Health care workers' exposure to blood-borne pathogens in Lebanon.

BACKGROUND: Accidental exposure to blood-borne pathogens (BBPs) is a risk for health care workers (HCWs). AIM: To study the pattern of occupational exposure to blood and body fluids (BBFs) at a tertiary care hospital. METHODS: This study reports a 17-year experience (1985-2001) of ongoing surveillance of HCW exposure to BBFs at a 420-bed academic tertiary care hospital. RESULTS: A total of 1,590 BBF exposure-related accidents were reported to the Infection Control Office. The trend showed a decrease in these exposures over the years with an average +/- standard error of 96 +/- 8.6 incidents per year. In the last 6 years, the average rate of BBF exposures was 0.57 per 100 admissions per year (average of needlestick injuries alone was 0.46 per 100 admissions). For 2001, the rates of exposure were found to be 13% for house officers, 9% for medical student, 8% for attending physicians, 5% for nurses, 4% for housekeeping, 4% for technicians and 2% for auxiliary services employees. The reason for the incident, when stated, was attributed to a procedural intervention (29%), improper disposal of sharps (18%), to recapping (11%) and to other causes (5%). CONCLUSIONS: The current study in Lebanon showed that exposure of HCWs to BBPs remains a problem. This can be projected to other hospitals in the country and raises the need to implement infection control standards more efficiently. Similar studies should be done prospectively on a yearly basis to study rates and identify high-risk groups.

Association between hepatitis A virus and Helicobacter pylori in a developing country: the saga continues.

BACKGROUND: The epidemiologic association between Helicobacter pylori and hepatitis A virus (HAV) has been evaluated by various different groups with conflicting conclusions. The aim of the present study was to determine the prevalence of HAV and H. pylori infection among adolescents attending high schools in Lebanon, and to identify the sociodemographic factors associated with their prevalence, individually and concurrently. METHODS: Nine hundred and two school students 14-18 years of age were selected randomly from 30 schools scattered all over Lebanon and tested for IgG antibodies against hepatitis A and H. pylori. Each student received a copy of a self-administered questionnaire to be completed by his/her parents inquiring about demographics, history of immunization, and prior viral hepatitis illness in the student. Bivariate analysis examined the association between different sociodemographic variables and prior HAV or H. pylori infection, and multivariate regression analysis was done to determine the factors independently associated with prior infection. RESULTS: Using ELISA the seroprevalence of antibodies against HAV was 71.3% as compared to 61.6% for anti-H. pylori. A total of 9.1% of those tested were negative for both agents. A multinomial regression analysis revealed that place of residence in relation to district or urban versus rural areas, in addition to mothers' education, were important determinants for the incidence of both agents. CONCLUSION: The low number of subjects negative for both H. pylori and HAV antibodies in Lebanon is indicative of their high prevalence in the country. It is possible that this high prevalence reflects an age-specific prevalence rather than a true association.

Erysipelas of the upper extremity following locoregional therapy for breast cancer.

Cellulitis is a well-known complication of lymphedema of the lower extremities. Erysipelas of the upper extremity complicating breast cancer therapy has never been reported in the English-language literature. We describe seven breast cancer patients with erysipelas of the upper extremity. Five had a predisposing injury to the extremity. All patients responded very well to intravenous antibiotics without any sequelae. They had rapid resolution with typical desquamation. No long-term sequelae were seen except for mild increase of lymphedema. Erysipelas should be listed as a rare complication after locoregional therapy for breast cancer. Intravenous penicillin should be used as the initial therapy. Prevention of arm lymphedema and avoidance of any trauma to the arm are important prophylactic measures. Sentinel lymph node biopsy reduces the rate of axillary lymph node dissection and thus should reduce the incidence of lymphedema and erysipelas.

Incidence of urinary tract infection following transrectal ultrasound guided prostate biopsy at a tertiary-care medical center in Lebanon.

OBJECTIVE: To determine the incidence of urinary tract infections (UTIs) following transrectal ultrasound guided needle biopsy of the prostate (TRUBP) and the bacteriology of these infections. DESIGN: Retrospective evaluation of the charts and records of all patients who underwent TRUBP between June 1, 2002, and August 31, 2003. SETTING: American University of Beirut Medical Center, a tertiary-care center in Lebanon. PATIENTS: Two hundred seven patients underwent TRUBP. All received prophylactic antibiotics. One hundred twenty (58%) received ciprofloxacin alone, whereas 87 (42%) received both ciprofloxacin and gentamicin. Sixty-one patients (29.5%) had an enema prior to the procedure, whereas 146 (70.5%) did not. RESULTS: Thirteen patients (6.3%) were admitted with UTI. All had rigors and fever on admission. Symptoms appeared at a mean of 2.7 days and the mean hospital stay was 9.2 days. The mean duration of antibiotic treatment was 23.2 days. Ten (77%) of the patients had positive bacteriology. Urine cultures were positive in 8 (61.5%) of the patients and blood cultures in 6 (46.2%). All positive cultures grew Escherichia coli resistant to ciprofloxacin, with 5 isolates producing extended-spectrum betalactamases. CONCLUSIONS: TRUBP continues to be associated with significant infectious complications, especially UTI. Given the increasing incidence of antibiotic resistance mainly among the Enterobacteriaceae, antimicrobial prophylaxis practices should be reevaluated and the universal administration of quinolones alone or in combination with aminoglycosides should be reconsidered.

Rhabdomyolysis and Salmonella typhi infection: case report and review of the literature.

Typhoid fever is endemic in Lebanon. Usual presentation includes fever, headache, abdominal pain and constipation or diarrhea. Extra-intestinal manifestations are not uncommon and involve variety of organ systems. Rhabdomyolysis is rare and has been reported in various Salmonella infections. We present a case of rhabdomyolysis and renal failure that was successfully treated with imipenem/cilastatin and hemodialysis.