度、阳性预测值及阴性预测值。结果共调查1345例新生儿,其中346例新生儿血培养凝固酶阴性葡萄球菌阳性,阳性率为25.72%;血流感染组新生儿的TTP为(9.35±4.53)h,血培养污染组新生儿的TTP为(17.45±7.69)h,两组差异有统计学意义(P<0.01)。结论血培养阳性报警时间是很好的辅助诊断新生儿凝固酶阴性葡萄球菌血流感染的方法,以TTP≤12h为折点,可有效的鉴别诊断新生儿凝固酶阴性葡萄球菌血流感染和血培养污染。%OBJECTIVE To evaluate the diagnose value of positive blood culture (Time to positive ,TTP) to the neonatal bloodstream infection of coagulase negative Staphylococcus so as to provide clinical references . METHODS A retrospective analysis was conducted from 346 neonatal with positive coagulase negative staphylococ‐cus in blood culture from Jan .2007 to Dec .2012 .They were divided into bloodstream infection group (n=145) and blood culture contamination group (n=201) .All the neonatal were conducting blood culture analysis .Then the TTP of bloodstream infection group was compared with blood culture contamination group and the influence of TTP was calcu leted to the sensitivity ,specificity ,positive predictive value and negative predictive value of the dif‐ferential diagnosis of the two groups .RESULTS Among the 1345 neonatal patients ,346 were found positive in co‐agulase negative Staphylococcus ,the

  20. 集束化干预管理预防肝移植患者外周中心静脉导管相关性血流感染的效果研究%Effect of bundle care on prevention of peripherally inserted central venous catheter-related bloodstream infections in liver transplantation patients

    Institute of Scientific and Technical Information of China (English)

    王丽芹; 陈东方; 李丽

    2014-01-01

    OBJECTIVE To explore the effect of bundle care on prevention of peripherally inserted central venous catheter (PICC)‐related bloodstream infections in the liver transplantation patients so as to provide guidance for clinical prevention of the PICC‐related bloodstream infections and the standardized nursing .METHODS Totally 32 liver transplantation patients who underwent PICC from Nov 2011 to Oct 2012 and did not receive the bundle care were assigned as the control group ,and 29 liver transplantation patients who underwent PICC from Nov 2012 to Oct 2013 and received the bundle care were set as the experimental group ;the incidence of catheter‐related blood‐stream infections was observed and compared between the two groups .RESULTS The catheter indwelling time of the control group was 3 840 days ,the experimental group 4 524 days;the catheter‐related bloodstream infections occurred in 7 cases of the control group with the infection rate of 1 .82‰ and occurred in 3 cases of the experimen‐tal group with the infection rate of 0 .66‰ ,there was statistically significant difference in the incidence of catheter‐related bloodstream infections between the two groups (P<0 .05) .CONCLUSION The bundle care can effectively prevent the catheter‐related bloodstream infections in the liver transplantation patients .%目的:探讨集束化干预管理预防肝移植患者外周中心静脉导管(PICC)相关性血流感染(CRBSI)的效果,为临床预防PICC导管相关性血流感染及规范化护理提供参考依据。方法将2011年11月-2012年10月32例肝移植患者行PICC术未采取集束化干预管理的患者作为对照组,将2012年11月-2013年10月29例肝移植患者行PICC术采取集束化干预管理的患者作为试验组,比较两组CRBSI的发生率。结果对照组患者导管留置时间3840 d ,发生CRBSI 7例,CRBSI发生率1.82‰;试验组29例,导管留置时间4524 d ,发生CRBSI 3例,C RBS I

  1. Differential forms theory and practice

    CERN Document Server

    Weintraub, Steven H

    2014-01-01

    Differential forms are utilized as a mathematical technique to help students, researchers, and engineers analyze and interpret problems where abstract spaces and structures are concerned, and when questions of shape, size, and relative positions are involved. Differential Forms has gained high recognition in the mathematical and scientific community as a powerful computational tool in solving research problems and simplifying very abstract problems through mathematical analysis on a computer. Differential Forms, 2nd Edition, is a solid resource for students and professionals needing a solid g

  2. Nitrogen Forms in Humic Substances

    Institute of Scientific and Technical Information of China (English)

    ZHUOSU-NENG; WENQI-XIAO

    1992-01-01

    In this paper,the nitrogen forms in newly-formed humic substances,including humic acid (HA),fulvic acid (FA) and humic acid in humin (HAI),were studied by using the 15N CP-MAS NMR technique in combination with chemical approaches.Results show that the majority of nitrogen in HA,FA and HAI was in the amide form with some presented as aliphatic and/ or aromatic amines and some as pyrrole type nitrogen,although the contents of nonhydrolyzable nitrogen in them differed greatly from each other (15-55%).

  3. Supergravity actions with integral forms

    Science.gov (United States)

    Castellani, L.; Catenacci, R.; Grassi, P. A.

    2014-12-01

    Integral forms provide a natural and powerful tool for the construction of supergravity actions. They are generalizations of usual differential forms and are needed for a consistent theory of integration on supermanifolds. The group geometrical approach to supergravity and its variational principle are reformulated and clarified in this language. Central in our analysis is the Poincaré dual of a bosonic manifold embedded into a supermanifold. Finally, using integral forms we provide a proof of Gates' so-called "Ectoplasmic Integration Theorem", relating superfield actions to component actions.

  4. Supergravity Actions with Integral Forms

    CERN Document Server

    Castellani, L; Grassi, P A

    2014-01-01

    Integral forms provide a natural and powerful tool for the construction of supergravity actions. They are generalizations of usual differential forms and are needed for a consistent theory of integration on supermanifolds. The group geometrical approach to supergravity and its variational principle are reformulated and clarified in this language. Central in our analysis is the Poincare' dual of a bosonic manifold embedded into a supermanifold. Finally, using integral forms we provide a proof of Gates' so-called "Ectoplasmic Integration Theorem", relating superfield actions to component actions.

  5. Cold-formed steel design

    CERN Document Server

    Yu, Wei-Wen

    2010-01-01

    The definitive text in the field, thoroughly updated and expanded Hailed by professionals around the world as the definitive text on the subject, Cold-Formed Steel Design is an indispensable resource for all who design for and work with cold-formed steel. No other book provides such exhaustive coverage of both the theory and practice of cold-formed steel construction. Updated and expanded to reflect all the important developments that have occurred in the field over the past decade, this Fourth Edition of the classic text provides you with more of the detailed, up-to-the-minute techni

  6. Multiple forming tools in incremental forming - Influence of the forming strategies on sheet contour

    Science.gov (United States)

    Dang, T.; Tebaay, L. M.; Gies, S.; Tekkaya, A. E.

    2016-10-01

    Single point incremental forming (SPIF) is a well known process which is used for rapid prototyping or for small-quantity production. The feature of this process is the flexible manufacturing of complex hollow shapes with the use of basic equipments. However, this forming process takes very long time. To speed up the process time, multiple forming tools can be used simultaneously. This paper presents the influence of the multiple tools in SPIF on the formed shape. The conventional SPIF with a single tool is taken into account for a comparative analysis. The results in this study showed that the tool arrangements and its distance have a significant effect on the geometrical accuracy. Moreover, it is shown the influence between the vertical step size of the tool and the strain distributions. This knowledge can be used for generation of new forming strategies.

  7. Candida Infection of the Bloodstream - Candidemia

    Science.gov (United States)

    ... are 17 different species of Candida. Of these, Candida albicans (C. albicans), C. glabrata, C. parapsilosis and C. ... blood. In many cases, the species found is Candida albicans , however, other species of Candida, Candida tropicalis , C. ...

  8. Uncommon opportunistic yeast bloodstream infections from Qatar

    NARCIS (Netherlands)

    Taj-Aldeen, S.J.; AbdulWahab, A.; Kolecka, A.; Deshmukh, A.; Meis, J.F.G.M.; Boekhout, T.

    2014-01-01

    Eleven uncommon yeast species that are associated with high mortality rates irrespective of antifungal therapy were isolated from 17/187 (201 episodes) pediatric and elderly patients with fungemia from Qatar. The samples were taken over a 6-year period (January 2004-December 2010). Isolated species

  9. Fields and Forms on -Algebras

    Indian Academy of Sciences (India)

    Cătălin Ciupală

    2005-02-01

    In this paper we introduce non-commutative fields and forms on a new kind of non-commutative algebras: -algebras. We also define the Frölicher–Nijenhuis bracket in the non-commutative geometry on -algebras.

  10. Movement in aesthetic form creation

    DEFF Research Database (Denmark)

    Thomsen, Bente Dahl

    2015-01-01

    This paper presents the good practice based experiences found when movement is used to strengthen form creation and to create flow in the process of artistic education. Faced with the design engineering students’ problems with creating forms with aesthetic statements, the experiences with movement...... inspired the thesis that the design engineers’ training in aesthetic form creation can be improved by integrating the movement potential into their education. The paper documents the on-going work on developing a model for embodied creation of form called ‘Somatechne model’. The study also identifies...... a lens to assess the students’ development of mind-body skills, known as ‘The Three Soma’. The Somatechne model also helps to identify the activity that gives the students the opportunity to develop their sensibility and thus aesthetic attention....

