BACKGROUND:The role of coagulase-negative staphylococci (CNS) in bacteremias continues to be controversial. Until the 1970s, CNS were mostly recognized as contaminants, being part of the cutaneous flora. Since then, several studies have reported increasing incidence and severity of infections due to CNS.PURPOSE:To review the literature concerning the epidemiology of CNS bacteremia in the United States and Europe with reference to the multiple definitions of infection versus contamination, considering the effect of potential biases influencing the validity of the reported results.METHODS:Literature search of the MEDLINE database from January 1980 to February 1998. Studies with fewer than 500 episodes of bloodstream infections or fewer than 100 episodes of CNS bacteremia were not included in the pooled analysis.RESULTS:(1) CNS remain the most frequent contaminants (58%-83% of positive blood cultures); (2) the proportion of all bloodstream infections caused by CNS is increasing (R=.51); (3) the overall incidence of true CNS bacteremia is increasing (R=.54, P=.0014); (4) comparing the United States to Europe, there is an increasing trend in the incidence of nosocomial bacteremia due to CNS in the United States (R=.82, P=.0006), but no trend is seen in European studies; (5) the mortality associated with true CNS bacteremia varies between 4.9% and 28%.DISCUSSION:This review confirms the increasing importance of CNS bacteremias, measured both as a proportion and as an incidence of bloodstream infections. The contributions of several possible explanations for the incidence increase and the difference between the United States and Europe need further evaluation: (1) increased recognition and awareness of CNS infections among clinicians; (2) a gradual change in the definition of true bacteremia from an obligatory two positive blood cultures to one positive blood culture associated with a clinical picture compatible with infection; (3) a change in blood culture practices and techniques; (4) an increase in the numbers of blood cultures performed, which is reported both in the United States and in Europe; (5) a shift toward more elderly patients with increasingly severe underlying illnesses; and (6) increasing use of intravascular devices.CONCLUSIONS:The apparent trend of increasing CNS bacteremia seems to be valid. Whether there is a real difference between the United States and Europe concerning the increase of CNS bacteremia is difficult to establish due to the large number of confounding factors. Few studies take into account the number of blood cultures performed or the use of intravascular devices to adjust for the observed trends. Further on-site surveillance studies are needed to investigate the phenomenon more extensively.

BACKGROUND:The role of coagulase-negative staphylococci (CNS) in bacteremias continues to be controversial. Until the 1970s, CNS were mostly recognized as contaminants, being part of the cutaneous flora. Since then, several studies have reported increasing incidence and severity of infections due to CNS.PURPOSE:To review the literature concerning the epidemiology of CNS bacteremia in the United States and Europe with reference to the multiple definitions of infection versus contamination, considering the effect of potential biases influencing the validity of the reported results.METHODS:Literature search of the MEDLINE database from January 1980 to February 1998. Studies with fewer than 500 episodes of bloodstream infections or fewer than 100 episodes of CNS bacteremia were not included in the pooled analysis.RESULTS:(1) CNS remain the most frequent contaminants (58%-83% of positive blood cultures); (2) the proportion of all bloodstream infections caused by CNS is increasing (R=.51); (3) the overall incidence of true CNS bacteremia is increasing (R=.54, P=.0014); (4) comparing the United States to Europe, there is an increasing trend in the incidence of nosocomial bacteremia due to CNS in the United States (R=.82, P=.0006), but no trend is seen in European studies; (5) the mortality associated with true CNS bacteremia varies between 4.9% and 28%.DISCUSSION:This review confirms the increasing importance of CNS bacteremias, measured both as a proportion and as an incidence of bloodstream infections. The contributions of several possible explanations for the incidence increase and the difference between the United States and Europe need further evaluation: (1) increased recognition and awareness of CNS infections among clinicians; (2) a gradual change in the definition of true bacteremia from an obligatory two positive blood cultures to one positive blood culture associated with a clinical picture compatible with infection; (3) a change in blood culture practices and techniques; (4) an increase in the numbers of blood cultures performed, which is reported both in the United States and in Europe; (5) a shift toward more elderly patients with increasingly severe underlying illnesses; and (6) increasing use of intravascular devices.CONCLUSIONS:The apparent trend of increasing CNS bacteremia seems to be valid. Whether there is a real difference between the United States and Europe concerning the increase of CNS bacteremia is difficult to establish due to the large number of confounding factors. Few studies take into account the number of blood cultures performed or the use of intravascular devices to adjust for the observed trends. Further on-site surveillance studies are needed to investigate the phenomenon more extensively.

