In this thesis I will review the current knowledge of community-acquired pneumonia, including its classification, pathogenesis, pathology, aetiology, diagnosis, and antibiotic therapy and report my experience with severe community-acquired pneumonia in patients requiring admission to our respiratory intensive care unit. The original research in this thesis comprises a prospective, descriptive analysis of 196 cases of severe community-acquired pneumonia requiring admission to the Respiratory Intensive Unit at Groote Schuur Hospital from January 1987 until December 1992, with emphasis on the influence of aetiology on the severity of pneumonia, the· aetiological diagnosis of pneumonia in severely ill patients, measures of severity of pneumonia, and an audit of ICU therapy and outcome. In addition, different aspects of novel therapies and specific aetiological varieties of pneumonia which have been investigated over the past ten years will be presented.

No description available.

Thesis (M.Med. (Internal Medicine))--University of the Witwatersrand, Faculty of Health Sciences, 2013. / Background Cryptococcus is a life-threatening opportunistic infection; data is limited regarding early infection. Treatment of cryptococcal antigenaemia may impact on disease progression. Screening those most at risk for cryptococcal antigenaemia is necessary to be cost effective. The prevalence of cryptococcal antigenaemia in patients hospitalised with community acquired pneumonia (CAP) at Chris Hani Baragwanath Academic Hospital (CHBAH) was evaluated. Methods 200 patients admitted to CHBAH with presumed CAP were enrolled. Clinical and laboratory data were collected and a Cryptococcal Lateral Flow Immunoassay was done on whole blood. Results Of the 200 patients, 185 (92.5%) were HIV-infected. Amongst the HIV-infected group, the median CD4 cell count was 47 cells/mm3 and 111 subjects (60%) had a CD4 cell count < 100 cells/mm3. The prevalence of cryptococcal antigenaemia was 0.5% (CI 0.01-2.75). Conclusion The prevalence of cryptococcal antigenaemia amongst inpatients with CAP was low. Routine screening of this group would not be cost-effective.

The purpose of this research was to determine the relationship of the slime layer antigen(s) to the "101" or LPS antigens and to attempt to evaluate the role of antibodies against the latter in protection against experimental infections in mice with the homologous strain of Pseudomonas aeruginosa. Results from agglutination tests, chromatographic separations, passive protection tests, and characterizations of the antigens by gel double diffusion do not support the concept that LPS is a necessary portion of the immunogenic material. The immunogenicity of LPS can be attributed to co-purification of residual amounts of slime layer antigens on the washed cells from which LPS was extracted.

