Reduction of serum albumin in non-critically ill patients during hospitalization is associated with incident hypoglycaemia.

AIM: Our study looked at the association between changes in serum albumin (SA) levels during hospitalization and incidence of hypoglycaemia among non-critically ill patients. METHODS: Included were patients discharged from internal medicine units with hospital stays ≤ 14 days. Patients were allocated to three groups: (1) admission SA > 3.5 g/dL with no decrease during hospitalization; (2) admission SA < 3.5 g/dL with no decrease during hospitalization; and (3) decrease in SA regardless of admission SA level. Incident hypoglycaemia (glucose ≤ 70 mg/dL) was predicted by applying regression analysis, using hypoglycaemia as a dependent variable. Mortality studies were performed using Cox regression. RESULTS: Included were 7718 patients (mean age 71.8 ± 17.4 years, 49.9% males, 27.1% with diabetes). Of these patients, 12.7% had at least one documented hypoglycaemia episode during hospitalization. Patients with decreases in SA levels during hospitalization (group 3) had higher rates of incident hypoglycaemia compared with patients in groups 1 and 2 (21.0% vs. 6.0% and 16.3%, respectively; P < 0.001 for both). Results remained significant after controlling for admission SA. Strong negative correlations were observed between SA and serum osmolarity (r = -0.204, P < 0.0001) and, separately, between changes in SA with changes in serum osmolarity (r = -0.157, P < 0.001), indicating that SA changes were not due to haemodilution. Overall 1-year mortality was 16.7%, and Cox regression analysis showed an increased 1-year mortality in patients in group 3 (27.9%) compared with those in groups 1 and 2 (15.2% and 13.8%, respectively). CONCLUSION: Changes in SA during hospitalization are associated with an increased risk of hypoglycaemia during hospitalization of non-critically ill patients.

Association of albumin and cholesterol levels with incidence of hypoglycaemia in people admitted to general internal medicine units.

AIM: To study the association between serum albumin and cholesterol levels at hospital admission and incident hypoglycaemia among people admitted to internal medicine units. METHODS: In this cross-sectional analysis, we examined the electronic medical records of people hospitalized in internal medicine departments. Data extracted included all glucose measurements as well as serum albumin and cholesterol, which were measured upon admission. A hypoglycaemia event was recorded for a given person if at least one glucose measurement of ≤ 3.9 mmol/l was recorded during the hospital stay. Regression analysis was used to determine which clinical measures predict hypoglycaemia. RESULTS: During the acquisition period, 45 224 people (mean age 68.9 ± 17.8 years, 49.4% male, 21.1% diabetes mellitus) were discharged from internal medicine units. Hypoglycaemia was documented in 7.5% of these individuals (15.4% of people with diabetes vs. 5.5% of those without; P < 0.001). Logistic regression showed that both serum albumin [odds ratio (OR) 0.908, 95% confidence interval (CI) 0.896-0.919; P < 0.001) and cholesterol (OR 0.938, 95% CI 0.896-0.981; P = 0.005] were significantly associated with incident hypoglycaemia. Results remained significant even after controlling for age, sex, average glucose during hospitalization, length of hospital stay, acute infection upon admission, diabetes status, haemoglobin, white blood cell count and C-reactive levels. A combination of hypoalbuminaemia (< 35 g/l) and hypocholesterolaemia (< 3.37 mmol/l) upon admission greatly increased the risk of incident hypoglycaemia (OR 2.544, 95% CI 2.096-3.088; P < 0.001). CONCLUSION: Hypoalbuminaemia and hypocholesterolaemia predict incident hypoglycaemia in the hospital setting among people with and without diabetes mellitus.

Impact of conversion from an open ward design paediatric intensive care unit environment to all isolated rooms environment on incidence of bloodstream infections and antibiotic resistance in Southern Israel (2000 to 2008).

We studied the epidemiology, microbiology, clinical aspects and outcome of bloodstream infections (BSI) in a tertiary paediatric intensive care unit. All BSI episodes were prospectively identified and analysed. The paediatric intensive care unit moved in 2006 from an open-plan unit to a new (all single room) unit. Three hundred and fifty-three BSI episodes occurred in 299 of 4162 patients. Overall, BSI incidence was 85 per 1000 hospitalised children. Fewer BSI episodes occurred during the last two years of the study (2007 to 2008), compared with 2000 to 2006 (70 of 1061 admissions, 6.5% versus 283 of 3101 admissions, 9.1%, respectively, P=0.01). There were 127 of 340 (37.4%) community-acquired and 213 of 340 (62.6%) nosocomial BSI episodes (31 of 1000 and 51 of 1000, respectively). Nosocomial BSI episodes decreased during 2007 to 2008 versus 2000 to 2006 (37.7% versus 55.8%, P=0.03). In 448 instances, pathogens were isolated, 231 (52%) Gram-positive and 188 (42%) Gram-negative. Coagulase-negative Staphylococci, S. pneumoniae and S. aureus (41.1%, 19.9% and 11.7%, respectively) were the most common Gram-positive and Enterobacteriaceae spp. the most frequent Gram-negative organisms (45.2%, of them Klebsiella spp. and E. coli 40% and 29.4%, respectively). A significant decrease was recorded during 2007 to 2008 in Enterobacteriaceae resistance to piperacillin, gentamicin and ciprofloxacin. Thirty of 299 (10%, 9 with S. pneumoniae-BSI) patients died. A significant decrease in BSI and nosocomial incidence and Enterobacteriaceae spp. antibiotic resistance was recorded following the conversion of the paediatric intensive care unit from an open ward to an all isolated rooms environment.