  11. Distances to star forming regions

    CERN Document Server

    Loinard, Laurent

    2014-01-01

    The determination of accurate distances to star-forming regions are discussed in the broader historical context of astronomical distance measurements. We summarize recent results for regions within 1 kpc and present perspectives for the near and more distance future.

  12. Detection of Life Forms Project

    Data.gov (United States)

    National Aeronautics and Space Administration — Gaia Genomics proposes to develop an instrument for the detection of earthborn and/or planetary life forms that are based on a nucleic acid paradigm. Highly...

  13. Mechanics of Forming Ring Disks

    Directory of Open Access Journals (Sweden)

    Avakyan R.M.

    2010-12-01

    Full Text Available The analysis of forming ring disk of constant thickness in conditions of large plastic deformations taking into account the interconnected change of effective strain and deformation hardening is carried out. The analytical dependences characterizing the relative size of plastic area are obtained. The interrelation between the initial and final form of a product is established at maximum possible size of internal pressure.

  14. Terra firma-forme dermatosis

    OpenAIRE

    2013-01-01

    Terra firma-forme dermatosis is characterized by ′dirty′ brown-grey cutaneous patches and plaques that can simply be eradicated by forceful swabbing with alcohol pads. The pathogenesis has been attributed to abnormal and delayed keratinization. Although affected patients present with typical lesions, the disorder is not well-known by dermatologists. In this report, we describe two patients with terra firma-forme dermatosis in the setting of xerosis cutis and atopic dermatitis. From a clinical...

  15. BILINEAR FORMS AND LINEAR CODES

    Institute of Scientific and Technical Information of China (English)

    高莹

    2004-01-01

    Abraham Lempel et al[1] made a connection between linear codes and systems of bilinear forms over finite fields. In this correspondence, a new simple proof of a theorem in [1] is presented; in addition, the encoding process and the decoding procedure of RS codes are simplified via circulant matrices. Finally, the results show that the correspondence between bilinear forms and linear codes is not unique.

  16. Forms of Approximate Radiation Transport

    CERN Document Server

    Brunner, G

    2002-01-01

    Photon radiation transport is described by the Boltzmann equation. Because this equation is difficult to solve, many different approximate forms have been implemented in computer codes. Several of the most common approximations are reviewed, and test problems illustrate the characteristics of each of the approximations. This document is designed as a tutorial so that code users can make an educated choice about which form of approximate radiation transport to use for their particular simulation.

  17. Oxidized Form of Creatine Kinase

    Institute of Scientific and Technical Information of China (English)

    王希成; 王帆; 邹晓明; 周海梦

    1994-01-01

    The purified rabbit muscle creatine kinase (R-CK) was previously considered homogeneousand without disulfide bonds.By the method of NR/R two-dimensional diagonal SDS-PAGE,two forms of R-CK,designated respectively "oxidized form" of creatine kinase which contained intrachain disulfide bondsand "reduced form" of creatine kinase which did not have any —S—S— bridges,were for the first time sepa-rated.They were found to be the same in amino acid composition,in subunit molecular Weight and in isoelec-tric point,and were almost identical in enzyme activities.Thus it is hard to isolate one from the other bycommon biochemical methods.More extensive studies show that the oxidized form of CK also contains a pair of reactive thiol groupswhich are essential to the enzyme activity,and it has one intrachain disulfide bond per subunit.In the nativestate,this —S—S— bond cannot be reduced by DTT,but by treating the reduced form of CK with some ox-idants,these —S—S— bonds can be formed in vitro.Thus it is presumed that the disulfide bonds are cross-linked through the oxidization of two shallowly buried —SH groups.

  18. Conjoint Forming - Technologies for Simultaneous Forming and Joining

    Science.gov (United States)

    Groche, P.; Wohletz, S.; Mann, A.; Krech, M.; Monnerjahn, V.

    2016-03-01

    The market demand for new products optimized for e. g. lightweight applications or smart components leads to new challenges in production engineering. Hybrid structures represent one promising approach. They aim at higher product performance by using a suitable combination of different materials. The developments of hybrid structures stimulate the research on joining of dissimilar materials. Since they allow for joining dissimilar materials without external heating technologies based on joining by plastic deformation seem to be of special attractiveness. The paper at hand discusses the conjoint forming approach. This approach combines forming and joining in one process. Two or more workpieces are joined while at least one workpiece is plastically deformed. After presenting the fundamental joining mechanisms, the conjoint forming approach is discussed comprehensively. Examples of conjoint processes demonstrate the effectiveness and reveal the underlying phenomena.

  19. TRASYS form factor matrix normalization

    Science.gov (United States)

    Tsuyuki, Glenn T.

    1992-01-01

    A method has been developed for adjusting a TRASYS enclosure form factor matrix to unity. This approach is not limited to closed geometries, and in fact, it is primarily intended for use with open geometries. The purpose of this approach is to prevent optimistic form factors to space. In this method, nodal form factor sums are calculated within 0.05 of unity using TRASYS, although deviations as large as 0.10 may be acceptable, and then, a process is employed to distribute the difference amongst the nodes. A specific example has been analyzed with this method, and a comparison was performed with a standard approach for calculating radiation conductors. In this comparison, hot and cold case temperatures were determined. Exterior nodes exhibited temperature differences as large as 7 C and 3 C for the hot and cold cases, respectively when compared with the standard approach, while interior nodes demonstrated temperature differences from 0 C to 5 C. These results indicate that temperature predictions can be artificially biased if the form factor computation error is lumped into the individual form factors to space.

  20. Pre-exposure to moving form enhances static form sensitivity.

    Directory of Open Access Journals (Sweden)

    Thomas S A Wallis

    Full Text Available BACKGROUND: Motion-defined form can seem to persist briefly after motion ceases, before seeming to gradually disappear into the background. Here we investigate if this subjective persistence reflects a signal capable of improving objective measures of sensitivity to static form. METHODOLOGY/PRINCIPAL FINDINGS: We presented a sinusoidal modulation of luminance, masked by a background noise pattern. The sinusoidal luminance modulation was usually subjectively invisible when static, but visible when moving. We found that drifting then stopping the waveform resulted in a transient subjective persistence of the waveform in the static display. Observers' objective sensitivity to the position of the static waveform was also improved after viewing moving waveforms, compared to viewing static waveforms for a matched duration. This facilitation did not occur simply because movement provided more perspectives of the waveform, since performance following pre-exposure to scrambled animations did not match that following pre-exposure to smooth motion. Observers did not simply remember waveform positions at motion offset, since removing the waveform before testing reduced performance. CONCLUSIONS/SIGNIFICANCE: Motion processing therefore interacts with subsequent static visual inputs in a way that can improve performance in objective sensitivity measures. We suggest that the brief subjective persistence of motion-defined forms that can occur after motion offsets is a consequence of the decay of a static form signal that has been transiently enhanced by motion processing.

  1. Sixth-Form Colleges: An Endangered Organisational Form?

    Science.gov (United States)

    Stoten, David William

    2014-01-01

    The sixth-form college sector is often marginalised in policy and academic discourse, where the much larger school and further education sectors dominate. This paper sets out to describe the sector's key features, assess its position within the wider education system and consider its future in an increasingly competitive education market. The…

  2. Form und Sinn: Sprachwissenschaftliche Betrachtungen (Form and Meaning: Linguistic Observations).

    Science.gov (United States)

    Jakobson, Roman

    This collection of 14 papers and articles by Roman Jakobson contains works written and published between 1931 and 1970 which deal either with global aspects of language or with specific grammatical issues. The collection emphasizes Jakobson's concern for finding the links between form and meaning in language. The text is entirely in German with…

  3. Induction interview form in EDH

    CERN Document Server

    Information technology Department, AIS (Administrative Information Services) Group

    2007-01-01

    As part of the efforts to rationalise administrative procedures, the IT and HR Departments have developed a new EDH form for induction interviews, which can be accessed using the link below. In accordance with Administrative Circular No. 2 ('Recruitment, Appointment and possible developments regarding the contractual position of Staff Members', Rev. 3), the work and training objectives to be achieved during the probation period shall be specified in writing to all new staff members during an induction interview. The interview shall take place between the new staff member and his supervisor within six weeks of his taking up his duties at the latest. https://edh.cern.ch/Document/MAPS/Induction1) (or from the EDH desktop, by clicking on 'Other Tasks' and going to the 'HR & Training' heading) Please note that this form is to be used exclusively for new staff members. A separate EDH form will be developed for fellows.Information technology Department, AIS (Administrative Information Services) Group Human Re...

  4. Induction interview form in EDH

    CERN Document Server

    Information technology Department, AIS (Administrative Information Services) Group,

    2007-01-01

    As part of the efforts to rationalise administrative procedures, the IT and HR Departments have developed a new EDH form for induction interviews, which can be accessed using the link below. In accordance with Administrative Circular No. 2 ('Recruitment, Appointment and possible developments regarding the contractual position of Staff Members', Rev. 3), the work and training objectives to be achieved during the probation period shall be specified in writing to all new staff members during an induction interview. The interview shall take place between the new staff member and his supervisor within six weeks of him taking up his duties at the latest. https://edh.cern.ch/Document/MAPS/Induction (or from the EDH desktop, by clicking on 'Other Tasks' and going to the 'HR & Training' heading) Please note that this form is to be used exclusively for new staff members. A separate EDH form will be developed for fellows. Information technology Department, AIS (Administrative Information Services) Group Human...

