Diss. (sammanfattning) Stockholm : Karol. inst.

No description available.

by Leung Chi-man. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2001. / Includes bibliographical references (leaves 106-117). / Abstracts in English and Chinese. / ABSTRACT (English) --- p.i-ii / ABSTRACT (Chinese) --- p.iii / ACKNOWLEDGMENT --- p.iv / LIST OF CONTENTS --- p.v-viii / LIST OF TABLES --- p.ix-x / LIST OF FIGURES --- p.xi / ABBREVIATIONS --- p.xii / TERMS --- p.xiii-xiv / Chapter CHAPTER 1 --- INTRODUCTION / Chapter 1.1 --- History and taxonomic background of Acinetobacter --- p.1 -3 / Chapter 1.2 --- "Microbiology, ecology and habitats of Acinetobacter species" --- p.4 / Chapter 1.2.1 --- Isolation of Acinetobacter --- p.4 / Chapter 1.2.2 --- Clinical importance of Acinetobacter species --- p.5 / Chapter 1.2.3 --- Acinetobacter 226}0ؤ An endemic nosocomial pathogens of particular importance in Hong Kong --- p.6-7 / Chapter 1.2.4 --- Lack of knowledge of Acinetobacter genomic DNA groups --- p.7 / Chapter 1.2.5 --- Human carriage of Acinetobacter species --- p.8-9 / Chapter 1.2.6 --- Species from environment --- p.9-10 / Chapter 1.3 --- Identification of Acinetobacter --- p.10-11 / Chapter 1.3.1 --- DNA-DNA hybridization --- p.11 / Chapter 1.3.2 --- Phenotypic identification by conventional tests --- p.11 / Chapter 1.3.3 --- Genotypic identification by Amplified Ribosomal DNA Restriction Analysis (ARDRA) --- p.12-13 / Chapter 1.3.4 --- Other PCR methods --- p.13 / Chapter 1.3.5 --- Genotypic identification by tDNA fingerprinting --- p.14 / Chapter 1.4 --- Biotyping --- p.14-15 / Chapter 1.5 --- Background of this research project --- p.15 / Chapter 1.5.1 --- Distribution of different species of Acinetobacter --- p.15-16 / Chapter 1.5.2 --- Consideration of taxonomical problems --- p.16 / Chapter 1.5.3 --- Characterization of Acinetobacter isolates --- p.17 / Chapter 1.6 --- Research objectives --- p.18 / Chapter CHAPTER 2 --- MATERIALS AND METHODS / Chapter 2.1 --- Materials --- p.19 / Chapter 2.1.1 --- Reference strains --- p.19-20 / Chapter 2.1.2 --- Antimicrobial agents and chemicals --- p.20-21 / Chapter 2.1.3 --- "Carbohydrates, enzymes and other materials" --- p.22 / Chapter 2.1.4 --- Commercial media and media prepared manually --- p.23-26 / Chapter 2.1.5 --- Reagents --- p.27 / Chapter 2.1.6 --- Instruments and Software used in this study --- p.28 / Chapter 2.2 --- Methods --- p.28 / Chapter 2.2.1 --- Routine laboratory collection --- p.28 / Chapter 2.2.2 --- Blood culture collection --- p.29 / Chapter 2.2.3 --- Human carriage site collection --- p.29-31 / Chapter 2.2.4 --- Surveillance screening of clinical specimens --- p.31-32 / Chapter 2.2.5 --- Environmental samples 226}0´ؤؤ vegetable --- p.32 / Chapter 2.2.6 --- Environmental samples 一 soil --- p.32-34 / Chapter 2.3 --- General bacteriological techniques for genus identification --- p.34-37 / Chapter 2.4 --- Molecular techniques used for the delineation of genomic DNA groups --- p.37 / Chapter 2.4.1 --- Amplified ribosomal restriction DNA analysis (ARDRA) --- p.37-39 / Chapter 2.4.2 --- Characterization of acinetobacters by tRNA spacer (tDNA) fingerprinting analysis --- p.40-42 / Chapter 2.5 --- Biotyping of Acinetobacter spp --- p.42 / Chapter 2.6 --- Minimum Inhibitory Concentration (MIC) --- p.43-44 / Chapter CHAPTER 3 --- DISTRIBUTION OF ACINETOBACTER