John S. Czachor

APACHE II and ISS scores as predictors of nosocomial infections in trauma patients.

BACKGROUND Nosocomial infections affect more than 2 million patients annually in the United States at a cost of

Transmission of Strongyloides steracolis Person to Person

4.5 billion. The aim of this study is to identify the role of the APACHE II score and the Injury Severity Scale (ISS) as independent predictors of nosocomial infections in trauma patients admitted to the intensive care unit (ICU). METHODS A retrospective chart review of 113 trauma patients admitted to the ICU was conducted by an infectious disease physician. Demographic data and incidence of nosocomial infections were recorded. Multivariate logistic regression analysis was used to determine variables that are predictive of the occurrence of nosocomial infections. RESULTS Presence or absence of intubation, ICU length of stay, APACHE II score, and ISS were related to the presence of infections; however, only the ICU length of stay was an independent predictor of a nosocomial infection, with an odds ratio of 1.81. By linear regression, 17% of the variance in the ICU duration of stay was a result of the APACHE II score in patients with a score >/=5. CONCLUSION APACHE II score and ISS score were not good predictors of the incidence of nosocomial infections in trauma patients admitted to the ICU, but the APACHE II score has a modest correlation with the duration of stay in the ICU. A stratified cohort study could identify the subset of patients for which the APACHE II score predicts a prolonged stay in the ICU, thus an increased risk of infection.

Bacteremic Nonmenstrual Staphylococcal Toxic Shock Syndrome Associated with Enterotoxins A and C

A case of presumed person-to-person transmission of Strongyloides steracolis is described. The index case was immunocompromised following high dose glucocorticosteroid therapy for myelodysplasia, which resulted in reactivation of latent strongyloides infection with the hyperinfestation syndrome. Physicians unfamiliar with this disease should realize that a history of foreign travel is unnecessary to acquire this parasite, and that transmission to persons in close proximity to the index case does occur and warrants treatment.

Lactobacillus endocarditis : Case report and literature review

We report a case of bacteremic nonmenstrual staphylococcal toxic shock syndrome (STSS) producing staphylococcal enterotoxins A and C. The bloodstream isolation of Staphylococcus aureus, as well as the production of enterotoxins A and C, are unusual as separate entities, and distinctly uncommon when found together.

MRSA Prevention and Control in County Correctional Facilities in Southwestern Ohio

Background: Lactobacillus infections and endocarditis have been reported in the medical literature for years. Scattered case reports and several case series have been published since the 1930s. A new mechanism of disease pathogenesis, however, has altered the clinical appearance of lactobacillus infections. Probiotic agents, serving as an entry vehicle for lactobacillus, have been identified in the genesis of these infections. Case report: A 42-year-old man had Lactobacillus casei endocarditis, most likely originating from his dentition. He underwent successful mitral valve replacement as well as repair of an atrial septal defect after a full dental extraction. There was no history suggestive of probiotics or vitamin use, or excessive dietary intake of dairy products. Conclusions: Lactobacillus infections, particularly endocarditis, are infrequently encountered, although they remain to be clinically important causes of infection. When treating endocarditis, determining the origin of the bacteremia is essential, and a search must include dietary origins. Physicians must recognize that lactobacilli are true pathogens and may present with an unusual pathway terminating in infection. Clinicians should also be aware of the possibility for an increasing number of lactobacillus infections.

Susceptibility of Stenotrophomonas maltophilia to Moxifloxacin, Trovafloxacin, Ofloxacin and Ciprofloxacin

The number of methicillin-resistant Staphylococcus aureus (MRSA) infections in correctional facilities around the country has been increasing. Considering the potential health impact of MRSA, it is important that correctional facilities have prevention and control protocols in place. The study results summarize the prevention and control preparedness activities of county jails in the Greater Dayton area of Ohio. Protocols and control measures were in place for environmental control (95.4%), MRSA screening (88.4%), standard precautions (84.3%), treatment (83.6%), personal hygiene (80.6%), and education (80.4%). Statistical analysis found no significant difference between rural and urban county jails in their handling of MRSA issues. The findings suggest significant compliance with MRSA prevention and control protocols among county jails in the Greater Dayton area.

A Case of Aphasic Endocarditis: Cardiobacterium hominis Bioprosthetic Valve Endocarditis With Mycotic Aneurysm

The Gram-negative bacterium Stenotrophomonas maltophilia is increasingly recognised as an important cause of nosocomial infection.[1] Management of S. maltophilia-associated infection is problematic because many strains of the bacterium manifest resistance to multiple antibiotics. Most studies have supported a combination of cotrimoxazole (trimethoprimsulfamethoxazole) and either ticarcillin/clavulanic acid or an extended spectrum cephalosporin as treatments of choice for infections caused by this organism.[1-4] The activity of quinolones against S. maltophilia strains varies. Previous in vitro studies with small numbers of isolates have shown that the newer quinolones, such as clinafloxacin, sparfloxacin, trovafloxacin and moxifloxacin, appear to be more active against this bacterium than the older agents in this class.[1-8] This study examines the in vitro susceptibility of 105 clinical isolates of S. maltophilia to the newer quinolones, moxifloxacin and trovafloxacin, compared with the older quinolones, ofloxacin and ciprofloxacin.

Knowledge acquisition: an infectious diseases perspective

AbstractCardiobacterium hominis, a member of the HACEK group of endocarditis pathogens, is notorious for a subacute presentation often involving cerebral embolization, as well as predilection for mycotic aneurysm formation. We describe a rare yet classic case of C. hominis late bioprosthetic aortic valve endocarditis presenting with neurological deficits and mycotic aneurysm. HACEK endocarditis should be considered in patients presenting with signs and/or symptoms of late subacute endocarditis and acute neurologic deficits that may be related to embolization or mycotic aneurysm.

Postoperative infectious complications of laparoscopic cholecystectomy in high-risk patients

A study was undertaken to evaluate the knowledge acquisition in Infectious Diseases during a one-month rotation completed by fourth-year medical students and residents. Fifty fourth-year medical students and 112 residents (internal medicine = 86, internal medicine/pediatrics = 18, orthopedics = 6, family medicine = 2) completed a one-month rotation in Infectious Diseases. The rotation took place between 1990 and 1998. The setting was community hospitals affiliated with a community-based medical school and medical school-sponsored residency programs. Medical students and residents completed a 103-item objective test (multiple choice, multiple true-false, matching) on a pre-test-post-test basis.The test covered 10 content areas including antibiotics, endocarditis, febrile neutropenia, HIV disease, meningitis, osteomyelitis, pneumonia, postoperative fever, sexually transmitted diseases and urinary tract infections. The mean score on the Infectious Diseases knowledge test increased from 65.8% to 77.4% for med...

Parvovirus B19: An emerging pathogen

Introduct ion Although an increasing number of laparoscopic cholecystectomy (LC) procedures have been performed each year since its introduction, little has been documented in regard to the infectious complications associated with this technique. In the most extensive evaluation to date, Myers et al. reported 18 infections (14 wound, 2 abscesses, 1 empyema, 1 pneumonia) following 1,518 LC operations (1.2%). Other reviews have placed the rate of postsurgical infection at 03.3%. Early in the genesis of this procedure, high-risk patients were excluded. As physicians became more adept at this operation, fewer restrictions were encountered, and these patients soon were added into the patient base. The purpose of this article is to review the postsurgical infections associated with patients undergoing LC.