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Nosocomial infection
Contaminated surfaces increase cross-transmission
Specialty
Infectious disease
A hospital-acquired infection (HAI), also known as a nosocomial infection, is an infection that is acquired in a hospital or other health care facility. To emphasize both hospital and nonhospital settings, it is sometimes instead called a health care–associated infection (HAI or HCAI).[1] Such an infection can be acquired in hospital, nursing home, rehabilitation facility, outpatient clinic, or other clinical settings. Infection is spread to the susceptible patient in the clinical setting by various means. Health care staff can spread infection, in addition to contaminated equipment, bed linens, or air droplets. The infection can originate from the outside environment, another infected patient, staff that may be infected, or in some cases, the source of the infection cannot be determined. In some cases the microorganism originates from the patient's own skin microbiota, becoming opportunistic after surgery or other procedures that compromise the protective skin barrier. Though the patient may have contracted the infection from their own skin, the infection is still considered nosocomial since it develops in the health care setting.
In the United States, the Centers for Disease Control and Prevention estimated roughly 1.7 million hospital-associated infections, from all types of microorganisms, including bacteria and fungi combined, cause or contribute to 99,000 deaths each year.[2] In Europe, where hospital surveys have been conducted, the category of gram-negative infections are estimated to account for two-thirds of the 25,000 deaths each year.[citation needed] Nosocomial infections can cause severe pneumonia and infections of the urinary tract, bloodstream and other parts of the body.[3][4] Many types display antimicrobial resistance, which can complicate treatment.
Contents
1Types
1.1Organisms
2Cause
2.1Transmission
3Prevention
3.1Sterilization
3.2Isolation
3.3Handwashing
3.4Gloves
3.5Surface sanitation
3.6Antimicrobial surfaces
4Treatment
5Epidemiology
5.1Belgium
5.2France
5.3Finland
5.4Italy
5.5Switzerland
5.6United Kingdom
5.7United States
6History
7See also
8References
9External links
Types
Hospital-acquired pneumonia
Ventilator-associated pneumonia
Urinary tract infection
Gastroenteritis
Puerperal fever
Central line-associated blood stream infection
Organisms
Staphylococcus aureus
Methicillin resistant Staphylococcus aureus[5]
Candida albicans[5]
Pseudomonas aeruginosa[5]
Acinetobacter baumannii'[5]
Stenotrophomonas maltophilia
Clostridium difficile
Escherichia coli[5]
Tuberculosis
Vancomycin-resistant Enterococcus
Legionnaires' disease
Cause
Transmission
In-dwelling catheters have recently been identified with hospital acquired infections.[6] To deal with this complication procedures are used, called intravascular antimicrobial lock therapy that can reduce infections that are unexposed to blood-borne antibiotics.[7] Introducing antibiotics, including ethanol, into the catheter (without flushing it into the bloodstream) reduces the formation of biofilms.[5]
Main routes of transmission
Route
Description
Contact transmission
The most important and frequent mode of transmission of nosocomial infections is by direct contact.
Droplet transmission
Transmission occurs when droplets containing microbes from the infected person are propelled a short distance through the air and deposited on the patient's body; droplets are generated from the source person mainly by coughing, sneezing, and talking, and during the performance of certain procedures, such as bronchoscopy.
Airborne transmission
Dissemination can be either airborne droplet nuclei (small-particle residue {5 µm or smaller in size} of evaporated droplets containing microorganisms that remain suspended in the air for long periods of time) or dust particles containing the infectious agent. Microorganisms carried in this manner can be dispersed widely by air currents and may become inhaled by a susceptible host within the same room or over a longer distance from the source patient, depending on environmental factors; therefore, special air-handling and ventilation are required to prevent airborne transmission. Microorganisms transmitted by airborne transmission include Legionella, Mycobacterium tuberculosis and the rubeola and varicella viruses.
Common vehicle transmission
This applies to microorganisms transmitted to the host by contaminated items, such as food, water, medications, devices, and equipment.
Vector borne transmission
This occurs when vectors such as mosquitoes, flies, rats, and other vermin transmit microorganisms.