Made available in DSpace on 2014-06-11T19:24:15Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-12-09Bitstream added on 2014-06-13T20:31:20Z : No. of bitstreams: 1 franchi_eplp_me_botfm.pdf: 4815496 bytes, checksum: 1dc26a3719261d8f1f4551fbb04a10f4 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Universidade Estadual Paulista (UNESP) / O gênero Staphylococcus está envolvido em infecções adquiridas tanto na comunidade como em hospitais, sobressaindo-se atualmente como um dos maiores problemas clínicos e epidemiológicos em infecções nosocomiais. Diante da importância do S.aureus como um dos microrganismos mais freqüentemente isolados de infecções de pele e tecidos moles e a crescente disseminação dos S. aureus resistentes a oxacilina (MRSA), este estudo objetiva identificar a presença de MRSA em feridas de pacientes atendidos em unidades básicas de saúde da cidade de Botucatu, caracterizar o cassete cromossômico mec e identificar fatores de risco para aquisição de S aureus e MRSA. Foram incluídas no estudo 126 amostras isoladas de 107 pacientes atendidos no período de março de 2010 à fevereiro de 2011. As amostras foram submetidas à identificação e detecção de resistência a oxacilina pelo método de difusão com disco de oxacilina e cefoxitina, penicilina, levofloxacina, clindamicina, eritromicina, gentamicina, sulfametazol/Trimetropim, tigeciclina, ácido fusídico, quinupristina/dalfopristina, linezolida e vancomicina. Foi realizada a caracterização do SCCmec por PCR multiplex nas amostras de S. aureus com gene mecA. Foi investigada a presença dos genes codificadores da Leucocidina Panton-Valentine (PVL). As amostras de Staphylococcus spp. também foram submetidas detecção de produção de -lactamase. Das 126 amostras estudadas, 73(58%) foram identificadas como genero Staphylococcus spp., sendo 49/73(67,1%) isolados S. aureus e 24/73(32,9%) estafilococos coagulase-negativa (ECN). A produção de -lactamase foi positiva em 65/73(89%) das amostras de Staphylococcus spp. Foi encontrado 7/49(14,2%) isolados de S. aureus e 13/24(54,1%) isolados de ECN com presença do gene mec A... / The genus Staphylococcus is involved in both community and hospital-acquired infections, currently standing out as major clinical and epidemiological problems in nosocomial infections. Given the importance of S. aureus as one of the most frequently microorganism isolated from skin and soft tissue infections and the increasing spread of methicillin-resistant S. aureus (MRSA), the aims of this study were to identify the presence of MRSA in wounds of patients treated at basic health units in Botucatu, characterize the cassette chromosome mec (SCCmec) and identify risk factors for acquisition of S aureus and MRSA. The study included 126 isolates from 107 patients treated from March 2010 to February 2011. The samples were identified and the disk diffusion method with cefoxitin and oxacillin disks was carried out in order to detect the resistance to oxacillin. The disk diffusion method was also carried out to set the susceptibility profile for the following antibiotics: penicillin, levofloxacin, clindamycin, erythromycin, gentamicin, sulfamethoxazole/trimethoprim, tigecycline, fusidic acid, quinupristin/dalfopristin, linezolid and vancomycin. mecA positive samples were submitted to SCCmec characterization using multiplex PCR. We also investigated the presence of genes encoding Panton-Valentine Leukocidin (PVL) as far as the - lactamase production. From the 126 samples studied, 73 (58%) were identified as genus Staphylococcus spp., and 49/73 (67.1%) isolates were identified as S.aureus and 24/73 (32.9%) as coagulase-negative Staphylococcus (CoNS). The -lactamase production was positive in 65/73 (89%) samples of Staphylococcus spp. The mecA gene was detected in 7/49 (14.2%) isolates of S. aureus and 13/24 (54.1%) isolates of CoNS. Among MRSA, 4/7 (57.2%) isolates were SCCmec type... (Complete abstract click electronic access below)

Problem detection is a critical component in nursing, such that superior detection could lead to quicker intervention, even if the nature of the problem is not yet clear. A critical problem intensive care nurses typically engage in is detecting the threat of an impending hospital-acquired infection. The purpose of this study was to investigate the effects of the presence of risk factors, expertise, and time pressure on problem detection. The results suggested that time pressure seemed to have a detrimental effect on problem detection, and nurses benefitted from the presence of more risk factors. When not under time pressure, nurses were more sensitive in their problem detection judgments, and only needed one risk factor to trigger problem detection. Experienced nurses were more sensitive to the type of infection at detection, and were more likely to identify the problem correctly after information had been accumulated. These results suggest that problem detection was differentially affected by risk factors based on the presence or absence of time pressure. In addition, experienced nurses took a different approach to problem detection when compared to novices. Finally, problem detection and problem identification can in some situations occur simultaneously, but are distinct processes.

