bluuebunny/crossref_metadata_2025 huggingface dataset:
Compliance With Guidelines on Antibiotic Prophylaxis in Total Hip Replacement Surgery: Results of a Retrospective Study of 416 Patients in a Teaching Hospital
Authors: Bedouch Pierrick , Labarère José , Chirpaz Emmanuel , Allenet Benoit , Lepape Alain , Fourny Magali , Pavese Patricia , Girardet Pierre , Merloz Philippe , Saragaglia Dominique , Calop Jean , Francois Patrice
Published: April 2006

Objective:

To assess compliance of anesthesiologist practices in antibiotic prophylaxis during total hip replacement (THR) surgery with the French Society of Anesthesiology and Intensive Care consensus-based guidelines.

Design:

Retrospective review of medical records. Compliance of anesthesiologist practices with the guidelines was assessed according to antibiotic prophylaxis use, antimicrobial agent, dosage of first injection, time from first dose to incision, and total duration of antibiotic prophylaxis.

Setting:

Orthopedic surgery wards in a 2,200-bed French teaching hospital.

Patients:

A random sample of 416 patients undergoing THR from January 1999 to December 2000.

Results:

Three hundred eighty-six (93%) of the sampled medical records were usable. Antibiotic prophylaxis was used for 366 (95%) of the patients. Total duration of prophylaxis did not exceed 48 hours in 98% (359 of 366) of the patients. Drug selection complied with national guidelines in 259 (71%) of the patients. Dosage and timing of the first injection were appropriate in 98% (290 of 296) and 80% (236 of 296) of the patients, respectively, who received one of the recommended antibiotics. Overall, 53% (203 of 386) of the patients met all five criteria. In multivariate analysis, there was a significant anesthesiologist effect on overall compliance with the guidelines (likelihood ratio chi-square with 9 degrees of freedom, 25.7; P < .01). Undergoing surgery during 2000 was the only patient characteristic associated with an increased rate of appropriate practices (adjusted OR, 1.56; CI95,1.02-2.38).

Conclusion:

The overall compliance rate should be improved by disseminating the guidelines and the results of this study following audit and feedback.
Rapid Monitoring by Quantitative Polymerase Chain Reaction for Pathogenic Aspergillus During Carpet Removal From a Hospital
Authors: Neely Alice N. , Gallardo Vince , Barth Ed , Haugland Richard A. , Warden Glenn D. , Vesper Stephen J.
Published: April 2006

Monitoring for pathogenic Aspergillus species using a rapid, highly sensitive, quantitative polymerase chain reaction technique during carpet removal in a burn unit provided data that allowed patients to be safely returned to the refloored area sooner than if only conventional culture monitoring had been used.
Prevalence and Fluconazole Susceptibility of Candida Species Recovered From the Oropharynx of Healthcare Workers (HCWs) and Non-HCWs
Authors: Klein Joel D. , Levin S.
Published: April 2006

We compared oropharyngeal cultures and fluconazole susceptibility for Candida in 100 healthcare workers (HCWs) and 100 non-HCWs. Isolates were identified using standard microbiological methods. Susceptibility was determined by Etest and microliter method. There was no significant difference in prevalence or species of oropharyngeal Candida between HCWs and non-HCWs. Fluconazole resistance was infrequent.
Increased Susceptibility to Vancomycin-Resistant Enterococcus Intestinal Colonization Persists After Completion of Anti-Anaerobic Antibiotic Treatment in Mice
Authors: Stiefel Usha , Pultz Nicole J. , Helfand Marion S. , Donskey Curtis J.
Published: April 2006

Background:

Antibiotic-associated disruption of the indigenous intestinal microflora may persist beyond the treatment period. Although piperacillin/tazobactam inhibits the establishment of vancomycin-resistant Enterococcus (VRE) stool colonization in mice during treatment, we hypothesized that this agent and other anti-anaerobic antibiotics would increase susceptibility to colonization during the period of recovery of the intestinal microflora.

