Volume 16, Issue 3, 2008
Review
The use of bundles in clinical practice
Ruscitti Luca Enrico,
Puro Vincenzo
A bundle is a small, straightforward set of scientifically grounded elements (generally three to five) that, when implemented together, result in better outcomes than when implemented individually. Bundles have found their greatest application in the prevention of Healthcare-Associated Infections (HAIs). The bundles examined concern the prevention of VAP for patients undergoing mechanical ventilation, the prevention of BSI CVC, the prevention of surgical side infection (SSI), the prevention of catheter-associated urinary tract infections, the prevention of infection by Clostridium difficile and the treatment of sepsis. Studies show a reduction in mortality rates, infection rates and in the length of hospital stay. Some studies have low statistical significance due to the small number of patients examined, and future studies will be needed to confirm these results.
Catheter-associated urinary tract infections: epidemiology and prevention
Esposito Silvano,
Noviello Silvana
Urinary tract infections (UTIs) represent the second most often observed infectious diseases in community, following the respiratory tract infections. In the United States, these infections account for up to 7 million/year of visits, with a mean yearly expense for the related antibiotic treatment that has been estimated in more than one billion dollars. In nosocomial setting, UTIs represent the most frequent diseases, whose incidence equates 40% of nosocomial infections overall considered; about 80% of UTIs is related to urinary catheterization.
In the present review, the authors, after a brief introduction about epidemiology, pathogenesis and aetiology of urinary tract infections, consider two particular settings: long term care facilities, where UTIs represent the most often diagnosed and treated infections, and the Intensive Care Units where occurrence of urinary tract infections represents an especially frequent event as well. Patients referred to both these settings are particular, as they undergo, in most cases, to urinary catheterization.
After describing the pathogenesis of UTIs related to catheterization, either short- or long term, the authors consider the different currently available catheters, focusing on silver-coated and silver alloy coated (silver, gold, and platinum). With regard to this latter issue, results presented by a number of papers in the literature are reported, where clinical experiences following the use of these urinary catheters are described.
In their conclusion, authors suggest the opportunity to increase any prevention strategy able to reduce the incidence of infections related to urinary catheterization and its consequences, as a more rational length and modality of catheterization, in addition to the use of innovative catheters.
Original article
Anti-varicella zoster vaccination in contacts of children receiving antineoplastic chemotherapy: a prospective pilot study
Timitilli Anna,
Bertoluzzo Luisella,
Micalizzi Concetta,
Faraci Maura,
Hanau Guia,
Ricci Rossella,
Giacchino Raffaella,
Castagnola Elio
Varicella may be a severe infection in children with malignancy. Varicella vaccination is either not recommended for immunocompromised children or it requires temporary discontinuation of immunosuppression. We prospectively evaluated the feasibility of a varicella vaccination programme of household contacts of varicella-negative children receiving antineoplastic chemotherapy. From April 2004 to April 2005, 207 children were evaluated; in 49 (24%) the attending physicians collected no history about previous varicella and performed no serological evaluation before any transfusion. Among the 158 patients with complete history and/or a screening test, 51 (32%) were negative, with a total of 110 household contacts eligible for the study. Of these, 13 (12%) subjects resulted negative for varicella. In three of them vaccination was not performed due to parental refusal. This study demonstrates the difficulties in implementing a varicella vaccination programme targeting negative household contacts of immunocompromised children. The attitude of paediatric oncologists and parental refusal currently represent the main challenges against the complete success of this strategy in countries where VZV vaccination is not inserted in the general vaccination programme.
Abnormal liver function in brucellosis
La Spada Emanuele,
Micalizzi Anna,
La Spada Monica,
Quartararo Pasquale,
Nugara Giuseppe,
Soresi Maurizio,
Affronti Mario,
Montalto Giuseppe
We assessed the prevalence of impaired liver function in 47 patients suffering from brucellosis consecutively admitted to our department over the last five years. Parameters of liver function and ultrasound of the upper abdomen were performed at entry and at the end of treatment. On admission, mean transaminase values were elevated and significantly higher than at recovery (p<0.001): 38% and 53% of patients had elevated baseline values of GOT and GPT vs 13 and 19% at the end of treatment, respectively. Mean serum values of alkaline phosphatase (AP) were within normal limits on admission, although in 12 of them serum values were elevated. The same proportion was seen for gamma-glutamyltranspeptidase. Both transaminases and AP were elevated in 8 patients (17%). There were no significant differences in serum values of albumin and bilirubin before and after therapy. The platelet count slightly decreased, but not significantly, during the acute phase of disease. At ultrasound one third of the patients showed hepatomegaly with a hepatitis-like pattern and 40% of patients had splenomegaly. In conclusion, this study confirms data in the literature showing a high frequency of liver impairment during the course of brucellosis, which is usually mild-moderate.
