Central venous catheter associated sepsis

The current work was designed to study the incidence of central venous catheter [CVC] infection and associated septicemia in critically ill patients admitted to the Intensive Care Unit, Armed Forces Hospital, Kuwait. We aimed also at assessing the value of blood culture as a parameter of catheter related sepsis and at determining the risk factors associated with seeding the catheters with micro organisms. Cultures of the tips and subdermal segment of 60 catheters inserted in the internal jugular or the subclavian veins, as well as 80 blood cultures, 80 skin entry site cultures, 100 distant foci of infection cultures, and 70 infusion fluid cultures were studied. CVC colonization rate was 15%, and infection rate was 8.3%. Catheter- related sepsis was primary in 5% and secondary in 3.3% of cases. 47% of positive blood cultures were associated with positive tips. Many factors appeared to affect seeding of our catheters with micro orgnisms, first of all was the existence of the same micro organisms in other body sites as well as contaminated infusion fluids. Staphylococcus epidermidis was the most commonly isolated micro organisms whether from colonized or infected catheters. Catheters inserted in the internal jugular were seeded by micro organisms more readily than those inserted in the subclavian veins. There was a direct proportion between colonization and/or infection of CVCs and the duration of their stay. Positive subdermal catheter segments were found to be a manifestation rather than a cause of positive catheters. We conclude that monitoring of CVC colonization and infection rates provide guidelines for periodic modification of our hospital CVC care protocol and for assessing various risk factors. Blood culture can be considered the only valuable parameter of catheter- related sepsis

mycofast [MF] as a means of diagnosing and determining the incidence of urogenital mycoplasma implicated in persistent and/or recurrent nongonococcal uretheritis in men

The current work was designed to test the value of Mycofast [MF], a new repid method of urogenital mycoplasma [UGM] detection, in the diagnosis of Ureaplasma urealyticum and Mycoplasma hominis implicated in persistent or recurrent nongonococcal uretheritis in male patients. We aimed also at determinig the incidence of these pathogens in such clinical condition. Three samples either uretheral discharge or first voided urine were collected from each of 66 patients attending the Venereology Clinic, Armed Forces Hospital, Kuwait, between January- June, 1990 and suffering from persistent or recurrent NGU. The first sample was used for N. gonorrhea isolation, the second for UGM isolation by conventional methods and the third for inoculation of the MF kit. No N. gonorrhea was isolated. 26 samples grew U. urealyticum by conventional methods. Those 26 samples in addition to one conventional methods negative sample showed U. urealyticum picture on M. F after 24-72 hours. The number of growth ranged between 10[3]-10[6]CCU/ml. All strains except one were sensitive to cyclines and all except one were resistant to ciprofloxacin. M. hominis was detected neither by conventional method nor by MF. The incidence of U. urealyticum in the cases studied was 39% by conventional methods and 43% by MF. We conclude that MF is an ideal method for the diagnosis of UGM. Due to its high incidence, U. urealyticum should be considered in the empirical antibiotic regimen for patients with persistent or recurrent NGU

Histopathological and microbiological study of patients suffering from chronic gastritis

Endoscopic gastric biopsies were taken from two hundred patients suffering from dyspepsia, these patients were taken from those patients attending to the endoscopy unit of the department of Internal Medicine of Zagazig University Hospitals, in the period extended from January 1988 to March 1991. These group of patients showing endoscopic picture of gastritis only, other organic gastric lesions were excluded. Multiple biopsies from the antrum, body and fundus were taken. The specimens were processed as usual and studied histopathologically and microbiologically using H and E, Giemsa and Half Gram stains. Endoscopic examination revealed gastritis in all cases and the main endoscopic diagnosis was non specific gastritis [106 patients]. The histopathological diagnosis proved that 173 patients had gastritis and 27 patients had normal gastric mucosa. The leading diagnosis for typing and grading of gastritis proved to be histopathological data. The microbiological studies revealed that Helicobacter pylori [H. pylori] were detected in 65% of cases [75] with chronic superficial, quiescent, gastritis, in 94% of cases with chronic superficial active gastritis. While in cases with atrophic gastritis [8 quiescent, 20 active and 12 cases with intestinal metaplasia] the detection of H. pylori were 37.5%, 90% and 33.3% respectively. The H. pylori was detected in only 3 cases of those patients with normal gastric mucosa. These findings through a light on the role of H. pylori in the pathogenesis of different type of chronic non auto immune gastritis and clarify its role in the activities and progression of gastritis that lead to chronic dyspeptic illness with its complications