Repository logo

Browsing by Issue Date, starting with "2014-05-07"

Filter results by year or month
Now showing 1 - 2 of 2
  • Interventions for preventing hospital-acquired legionnaires' disease
    Publication . Almeida, Dejanira Alexandra de; Marques, Teresa; Ferreira, Joaquim
    Background Legionnaires’ Disease (LD) has been recognized as a significant source of morbidity and mortality in many hospitals worldwide. Legionella in the hospital water distribution system has been epidemiologically linked to hospital-acquired LD. Despite the several disinfection methods available the optimal method to control hospital-acquired LD has not been established yet. Objectives To assess the efficacy of interventions for preventing hospital-acquired LD in hospitalized patients at high risk of developing the disease and the effect on environmental colonization associated to the risk of developing hospital-acquired LD. Search Methods We searched The Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library and MEDLINE (PubMed). We also handsearched the reference lists of all primary studies identified by the initial search. Selection Criteria All controlled studies investigating the efficacy of interventions for the prevention of hospital-acquired LD, in hospitalized patients at high-risk for developing LD, were eligible for inclusion. Data collection and analysis Two authors independently assessed the trials and extracted data. Data was analysed using statistical software, Review Manager 5.2. Results Three controlled trials, two assessing copper-silver ionization and one assessing ultraviolet light (UVL), met the inclusion criteria. The meta-analysis showed a significant benefit in using copper-silver ionization rather than no intervention for Legionella positivity in distal sites, with RR = 0.04 (95% CI Fixed Effects 0.001, 0.29). One study demonstrated benefit of UVL versus no intervention with a RR = 0.03 (95% CI 0.00, 0.41) for Legionella positivity in water samples. Authors’ conclusions Our review demonstrates that copper-silver ionization and UVL are beneficial, compared with no treatment, to prevent hospital-acquired LD. However the quality of the body of evidence identified does not allow a robust conclusion regarding the effectiveness of interventions for preventing hospital-acquired LD. Further research with well design and high quality studies is needed.
    2014-05-07Master thesis Open access Show more
  • Accuracy of diagnostic tests for legionnaires' disease
    Publication . Santos, Elisabete Cristovam; Marques, Teresa; Ferreira, Joaquim
    Background Legionellosis are infections caused by Legionella spp. The diagnosis of high-risk patients should rely on microbiological tests which allow the establishment of this infection etiology. Cases have to be confirmed through the available diagnostic methods which have different performances, sensitivity, specificity, error causes, limitations, and needs of careful interpretation. Objectives Assess the accuracy of urinary antigen detection, direct fluorescent antibody (DFA) staining, serological testing, Protein Chain Reaction (PCR) versus culture (reference standard), in patients suspected to be infected with Leggionella or patients with laboratory confirmed Legionnaire Disease (LD). Search Methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in The Cochrane Library and MEDLINE (PubMed). We also handsearched the reference lists of the included studies. Selection criteria Observational studies were included, comparing the index tests with culture in patients suspected to be infected with Legionella or patients with laboratory confirmed LD. Data collection and analysis Two authors independently assessed the trials and extracted data. Data was analysed using statistical software Review Manager 5.1. Main results Five studies met the inclusion criteria. All studies evaluated PCR and DFA tests to detect Legionella in clinical specimens, comparing it with culture (reference standard) and were included in meta-analysis. PCR sensitivity and specificity ranged from 56% to 100% and from 89% to 100%, respectively. The pooled sensitivity was 74% (95% IC 67%-80%), and the specificity 97% (95%IC 96%-80%). DFA sensitivity varied from 33% to 44% and the specificity from 100% the pooled sensitivity was 40% (95% IC 21%-61%) and the specificity 100% (95% IC 81%-100%). Author´s conclusions This review demonstrates that PCR have a high sensitivity and specificity for early diagnosis of LD. However standardization is required for biological samples. Although this, culture is always required for epidemiological studies, strains molecular typing and antibiotic sensibility evaluations if needed
    2014-05-07Master thesis Open access Show more