  5. Amorphous drugs and dosage forms

    DEFF Research Database (Denmark)

    Grohganz, Holger; Löbmann, K.; Priemel, P.;

    2013-01-01

    formulation principles are needed to ensure the stability of amorphous drug forms. The formation of solid dispersions is still the most investigated approach, but additional approaches are desirable to overcome the shortcomings of solid dispersions. Spatial separation by either coating or the use of micro......The transformation to an amorphous form is one of the most promising approaches to address the low solubility of drug compounds, the latter being an increasing challenge in the development of new drug candidates. However, amorphous forms are high energy solids and tend to recry stallize. New......-containers has shown potential to prevent or delay recrystallization. Another recent approach is the formation of co-amorphous mixtures between either two drugs or one drug and one low molecular weight excipient. Molecular interactions between the two molecules provide an energy barrier that has to be overcome...

  6. Method of forming structural heliostat

    Science.gov (United States)

    Anderson, Alfred J.

    1984-06-26

    In forming a heliostat having a main support structure and pivoting and tilting motors and gears and a mirror module for reflecting solar energy onto a collector, the improvement characterized by a method of forming the mirror module in which the mirror is laid upon a solid rigid supporting bed in one or more sections, with or without focusing; a mirror backing sheet is applied by first applying respective thin layers of silicone grease and, thereafter, progressively rolling application to eliminate air bubbles; followed by affixing of a substrate assembly to the mirror backing sheet to form a mirror module that does not curve because of thermally induced stresses and differential thermal expansion or contraction effects. The silicone grease also serves to dampen fluttering of the mirror and protect the mirror backside against adverse effects of the weather. Also disclosed are specific details of preferred embodiments.

  7. Methods of forming boron nitride

    Science.gov (United States)

    Trowbridge, Tammy L; Wertsching, Alan K; Pinhero, Patrick J; Crandall, David L

    2015-03-03

    A method of forming a boron nitride. The method comprises contacting a metal article with a monomeric boron-nitrogen compound and converting the monomeric boron-nitrogen compound to a boron nitride. The boron nitride is formed on the same or a different metal article. The monomeric boron-nitrogen compound is borazine, cycloborazane, trimethylcycloborazane, polyborazylene, B-vinylborazine, poly(B-vinylborazine), or combinations thereof. The monomeric boron-nitrogen compound is polymerized to form the boron nitride by exposure to a temperature greater than approximately 100.degree. C. The boron nitride is amorphous boron nitride, hexagonal boron nitride, rhombohedral boron nitride, turbostratic boron nitride, wurzite boron nitride, combinations thereof, or boron nitride and carbon. A method of conditioning a ballistic weapon and a metal article coated with the monomeric boron-nitrogen compound are also disclosed.

  8. 综合ICU导管相关性血流感染的危险因素分析%Research on risk factors for central venous catheter-related bloodstream infections in general ICU

    Institute of Scientific and Technical Information of China (English)

    许燕卿; 周立新; 罗盛鸿; 李杏崧; 李轶男; 莫韶妹; 吕春梅; 邵劲松

    2012-01-01

    目的 探讨ICU导管相关性血流感染(CRBSI)的感染率及危险因素.方法 采用前瞻性监测,对2009年7月-2010年11月入住ICU> 24 h、年龄>1月龄的置管患者进行监测,并对发生CRBSI的病例进行危险因素分析.结果 监测患者共1145例,其中接受血管内置管的患者890例,血管内导管使用率为77.7%,置管日为9189 d,发生CRBSI 26例,CRBSI感染率为2.9%,平均日感染率为2.8/千日;CRBSI感染率与置管时间、置管次数均呈正相关(x2=40.71,P=0.000;x2=28.6,P=0.000);留置天数(OR=2.415)与置管次数(OR=1.531)是综合ICU的CRBSI独立危险因素.结论 严格执行手卫生、无菌技术置管和维护、尽早拔除导管是预防CRBSI发生的关键.%OBJECTIVE To determine the incidence rate and risk factors for catheter-related bloodstream infections (CRBSI ) in general ICU. METHODS Prospective monitoring was carried out on patients aged over one month whose ICU length of stay was over 24 hours from Jul 2009 to Nov 2010. The risk factors for CRBSI were analyzed. RESULTS Among the 1145 cases surveyed,890 cases were under intravenous catheterization. The rate of intravenous catheterization was 77. 7% while the overall duration was 9189 days. A total of 26 cases of CRBSI were observed with the incidence rate of 2. 9% and the mean daily incidence rate of 2. 8 per 1,000 catheter-day; the incidence rate of CRBSI was positively correlated with the duration of catheterization (x2 =40. 71,P = 0. 000) and frequency of catheterization (x2 =28. 6, P=0. 000), respectively. The duration (OR=2. 415) and frequency (OR=l. 531) of the catheterization were the independent risk factors for CRBSI in general ICU patients with central intravenous catheter. CONCLUSION The incidence rate of CRBSI can be reduced by performing strict hand hygiene procedures, aseptic technique for insertion, care for intravascular catheters and the removal of catheters in a timely manner.

  9. Prognostic determinants of death of patients with bloodstream infections in emergency department%急诊病区血行感染患者的死亡危险因素分析

    Institute of Scientific and Technical Information of China (English)

    李楠; 白传哲; 王静; 高燕

    2013-01-01

    目的 对急诊病区血行感染(BSI)患者的流行病学资料进行调查,探讨BSI患者死亡的危险因素.方法 对2009年1月-2010年12月沈阳军区总医院急诊科病区BSI患者进行回顾性调查,按照其病情转归将其分为生存组和死亡组,筛选BSI患者死亡危险因素.结果 52例患者被确诊为BSI,发生率为2.9%,28 d死亡率为30.8%;革兰阴性菌检出最高,占51.9%,BSI致患者的死亡率为56.3%;诊断BSI后的APACHEⅡ评分、器官功能障碍的数目、肾功能不全和凝血功能障碍均为BSI患者死亡的独立危险因素;及时正确使用抗菌药物可显著提高BSI患者生存率(P=0.038).结论 确诊BSI时的APACHEⅡ评分、器官功能障碍的数目、肾功不全和凝血功能障碍可以预测BSI患者病情的转归,及时正确使用抗菌药物是病情转归的关键因素.%OBJECTIVE To investigate the epidemiological data of the patients with bloodstream infections (BSD in emergency department and explore the risk factors associated with the death of the BSI patients. METHODS A retrospective study was performed to analyze the epidemic data of BSI in ED of General Hospital of Shenyang Military Region from Jan 2009 to Dec 2010. The patients were divided into the survival group and the death group according to the clinical outcomes, and the risk factors of the death of the BSI patients were screened. RESULTS Totally 52 cases were diagnosed as hospital-acquired BSI with the incidence rate of 2. 9% , and the 28-day mortality was 30. 8%. The gram-negative bacteria were the most frequently isolated pathogens, accounting for 51. 9%, an the mortality of the patients with BSI caused the pathogens was 56. 3%. The APACHE Ⅱ score, the number of involving organs of dysfunctions, renal dysfunction, and coagulation disorders at onset of the BSI were the independent predictors of mortality. Appropriate use of antimicrobial agents could significantly improve the survival rate of the BSI

  10. 中心静脉导管相关性血流感染危险因素分析%Risk factors of central venous catheter-related bloodstream infections

    Institute of Scientific and Technical Information of China (English)

    杨大运; 齐战; 高少伟

    2013-01-01

    目的 研究分析中心静脉导管相关性血流感染(CLABSI)的临床特征,为预防与控制CLABSI提供临床依据.方法 采用回顾性调查方法对2009-2011年CLABSI资料汇总进行统计分析.结果 600例住院患者发生CLABSI53例,发病率为7.1‰;在分离出的53株病原菌中以革兰阳性球菌为主,共27株占50.94%,真菌14株占26.42%,革兰阴性杆菌12株占22.64%;CLABSI发病率与插管时间、插管部位、导管腔数、全胃肠外营养(TPN)有关,差异有统计学意义(P<0.05),CLABSI发病率与最大无菌屏障及灌注抗菌药物无关(P>0.05).结论 插管时间、插管部位、导管腔数、全胃肠外营养是CLABSI的主要因素,应针对上述因素制定相应的干预措施,以降低CLABSI的发生.%OBJECTIVE To investigate and analyze the clinic features of central venous catheter-related infections so as to provide basis for the prevention and control of catheter-related bloodstream infections.METHODS By means of the retrospective survey,the data of the patients with central venous catheter-related infections who were hospitalized during 2009-2011 were statistically analyzed.RESULTS Of totally 600 cases of hospitalized patients,the central venous catheter-related infections occurred in 53 cases with the incidence rate of 7.1%.There were totally 53 strains of pathogens isolated,including 27 (50.94%) strains of gram-positive bacteria,14 (26.42%) strains of fungi,and 12 (22.64%) strains of gram-negative bacilli.The incidence of central venous catheterrelated infections was related to the catheterization duration,intubation site,number of catheter lumen,and total parenteral nutrition (TPN),and the difference was significant (P<0.05);the incidence of central venous catheter-related infections was not related to the maximum sterile barrier or the perfusion of antibiotics (P>0.05).CONCLUSION The catheterization duration,intubation site,number of catheter lumen,and TPN are the main