Contact transmission is divided into two subgroups: direct-contact transmission and indirect-contact transmission.
Routes of contact transmission
Route
Description
Direct-contact transmission
This involves a direct body surface-to-body surface contact and physical transfer of microorganisms between a susceptible host and an infected or colonized person, such as when a person turns a patient, gives a patient a bath, or performs other patient-care activities that require direct personal contact. Direct-contact transmission also can occur between two patients, with one serving as the source of the infectious microorganisms and the other as a susceptible host.
Indirect-contact transmission
This involves contact of a susceptible host with a contaminated intermediate object, usually inanimate, such as contaminated instruments, needles, or dressings, or contaminated gloves that are not changed between patients. In addition, the improper use of saline flush syringes, vials, and bags has been implicated in disease transmission in the US, even when healthcare workers had access to gloves, disposable needles, intravenous devices, and flushes.[8]
Prevention
Controlling nosocomial infection is to implement QA/QC measures to the health care sectors, and evidence-based management can be a feasible approach. For those with ventilator-associated or hospital-acquired pneumonia, controlling and monitoring hospital indoor air quality needs to be on agenda in management,[9] whereas for nosocomial rotavirus infection, a hand hygiene protocol has to be enforced.[10][11][12]
To reduce HAIs, the state of Maryland implemented the Maryland Hospital-Acquired Conditions Program that provides financial rewards and penalties for individual hospitals based on their ability to avoid HAIs. An adaptation of the Centers for Medicare & Medicaid Services payment policy causes poor-performing hospitals to lose up to 3% of their inpatient revenues, whereas hospitals that are able to avoid HAIs can earn up to 3% in rewards. During the program’s first 2 years, complication rates fell by 15.26 percent across all hospital-acquired conditions tracked by the state (including those not covered by the program), from a risk-adjusted complication rate of 2.38 per 1,000 people in 2009 to a rate of 2.02 in 2011. The 15.26-percent decline translates into more than $100 million in cost savings for the health care system in Maryland, with the largest savings coming from avoidance of urinary tract infections, septicemia and other severe infections, and pneumonia and other lung infections. If similar results could be achieved nationwide, the Medicare program would save an estimated $1.3 billion over 2 years, while the health care system as a whole would save $5.3 billion.[13]
Hospitals have sanitation protocols regarding uniforms, equipment sterilization, washing, and other preventive measures. Thorough hand washing and/or use of alcohol rubs by all medical personnel before and after each patient contact is one of the most effective ways to combat nosocomial infections.[14] More careful use of antimicrobial agents, such as antibiotics, is also considered vital.[15]
Despite sanitation protocol, patients cannot be entirely isolated from infectious agents. Furthermore, patients are often prescribed antibiotics and other antimicrobial drugs to help treat illness; this may increase the selection pressure for the emergence of resistant strains.[16]
Sterilization
Sterilization goes further than just sanitizing. It kills all microorganisms on equipment and surfaces through exposure to chemicals, ionizing radiation, dry heat, or steam under pressure.[17]
Isolation
Main article: Isolation (health care)
Isolation is the implementation of isolating precautions designed to prevent transmission of microorganisms by common routes in hospitals. (See Universal precautions and Transmission-based precautions.) Because agent and host factors are more difficult to control, interruption of transfer of microorganisms is directed primarily at transmission for example isolation of infectious cases in special hospitals and isolation of patient with infected wounds in special rooms also isolation of joint transplantation patients on specific rooms.
Handwashing
Handwashing frequently is called the single most important measure to reduce the risks of transmitting skin microorganisms from one person to another or from one site to another on the same patient. Washing hands as promptly and thoroughly as possible between patient contacts and after contact with blood, body fluids, secretions, excretions, and equipment or articles contaminated by them is an important component of infection control and isolation precautions.
