Screening for Chagas' disease in HIV-positive immigrants from endemic areas.

Chagas' disease is an opportunistic infection in the setting of HIV/AIDS. The arrival of HIV-positive immigrants from endemic areas to non-endemic countries makes possible the detection of Chagas' disease in this group of patients. We describe the results of a screening programme conducted in the HIV-positive immigrant population arriving from endemic areas who attended the Tropical Medicine Unit of Hospital Universitario Central of Asturias during 2008. We determined anti-T. cruzi antibodies in all HIV patients arriving from endemic areas who were followed up. The ID-Chagas antibody test was used as a screening assay. The positive cases were confirmed with ELISA, IFAT and PCR. We analysed 19 HIV-positive immigrants, of which two (10·5%) had a positive antibody test for Chagas' disease confirmed. PCR was positive in both cases. There was no difference between the co-infected and the non-co-infected patients with respect to race, place of birth and residence, CD4+ cell count, and HIV viral load count. Direct microscopic examination of blood was negative in both positive cases. The positive patients were a man from Bolivia and woman from Paraguay. The overlap of HIV and T. cruzi infection occurs not only in endemic areas but also in non-endemic areas of North America and Europe where the diagnosis may be even more difficult due to low diagnostic suspicion. The implementation of screening programmes in this population group is needed for the early diagnostic of Chagas' disease.

[Estimating the costs associated with nosocomial urinary tract infection. A case-control study]. / Estimación de los costes asociados a la infección urinaria nosocomial. Un estudio de casos y controles.

BACKGROUND: Nosocomial infection (NI) is associated with increased resource use. The current study addressed the cost excess attributable to nosocomial urinary tract infection (NUTI). METHODS: Case-control study conducted in a cohort population. For matching, the Diagnostic Related Group (DRG) to which the episode of case patient was ascribed was used. Then, a further search was conducted in the hospital discharge database with the following parameters: DRG, gender, age, admission date, department, comparison of length of stays, main diagnosis, co-morbidities, number of secondary diagnoses and procedures. Matching was achieved for 64 episodes (71%), and upon them an estimation of costs was performed. RESULTS: The mean length of stay for cases were 15.3 (median: 12) and 12.3 (median: 11) days for cases and controls, respectively (p = 0.0001). The excess of length of stay attributable to NUTI was 3 days (95% CI 1.6-4.7), longer for patients admitted to Medical Departments (5.3 days) than for patients admitted to Surgical Departments (2 days) (p = 0,03). The use of diagnostic resources was significantly higher for bacteriological testing only. The use of antibiotics and fluid therapy was higher among infected patients. Out of the total excess of the estimated costs per episode, 132,047 ptas, 93% corresponded to the increase in hospital stay. Ten patients (15.6%) were responsible for 68% of the total of extra-costs. In 17 occasions (26.6%), the control patient used more resources than the infected patient. CONCLUSIONS: Nosocomial urinary tract infection is associated with a resource use directly related to its presence. For the most part, it is related to the prolongation of hospital stay.

Estimación de los costes asociados a la infección urinaria nosocomial. Un estudio de casos y controles / Estimating the costs associated with nosocomial urinary tract infection. A case-control study

Fundamento. La infección nosocomial (IN) se acompaña de un incremento en el consumo de recursos. En el presente estudio se estima el exceso de costes atribuible a la infección urinaria nosocomial (IUN).Métodos. Se realizó un estudio de casos y controles anidado en un estudio de cohortes. Para el apareamiento se partió del Grupo Relacionado con el Diagnóstico (GRD) al que se adscribió el episodio del paciente caso, con una búsqueda ulterior en la base de datos de altas hospitalarias utilizando las siguientes variables: GRD, sexo, edad, fecha de ingreso, servicio, comparación de estancias, diagnóstico principal, comorbilidad, número de diagnósticos secundarios y procedimientos. Se logró el apareamiento en 64 episodios (71 por ciento), sobre los que se realizó la estimación de costes. Resultados. La estancia media fue para los casos de 15,3 días (mediana: 12) y para los controles de 12,3 días (mediana: 11); p = 0,0001. El exceso de estancia atribuible a la IUN fue de 3 días (IC 95 por ciento: 1,6-4,7), mayor para los pacientes ingresados en los servicios médicos, 5,3 días, que en aquellos que sufrieron intervenciones quirúrgicas, 2 días; p = 0,03. El consumo de recursos diagnósticos fue significativamante más elevado únicamente en pruebas bacteriológicas. El consumo de antibióticos y fluidoterapia fue mayor en los pacientes infectados. Del exceso total del coste estimado por episodio, 132.048 pesetas, el 93 por ciento corresponde al incremento de estancias. Diez pacientes (15,6 por ciento) fueron responsables del 68 por ciento del total de costes extras. En 17 ocasiones (26,6 por ciento) el paciente control consumió más recursos que el paciente infectado. Conclusiones. La infección urinaria nosocomial se acompaña de un consumo de recursos directamente relacionado con su existencia. En su mayor parte está relacionado con la prolongación de la estancia hospitalaria (AU)

[Postsurgical meningitis caused by Pseudomonas aeruginosa: study of 15 cases and review of the literature]. / Meningitis postquirúrgica por Pseudomonas aeruginosa: estudio de 15 casos y revisión de la literatura.

