Hana Edelstein

Seasonal variation in Escherichia coli bloodstream infections in northern Israel

Seasonal variation in the infection rate with certain Gram-negative organisms has been previously described, but few studies have been published regarding Escherichia coli. The aim of this study was to investigate the incidence rate of E. coli bloodstream infection (BSI) and the association with temperature in different seasons in the Yizrael Valley. Positive blood cultures sent to the microbiology laboratory of HaEmek Medical Centre over a period of 8 years (January 2001 to December 2008) were included. The mean monthly temperature in the Yizrael Valley in the same period was compared with the monthly E. coli BSI rate. We divided the year into three periods: winter (December to February: mean temperature <15°C), transitional (March, April and November: mean temperature 15-19°C) and summer (May to October: mean temperature ≥20°C). In addition, we correlated the mean monthly antibiotic use in the same period measured as total defined daily doses for the whole regional population with E. coli BSI. During the study period, 2810 BSIs were recorded (35%E. coli). In 67.4% of the cases of E. coli bacteraemia, the source was urinary tract infection. The crude incidence of E. coli BSI was 4.1/1000 admissions. There was no difference in the number of cultures/month (mean: 29 ± 6). However, E. coli BSI was 19% and 21% more frequent in summer than in the transitional and winter seasons, respectively (p 0.01). The antibiotic consumption was significantly higher in the winter period. We found significantly higher rates of E. coli BSI in the summer period. Host, bacterial and ecological factors, together with high consumption of antibiotics during the winter season, could partially explain these findings.

Risk factors for non- Escherichia coli community-acquired bacteriuria

PurposeUrinary tract infection (UTI) is one of the most common bacterial infections, with Escherichia coli causing up to 80xa0% of community-acquired bacteriuria (CA-Bu). The epidemiology and pathogenesis of E. coli have been intensively studied, yet, less is known about risk factors for CA-Bu due to other uropathogens. The purpose of this study was to clarify the latest knowledge.MethodsA clinical epidemiological study among adult ambulatory patients was conducted. During November 2009, all urine cultures sent to our Microbiology Laboratory were evaluated, including demographic characteristics of the patients, underlying diseases and antibiotic treatment. Data were analysed by the SPSS statistical package.ResultsDuring the study period, 4,653 cultures were sent for evaluation. Of the 1,047 (22.5xa0%) that were positive, 838 were included in the study; 82.5xa0% were from females. E. coli was the most common pathogen, comprising 58.6xa0% of all positive cultures. By multivariate analysis, five independent risk factors were associated with non-E. coli CA-Bu: presence of foreign body in the urinary tract [odds ratio (OR) 5.8], nitrite urine test negative (OR 3.2), male gender (OR 2.5), normal erythrocyte count in urine test (OR 1.5) and recurrent UTI in the past year (OR 1.5).ConclusionsFor adult outpatients presenting with CA-Bu, five independent factors suggesting the involvement of uropathogens other than E. coli were identified. These should be taken into consideration when empiric antibiotic treatment is prescribed.

Trends in the burden of infectious disease hospitalizations among the elderly in the last decade.

BACKGROUNDnInfectious disease is a leading cause of hospitalization. We investigated trends in infectious disease hospitalizations among the elderly in the last decade.nnnMETHODSnA total of 81,077 hospitalizations of elderly patients between 2001 and 2010 were available on the computerized database of the Haemek Medical Center, Israel. The proportion of hospitalizations attributable to infectious diseases was calculated.nnnRESULTSnOverall, lower respiratory tract infection (LRTI) accounted for 41.0% of hospitalizations attributable to infectious diseases followed by kidney, urinary tract and bladder infections (UTI) (21.4%), upper respiratory tract infections (URTI) (10.2%), and hepatobiliary tract infections (9.8%). The proportion of hospitalizations attributable to infectious diseases increased by 14.2% during the study period, rising from 16.9% in 2001 (1023 infectious disease hospitalizations of a total of 6043 hospitalizations) to 19.3% in 2010 (1907 infectious disease hospitalizations of a total of 9876 hospitalizations) (P for trend<0.001). A significant increasing trend persisted after adjustment for age, ethnicity, and season, resulting in an increase from 16.9% in 2001 to 18.8% in 2010 (P for trend=0.001). A significant increasing trend was observed in males (P for trend<0.001) and a borderline significant trend was observed in females (P for trend=0.062). The proportion of hospitalizations attributable to infectious diseases was higher in males and increased with age. LRTI and URTI were the major contributors to the increasing trend (P for trend=0.018 and <0.001, respectively).nnnCONCLUSIONSnThis study shows an increasing trend in infectious disease hospitalizations among the elderly in the last decade. Public health measures are needed to reduce infectious disease hospitalizations.

Providing detailed information about latent tuberculosis and compliance with the PPD test among healthcare workers in Israel: a randomized controlled study.

Background: The compliance of screening for latent tuberculosis (TB) with the tuberculin purified protein derivative (PPD) test is very low among healthcare workers (HCWs) in Israel. Methods: This randomized controlled study uses the Health Belief Model (HBM) as a conceptual framework to examine whether providing more information about latent TB and the PPD test increases the response rate for PPD screening among HCWs. All candidate HCWs for latent TB screening were randomly allocated to one of the following two invitations to perform the PPD test: regular letter (control group, n = 97), and a letter with information about latent TB and the PPD test (intervention group, n = 196). Results: 293 HCWs were included (185 nurses, and 108 physicians). Overall, 36 (12.3%) HCWs were compliant with the PPD test screening. Compliance with PPD testing in the intervention group was not statistically different from the control group, RR 0.87 (95% CI, 0.46–1.65). Conclusions: Compliance for latent TB screening is low among HCWs in northeastern Israel. Providing detailed information about latent TB was not associated with increased test compliance. Understanding existing disparities in screening rates and potential barriers to latent TB screening among HCWs is important in order to move forward and successfully increase screening rates.

Attitudes, beliefs and knowledge concerning antibiotic use and self-medication

PURPOSEnAlthough the relevance of cultural factors for antibiotic use has been recognized, few studies exist in Europe. We compared public attitudes, beliefs and knowledge concerning antibiotic use and self-medication between 11 European countries.nnnMETHODSnIn total, 1101 respondents were interviewed on their attitudes towards appropriateness of self-medication with antibiotics and situational use of antibiotics, beliefs about antibiotics for minor ailments, knowledge about the effectiveness of antibiotics on viruses and bacteria and awareness about antibiotic resistance. To deal with the possible confounding effect of both use of self-medication and education we performed stratified analyses, i.e. separate analyses for users and non-users of self-medication, and for respondents with high and low education. The differences between countries were considered relevant when regression coefficients were significant in all stratum-specific analyses.nnnRESULTSnRespondents from the UK, Malta, Italy, Czech Republic, Croatia, Israel and Lithuania had significantly less appropriate attitudes, beliefs or knowledge for at least one of the dimensions compared with Swedish respondents. The Dutch, Austrian and Belgian respondents did not differ from Swedish for any dimension.nnnCONCLUSIONSnThe most pronounced differences were for awareness about resistance, followed by attitudes towards situational use of antibiotics. Awareness about antibiotic resistance was the lowest in countries with higher prevalence of resistance.