Nosocomial infections in patients with HIV disease

Lower Respiratory Tract Infections

This review will focus on the infectious etiologies and more common noninfectious causes of lower respiratory tract syndromes among major immunosuppressed populations. The changing epidemiology of infections in the era of highly active antiretroviral therapy (HAART) in the case of HIV-positive patients and the impacts of both newer immune-suppressant therapies and anti-infective prophylaxis for other immunocompromised hosts will be discussed, with emphasis on diagnostic approaches and practice algorithms.

Outbreaks, persistence, and high mortality rates of multiresistant Pseudomonas aeruginosa infections in a hospital with AIDS-predominant admissions

INTRODUCTION

Authors have reported increased incidence of multiresistant Pseudomonas aeruginosa (MR-PA) infections worldwide over the last decade. Researchers have proposed multifaceted approaches to control MR-PA infections, but none have been reported in the acquired immunodeficiency syndrome (AIDS) setting.

OBJECTIVE AND METHODS

Herein we report the impact of a multifaceted intervention for controlling MR-PA over five years in a hospital with AIDS-predominant admissions and describe the clinical characteristics of MR-PA infection in our patient population. The clinical outcomes of infected patients and molecular characteristics of the isolated strains were used as tools for controlling MR-PA infection rates.

RESULTS

Significant temporary decrease of new infections was achieved after intervention, although a high level of diagnostic suspicion of nosocomial infection was maintained. We obtained 35 P. aeruginosa isolates with multiresistant profiles from 13 infected and 3 colonized patients and 2 environmental samples. Most of the patients (94%) were immunocompromised with AIDS (n = 10) or HTLV-1 infections (n = 5). Of the followed patients, 67% had persistent and/or recurrent infections, and 92% died. We observed differences in the antibiotic-resistance pattern of MR-PA infection/colonization during two outbreaks, although the genetic profiles of the tested strains were identical.

CONCLUSIONS

Therefore, we concluded that early multidisciplinary interventions are essential for reducing the burden caused by this microorganism in patients with AIDS. Prolonged or suppressive antibiotic-based therapy should be considered for MR-PA infections in patients with AIDS because of the persistence characteristic of MR-PA in these patients.

Health-care-associated infection: morbidity, mortality and costs

Health-care-associated infection is rightly an area of increasing attention, not least because of considerable resource issues. Not all infection is preventable. However, much is possible and is indeed obligatory to avoid unnecessary infection, and attendant morbidity, mortality and, increasingly, litigation.

Isolation of non-tuberculous mycobacteria from hospital cockroaches (Periplaneta americana)

This study attempted to isolate mycobacteria from hospital and household cockroaches from 90 hospitals and 40 households in Kaohsiung City and Kaohsiung County, South Taiwan. Among 203 cockroaches (139 Periplaneta americana and 64 Blattella germanica) collected from the hospitals, six Mycobacterium spp. were isolated and identified by polymerase chain reaction-restriction fragment length polymorphism analysis. In 12 cockroaches (P. americana): four Mycobacterium kansaii, three Mycobacterium xenopi, two Mycobacterium gordonae, one Mycobacterium hemophilium, one Mycobacterium fortuitum, and one Mycobacterium avium. However, no mycobacteria were obtained form the hospital B. germanica or 226 household cockroaches (123 P. americana and 103 B. germanica). As cockroach infestation occurs commonly in the hospital environment, they may potentially be implicated as a cause of hospital-acquired infections due to non-tuberculous mycobacteria.

Buparvaquone mucoadhesive nanosuspension: preparation, optimisation and long-term stability

The poorly soluble drug buparvaquone is used in experimental clinics against the gastrointestinal persisting parasite Cryptosporidium parvum. It was produced as nanosuspension by high pressure homogenisation. Main advantages of nanosuspensions (amongst others) are their increase of saturation solubility and dissolution velocity, improving the bioavailability of drugs. The buparvaquone nanosuspension had a bulk population of about 600 nm (analysed by photon correlation spectroscopy (PCS)). The additional analysis performed with laser diffraction showed that only a very small content of microparticles occurred, which is, for the special features of nanosuspensions, negligible because they were still below 3 microm. Another feature of nanosuspensions is the adhesion properties to surfaces, e.g. mucosa. To further increase the adhesion time of the buparvaquone nanosuspension to C. parvum, the nanosuspension was formulated with hydrogels made from mucoadhesive polymers, e.g. different types of Carbopol and chitosan. Only a small increase of the particle size of the bulk population occurred directly after the incorporation of buparvaquone nanosuspension into the hydrogels. The nanosuspension/hydrogel systems were physically long-term stable over a period of 6 months as indicated by the unchanged particle sizes.

A new approach for targeting to Cryptosporidium parvum using mucoadhesive nanosuspensions: research and applications

A new strategy to deliver antibiotics to the Cryptosporidium-infected gastrointestinal tract is presented. In an effort to augment the anticryptosporidial effect of clinically used drugs, mucoadhesive nanosuspensions were prepared. They have the ability to reside in the gastrointestinal tract for an extended period. The hydrogel contained bupravaquone nanosuspensions and an adhesive polymer (chitosan) powder dispersed in water. By the development of mucoadhesive nanosuspensions, a potential drug delivery system for poorly soluble drugs has been investigated to overcome bioavailability problems caused by the pathophysiological diarrhoeic situation in patients suffering from cryptosporidiosis. Adapting drug delivery systems to the situation of Cryptosporidium parvum infections in man allows increased retention times with a prolonged action at reduced elimination in the gastrointestinal tract. In this communication, in vivo data are presented to document the efficiency of bupravaquone formulated as mucoadhesive polymers to improve its activity against C. parvum.