The spread of nosocomial infections, among immunocompromised patients is connected with health care workers' hand contamination in almost 40% of cases, and is a challenging problem in the modern hospitals. The best way for workers to overcome this problem is conducting correct hand-hygiene procedures; this is why the WHO launched in 2005 the GLOBAL Patient Safety Challenge.[18]
Two categories of micro-organisms can be present on health care workers' hands: transient flora and resident flora. The first is represented by the micro-organisms taken by workers from the environment, and the bacteria in it are capable of surviving on the human skin and sometimes to grow. The second group is represented by the permanent micro-organisms living on the skin surface (on the stratum corneum or immediately under it). They are capable of surviving on the human skin and to grow freely on it. They have low pathogenicity and infection rate, and they create a kind of protection from the colonization from other more pathogenic bacteria. The skin of workers is colonized by 3.9 x 104 – 4.6 x 106 cfu/cm2. The microbes comprising the resident flora are: Staphylococcus epidermidis, S. hominis, and Microccocus, Propionibacterium, Corynebacterium, Dermobacterium, and Pitosporum spp., while transient organisms are S. aureus, and Klebsiella pneumoniae, and Acinetobacter, Enterobacter and Candida spp. The goal of hand hygiene is to eliminate the transient flora with a careful and proper performance of hand washing, using different kinds of soap, (normal and antiseptic), and alcohol-based gels. The main problems found in the practice of hand hygiene is connected with the lack of available sinks and time-consuming performance of hand washing. An easy way to resolve this problem could be the use of alcohol-based hand rubs, because of faster application compared to correct hand-washing.[19]
Improving patient hand washing has also been shown to reduce the rate of nosocomial infection. Patients who are bed-bound often do not have as much access to clean their hands at mealtimes or after touching surfaces or handling waste such as tissues. By reinforcing the importance of handwashing and providing santizing gel or wipes within reach of the bed, nurses were directly able to reduce infection rates. A study published in 2017 demonstrated this by improving patient education on both proper hand-washing procedure and important times to use sanitizer and successfully reduced the rate of enterococci and "S. aureus".[20]
All visitors must follow the same procedures as hospital staff to adequately control the spread of infections. Moreover, multidrug-resistant infections can leave the hospital and become part of the community flora if steps are not taken to stop this transmission.
It is unclear whether or not nail polish or rings affected surgical wound infection rates.[21]
Gloves
In addition to hand washing, gloves play an important role in reducing the risks of transmission of microorganisms. Gloves are worn for three important reasons in hospitals. First, they are worn to provide a protective barrier for personnel, preventing large scale contamination of the hands when touching blood, body fluids, secretions, excretions, mucous membranes, and non-intact skin. In the United States, the Occupational Safety and Health Administration has mandated wearing gloves to reduce the risk of bloodborne pathogen infections.[22] Second, gloves are worn to reduce the likelihood that microorganisms present on the hands of personnel will be transmitted to patients during invasive or other patient-care procedures that involve touching a patient's mucous membranes and nonintact skin. Third, they are worn to reduce the likelihood that the hands of personnel contaminated with micro-organisms from a patient or a fomite can transmit those micro-organisms to another patient. In this situation, gloves must be changed between patient contacts, and hands should be washed after gloves are removed.
Wearing gloves does not replace the need for handwashing due to the possibility of contamination when gloves are replaced, or by damage to the glove. Doctors wearing the same gloves for multiple patient operations presents an infection control hazard.[23]
Surface sanitation
Sanitizing surfaces is part of nosocomial infection in health care environments. Modern sanitizing methods such as Non-flammable Alcohol Vapor in Carbon Dioxide systems have been effective against gastroenteritis, MRSA, and influenza agents. Use of hydrogen peroxide vapor has been clinically proven to reduce infection rates and risk of acquisition. Hydrogen peroxide is effective against endospore-forming bacteria, such as Clostridium difficile, where alcohol has been shown to be ineffective.[24][non-primary source needed] Ultraviolet cleaning devices may also be used to disinfect the rooms of patients infected with Clostridium difficile or MRSA after discharge.[25][non-primary source needed]
Antimicrobial surfaces
Micro-organisms are known to survive on inanimate ‘touch’ surfaces for extended periods of time.[26] This can be especially troublesome in hospital environments where patients with immunodeficiencies are at enhanced risk for contracting nosocomial infections.