Malnutrition risk in newly hospitalized overweight and obese individuals: Mr NOI.

BACKGROUND/OBJECTIVES: Malnutrition risk and its consequences have not been reported in obese and overweight newly hospitalized patients. To estimate malnutrition risk among newly hospitalized overweight or obese patients, and to assess the effect of body mass index (BMI) on duration of hospitalization and risk of in-hospital death among hospitalized adults at increased risk of malnutrition. SUBJECTS/METHODS: In this survey, all adults newly admitted to internal medicine and surgical departments at a large tertiary medical center, during the 5-week data acquisition period in 2010, were screened for malnutrition risk using the Nutrition Risk Screen (NRS 2002). Malnutrition risk was compared across body weight categories. In addition, overweight/obese subjects were compared by malnutrition risk category. RESULTS: Of the 431 individuals analyzed, 138 were overweight and 105 were obese. Among overweight or obese patients, 23.2% and 24.8%, respectively, were at increased risk for malnutrition. Elevated risk for malnutrition prolonged hospitalization for both overweight and obese patients (from 5.6 ± 7.9 to 10.0 ± 10.3 days (P=0.04) and from 4.8 ± 4.6 to 15.1 ± 25.7 days (P=0.001), respectively). Prolonged hospital stay remained associated with malnutrition risk after controlling for age and BMI. Malnutrition risk significantly increased odds of in-hospital death: odds ratio (OR) 6.4, 95% confidence interval (CI) 1.2-33.2, P=0.03, even after controlling for age and BMI. CONCLUSIONS: Increased malnutrition risk is a frequent finding in newly hospitalized overweight/obese adults, prolongs length of hospital stay and increases risk of in-hospital mortality.

Pneumococcal acute otitis media in infants and children in central Romania, 2009-2011: microbiological characteristics and potential coverage by pneumococcal conjugate vaccines.

OBJECTIVE: To assess the epidemiological and microbiological characteristics of pneumococcal acute otitis media (AOM) in children in Brasov, Central Romania, before the introduction of pneumococcal conjugate vaccine (PCV) into the routine national immunization program. METHODS: All AOM patients aged <5 years who underwent tympanocentesis or presented with purulent otorrhea of ≤24h duration during 2009-2011 were enrolled. RESULTS: Two hundred and twelve consecutive AOM patients had a middle ear fluid (MEF) culture performed; 99 (46.6%) episodes occurred in patients <12 months of age. One hundred and eleven (52.4%) episodes were culture-positive. Tympanocentesis was performed in 142 patients and spontaneous otorrhea cultures in 70 patients. Overall, 114 pathogens were recovered: Streptococcus pneumoniae was the most common isolate (81 isolates, 70.3% of all culture-positive episodes), followed by non-typeable Haemophilus influenzae (26, 20.7%), Streptococcus pyogenes (5, 4.5%), and Moraxella catarrhalis (2, 1.8%). Antibiotic susceptibility and serotyping were performed for 48 (59.3%) S. pneumoniae isolates: 45 (93.8%) were non-susceptible to penicillin (minimal inhibitory concentration (MIC) ≥2.0µg/ml in 24, 53.3%) and 37 (77.1%) isolates had ceftriaxone MIC values ≥0.5µg/ml (16 with MIC >2.0µg/ml). S. pneumoniae non-susceptibility rates to trimethoprim-sulfamethoxazole, erythromycin, and clindamycin were 75.0%, 58.3%, and 35.4%, respectively. All isolates were susceptible to chloramphenicol. Multidrug resistance was found in 33 (68.7%) isolates. The most common S. pneumoniae serotypes were 19F (14, 29.2%), 6B (8, 16.7%), 23F (8, 16.7%), and 14 (6, 12.5%). Serotype 19A was found in three (6.2%) patients and 6A in two (4.1%). Non-PCV13 serotypes represented six (12.6%) of all serotypes (four of them non-susceptible to penicillin). Thirty-six (75.0%) isolates were potentially covered by PCV7, 37 (77.0%) by PCV10, and 42 (87.5%) by PCV13. CONCLUSIONS: (1) S. pneumoniae was the most prevalent pathogen, with frequent antibiotic resistance and multi-resistance patterns; (2) most pneumococcal AOM and multidrug-resistant episodes could be prevented by PCVs.

Prevalence of pilus-encoding islets among acute otitis media Streptococcus pneumoniae isolates from Israel.

We evaluated the distribution of the two known Streptococcus pneumoniae pilus encoding islets (PI-1 and PI-2) among a panel of 113 acute otitis media clinical isolates from Israel. PI-1 was present in 30.1% (n = 34) of the isolates tested, and PI-2 was present in 7% (n = 8). In addition, we found that: (i) the PI positive isolates, 50% of which belong to the international clones Spain(9V)-3 (ST156) and Taiwan(19F)-14 (ST236), correlate with the genotype (as determined by multilocus sequence typing) but not with the serotype; (ii) PI-2 was not present in the absence of Pl-1; and (iii) the frequency of PI-1 was higher among antibiotic-resistant isolates.