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- Southern African Journal of Epidemiology and Infection
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- Volume 20, Issue 2, 2005
Southern African Journal of Epidemiology and Infection - Volume 20, Issue 2, 2005
Volume 20, Issue 2, 2005
The Federation of Infectious Diseases Societies of Southern Africa - towards an integrative future : editorialAuthor Mark CottonSource: Southern African Journal of Epidemiology and Infection 20, pp 34 –35 (2005)More Less
Infectious diseases have an impact on all levels of society. Patterns and type of infection can be influenced by and in turn influence human behaviour and socio-economic factors. At one end of the spectrum, infections such as tuberculosis and HIV cause extensive disease, have significant public health implications and have a major impact on poor people. The severity of both diseases can be ameliorated by adequate access to healthcare. At the other extreme, rhinovirus infections, although considered fairly innocuous, affect all members of society regardless of socioeconomic status, cause morbidity through the precipitation of asthma and have an economic impact through loss of work.
Source: Southern African Journal of Epidemiology and Infection 20 (2005)More Less
This congress edition of the journal is a bumper issue and is particularly exciting for a number of reasons. This edition appears in association with the first combined congress of the various infectious disease societies of South Africa and with the impending launch of FIDSSA, the Federation of the Infectious Diseases Societies of South Africa. Mark Cotton, as the incumbent president of the Infectious Diseases Society of Southern Africa, has kindly written the editorial describing the background, purpose and benefits of a single umbrella organisation for the various societies with interest in infectious diseases. Ultimately it is intended that each of the individual societies will embrace the journal as their own and have considerable input into the journal from a number of points of view, including editorial comment, manuscript review, and article submission. In this way the journal will embrace the motto of the first congress, which is "Simunye".
Author A.G. DuseSource: Southern African Journal of Epidemiology and Infection 20, pp 37 –41 (2005)More Less
Guidelines for infection control in South Africa and developing countries have been formulated to assist healthcare professionals to deal with five important challenges that face healthcare workers : antimicrobial resistance, nosocomial pneumonia, bloodstream infections caused by intravascular catheters, nosocomial urinary tract infections, and nosocomial intra-abdominal infections. Intelligent infection control strategies are essential to minimise the impact of these challenges on patient outcomes. Nosocomial (healthcare-associated) infections are a cause of significant morbidity and mortality in patients receiving healthcare and the costs (direct and indirect) of these infections deplete the already limited financial resources allocated to healthcare delivery. Lower respiratory tract infections, urinary tract infections, bloodstream infections, and post-surgical (including intra-abdominal) infections collectively account for the majority of nosocomial infections. The burgeoning problems and challenges posed by antimicrobial resistance have far-reaching implications for treatment of these infections worldwide and it is therefore appropriate that the emphasis of this guideline document is on these five issues.
Author A. BrinkSource: Southern African Journal of Epidemiology and Infection 20, pp 42 –45 (2005)More Less
Bacterial and fungal resistance is an increasing threat to the successful treatment of nosocomial infections. As bacterial resistance continues to evolve, some pathogens that were once considered routine to treat have become resistant to almost all antimicrobial agents. In particular, the emergence of vancomycin resistance in Staphylococcus aureus and carbapenem resistance in strains of Enterobacter spp and Klebsiella pneumoniae is of great concern. Similarly, increased production and spread of extended spectrum beta-lactamases (ESBL) in Gram-negative bacilli like Escherichia coli are worrisome.
Author P.D. GopalanSource: Southern African Journal of Epidemiology and Infection 20, pp 46 –48 (2005)More Less
The diagnosis of hospital-acquired infections or sepsis is often difficult. The ACCP/SCCM Consensus Conference definition of infection refers to the presence of bacteria, viruses, fungi or parasites. Their definition of sepsis suggests that there should be proven or suspected infection in combination with two or more of the four features of the systemic inflammatory response syndrome (SIRS) reflected in Table 1. These non-specific features are not extremely helpful in the clinical situation as they are common to many hospitalised patients even in the absence of infection/sepsis. Consequently, attempts at proving the existence of an infective process are of paramount importance.
