Propagation of methicillin-resistant Staphylococcus aureus due to the overloading of medical nurses in intensive care units.

Morbidity and mortality due to nosocomial infections are on the increase. The effectiveness of infection control has become an important indicator of the quality of hospital work, as well as contributing towards cost reduction. The aim of this three-year prospective study was to investigate the daily workload of medical nurses to see if there was a correlation with the spread of infections caused by methicillin-resistant Staphylococcus aureus (MRSA) in a surgical intensive care unit (SICU) using a Therapeutic Intervention Scoring System (TISS). Although this SICU pays great attention to continuing education, the incidence of MRSA is still high. By means of the TISS, it was estimated that nurses in the SICU are overloaded by an average of 57%. Infections with MRSA occurred during periods when nurses were, on average, overloaded by more than 25%. During the study period, 47 new cases of MRSA infection were detected. These results suggest that adequate human resource management, particularly with respect to nursing care staff in SICUs, could contribute towards infection control.

Treatment of chronic hepatitis C: our experience.

BACKGROUND/AIMS: While an optimal treatment of chronic hepatitis C has not yet been established, it has been demonstrated that the interferon alpha/ribavirin combination is more effective than interferon alpha monotherapy. METHODOLOGY: One hundred and forty-three patients with chronic hepatitis C received the following treatment: eighty patients an 18-month monotherapy (3-month follow-up) and sixty-three patients a 12-month combined therapy (6-month follow-up). Therapeutic efficacy and adverse effects were compared. RESULTS: In 80 patients in the monotherapy group, complete response was achieved in 49.2%. This was reduced to 27.5% three months after therapy. Significant differences were observed in HCV 3 genotype where complete response was achieved in 12 out of 14 patients (p=0.01). With the combined therapy administered to 63 patients, complete response was achieved in 54.5%. This was reduced to 43.2% after 6 months of follow-up. Among the responders or partial responders, significant differences were observed with regard to age (p=0.0047) and subtype 1b (p=0.012). Comparing the groups of naive patients and relapsers, a statistically significant difference (p=0.027) was found in therapeutic efficacy. CONCLUSIONS: In the treatment of chronic hepatitis C, combined therapy proved more effective than monotherapy. This is, however, not yet a satisfactory solution.

Aetiology and clinical presentation of mild community-acquired bacterial pneumonia.

A prospective study was initiated to analyse the bacterial aetiology and clinical picture of mild community-acquired pneumonia in Slovenia using the previously described Pneumonia Severity Index. Radiographically confirmed cases of pneumonia in patients treated with oral antibiotics in seven study centres were included. An aetiological diagnosis was attempted using culture of blood and sputum, urinary antigen testing for Streptococcus pneumoniae and Legionella pneumophila, and antibody testing for Mycoplasma pneumoniae, Chlamydia pneumoniae, and Legionella pneumophila in paired serum samples. One hundred thirteen patients were evaluable for clinical presentation and 109 for aetiological diagnosis. At least one pathogen was detected in 62.4% patients. The most common causative agents were Mycoplasma pneumoniae in 24.8%, Chlamydia pneumoniae in 21.1%, and Streptococcus pneumoniae in 13.8% of patients. Dual infection was detected in 8.3% of patients. Most patients suffered from cough, fatigue, and fever. Patients with atypical aetiology of pneumonia differed from those with typical bacterial pneumonia or pneumonia of unknown aetiology in age, presence of dyspnea, and bronchial breathing on lung auscultation. Patients with pneumococcal, chlamydial, and mycoplasmal infections differed in age, risk class, presence of dyspnea, bronchial breathing, and proteinuria. There was an overlap of other clinical symptoms, underlying conditions, and laboratory and radiographic findings among the groups of patients classified by aetiology. Since patients with mild community-acquired pneumonia exhibit similar clinical characteristics and, moreover, since a substantial proportion of cases are attributable to atypical bacteria, broad-spectrum antibiotic treatment seems to be recommended.

Complex regional pain syndrome and lyme borreliosis: two different diseases?

Complex regional pain syndrome (CRPS) is a frequent complication appearing as pain of unexplained pathogenesis. Its association with Lyme borreliosis (LB) is fairly rare. In the presented clinical case, clinical features as well as the findings of radiological, radionuclide, neurophysiological and serological investigations pointed to an association between the two conditions. The patient fulfilled the criteria for both diagnoses, i.e. CRPS and LB. The subsequent antibiotic therapy resulted in a complete remission of both clinical entities.

Second-generation Hybrid capture test and Amplicor monitor test generate highly correlated hepatitis B virus DNA levels.

The performance of the Digene Hybrid Capture II HBV DNA Test HC II and the Roche Cobas Amplicor Monitor Test (Cobas-HBV) was evaluated on 252 serum samples. One hundred and seventy-three samples were HBV DNA positive and 75 HBV DNA negative by both assays. Four samples were HBV DNA positive by Cobas-HBV only. Linear regression analysis showed that the HBV DNA concentrations obtained from both assays were significantly related (n=173, r=0.976, P<0.0001). The results of the study show that Hybrid capture II and Cobas-HBV could be used equally in the management for patients with chronic HBV infection.

Comparative evaluation of semiautomated COBAS AMPLICOR hepatitis B virus (HBV) monitor test and manual microwell plate-based AMPLICOR HBV MONITOR test.

