27 September 2014

SWISS MEDICAL WEEKLY: ICU INFECTIONS.

Review article | Published 24 September 2014, doi:10.4414/smw.2014.14009
Cite this as: Swiss Med Wkly. 2014;144:w14009

Enterococci, Clostridium difficile and ESBL-producing bacteria: epidemiology, clinical impact and prevention in ICU patients

Jan A. Sidler, Manuel Battegay, Sarah Tschudin-Sutter, Andreas F. Widmer, Maja Weisser

Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland

Summary

Abbreviations

ARE ampicillin-resistant enterococci

CI confidence interval

ESBL extended-spectrum ß-lactamase

ESBL-GNB extended-spectrum ß-lactamase producing gram-negative bacteria

ICU intensive care unit

MRSA methicillin-resistant Staphylococcus aureus

OR odds ratio

VRE vancomycin-resistant enterococci

Most hospital-acquired infections arise from colonising bacteria. Intensive care patients and immunocompromised individuals are at highest risk for microbial invasion and subsequent infection due to multiple invasive procedures in addition to frequent application of chemotherapeutics and presence of poor microperfusion leading to mucosal disruption. In this narrative review, we summarise the literature on bacterial colonisation in intensive care patients, in particular the epidemiology, the clinical impact and respective infection control strategies of three pathogens, i.e., Enterococcus spp., extended-spectrum ß-lactamase producing gram-negative bacteria and Clostridium difficile, which have evolved from commensals to a public health concern today.

Key words: Clostridium difficile; colonisation; enterococcus; enterobacteriaceae; ESBL; infection; intensive care unit; multidrug-resistant; outcome; VRE

Introduction

Infections are the leading cause of death in intensive care units (ICUs) worldwide and mortality in infected ICU patients is more than twice as high compared to non-infected patients [1, 2]. Despite significant advances in intensive care therapy and infection prevention, incidence of nosocomial infections in ICU patients has remained high [1, 3]. The bacteria causing most hospital-acquired infections are staphylococci including methicillin-resistant S. aureus (MRSA), enterococci including vancomycin-resistant enterococci (VRE), Candida spp., Clostridium difficile and different often multidrug-resistant gram-negative bacteria [1].

In healthy individuals, an ecological community of commensals, symbiotes and pathogens – the microbiome – is in equilibrium with the host. If anatomical barriers or host defenses are disrupted, invasion of colonising bacteria and subsequent infection can arise [4].

In ICU patients, multiple invasive procedures (e.g., central venous catheters) and the presence of poor microperfusion lead to integrity loss of skin and mucosae with risk of invasive infection [5]. Furthermore, ICU patients are per se immunocompromised due to the severity of the disease [6].

UK DAILY MAIL: Dr.JOHN RAE recognised after over 150 years.

Great Arctic explorer to be finally honoured after having career discredited for telling truth about British voyagers' cannibalism

John Rae was sent to find crew of Sir John Franklin lost in Arctic
Discovered that they had reported to cannibalism and reported back
But had reputation trashed and story discredited by Charles Dickens
To be honoured with plaque at Westminster Abbey next week

By Alex Finnis for MailOnline

Published: 18:50 GMT, 27 September 2014 | Updated: 18:51 GMT, 27 September

A painting by Stephen Pearce of Dr John Rae, who is to be honoured with a plaque at Westminster Abbey

One of Britain's greatest Arctic explorers, whose reputation was trashed when he reported cannibalism within a lost British crew, will be honoured with a plaque at Westminster Abbey.

Dr John Rae was sent to the Arctic to find out what had happened to Sir John Franklin and his crew - who went missing in 1846 - and made a discovery so shocking it was refused by the establishment.

Inuit tribesmen told Dr Rae that Franklin's men has starved to death and resorted to eating each other after their ships got trapped in the ice.

After three journeys across the Arctic, Dr Rae reported back, saying that the men had 'been driven to the last dread alternative as a means of supporting life'.

His unfavourable findings were widely criticised and led to him being completely discredited - Charles Dickens wrote a two-part essay theorising that it had actually been the Inuits who killed Franklin's men - and his version became the accepted story.

In his essays, Dickens wrote about the 'firmness, fortitude and courage' of the crew, compared with the Inuits - a 'gross handful of uncivilised people, with a domesticity of blood and blubber', The Times reports.

The successful campaign to sully Dr Rae's account was started by Franklin's widow, and he never recovered from it - he was the only Victorian explorer who was not knighted.

24 September 2014

UK DAILY MAIL: Diphyllobothrium infection from uncooked unfrozen fish

The Chinese man had seen his doctor complaining of stomach ache and itchy skin. Scans revealed his entire body had been infected with tapeworm parasites after eating too much sashimi - raw slices of fish

Humans contract tapeworm infections from sushi by eating raw fish that has been infected with the worm in its larvae stage.

When fish eat tapeworm eggs, the hatching larvae attach themselves to the intestinal wall of the fish and the worms infect the fish flesh.

Because sushi is not cooked, the larvae can in turn transfer into the flesh of any human that eats the fish.

Once a human is infected, a tapeworm will grow inside the intestine to a length of up to 15metres over a period of weeks. It can survive for years and go undetected for weeks or months, in turn releasing its own eggs that infect other parts of the human body.

Symptoms include fatigue, constipation and abdominal discomfort - which can be so mild the victim may not notice anything is wrong.

