Changes in the incidence of health care-associated pathogens at a university hospital from 2005 to 2011.

BACKGROUND: Data on health care-associated infections (HAIs) outside of intensive care units (ICU) are scarce. We assessed hospital-wide changes in the incidence of health care-associated pathogens by infection site and by service between 2005 and 2011. METHODS: All data on health care-associated pathogens in 2005-2011 based on comprehensive hospital-wide surveillance were extracted from an electronic database. The incidence of HAI by pathogen was calculated per 1000 patient-days and per 1000 device-days. Regression analyses were conducted to estimate trend changes in the yearly incidence of pathogens for selected HAIs. RESULTS: The majority (8784 of 10,070; 87.2%) of the HAIs recorded over the 7-year period had at least 1 pathogen; a total of 10,585 pathogens were isolated. Overall, across all major service categories (eg, ICU, medicine), significant trends toward decreasing incidence were observed for all pathogens except Clostridium difficile. The decrease in incidence was greatest for central line-associated bloodstream infections, less for catheter-associated urinary tract infections, and lowest for ventilator-associated pneumonias. CONCLUSIONS: This study showed significant decreases in incidence of the majority of HAIs caused by various pathogens, but significant increases in patient-days during the study period. Only HAIs due to C difficile showed a significantly increased incidence.

Relative frequency of health care-associated pathogens by infection site at a university hospital from 1980 to 2008.

BACKGROUND: We describe the relative frequency of health care-associated pathogens by infection site over 29 years using hospital-wide surveillance data from a large academic hospital. METHODS: Comprehensive hospital-wide surveillance was provided by trained infection preventionists using Centers for Disease Control and Prevention definitions. Five 5-year blocks and one 4-year block were created for each site: bloodstream infections (BSI), urinary tract infections (UTI), respiratory tract infections (RTI), and surgical site infections (SSI). The blocks of relative frequency of health care-associated pathogens were compared by χ(2) analysis, and trends for each pathogen were estimated by regression analysis. RESULTS: At least 1 pathogen was isolated from 28,208 (83.5%) of 33,797 health care-associated infections (HAI). Staphylococcus aureus, coagulase-negative staphylococci (CoNS), Enterococcus species, and Clostridium difficile and other anaerobes significantly increased, whereas Escherichia coli, Pseudomonas aeruginosa, Klebsiella species, Enterobacter species, and other streptococci significantly decreased in the relative proportion of pathogens during the study period. By infection site, results showed significant increasing trends of S aureus in UTI, RTI, and SSI; CoNS in BSI and SSI; Candida in SSI; and Enterococcus in BSI and UTI. CONCLUSION: Significant changes in relative frequency of health care-associated pathogens by infection site occurred over the 29-year period. These findings have implications for implementation of infection prevention strategies.

An inflamed trichilemmal (pilar) cyst: Not so simple?

CONTEXT: Trichilemmal (pilar) cysts are common skin lesions that often present on the scalps of mature men and women. These cysts often become inflamed when the wall of the cyst ruptures, but few reports have addressed the immunologic features of this process. CASE REPORT: A 22-year-old female presented with rapidly growing nodule on her left cheek, with evidence of acute inflammation. Skin tissue for hematoxylin and eosin examination, as well as for immunohistochemical analysis was taken and reviewed. As controls, we utilized two archival, non-inflamed trichilemmal cysts. Hematoxylin and eosin staining demonstrated classic features of an inflamed trichilemmal cyst. No cytologic atypia was noted, and no significant number of mitotic figures was identified. Immunohistochemistry stains revealed that several cell cycle/tumor suppressor/apoptotic markers, antigen presenting cell markers, metalloproteinases and T cell response markers were highly expressed inside and around the disrupted cyst. The control, non-inflamed cysts were negative for the same markers. CD1a was also appreciated within the epidermis, suprajacent to the inflamed cyst. CONCLUSIONS: Upregulation and/or downregulation of selected cell cycle regulator and/or tumor suppressor/apoptotic markers, as well as antigen presenting cells and some protein kinases could recruit and activate T lymphocytes and other inflammatory cells to the non-disrupted cyst for unknown reasons. The immune response may be involved in the initial cyst rupture, or induced by an unknown alteration in the cyst. Larger studies are needed to address these questions.

Antibodies to piloerector muscle in a patient with lupus-lichen planus overlap syndrome.

CONTEXT: Smoot muscle (SM) is a muscle tissue that contracts without conscious control, made up of spindle-shaped, untreated cells with single nuclei and found in the walls of the internal organs, such us the stomach, intestine, bladder, and blood vessels, excluding the heart and in the (arrector pili) muscle in the skin. CASE REPORT: A 59 Caucasian woman was evaluated for pruritic rash and violaceous plaques mostly in the upper extremities with some with ulcers in her mouth. Biopsies for hematoxylin and eosin and immunohistochemistry examination, as well as for direct immunofluorescence analysis were performed. The hematoxylin and eosin staining demonstrated mild epidermal atrophy with focal follicular plugging. A mild interface infiltrate of lymphocytes and histiocytes and a superficial and deep, perivascular and periadnexal dermal infiltrate of lymphocytes, histiocytes and plasma cells was observed. Was difficult to diagnose as either lichen planus or lupus erythematosus. The histological studies from two places showed features of both lupus erythematosus and lichen planus. The direct immunofluorescence revealed focal deposits of immunoglobulins IgG, present at the basement membrane junction of the skin as well as in the sweat glands of IgM, fibrinogen and complement/C3. In addition, deposits of IgE surrounding the superficial dermal blood vessels and ecrine glands. Antibodies to piloerector muscle using several immunoglobulins, corroborated by immunohistochemistry stains. CONCLUSIONS: This is the first case reporting autoantibodies to the piloerector muscle in a patient having mixed clinical and histopathological diagnoses of lupus/lichen planus overlapping syndrome with strong IgE immune response.

Compliance with isolation precautions at a university hospital.

Compliance with isolation precautions recommended by the Centers for Disease Control and Prevention (CDC) was evaluated in 3 hospital-wide observational surveys. The compliance rate, by type of isolation, was as follows: droplet transmission, 100% (4 observations); airborne transmission, 61.5% (13 observations); contact isolation, 73.3% (165 observations); and protective isolation, 73.6% (72 observations). As with hand hygiene, there is suboptimal compliance with recommended isolation precautions.

Lessons learned from a norovirus outbreak in a locked pediatric inpatient psychiatric unit.

We report an outbreak of norovirus in a locked pediatric inpatient psychiatric unit with attack rates of 75% among 4 patients and 26% among 38 staff. Factors contributing to the outbreak included environmental contamination, close staff-patient contact including sharing meals, and inability to confine the index patient with the use of contact precautions.