Design:

Mice received 104 colony-forming units of vancomycin-resistant E. faecium by orogastric inoculation 2, 5, or 10 days after completing 5 days of subcutaneous antibiotic treatment, or both during and 2 days after the completion of treatment. Denaturing gradient gel electrophoresis (DGGE) was performed to assess changes in the intestinal microflora.

Results:

Anti-anaerobic antibiotics (ie, piperacillin/tazobactam, cefoxitin, and clindamycin) caused significant disruption of the indigenous microflora (mean DGGE similarity indices ≤ 27% in comparison with saline controls) and promoted the establishment of high-density colonization when VRE was inoculated 2 or 5, but not 10, days following treatment (P < .001). Piperacillin/tazobactam exhibited a biphasic effect on the establishment of colonization (ie, inhibition when exposed to VRE during treatment and promotion when exposed to VRE after discontinuation of treatment), resulting in greater overall promotion of colonization than did agents with minimal anti-anaerobic activity (ie, levofloxacin, cefepime, and aztreonam) when VRE was inoculated both during and 2 days after treatment (P< .001).

Conclusion:

Patients receiving anti-anaerobic antibiotics, including piperacillin/tazobactam, may be susceptible to the establishment of high-density VRE colonization during the period of recovery of the anaerobic microflora.
Impact of Surveillance for Vancomycin-Resistant Enterococci on Controlling a Bloodstream Outbreak Among Patients With Hematologic Malignancy
Authors: Hachem Ray , Graviss Linda , Hanna Hend , Arbuckle Rebecca , Dvorak Tanya , Hackett Brenda , Gonzalez Virginia , Perego Cheryl , Tarrand Jeffrey , Raad Issam
Published: April 2006

Objective:

To determine the impact of stool surveillance cultures of critically ill patients on controlling vancomycin-resistant enterococci (VRE) outbreak bacteremia.

Design:

Stool surveillance cultures were performed on patients who had hematologic malignancy or were critically ill at the time of hospital admission to identify those colonized with VRE. Hence, contact isolation was initiated.

Setting:

A tertiary-care cancer center with a high prevalence of VRE.

Participants:

All patients with hematologic malignancy who were admitted to the hospital as well as all of those admitted to the intensive care unit were eligible.

Results:

Active stool surveillance cultures performed between 1997 and 2001 decreased the incidence density of VRE bacteremias eightfold while vancomycin use remained constant. In fiscal year (FY) 1997 and FY 1998, there were five and three VRE outbreak bacteremias, respectively. The outbreak clones were responsible for infection in 69% of those patients with VRE bacteremia. However, the stool surveillance program resulted in the complete control of VRE bacteremia by FY 1999 until the end of the study.

Conclusion:

Despite the steady use of vancomycin, the active surveillance program among high-risk patients with hematologic malignancy and those who were critically ill resulted in the complete control of VRE outbreak bacteremia at our institution.
Failure to Develop Vancomycin-Resistant Enterococcus With Oral Vancomycin Treatment of Clostridium difficile
Authors: Salgado Cassandra D. , Giannetta Eve T. , Farr Barry M.
Published: April 2006

Objective:

Oral vancomycin therapy has been a risk factor for turning culture positive for vancomycin-resistant Enterococcus (VRE). VRE colonization status was reviewed for all patients who received oral vancomycin and underwent prospective cultures.

Methods:

Data were extracted from the medical records of all patients receiving oral vancomycin between August 1995 and February 2001 regarding history, hospital course, and perirectal VRE cultures. Hospital policy required contact isolation for patients receiving oral vancomycin until colonization with VRE was excluded.

Results:

Twenty-six courses of oral vancomycin were given to 22 patients. VRE colonization status after completion of therapy was evaluated for 23 courses in 20 (91%) of these patients. None of these patients became VRE culture positive during a median follow-up of 18 days (range, 9 to 39 days), with a median duration of treatment of 10 days (range, 3 to 58 days), and with a median total dose of 6,500 mg (range, 1,250 to 29,000 mg). All patients received other antibiotics within 30 days prior to therapy with oral vancomycin, during therapy with oral vancomycin, or both; 95% had received anti-anaerobic therapy and 35% had received parenteral vancomycin.