OBJECTIVE: Pseudomonas aeruginosa meningitis is a rare condition which is usually associated with pathology in the ORL field, neurosurgery or local neurologic manipulations. The characteristics, epidemiology, and course of this entity were determined. METHODS: Fifteen episodes of nosocomial postsurgical Pseudomonas aeruginosa meningitis occurred between 1989 and 1996 were retrospectively analyzed. RESULTS: A previous cranioencephalic trauma was recorded in 46.6% of patients. The portals of entry included: intraventricular catheter (IC) (12 cases), CSF fistula (2 cases), and craniotomy (1 case). In five occasions (41.6%) the microorganism was also recovered from the intraventricular catheter. Once culture results were available, therapy with active drugs against Pseudomonas was instituted and in 7 occasions was accompanied by the removal of IC. Eight patients eventually cured and two patients relapsed. The absence of cure was significantly associated with non-removal of the IC (p < 0.01). The infection resulted in death in 26.6% of patients. CONCLUSIONS: Postsurgical Pseudomonas aeruginosa meningitis is an entity of growing relevance. It is associated with relevant morbi-mortality. Catheter removal is essential to obtain a favorable outcome.

Meningitis postquirúrgica por Pseudomonas aeruginosa: estudio de 15 casos y revisión de la literatura / Postsurgical Pseudomonas aeruginosa meningitis: report of 15 cases and review of the literature

Objetivo. La meningitis por Pseudomonas aeruginosa es una entidad poco frecuente que suelen asociarse a patología del área otorrinolaringológica, intervenciones neuroquirúrgicas o manipulaciones neurológicas locales. Se determinaron las características, epidemiología y evolución de esta entidad.Métodos. Se analizaron de forma retrospectiva entre 1989-1996 quince episodios de meningitis nosocomial postquirúrgica por Pseudomonas aeruginosa. Resultados. En un 46,6 por ciento de los pacientes se recogió el antecedente de un traumatismo craneoencefálico.Las puertas de entrada fueron: catéter intraventricular (doce casos), en dos una fístula de líquido cefalorraquídeo y en uno la craniotomía. En cinco ocasiones (41,6 por ciento) el microorganismo se cultivó también en el catéter intraventricular. Tras la llegada del cultivo se instauró tratamiento con fármacos activos frente a Pseudomonas, que en siete ocasiones se acompañó de la retirada del catéter intraventricular. En ocho casos se produjo la curación y dos enfermos recidivaron. La ausencia de curación se asoció de forma significativa (p < 0,01) a la no retirada del catéter. El 26,6 por ciento de los pacientes falleció a consecuencia de la infección. Conclusiones. La meningitis postquirúgica por Pseudomonas aeruginosa es una entidad de importancia creciente. Se asocia a una importante morbimortalidad. La retirada del catéter es fundamental en su curación (AU)

No disponible

[Study of costs associated with catheter-related bacteremia]. / Estudio de los costes asociados a la bacteriemia relacionada con el catéter.

BACKGROUND: Nosocomial infection (NI) is associated with an increase in resource consumption. The estimation of extra costs attributable to NI in a group of patients with catheter-related bacteremia (CRB) was the objective of the present study. METHODS: A matched case-control, study was conducted in a cohort population. Individual matching was accomplished departing from the diagnosis related group (DRG) to which the case patient episode was ascribed and later searching in the hospital discharge data base using the following parameters: DRG, sex, age, admission date, department, comparison of hospital stays, main diagnosis, co-morbidity, number of secondary diagnoses and procedures. Matching was obtained for 22 cases (68.7%), upon which the cost estimations were performed. RESULTS: The mean hospital stay length for cases was 26.5 days (median: 24.5) and for controls 14.5 days (median: 13.5), p = 0.0002. The excess stay attributable to CRB was 11.5 days. The use of diagnostic resources was significantly higher for bacteriological tests and complete blood counts. The consumption of antibiotics and fluid therapy was higher in infected patients. Eighty-nine percent of 536,736 pesetas, the total excess of the estimated cost per episode, corresponded to the increase in hospital stay length. Seven patients (32%) were responsible for 64% of the total of extra costs. CONCLUSIONS: The method employed proved useful for estimating the costs associated with NI. The prolongation of hospital stay is responsible for most of the associated cost.

[Pyogenic hepatic abscess. Review of 59 cases and experience with imipenem]. / Abscesos hepáticos piogénicos. Revisión de 59 casos y experiencia con imipenem.