  11. 探讨血培养阳性结果在新生儿血流感染中的意义%Significance of blood culture positive results in judging neonatal bloodstream infections

    Institute of Scientific and Technical Information of China (English)

    张斗星; 张林; 李宗光; 胡安群

    2012-01-01

    目的 探讨新生儿血培养阳性的临床意义.方法 对2011年1 月至2011年12月科住院患儿血培养标本中分离到的阳性结果116 例进行分析,区别致病菌和污染菌.结果 116 例血培养阳性结果中,主要为革兰阳性球菌82 例(70.7%),革兰阴性杆菌33例(28.4%),白色念珠菌1 例(0.9%),判断为血流感染为52 例(44.8%),污染菌为64 例(55.2%),污染菌主要以血浆凝固酶阴性葡萄球菌为主;MRSA、MRCNS 和产ESBLs 细菌在致病菌和污染菌检出率基本一致,耐药谱基本相同;致病菌的阳性报警时间明显少于污染菌报警时间.结论 新生儿血培养报警阳性中,污染率较高,以血浆凝固酶阴性葡萄球菌为主,医师需将实验室结果与临床资料结合考虑,正确区分污染菌,发挥血培养的作用.%Objective To explore the clinical significance of the positive blood culture results in neonates. Methods A retrospective analysis of positive blood culture from 116 neonatal hospitalized patients in Anqing Municipal Hospital from January 2011 to December 2011 was done. Strains of pathogen and bacterium were identified. Results Eighty-two of 116 strains were from patients with gram-positive bacteria, 33 strains with gram negative bacilli, 1 strain with Candida albicans; fifty-two of 116 strains from patients with bloodstream infection and the other 64 strains with bacterium, mainly coagula.se negative staphylococcus (CNS). The detection rales of MRSA, MRCNS and KSBI.s from pathogen and bacterium were basically the same and the drug resistance was also similar. The mean growth time of pathogen was significantly shorter than that oi bacterium. Conclusion The incidence of coagulase negative staphylococcus bacterium in neonatal positive blood culture was relatively high. It is important for doctors to combine laboratory results with clinical materials to indentify bacterium and play the role of blood culture.

  12. 基层医院ICU中心静脉导管相关性血流感染的危险因素分析%Risk Factors of Catheter-Associated Bloodstream Infections in Intensive Care Unit of Primary Hospital

    Institute of Scientific and Technical Information of China (English)

    张细江

    2012-01-01

    Objective To explore the risk factors of catheter-associated bloodstream infections (CRBSI) in intensive care unit (ICU) of primary hospital. Methods A total of 623 patients with central venous catheters were recruited in the study. 60 of them suffered from CRBSI served as an observation group and other 563 cases without CRBSI served as control. Univariate analysis was used to scan possible risk factors. Then logistic regression analysis was used to exclude the confounding factors. Results The overall incidence rate of CRBSI was 9. 63% (60/623). There were significant differences in APACHE score, type of catheter,location of catheter,duration of central venous catheter,intravenous nutrition, use of steroid,times of intubation, urgent intubations, nutritional status, diabetes, and MODS between the two groups. Logistic regression analysis revealed that higher APACHE score, double-lumen catheter, femoral vein catheter, catheter indwelling more than two weeks, intravenous nutrition, intubation more than 2 times, and emergency intubation were risk factors of CRBSI. Conclusions Higher APACHE score,double-lumen catheter,femoral vein catheter,catheter indwelling more than two weeks,intravenous nutrition,intubation more than 2 times, and emergency intubation were major risk factors of CRBSI in ICU of primary hospital.%目的 探讨基层医院ICU中心静脉导管相关血流感染(CRBSI)的危险因素.方法 以台州市立医院ICU就诊的中心静脉导管留置患者为研究对象,根据是否发生CRBSI分成感染组(60例)和非感染组(563例),首先单因素分析初步筛查CRBSI的危险因素,然后以是否发生CRBSI(1=是,0=否)为因变量,以单因素分析有差别的危险因素为自变量,进行Logistic多因素回归分析,寻找CRBSI的危险因素.结果 CRBSI的发生率为9.63% (60/623);感染组与非感染组APACHE评分、导管类型、导管留置部位、留置时间、静脉营养、激素使用、插管次数、紧急插管、营

  13. Risk factors for catheter-related bloodstream infection in an intensive care unit%ICU 导管相关血流感染危险因素分析

    Institute of Scientific and Technical Information of China (English)

    刘银梅; 余红; 杨惠英

    2014-01-01

    目的:了解重症监护室(ICU)导管相关血流感染(CRBSI)的危险因素,为其预防控制提供科学依据。方法选取2008年1月-2012年12月某院 ICU 行中心静脉置管(CVC)且时间>48 h 的住院患者1677例,分为CRBSI 组和非 CRBSI 组,对其进行危险因素分析。结果 CVC 使用率为92.88%(21041 d);发生 CRBSI 86例, CRBSI 发生率为5.13%,千导管日 CRBSI 发生率为4.02/1000,CRBSI 组患者病死率为58.14%(50/86),显著高于非CRBSI 组的36.83%(586/1591),差异有统计学意义(χ2=15.74,P <0.01)。多因素 logistic 回归分析结果显示,入住ICU 时间>5 d、CVC 时间>5 d、CVC 次数>1次是 CRBSI 的危险因素(均 P <0.01)。结论了解 ICU 住院患者CRBSI 状况及其危险因素,可为进一步开展目标性监测,实现 CRBSI“零宽容”的奋斗目标提供参考。%Objective To study the risk factors for catheter-related bloodstream infection (CRBSI)in an intensive care unit (ICU),and provide scientific evidence for CRBSI prevention and control.Methods 1 677 ICU patients with central venous catheterization (CVC)for>48 hours between January 2008 and December 2012 were divided in-to CRBSI group and non-CRBSI group,risk factors for CRBSI were analyzed.Results The utilization rate of CVC was 92.88% (21 041 d);86 (5.13%)patients developed CRBSI,the incidence of CRBSI per 1 000 catheterization-day was 4.02,the mortality of CRBSI group was significantly higher than non-CRBSI group (58.14% [50/86]vs 36.83%[586/1 591])(χ2 =15.74,P 5 days,CVC>5 days,the episode of CVC>1 (P <0.01).Conclusion Realizing the occur-rence status and risk factors of CRBSI in ICU patients can provide reference for further targeted monitor and implementation of zero tolerance goal of the CRBSI.

  14. Differential forms on electromagnetic networks

    CERN Document Server

    Balasubramanian, N V; Sen Gupta, D P

    2013-01-01

    Differential Forms on Electromagnetic Networks deals with the use of combinatorial techniques in electrical circuit, machine analysis, and the relationship between circuit quantities and electromagnetic fields. The monograph is also an introduction to the organization of field equations by the methods of differential forms. The book covers topics such as algebraic structural relations in an electric circuit; mesh and node-pair analysis; exterior differential structures; generalized Stoke's theorem and tensor analysis; and Maxwell's electromagnetic equation. Also covered in the book are the app

  15. Language, Culture and Symbolic Forms

    OpenAIRE

    Theis, Wolfgang

    2010-01-01

    As Ernst Cassierer introduced in his “Philosophie der symbolischen Formen” in 1923, he specifically mentioned “language” as well as a way of symbolic forms. In 1991, the self declared “researcher on human sciences”, Norbert Elias, published his work called “The Symbol Theory” where he mainly writes about language as an application of symbolic forms and symbols. Elias does not make any reference to Cassirer at all, but states that languages are a part of a civilization process and part of cult...

  16. Metallurgical Characterization of Superplastic Forming

    Science.gov (United States)

    1980-09-01

    The trans - formation of constant-crosshead-speed stress-strain curves into constant-strain- rate curves is clearly not satisfactory because it is based...MILL-ANNEALED AND SUPERPLASTICALLY- FORMED CONDITIONS; FORMING TEMPERATURE - 949EPC (17400F). 01"tln Stoi rte yeld grasa Ultimate l to oret~lSri as...1975), p. 163. 7. G. Rai and N. J. Grant, "On the Measurermients of Superplasticity in an Al-Cu Alloy," Met. Trans . 6A, 385 (1975). 8. A. K, Mukherjee

  17. Auxin biosynthesis and storage forms.

    Science.gov (United States)

    Korasick, David A; Enders, Tara A; Strader, Lucia C

    2013-06-01

    The plant hormone auxin drives plant growth and morphogenesis. The levels and distribution of the active auxin indole-3-acetic acid (IAA) are tightly controlled through synthesis, inactivation, and transport. Many auxin precursors and modified auxin forms, used to regulate auxin homeostasis, have been identified; however, very little is known about the integration of multiple auxin biosynthesis and inactivation pathways. This review discusses the many ways auxin levels are regulated through biosynthesis, storage forms, and inactivation, and the potential roles modified auxins play in regulating the bioactive pool of auxin to affect plant growth and development.