Touch surfaces commonly found in hospital rooms, such as bed rails, call buttons, touch plates, chairs, door handles, light switches, grab rails, intravenous poles, dispensers (alcohol gel, paper towel, soap), dressing trolleys, and counter and table tops are known to be contaminated with Staphylococcus, MRSA (one of the most virulent strains of antibiotic-resistant bacteria) and vancomycin-resistant Enterococcus (VRE).[27] Objects in closest proximity to patients have the highest levels of MRSA and VRE. This is why touch surfaces in hospital rooms can serve as sources, or reservoirs, for the spread of bacteria from the hands of healthcare workers and visitors to patients.
A number of compounds can decrease the risk of bacteria growing on surfaces including: copper, silver, and germicides.[28]
There have been a number of studies evaluating the use of no-touch cleaning systems particularly the use of ultraviolet C devices. One review was inconclusive due to lack of, or of poor quality evidence.[29] Other reviews have found some evidence, and growing evidence of their effectiveness.[30][31]
Treatment
Two of the bacteria species most likely to infect patients are the gram-positive strains of methicillin-resistant Staphylococcus aureus (MRSA), and gram-negative Acinetobacter baumannii. While antibiotic drugs to treat diseases caused by MRSA are available, few effective drugs are available for Acinetobacter. Acinetobacter bacteria are evolving and becoming immune to existing antibiotics, so in many cases, polymyxin-type antibacterials need to be used. "In many respects it’s far worse than MRSA," said a specialist at Case Western Reserve University.[32]
Another growing disease, especially prevalent in New York City hospitals, is the drug-resistant, gram-negative Klebsiella pneumoniae. An estimated more than 20% of the Klebsiella infections in Brooklyn hospitals "are now resistant to virtually all modern antibiotics, and those supergerms are now spreading worldwide."[32]
The bacteria, classified as gram-negative because of their reaction to the Gram stain test, can cause severe pneumonia and infections of the urinary tract, bloodstream, and other parts of the body. Their cell structures make them more difficult to attack with antibiotics than gram-positive organisms like MRSA. In some cases, antibiotic resistance is spreading to gram-negative bacteria that can infect people outside the hospital. "For gram-positives we need better drugs; for gram-negatives we need any drugs," said Dr. Brad Spellberg, an infectious-disease specialist at Harbor-UCLA Medical Center, and the author of Rising Plague, a book about drug-resistant pathogens.[32]
One-third of nosocomial infections are considered preventable. The CDC estimates 2 million people in the United States are infected annually by hospital-acquired infections, resulting in 99,000 deaths.[33] The most common nosocomial infections are of the urinary tract, surgical site and various pneumonias.[34]
An alternative treatment targeting localised infections is the use of irradiation by ultraviolet C.[35]
Epidemiology
The methods used differ from country to country (definitions used, type of nosocomial infections covered, health units surveyed, inclusion or exclusion of imported infections, etc.), so the international comparisons of nosocomial infection rates should be made with the utmost care.
Belgium
In Belgium the prevalence of nosocomial infections is about 6.2%. Annually about 125,500 patients become infected by a nosocomial infection, resulting in almost 3000 deaths. The extra costs for the health insurance are estimated to be approximately €400 million/year.[36]
France
Estimates ranged from 6.7% in 1990 to 7.4% (patients may have several infections).[37] At national level, prevalence among patients in health care facilities was 6.7% in 1996,[38] 5.9% in 2001[39] and 5.0% in 2006.[40] The rates for nosocomial infections were 7.6% in 1996, 6.4% in 2001 and 5.4% in 2006.
