Comparison of direct plating and broth enrichment culture for the detection of intestinal colonization by glycopeptide-resistant enterococci among hospitalized patients.
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The results of prevalence studies on glycopeptide-resistant enterococci (GRE) in the intestine may be influenced by the detection methods applied. In most studies different media, different concentrations of antibiotics, and different methods are used, and these differences result in differences in recovery rates. In this cross-sectional study on the carrier state of GRE among patients at the University Hospital Antwerp, Antwerp, Belgium, performed on 21 May 1996, direct plating and broth enrichment were compared by using the same media. Stool samples (n = 213) or rectal swabs (n = 122) were plated directly on Enterococcosel agar (bioMerieux) and after enrichment in Enterococcosel broth. The prevalence of GRE was 12.8%. Direct plating recovered 53.4% of the GRE isolates, and broth enrichment recovered an additional 46.5% of them; in the latter test the isolates were thus present at less than 10(3) CFU per g of feces. The prevalence of GRE among dialysis patients was higher than among the other patients, but the difference was not significant (P = 0.06), possibly as a result of the small numbers of dialysis patients examined. The GRE species isolated included 19 E. gallinarum (44.2%), 13 E. faecium (30.2%), 6 E. faecalis (13.9%), and 5 E. casseliflavus (11.6%) isolates. All E. faecalis and E. faecium strains isolated carried the vanA gene, and E. gallinarum and E. casseliflavus carried the vanC1 and vanC2 gene, respectively. The majority of isolates were polyclonal. Our data indicate that the rate of detection of GRE from both stool samples and rectal swabs is significantly increased with enrichment cultures. (+info)
Risk of primary biliary liver cirrhosis in patients with coeliac disease: Danish and Swedish cohort data.
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BACKGROUND: Several case reports, but only a few studies, have examined the coexistence of coeliac disease and primary biliary cirrhosis. AIM: To estimate the risk of primary biliary cirrhosis in two national cohorts of patients with coeliac disease in Denmark and Sweden. METHODS: Through record linkage all Danish patients hospitalised with coeliac disease were followed for possible occurrence of primary biliary cirrhosis from 1 January 1977 until 31 December 1992. All patients hospitalised with coeliac disease in Sweden from 1987 to 1996 were also followed in a separate analysis. RESULTS: A total of 896 patients with coeliac disease were identified in Denmark with a median follow up period of 9.1 years for a total of 8040 person-years at risk. Two cases of primary biliary cirrhosis were observed where 0.07 were expected, giving a standardised incidence ratio of 27.6 (95% confidence interval 2.9 to 133.5). A total of 7735 patients with coeliac disease were identified in Sweden with a median follow up period of 5.1 years for a total of 39 284 person-years at risk. Twenty two people with primary biliary cirrhosis were identified compared with 0.88 expected, giving a standardised incidence ratio of 25.1 (95% confidence interval 15.7 to 37.9). CONCLUSION: Patients with coeliac disease are at increased risk of having primary biliary cirrhosis. (+info)
A worldwide assessment of the frequency of suicide, suicide attempts, or psychiatric hospitalization after predictive testing for Huntington disease.
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Prior to the implementation of predictive-testing programs for Huntington disease (HD), significant concern was raised concerning the likelihood of catastrophic events (CEs), particularly in those persons receiving an increased-risk result. We have investigated the frequency of CEs-that is, suicide, suicide attempt, and psychiatric hospitalization-after an HD predictive-testing result, through questionnaires sent to predictive-testing centers worldwide. A total of 44 persons (0.97%) in a cohort of 4,527 test participants had a CE: 5 successful suicides, 21 suicide attempts, and 18 hospitalizations for psychiatric reasons. All persons committing suicide had signs of HD, whereas 11 (52.4%) of 21 persons attempting suicide and 8 (44.4%) of 18 who had a psychiatric hospitalization were symptomatic. A total of 11 (84.6%) of 13 asymptomatic persons who experienced a CE during the first year after HD predictive testing received an increased-risk result. Factors associated with an increased risk of a CE included (a) a psychiatric history +info)
A randomised controlled trial to assess the relative benefits of large volume spacers and nebulisers to treat acute asthma in hospital.
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OBJECTIVES: To compare the clinical effectiveness, acceptability, and cost benefit of administering beta2 agonists by means of a metered dose inhaler and large volume spacer with conventional nebulisers to children admitted to hospital with acute asthma. METHODS: A randomised controlled trial was conducted over five months. Sixty one children older than 3 years admitted to a large teaching hospital and a district general hospital with acute asthma completed the study. Children received either 5 mg of salbutamol up to one hourly by jet nebuliser, or up to 10 puffs of salbutamol 100 microg by means of a metered dose inhaler and spacer up to one hourly. RESULTS: Median hospital stay was 40 hours in the nebuliser group and 36.5 hours in the spacer group. Asthma disability scores at two weeks after discharge were significantly improved in the spacer group. Drug costs were pound 14.62 less for each patient in the spacer group. CONCLUSIONS: Large volume spacers are an acceptable, cost effective alternative to nebulisers in treating children admitted with acute asthma, provided that the children can use the mouthpiece, and symptoms are not severe. Their use facilitates effective home treatment by parents, with subsequent reduction in morbidity and re-admission rates. (+info)
Outcome of medium chain acyl-CoA dehydrogenase deficiency after diagnosis.