SPECIES / Chapter 3.1 --- Results --- p.45 / Chapter 3.1.1 --- Isolation of acinetobacters from surveillance screening of clinical specimens --- p.45-49 / Chapter 3.1.2 --- Isolation of acinetobacters from routine laboratory specimens --- p.49-50 / Chapter 3.1.3 --- Distribution of acinetobacter genomic DNA groups in all clinical specimens --- p.50-51 / Chapter 3.1.4 --- Isolation of acinetobacters from blood culture --- p.51 -52 / Chapter 3.1.5 --- Isolation of acinetobacters from human carriage sites --- p.53-55 / Chapter 3.1.6 --- Isolation of acinetobacters from environmental samples --- p.56-59 / Chapter 3.2 --- Discussion --- p.60 / Chapter 3.2.1 --- Prevalence of Acinetobacter species in clinical specimens --- p.60-61 / Chapter 3.2.2 --- Distribution of acinetobacter genomic DNA groups in clinical specimens --- p.61 -63 / Chapter 3.2.3 --- Distribution of different genomic DNA groups of Acinetobacter on carriage sites --- p.63-65 / Chapter 3.2.4 --- Distribution of different genomic DNA groups of Acinetobacter in environmental samples --- p.65-66 / Chapter CHAPTER 4 --- AN ASSESSMENT OF TDNA FINGERPRINTING IN THE IDENTIFICATION OF ACINETOBACTER SPECIES / Chapter 4.1 --- Results --- p.67 / Chapter 4.1.1 --- Complexity of tDNA fingerprint patterns --- p.67 / Chapter 4.1.2 --- Assessment of tDNA fingerprinting --- p.67-69 / Chapter 4.1.3 --- Construction of fingerprints database with the reference Acinetobacter strains --- p.70 / Chapter 4.1.4 --- Delineation of different genomic DNA groups in the fingerprints database --- p.71 / Chapter 4.1.5 --- Cluster analysis of tDNA fingerprints of Acinetobacter isolates classified by ARDRA --- p.71-73 / Chapter 4.2 --- Discussion --- p.74-75 / Chapter 4.3 --- Conclusion --- p.75-76 / Chapter CHAPTER 5 --- "BIOTYPING OF ISOLATES FROM CLINICAL SPECIMENS, CARRIAGE SITES AND ENVIRONMENTAL SAMPLES" / Chapter 5.1 --- Results --- p.77 / Chapter 5.1.1 --- Biotypes of A. baumannii --- p.77 / Chapter 5.1.2 --- Biotypes of genomic DNA group --- p.3 78 / Chapter 5.1.3 --- Biotypes of genomic DNA group 13TU --- p.78-79 / Chapter 5.2 --- Discussion --- p.79-80 / Chapter CHAPTER 6 --- ANTIMICROBIAL SUSCEPTIBILITIES OF ACINETOBACTER SPECIES / Chapter 6.1 --- Results --- p.81 / Chapter 6.1.1 --- Bacterial strains --- p.81 / Chapter 6.1.2 --- Susceptibilities of Acinetobacter genomic DNA groups --- p.82-86 / Chapter 6.1.3 --- Distribution of resistance patterns in Acinetobacter species --- p.87-90 / Chapter 6.2 --- Discussion --- p.91 / Chapter 6.2.1 --- Antimicrobial susceptibilities of different genomic DNA groups of Acinetobacter from different sources --- p.91-92 / Chapter 6.2.2 --- Emergence of P-Lactam resistance --- p.92 / Chapter 6.2.3 --- Activity of sulbactam --- p.93 / Chapter 6.2.4 --- Susceptibility of carbapenem --- p.93 / Chapter 6.2.5 --- Quinolones resistance --- p.94 / Chapter 6.2.6 --- Aminoglycoside resistance --- p.94-95 / Chapter 6.3 --- Conclusion --- p.95 / Chapter CHAPTER 7 --- GENERAL DISCUSSION / Chapter 7.1 --- Significance of delineation of genomic DNA groups of Acinetobacter --- p.96-98 / Chapter 7.2 --- Epidemiology and clinical implication of Acinetobacter species in Hong Kong --- p.99-104 / Chapter 7.3 --- Characterization of Acinetobacter --- p.104 / Chapter 7.4 --- Future work --- p.104-105 / REFERENCES --- p.106-117 / APPENDIX --- p.118-126

