Direct Detection of Carbapenem-Resistant Organisms from Environmental Samples Using the GeneXpert Molecular Diagnostic System.

In this pilot study, traditional culture and PCR methods were compared to the Cepheid GeneXpert IV molecular diagnostic system with the Xpert Carba-R assay (Carba-R assay) for detection of carbapenem resistance genes in primary environmental samples collected during a health care-related outbreak. Overall, traditional culture-dependent PCR and the Carba-R assay demonstrated 75% agreement. The Carba-R assay detected carbapenemase genes in five additional samples and in two samples that had additional genes when compared to culture-dependent PCR. The Carba-R assay could be useful for prioritizing further testing of environmental samples during health care-related outbreaks.IMPORTANCE Use of the Carba-R assay for detection of carbapenem-resistant Gram-negative organisms (CROs) can provide data for implementation of a rapid infection control response to minimize the spread of CROs in the health care setting.

Is there an increased risk for drug treated attention deficit/hyperactivity disorder in children born after in vitro fertilization?

BACKGROUND: There is mounting evidence that children born after in vitro fertilization (IVF) run an increased risk of neurological complications and notably cerebral palsy. Whether developmental disturbances occur more often than expected is debated. AIM: To investigate the risk for ADHD in children conceived after IVF. METHODS: Children conceived after IVF and born between 1982 and 2005 were identified from all IVF clinics in Sweden. Children who developed attention deficit/hyperactivity disorder (ADHD) were identified with the use of a register over all prescribed drugs in Sweden, using prescriptions for methylphenidate or atomixetine as indicators of ADHD. Maternal and neonatal characteristics were obtained by linkage with the Medical Birth Register and relevant confounders were adjusted for using Mantel-Haenszel procedures. We studied 28 158 children born after IVF and compared them with 2 417 886 children in the population. RESULTS: After adjustment for year of birth, maternal age, parity, smoking, BMI, and maternal education and after exclusion of women who did not cohabit, a weak but statistically significant association was found with an odds ratio=1.18, 95% confidence interval 1.03-1.36. The effect was stronger in girls (OR=1.40) than boys (OR=1.11) but this difference could be random. After adjustment for length of involuntary childlessness, the OR decreased slightly and lost statistical significance. CONCLUSIONS: The study suggests a weak association between IVF and drug treated ADHD.

Cerebral palsy in children born after in vitro fertilization. Is the risk decreasing?

BACKGROUND: Infants born after in vitro fertilization (IVF) differ from spontaneously conceived infants in a number of aspects which could increase the risk for future cerebral palsy (CP), e.g., multiple births, preterm births, neonatal complications. AIMS: To follow up children conceived by IVF with respect to risk for CP. METHODS: Infants born after IVF were identified from all IVF clinics in Sweden 1982-2007. Perinatal characteristics were obtained by linkage with the Medical Birth Register. The presence of CP in children born after IVF and in other children was identified from the Patient Register which contains diagnoses given at hospitalizations or specialist outpatient clinics. The risk for CP after IVF was studied after adjustment for year of birth, maternal age, parity, and smoking, all factors which co-vary both with IVF and with CP. Stratification was made for singletons and multiple births and for various neonatal outcomes. RESULTS: The adjusted odds ratio for CP after IVF was 1.81 (95% confidence interval, 95% CI 1.52-2.13), lower and not statistically significant when singletons or when unlike-sexed twins were analyzed. Stratification for various neonatal characteristics also reduced odds ratios to non-significant levels. For the last few years of the study (2004-2007) when the twinning rate after IVF was <10%, the odds ratio for CP was 0.97 (95% CI 0.57-1.66). CONCLUSIONS: The moderately increased risk for CP was most likely a consequence of an increased risk of neonatal morbidity, notably associated with multiple births.

Staphylococcus aureus community-onset pneumonia in patients admitted to children's hospitals during autumn and winter of 2006-2007.