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BACKGROUND: Medium chain acyl-CoA dehydrogenase (MCAD) deficiency is the most common inborn error of fatty acid metabolism. Undiagnosed, it has a mortality rate of 20-25%. Neonatal screening for the disorder is now possible but it is not known whether this would alter the prognosis. OBJECTIVE: To investigate the outcome of MCAD deficiency after the diagnosis has been established. METHOD: All patients with a proved diagnosis of MCAD deficiency attending one centre in a four year period were reviewed. RESULTS: Forty one patients were identified. Follow up was for a median of 6.7 years (range, 9 months to 14 years). Nearly half of the patients were admitted to hospital with symptoms characteristic of MCAD deficiency before the correct diagnosis was made. After diagnosis, two patients were admitted to hospital with severe encephalopathy but there were no additional deaths or appreciable morbidity. There was a high incidence (about one fifth) of previous sibling deaths among the cohort. CONCLUSIONS: Undiagnosed, MCAD deficiency results in considerable mortality and morbidity. However, current management improves outcome, supporting the view that the disorder should be included in newborn screening programmes. (+info)
Complications of varicella in a defined central European population.
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AIMS: To describe complications of varicella requiring hospitalisation in a defined population (canton of Bern) and to compare the hospitalisation rates for varicella with published data. METHODS: Retrospective analysis of hospital records of patients less than 16 years of age admitted with complications of varicella to the hospitals serving this population (University Children's Hospital of Bern and the Wildermeth Children's Hospital of Biel, Switzerland), and calculation of hospitalisation rates for varicella and its complications based on birth rates and varicella antibody prevalence rates. RESULTS: From 1986 to 1996, 113 cases (median age, 5.6 years) were identified. Younger siblings were overrepresented (odds ratio (OR), 1.42; 95% confidence interval (CI), 1.09 to 1.84). Central nervous system (CNS) complications (26 patients; 23%) were found predominantly in previously healthy children (relative risk, 7.1; 95% CI, 1.01 to 49.86). Group A beta haemolytic streptococci were recovered from only one of 35 patients with bacterial complications. The hospitalisation rates for primary varicella (9.2/10(4) cases; 95% CI, 7.4 to 11/10(4), skin infections (2.0/10(4) cases; 95% CI, 1.2 to 2.9/10(4), and pneumonia (0.8/10(4) cases; 95% CI, 0.3 to 1.3/10(4)) were significantly lower than reported previously. The CNS complication rate (2.2/10(4) cases; 95% CI, 1.3 to 3.1/10(4) was among the highest rates reported. CONCLUSIONS: The low hospitalisation rate in comparison with studies from elsewhere indicates that there is a large regional variability in complications associated with varicella. Such data should be taken into consideration when local varicella immunisation strategies are developed. (+info)
Increasing levels of interleukin (IL)-1Ra and IL-6 during the first 2 days of hospitalization in unstable angina are associated with increased risk of in-hospital coronary events.
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BACKGROUND: A growing body of evidence suggests a role for inflammation in acute coronary syndromes. The aim of this study was to assess the role of proinflammatory cytokines, their time course, and their association with prognosis in unstable angina. METHODS AND RESULTS: We studied 43 patients aged 62+/-8 years admitted to our coronary care unit for Braunwald class IIIB unstable angina. In each patient, serum levels of interleukin-1 receptor antagonist (IL-1Ra), interleukin-6 (IL-6) (which represent sensitive markers of biologically active IL-1beta and tumor necrosis factor-alpha levels, respectively), and troponin T were measured at entry and 48 hours after admission. Troponin T-positive patients were excluded. Patients were divided a posteriori into 2 groups according to their in-hospital outcome: group 1 comprised 17 patients with an uneventful course, and group 2 comprised 26 patients with a complicated in-hospital course. In group 1, mean IL-1Ra decreased at 48 hours by 12%, and IL-6 diminished at 48 hours by 13%. In group 2, IL-1Ra and IL-6 entry levels were higher than in group 1 and increased respectively by 37% and 57% at 48 hours (P<0.01). CONCLUSIONS: These findings indicate that although they receive the same medical therapy as patients who do not experience an in-hospital event, patients with unstable angina and with complicated in-hospital courses have higher cytokine levels on admission. A fall in IL-1Ra and IL-6 48 hours after admission was associated with an uneventful course and their increase with a complicated hospital course. These findings may suggest novel therapeutic approaches to patients with unstable angina. (+info)
Asthma: an increasing problem in children?
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The study of asthma trend, nonhospitalized and hospitalized cases, and factors correlated with asthma admissions were carried out at Queen Sirikit National Institute of Child Health (Children's Hospital) between 1986-1995. Asthma OPD visits had increased significantly (r = 0.9039, p < 0.001). The age distribution of the cases are 0-2, 2-5, 5-10 and > 10 years old group. The number of visits in 0-2 and 2-5 years groups were significantly increased (r = 0.908, p = 0.000, r = 0.904, p = 0.000), while in 5-10 and >10 years old groups were not (r = 0.054, p = 0.137, r = -0.565, p = 0.089). Although the OPD visits were increasing, there was a decreasing trend in the age-adjusted percentage of admissions (r = -0.798, p = 0.006). The percentage of admissions was significantly decreased in 0-2, 2-5, and >10 years old groups (r = -0.881, p = 0.001, r = -0.632, p = 0.05, r = -0.815, p = 0.004, respectively). The correlation with the environment was observed (r = 0.915, p < 0.001). There was no correlation with allergic diseases in the family (r = 0.2825, p = 0.4). The 2,312 admission charts (86.69% of total IPD cases) were reviewed and there were 1,855 cases of true asthma. Almost 70% of cases were in the under-five age group and the male to female ratio was 1.3:1. The increasing trend in steroid use was observed (r = 0.693, p = 0.026), while the use of antibiotics was unchanged (r = 0.068, p = 0.852). The percentage of admissions began to decline in 1989 when the aerosolized beta-2 agonists were introduced in the hospital and declined further in 1991 when increased use of aerosolized therapy and prophylactic drugs was observed. Better patient education and regular follow-up care during the past five years are believed to be one of the major contributions to this reduction in admissions. (+info)