Association between hand hygiene compliance and methicillin-resistant Staphylococcus aureus prevalence in a French rehabilitation hospital.

We simultaneously investigated the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and compliance with hand hygiene in the clinical wards of a French rehabilitation hospital. We found that the rate of hand hygiene compliance observed at the patient's bedside was a strong predictor of MRSA prevalence.

Diagnostic value of two reagent strips (Multistix 8 SG and Combur 2 LN) in cirrhotic patients with spontaneous bacterial peritonitis and symptomatic bacterascites.

OBJECTIVE: Spontaneous bacterial peritonitis is a life-threatening complication in patients with liver cirrhosis requiring a rapid diagnosis. We have tested two reagent strips, Multistix 8 SG and Combur 2 LN for bedside diagnosis of spontaneous bacterial peritonitis and symptomatic bacterascites, a variant of spontaneous bacterial peritonitis. METHODS: Responses of the two strips in colorimetric scale were compared with results given by cyto-bacteriological analysis of ascitic fluid. Results with positivity in grades 1 and 2 of colorimetric scale were analyzed. RESULTS: Four hundred and forty three paracentesis were performed in 116 patients including 46 samples of ascitic fluid with spontaneous bacterial peritonitis occurring in 25 patients and 20 samples of ascitic fluid with symptomatic bacterascites occurring in 17 patients. Forty two percent of spontaneous bacterial peritonitis were culture-negative neutrocytic ascites, gram-positive pathogens and enterobacteriaceae were responsible for 36% and 21% episodes of spontaneous bacterial peritonitis and 71% and 29% episodes of symptomatic bacterascites respectively. Fifty seven percent of spontaneous bacterial peritonitis had polymorphonuclear cell count<1000/mm3. For spontaneous bacterial peritonitis diagnosis, grade 1 positive Multistix and Combur tests had a sensitivity of 69.6% and 80.4% respectively, and a negative predictive value of 96% and 97.3%. Grade 2 positivity increased specificity to 98% and 99.2% and positive predictive value to 75% and 91% for the two strips respectively. Grade 1 positive tests had a sensitivity of 100% and 90% and a negative predictive value of 100% and 99.4% respectively for diagnosis of spontaneous bacterial peritonitis with polymorphonuclear count > 1000/mm3. For symptomatic bacterascites diagnosis, grade 1 positive tests had a sensitivity of 22.4% and 44.4% respectively and a negative predictive value of 96% and 97%. CONCLUSION: Although Combur had a higher sensitivity than Multistix for the diagnosis of spontaneous bacterial peritonitis, sensitivity of the two strips remains low with polymorphonuclear cell count<1000/mm3. Grade 2 positive Combur test had an acceptable positive predictive value. Sensitivity of both strips is insufficient for diagnosis of symptomatic bacterascites. Rapid cyto-bacteriological analysis of ascitic fluid remains necessary for diagnosis of these complications.

Oral candidiasis and nutritional deficiencies in elderly hospitalised patients.

The prevalence of oral candidiasis and its association with malnutrition in terms of protein-energy malnutrition and mineral and vitamin depletion were evaluated in ninety-seven hospitalised older adults aged 82.1 (SD 8.6) years. Patients underwent a complete oral examination with microbiological investigation on admission to our geriatric rehabilitation unit. Patients were assessed nutritionally by evaluation of dietary intake and measurement of anthropometric variables, serum nutritional proteins, ferritin, Zn, folate, vitamins B12 and C. The prevalence of oral candidiasis was 37% (n 36); the proportion of patients with BMI <20 kg/m(2) was 32% (n 31). The nutritional status of the population was studied by comparing two groups defined according to the absence (group I; n 61) or presence (group II; n 36) of oral candidiasis. The two groups did not differ on the basis of BMI and mid-arm circumference. However, group II had a smaller leg circumference, lower daily energy and protein intakes, lower albumin and transthyretin levels. Patients successfully treated with fluconazole increased their intake on day 30. The proportion of patients with hypozincaemia (<12.5 micromol/l) and vitamin C deficiency (<0.7 mg/l) was higher in group II. Treatment with antibiotics, poor oral hygiene, denture wearing, and vitamin C deficiency appeared as the most significant independent risk factors associated with oral candidiasis. The present findings show that oral candidiasis appears to be related to malnutrition and results in mucosal lesions that have a negative impact on energy intake, which may subsequently worsen nutritional status.

Nosocomial spontaneous bacterial peritonitis and bacteremia in cirrhotic patients: impact of isolate type on prognosis and characteristics of infection.

The characteristics of and prognosis for nosocomial spontaneous bacterial peritonitis (SBP) and bacteremia were examined in a prospective study that included data from 194 consecutive episodes of SBP and 119 episodes of bacteremia, 93.3% of which were nosocomial, in 200 hospitalized cirrhotic patients. Gram-positive pathogens were predominant (70% of the total) among isolates from nosocomial infections; the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was 24.8%. Nosocomial and staphylococcal infections were associated with a higher mortality rate than were community-acquired infections (P=.0255) and nonstaphylococcal infections (P<.001), respectively. In comparison with non-MRSA infections, MRSA infections were more likely to recur and occurred in a greater number of sites other than ascitic fluid and blood (P=.0004). Older age (P=.0048), higher Child-Pugh score (P=.0011), and infection with staphylococci (P=.0031) were independently associated with a higher mortality rate. The emergence of MRSA is important because of the recurrence and poor outcome associated with infection with such organisms.