Decolonization of orthopedic surgical team S. aureus carriers: impact on surgical-site infections.

BACKGROUND: Orthopedic surgical-site infection (SSI), mostly due to S. aureus, is recognized as a major adverse event. This research aims to verify the usefulness of surgical team decolonization in order to reduce the risk of surgical-site infection. MATERIALS AND METHODS: We performed swabs of both nares and oropharynx to identify S. aureus carriers among orthopedic team members who consented to cooperate with the study. Carriers were treated with local application of mupirocin ointment. RESULTS: Retrospective study of 1,000 consecutive patients operated before surgical team decolonization showed 6 per thousand SSIs. Of the 300 cases considered after decolonization, none developed SSI. CONCLUSIONS: Though we are aware that more data need to be collected, this work might be relevant for the introduction of a new preventive protocol.

A prospective study of prevalence of 60-days postoperative wound infections after cardiac surgery. An updated risk factor analysis.

AIM: Postoperative wound infections generally cause considerable extra morbidity, mortality and costs. The prevalence of total wound infections after cardiac surgery, including both sternal wound and donor site infections, ranges from 1.3 to 12.8%. The present study was conducted to identify the incidence of wound infections following cardiac surgery, to identify the risk factors and evaluate the efficacy of present modes of management. METHODS: From September 2004 to May 2005, 493 consecutive patients undergoing cardiac surgery were included in the study and were followed for the prevalence of surgical site infection (SSI) up to 60 days postoperatively. The wound infections were defined according to the Centers for Disease Control and Prevention (CDC) and U.S. National Nosocomial Infections Surveillance (NNIS) system criteria. RESULTS: The total incidence of SSI was 3.9%. Sternal wound infection (SWI) occurred in 17 patients (3.4%). Superficial wound infection was diagnosed in 10 patients (2%) and deep wound infection in 7 patients (1.4%). Donor site infection (DSI) occurred in 2 patients (0.4%). Early reoperation for bleeding, postoperative dialysis and the use of one internal mammary artery were independently associated with an increased risk of SWI. CONCLUSION: Preventing SSI in the operating room is the primary goal of the surgical team. Attention should be paid to antibiotic prophylaxis and Methicillin-resistant Staphylococcus aureus (MRSA) nasal carriage treatment. The identification of risk factors will help to further reduce the incidence of wound infection.

Antibiotic treatment for acute 'uncomplicated' or 'primary' pyelonephritis: a systematic, 'semantic revision'.

The definition of acute pyelonephritis is controversial. There are two contrasting approaches: (1) acute pyelonephritis is a severe infectious disease involving the kidney parenchyma, and specific imaging techniques are required for diagnosis; (2) acute pyelonephritis is a urinary tract infection, and diagnosis and therapy follow simplified clinical and laboratory pathways. In this study, recent randomized controlled trials (RCTs) were systematically reviewed and the diagnostic and therapeutic approaches to acute 'uncomplicated' pyelonephritis were analysed. Medline, Embase, Cochrane Central Register of Controlled Trials (CCTR) and Chinal were searched employing Mesh, Emtree and free terms on 'pyelonephritis'. Limits included human, period (1995-2004), and trials-reviews (where available). In total, 904 references and 175 full-text were retrieved; 29 were pertinent RCTs. Seven RCTs were added from reference lists (indexed on urinary tract infections). Imaging examinations were performed in 11 of 14 studies on children (diagnostic requisite in two) and in two studies on adults; scarring was not analysed in adults. Clinical definitions varied widely (fever >37.8 to >39 degrees C, culture titres 10(4) >10(5)). Studies on adults were limited to short-term end-points (microbiological sterilization, clinical improvement). Duration of therapy was 4-20 days. The trend was towards shorter periods of therapy, mainly on an outpatient basis; intravenous therapy, if performed, was usually limited to the first 1-3 days. For acute uncomplicated pyelonephritis, the tendency is towards 2 weeks of mainly oral antibiotic therapy. However, the recent literature on adults does not discriminate among different upper urinary tract infections nor does it provide data on renal scarring. While cost constraints point towards short-term therapies, further studies are needed to assess the prevalence and long-term effect of kidney scars.

Imaging data suggesting acute pyelonephritis in the kidney graft: report of five cases with atypical clinical presentation.

Acute pyelonephritis is a common complication of kidney transplantation, occurring in up to 1% of grafts. Diagnosis is mainly clinical and atypical presentations have seldom been reported. The diagnostic role of imaging techniques has not been defined. Five cases of acute graft pyelonephritis are reported (three kidney, two pancreas-kidney grafts). The patients (median age 48 years) comprised three females and two males. Median post-transplant follow-up was 3 months, with three patients having predisposing factors for diabetes and one for an enteric bladder. None of the patients presented the 'classic' diagnostic tetrad (i.e. fever, positive urine cultures, low urinary tract symptoms and serum creatinine increase); although, at diagnosis, two of five patients presented with fever, one had increased creatinine levels and one had positive urine cultures. Of note, three patients had leucocyte casts at urinary sediment analysis, thus raising clinical suspicion. Renal ultrasounds were negative in all patients. Renal (99m)Tc-MAG3 (mercaptoacetyltriglycine) scintigraphy, which was used for the definition of kidney function impairment (one patient) or because of the presence of urinary casts (three patients), or after the biopsy diagnosis to locate the parenchymal lesions (one patient), was positive in all patients. The presence and pyelonephritic origin of the parenchymal lesions was confirmed by nuclear magnetic resonance or computed tomography scans. Acute graft pyelonephritis may develop in the absence of a full-blown clinical picture. Smouldering symptoms may occur in the presence of large perfusion deficits. (99m)Tc-MAG3 scintigraphy could be an important diagnostic tool in such cases.

