Pyogenic liver abscess is a rare complication of diabetes, usually seen in adults greater than 50 years of age who have had diabetes for many years. We describe an 18-year-old male with type 2 diabetes found to have a pyogenic liver abscess caused by Klebsiella pneumoniae, and show accompanying images from his evaluation for fever of unknown origin (FUO). We conclude that in a child or adolescent with FUO and diabetes, occult pyogenic liver abscess must be considered.
Polyclonal antibodies against recombinant human nerve growth factor (rhNGF) potently inhibited PC12 neurite outgrowth, blocked high‐affinity 125I‐rhNGF binding but not its receptor, and cross‐reacted with rat, mouse, and human nerve growth factor (NGF) but not with brain‐derived neurotrophic factor, neurotrophin‐3, ciliary neurotrophic factor, insulin‐like growth factor, epidermal growth factor, or activin A. Immunocytochemistry revealed many NGF‐positive neurons in the rat neostriatum. The NGF‐positive neurons disappeared by 3 days after mechanical injury to the neostriatum and were replaced by intensely NGF‐ and glial fibrillary acidic protein‐positive astrocytes. Enzyme‐linked immunosorbent assay measurements revealed that the NGF content of the injured striatum was elevated by eightfold 3 days postinjury and by twofold 2 weeks later. The high‐affinity choline uptake (HACU) into cholinergic nerve terminals was decreased by 23% at 2 and 4 weeks postinjury, yet choline acetyltransferase (ChAT) activity in these neurons was unchanged at 2 weeks and decreased by 14% at 4 weeks. Daily infusion of 1 μg of rhNGF into the injury area did not alter the loss of HACU. However, this treatment elevated ChAT activity by 23–29% above intact neostriatal levels and by 53–65% relative to HACU at both survival times. Thus, lesion‐induced increases in NGF levels within astrocytes are associated with maintenance of striatal ChAT activity at normal levels following cholinergic injury, even with decreases in HACU. Pharmacologic doses of rhNGF can further augment ChAT activity in damaged cholinergic neurons, showing the usefulness of exogenous NGF even when endogenous NGF is elevated in response to injury.
BackgroundMRSA is a major concern for hospitalized patients in the United States. Hospital-Onset (HO) MRSA bacteremia is used as a proxy measurement of MRSA healthcare acquisition, exposure, and infection burden. HO MRSA bacteremia standardized infection ratio (SIR) is used by several national agencies as a quality report metric. Our institution had more than expected HO MRSA bacteremia cases despite several interventions. We describe the impact of a bundle of interventions aimed to decrease HO MRSA bacteremia in an acute care facility.MethodsThis quality improvement project was implemented in a 380-bed community hospital in Miami, FL from January 2015 to March 2019. HO MRSA bacteremia was defined as non-duplicate MRSA isolated from a blood culture collected >3 days after admission. SIR was calculated dividing the number of observed events by the number of predicted events; predicted events were obtained from the NHSN report. During baseline period (Figure1 Phase 1 January 2015–August 2016) all adult patients in the intensive care unit (ICU) were screened for MRSA nasal colonization on admission and weekly thereafter, ICU patients received daily Chlorhexidine (CHG) bathing, and colonized/infected patients with MRSA were placed in contact precautions. In Phase 2 (September 2016–June 2017)daily CHG bathing was switched from 2% wipes to 4% soap foam and expanded to all adult patients; ICU patients also received nasal decolonization with mupirocin. Nasal mupirocin in ICU was replaced with alcohol-based nasal sanitizer for all adult units in July 2017 (Phase 3). In April 2017 we discontinued using contact precautions for MRSA patients; nasal surveillance cultures were discontinued in October 2017. In May 2018 (Phase 4) we introduced alcohol-based wipes for patient hand hygiene at the bedside. SIR were compared by exact binomial test.ResultsWe observed 48 HO MRSA bacteremia cases during the study period. The SIR decreased from 3.66 to 0.97 from baseline to postintervention periods (P = 0.003). The largest decrease in cases and SIR was attained using combined hospital-wide daily CHG bathing, alcohol-based nasal sanitizer, and alcohol wipes for patient hand hygiene during Phase 4 (Table 1).ConclusionOur bundle of interventions for universal decolonization was successful in decreasing HO MRSA bacteremia. Disclosures All authors: No reported disclosures.
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