ABSTRACT
Nosocomial blood stream infection (or nosocomial bacteremia) is a common problem in hospitals worldwide, including Malaysia. A three-year prospective cohort study (October 2003-March 2007) of the incidences, risk factors, and patterns of the microorganisms causing bacteremia was conducted using a validated surveillance form in three intensive care units (ICUs) in Malaysia. Center for Disease Control criteria were used to diagnose bacteremia. Patients were monitored from admission until the end point of study, which was the first detection of bacteremia in the blood in each patient. The frequency of occurrence of bacteremia with clinical symptoms was 10.7% (n = 23). Bacteremia was observed to occur within a mean length of stay of 10 days in ICU. The rate of device-related infection was 10.4% per device utilization days with a device utilization rate of 95.9%/1000 patient days. The total number of patient days was 2309 and the period of device utilization was 2211 days. The common bacteria detected were extended-spectrum beta-lactamases (ESBLs) Klebsiella pneumoniae (n = 6); Pseudomonas aeruginosa (n = 6); Acinetobacter species (n = 5); Methicillin-resistant Staphylococcus aureus (MRSA)(n = 3); and (non- ESBL) Klebsiella pneumoniae (n = 2). Multivariable analysis using Cox Proportional Hazard Model showed that the predictors for developing bacteremia were cancer, MRSA carriage, duration of central venous catheter (CVC) infusion, frequency change of CVC, and the administration of hydrocortisone drugs. These results indicate that a combination of nursing and medical interventions as well as patients' severity of illness could lead to bacteremia in ICU. Strategic implementation of quality assurance measures in ICUs could help to control this problem.
ABSTRACT
Two commercial serological kits, Pylori-set (Orion Diagnostica, Finland) and Helico-G (Cambridge Biomedical Ltd, UK), and an in-house ELISA were evaluated with sera from 24 Helicobacter pylori-positive and 146 H. pylori-negative dyspeptic patients. Sensitivity, specificity, positive and negative predictive values of Pylori-set were lower than that of Helico-G and in-house ELISA. Helico-G was more sensitive (91.7%) than in-house ELISA (83.3%) and both had comparable negative predictive values of 98.3% and 97.3%, respectively. However, specificity (97.9%) and positive predictive value (86.9%) of an in-house ELISA were much higher than specificity (80.1%) and positive predictive value (43.1%) of Helico-G. Kappa index of agreement between the three serological tests (Pylori-set, Helico-G or in-house ELISA) and the presence of H. pylori in antral biopsies was very low (k = 0.13; z = 1.9; p > 0.05), moderate (k = 0.49; z = 7.1; p < 0.0001), or substantial (k = 0.82; z = 10.8; p < 0.0001), respectively. Overall, statistical evaluations demonstrated that both commercial kits were not as reliable as the in-house ELISA for serodiagnosing H. pylori infection.
Subject(s)
Adolescent , Adult , Aged , Aged, 80 and over , Antibodies, Bacterial/blood , Biopsy , Dyspepsia/diagnosis , Female , Helicobacter Infections/diagnosis , Helicobacter pylori/immunology , Humans , Male , Middle Aged , Pyloric Antrum/microbiology , Reagent Kits, Diagnostic , Reproducibility of Results , Sensitivity and Specificity , Serologic Tests/instrumentationABSTRACT
Cerebrospinal fluid from patients with clinically diagnosed meningitis was tested for meningococcal, pneumococcal, streptococcal Group B and Haemophilus influenzae antigens by counterimmunoelectrophoresis. Antigens were rapidly identified and the results compared favourably with that of bacteriological culture. In the case of pneumococcal meningitis counterimmunoelectrophoresis proved to be more sensitive than culture. The procedure was shown to be sensitive, specific, rapid and easily performed.
Subject(s)
Acute Disease , Counterimmunoelectrophoresis , Humans , ImmunoelectrophoresisABSTRACT
Iris monkeys resistant to repeated infections with B. malayi were subjected to immunosuppression by treatment with cortisone. Degree of immunosuppression was measured by: (a) blood counts, (b) lymphocyte transformation to mitogens and (c) immunofluorescent antibody to microfilarial antigens. Attempts were made to infect such immunosuppressed animals with B. malayi. No microfilariae were detected in the blood of any of the Iris monkeys during the 6 months of study. There was a sharp drop in the percentages of lymphocytes, but a rise in neutrophil counts during the first week of cortisone administration. Treatment with cortisone did not alter the antibody titres. The significance of this line of approach in the understanding of filarial resistance is discussed.
Subject(s)
Animals , Antibody Formation/drug effects , Blood/parasitology , Brugia , Cortisone/pharmacology , Filariasis/immunology , Immunosuppression Therapy , Leukocyte Count , Lymphocyte Activation/drug effects , MacacaABSTRACT
The in vitro effect of immune monkey serum on microfilariae of Brugia malayi was investigated using the electron microscope. The sheaths of microfilaria incubated with immune serum were seen to be covered with electron dense precipitates. After 24 hours of incubation, majority of microfilariae incubated with immune serum exhibited degenerative changes. Comparable changes were not seen in microfilariae incubated with normal serum. The significance of these observations are discussed.