Prevalence of skin tears in a long-term care facility.

PURPOSE: The purpose of this study was to collect baseline data of the prevalence of skin tears in a Canadian long-term care (LTC) facility. SUBJECTS AND SETTING: The research setting was a 114-bed long-term care facility located in Eastern Ontario, Canada. The sample population comprised 113 residents from the facility. DESIGN: A cross-sectional, quantitative study design was used to gather baseline data on the prevalence of skin tears in the Canadian population living in LTC. METHODS: Residents were assessed for presence of skin tears, the number of skin tears, and location. Skin tears were categorized according to the validated Payne Martin Classification system. Data were collected using a predetermined data collection sheet developed for this study. A certified enterostomal therapy nurse with previous experience with the assessment of skin tears collected the data along with 1 nurse employed by the facility. Data were collected on a single day over a 6-hour period. RESULTS: Twenty-five of the 113 participating residents in the LTC facility had skin tears, yielding a prevalence of 22%. Category I accounted for 51% of skin tears, 16% were category II, and 33% were category III. Individuals who were found to have more than 1 skin tear had at least 1 category III skin tear. The most common anatomical locations were arms (48%), lower legs (40%), and hands (12%). Possible etiologic factors included blunt trauma such as banging into objects (44%), trauma associated with activities of daily living (20%), and falls (12%); 24% were categorized as idiopathic. CONCLUSION: Study findings highlight gaps in our knowledge of skin tears and the need for additional studies to more clearly define their epidemiology.

Characterization of the new metallo-beta-lactamase VIM-13 and its integron-borne gene from a Pseudomonas aeruginosa clinical isolate in Spain.

During a survey conducted to evaluate the incidence of class B carbapenemase (metallo-beta-lactamase [MBL])-producing Pseudomonas aeruginosa strains from hospitals in Majorca, Spain, five clinical isolates showed a positive Etest MBL screening test result. In one of them, strain PA-SL2, the presence of a new bla(VIM) derivative (bla(VIM-13)) was detected by PCR amplification with bla(VIM-1)-specific primers followed by sequencing. The bla(VIM-13)-producing isolate showed resistance to all beta-lactams (except aztreonam), gentamicin, tobramycin, and ciprofloxacin. VIM-13 exhibited 93% and 88% amino acid sequence identities with VIM-1 and VIM-2, respectively. bla(VIM-13) was cloned in parallel with bla(VIM-1), and the resistance profile conferred was analyzed both in Escherichia coli and in P. aeruginosa backgrounds. Compared to VIM-1, VIM-13 conferred slightly higher levels of resistance to piperacillin and lower levels of resistance to ceftazidime and cefepime. VIM-13 and VIM-1 were purified in parallel as well, and their kinetic parameters were compared. The k(cat)/K(m) ratios for the antibiotics mentioned above were in good agreement with the MIC data. Furthermore, EDTA inhibited the activity of VIM-13 approximately 25 times less than it inhibited the activity of VIM-1. VIM-13 was harbored in a class 1 integron, along with a new variant (Ala108Thr) of the aminoglycoside-modifying enzyme encoding gene aacA4, which confers resistance to gentamicin and tobramycin. Finally, the VIM-13 integron was apparently located in the chromosome, since transformation and conjugation experiments consistently yielded negative results and the bla(VIM-13) probe hybridized only with the genomic DNA.

Molecular mechanisms of beta-lactam resistance mediated by AmpC hyperproduction in Pseudomonas aeruginosa clinical strains.

The molecular mechanisms of beta-lactam resistance mediated by AmpC hyperproduction in natural strains of Pseudomonas aeruginosa were investigated in a collection of 10 isogenic, ceftazidime-susceptible and -resistant pairs of isolates, each sequentially recovered from a different intensive care unit patient treated with beta-lactams. All 10 ceftazidime-resistant mutants hyper-produced AmpC (beta-lactamase activities were 12- to 657-fold higher than those of the parent strains), but none of them harbored mutations in ampR or the ampC-ampR intergenic region. On the other hand, six of them harbored inactivating mutations in ampD: four contained frameshift mutations, one had a C-->T mutation, creating a premature stop codon, and finally, one had a large deletion, including the complete ampDE region. Complementation studies revealed that only three of the six ampD mutants could be fully trans-complemented with either ampD- or ampDE-harboring plasmids, whereas one of them could be trans-complemented only with ampDE and two of them (including the mutant with the deletion of the ampDE region and one with an ampD frameshift mutation leading to an ampDE-fused open reading frame) could not be fully trans-complemented with any of the plasmids. Finally, one of the four mutants with no mutations in ampD could be trans-complemented, but only with ampDE. Although the inactivation of AmpD is found to be the most frequent mechanism of AmpC hyperproduction in clinical strains, our findings suggest that for certain types of mutations, AmpE plays an indirect role in resistance and that there are other unknown genes involved in AmpC hyperproduction, with at least one of them apparently located close to the ampDE operon.