  18. 儿童大肠埃希菌血流感染临床特征及耐药分析%Clinical features and antibiotic resistance of Escherichia coli bloodstream infections in children

    Institute of Scientific and Technical Information of China (English)

    李绍英; 郭凌云; 刘琳琳; 董方; 刘钢

    2016-01-01

    目的 分析儿童大肠埃希菌血流感染的易患因素、临床特点、转归及细菌耐药性.方法 以2012年1月至2014年5月首都医科大学附属北京儿童医院血培养为大肠埃希菌的112例患儿为研究对象,男66例(58.9%),女46例(41.1%),年龄2d~16岁,其中新生儿43例(38.4%),>28 d~1岁19例(17.0%),>1 ~3岁14例(12.5%),>3岁36例(32.1%).对患儿的科室分布、感染类型、基础疾病、临床特征、抗生素耐药、治疗转归及影响预后的因素等进行分析.结果 血液科46例(41.1%),新生儿中心42例(37.5%),内科9例(8.0%),外科8例(7.1%),重症监护室(PICU)7例(6.3%).有基础疾病的65例(58.0%).发热为最常见首发症状,共91例(81.3%).呼吸系统损害52例(46.4%),其中肺炎43例,呼吸衰竭3例,上呼吸道感染3例,肺出血2例,支气管炎1例,严重脓毒血症26例(23.2%),化脓性脑膜炎26例(23.2%),泌尿系统感染14例(12.5%).产超广谱β内酰胺酶(ESBLs) 73株(65.2%),其中阿米卡星耐药6株(8.2%),耐碳青霉烯类10株(13.7%).其他抗菌药物耐药率为64.6%~ 100%.转归:痊愈及好转92例(82.1%),未愈及死亡20例(17.9%).预后不良的相关因素为产ESBLs菌株感染(x2=6.609,P=0.010)、并发严重脓毒血症(x2=40.253,P=0.000)及机械通气(x2=34.441,P =0.000).结论 有基础疾病者、新生儿是大肠埃希菌血流感染的易患因素.产ESBLs菌株感染、严重脓毒血症及机械通气者预后差.碳青霉烯类可作为产ESBLs菌株感染的经验性用药,疗效不佳时,需警惕耐药菌.%Objective To analyze risk factors,clinical features,outcomes and antibiotic resistance of Escherichia coli(E.coli) causing bloodstream infections in children.Method All inpatients with E.coli positive blood culture in Beijing Children's Hospital from January 2012 to May 2014 were enrolled;112 cases were included,66 cases (58.9%) were male,and 46 cases(41.1%) were female.Age range

  19. Risk factors of bloodstream infection-related death after liver transplantation%肝移植术后血流感染死亡的危险因素分析

    Institute of Scientific and Technical Information of China (English)

    万齐全; 谢建飞; 叶少军; 刘忠忠; 仲福顺; 周建党; 叶啟发

    2016-01-01

    发生≥3次的血流感染(最多发生了6次).41.12% (44/107)发生血流感染的肝移植受者接受了不恰当的抗感染处理.原发感染部位:腹腔内、肺、尿道、血管内导管、部位不明分别为40、39、3、1、24例.微生物感染类型:革兰氏阳性菌、革兰氏阴性菌、真菌、混合感染分别为28、24、4、51例.102例为院内感染.186株血液标本细菌培养结果显示:84株为革兰氏阳性菌是其主要的致病菌,其中又以肠球菌(31株)及金黄色葡萄球菌(23株)为优势菌株.血流感染病死率为37.38% (40/107),其中因感染性休克死亡35例.(2)影响肝移植受者术后血流感染相关死亡的危险因素分析指标:单因素分析结果显示:受者的性别、供肝来源、感染时体温、病原微生物类型、血清Cr水平、血清Alb水平、外周血WBC、外周血PLT、感染性休克是肝移植术后血流感染死亡的危险因素(x2=5.801,5.920,13.047,12.776,11.366,7.976,25.173,9.289,51.905,P<0.05).多因素分析结果表明:血清Alb水平<30 mg/L和感染性休克是肝移植术后血流感染相关死亡的独立危险因素(OR=5.839,44.983,95%可信区间:1.145~29.767,12.606~160.514,P <0.05).结论 肝移植术后易发生血流感染,血清Alb水平<30mg/L和感染性休克是肝移植术后血流感染相关死亡的独立危险因素.%Objective To investigate the risk factors of bloodstream infection-related death after liver transplantation.Methods The retrospective case-control study was adopted.The clinical data of the 107 patients with bloodstream infection from 365 liver transplantation patients who were admitted to the Third Xiangya Hospital of Central South University (220 patients) and South Central Hospital Affiliated to Wuhan University (145 patients) from January 1,2002 to December 31,2015 were collected.The patients received modified piggyback liver transplantation.The second or third generation celphalosporin or carbapenems antibiotics

  20. Analysis of resistance tendency of bloodstream-infecting pathogens in China%2004-2010年中国血标本中致病菌耐药趋势分析

    Institute of Scientific and Technical Information of China (English)

    吕媛; 李耘; 薛峰; 张秀珍; 胡云建; 金玉芬; 褚云卓; 胡志东; 赵建宏

    2013-01-01

    Objective To investigate the resistance profiles and the trend of bloodstream-infecting pathogens isolated from hospitalized patients during 2004-2010.Methods The bloodstream isolates were collected from 18 hospitals in 17 cities.Minimum inhibition concentrations (MIC) were determined using the agar dilution method recommended by CLSI (Clinical and Laboratory Standards Institute),and susceptibility results were analyzed according to the 2011 CLSI guideline.Results Among the 2004-2005,2007-2008 and 2009-2010 periods,the proportions of clinical isolates were similar; 43.1% (149 isolates),34.0% (151 isolates) and 47.5% (776 isolates) for Gram positive strains,56.9% (197 isolates),66.0% (293 isolates) and 52.5% (858 isolates) for Gram negative strains,respectively.The isolating rate of MRSA was 54.1% (20/37) in 2007-2008,which was the highest among the 3 periods during 2004 to 2010,while it decreased in 2009-2010 (36.5%,62/170).The MRCNS proportions were similar across the 3 periods.One (1.8%) vancomycin-resistant Enterococcus faecium and 1 linezolidresistant Enterococcus faecalis were found.Although the isolating rates of penicillin non-sensitive strains (oral) were similar between 2009-2010 and 2007-2008 [54.5% (6/11) and 53.9% (7/13),respectively],the resistant rates increased from 0% in 2007-2008 to 30.8% (4/13) in 2009-2010.The results were similar according to the non-meningitis criterion (Ⅳ),and the susceptibility rates decreased from 100.0% (11 isolates) in 2007-2008 to 84.6% (11/13) in 2009-2010.ESBL-harboring strains in E.coli were similar among the 3 periods during 2004 to 2010 [66.7% (30/45),73.2% (71/97) and 67.9% (233/343),respectively].ESBL-producing strains in Klebsilla pnuemoniae decreased year after year,72.4% (21/29),50.0% (18/36) and 41.1% (65/158) in 2004-2005,2007-2008 and 2009-2010,respectively.Except that the sensitive rate of Enterobacter cloacae to ertapenem was 80% (32/40),the sensitive rates of

  1. 75 FR 26782 - Agency Information Collection Activities: Form I-864, Form I-864A, Form I-864EZ, and Form I-864W...

    Science.gov (United States)

    2010-05-12

    ... Agency Information Collection Activities: Form I-864, Form I- 864A, Form I-864EZ, and Form I-864W... Collection Under Review; Form I- 864, Affidavit of Support Under Section 213A of the Act; Form I-864A, Contract Between Sponsor and Household Member, Form I-864EZ, Affidavit of Support Under Section 213A of...

  2. 肝移植术后耐甲氧西林金黄色葡萄球菌血流感染危险因素的17年回顾性分析%A 17-year retrospective study of the risk factor of bloodstream infection with MRSA after liver transplantation

    Institute of Scientific and Technical Information of China (English)

    邰强; 何晓顺; 巫林伟; 鞠卫强; 王东平; 王国栋; 马毅; 胡安斌; 郭志勇; 朱晓峰

    2011-01-01

    目的 探讨本院肝移植术后耐甲氧西林金黄色葡萄球菌(MRSA)血流感染的危险因素及临床结果.方法 回顾分析1993年1月至2010年5月肝移植术后血液MRSA阳性感染者的资料.结果 695例肝移植患者中,53例(7.6%)出现革兰氏阳性球菌血流感染,以肠球菌最为常见,7例病人发生7次MRSA血流感染.分析肝移植术后MRSA血流感染的危险因素发现,急性排斥(P=0.03)是出现MRSA血流感染的危险因素.肝移植术后MRSA血流感染与非MRSA血流感染的15d、30 d、1年病死率差异无统计学意义.结论 急性排斥是出现肝移植术后MRSA血流感染的危险因素,但肝移植术后MRSA血流感染后15d、30 d、1年的死亡率未明显增加.%Objective To define the risk factor and mortality of methicillin-resistant Staphylococcus aureus (MRSA) of bloodstream infections(BSI) after liver transplantation. Method From January 1993 to May 2010, a retrospective analysis of methicillin-resistant Staphylococcus aureus in liver transplants are conducted. Results S3 out of 695 patients had BSI, commonly infected with enterococcus. Postoperative acquisition of MRSA was detected in 7 patients. Univariate analysis identified acute rejection was the risk factor for methicillin-resistant Staphylococcus aureus bacteremia(P=0.03). No significant differences was found in mortality at 15 days,30 days and 1 year in methicillin-resistant Staphylococcus aureus bacteremia after liver transplantation. Conclusions Risk factor associated with methicillin-resistant Staphylococcus aureus of bloodstream infections was acute rejection. Methicillin-resistant Staphylococcus aureus bloodstream infection show no significance in mortality at 15 days, 30 days and 1 year after operation.