In 2006, the most common infection sites were urinary tract infections (30,3%), pneumopathy (14,7%), infections of surgery site (14,2%). Infections of the skin and mucous membrane (10,2%), other respiratory infections (6,8%) and bacterial infections / blood poisoning (6,4%).[41] The rates among adult patients in intensive care were 13,5% in 2004, 14,6% in 2005, 14,1% in 2006 and 14.4% in 2007.[42]
Nosocomial infections are estimated to make patients stay in the hospital four to five additional days. Around 2004-2005, about 9,000 people died each year with a nosocomial infection, of which about 4,200 would have survived without this infection.[43]
Finland
Rate were estimated at 8.5% of patients in 2005.[44]
Italy
Since 2000, estimates show about a 6.7% infection rate, i.e. between 450,000 and 700,000 patients, which caused between 4,500 and 7,000 deaths.[45] A survey in Lombardy gave a rate of 4.9% of patients in 2000.[46]
Switzerland
Estimates range between 2 and 14%.[47] A national survey gave a rate of 7.2% in 2004.[48]
United Kingdom
In 2012 the Health Protection Agency reported the prevalence rate of HAIs in England was 6.4% in 2011, against a rate of 8.2% in 2006.[49] with respiratory tract, urinary tract and surgical site infections the most common types of HAI reported.[49] In 2018 it was reported that in-hospital infections had risen from 5,972 in 2008 to 48,815 in 2017. [50]
United States
The Centers for Disease Control and Prevention (CDC) estimated roughly 1.7 million hospital-associated infections, from all types of bacteria combined, cause or contribute to 99,000 deaths each year.[51] Other estimates indicate 10%, or 2 million, patients a year become infected, with the annual cost ranging from $4.5 billion to $11 billion. In the USA, the most frequent type of infection hospitalwide is urinary tract infection (36%), followed by surgical site infection (20%), and bloodstream infection and pneumonia (both 11%).[32][needs update]
History
Mortality rates 1841–1846 in two clinics documented by Semmelweis
In 1841, Ignaz Semmelweis, a Hungarian obstetrician was working at a Vienna maternity hospital. He was "shocked" by the death rate of women who developed puerperal fever. He documented that the infection was 20 times higher in the ward where the medical students were delivering babies than in the next ward that was staffed by midwifery students. The medical students were also routinely working with cadavers. He compared the rates of infection with a similar hospital in Dublin, Ireland and hypothesized that it was the medical students who somehow were infecting the women after labor. He instituted mandatory hand-washing in May 1847 and infection rates dropped dramatically. Louis Pasteur proposed the germ theory of disease and began his work on cholera in 1865 by identifying that it was microorganisms that were associated with disease.[52][53]
See also
Cubicle curtain
Infection control
Iatrogenesis
NAV-CO2
Phototherapy
Sanitation Standard Operating Procedures
References
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^Chan PC, Huang LM, Lin HC, et al. (April 2007). "Control of an outbreak of pandrug-resistant Acinetobacter baumannii colonization and infection in a neonatal intensive care unit". Infect Control Hosp Epidemiol. 28 (4): 423–9. doi:10.1086/513120. PMID 17385148.
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^"Statewide, All-Payer Financial Incentives Significantly Reduce Hospital-Acquired Conditions in Maryland Hospitals". Agency for Healthcare Research and Quality. 2013-07-03. Retrieved 2013-07-06.
^McBryde ES, Bradley LC, Whitby M, McElwain DL (October 2004). "An investigation of contact transmission of methicillin-resistant Staphylococcus aureus". J. Hosp. Infect. 58 (2): 104–8. doi:10.1016/j.jhin.2004.06.010. PMID 15474180.
^Lautenbach E (2001). "Chapter 14. Impact of Changes in Antibiotic Use Practices on Nosocomial Infections and Antimicrobial Resistance—Clostridium difficile and Vancomycin-resistant Enterococcus (VRE)". In Markowitz AJ. Making Health Care Safer: A Critical Analysis of Patient Safety Practices. Agency for Healthcare Research and Quality.
^Kolár, M.; Urbánek, K.; Látal, T. (May 2001). "Antibiotic selective pressure and development of bacterial resistance". International Journal of Antimicrobial Agents. 17 (5): 357–363. doi:10.1016/S0924-8579(01)00317-X. ISSN 0924-8579. PMID 11337221.
^"The Different Methods of Sterilizing Medical Equipment". Gibraltar Laboratories. 2013-05-31. Retrieved 2018-12-06.
