Japanese journal of infectious diseases
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Jpn. J. Infect. Dis. · Jan 2012
Alterations in bacterial spectrum and increasing resistance rates in isolated microorganisms from device-associated infections in an intensive care unit of a teaching hospital in Istanbul (2004-2010).
The aim of the present study was to determine the rate of device-associated infection (DAI) and the change in profiles and antimicrobial resistance patterns of the causative microorganisms in a medical-surgical intensive care unit (ICU), as well as to evaluate the effect of a new nationwide hospital infection control program (NHICP), which has been implemented in Turkey. In this study, 5,772 patients that were hospitalized for a total of 43,658 days acquired 1,321 DAIs, with an overall rate of 30.2% per 1,000 ICU days. Between 2004 (before the NHICP) and 2010, the incidence densities of catheter-associated urinary tract infection (CAUTI) decreased from 10.2 to 5.7 per 1,000 device-days (P < 0.0001), and central venous catheter-associated bloodstream infection (CVC-BSI) decreased from 5.3 to 2.1 per 1,000 device-days (P < 0.0001). ⋯ The extended-spectrum β-lactamase-producing Enterobacteriaceae rate increased from 23.1% to 54.2% (P = 0.01); the vancomycin-resistance rate among Enterococcus spp. increased from 0% in 2004 to 12.5% in 2010 (P = 0.0003). In conclusion, while a significant decrease was achieved in the incidences of CAUTI and CVC-BSI, the NHICP was not completely effective in our ICU. The high incidence of DAI and the increasing prevalence of multidrug-resistant microorganisms indicate that further interventions are urgently needed.
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Jpn. J. Infect. Dis. · Jan 2012
Evaluation of an expanded case definition for vaccine-modified measles in a school outbreak in South Korea in 2010.
In this study, we have described the clinical characteristics of vaccine-modified measles to assess the performance of an expanded case definition in a school outbreak that occurred in 2010. The sensitivity, specificity, and the positive and negative predictive values were evaluated. Among 74 cases of vaccine-modified measles, 47 (64%) met the original case definition. ⋯ The presence of fever and one or more of cough, coryza, or conjunctivitis scored the highest sensitivity among the combinations of signs and symptoms (77.0%), but scored the lowest specificity (52.9%). The expanded case definition was sensitive in identifying suspected cases of vaccine-modified measles. We suggest using this expanded definition for outbreak investigation in a closed community, and consider further discussions on expanding the case definition of measles for routine surveillance in South Korea.
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Jpn. J. Infect. Dis. · Jan 2012
Oxacillin or cefalotin treatment of hospitalized children with cellulitis.
Cellulitis is an important cause of hospitalization in pediatrics. Because Staphylococcus aureus is the main pathogen of cellulitis, medicinal therapeutics should take the changing resistance profile of this organism into consideration. The aim of this study was to evaluate the progression and outcomes of children hospitalized for cellulitis and treated with oxacillin or cefalotin. ⋯ None of the patients died, needed intensive care, or had sequelae. By comparing the daily frequency of clinical findings during hospitalization, significant decreases were found in the frequencies of fever (admission day [42.2%], first day [20.8%], second day [12.9%], third day [8.3%], fourth day [6.1%]), toxemia, irritability, somnolence, vomiting, tachycardia, and need for intravenous hydration. In conclusion, oxacillin or cefalotin remain the drugs of choice for treating uncomplicated cellulitis in regions where community-acquired methicillin-resistant S. aureus is infrequent (<10%).
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Jpn. J. Infect. Dis. · Jan 2011
Clinical knowledge and attitudes of Turkish physicians toward rabies caused by animal bites.
Rabies is an endemic infectious disease and one of the most important causes of human mortality in both underdeveloped and developing countries. In Turkey, 167,000 individuals are believed to be victims of animal bites annually. In this study, we investigated Turkish physicians' knowledge and clinical awareness of rabies caused by animal bites. ⋯ Finally, 30% of the physicians were not aware of the correct vaccine schedules in postexposure prophylaxis. Our data indicate that Turkish physicians' basic and clinical knowledge of rabies was insufficient. Rabies prophylaxis educational programs should be designed to educate physicians on the guidelines provided by the World Health Organization and the Advisory Committee on Immunization Practices for the treatment of rabies caused by animal bites.