Brucellosis outbreak in Treviso province caused by infected cheese from an endemic area
Farina Francesca,
Fuser Rodolfo,
Rossi Mariacristina,
Scotton Pier Giorgio
Brucellosis is one of the most common zoonoses in the world. Its distribution has changed in recent years due to socioeconomic factors and international travel. In Italy its trend has followed the international pattern, albeit with major differences between the north and south of the country. In northern Italy brucellosis is import-related and rarely laboratory acquired. We describe an outbreak of five cases of brucella infection occurred in Treviso province during August 2005. All the patients had a positive Wright test and two of them had a positive blood culture for Brucella abortus. The source of infection was cheese from an area of Italy where brucellosis is endemic. All the people who consumed the cheese had clinical and laboratory signs of brucellosis. All of them received six weeks of rifampin and doxycycline treatment; none developed any complication or relapse during the two follow-up years. In conclusion, brucellosis should be considered as a differential diagnosis of fever of unknown origin even in countries where it is not endemic; it is necessary not only to rule out travels to endemic regions through clinical history, but also the consumption of infected foods imported from such areas.
Case report
Thrombocytopenia associated with brucellosis: a case report.
Giordano Salvatore,
Failla Maria Concetta,
Di Gangi Maria,
Miceli Silvana,
Abbagnato Luisa,
Dones Piera
Brucellosis, a common disease in some areas of the world, beside its typical signs and symptoms, as fever, arthropathy, hepatomegaly and splenomegaly, sometimes can complicate into thrombocytopenia, even in severe forms. The pathogenesis of thrombocytopenia in course of brucellosis is variable, and a main role is played by immunological reactions. Authors describe a case report of an eight years child who presented a severe thrombocytopenia in course of acute brucellosis. The patient responded efficaciously to the antibiotic therapy combined with immunoglobulin intravenous therapy.
Cerebral abscess caused by Capnocytophaga spp in an immunocompetent subject: case report
Ricciardi Barbara,
Galgani Ilaria,
Trezzi Michele,
Toti Mario
Capnocytophaga spp are Gram-negative bacteria commonly identified as oral saprophytes of humans, dogs and cats; they rarely cause invasive infections in immunocompetent subjects. This case report is about a rare case of cerebral abscess caused by Capnocytophaga spp in an immunocompetent subject who had no risk factors for Capnocytophaga invasive infections (oral alterations, traumatic or iatrogenic lesions of pharynx and/or oesophagus, recent dog bite). We also report Capnocytophaga spp naturally resistant to metronidazole, this being the cause of inefficacy of this drug usually included in empiric chemotherapy of cerebral abscess.
Associated actinomycosis and rhinopharyngeal adenocarcinoma during HIV infection: diagnostic and therapeutic issues
Sabbatani Sergio,
Fulgaro Ciro,
Latini Gino,
Burzi Marcellino,
Manfredi Roberto
An extremely infrequent episode of nasopharyngeal actinomycosis associated with squamous adenocarcinoma occurred in an HIV-infected male patient with a previous diagnosis of AIDS, treated with combined antiretroviral therapy taken with insufficient adherence, such that a satisfactory immune system recovery (as expressed by a CD4 lymphocyte count persistently above 400 cells/mcl), contrasted with a low-level persistence of detectable HIV viraemia, and enlarged genotypic resistance mutations. Interestingly, a number of local and specific risk factors for both infectious and neoplastic disorders were recognized by healthcare staff (tobacco smoke, long-term inhalatory substance abuse, in particular cocaine, and semi-professional mushroom-truffle hunting, including evaluation by systematic smelling). Despite appropriate and timely diagnostic assessment carried out with repeated, combined computerized tomography, magnetic resonance imaging, and fiberoptic rhinoscopy with biopsy and histopathologic studies, the final diagnosis of a combined dual infectious-neoplastic pathology occurred only after a demolishing surgical intervention and subsequent pathology studies. Despite proper antimicrobial therapy, and an associated radiotherapy and cytotoxic chemotherapy schedule, rapid dissemination of multiple secondary lesions to the brain rapidly led to our patient’s death. The imaging and histopathological diagnostics of the dual illnesses of our HIV-infected patient, and its therapeutic and outcome features, are presented and discussed on the basis of the evidence from the available literature. To the best of our knowledge, this is the first described case of actinomycosis associated with a local, underlying squamous cell adenocarcinoma of the same ear, nose, and throat district in either HIV-infected or HIV-non-infected subjects.
Monoclonal gammopathy after visceral leishmaniasis: just a coincidence?
Rombolà Ferdinando,
Spinoso Antonio,
Bertuccio Salvatore Nicola
The authors describe a case of monoclonal gammopathy occurring about six months after a visceral leishmaniasis. A literature survey suggests that strong antigenic stimulation caused by visceral leishmaniasis can induce monoclonal gammopathy in a predisposed subject.
The Infections in the History of Medicine
Syphilis, brothels, unwanted children and wet nurses. Italy and syphilis infection in the 19th century
Sabbatani Sergio
In 1861 in Italy a repressive law was passed against prostitution to reduce syphilis transmission. After the constitution of the Kingdom of Italy there began a debate on this law which was harsh on prostitutes and failed to resolve the health problem in question. In 1880, in Italy, studies were promoted under the aegis of a royal commission to understand the social situation of prostitution and the epidemic spread of syphilis. In 1888 Crispi issued new regulations concerning prostitution, prevention and therapy of infectious diseases: three years later a new regulation was established which partly restored the 1861 law. In this paper we present not only the question of prostitution in Italy in relation to syphilis, but also the serious problem of infection transmission to unweaned babies and to wet nurses in orphanages.