Staphylococcus aureus is a relatively uncommon cause of community-onset pneumonia (COP) that may complicate influenza infection. We reviewed admissions to children's hospitals to describe more systematically this entity. Records of patients hospitalized at three children's hospitals between 1 October 2006 and 30 April 2007 who had a positive S. aureus culture from a sterile site or respiratory specimen were reviewed and data were abstracted for episodes of primary S. aureus COP. Overall, 30 episodes met criteria for primary S. aureus COP; 12 (41%) involved methicillin-resistant S. aureus. Patients in 11 (37%) episodes were seen by a healthcare provider for their symptoms prior to hospital admission; three received an antimicrobial, none of which had activity against the S. aureus isolated. Mechanical ventilation was required in 21 (70%) episodes; five (17%) patients died. When evaluating patients with severe COP, providers should be aware of the potential for S. aureus, including methicillin-resistant strains.

In search of a rational approach to chronic kidney disease detection and management.

Rates of incident end-stage renal disease persist above established goals, driving efforts for early identification of chronic kidney disease (CKD) to reduce progression. The detection of CKD using existing electronic data sources has been proposed as an efficient identification method; however, this method is not without potential challenges and limitations.

Increase in community-acquired methicillin-resistant Staphylococcus aureus at a Naval Medical Center.

A retrospective review of methicillin-resistant Staphylococcus aureus isolates from the Naval Medical Center, San Diego, for the years 1994 through 1997, found that the annual number of community-acquired MRSA isolates increased during the period. These outpatient isolates were more likely than inpatient isolates to be sensitive to a greater number of antibiotics.

Canines as sentinels for Lyme disease in San Diego County, California.

Prevalence of Lyme borreliosis in canine sentinels has been shown to correlate with infection in humans. One thousand canine sera (917 dogs, 83 coyotes) obtained from animal control authorities and area veterinarians were screened by ELISA for antibodies to Borrelia burgdorferi. Results were validated by Western blot and indirect fluorescent antibody (IFA) tests at referee laboratories. Criterion for a positive Western blot was presence of 5 of 10 of the most common antigen IgG bands; for IFA, >1:128 or the equivalent when correcting for interlaboratory variability. Twenty-two of 1,000 canines were confirmed serologically positive (21 dogs and 1 coyote; seroprevalence 2.3% and 1.2%, respectively). Lifestyle, breed size, gender, and age were not statistically predictive of seropositive status. No regional clustering of seropositive animals was detected. The low prevalence of seropositivity in sentinel canines suggests the Lyme borreliosis hazard in San Diego County is minimal.

Atypical Pneumocystis carinii infection in AIDS: massive cervical lymphadenitis and fever of unknown origin.

Pulmonary Pneumocystis carinii infections are relatively common in patients with the acquired immunodeficiency syndrome (AIDS). Extrapulmonary pneumocystis is a less common manifestation, particularly when it occurs without concurrent Pneumocystis carinii pneumonia. Disseminated pneumocystis is most commonly found in lymph nodes, the liver, and the spleen and may result in nonspecific debilitating illness, which is often overlooked in the absence of pulmonary symptoms. We present the case of an AIDS patient who had massive cervical pneumocystis lymphadenitis and minimal pulmonary infiltrates of undetermined etiology and a clinical picture of severe wasting and fever of unknown origin.

Infant mortality in Denmark and Sweden. A comparison based on data in two national registries.

OBJECTIVES: To study in detail the differences in infant mortality between Denmark and Sweden. STUDY DESIGN: Data retrieved from national health registers on infant death rates were compared for 1980-1988, supplemented with a study on the impact of socio-economic conditions in 1985-86 (Denmark) or 1986 (Sweden). RESULTS: Even after stratification for maternal age, parity, and socio-economic group, the Danish mortality rate was higher in all age-at-death intervals except for stillbirths. Maternal age-parity distribution was more favourable in Denmark, the socio-economic distribution in Sweden. The most marked country differences was seen in young women. The difference in the rate of perinatal deaths but not of later deaths is explainable by a more favourable birth weight distribution in Sweden than in Denmark. CONCLUSIONS: The studied variables do not explain the difference in mortality risk but it may be due to life style factors so far not identified.

Twin births to mothers who are twins: a registry based study.