^World Alliance for patient safety. WHO Guidelines on Hand Hygiene in Health Care. http://www.who.int/rpc/guidelines/9789241597906/en/. 2009
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^Haverstick, Stacy. ( 2017, June). Patients' Hand Washing and Reducing Hospital-Acquired Infection. Critical Care Nurse 37, no 3: e1-e8. http://ccn.aacnjournals.org/content/37/3/e1.abstract
^Arrowsmith, VA; Taylor, R (Aug 4, 2014). "Removal of nail polish and finger rings to prevent surgical infection". The Cochrane Database of Systematic Reviews (8): CD003325. doi:10.1002/14651858.CD003325.pub3. PMID 25089848.
^"Occupational Exposure to Bloodborne Pathogens;Needlestick and Other Sharps Injuries; Final Rule. - 66:5317-5325". Osha.gov. Retrieved 2011-07-11.
^Otter JA, French GL (January 2009). "Survival of nosocomial bacteria and spores on surfaces and inactivation by hydrogen peroxide vapor". J. Clin. Microbiol. 47 (1): 205–7. doi:10.1128/JCM.02004-08. PMC 2620839. PMID 18971364.
^"Performance Feedback, Ultraviolet Cleaning Device, and Dedicated Housekeeping Team Significantly Improve Room Cleaning, Reduce Potential for Spread of Common, Dangerous Infection". Agency for Healthcare Research and Quality. 2014-01-15. Retrieved 2014-01-20.
^Wilks, S.A., Michels, H., Keevil, C.W., 2005, The Survival of Escherichia Coli O157 on a Range of Metal Surfaces, International Journal of Food Microbiology, Vol. 105, pp. 445–454. and Michels, H.T. (2006), Anti-Microbial Characteristics of Copper, ASTM Standardization News, October, pp. 28-31
^U.S. Department of Defense-funded clinical trials, as presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in Washington, D.C., October 28, 2008
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^Health Quality Ontario, . (2018). "Portable Ultraviolet Light Surface-Disinfecting Devices for Prevention of Hospital-Acquired Infections: A Health Technology Assessment". Ontario Health Technology Assessment Series. 18 (1): 1–73. PMC 5824029. PMID 29487629.
^Weber, DJ; Kanamori, H; Rutala, WA (August 2016). "'No touch' technologies for environmental decontamination: focus on ultraviolet devices and hydrogen peroxide systems". Current Opinion in Infectious Diseases. 29 (4): 424–31. doi:10.1097/QCO.0000000000000284. PMID 27257798.
^Weber, DJ; Rutala, WA; Anderson, DJ; Chen, LF; Sickbert-Bennett, EE; Boyce, JM (2 May 2016). "Effectiveness of ultraviolet devices and hydrogen peroxide systems for terminal room decontamination: Focus on clinical trials". American Journal of Infection Control. 44 (5 Suppl): e77–84. doi:10.1016/j.ajic.2015.11.015. PMID 27131140.
^ abcdPollack, Andrew. "Rising Threat of Infections Unfazed by Antibiotics" New York Times, Feb. 27, 2010
^"99,000 Americans die of Healthcare-Aquired Infections Every Year". 2013-07-26.
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^Dai, T; Vrahas, MS; Murray, CK; Hamblin, MR (February 2012). "Ultraviolet C irradiation: an alternative antimicrobial approach to localized infections?". Expert Review of Anti-infective Therapy. 10 (2): 185–95. doi:10.1586/eri.11.166. PMC 3292282. PMID 22339192.
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^Comité technique des infections nosocomiales (CTIN), Cellule infections nosocomiales, CClin Est, CClin Ouest, CClin Paris-Nord, CClin Sud-Est, CClin Sud-Ouest, avec la participation de 830 établissements de santé. Enquête nationale de prévalence des infections nosocomiales,1996, BEH n° 36/1997, 2 sept. 1997, 4 pp.. Résumé.