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Science in Medicine in Pharmaceutical Affairs Johannesburg, May 2012 / ABSTRACT Introduction Nosocomial infections which occur after 72 hours in hospitalised neonates cause morbidity and mortality particularly in very low birth weight neonates admitted to a neonatal intensive care unit (NICU). Prolonged hospitalisation and use of sophisticated, expensive antibiotics lead to spiraling costs. Prevention of nosocomial infections are of the essence to contain expenditure and prevent life-threatening complications in vulnerable neonates. A prospective, descriptive study was undertaken to determine the cost of antibiotics used in the neonatal unit at Kalafong Hospital for nosocomial infections. Patients and Methods Neonates with nosocomial infections admitted consecutively to the neonatal unit were studied prospectively by documenting the birth weight, site of infection, pathogen, outcome, admission to the NICU and antibiotics administered. The cost related to antibiotic use was determined for each antibiotic, for individual neonates (expressed as the mean and standard deviation) and for the group as a whole. Results Over a period of seven months (1/1/2011 - 31/7/2011) 682 neonates with a mean birth weight of 2375g, ±868g were admitted to the neonatal unit for ~72 hours of whom 53/682 (7.8%) developed a nosocomial infection and of the 53 who developed a nosocomial infection, eight demised (15.1 %). Of the remaining 629 neonates who did not develop a nosocomial infection, 15/629 (2.4%) demised (p=0.7). Nosocomial infection occurred in 21/36 (58%) neonates <1 OOOg vs 22/646 (3.4%) ~1 OOOg (p<0.01 ).Of 199/682 neonates admitted to the NICU, 42/199 (21.1 %) developed a nosocomial infection vs 11/483 (2 .3%) not admitted to the NICU (p=<0.01 ). Of 22 pathogens cultured from blood, coagulase negative Staphylococcus aureus was the most common (7/22). The total cost of second line antimicrobials (meropenem, vancomycin and fluconazole) for the study period of seven months was R27 032.00 of which an amount of R1 0 321.00 was spent on neonates weighing <1000g. The mean cost per neonate was R563.77±283 for meropenem (n=51), R70.23±32 for vancomycin (n=5) and R78.66±53 for fluconazole (n=6) of which drug wastage comprised at least 50% in each instance. Conclusions Extremely low birth weight ( <1 OOOg) and admission to the NICU place neonates at risk of nosocomial infection at Kalafong Hospital. Meropenem was the most commonly used second line) antibiotic followed by vancomycin and fluconazole. Pharmaceutical curtailment of expenditure generated by nosocomial infections should be addressed by the manufacture of vials with a lower concentration of drug for neonates to minimise wastage.