Incidencia de infecciones genitales causadas por el virus del herpes simple tipo 1 (VHS-1) durante el período 1995-2003 / Incidence of genital infections caused by herpes simplex virus type 1 (HSV-1) from 1995 to 2003

Introducción. Estudios recientes demuestran que en los últimos años se ha producido a nivel mundial un incremento significativo en el porcentaje de casos de infección genital causados por el virus del herpes simple (VHS-1), especialmente en las mujeres. Métodos. Se presenta un estudio sobre las infecciones genitales causadas por el VHS-1 en nuestra área geográfica durante el período 1995-2003. Las muestras genitales se inocularon en la línea celular Vero y las monocapas teñidas con monoclonales específicos frente al VHS-1 y VHS-2. Resultados. Durante el estudio se han obtenido 263 muestras positivas a herpesvirus: 146 a VHS-1 (55,5%) y 117 a VHS-2 (44,5%). Los 20 VHS-1 aislados en el tracto genital representan el 7,6% de todos los herpesvirus aislados en este estudio. De los 146 VHS-1 aislados, 20 (13,7%) lo fueron en muestras genitales, correspondiendo 15 a mujeres (75%) y 5 a hombres (25%) (p < 0,005). Cuatro hombres (80%) declararon ser homosexuales. Ningún paciente estaba infectado por el VIH ni ejercía la prostitución. Conclusión. Se ha observado un incremento del porcentaje de VHS-1 aislados en muestras genitales en el último año (33%), especialmente en mujeres de la población general. Es importante caracterizar el herpesvirus aislado en estas muestras ya que, en general, el VHS-1 no acostumbra a desarrollar en este territorio latencia e infecciones recurrentes (AU)

Introduction. In recent years studies from various parts of the world have reported a significant increase in the number of genital infections caused by HSV-1, especially among women. Methods. We report a study of genital infections caused by HSV-1 in our geographic area from 1995 to 2003. Genital samples were inoculated in the Vero cell line and cultures were stained by monoclonal antibodies against HSV-1 and HSV-2. Results. During the study period, 263 samples were positive for herpesviruses: 146 for HSV-1 (55,5%) and 117 for HSV-2 (44.5%). The 20 HSV-1 isolated in the genital tract represented 7.6% of all the herpesviruses isolated in this study. Of the 146 HSV-1 isolated, 20 (13.7%) were obtained in genital samples, 15 (75%) in women and 5 (25%) in men (p < 0.005). Four men (80%) were homosexual. No patient, male or female, was infected with the HIV and none worked as prostitutes. Conclusions. The percentage of HSV-1 genital infections increased in the last year of the study (33%), especially among women from the general population. The herpesvirus isolated in these samples should be characterized, since, in general, HSV-1 does not usually develop latency or recurrent infections in this anatomical area (AU)

[Incidence of genital infections caused by herpes simplex virus type 1 (HSV-1) from 1995 to 2003]. / Incidencia de infecciones genitales causadas por el virus del herpes simple tipo 1 (VHS-1) durante el período 1995-2003.

INTRODUCTION: In recent years studies from various parts of the world have reported a significant increase in the number of genital infections caused by HSV-1, especially among women. METHODS: We report a study of genital infections caused by HSV-1 in our geographic area from 1995 to 2003. Genital samples were inoculated in the Vero cell line and cultures were stained by monoclonal antibodies against HSV-1 and HSV-2. RESULTS: During the study period, 263 samples were positive for herpesviruses: 146 for HSV-1 (55.5%) and 117 for HSV-2 (44.5%). The 20 HSV-1 isolated in the genital tract represented 7.6% of all the herpesviruses isolated in this study. Of the 146 HSV-1 isolated, 20 (13.7%) were obtained in genital samples, 15 (75%) in women and 5 (25%) in men (p < 0.005). Four men (80%) were homosexual. No patient, male or female, was infected with the HIV and none worked as prostitutes. CONCLUSIONS: The percentage of HSV-1 genital infections increased in the last year of the study (33%), especially among women from the general population. The herpesvirus isolated in these samples should be characterized, since, in general, HSV-1 does not usually develop latency or recurrent infections in this anatomical area.

Evaluación preliminar de un método inmunocromatográfico (Directigen EZ-RSV) en la detección antigénica del virus respiratorio sincitial / Preliminary assessment of an immunochromatographic method (Directigen EZ-RSV) for antigenic detection of syncytial respiratory virus

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Lack of association between hypermutation and antibiotic resistance development in Pseudomonas aeruginosa isolates from intensive care unit patients.

Hypermutation is a common feature of Pseudomonas aeruginosa isolates from chronically infected cystic fibrosis patients that is linked with antibiotic resistance development. In this work, using a large collection of sequential P. aeruginosa isolates from ICU patients, we found that despite the fact that mutational antibiotic resistance development is a frequent outcome, the prevalence of hypermutable strains is low (found in isolates from only 1 of 103 patients) and there is no evidence of coselection of the hypermutable and antibiotic resistance phenotypes.