Volume 19, Issue 2, 2011
Review
Does the use of a polyurethane patch in the CVC dressing further reduce the risk of infection compared with sterile gauze dressing?
Storti Matteo
Half of the patients hospitalized in intensive care units have a central venous catheter (CVC) inserted. Management of CVC is not simple and the wrong medication on the insertion site may cause many complications including sepsis. Among the various modes of dressing are transparent polyurethane patches and sterile gauze, and both have both advantages and drawbacks. The aim of this literature review is to compare these two methods in terms of effectiveness in reducing infections. Seven bio-medical databases of the primary and secondary literature were consulted. We considered all articles published in the last five years, in Italian or English, and research that studies purely human subjects. Moreover, the work was limited to all RCT, all systematic reviews and guidelines published on the databases consulted. Only five studies tackled the research question. The results show that CVC-related infections are a frequent problem in intensive care units. This research found two systematic reviews and two randomized controlled trials. None of the studies show any evidence of the type of dressing applied to the CVC. In conclusion, despite consulting several databases, we found no evidence recommending the type of medication to apply.
Management and prevention of catheter-associated urinary tract infections: current opinions and clinical practice
Esposito Silvano,
Emmi Vincenzo,
Saverio Francesco,
Montorsi Francesco,
Sganga Gabriele,
Noviello Silvana,
Leone Sebastiano,
Catheter-associated urinary tract infection (CA-UTI) is an important epidemiological event in the hospital setting as urethral catheterization has a profound impact in terms of local and systemic extension, mortality rate, prolonged length of stay and costs, other than representing a reservoir of multi-resistant bacterial pathogens. All these issues make it mandatory to set up effective prevention measures. Any initiative able to prevent or reduce incidence of catheter-associated UTI and possible complications should be encouraged. In this context, an important role could be played by innovative catheters coated with noble metal alloy and hydrogel. Results from this consensus may prove useful as a guide for the management and prevention of CA-UTIs in Italy and elsewhere, and may also provide a basis for comparison with other studies.
Original article
Survey on the ability to prescribe antibiotic therapy among Italian residents in geriatrics and internal medicine
Manganaro Davide,
Del Giudice Elena,
Ferretti Elisabetta,
Di Maria Anna,
Luzzati Roberto,
Concia Ercole,
Toigo Gabriele
Antibiotic therapy is a crucial and often life-saving strategy. This study assessed the ability to prescribe antibiotic therapy among a series of Italian postgraduate students in geriatrics and internal medicine. Participants were administered an anonymous questionnaire consisting of self-assessment of their ability to prescribe antibiotics and then manage a case of community-acquired pneumonia. The Wilcoxon test for comparisons between two independent samples was used for statistical analysis. Almost half the 70 students considered their knowledge of antibiotic therapy insufficient and were not satisfied with the notions received during their studies. Indeed, the change in antibiotic therapy required to control acute exacerbation of pneumonia was correctly identified by only 36% of students. Moreover, 38% of them gave the correct answer on factors influencing the duration of antibiotic therapy in the presence of definite improvement of pneumonia. No significant difference was found between the responses of residents in geriatrics and internal medicine. Overall, our study shows that nearly half of our students think they have inadequate antibiotic prescribing skills. This is confirmed by a low ability to establish the best management of the clinical case. To repair this severe shortcoming, different training methods need to be compared and more effective forms of instruction adopted.
Streptococcal tonsillopharyngitis: clinical vs. microbiological diagnosis
Boccazzi Antonio,
Garotta Matteo,
Pontari Sara,
Agostoni Carlo Virgilio
This study aimed to evaluate the role of clinical diagnosis vs. rapid antigen detection tests (RADT) in identifying streptococcal vs. non-streptococcal cases of acute pharyngitis (AP) with respect to a scoring schedule. The Breese scoring system, modified by eliminating the count of peripheral WBC, was used in the study.
At enrolment, cases of AP observed by office-based pediatricians were judged on a clinical basis as possibly of streptococcal or of non-streptococcal origin and a clinical score recorded. At the end of the visit and following completion of the clinical score to document the presence/absence of a group A beta haemolytic streptococcus (GABHS), a confirmatory RADT was performed. In RADT negative cases a standard throat swab and culture were performed.
In all, 629 children presenting with AP were enrolled in the study. A correct clinical diagnosis was predicted on the basis of the clinical observation in 74.2% of cases (with a sensitivity of 81.1% and specificity of 70.5%). In cases judged as “streptococcal”, a mean score of 27.6 was recorded both in those patients with a positive or negative RADT/throat swab for GABHS. By contrast, among cases considered of non-streptococcal aetiology, negative RADT/culture had a mean score of 24.3 (+SD 2.5) compared to a mean score of 25 (+2.5) in those with a positive RADT/culture. Intragroup score differences were not significant, while intergroup differences were highly significant.
Optimization of AP treatment requires careful identification of streptococcal cases, avoiding unnecessary antibiotic treatment which would contribute to enhancing antibiotic resistance and increase medical treatment costs. We document that clinical observation alone, although performed by skilled pediatricians, will misdiagnose a sizeable percentage of cases. As indicated by this study, scores may suffer from a subjective interpretative bias in grading the severity of signs and symptoms.