Conclusions:

Even when other risk factors were present, no patient receiving oral vancomycin at our facility subsequently became culture positive for VRE. This suggests that oral vancomycin therapy or other antibiotic use, including anti-anaerobic therapy, may not be a significant independent risk factor for turning culture positive for VRE among patients not previously exposed to the microbe.
A Cost-Benefit Analysis of Gown Use in Controlling Vancomycin-Resistant Enterococcus Transmission Is It Worth the Price?
Authors: Puzniak Laura A. , Gillespie Kathleen N. , Leet Terry , Kollef Marin , Mundy Linda M.
Published: April 2006

Objective:

To determine the net benefit and costs associated with gown use in preventing transmission of van-comycin-resistant Enterococcus (VRE).

Design:

A cost-benefit analysis measuring the net benefit of gowns was performed. Benefits, defined as averted costs from reduced VRE colonization and infection, were estimated using a matched cohort study. Data sources included a step-down cost allocation system, hospital informatics, and microbiology databases.

Setting:

The medical intensive care unit (MICU) at Barnes-Jewish Hospital, St. Louis, Missouri.

Patients:

Patients admitted to the MICU for more than 24 hours from July 1, 1997, to December 31, 1999.

Interventions:

Alternating periods when all healthcare workers and visitors were required to wear gowns and gloves versus gloves alone on entry to the rooms of patients colonized or infected with VRE.

Results:

On base-case analysis, 58 VRE cases were averted with gown use during 18 months. The annual net benefit of the gown policy was $419,346 and the cost per case averted of VRE was $1,897. The analysis was most sensitive to the level of VRE transmission.

Conclusions:

Infection control policies (eg, gown use) initially increase the cost of health services delivery. However, such policies can be cost saving by averting nosocomial infections and the associated costs of treatment. The cost savings to the hospital plus the benefits to patients and their families of avoiding nosocomial infections make effective infection control policies a good investment.
Emergence of Resistant Staphylococci on the Hands of New Graduate Nurses
Authors: Cimiotti Jeannie P. , Wu Fann , Della-Latta Phyllis , Nesin Mirjana , Larson Elaine
Published: April 2006

Objective:

To describe the aerobic microbial flora on the hands of experienced and new graduate nurses over time.

Design:

A prospective cohort design that examined the relationship between duration of employment in an intensive care unit (ICU) and the microbial flora on the hands of experienced and new graduate nurses during a 23-month period.

Setting:

A 50-bed, level III-IV neonatal ICU in New York City.

Participants:

Twelve experienced nurses and 9 new graduate nurses working full time in the NICU.

Intervention:

One hundred fifty samples were obtained from the clean, dominant hands of the nurses. Cultures were performed at baseline and then quarterly for each experienced and new graduate nurse. Baseline and final cultures of Staphylococcus epidermidis were further examined using pulsed-field gel electrophoresis.

Results:

At baseline, a significantly larger proportion of the experienced nurses had methicillin-resistant, coagulase-negative staphylococci isolated from their hands compared with the new graduate nurses (95% and 33%, respectively; P = .0004). For a second culture, performed 1 to 4 months later, there were no longer significant differences between the two groups (82% and 54%, respectively; P = .12). By the last culture, all staphylococcal isolates were methicillin resistant in both groups of nurses; 3 were methicillin-resistant S. aureus.

Conclusions:

Colonization with methicillin-resistant staphylococci occurred after brief exposure to the hospital environment, despite the use of antiseptic hand hygiene agents. Furthermore, at final culture, the two groups shared one dominant hospital-acquired strain of S. epidermidis.
Surgical-Site Infection Due to Staphylococcus aureus Among Elderly Patients Mortality, Duration of Hospitalization, and Cost
Authors: McGarry Sarah A. , Engemann John J. , Schmader Kenneth , Sexton Daniel J. , Kaye Keith S.
Published: April 2006

Objectives:

To examine the impact of surgical-site infection (SSI) due to Staphylococcus aureus on mortality, duration of hospitalization, and hospital charges among elderly surgical patients and the impact of older age on these outcomes by comparing older and younger patients with S. aureus SSI.