In patients with panic disorder or premenstrual dysphoria, anxiety attacks can be triggered by intravenous administration of sodium lactate. Since respiratory symptoms, such as hyperventilation and shortness of breath, are characteristic features of spontaneous as well as lactate-induced panic, an involvement of central or peripheral chemoreceptors in this reactionIn patients with panic disorder (Liebowitz et al. , 1985Pitts and McClure 1967) or premenstrual dysphoria (Facchinetti et al. 1992;Sandberg et al. 1993), but not in healthy controls, intravenous (i.v.) administration of sodium lactate elicits an anxiety reaction strongly resembling spontaneous panic attacks. The anxiogenic effect of sodium lactate has been attributed to changes in calcium concentrations (Pitts and McClure 1967), pH (Grosz andFarmer 1972), redox activity (Carr et al. 1986), pCO 2 (Gorman et al. 1988a), and osmolarity (Jensen et al. 1991;Peskind et al. 1998). However, all these theories and findings have also been questioned, and the mechanism by which sodium lactate elicits panic attacks hence is as yet unexplained.Likewise, the reason why patients with panic disorder or premenstrual dysphoria differ from controls with respect to sensitivity to lactate is a matter of controversy. Notably, a more rapid and substantial rise in brain lactate has been observed in panic patients as compared with control subjects (Dager et al. 1999), but the difference between patients and controls may also be due to different responsiveness to a given concentration (Pohl et al. 1994;Rifkin et al. 1981).Panic attacks are almost always associated with hyperventilation and respiratory discomfort, such as shortness of breath; it has thus been suggested that lactate-induced as well as spontaneous panic attacks may be due to an activation of a hyperresponsive suffocation alarm system involving activation of central or peripheral chemoreceptors (Klein 1993). Supporting this concept, an anxiety-provoking effect similar to that of lactate has been observed after inhalation of CO 2 in panic disorder subjects and in women with premenstrual dysphoria (Gorman et al. , 1988aGriez et al. 1987;Harrison et al. 1989;Kent et al. 2001;Papp et al. 1997;Perna et al. 1994;Woods et al. 1986).We have previously reported that intravenous administration of sodium lactate to Wistar rats, but not to rats of the Sprague-Dawley strain, elicits an increase in blood pressure and variable effects on heart rate (Wikander et al. 1995). Such cardiovascular response is in line with the assumption that lactate induces a stimulation of central or peripheral chemoreceptors. In the present study, the effect of sodium lactate on respiratory rate and tidal volume in freely moving, unrestrained male and female rats of the Wistar strain was explored. Given the previous reports suggesting that spontaneous panic attacks are menstrual cycle-dependent (Basoglu et al. 2000;Breier et al. 1986;Cameron et al. 1988;Cook et al. 1990;Klein 1993), that panic disorder may improve during pregnancy (Hertzberg and Wa...

Purpose: To analyse the risk of rhegmatogenous retinal detachment (RRD) after cataract surgery, and to identify possible risk factors. Method: Observational cohort study of patients undergoing cataract surgery in Region Sk ane, southern Sweden, during 2015-2017 were retrieved from the Swedish National Cataract Register. These were then cross-referenced with cases of retinal detachment surgery performed at the Sk ane University Hospital in Lund from 2015 to 2020. The main outcome was RRD after cataract surgery. The influence of sex, age, axial length of the eye, rupture of the posterior capsule, patient comorbidity and other cataract complications were analysed. Results: Among the 58 624 cases of cataract surgery, a total of 298 RRDs (0.51%) were identified up to the end of 2020. The mean time from cataract surgery to RRD was 667 days. The mean age was 65.3 years, compared to 74 years in the control group. A strong correlation was found between RDD and age: <60 years, incidence = 0.50%; 60-75 years, incidence = 0.14%; and >75 years, incidence = 0.04%. The correlation with axial length was also very strong: mean value 23.73 mm in those without RRD, and 25.13 mm in those with RRD (p < 0.001). Sex was also strongly correlated to RDD; 68.8% of cases of RRD being men. Among men younger than 60 years of age, with an axial length ≥25 mm, 9.46% exhibited RRD within the follow-up period (mean 4.7 years). Rupture of the posterior capsule was found in 2.01% of RRD patients compared to 0.74% in the control group. Diabetes, glaucoma or pseudoexfoliation had no impact on the prevalence of RRD. Conclusions: The three main risk factors for RRD following cataract surgery were found to be sex, age and axial length. The highest incidence of RRD (9.46%) were identified among men younger than 60 years of age and an axial length ≥25 mm.