OBJECTIVES: To estimate the risk of having twin infants for mothers who are twins; to investigate the genetic influence on twinning. DESIGN: Retrospective study of multiple births in two nationwide registries. SETTING: Sweden. SUBJECTS: Multiple births among 31,586 deliveries between 1973 and 1991 to women who were twins. MAIN OUTCOME MEASURES: Numbers of monozygotic and dizygotic twin births expected and estimated. RESULTS: Women who are dizygotic twins have a moderately increased risk of having twins (relative risk 1.30, 95% confidence interval 1.14 to 1.49) which seems to be completely the result of dizygotic twinning. When a mother is a monozygotic twin, her risk of having twins of the same sex is significantly increased (1.47; 1.10 to 1.97). This is the result of an excess of monozygotic twins (39 pairs estimated, 18 expected). CONCLUSIONS: Women who are twins have an increased risk of giving birth to twins. Genetic components of monozygotic and dizygotic twinning seem to be independent.

Maternal carbamazepine and infant spina bifida.

Women with epilepsy giving birth during 1973 to 1991 were identified by record linkage of Swedish health registries. Among 3,625 identified infants, 9 had spina bifida. A nested case-control study was performed, comparing drugs used in early pregnancy in the 9 cases and in 18 controls, matched for year of delivery, maternal age, and parity. Six of the spina bifida mothers had used carbamazepine and two had used valproic acid. Among the controls, 5 women used carbamazepine and one valproic acid. There is an apparent excess risk for spina bifida after use of either of these two drugs, but it is not statistically significant when the analysis is restricted to drug-using women. The findings support earlier reports in the literature of an association between carbamazepine and spina bifida.

Psoralen photochemotherapy (PUVA) and pregnancy.

BACKGROUND AND DESIGN: Psoralen photochemotherapy (PUVA) may carry a risk of mutagenesis and teratogenesis. Using a medical birth registry and other health registries, infants born to women who had been treated with PUVA were identified. Exposure information was obtained from treating hospitals and from the license-granting agency. A total of 504 infants were born of pregnancies occurring after PUVA treatment, and 689 infants were born of pregnancies occurring before such treatment. In another 14 cases, treatment occurred during pregnancy. RESULTS: No increase in infant or child mortality or in the presence of congenital malformations could be seen after PUVA treatment. There was a marked increase in low-birth-weight infants when pregnancy occurred after treatment, and this is probably not explained by maternal smoking, but could be an effect of the underlying disease. CONCLUSIONS: The theoretical mutagenic and teratogenic effect of PUVA treatment apparently does not carry any significant risk for abnormal delivery outcome.

Drug intoxication during pregnancy: a study with central registries.

By linking two health registries, one on all infants born and one on hospital discharges, 424 infants were identified born after pregnancies when the mothers had been hospitalized for an intoxication, mainly with drugs. In 126 infants, exposure had occurred during the organ forming period, 99 of them because of suicidal or accidental overdosage of drugs; 70 of these were psychoactive drugs. None of the 70 infants had a congenital malformation, but the upper 95% confidence limit includes a 10% risk increase. An effect on low birth weight rate was seen only after drug complications following medical treatments during weeks 12 to 30. The study supports an earlier study from Hungary that reported that drug intoxication during pregnancy does not carry a substantial teratogenic risk.

Hospitalization for miscarriage and delivery outcome among Swedish nurses working in operating rooms 1973-1978.

All infants born in 1973-1978 to nurses working in anesthesiology or as operating room nurses were identified from a nationwide registry of all births in Sweden, a registry of hospitalized spontaneous and legally induced abortions that covers 70% of Sweden, and a nurse registry (n = 1323). For comparison, a group was formed that consisted of nurses working in medical wards (n = 1382). Delivery outcome was also compared with the estimate expected from nationwide figures. No statistically significant differences were seen, but infants of the anesthesiology/operating room nurses had a slightly higher perinatal death rate and a slightly higher rate of preterm births and low birth weights than infants in the comparison group and the nationwide average. On the other hand, the malformation rate was lower in the infants of anesthesiology/operating room nurses than in the control group or nationwide average. A case-control study within the group of anesthesiology/operating room nurses was performed. Questionnaires were sent to 75 nurses (25 cases whose infants died or had serious malformations; 50 controls whose infants were normal); 74 responded. The only difference in working conditions for cases and controls was that the cases had worked after the twenty-eighth week of pregnancy more often than the controls. However, this finding was restricted to nurses whose infants were malformed, and work after the twenty-eighth week cannot affect malformation rate. Work in anesthesiology or operating rooms had no effect on the incidence of hospitalization for miscarriage, perinatal deaths, or malformations detected in the neonatal period.