Decreasing candidaemia rate in abdominal surgery patients after introduction of fluconazole prophylaxis*.

Although abdominal surgery is an established risk factor for invasive candidiasis, the precise role of antifungal prophylaxis in these patients is not agreed upon. In 2007, fluconazole was added to the prophylactic antibiotic treatment for patients with gastrointestinal tract perforations or reoperation after colorectal surgery in two university hospitals in Copenhagen. Changes in candidaemia rates associated with this intervention were examined and potential interfering factors evaluated. Rates and clinical characteristics of candidaemias and other blood stream infections (BSIs) in abdominal surgery patients were compared before (1 January 2006 to 30 June 2007) and after the intervention (1 January 2008 to 30 June 2009). The departments' activity was assessed by number of bed-days, admissions and surgical procedures, and the consumption of antifungals was analysed. The candidaemia rate decreased from 1.5/1000 admissions in the pre-intervention to 0.3/1000 admissions in the post-intervention period (p 0.002). Numbers of BSIs and bed-days remained stable, and numbers of admissions and surgical procedures performed increased during the study period. Fluconazole consumption in the two abdominal surgery departments increased from 4.6 to 12.2 defined daily doses per 100 bed-days (p <0.001), and 3.2 to 5.0 (p 0.01), respectively, but remained unchanged in the intensive care units. We could not detect any increase in fluconazole-resistant strains (14/29 pre- and 2/7 post-intervention, p 0.43). The introduction of fluconazole prophylaxis was followed by a significantly decreased candidaemia rate. However, the observational study design does not allow conclusions regarding causality. No increase in resistance was detected, but follow-up was short and continuing surveillance is needed.

[Prevention of lower extremity injuries in handball: initial results of the handball injuries prevention programme]. / Prävention von Verletzungen der unteren Extremität im Handball: Erste Ergebnisse des Kieler Handball-Verletzungs-Präventionsprogrammes.

INTRODUCTION: Injuries of the lower extremity lead to disability to perform sports and may cause degenerative changes of the joints. Hence, we developed a specific injury prevention programme for European team handball and tested this programme in a prospective study. METHOD: One handball team (2 nd division) performed a proprioceptive and neuromuscular training during the preseason. The programme consists of 3 different components: 1. Information on injury mechanisms, 2. Proprioceptive training, and 3. Jump training. During the season the exercises have been continued with lower intensity. Another handball team which performed no injury prevention training served as control. Injuries were recorded in a prospective manner. In a retrospective arm of the study we compared the frequency of severe injuries of the training season with the frequency of severe injuries during the last season. RESULTS: In comparison to the last year no player from the prevention training team suffered a severe injury of the ankle or the knee. During the last season three athletes ruptured their anterior cruciate ligament. In the untrained control group one athlete suffered from an ACL rupture and one athlete had a rupture of the lateral ankle ligaments. These findings have no statistical significance because of the low number of individuals investigated. However, the incidence of light and medium injuries was significantly lower in the injury prevention group. CONCLUSIONS: This study demonstrates that proprioceptive and neuromuscular training is appropriate for the prevention of lower extremity injuries. Prevention strategies should be included in routine handball training programmes.

[House dust mite allergens and mite allergy in Copenhagen dwellings. A cross-sectional study]. / Støvmideallergener og mideallergi i københavnske boliger. En tvaersnitsundersøgelse.

The aim of the study was to investigate the influence of various environmental factors on occurrence of house dust mite allergens and the influence of allergen exposure on mite allergy. Ninety-two persons from a population study filled in a questionnaire, were skin prick and lung function tested and dust samples were collected from their mattresses for analyses. Two out of five patients with asthma had a positive skin reaction to house dust mite allergen in contrast to five out of 87 non-asthmatics. Fifty-nine per cent of the dust samples contained (group 1) mite allergen > 2 micrograms/g dust. Such mattresses were older (median 7 years, range 1-22) than mattresses with less allergen (median 4 years, range 1-20). In the six bedrooms reported to be humid or mouldy, mattresses contained high concentration of mite allergens. No other parameter investigated could predict the allergen contents. In almost all cases dust analyses are crucial to be able to advise patients with house dust mite allergy.