Comparative evaluation of the semiautomated COBAS AMPLICOR hepatitis B virus (HBV) MONITOR Test (COBAS-HBV) and manual AMPLICOR HBV MONITOR Test (AMPLICOR-HBV) on 208 serum samples revealed no significant difference in the sensitivities of the two assays. Twenty samples tested HBV DNA negative and 183 samples tested HBV DNA positive by both assays. Three samples tested positive by COBAS-HBV only and two samples tested positive by AMPLICOR-HBV only. HBV DNA concentrations determined by the two assays were significantly related (n = 183, r = 0.97, P < 0.0001), which indicates that COBAS-HBV could replace AMPLICOR-HBV. The major inconvenience of COBAS-HBV is the required performance of appropriate predilutions of high-titer samples in order to extend the narrow dynamic range of the assay.

Meningococcal disease in Slovenia (1993-1999): serogroups and susceptibility to antibiotics. Slovenian Meningitis Study Group.

The epidemiology of meningococcal disease was studied prospectively in Slovenia from 1993 to 1999 in children and from 1995 to 1999 in adults. Patients with meningococci isolated from normally sterile body sites were included in the study. Altogether 75 patients (57 children, 18 adults) were found with meningococcal diseases. The overall yearly incidence was 0.43 per 100000 inhabitants. The highest annual incidence (18.5/100000) was found in children between 1 month and 1 year of age. The case to fatality ratio was 4.1%. Group B meningococci were isolated most frequently (84.7%), followed by group C (11.1%). In six patients (8.3%) isolates were less susceptible to penicillin. Four of these were successfully treated with penicillin alone.

Distribution of hepatitis C virus genotypes in Slovenia.

To determine the prevalence of HCV genotypes in Slovenia, 203 subjects infected with hepatitis C virus (HCV) were studied using the Inno-Lipa HCV II assay (Innogenetics, Belgium). Of 21 patients infected by blood transfusion 19% had HCV subtype 1a, 81% had subtype 1b, and none of them was infected with genotype 3. In chronic hepatitis C patients infected by unknown cause subtype 1b was the most prevalent (54.4%), followed by subtype 1a (24.6%), genotype 3 (15.8%) and genotype 2 (5.2%). Genotype 3 (45.9%) and subtype 1a (43.2%) predominated among 74 intravenous drug users. In 37 haemodialysis patients genotypes 1 and 2 were almost equally frequent (40.5% and 37.8%, respectively), followed by genotype 3 (21.6%). Significant differences in HCV genotype distribution among distinct epidemiological groups observed in Slovenia indicate a close relationship between certain HCV genotypes and particular routes of viral transmission.

A prospective study of viral hepatitis A and the question of chronicity.

In a prospective study, the author followed up the course of hepatitis A (HA) in 451 patients, predominantly schoolchildren, who were treated in the years 1982-1985 in the Department for Infectious Diseases of the Celje Municipal Hospital. HA was identified by the present of hepatitis A virus IgM class (anti-HAV-IgGM) in the serum, and in one-third of the patients (38.6%) also with serological proof of the presence of the hepatitis A virus antigen (HAAg) in the feces. Other liver diseases which might present a similar picture were excluded. In 378 patients (83.8%) the course of the disease was mild, the biochemical "liver tests" normalised within three months; in 73 patients (16.2%) the course was prolonged up to twelve months. In eight patients with a relapsed or protracted course that lasted from six to twelve months after the normalization of clinical and biochemical results, a liver biopsy was performed. The histologic picture revealed only slight residual changes which were evident mainly in portal and periportal areas of the liver. All of the HA convalescents were free of subjective signs and had no clinical symptoms after two to three years. In 23 patients (5.1%) posthepatitic indirect hyperbilirubinemia remained a laboratory finding. On the basis of our results, we came to the conclusion that, also in patients with a protracted and relapsed course, HA takes a benign course which in itself tends toward recovery and does not leave any permanent sequelae in the liver.

Sequeale of acute viral hepatitis type B.

In 1976 we undertook to evaluate the incidence of chronic liver lesions in 161 patients treated in hospital during the years 1970-1975 for their serologically established acute viral hepatitis type B (AVH-B). At systematic control examination mode in 1976, after a period from 1-5 years since the acute onset of disease, it was established that in 133 individuals (82.6%) the antigen HBs had disappeared from blood and the BLT had become normal. Persistent HBs antigenemia was established in 20 (12.4%) individuals. In 15 (9.2%) patients persistent HBs antigenemia was accompanied by pathologic BLT, in 5 (3.1%) cases liver function became returned to normal yet with the persistent HBs antigenemia after their recovery from A VH-B. In 8 (4.9%) patients pathologic BLT persisted although HBsAg had disappeared from blood. Among 28 persons with persistent pathological BLT or with persistent HBs antigenemia out of a total of 161 patients who had had A VH-B, there were 11 (6.8%) cases with the bioptically proved CPHf, 8 (5.0%) cases with CPH, 5 (3.1%) cases with CAH, while 4 (2.5%) patients showed fatty liver metamorphosis or had by light microskopy completely normal liver. CAH was established only in cases with persistent BHs antigenemia and pathological BLT. The incidence of the chronic liver lesion and of the persistent antigenemia was among our patients who had had A VH-B in inverse ratio to the intensity of their initial infection. Our study suggests that no prodisposition for persistent HBs antigenemia is created by the prednisolone therapy.