Development of kidney scars after acute uncomplicated pyelonephritis: relationship with clinical, laboratory and imaging data at diagnosis.

BACKGROUND: Acute pyelonephritis is a potential cause of kidney scars. AIM: To evaluate the relationship between clinical, laboratory and imaging data and the development of kidney scars in acute pyelonephritis. METHODS: All consecutive patients hospitalized for acute uncomplicated pyelonephritis in our nephrology unit from June 1996 to June 2004 were considered: 58 females, median age 25.6 years (16-52). Diagnosis of pyelonephritis required parenchymal lesions shown by CT or NMR scan. RESULTS: The lesions were bilateral in 17.2% (10/58) patients, unilateral, but multifocal in 81.0% (47/58); at CT or NMR, 65.5% of the lesions were classified as simple, 19% with tendency to colliquation and 15.5% abscessual. The median interval between first symptoms and diagnosis was 5 days (1-25); at referral, only 20.7% had a positive urine culture and 94.8% (55/58) had undergone previous antibiotic treatment. The therapeutic protocol required intravenous therapy for > or = 2 weeks, followed by 2-4 weeks of oral therapy. At 6-8 months, the prevalence of kidney scars was 29.3%. Their development was highly correlated with the type of lesions at diagnosis (highest risk with abscessual lesions; uni- and multivariate analysis). No other clinical or laboratory marker (age, fever, positive cultures, levels of acute phase reactants, interval between onset and diagnosis) was correlated with the outcome (scars). CONCLUSIONS: The type of lesion at diagnosis of acute uncomplicated pyelonephritis is highly correlated with the development of kidney scars. Further studies are needed to test the therapeutic schedules tailored according to the imaging data.

[Clinical and pharmacokinetic observations on fluconazole in the management of cryptococcal meningitis]. / Osservazioni cliniche e farmacocinetiche sul fluconazolo nel trattamento della meningite da criptococco.

The above study was intended to evaluate certain pharmacokinetic properties as well as the pharmacological activity of fluconazole in patients with cryptococcal meningitis. The results obtained show satisfactory bioavailability of the drug in the cerebrospinal fluid and marked reduction of the number of fungi found in the liquor.

IgM antibody against hepatitis B core antigen (IgM anti-HBc): diagnostic and prognostic significance in acute HBsAg positive hepatitis.

IgM antibody against hepatitis B core antigen (IgM anti-HBc), a marker of recent hepatitis B virus infection, was sought by radioimmunoassay in sera diluted 1/4000 from 376 patients presenting to four centres in Italy with acute, apparently type B hepatitis (hepatitis B surface antigen (HBsAg) positive). In 320 patients (85%) a positive IgM anti-HBc test result confirmed that hepatitis was due to primary infection with hepatitis B virus. In the remaining 56 patients absence of the IgM marker indicated that they were previously unrecognised long term carriers of HBsAg. Further serum analysis often showed delta infection and occasionally hepatitis A or cytomegalovirus infection as the true cause of their illness. After six to eight months circulating HBsAg persisted in 38 of 45 patients (84%) without IgM anti-HBc but in only six of 150 patients (4%) with the IgM antibody (p less than 0.0001). A negative IgM anti-HBc test result in patients with acute HBsAg positive hepatitis points to a factor other than hepatitis B virus as the cause of the liver damage and predicts the carriage of HBsAg.

[Hemolytic crisis due to a G-6-PD deficiency during the course of viral hepatitis A]. / Crisi emolitica da deficit di G-6-PD in corso di epatite virale di tipo A.

Pathogenetic hypotheses regarding G-6-PD deficiency syndromes are reviewed and a case of viral hepatitis with concomitant haemolytic crisis due to a deficiency in this enzyme is reported. In agreement with other workers, it is noted that viral hepatitis may be one of a variety of factors triggering of the phenomenon and may in such cases present a more serious clinical course.

The immunological diagnosis of HBsAg liver disease by combined screening for the e system in the serum and the HB core and surface antigens in liver biopsy samples.

Serological screening for HBeAg and anti-HBe, combined with the immunohistochemical localization of the hepatitis B core and surface antigen in 110 HBsAg carriers, established different immunological profiles indicative of the liver status and prognostic of the future absence or progression of the disease. Intrahepatic HBcAg and serum HBeAg appeared the most sensitive indexes of chronic and progressive liver disease, anti-HBe and large amounts of cytoplasmic HBsAg suggest, instead, the asymptomatic carrier state without liver damage. Only the nuclear localization of HBcAg in immunohistochemical studies was a reliable prognostic indicator of transition to chronicity; absence or presence of serum HBeAg was of no help in predicitng the outcome of acute HBsAg hepatitis.

[Controlled trial with ACTH and corticosteroids in patients with cholestatic viral hepatitis]. / Ricerca controllata con ACTH e corticosteroidi in pazienti affetti da epatite virale ad impronta colostatica

Comparison was made between synthetic ACTH (tetracosactide), betamethasone and a normal paradigm (dietary management with glucose solutions, detoxicants and vitamins) over a period at least of 21 days in 27 patients with cholostatic viral hepatitis. Assessment of the clinical and laboratory parameters by means of both covariance and multivariance analysis showed that hormonal therapy offered no significant advantages with respect to the basic treatment protocol.

[Distribution and metabolism of testosterone in rats]. / Studio sulla distribuzione e sul metabolismo del testosterone nel ratto.

Distribution and metabolism of testosterone were studied in male and female rats. While no differences between sexes were observed in the hormone distribution to liver, kidney, spleen, heart, adipose tissue, muscle, brain and adrenal, male liver was found to metabolize testosterone mainly to polar compounds; female liver mainly to A-ring reduced compounds.