Author C. FeldmanSource: Southern African Journal of Epidemiology and Infection 20, pp 49 –57 (2005)More Less
A nosocomial infection is an infection acquired by a patient as a result of hospitalisation or contact with the hospital environment that was neither present nor incubating at the time of the patient's visit or admission to hospital. Infections are generally considered to be nosocomial if acquired < 48-72 hours following hospital admission. Nosocomial pneumonia (NP) or hospital-acquired pneumonia (HAP) is defined as pneumonia occurring < 48 hours after hospital admission that was neither present nor incubating at the time of admission to hospital. Ventilator-associated pneumonia (VAP) is defined as pneumonia occurring in a patient undergoing mechanical ventilation that was neither present nor incubating at the time of intubation (occurring < 48 hours after intubation). Recently, the term "healthcare-associated pneumonia" (HCAP) has been included in the description of NPs and this entity includes all patients who have been hospitalised in an acute care hospital for two or more days within 90 days of the infection, resided in a nursing home or long term facility, received intravenous antibiotic therapy, chemotherapy or wound care within the past 30 days of the current infection or attended a hospital haemodialysis clinic.
Source: Southern African Journal of Epidemiology and Infection 20, pp 58 –60 (2005)More Less
The urinary tract is the commonest site of nosocomial infections, accounting for 40% of infections. Sixty-six to 86% of these infections follow instrumentation of the urinary tract, particularly catheterisation. In the USA, each hospital-acquired urinary tract infection adds approximately $675 to the costs of hospitalisation. When bacteraemia develops, this additional cost increases to at least $2800, and patient mortality may be as high as 30% Decreasing the inappropriate use of indwelling urinary catheters, using a closed drainage system, and ensuring that the catheter is removed as soon as it is no longer necessary, remain the main interventions in reduction of nosocomial urinary tract infections.
Source: Southern African Journal of Epidemiology and Infection 20, pp 61 –62 (2005)More Less
Bloodstream infection (BSI) is a serious problem in many hospitalised patients and is referred to as being primary where there is no obvious source, or secondary, arising as a complication of infection elsewhere (such as pneumonia, urinary tract, skin and soft tissue, intra-abdominal, device-related, etc). Several of these entities are dealt with in greater detail in the context of this document.
Source: Southern African Journal of Epidemiology and Infection 20, pp 64 –70 (2005)More Less
Intravascular devices are an integral component of modern-day medical practice. They are used to administer intravenous fluids, medications, blood products and parenteral nutrition. In addition, they serve as a valuable monitor of the haemodynamic status of critically ill patients.
Source: Southern African Journal of Epidemiology and Infection 20, pp 71 –73 (2005)More Less
Peritonitis may be primary, secondary or tertiary and it may be community-acquired (CA) or nosocomial. Primary peritonitis, the entity whereby spontaneous infection of the peritoneum with Streptococcus pneumoniae occurs, does not occur as a nosocomial phenomenon. Tertiary peritonitis which is defined as ongoing intra-abdominal sepsis, despite apparently adequate surgical intervention, can occur either as a consequence of nosocomial or CA sepsis and has a high mortality. The term 'nosocomial infection' is designated to describe infections acquired in-hospital and are defined as "infections which become evident <48 hours after admission". Nosocomial infections are more frequently caused by organisms which are resistant to many antimicrobial agents. Intra-abdominal infections include diffuse peritonitis, localised organ infection, localised multiple or diffuse abscesses, and combinations of these clinical conditions.
Source: Southern African Journal of Epidemiology and Infection 20, pp 74 –76 (2005)More Less
Surgical site infections may be divided into organ/body cavity infections and skin/soft tissue infections (SSTI). This article will cover nosocomial guidelines for superficial surgical wound infections, ie. infections of the skin, skin-related structures and soft tissues. SSTIs may be further divided into those which are truly superficial, ie. involving only the skin and subcutaneous tissue; and deep SSTIs which also involve fascia and muscle.