^Lepoutre A, Branger B, Garreau N, Boulétreau A, Ayzac L, Carbonne A, Maugat S, Gayet S, Hommel C, Parneix P, Tran B pour le Réseau d’alerte, d’investigation et de surveillance des infections nosocomiales (Raisin). Deuxième enquête nationale de prévalence des infections nosocomiales, France, 2001, Surveillance nationale des maladies infectieuses, 2001-2003. Institut de veille sanitaire, sept. 2005, 11 pp. Résumé.
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^Sax H, Pittet D pour le comité de rédaction de Swiss-NOSO et le réseau Swiss-NOSO Surveillance. Résultats de l’enquête nationale de prévalence des infections nosocomiales de 2004 (snip04). Swiss-NOSO 2005;12(1):1-4. Archived November 11, 2007, at the Wayback Machine
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External links
Classification
D
ICD-10: Y95
External resources
eMedicine: article/967022
The dictionary definition of nosocomial at Wiktionary
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1. 成人の院内肺炎や人工呼吸器関連肺炎の疫学、発症機序、細菌学、診断 epidemiology pathogenesis microbiology and diagnosis of hospital acquired and ventilator associated pneumonia in adults
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4. 感染症予防：一般原則 infection prevention general principles
5. 成人の院内肺炎および人工呼吸器関連肺炎の治療 treatment of hospital acquired and ventilator associated pneumonia in adults
English Journal
Efficacy, safety, and immunogenicity of the human papillomavirus 16/18 AS04-adjuvanted vaccine in women older than 25 years: 4-year interim follow-up of the phase 3, double-blind, randomised controlled VIVIANE study.
Lancet.Lancet.2015 Dec 20;384(9961):2213-2227. doi: 10.1016/S0140-6736(14)60920-X. Epub 2014 Sep 1.
BACKGROUND: Although adolescent girls are the main population for prophylactic human papillomavirus (HPV) vaccines, adult women who remain at risk of cervical cancer can also be vaccinated. We report data from the interim analysis of the ongoing VIVIANE study, the aim of which is to assess the effic
Inflammation-induced phenoconversion of polymorphic drug metabolizing enzymes: hypothesis with implications for personalized medicine.
Shah RR1, Smith RL2.
Drug metabolism and disposition: the biological fate of chemicals.Drug Metab Dispos.2015 Mar;43(3):400-10. doi: 10.1124/dmd.114.061093. Epub 2014 Dec 17.
Phenoconversion transiently converts genotypic extensive metabolizers (EMs) into phenotypic poor metabolizers (PMs) of drugs, potentially with corresponding changes in clinical response. This phenomenon, typically resulting from coadministration of medications that inhibit certain drug metabolizing
Management experience of subglottic stenosis by endoscopic bougie dilatation with mitomycin C and review of literature: case series.
Liew YT1, Yong DJ1, Somasundran M1, Lum CL1.
Indian journal of otolaryngology and head and neck surgery : official publication of the Association of Otolaryngologists of India.Indian J Otolaryngol Head Neck Surg.2015 Mar;67(Suppl 1):129-33. doi: 10.1007/s12070-014-0801-8. Epub 2014 Nov 19.
The aim of the study was to examine and analyze the epidemiology and outcome of treatment for paediatric acquired subglottic stenosis treated with endoscopic bougie dilatation and topical mitomycin C. There were 15 patients identified from 2008 until 2013. All of them had acquired subglottic stenosi
Bacteremia Caused by Pseudomonas luteola in Pediatric Patients
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Japanese Journal of Infectious Diseases 68(1), 50-54, 2015
… Six of these patients had hospital-acquired bacteremia, whereas 1 patient had community-acquired P. … luteola infection. … luteola can cause both community- and hospital-acquired bacteremia. …
Hospital-acquired infections are caused by viral, bacterial, and fungal pathogens; the most common types are bloodstream infection (BSI), pneumonia (eg, ventilator-associated pneumonia [VAP]), urinary tract infection (UTI), and surgical site infection (SSI). Essential update: CDC reports progress in ...
New problems in hospital infection have arisen since the publication of the first edition. Methicillin-resistant "Staphylococcus aureus" have been causing increasing infections all over the world. The prevention of the spread of these organisms has increased the need for effective isolation procedures and the ...
