ABSTRACT
Background@#Fungal pneumonia is a common infectious complication of hematological cancer (HC) patients. In this retrospective study, the objective was set to identify the risk factors and outcome of fungal pneumonia in adult HC patients. @*Materials and Methods@#This retrospective study was conducted with adult (>16 years) HC patients from January 2017 and December 2018. @*Results@#During the study period, of 181 patients included 76 were diagnosed with fungal pneumonia. The most common HC was identified as acute myeloid leukaemia (40%). Of the participating patients, 52 (29%) were hematopoietic stem cell transplant (HSCT) recipients.The median age of patients with fungal pneumonia was significantly greater: 57 vs. 48 (odds ratio [OR]: 1.08) and they had longer hospitalization durations (OR: 1.14). Overall, 37 patients (20%) died, and 28-day mortality was significantly greater among patients with fungal pneumonia than without fungal pneumonia (33% vs. 11%). The most significant risk factors for mortality in fungal pneumonia were identified as need of intensive care unit (ICU) (OR: 191.2, P <0.001) and the need of vasopressor support (OR:81.6, P <0.012). ICU-mortality was (88%). @*Conclusion@#Fungal pneumonia is a lethal complication in HC patients. Intensive care need is the most important predictive factor for mortality.
ABSTRACT
Background@#Fungal pneumonia is a common infectious complication of hematological cancer (HC) patients. In this retrospective study, the objective was set to identify the risk factors and outcome of fungal pneumonia in adult HC patients. @*Materials and Methods@#This retrospective study was conducted with adult (>16 years) HC patients from January 2017 and December 2018. @*Results@#During the study period, of 181 patients included 76 were diagnosed with fungal pneumonia. The most common HC was identified as acute myeloid leukaemia (40%). Of the participating patients, 52 (29%) were hematopoietic stem cell transplant (HSCT) recipients.The median age of patients with fungal pneumonia was significantly greater: 57 vs. 48 (odds ratio [OR]: 1.08) and they had longer hospitalization durations (OR: 1.14). Overall, 37 patients (20%) died, and 28-day mortality was significantly greater among patients with fungal pneumonia than without fungal pneumonia (33% vs. 11%). The most significant risk factors for mortality in fungal pneumonia were identified as need of intensive care unit (ICU) (OR: 191.2, P <0.001) and the need of vasopressor support (OR:81.6, P <0.012). ICU-mortality was (88%). @*Conclusion@#Fungal pneumonia is a lethal complication in HC patients. Intensive care need is the most important predictive factor for mortality.
ABSTRACT
In this study, we aimed to evaluate the incidence and economic burden of prosthetic joint infections [PJIs] in a university hospital in a middle-income country. Surveillance data between April 2011 and April 2013 in the Orthopedic Surgery Department was evaluated. Patients [>16 years old] who had primary arthroplasty in Erciyes University were included in the study, and patients with preoperative infection were excluded. Patients were followed up during their stay in the hospital and during readmission to the hospital for PJI by a trained Infection Control Nurse. During the study period, 670 patients were followed up. There were 420 patients [62.7%] with total hip arthroplasty [THA], 241 [36.0%] with total knee arthroplasty [TKA] and 9 [1.3%] with shoulder arthroplasty [SA]. The median age was 64, and 70.6% were female. The incidence of PJI was 1.2% [5/420] in THA, 4.6% [11/241] in TKA and 0% [0/9] in SA. PJI was significantly more prevalent in TKA [p = 0.029]. All of the PJIs showed early infection, and the median time for the development of PJI was 23.5 days [range 7-120 days]. The median total length of the hospital stay was seven times higher in PJI patients than patients without PJI [49 vs. 7 days, p = 0.001, retrospectively]. All hospital costs were 2- to 24-fold higher in patients with PJI than in those without PJI [p = 0.001]. In conclusion, the incidence and economic burden of PJI was high. Implementing a national surveillance system and infection control protocols in hospitals is essential for the prevention of PJI and a cost-effective solution for the healthcare system in low-middle-income countries
ABSTRACT