No description available.

Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 64-69).

Cross infection is a global health problem. The cost for cross infection increases every year. Florence Nightingale focused her attention on preventing cross infections by using good hygiene and as a nurse that is one of your more important tasks. Nurses have guidelines for how hygiene should be implemented in practice. The aim of this study is to investigate factors that influence nurses´ compliance to guidelines regarding hygiene. A literature review was used to analyze scientific articles related to the topic. The result showed that education increases nurses´ compliance to follow guidelines. Furthermore compliance to hand hygiene was higher after contact with the patient then before. The result also showed that the nurses were more worried about attracting an infection from the patient then giving an infection to the patient. The studies revealed that nurses want more education about guidelines and the latest research on the subject. The authors think that nurses need more education about hygiene in order to understand the importance of following guidelines. Nurses also need time for both reading updated information infection control and implementing the hygiene guidelines more frequently in practice.

Orientador: Fernando Antônio de Ávila / Banca: Patrícia Amoroso / Banca: Branca Maria de Oliveira Santos / Banca: Ruben Pablo Schocken-Iturrino / Banca: José Moacir Marin / Resumo: Este trabalho objetivou trazer uma contribuição aos estudos relacionados à infecção cruzada, por Staphylococcus spp, dentro do ambiente dos consultórios odontológicos, destacando as principais fontes de contaminação e o provável risco a que os profissionais e pacientes estão expostos. Foram coletadas 160 amostras de água, 300 amostras de fômites e 360 amostras das mãos (direita e esquerda) e da cavidade nasal de dentistas, auxiliares e pacientes em 40 consultórios. A determinação da contagem de Staphylococcus spp na água, pelo método de filtração em Millipore® ,mostrou que 28% não atenderam ao padrão de potabilidade estabelecidos pela American Dental Association. Dentre os consultórios estudados, os de atendimento de convênio apresentaram a maior contaminação da água (62,5%) e os consultórios particulares (36%) e de convênios (35%) apresentaram maior contaminação em relação aos fômites pesquisados. As regiões de fômites mais contaminadas foram: assento (90%), maçaneta (80%), aparelho de Rx (76%) e caneta de alta rotação (70%). A área anatômica mais contaminada foi à cavidade nasal (66%) seguido da mão esquerda (57%) e mão direita (42%). A correlação entre os isolados de Staphylococcus spp nos fômites, água e áreas anatômicas significativa, podendo ser sugerido que houve infecção cruzada nos consultórios odontológicos estudados. As cepas de Staphylococcus spp, isoladas das águas de abastecimento do equipamento odontológico, foram sensíveis aos antibióticos ciprofloxacina (97%) e vancomicina (91%) e resistentes a oxacilina (78%), enquanto, as cepas, isoladas de fômites, das mãos e cavidade nasal foram sensíveis ao antibiótico ciprofloxacina (85%) e resistentes a oxacilina (88%). / Abstract: This work aimed at making a contribution to studies related to cross infection by Staphylococcus spp in the environment of dental offices, focusing on main contamination sources and possible risk for professionals and patients. There have been collected 160 samples of water, 300 samples of fomites, and 360 samples from hands (right and left) and nasal cavities of dentists, assistants, and patients in 40 dental offices. The count determination of Staphylococcus spp in water, through the Millipore® filtering method, has shown that 28% did not meet the standard of potability established by the American Dental Association. Among studied dental offices, dental care plan offices have presented the highest rate of contamination of water (62,5%), and private offices (36%) and dental care plan offices (35%) have presented the highest rate of contamination as to researched fomites. The most contaminated fomites areas were: chair (90%), door knob (80%), Rx device (76%), and high-speed handpiece (70%). The most contaminated anatomical area was the nasal cavity (66%), followed by left (57%) and right hands (42%). The correlation among isolated Staphylococcus spp in fomites, water, and anatomical areas was significant, therefore, it might be suggested that there has been cross infection in the studied dental offices. Strains of Staphylococcus spp, which had been isolated from dental equipment water, were sensible to antibiotics ciprofloxacin (97%) and vancomycin (91%), and they were resistant to oxacillin (78%); on the other hand, strains isolated from fomites in hands and nasal cavities were sensible to antibiotics ciprofloxacin (85%) and oxacillin (88%). / Doutor