OBJECTIVES: To study the different etiopathogenic, microbiological, clinical, evolutive, and therapeutic aspects in patients with pyogenic liver abscesses, with a special emphasis in the usefulness of imipenem-cilastatin therapy. MATERIALS AND METHODS: The clinical records of 59 patients with liver abscesses (45 single abscess and 14 multiple abscesses) diagnosed at our institution in the last eleven years were studied. RESULTS: The most common predisposing conditions included biliary (35.6%) and colon (15.3%) diseases, and abdominal trauma (15.3%). The microorganisms responsible for these abscesses included E. coli, Bacteroides spp., and different streptococci. CT and/or abdominal echography were the diagnostic techniques most commonly used. Twenty-three patients were treated with percutaneous drainage and antibiotics, 22 with surgical drainage and antibiotics, 6 with both types of drainage and antibiotics, and 8 exclusively with antibiotics. Twenty-three patients received imipenem (1 g/IV/8 h) and 29 other antibiotics. Twelve patients died and 9 required admission at the ICU. With regard to patients treated with imipenem, 17 (73.9%) cured, 3 of them (one single abscess and two multiple abscesses) without drainage. Two patients treated with imipenem (8.7%) and 4 treated with other antibiotics (13.8%) relapsed. CONCLUSIONS: Imipenem can be a useful antibiotic in association with percutaneous or surgical drainage for the treatment of pyogenic liver abscesses.

[Thrombocytopenia associated with human immunodeficiency virus infection. Pathogenic significance of platelet autoimmunity phenomena]. / Trombocitopenia asociada a la infección por el virus de la inmunodeficiencia humana. Significado patogénico de los fenómenos de autoinmunidad plaquetaria.

OBJECTIVES: Several mechanisms in formation and destruction of platelets could be involved in thrombocytopenia associated with HIV infection (TP/HIV). This epidemiological study investigated the pathogenic role of immunoglobulins associated with platelets (IAP), circulant immunocomplexes (CIC) and anticardiolipin antibodies (ACA) in patients with TP/HIV: PATIENTS AND METHODS: A total of 207 adults patients infected with HIV were studied. Patients were classified as thrombocytopenic (platelet count < 100,000/mm3, n = 68); borderline thrombocytopenic (platelet count from 100,000 to 150,000/mm3, n = 23) and non-thrombopenic (platelet count > 150,000/m3, n = 116). IAP were investigated by an immunofluorescence technique with flow cytometry reading and eluate technique. CIC were investigated by C1q fixation measured by nephelometry. IgG-ACA determination was made with a commercially available ELISA technique. RESULTS: Prevalence of thrombocytopenia in the general cohort of seropositive patients was 16%. Fifteen per cent of these patients had severe TP. There were no significant differences in epidemiology or prognosis among patients with and without TP. Patients with TP/HIV had increase rates of IAP, CIC and ACA (78%, 42% and 89%). These parameters were also increased in a similar percentage of non-TP infected patients (73%, 52%, 94% respectively). No correlation was observed between platelet counts and values of these immunological phenomena. CONCLUSIONS: TP/HIV is common, mild, with no prognostic significance and occurs in an heterogeneous patient population. Immune phenomena associated with a decreased platelet survival occur nonspecifically and with an uncertain pathogenic meaning.

[Immunological changes in chronic osteomyelitis]. / Alteraciones immunológicas en la osteomielitis crónica.

We have studied several aspects of cellular and humoral immunity in 19 patients with chronic osteomyelitis (CO) compared with 11 healthy controls of similar characteristics. Patients with CO showed significantly higher values of GSR, reactive protein C (RPC), IgG and lymphocytes CD3+ and lower values of the CD4+/CD3+ ratio, as well as an hypoergic response to 7 antigens in the different cutaneous hypersensibility tests, compared with healthy controls. The rate of "in vitro" blastic stimulation by different lectins was significantly lower in the group of patients, compared with controls. These changes in the cellular immunity are not correlated with the extent, chronicity and prognosis of the disease, although we did not performed sequential studies of the immunitary condition. None of these immunological markers seem to be a better predictor of the bone infectious activity than the traditional GSR or RPC.

[Experience and evaluation of studies on the prevalence of nosocomial infections at a general hospital]. / Experiencia y valoración de los estudios de prevalencia de la infección nosocomial en un hospital de tercer nivel.

From November 1986 to December 1987 we undertook 5 different counts of the prevalence of nosocomial infections (NI) in 4,572 patients (100% of the population). The following are the most important average values: NI overall, 14.4%, distributed as follows: urinary infections, 29.1%; surgical wounds, 21.6%; pneumonias 8.6%; phlebitis due to catheter insertion, 14.5%; and bacteremias, 5.2%. The most commonly found microorganisms were E. coli, S. aureus, Proteus mirabilis and Enterococcus. These studies reflect the need to decrease the prevalence of NI, mainly those coming from surgical wounds and from the urinary tract. These type counts are feasible with limited human resources. However, they are not appropriate for analyzing in detail the causes of the different types of NI nor in epidemic situations.