Methicillin-resistant Staphylococcus aureus (MRSA) is a successful pathogen which was historically found in hospital settings but now is a common cause of infection in communities. The rapid emergence of community-acquired MRSA (CA-MRSA) at the turn of the 21st century has established this bacterium’s presence throughout the globe and MRSA continues to be endemic in certain countries. Asia is the most populous continent in the world and also holds a high burden of MRSA infection. This presents a concern for both public health and the acquisition of antibiotic resistance in this region. This literature review describes how MRSA became a successful pathogen. It provides a systematic review of the recent literature on MRSA in East Asia to identify major MRSA clones by country as determined by their molecular characteristics. Also to identify notable genetic and epidemiological factors associated with these MRSA clones. The results of this survey provided evidence of the importance of using molecular categorization techniques to accurately distinguish MRSA strains that require specific antibiotic treatment methods. It also provided evidence of CA-MRSA clones invading hospital settings and traditional hospital-acquired MRSA (HA-MRSA) clones continuing to develop multi-drug resistance throughout East Asian countries. The results also detected novel MRSA strains across hospitals and reported the spread of major MRSA clones within and between countries. Strengthening existing surveillance systems and collaborative efforts between countries within Asia should be a priority to monitor the evolution and movement MRSA especially in the age of globalization and accessible travel.

Orientador: Maria de Lourdes Ribeiro de Souza da Cunha / Banca: Carlos Magno Castelo Branco Fortaleza / Banca: Maria Clara Padoveze / Resumo: O gênero Staphylococcus está envolvido em infecções adquiridas tanto na comunidade como em hospitais, sobressaindo-se atualmente como um dos maiores problemas clínicos e epidemiológicos em infecções nosocomiais. Diante da importância do S.aureus como um dos microrganismos mais freqüentemente isolados de infecções de pele e tecidos moles e a crescente disseminação dos S. aureus resistentes a oxacilina (MRSA), este estudo objetiva identificar a presença de MRSA em feridas de pacientes atendidos em unidades básicas de saúde da cidade de Botucatu, caracterizar o cassete cromossômico mec e identificar fatores de risco para aquisição de S aureus e MRSA. Foram incluídas no estudo 126 amostras isoladas de 107 pacientes atendidos no período de março de 2010 à fevereiro de 2011. As amostras foram submetidas à identificação e detecção de resistência a oxacilina pelo método de difusão com disco de oxacilina e cefoxitina, penicilina, levofloxacina, clindamicina, eritromicina, gentamicina, sulfametazol/Trimetropim, tigeciclina, ácido fusídico, quinupristina/dalfopristina, linezolida e vancomicina. Foi realizada a caracterização do SCCmec por PCR multiplex nas amostras de S. aureus com gene mecA. Foi investigada a presença dos genes codificadores da Leucocidina Panton-Valentine (PVL). As amostras de Staphylococcus spp. também foram submetidas detecção de produção de -lactamase. Das 126 amostras estudadas, 73(58%) foram identificadas como genero Staphylococcus spp., sendo 49/73(67,1%) isolados S. aureus e 24/73(32,9%) estafilococos coagulase-negativa (ECN). A produção de -lactamase foi positiva em 65/73(89%) das amostras de Staphylococcus spp. Foi encontrado 7/49(14,2%) isolados de S. aureus e 13/24(54,1%) isolados de ECN com presença do gene mec A... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: The genus Staphylococcus is involved in both community and hospital-acquired infections, currently standing out as major clinical and epidemiological problems in nosocomial infections. Given the importance of S. aureus as one of the most frequently microorganism isolated from skin and soft tissue infections and the increasing spread of methicillin-resistant S. aureus (MRSA), the aims of this study were to identify the presence of MRSA in wounds of patients treated at basic health units in Botucatu, characterize the cassette chromosome mec (SCCmec) and identify risk factors for acquisition of S aureus and MRSA. The study included 126 isolates from 107 patients treated from March 2010 to February 2011. The samples were identified and the disk diffusion method with cefoxitin and oxacillin disks was carried out in order to detect the resistance to oxacillin. The disk diffusion method was also carried out to set the susceptibility profile for the following antibiotics: penicillin, levofloxacin, clindamycin, erythromycin, gentamicin, sulfamethoxazole/trimethoprim, tigecycline, fusidic acid, quinupristin/dalfopristin, linezolid and vancomycin. mecA positive samples were submitted to SCCmec characterization using multiplex PCR. We also investigated the presence of genes encoding Panton-Valentine Leukocidin (PVL) as far as the - lactamase production. From the 126 samples studied, 73 (58%) were identified as genus Staphylococcus spp., and 49/73 (67.1%) isolates were identified as S.aureus and 24/73 (32.9%) as coagulase-negative Staphylococcus (CoNS). The -lactamase production was positive in 65/73 (89%) samples of Staphylococcus spp. The mecA gene was detected in 7/49 (14.2%) isolates of S. aureus and 13/24 (54.1%) isolates of CoNS. Among MRSA, 4/7 (57.2%) isolates were SCCmec type... (Complete abstract click electronic access below) / Mestre