The aim of this study is to determine the risk factors for percutaneous and mucocutaneous exposures in healthcare workers [HCW] in one of the largest centers of a middle income country, Turkey. This study has a retrospective design. HCWs who presented between August 2011 and June 2013, with Occupational Exposures [OEs] [cases] and those without [controls] were included. Demographic information was collected from infection control committee documents. A questionnaire was used to ask the HCWs about their awareness of preventive measures. HCWs who work with intensive work loads such as those found in emergency departments or intensive care units have a higher risk of OEs. Having heavy workloads and hours increases the risk of percutaneous and mucocutaneous exposures. For that reason the most common occupation groups are nurses and cleaning staff who are at risk of OEs. Increasing work experience has reduced the frequency of OEs
ABSTRACT
Microbiology laboratories play an important role in epidemiology and infection control programs. Within microbiology laboratories, molecular microbiology techniques have revolutionized the identification and surveillance of infectious diseases. The combination of excellent sensitivity, specificity, low contamination levels and speed has made molecular techniques appealing methods for the diagnosis of many infectious diseases. In a well-equipped microbiology laboratory, the facility designated for molecular techniques remains indiscrete. However, in most developing countries, poor infrastructure and laboratory mismanagement have precipitated hazardous consequences. The establishment of a molecular microbiology facility within a microbiology laboratory remains fragmented. A high-quality laboratory should include both conventional microbiology methods and molecular microbiology techniques for exceptional performance. Furthermore, it should include appropriate laboratory administration, a well-designed facility, laboratory procedure standardization, a waste management system, a code of practice, equipment installation and laboratory personnel training. This manuscript lays out fundamental issues that need to be addressed when establishing a molecular microbiology facility in developing countries
ABSTRACT
A structured questionnaire was administered to health-care workers [HCWs]. The HCWs were also screened for measles, rubella, mumps, and varicella [MMRV] using serological methods. One thousand two hundred and fifty-five HCWs were tested. Of the HCWs examined, 94% were immune to measles, 97% to rubella, 90% to mumps and 98% to varicella. The positive predictive values of histories of measles, mumps, rubella and varicella were 96%, 93%, 100% and 98%, respectively. The negative predictive values of histories of measles, mumps, rubella and varicella were 13%, 17%, 5% and 2%, respectively. The cost of vaccination without screening was significantly more expensive [cost difference: 24,385] for varicella, although vaccination without screening was cheap [cost difference: 5693] for MMR. Although the use of cheaper vaccines supports the implementation of vaccination programs without screening, the cost of vaccination should not be calculated based only on the direct costs. The indirect costs associated with lost work time due to vaccination and its side effects and the direct costs of potential side effects should be considered. However, if prescreening is not conducted, some HCWs [2-7%] would be unprotected against these contagious illnesses because of the unreliability of their MMRV history. In conclusion, the screening of HCWs before vaccination continues to be advisable
ABSTRACT
The aim of this study is to identify the beliefs and perceptions associated with hand hygiene performance in two different institutions with limited resources and recently established infection control programme later than developed institutions. The study was conducted in two different hospitals [University Hospital-U-hospital and Community Hospital-C-hospital] in the same city by a selfadministered questionnaire. Most questions were drawn from questionnaires used previously in other studies from "industrialized" countries based on "The Theory of Planned Behavior". All nurses, nurse students [last class], physicians and intern medical students in the U-hospital, and all nurses in the C-hospital were included into the study. Of 1764 questionnaires, 941 [41%] were returned. The return rate was highest for nurses in C-hospital [63.8% [303 of 475]] and lowest for senior physicians in U-hospital [7.5% [16 of 212]]. Out of the respondent a total of 16 [1.7%] were senior physicians, 110 [11.6%] were physician assistants, 400 [42.6%] were nurses in the U-hospital, 303 [32%] were nurses in the C-hospital, 66 [7%] were medical students and 46 [4.9%] were nurse students. Seven hundred and ninety five [85.9%] of 926 respondents were female. Respondents provided demographic information and data about various behavioral, normative, and control beliefs that determined their intentions with respect to performing hand hygiene. Among individuals