  3. Role of Calcitonin Original Level Testing in Identifying Strains of Bloodstream Infections of Patients in ICU%降钙素原水平检测对鉴别重症监护病房血流感染患者菌种的作用

    Institute of Scientific and Technical Information of China (English)

    龚剑锋; 向镜芬; 杨祥; 孟启勇; 雷伟健

    2015-01-01

    目的:探讨PCT水平对鉴别重症监护病房血流感染患者菌种的价值。方法:选择2011年3月-2014年1月本院ICU患者131例作为研究对象,按照其菌种将其分为G-组、G+组及真菌组,比较各组PCT水平差异,并根据其ROC曲线判断血清PCT的诊断性能。结果:三组血清PCT中位数水平差异具有统计学意义(P<0.05);血清PCT水平对G-菌与G+菌及真菌所致的血流感染鉴别诊断性能较高。结论:血清PCT水平对于鉴别G-菌与G+菌或真菌引起的血流感染有一定的临床鉴别价值,但是对于G+菌与真菌引起的感染鉴别意义尚不明确。%Objective:To investigate the value of calcitonin original level in identifying bacterial bloodstream infections of patients in intensive care unit. Method:131 patients in ICU of our hospital from March 2011 to January 2014 were selected as the objects.They were divided into group G-,group G+and group fungi according to different strains.Differences in PCT levels were compared among the three groups and diagnostic performance of serum PCT was determined according to its ROC curve. Result:Differences in median serum PCT levels of the three groups were statistically significant.Serum PCT level has a higher diagnostic capacity in differentiating bloodstream infections caused by G-bacteria and G+bacteria or fungi.Conclusion:Serum PCT level plays a certain role in differentiating bloodstream infections caused by G-bacteria and G+bacteria or fungi,but it plays an uncertain role in differentiating infections caused by G+bacteria and fungi.

  4. Free Form Technology from Delft

    NARCIS (Netherlands)

    Eekhout, A.J.C.M.; Van Gelder, B.L.; Lockefeer, W.A.A.M.; Veltkamp, M.; Vollers, K.J.

    2016-01-01

    The success of the Guggenheim Museum in Bilbao, designed and engineered by Frank O. Gehry and inaugurated in 1997, opened the eyes of the world to the plastic possibilities of Free Form Design. That is, on the side of architects and their admiring clients. Some architects draw up complicated but sur

  5. Spin-forming Project Report

    Energy Technology Data Exchange (ETDEWEB)

    Switzner, Nathan; Henry, Dick

    2009-03-20

    In a second development order, spin-forming equipment was again evaluated using the test shape, a hemispherical shell. In this second development order, pure vanadium and alloy titanium (Ti-6Al-4V) were spin-formed, as well as additional copper and 21-6-9 stainless. In the first development order the following materials had been spin-formed: copper (alloy C11000 ETP), 6061 aluminum, 304L stainless steel, 21-6-9 stainless steel, and tantalum-2.5% tungsten. Significant challenges included properly adjusting the rotations-per-minute (RPM), cracking at un-beveled edges and laser marks, redressing of notches, surface cracking, non-uniform temperature evolution in the titanium, and cracking of the tailstock. Lessons learned were that 300 RPM worked better than 600 RPM for most materials (at the feed rate of 800 mm/min); beveling the edges to lower the stress reduces edge cracking; notches, laser marks, or edge defects in the preform doom the process to cracking and failure; coolant is required for vanadium spin-forming; increasing the number of passes to nine or more eliminates surface cracking for vanadium; titanium develops a hot zone in front of the rollers; and the tailstock should be redesigned to eliminate the cylindrical stress concentrator in the center.

  6. English Pidgins: Form and Function.

    Science.gov (United States)

    Mufwene, Salikoko S.

    1988-01-01

    Highlights similarities and variation in both form and function of English pidgins the world over. It is argued that English pidgins are related more by socio-historical conditions and directions of development than by details of their formal structure. Reference list includes 68 citations. (Author/DJD)

  7. Education fees – New forms

    CERN Multimedia

    2015-01-01

    The application forms for the payment of education fees have been updated and are now available in the Admin e-guide (under the “Useful Documents” heading):   Payment of education fees (including language course fees) – AC12A (form to be used by staff members recruited before 1 January 2007, with the exception of former “local staff”).   Payment of education fees – AC12B (form to be used by staff members recruited on or after 1 January 2007, by fellows, scientific associates and guest professors and by former “local staff” whose contracts started before 1 January 2007). The Education Fees service will continue to accept the old forms until the end of the current academic year, i.e. until 31 August 2015. Members of the personnel are reminded that any false declaration or failure to declare information with a view to deceiving others or achieving a gain that would result in a financial loss for CERN or...

  8. Multiplicative forms and Spencer operators

    NARCIS (Netherlands)

    Crainic, Marius; Salazar Pinzon, Maria; Struchiner, Ivan

    2014-01-01

    Motivated by our attempt to recast Cartan’s work on Lie pseudogroups in a more global and modern language, we are brought back to the question of understanding the linearization of multiplicative forms on groupoids and the corresponding integrability problem. From this point of view, the novelty of

  9. Application of Incremental Sheet Forming

    Directory of Open Access Journals (Sweden)

    Karbowski Krzysztof

    2015-12-01

    Full Text Available This paper describes some manufacturing aspects and an example of application of the Incremental Sheet Forming (ISF technology which was used for production of the craniofacial prosthesis. The brief description of prosthesis designing was presented as well. The main topic of the paper is comparison of milling and ISF technologies for preparing the tools for prosthesis thermoforming.

  10. Temporal form in interaction design

    DEFF Research Database (Denmark)

    Vallgårda, Anna; Winther, Morten Trøstrup; Mørch, Nina;

    2015-01-01

    a nuanced account of what temporal form is in interaction design, and we look at related work synthesizing what we already know of the temporal concerns in interaction design and HCI. In the second part we present a design experiment through which we explore the experiential qualities of a set of 11 simple...

  11. Technetium Immobilization Forms Literature Survey

    Energy Technology Data Exchange (ETDEWEB)

    Westsik, Joseph H.; Cantrell, Kirk J.; Serne, R. Jeffrey; Qafoku, Nikolla

    2014-05-01

    Of the many radionuclides and contaminants in the tank wastes stored at the Hanford site, technetium-99 (99Tc) is one of the most challenging to effectively immobilize in a waste form for ultimate disposal. Within the Hanford Tank Waste Treatment and Immobilization Plant (WTP), the Tc will partition between both the high-level waste (HLW) and low-activity waste (LAW) fractions of the tank waste. The HLW fraction will be converted to a glass waste form in the HLW vitrification facility and the LAW fraction will be converted to another glass waste form in the LAW vitrification facility. In both vitrification facilities, the Tc is incorporated into the glass waste form but a significant fraction of the Tc volatilizes at the high glass-melting temperatures and is captured in the off-gas treatment systems at both facilities. The aqueous off-gas condensate solution containing the volatilized Tc is recycled and is added to the LAW glass melter feed. This recycle process is effective in increasing the loading of Tc in the LAW glass but it also disproportionally increases the sulfur and halides in the LAW melter feed which increases both the amount of LAW glass and either the duration of the LAW vitrification mission or the required supplemental LAW treatment capacity.

  12. Polynomial Algebra in Form 4

    Science.gov (United States)

    Kuipers, J.

    2012-06-01

    New features of the symbolic algebra package Form 4 are discussed. Most importantly, these features include polynomial factorization and polynomial gcd computation. Examples of their use are shown. One of them is an exact version of Mincer which gives answers in terms of rational polynomials and 5 master integrals.

  13. PIC Reading Readiness Test Form.

    Science.gov (United States)

    Short, N. J.