Abstract Systematic analyses of infections in critical illness are sparse and mostly restricted to specific infection categories. Thus, a prospective study was carried out in a medical-surgical ICU during 14 months on patients whose ICU stay was longer than 48 h. The prospectively gathered data included detailed patient history, infection survey, severity of illness scores (APACHE II, SOFA), resource use, short-term and long-term outcome and quality of life following hospital discharge. Altogether 335 patients were included, of whom 251 (74.9%) had an infection on admission; 59.3% had a community-acquired infection (CAI) and 40.7% a hospital-acquired infection (HAI), while 84 (25.1%) did not have any infection (NI). APACHE II scores and ICU or hospital mortality rates did not differ between the groups. The median hospital stay was longer in the HAI than in the CAI or NI groups. Eighty (23.9%) of the 335 patients developed an ICU-acquired infection (48 per 1000 patient days): ventilator-associated pneumonia (VAP) in 33.8% of the cases, central catheter-related (CRI) or primary bloodstream infections in 6.3% and urinary tract infections in 1.3%, while the corresponding device-related incidences per 1000 days were 18.8, 2.2 and 0.5, respectively. ICU-acquired infection was an independent risk factor for hospital mortality. It doubled the risk for hospital mortality in patients with an infection on admission and caused a threefold the risk in patients without an infection on admission and an almost fourfold increase in the use of nursing resources. Of the 272 hospital survivors, 83 (30.5%) died after discharge during the median follow-up of 17 weeks. Infection status on admission or during the ICU stay did not affect long-term mortality. ICU-acquired infection did not have an impact on patients' quality of life. The current general level of health compared to the status before ICU admission did not differ between the groups, either. Only 36% of those employed resumed their previous jobs. Three-fourths of patients had an infection on admission, while nearly one fourth acquired an ICU infection. The high VAP rate suggests a need for re-evaluation of preventive measures, whereas the low CRI indicates more successful prevention. ICU-acquired infection was a significant risk factor for hospital mortality, but did not affect patients' long-term survival or quality of life.

Title: Vietnamese nursing students’ knowledge and attitudes to hospital-acquired infections and hygiene guidelines. Background: Increased hospital-acquired infections are a global concern. Compliance to hygiene guidelines is essential to prevent infections in health care. Knowledge and attitudes are important factors that affect implementations of precautions in health care. Aim: The aim of this study was to describe the knowledge and attitudes of Vietnamese nursing students’ in year 2, 3 and 4 regarding hospital-acquired infections and hygiene guidelines. Method: An empirical cross-sectional study were 2 questionnaires with set responses was answered by 235 nursing students at a Vietnamese university. Result: The result showed that the students’ knowledge was overall at a moderate level. The 3rd year students reported best amount of knowledge, 2nd year the next best and 4th year students reported the lowest. Students’ attitudes regarding hand hygiene were mostly positive. Questions students reported negative attitudes into were regarded priorities due to lack of time and resources, the effort of remember hand hygiene actions and comfort in reminding other health care workers. Students in 4th year were the ones with the least positive attitudes while year 2 and 3 were more equal. Conclusion: The scores on the hand hygiene (HH) knowledge test improved from year 2 to year 3 but decreased in year 4. The amount of positive attitudes in the subject was equal in year 2 and 3 but less positive in year 4. This indicates that infection control training needs to be ongoing during all the education. We also think it should be highlighted to clinical supervisors and other HCWs that they have a responsibility to emphasize the importance of hand hygiene when teaching future nurses.