Risk factors for acquiring extended-spectrum ß-lactamase-producing Enterobacteriaceae in geriatric patients with multiple comorbidities in respiratory care wards.

AIM: Extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae is associated with a high mortality rate and increased medical care costs. Elderly patients might receive mechanical ventilation with respiratory treatment for the long term in respiratory care wards (RCW). This retrospective case-control study sought to determine the risk factors for geriatric patients who acquire a urinary tract infection with ESBL-producing Escherichia coli or Klebsiella pneumoniae in this type of hospital. METHODS: Two RCW participated in this study from September 2006 to March 2007. Patients suspected of having a UTI were enrolled in this study. Urine samples were collected for culture. The medical records and demographic data of patients, including days of hospitalization, comorbidities and duration of invasive instruments, were recorded. UTI was diagnosed by physicians. ESBL-producing isolates were detected using the phenotypic confirmatory tests according to the Clinical and Laboratory Standard Institute standards. RESULTS: There were 109 patients having 240 sets of clinical data and laboratory specimens. The prevalence of ESBL-producing isolates of E. coli. and K. pneumoniae were 39.5% and 69.7%, respectively. Patients with multiple underlying comorbidities (OR=2.88, P<0.05) or receiving more than two antimicrobial agents (OR=3.71, P<0.05) were at an increased risk for acquiring the ESBL-producing microorganisms after adjustment for sex, age and days of hospitalization. CONCLUSIONS: Geriatric patients with recent exposure to two or more antibiotics and two or more numbers of comorbidities were at risk for ESBL-producing organism infection. Our results suggest that infection control procedures in RCW should be concerned with reducing antimicrobial prescriptions and patient comorbidities.

Blastocystis hominis infection in long-term care facilities in Taiwan: prevalence and associated clinical factors.

Blastocystis hominis is probably the most common protozoan found in the human gut worldwide. In Taiwan, the prevalence of B. hominis infection is yet to be determined but is expected to be relatively higher among foreign workers. No data is available on the prevalence of B. hominis infection in long-term care facilities in Taiwan. This study included 713 subjects (552 residents and 161 care workers) from ten long-term care facilities in Taiwan who completed stool microscopic examinations with Merthiolate-iodine-formalin stain technique. The prevalence rate of blastocystosis was the highest among foreign and domestic care workers followed by residents (12.2%, 4.6%, and 2.7%, respectively). Older age (p = 0.04) and lower educational level (p = 0.008) were significantly associated with blastocystosis among care workers. Among residents, B. hominis infection was negatively associated with prolonged use of antibiotics within 3 months prior to examination (p = 0.05) and positively associated with tracheostomy in-place (p = 0.028). In conclusion, B. hominis infection was the most prevalent intestinal parasitic infection among both care workers and residents of long-term care facilities in Taiwan. Use of antibiotics was negatively associated with B. hominis infection among residents. Additionally, appropriate preventive measures should be implemented to older care workers with lesser educational attainment in order to reduce the risk of blastocystosis infection.

Additive effect of smoking and cotton dust exposure on respiratory symptoms and pulmonary function of cotton textile workers.

One hundred and sixty-nine and 175 cotton textile workers (CTWs) were enrolled in the first (1991) and second (1996) surveys to investigate the prevalence of byssinosis. The synergistic effect of smoking on cotton dust exposure was also evaluated. Although the difference in prevalence of abnormal pulmonary function between the first (38.5%) and second study (38.9%) was not statistically significant, smokers had significantly higher frequency than nonsmokers in both surveys. A significant trend existed between the cotton dust levels and the frequency of abnormal lung function. The significant trend was also noted in both smokers and nonsmokers. The frequency of respiratory symptoms and the prevalence of severe byssinosis in the second survey (14.9% and 12.6%, respectively) were significantly lower than that in the first survey (39.7% and 21.9%, respectively). The reduction of symptoms was due to remodeling of this old cotton mill. The prevalences of respiratory symptoms and byssinosis in smokers being significantly higher than in nonsmokers only found in the first survey, but not found in the second survey. These results indicate that smoking potentiates the effect of cotton dust exposure on respiratory symptoms and byssinosis. The second study reveals high prevalence of byssinosis still existed in Taiwanese cotton mill, although the prevalence was declining. Smoking was found to show an additive effect on cotton dust exposure. Anti-smoking campaign, occupational health program to reduce the dust exposure, and periodical medical examination are measures to prevent from byssinosis.

Study on the effect of food on the absorption of theophylline.

BACKGROUND: The pharmacokinetics of theophylline under fasting and normal meal have been widely studied, but that of Euphyllin Retard in Chinese subjects has not been reported. Since various food-induced absorption changes occur with sustained-release theophylline, it is of interest to study the food effect (especially Chinese food) on this drug product. METHODS: A total of 10 non-smoking healthy male volunteers were involved in the study with a 2-period crossover comparison. They were randomly divided into 2 groups. In the first phase study, group A took a single dose of 350 mg Euphyllin Retard (theophylline-ethylenediamine formulation, containing 255 anhydrous theophylline) under fasting condition. Group B took the same dose with breakfast. Blood samples were collected before and during the 36 hours following administration of the drug. For the second-phase study after 2 weeks, the group A acted as fasting group and group B as non-fasting group. The difference in the absorption of theophylline with fasting versus non-fasting administration was assessed using pharmacokinetic parameters derived from a serum theophylline concentration (STC) vs time curve. RESULTS: The means of maximum drug concentration (Cmax), unextrapolated area under the concentration vs time curve (AUC) from time 0 to 24 hours (AUCun), extrapolated AUC from time 0 to infinity (AUCex), and terminal elimination rate constant (Kel) were higher in the non-fasting group. The fasting group showed a more delayed time to maximum concentration (Tmax). The mean of half-life (T50%) was slightly higher in fasting group. In comparing each of the variables, no statistically significant differences were demonstrated between the 2 modes of administration except Cmax. CONCLUSION: Food increases the rate but not the extent of the absorption of Euphyllin Retard, and one should be aware of the possibility of unwanted side effects caused by high peak concentration. There were wide variations in serum drug levels among individuals, so serum theophylline level monitoring is necessary for an optimal effect. This study was performed in a limited number of normal healthy subjects and the same result is yet to be in asthmatic patients and a larger population of normal subjects.