    This rating form concerns the measurement of basic skills in connection with assessing reading readiness. Motor skills, ability to adjust to learning situations, familiarity with the alphabet, and general knowledge are assessed. See TM 001 111 for details of the Regional PIC program in which it is used. (DLG)

  14. Form Filling with SCC in a Vertical Form

    DEFF Research Database (Denmark)

    Thrane, Lars Nyholm

    2004-01-01

    University of Denmark and the second largest ready-mix manufacturer in Denmark, 4K-Beton A/S. The aim is to identify the flow characteristic of SCC and the effect of concrete properties, casting technique, reinforcement configuration, and form geometry. A wall form of dimensions l = 3m, w = 0.3m, h =1m has....... Monitoring equipment has been produced and tested and is valuable as documentary evidence of the flow in combination with visual observations. In one experiment reinforcement gap sizes of 1.5 and 3⋅Dmax,agg have been applied and blocking occurred at 1.5⋅Dmax,agg. Pumping from the bottom corner at casting...... rate of 10 m/h resulted in hydrostatic pressure. Continuously shearing across the surface seems to have a positive effect on the surface quality (no blowholes)....

  15. Form Factors of Few-Body Systems: Point Form Versus Front Form

    CERN Document Server

    Gómez-Rocha, Maria; Schweiger, Wolfgang

    2011-01-01

    We present a relativistic point-form approach for the calculation of electroweak form factors of few-body bound states that leads to results which resemble those obtained within the covariant light-front formalism of Carbonell et al. Our starting points are the physical processes in which such form factors are measured, i.e. electron scattering off the bound state, or the semileptonic weak decay of the bound state. These processes are treated by means of a coupled-channel framework for a Bakamjian-Thomas type mass operator. A current with the correct covariance properties is then derived from the pertinent leading-order electroweak scattering or decay amplitude. As it turns out, the electromagnetic current is affected by unphysical contributions which can be traced back to wrong cluster properties inherent in the Bakamjian-Thomas construction. These spurious contributions, however, can be separated uniquely, as in the covariant light-front approach. In this way we end up with form factors which agree with tho...

  16. Terra firma-forme dermatosis

    Directory of Open Access Journals (Sweden)

    Emel Erkek

    2012-01-01

    Full Text Available Terra firma-forme dermatosis is characterized by ′dirty′ brown-grey cutaneous patches and plaques that can simply be eradicated by forceful swabbing with alcohol pads. The pathogenesis has been attributed to abnormal and delayed keratinization. Although affected patients present with typical lesions, the disorder is not well-known by dermatologists. In this report, we describe two patients with terra firma-forme dermatosis in the setting of xerosis cutis and atopic dermatitis. From a clinical point of view, we lay emphasis on its unique expression and diagnosis/treatment. From a histological perspective, we highlight its resemblance to dermatosis neglecta and speculate on the role of ′neglect′ in a patient with seemingly adequate hygiene. The role of urea containing emollients in the development of this disorder remains to be determined.

  17. Free-form illumination optics

    Science.gov (United States)

    Mohedano, Rubén; Chaves, Julio; Hernández, Maikel

    2016-04-01

    In many illumination problems, the beam pattern needed and/or some geometrical constraints lead to very asymmetric design conditions. These asymmetries have been solved in the past by means of arrangements of rotationally symmetric or linear lamps aimed in different directions whose patterns overlap to provide the asymmetric prescriptions or by splitting one single lamp into several sections, each one providing a part of the pattern. The development of new design methods yielding smooth continuous free-form optical surfaces to solve these challenging design problems, combined with the proper CAD modeling tools plus the development of multiple axes diamond turn machines, give birth to a new generation of optics. These are able to offer the performance and other advanced features, such as efficiency, compactness, or aesthetical advantages, and can be manufactured at low cost by injection molding. This paper presents two examples of devices with free-form optical surfaces, a camera flash, and a car headlamp.

  18. Unsplit bipolar pulse forming line

    Science.gov (United States)

    Rhodes, Mark A.

    2011-05-24

    A bipolar pulse forming transmission line module and system for linear induction accelerators having first, second, third, and fourth planar conductors which form a sequentially arranged interleaved stack having opposing first and second ends, with dielectric layers between the conductors. The first and second planar conductors are connected to each other at the first end, and the first and fourth planar conductors are connected to each other at the second end via a shorting plate. The third planar conductor is electrically connectable to a high voltage source, and an internal switch functions to short at the first end a high voltage from the third planar conductor to the fourth planar conductor to produce a bipolar pulse at the acceleration axis with a zero net time integral. Improved access to the switch is enabled by an aperture through the shorting plate and the proximity of the aperture to the switch.

  19. The faintest star forming galaxies

    CERN Document Server

    Ranalli, P

    2003-01-01

    I briefly report on the X-ray detection of 10 radio sub-mJy sources in the 2 Ms Chandra observation of the Hubble Deep Field North region. These sources follow the same radio/X-ray luminosities relation which holds for nearby galaxies. Making use of this relation, X-ray number counts from star forming galaxies are predicted from the deep radio Log N-Log S's.

  20. Old and New Insurgency Forms

    Science.gov (United States)

    2016-03-01

    of this type of terrorism is to create religious—predominately Islamic—states and relies heavily upon suicide bombing techniques. 9 Extremist... minority rule, would include the independence wars by anti-colonial na- tionalist groups in the Portuguese colonies of Angola, Guinea-Bissau, and...2015 essay on this insurgency form, Bunker identi- fied such predatory capitalist activities as follows: • Stress profit and equity gain at all costs

  1. The Integral Form of Supergravity

    CERN Document Server

    Castellani, L; Grassi, P A

    2016-01-01

    By using integral forms we derive the superspace action of D=3, N=1 supergravity as an integral on a supermanifold. The construction is based on target space picture changing operators, here playing the role of Poincare' duals to the lower-dimensional spacetime surfaces embedded into the supermanifold. We show how the group geometrical action based on the group manifold approach interpolates between the superspace and the component supergravity actions, thus providing another proof of their equivalence.

  2. Current forms and gauge invariance

    Energy Technology Data Exchange (ETDEWEB)

    Lopez, M Castrillon [Departemento de GeometrIa y TopologIa, Facultad de Matematicas, Universidad Complutense de Madrid, 28040-Madrid (Spain); Masque, J Munoz [Instituto de FIsica Aplicada, CSIC, C/Serrano 144, 28006-Madrid (Spain)

    2004-05-14

    Let C be the bundle of connections of a principal G-bundle {pi}:P {yields} M, and let V be the vector bundle associated with P by a linear representation G {yields} GL(V) on a finite-dimensional vector space V. The Lagrangians on J{sup 1}(C x {sub M}V) whose current form is gauge invariant, are described and the gauge-invariant Lagrangians on J{sup 1}(V) are classified.

  3. SOD FORM OF PERENNIAL GRASSES

    OpenAIRE

    Belyuchenko I. S.

    2014-01-01

    The article considers the peculiarities of turf and sod, specificity of formation of kidneys for regeneration, types of shoots, vegetative mobility and specificity of growth in certain conditions, turf grasses are divided into loosely-and tightly-turf characterized, by specific features of environmental, biological characteristics; forming turf from generative rosettes, elongated and shortened vegetative, side ground shoots, differing specificity of morphological, biochemical and fitocoenotic...

  4. Do atmospheric aerosols form glasses?

    OpenAIRE

    Zobrist, B.; Marcolli, C.; Pedernera, D. A.; Koop, T.

    2008-01-01

    A new process is presented by which water soluble organics might influence ice nucleation, ice growth, chemical reactions and water uptake of aerosols in the upper troposphere: the formation of glassy aerosol particles. Glasses are disordered amorphous (non-crystalline) solids that form when a liquid is cooled without crystallization until the viscosity increases exponentially and molecular diffusion practically ceases. The glass transition temperatures, Tg

  5. Lecture Notes on Differential Forms

    OpenAIRE

    2016-01-01

    This is a series of lecture notes, with embedded problems, aimed at students studying differential topology. Many revered texts, such as Spivak's "Calculus on Manifolds" and Guillemin and Pollack's "Differential Topology" introduce forms by first working through properties of alternating tensors. Unfortunately, many students get bogged down with the whole notion of tensors and never get to the punch lines: Stokes' Theorem, de Rham cohomology, Poincare duality, and the realization of various t...

  6. Superprocesses on Two Space Forms

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    Superprocess is one class of measure-valued branching Markov processes. Many results of the process on abstract spaces and Euclidean spaces are obtained in the literature. In this paper, we discuss super-Brownian motions on two space forms and reveal partially the relationship between the properties of superprocesses and the geometric structure of the underlying state spaces. Finally, we also presents some open problems.

  7. Fuzzy logic of Aristotelian forms

    Energy Technology Data Exchange (ETDEWEB)

    Perlovsky, L.I. [Nichols Research Corp., Lexington, MA (United States)

    1996-12-31

    Model-based approaches to pattern recognition and machine vision have been proposed to overcome the exorbitant training requirements of earlier computational paradigms. However, uncertainties in data were found to lead to a combinatorial explosion of the computational complexity. This issue is related here to the roles of a priori knowledge vs. adaptive learning. What is the a-priori knowledge representation that supports learning? I introduce Modeling Field Theory (MFT), a model-based neural network whose adaptive learning is based on a priori models. These models combine deterministic, fuzzy, and statistical aspects to account for a priori knowledge, its fuzzy nature, and data uncertainties. In the process of learning, a priori fuzzy concepts converge to crisp or probabilistic concepts. The MFT is a convergent dynamical system of only linear computational complexity. Fuzzy logic turns out to be essential for reducing the combinatorial complexity to linear one. I will discuss the relationship of the new computational paradigm to two theories due to Aristotle: theory of Forms and logic. While theory of Forms argued that the mind cannot be based on ready-made a priori concepts, Aristotelian logic operated with just such concepts. I discuss an interpretation of MFT suggesting that its fuzzy logic, combining a-priority and adaptivity, implements Aristotelian theory of Forms (theory of mind). Thus, 2300 years after Aristotle, a logic is developed suitable for his theory of mind.