from the other professional categories, a greater percentage of U-hospital nurses [57.6% vs. 53.9%, respectively] believed that healthcare-associated infections to be greater than 20%, and mortality rate among infected patients to be greater than 5%. C-hospital nurses generally believed the frequency, severity, and impact of healthcare-associated infections to be lower than U-hospital nurses and other individuals. However, all professional categories believed that good hand hygiene effectively prevents infections [98%]. In univariate analysis, receipt of structured training in hand hygiene, perceived colleagues adherence's as good, adherence models good practices for others, having been observed for their adherence [normative beliefs], the perception that hand hygiene is relatively easy to perform and high workload [control beliefs] was associated with good hand hygiene. However, in multivariate analysis, high self reported adherence to hand hygiene was independently associated with receipt of structured training in hand hygiene, perceived good adherence by colleagues, the perception that hand hygiene is relatively easy to perform and having been observed for their adherence. In a country with limited resources, intention to comply was associated with training and strong normative and control beliefs. Also, in two different kinds of institution with the similar hand hygiene promotion campaign in the same city, the believes of nurses were different. In developing countries, more resources have to be allocated for training of HCWs and easy access for hand hygiene products
Subject(s)
Humans , Female , Male , Developing Countries , Hand , Education , Cross Infection , HospitalsABSTRACT
Anthrax is still an endemic disease in some countries in the world and has become a re-emerging disease in western countries with recent intentional outbreak. The aim of this study was to review our clinical experience with cutaneous anthrax cases. From the patient's files, transmission of the diseases, clinical findings and severity of infection, treatment and outcome of patients were recorded. Twenty-two cases were diagnosed as cutaneous anthrax in the last 7 years. Of these cases, 10 cases were severe form of cutaneous anthrax, 10 cases were mild form and 2 cases were toxemic shock due to cutaneous anthrax. The incubation period was between 1 and 17 days. The main clinical characteristics of the cases with severe cutaneous anthrax were fever, hemorrhagic bullous lesions surrounded by an extensive erythema and edema, and leukocytosis. Two cases with toxemic shock had low systolic blood pressure, apathy and toxemic appearance, leukocytosis, hypoalbuminemia and hyponatremia. Penicillin G was given in 15 cases, amoxicillin in 4 and other antibiotics in 3 cases for 3-10 days. Skin lesion left deep tissue scar in 4 cases and were grafted. Physicians working in endemic areas and also in western countries should be aware of all clinical forms of anthrax
Subject(s)
Humans , Male , Female , Anthrax/drug therapy , Treatment Outcome , Shock, Septic , Bacillus anthracis , Fever , Skin Diseases, Vesiculobullous , Erythema , Edema , Leukocytosis , Penicillin G , AmoxicillinABSTRACT
PURPOSE: This study focused on the effect of immuno-compromising conditions on the clinical presentation of severe listerial infection. PATIENTS AND METHODS: Nine human listeriosis cases seen from 1991-2002 were reviewed. All adult patients, from whose blood, peritoneal fluid or cerebrospinal fluid (CSF) the L. monocytogenes was isolated, were included in this retrospective study. RESULTS: Listeriosis presented as primary sepsis with positive blood cultures in 5 cases and meningitis with positive CSF cultures in 4 cases. All of these patients had at least one underlying disease, most commonly, hematologic malignancy, diabetes mellitus, amyloidosis and hepatic cirrhosis; 55.6% had received immunosuppressive or corticosteroid therapy within a week before the onset of listeriosis. The patients were adults with a mean age of 60 years. Fever, night sweats, chills and lethargy were the most common symptoms; high temperature (> 38 degrees C), tachycardia, meningeal signs and poor conditions in general were the most common findings on admission. The mortality rate was 33.3% and was strictly associated with the severity of the underlying disease. Mortality differences were significant between sepsis (20%) and meningitis (50%) patients. CONCLUSION: Listeriosis as an uncommon infection in our region and that immuno- suppressive therapy is an important pre-disposing factor of listeriosis. Sepsis and meningitis were more common in this group of patients and had the highest case-fatality rate for food-borne illnesses.