Herpes zoster in general medicine: experience of the Italian group Netaudit
Del Zotti Francesco,
Guglielmetti Lorenzo,
Conti Michela,
Valentinotti Romina,
Cazzadori Angelo,
Concia Ercole
Herpes zoster is caused by the reactivation of the varicella-zoster virus (VZV) and usually appears many years after primary infection (varicella), induced by immunosuppression due to underlying diseases. Few epidemiological data in Italy are available concerning Herpes zoster, mainly because disease notification is not mandatory. An observational perspective trial was conducted for 12 months by 41 Italian general practitioners belonging to the Netaudit network (www.netaudit.org) to determine herpes zoster incidence and its correlation to patients’ characteristics (age, gender, educational qualification, co-morbidities), the delay from correct diagnosis to the start of treatment and different drug prescription. In all, the study involved 193 patients with herpes zoster: this population included mostly female (60.6%) and elderly subjects (59.6%) with a mean age of 60.4 years. 46.1% of patients presented underlying diseases (diabetes 13%, solid tumours 5.7%). Correct diagnosis was achieved after a mean delay of 49 hours while therapy was started within 48 hours in most cases (75.1%). Aciclovir (51%) and valaciclovir (24%) were the most commonly used drugs. A significant correlation between educational level and prompt treatment suggests the major role of education in primary health prevention campaigns.
Key words: Herpes zoster, Netaudit, General Practitioners
Incidence assessment of rotavirus and adenovirus associated acute gastroenteritis cases in early childhood
Bicer Suat,
Sahin Gulhan Tunca,
Koncay Berkun,
Gemici Hakan,
Siraneci Rengin,
Ozturk Nilufer Yalindag,
Sevketoglu Esra
This study was undertaken to give an insight into the incidence of acute gastroenteritis cases of rotaviral/adenoviral aetiology in patients presenting to the emergency room of an inner-city government teaching hospital. Group A rotavirus and adenovirus serotype 40-41 antigen results were obtained via immunochromatography. In 2007, there were 1543 patients with gastroenteritis between 0-5 years of age whose stool samples were tested for rota and adenovirus, of whom 386 (25%) had positive stool samples for rotavirus, and 133 (8.6%) for adenovirus serotype 40-41. The majority of rotavirus (74.6%) and adenovirus (73%) cases were between 0-2 years of age. The peak season for rotavirus gastroenteritis was January (44%) and February (50.6%), whereas July (9.7%) and August (9%) were months of low incidence. For enteric adenoviral infections summer was the peak season, with August (20.9%) and July (17.3%) being the foremost months. Among the viral gastroenteritis cases, rotavirus infections were in the majority. A seasonal trend emerges for viral gastroenteritis: Rota virus infections are most frequently seen in winter whereas adenoviral infections prefer summer months. Both viruses mostly affect children up to 2 years.
Case report
Iliopsoas abscess and spondylodiscitis by Staphylococcus aureus: successful clinical treatment
dos Santos Vitorino Modesto,
Silva Leao Carlos Eduardo,
Borges Santos Fabio Herbert,
Fastudo Custódio Abel,
Machado Lima Regina Lucas
Although pyogenic abscess of the iliopsoas muscle is considered an uncommon condition, its incidence is on the increase. This abscess may be primary if it occurs without a causal factor; more frequently, it is secondary to gastrointestinal or genitourinary affections, or trauma. The main aetiological agents differ among primary (Staphylococcus aureus) and secondary (Escherichia coli, Klebsiella spp, Streptococcus spp, Bacteroides spp) abscess. We report the case of a 64-year-old man with iliopsoas abscess by S. aureus associated with spondylodiscitis in lumbar vertebrae (L4-L5). Our aim is to emphasize the successful treatment with exclusive intravenous antimicrobials, and highlight the role of control through imaging studies and laboratory tests.
Proteinuria in an African HIV-infected patient: effects of telmisartan
Ucciferri Claudio,
Falasca Katia,
Mancino Paola,
Pizzigallo Eligio,
Vecchiet Jacopo
Kidney disease remains a major comorbidity of HIV infection especially in subjects of African ethnicity. HIV-associated renal disease with overt proteinuria has been associated with poorer outcomes and increased mortality. Telmisartan, an angiotensin II receptor blocker partial agonist of the PPAR-γ approved for the treatment of hypertension, seems to exert a nephro-protective effect independent of blood pressure reduction in the general population. But data are lacking in HIV-positive patients with proteinuria. A case is described of an HIV-positive African patient with severe proteinuria treated with telmisartan. This therapy allowed proteinuria to be improved. This case shows for the first time that therapy with telmisartan has renoprotective effects also in an African HIV-infected patient.
The Infections in the History of Medicine
The Plague of 1478 in Brescia from Giacomo Melga’s diary
Vaglia Alberto
A severe epidemic of bubonic plague devastated Brescia in 1478. We became aware of the tragic events via a manuscript preserved in the town’s Queriniana Library after it had been rediscovered and brought to light by the well-known local historian, Paolo Guerrini, who also edited the complete transcription. An important symptom of the disease, as reported from the beginning of a notary’s dramatic description, was a splitting headache, described by people as mal del zuchòt or del mazzucco. The disease appeared slowly at the beginning of March and spread like wildfire in July; the epidemic continued in its serious form for several months until July the following year.
It is worth noting that at that time in Brescia popular devotion started to be paid to Saint Rocco, the French pilgrim invoked as patron saint against the plague. From the town, devotion to this Saint spread throughout the Province. In the space of a few years there was no parish nor village where Saint Rocco was not accepted among its patron saints; an oratory or altar was erected in his honour.