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / As infecÃÃes relacionadas à assistÃncia à saÃde estÃo entre as principais complicaÃÃes em pacientes que se submetem a transplante de rim, em virtude, nÃo somente, dos regimes de imunossupressÃo a que estÃo submetidos, como a cuidados desempenhados pelas equipes de saÃde. O objetivo deste estudo foi analisar infecÃÃes relacionadas à assistÃncia à saÃde em pacientes transplantados renais em 2012, no MunicÃpio de Fortaleza, que possui serviÃos de transplante renal consolidados. Fez-se um estudo transversal onde foram analisadas as fichas ambulatoriais, prontuÃrios e fichas de notificaÃÃo e investigaÃÃo da CCIH de pacientes que realizaram transplante renal em 2012, no HUWC e HGF, instituiÃÃes com recordes sucessivos neste tipo de procedimento. Um total de 237 participantes, sendo, 101 (mÃdias de idade: 43,2 anos) pertencentes ao HUWC e 136 (mÃdias de idade: 45,4 anos) ao HGF, foi incluÃdo no estudo. Em ambas as instituiÃÃes, a maioria das pessoas era do sexo masculino, casada e residia na Capital do CearÃ. Grande parte delas tambÃm tinha o IMC normal, era hipertensa, tinha como principais causas de IRC: inderterminada, HAS e nefrites. A proporÃÃo de procedimentos invasivos realizados foi: biopsia do enxerto (HUWC: 45,54%; HGF: 26,47%), punÃÃo de cateter venoso central (HUWC: 98,01%; HGF: 97,06%), FAV (HUWC: 66,33%; HGF: 94,11%), e passagem de cateter duplo J (HUWC: 39,6%; HGF: 22,06%). A estimativa de prevalÃncia de IRAS nos 101 pacientes transplantados renais no HUWC foi de 50 (49,05%), e no HGF, 31 (22,79%). As IRAS mais comuns, tanto no HUWC, como no HGF, foram infecÃÃes do trato urinÃrio, e os principais agentes etiolÃgicos isolados, Klebsiella pneumoniae e Escherichia coli. No HUWC, os fatores sociodemogrÃficos, clÃnicos e epidemiolÃgicos que apresentaram associaÃÃo estatisticamente significante com o acometimento por IRAS foram: a classificaÃÃo do IMC (p<0,03), o tempo em diÃlise antes do transplante (p<0,05), o tempo de internaÃÃo total (p<0,0001), o tempo de cirurgia (p<0,001), o tempo de isquemia fria (p<0,01), a passagem de cateter duplo J (p<0,003), o tempo de uso do TOT (p<0,03) e o tempo de uso da SVD (p<0,04) no HUWC; no HGF, a classificaÃÃo do IMC (p<0,04), o LES como causa de IRC (p<0,01), a transfusÃo sanguÃnea antes do transplante (p<0,02), o tempo de internaÃÃo total (p<0,001) e o tempo de uso do CVC (p<0,04). Portanto, durante todo o perÃodo perioperatÃrio, hà necessidade de desenvolvimento de aÃÃes cautelosas por toda a equipe de saÃde, de forma a prevenir infecÃÃes e gastos desnecessÃrios do governo com internamentos e tratamentos prolongados, sustentando o crescimento da tÃcnica de transplantaÃÃo renal no Estado nos Ãltimos anos. / The healthcare-related infections are among the major complications in patients who undergo kidney transplant, by virtue not only of immunosuppression schemes to which they are subjected, as the care carried out by health teams. The aim of this study was to analyze healthcare-related infections in renal transplant recipients in 2012, in the city of Fortaleza, which has consolidated renal transplant services. A cross-sectional study where outpatient records were analyzed, charts and tokens for notification and investigation of patients who performed CCIH kidney transplant in 2012, in HUWC and HGF, institutions with successive records in this type of procedure. A total of 237 attendees, being, 101 (average age: 43.2 years) belonging to the HUWC and 136 (average age: 45.4 years) to the HGF, was included in the study. In both institutions, most people were male, married and resided in the Capital of CearÃ. Most of them also had the normal BMI was hypertensive, had as main causes of IRC: inderterminada, SAH and lupus nephritis. The proportion of invasive procedures performed were: graft biopsy (HUWC: 45.54%; HGF: 26.47%), central venous catheter puncture (HUWC: 98.01%; HGF: 97.06%), FAV (HUWC: 66.33%; HGF: 94.11%), and passage of double-J catheter (HUWC: 39.6%; HGF: 22.06%). The estimated prevalence of IRAS in 101 renal transplant recipients at HUWC was 50 (49.05%), and HGF, 31 (22.79%). The most common IRAS, both in HUWC, as in HGF, were urinary tract infections, and the main etiological agents isolated Klebsiella pneumoniae and Escherichia coli. In HUWC, the socio-demographic factors, clinicians and epidemiologists who presented statistically significant association with involvement by IRAS were: the classification of BMI (p<0.03) time on dialysis before transplantation (p<0.05), the total length of stay (p<0.0001), the time of surgery (p<0.001), cold ischemia time (p<0.01), the passage of double-J catheter (p<0.003), the speaking time of TOT (p<0.03) and time of use of the SVD (p<0.04) in HUWC; on HGF, classification of BMI (p<0.04), LES as a cause of IRC (p<0.01), blood transfusion before transplantation (p<0.02), the total length of stay (p<0.001) and time of use of the CVC (p<0.04). Therefore, throughout the perioperative period, there is a need for development of cautious actions throughout the health team, in order to prevent infections and unnecessary government spending with hospitalizations and prolonged treatments, supporting the growth of renal transplantation technique in the State in recent years.

The objectives of this thesis are : 1) To provide a review of the literature on the significance, pathogenesis, diagnosis and management of secondary infections in the Intensive Care Unit. 2) To present the findings of a study of the technique of selective parenteral and enteral antisepsis regimen (SPEAR) in the patient population of the Respiratory ICU at Groote Schuur Hospital, aimed at reducing the incidence of secondary infection and, further to evaluate the study in terms of the effect of SPEAR on the incidence of secondary infection and its influence on the mortality due to secondary infection. 3) To present the findings of the effect of SPEAR on patient bacterial colonisation in the ICU, and to evaluate its longterm influence on the microbial flora of the ICU.