SPIR01 and SPIR02: a two-year 1-day point prevalence multicenter study of infections in intensive care units in Piedmont, Italy

This study reports the results of a one-day point prevalence study of infections performed in 2001 (SPIR01) and 2002 (SPIR02) in a Regional network of ICUs in Piedmont, Italy. The study aims were to illustrate the overall proportion of infected patients and the rate of ICU-acquired infections. Mortality rate was evaluated three weeks after the study days. Resistance pattern of Staphylococcus aureus, coagulase negative Staphylococci and Pseudomonas aeruginosa were recorded. The primary end-point of the study was to document the prevalence and associated risk factors of the ICU-acquired infections, and the impact of infections on mortality. The prevalence of ICU-acquired infection was 30% in SPIR01, and 38.3% in SPIR02. The rate of methicillin-resistance was high among isolates of Staphylococcus aureus and coagulase-negative Staphylococci. The prevalence of ICU-acquired infections was lower than that reported in the EPIC study. In our experience, this Regional survey stimulated further research and collaboration to improve the prophylaxis, diagnosis and treatment of ICU-acquired infections.

Chlamydia pneumoniae and cytomegalovirus seropositivity, inflammatory markers, and the risk of myocardial infarction at a young age

BACKGROUND

Pathogens causing chronic infections may promote atherosclerosis. The aim of our study was to evaluate the association of Chlamydia pneumoniae (Cp) and cytomegalovirus (CMV) infection and of inflammatory activation with premature myocardial infarction (MI).

METHODS

Specific anti-Cp and anti-CMV immunoglobulin G (IgG), fibrinogen, white blood cells (WBC), and C-reactive protein (CRP) were measured in 120 post-MI patients </=50 years old and in 120 age-matched controls.

RESULTS

Seropositivity to Cp and elevated concentrations of anti-Cp and anti-CMV IgGs were more frequent (P =.01) in patients than in control subjects, and fibrinogen, CRP, and WBC levels (P =.02) were more elevated. After adjustment for coronary risk factors and socioeconomic status, the odds ratios (95% confidence intervals) for premature MI were 2.4 (1.3-4.6) for Cp infection and 2.9 (1.5-5.8) for CMV. The risk of Cp infection was greater in smokers (3.7, 1.8-7.6). When both infections were present (35% of patients vs 8% of controls, P =.001), CRP was higher (P =.01) and the risk increased by 12 times (12.5, 4-38.9) compared with that in subjects without any infection and by 5 times (4.9, 2.2-10.9) if only one was present.

CONCLUSIONS

After adjustment for confounders, seropositivity to both Cp and CMV infections is associated with the diagnosis of premature MI. The combination of both infections is associated with an enhanced inflammatory response and a markedly increased risk of premature MI.

[Pefloxacin in the treatment of the bone and joint infections]

BACKGROUND

To assess efficacy and tolerability of pefloxacin in association with other antibiotics in the treatment of acute and chronic bone and joint infections.

METHODS

From January to December 1997, all the outpatients with diagnosis of acute or chronic bone and joint infections have been enrolled in a perspective study. If possible a cultural or histopathological study was performed. Treatment response was evaluated with radiological and clinical chemistry parameters.

RESULTS

Fifteen patients [10 males, 5 females; mean age 40.7 +/- 15 years (range 15-71)] have been studied. They had 5 knee septic arthritis, 1 sacroileitis, 1 hip septic arthritis, 4 long bone osteomyelitis, 1 sterum osteomyelitis, 3 spondilitis. Three patients were HIV infected. Twelve were acute infections, 3 chronic ones. Overall, 7 were hematogenous infections, 6 subsequent to elective surgery, 1 post-traumatic thighbone osteomyelitis, 1 osteomyelitis by external fixation device. Isolates were S. aureus in 5 cases, P. mirabilis in 1 case, S. aureus+ Serratia marcescens in 1. In the remaining part cultural tests were negative. Pefloxacin was administered i.v. or orally at the dose of 400 mg/bid for a mean time of 114 +/- 74.5 days (range 30-270) in association with other chemotherapic agents. Ten good recoveries, 3 partial and 2 no responses were observed.

CONCLUSIONS

Pefloxacin resulted to be useful in the treatment of acute and chronic bone and joint infections. No severe side effect was observed during the treatment.