Hospital patients infection

Table 6.3 Urinary tract infection—distribution of pathogenic bacteria in the community and hospitalized patients...

Acquired resistance to the glycopeptides is transposon-mediated and has so far been largely confined to the enterococci. This has been a problem clinically because many of these strains have been resistant to all other antibiotics and were thus effectively untreatable. Fortunately, the enterococci are not particularly pathogenic and infections have been confined largely to seriously ill, long-term hospital patients. Two types of acquired glycopeptide resistance have been described (Woodford et al. 1995). The VanA phenotype is resistant to vancomycin and teicoplanin, whereas VanB is resistant... 

In hospitals today a wide variety of complex equipment is used in the course of patient treatment. Humidifiers, incubators, ventilators, resuscitators and other apparatus require proper maintenance and decontamination after use. Chemical disinfectants used for this purpose have in the past through misuse become contaminated with opportunist pathogens, such as Ps. aeruginosa, and ironically have contributed to, rather than reduced, the spread of cross-infection in hospital patients. Disinfectants should only be used for their intended purpose and directions for use must be followed at all times. 

A patient s resistance is cmcial in determining the outcome of a medicament-borne infection. Hospital patients are more exposed and susceptible to infection than those treated in the general community. Neonates, the elderly, diabetics and patients traumatized by surgeiy or accident m have impaired defence mechanisms. People suffering fiom leukaemia and those treated with immunosuppressants are most vulnerable to infection there is a strong case for providing all medicines in a sterile form for these patients. 

Siebenga, J. J., Beersma, M. F., Vennema, H., van Biezen, P., Hartwig, N. J., and Koopmans, M. (2008). High prevalence of prolonged norovirus shedding and illness among hospitalized patients A model for in vivo molecular evolution. J. Infect. Dis. 198,994—1001. 

VRE) may colonize hospitalized patients or patients who access the health care system frequently. It is key to know which patients have acquired these organisms because patients generally become colonized prior to developing infection, and colonized patients should be placed in isolation (per infection-control policies) to minimize transmission to other patients. 

Most initial antimicrobial therapy is empirical because cultures usually have not had sufficient time to identify a pathogen. Empirical therapy should be based on patient- and antimicrobial-specific factors such as the anatomic location of the infection, the likely pathogens associated with the presentation, the potential for adverse effects in a given patient, and the antimicrobial spectrum of activity. Prompt initiation of appropriate therapy is paramount in hospitalized patients who are critically ill. Patients who receive initial antimicrobial therapy that provides coverage against the causative pathogen survive at twice the rate of patients who do not receive adequate therapy initially.8... 

SSIs negatively affect patient outcomes and increase health care costs. Patients who develop SSIs are five times more likely to be readmitted to the hospital and have twice the mortality of patients who do not develop an SSI.1 A patient infected with an SSI is also 60% more likely to be admitted to an intensive care unit.1 Clinical studies have shown that SSIs increase lengths of hospital stay and costs.1,3,4 The type of SSI can also affect outcome. Deep SSIs, involving organs or spaces, result in longer durations of hospital stay and higher costs compared to SSIs that are limited to the incision.5... 

Maintaining adequate nutritional status, especially during periods of illness and metabolic stress, is an important part of patient care. Malnutrition in hospitalized patients is associated with significant complications, including increased infection risk, poor wound healing, prolonged hospital stay, and increased mortality, especially in surgical and critically ill patients.1 Specialized nutrition support refers to the administration of nutrients via the oral, enteral, or parenteral route for therapeutic purposes.1 Parenteral nutrition (PN), also... 

Bacterial resistance to antibiotics is an emerging public health crisis. The prevalence of pathogens resistant to currently available antibiotics continues to grow annually. Two million patients in the U.S. acquire an infection during a hospital stay and approximately 90,000 of these patients die each year as a result of the infection [1]. More than 70% of hospital-acquired infections are now resistant to... 

Nosocomial Denoting a new disorder (not the patient s original condition) associated with being treated in a hospital, such as a hospital-acquired infection. 

Enterococci bacteria, although less common than S. aureus, can infect hospitalized patients, comphcate diseases, and prolong hospital stays. A particular strain that is vancomycin resistant (VRE) can be fatal and accounts for one-third of the infections in intensive care units. 

Fungal infections are rarely transmitted directly from person to person. Fungi are derived from the commensal flora of the patient or from animal and innate sources in the environment, and are inoculated by (micro)trauma, ingestion or inhalation of spores. The incidence of invasive fungal infections among hospitalized patients has increased primarily due to the introduction of medical interventions that compromise the natural defenses of the patients. 

A small increased risk of enteric infections may exist in patients taking proton pump inhibitors, especially when traveling in underdeveloped countries. Hospitalized patients may have an increased risk for Clostridium difficile infection. 

In developed countries, protein-calorie malnutrition is seen most frequently in hospital patients with chronic illness, or in individuals who suffer from major trauma, severe infection, or the effects of major... 

Several tests with silicon containing compounds as therapeutics in human medicine have already been crowned with success. In France certain organosilicon preparations, DNR and RDN (compare Chap. 5.5), are used in the treatment of cardiovascular diseases, cancer and virus infections. In the Soviet Union extensive clinical tests with ointments of l-(chloromethyl)- and 1-ethoxysilatrane as possible drugs for treatment of different typs of alopecia were successful (compare Chap. 5.1). Further clinical studies showed that l-(chloromethyl)silatrane is also very promising in treatment of wounds and bums. In a Swedish hospital patients with poorly differentiated prostatic carcinoma were treated with 2,6-c/s-diphenyl-hexamethyl-cyclo-tetrasiloxane (Cisobitan ) the clinical study also yielded promising results (compare Chap. 5.3). 

Rohr, U. et al., Methicillin-resistant Staphylococcus aureus whole-body decolonization among hospitalized patients with variable site colonization by using mupirocin in combination with octenidine dihydrochloride. J. Hosp. Infect. 54, 305-309, 2003. 

Increasing numbers, world-wide, of nosocomical (hospital-acquired) infections are caused by MRSA strains [255], Such strains particularly affect patients in intensive-care units [246], In the UK, gentamicin resistance suddenly appeared in 1976 and MGRSA strains caused severe major hospital outbreaks. It has been proposed [186, 227, 229] that, since resistance to nucleic acid-binding (NAB) compounds, such as chlorhexidine, amidines,... 

Although i.v. therapy is usually restricted to hospital patients, continuation parenteral therapy of certain infections, e.g. cellulitis, in patients in the community is sometimes performed by specially-trained nurses. The costs of hospital stays are avoided, but this type of management is suitable only when the patient s clinical state is stable and oral therapy is not suitable. 

In decompensated liver cirrhosis or gastrointestinal bleeding, the use of antibiotics is recommended for the primary prevention of SBP as well as to avert a relapse. This is especially true if predisposing factors for SBP are present. In cirrhosis with ascites, for example, SBP occurs in about 80% of hospitalized patients within the first week. For this reason, SBP is deemed to be a nosocomial infection (H.o. Conn, 1987) although other investigators regard the domestic surroundings as the most... 

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