  8. Study the role of procalcitonin in species identification and prognosis in patients with bloodstream infections in ICU%降钙素原在重症监护室血流感染患者鉴别菌种和预后判断中的作用

    Institute of Scientific and Technical Information of China (English)

    薛坚; 王晓红; 李奇; 孙政

    2014-01-01

    目的:探讨降钙素原在重症监护室(ICU)血流感染患者鉴别菌种及预后判断中的作用。方法选择ICU 血流感染患者共69例,检测所有研究对象血清降钙素原(PCT)水平,进行血培养、菌种鉴定,并随访30 d 患者预后,评价 PCT 在 ICU 血流感染患者早期鉴别菌种与预后判断中的作用。结果革兰阴性菌感染患者的 PCT 水平显著高于革兰阳性菌和真菌感染的患者,真菌感染的患者 PCT 水平显著高于革兰阳性菌感染患者(均 P <0.01)。在区分革兰阳性菌与革兰阴性菌和革兰阴性菌与真菌时计算 PCT 的界值分别为1.94 ng/mL 和4.35 ng/mL,能获得最好的灵敏度和特异性与 ROC 曲线下面积,分别为0.87和0.59。革兰阴性菌和真菌感染的死亡患者血清 PCT 水平显著高于存活患者(P =0.003、0.013),而在革兰阳性菌感染的患者中差异无统计学意义(P =0.473)。结论PCT 在 ICU 血流感染患者鉴别菌种和预后判断中具有较好的预测作用,值得临床借鉴。%Objective To investigate the roles of procalcitonin(PCT)in species identification and prognosis in patients with bloodstream infections in intensive care unit (ICU).Methods 69 patients with bloodstream infections in ICU were collected.Test the levels of Serum PCT,blood culture and strain identification levels blood cultures. Follow-up of 30 d ,Identification of bacteria and evaluation of prognosis were undertaken with PCT in patients with bloodstream infections in the ICU.Results PCT levels in patients with G- bacterial infections were significantly higher than that with G+ bacterial and fungi infections.PCT levels in patients with fungi infections were significant-ly higher than G+ bacteria-infected patients (P <0.01).Boundary value of PCT in distinguishing G+ bacteria and G- bacteria,G- bacteria and fungi were 1.94ng/mL and 4.35 ng/mL,which could get the best specificity

  9. Utilização de cateter central de inserção periférica e ocorrência da infecção da corrente sanguínea em uma Unidade de Terapia Intensiva Neonatal | Use of peripherally inserted central catheters and occurrence of bloodstream infections in a neonatal intensive care unit

    Directory of Open Access Journals (Sweden)

    Márcia Yumi Yonekura

    2015-02-01

    Full Text Available Objetivo: Analisar a prevalência de infecção hospitalar primária da corrente sanguínea em uma Unidade de Terapia Intensiva Neonatal. Métodos: Estudo retrospectivo, com análise de prontuários de uma Unidade de Terapia Intensiva Neonatal, no período de janeiro a dezembro de 2010. Foi calculada a densidade de incidência de infecção de corrente sanguínea associada ao cateter por 1000 cateteres-dia. Resultados: Dos 192 recém-nascidos, 16 (8,3% apresentaram infecção da corrente sanguínea e todos estes utilizaram o cateter central de inserção periférica. A densidade de infecção confirmada por hemocultura foi de 5,9 e a baseada em critérios clínicos foi de 3,5 por 1000 pacientes com cateter vascular central-dia. A distribuição por faixa de peso foi de: 30,9 (750-999g; 11 (1000-1499g; 8,5 (1500-2499g e 6,8 (> 2500g por 1000 pacientes com cateter vascular dia. A média do tempo de uso do cateter foi de 11 dias. O sítio de inserção mais comum foi o acesso jugular (37,5% e a mortalidade associada à infecção da corrente sanguínea foi de 31%. Conclusões: A utilização do cateter central de inserção periférica é uma prática não isenta de riscos, considerando que este é um dispositivo invasivo e pode predispor à ocorrência de infecção. ------------------------------------------------------------------------------------------ Objective: To analyze the prevalence of hospital primary bloodstream infections in a neonatal intensive care unit (NICU. Methods: A retrospective study involving analyses of records of patients admitted to the NICU from January to December 2010 was conducted. The incidence density of catheter-associated bloodstream infections per 1000 catheter-days was calculated. Results: Among 192 newborns, 16 (8.3% who used peripherally inserted central catheters had bloodstream infections. The infection density confirmed by blood culture reached 5.9, while the density based on clinical criteria accounted for

  10. 综合重症监护病房中心静脉导管相关性血流感染监测与控制效果分析%Monitor and control of central venous catheter-related bloodstream infections in general intensive care unit

    Institute of Scientific and Technical Information of China (English)

    张淑敏; 刘香玲; 冯丽媛; 宋雪苹; 张豫生

    2011-01-01

    目的 降低重症监护病房导管相关性血流感染(CRBSI)的发生率.方法 A组采取回顾性调查方法,查阅出院病历,逐项填写记录表;B组采取目标性监测方法,由两名深静脉导管专职护理护士负责具体操作,采取一系列感染控制措施,将两组资料分别进行汇总统计、分析判断、计算感染率并做比较.结果 A组导管相关性血流感染率为20.9‰,B组实行目标性监测落实感染控制各项措施后,导管相关性血流感染率下降至5.4‰,差异有统计学意义(P<0.05).结论 在综合控制措施中,提高医护人员在医疗活动中的技术水平和执行力,设专业导管护理小组进行中心静脉置管全过程质量管理,是降低导管相关性血流感染非常有效的措施.%OBJECTIVE To reduce the incidence of catheter-related bloodstream infections.METHODS A retrospective survey was performed to Group A by searching for discharged patients and completing a record sheet item by item.A targeted surveillance to Group B was performed, There were two full-time care nurses in charge of specific operations on central venous catheter by adopting a series of infection control measures, the data of the two groups were aggregated statistics, analyzed and judged, the infection rates were calculated and compared.RESULTS The catheter-related bloodstream infection rate of group A was 20.9‰, Group B took the method of targeted survey and implemented measures of infection control, the catheter-related bloodstream infection rate fell to 5.4 ‰, it was significantly different(P<0.05).CONCLUSION In the comprehensive control measures, it is a very effective measure of setting professional nursing team on the whole process of quality management on central venous catheter tube and improving the technical level and execution of the doctors and nurses in the medical activities to reduce the catheter-related bloodstream infections.

  11. 短信及时报告阳性血培养对细菌性血流感染的诊治价值初探%Preliminary study on the value of short message service timely reporting of positive blood cultures for bacterial diagnosis and treatment of bloodstream infections

    Institute of Scientific and Technical Information of China (English)

    蒋晓飞; 田月如; 刘红; 阮斐怡

    2012-01-01

    目的 寻找合理评价缩短报告阳性血培养结果时间的价值指标,了解短信及时报告阳性血培养结果的临床价值.方法 采用率的x2检验比较短信报告阳性血培养结果前、后2组血流感染患者年龄、血流感染病原菌、血培养阳性率及30 d死亡率.结果 短信报告阳性血培养结果前、后2组的年龄、血流感染病原菌构成及血培养阳性率差异无统计学意义,30 d死亡率差异有统计学意义(P<0.05).结论 短信及时报告阳性血培养结果对临床有一定价值.%Objective To find a reasonable indicator to evaluate the value of reducing the time to report the positive blood culture results, and understand the clinical value of timely reporting of positive blood culture results by short message service. Methods With the statistics method X2 test, the disparities in age, bloodstream infection pathogens, blood culture positive rate and 30 d mortality of 2 groups before and after the reporting positive blood culture results by short message service were compared. Results The disparities in age, bloodstream infection pathogens and blood culture positive rate of the 2 groups were not statistically significant, but the disparity in 30 d mortality of the 2 groups was statistically significant (P<0. 05). Conclusions Short message service timely reporting of positive blood culture results are valuable for clinic.

  12. Development of unconventional forming methods

    Directory of Open Access Journals (Sweden)

    S. Rusz

    2012-10-01

    Full Text Available Purpose: Paper presents results of progress ECAP processing method for UFG structure reached (gained.The properties and microstructure are influenced by technological factors during application ECAP method.Design/methodology/approach: Summary of methods studied on Department of technology at Machining faculty of VŠB-TU Ostrava through of co-operation with Institute of Engineering Materials and Biomaterials, Silesian University of Technology is presented.Findings: Achievement of ultra-fine grained structure in initial material leads to substantial increase of plasticity and makes it possible to form materials in conditions of „superplastic state“. Achievement of the required structure depends namely of the tool geometry, number of passes through the matrix, obtained deformation magnitude and strain rate, process temperature and lubrication c