If larvae begin to migrate to other parts of the body they can start to eat away at the liver, eyes, heart or brain and cause life-threatening conditions.

Doctors believe some of the uncooked Japanese delicacy of raw meat or fish must have become contaminated.

He was treated at the Guangzhou No. 8 People's Hospital in Guangdong Province, in eastern China.

Research has shown that eating raw or undercooked fish can lead to a variety of parasitic infections.

Tapeworm infections occur after ingesting the larvae of diphyllobothrium, found in freshwater fish such as salmon, although marinated and smoked fish can also transmit the worm.

While cases have increased in poorer areas due to improved sanitation, cases have increased in more developed countries,.

This is most likely due to the soaring popularity of sushi, say doctors writing in the journal Canadian Family Physician.

Study author Nancy Craig wrote: 'The widespread popularity of Japanese sushi and sashimi (slices of raw fish) is a contributor.

'But other popular dishes might also be implicated, such as raw salted or marinated fillets - which originate from Baltic and Scandinavian countries - carpaccio - very thin slices of raw fish common in Italy, raw salmon and ceviche - lightly marinated fish.'

Dr Yin, of Guangzhou No. 8 People’s Hospital, told the website that'smags.com that eating uncooked food contaminated with tapeworms' eggs could eventually cause cysticercosis, when the adult worms enters a person’s blood stream.

This type of infection is life-threatening once it reaches the brain.

Read more: http://www.dailymail.co.uk/health/article-2768117/Sushi-lover-s-entire-body-left-riddled-tapeworm-parasites-eating-contaminated-sashimi.html#ixzz3EGoALL2R
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(COMMENT: TORONTO PUBLIC HEALTH wanted to insist that SUSHI restaurants freeze fish. The SUSHI lobby managed to revoke this proposed legislation on basis that freezing would affect taste.)

21 September 2014

ProMED: SYPHILIS increased incidence in AUSTRALIA

20 Sep (1 day ago)

A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

Date: Thu 18 Sep 2014
Source: The Sydney Morning Herald [edited]
<http://www.smh.com.au/nsw/venereal-disease-mystery-as-syphilis-hits-record-high-20140917-10iaar.html>

Sexually transmitted diseases are on the rise, and syphilis has hit
record levels. The venereal disease is widely perceived as a relic of
the pre-antibiotic era, but research from UNSW [University in New
South Wales]'s Kirby Institute for Infection and Immunity in Society
shows that more Australians were diagnosed with the disease in 2013
than in any year since recording began.

More than 1760 syphilis notifications were recorded, a 34 per cent
increase since 2009. The rate of diagnosis was highest in people aged
between 20 and 39, and almost all were gay men. Nearly 600 of them
were in NSW [New South Wales].

The Kirby Institute head of surveillance and evaluation, David Wilson,
said that in the 1990s, the disease was almost non-existent. "Most
people do consider syphilis to be a rare and isolated disease, not
really of relevance today, and even 15 years ago that was true,"
Associate Professor Wilson said. "But we've seen a real resurgence,
particularly among gay men and HIV positive gay men."

Historical data indicates that syphilis rates peaked in 1920 but there
was a dramatic decrease after the advent of antibiotics. "What we're
seeing now is the highest rates in recorded history," Associate
Professor Wilson said. "Before penicillin, syphilis would have been
higher than it is now."

The report -- HIV, Viral Hepatitis and Sexually Transmissable
Infections in Australia -- also indicated an increase in notifications
of gonorrhoea with 14 947 notifications in 2013 compared with 13 842
in 2012. There has been an 80 per cent increase in gonorrhoea
notifications in the past 5 years. The most prevalent sexually
transmitted infection was chlamydia, with 82 537 new diagnoses in
2013.

NSW Health data also released this week indicates that chlamydia and
gonorrhoea notifications rose sharply in the 1st quarter of this year
[2014], with 1211 cases of gonorrhoea and 5963 cases of chlamydia.

19 September 2014

UK DAILY MAIL : Surgeon David SELLU jailed for GROSS NEGLIGENCE MANSLAUGHTER

A senior doctor at a private hospital has been convicted of killing a patient.
Surgeon David Sellu, 66, was found guilty of gross negligence manslaughter over the death of father of six James Hughes, following a trial at the Old Bailey.
Mr Hughes, 66, died at the Clementine Churchill Hospital in Harrow, north-west London, on February 14, 2010.
Sellu, of Hillingdon, west London, was found not guilty of perjury after he was accused of lying to the victim’s inquest under oath.

Dr David Sellu knew his patient had a perforated bowel, he failed to operate for 40 hours

James Hughes was in excruciating pain, the Old Bailey heard

James Hughes (right) was in excruciating pain, the Old Bailey heard. Although Dr David Sellu (left) knew his patient had a perforated bowel, he failed to operate for 40 hours. Mr Hughes later died

Mr Hughes suffered an unexplained tear to his bowel after a routine knee operation at the privately-run Churchill Clementine Hospital in Harrow, northwest London.
Sellu ignored concerns that Mr Hughes was in excruciating pain and failed to operate for at least 24 hours.

Mr Hughes’ suffered blood poisoning as a result of the ‘exceptionally bad care’ and died of a heart attack on February 14, 2010.
Sellu was convicted after a month-long trial at the Old Bailey. Following the verdict, prosecutor Bobbie Cheema QC read an impact statement from Mr Hughes’ wife Ann about the effect on her family.