Design:

A nested cohort study.

Setting:

A 750-bed, tertiary-care hospital and a 350-bed community hospital.

Patients:

Ninety-six elderly patients (70 years and older) with S. aureus SSI were compared with 2 reference groups: 59 uninfected elderly patients and 131 younger patients with S. aureus SSI.

Results:

Compared with uninfected elderly patients, elderly patients with S. aureus SSI were at risk for increased mortality (odds ratio [OR], 5.4; 95% confidence interval [CI95], 1.5-20.1), postoperative hospital-days (2.5-fold increase; CI95, 2.0-3.1), and hospital charges (2.0-fold increase; CI95, 1.7-2.4; $41,117 mean attributable charges per SSI). Compared with younger patients with S. aureus SSI, elderly patients had increased mortality (adjusted OR, 2.9; CI95, 1.1-7.6), hospital-days (9 vs 13 days; P = .001), and median hospital charges ($45,767 vs $85,648; P < .001).

Conclusions:

Among elderly surgical patients, S. aureus SSI was independently associated with increased mortality, hospital-days, and cost. In addition, being at least 70 years old was a predictor of death in patients with S. aureus SSI.
Risk Factors for Surgical-Site Infection Following Primary Total Knee Arthroplasty
Authors: Minnema Brian , Vearncombe Mary , Augustin Anne , Gollish Jeffrey , Simor Andrew E.
Published: April 2006

Objective:

To identify risk factors associated with the development of surgical-site infection (SSI) following total knee arthroplasty (TKA).

Design:

A case-control study.

Setting:

A 1,100-bed, university-affiliated, tertiary-care teaching hospital.

Methods:

Case-patients with SSI occurring up to 1 year following primary TKA performed between January 1999 and December 2001 were identified prospectively by infection control practitioners using National Nosocomial Infections Surveillance (NNIS) System methods. Three control-patients were selected for each case-patient, matched by date of surgery. Stepwise logistic regression analysis was used to determine the relation of potential risk factors to the development of infection.

Results:

Twenty-two patients with infections (6 superficial and 16 deep) were identified. Infection rates per year were 0.95%, 1.07%, and 1.19% in 1999, 2000, and 2001, respectively. Logistic regression analysis identified two variables independently associated with the development of infection: the use of closed suction drainage (odds ratio [OR], 7.0; 95% confidence interval [CI95], 2.1-25.0; P = .0015) and increased international normalized ratio (INR) (OR, 2.4; CI95, 1.1-5.7; P = .035). Factors not statistically associated with the development of infection included age, NNIS System risk index score, presence of various comorbidities, surgeon, duration of procedure or tourniquet time, type of bone cement or prosthesis used, or receipt of blood product transfusions.

Conclusions:

The use of closed suction drainage and a high postoperative INR were associated with the development of SSI following TKA. Avoiding the use of surgical drains and careful monitoring of anticoagulant prophylaxis in patients undergoing TKA should reduce the risk of infection.
Preoperative Risk Factors for Nasal Carriage of Staphylococcus aureus
Authors: Herwaldt Loreen A. , Cullen Joseph J. , French Pamela , Hu Jianfang , Pfaller Michael A. , Wenzel Richard P. , Perl Trish M.
Published: April 2006

Background:

Staphylococcus aureus nasal carriage is a risk factor for surgical-site infections (SSIs) caused by S. aureus, and eradication of carriage reduces postoperative nosocomial infections caused by it. No study has compared large groups of preoperative carriers and non-carriers to identify factors that are linked to S. aureus nasal carriage.

Methods:

While conducting a clinical trial evaluating whether mupirocin prevented S. aureus SSIs, we prospectively collected data on 70 patient characteristics that might be associated with S. aureus carriage. We performed stepwise logistic regression analysis.

Results:

Of the 4,030 patients, 891 (22%) carried S. aureus. Independent risk factors for S. aureus nasal carriage were obesity (odds ratio [OR], 1.29; 95% confidence interval [CI95], 1.11-1.50), male gender (OR, 1.29; CI95,1.11-1.51), and a history of a cerebrovascular accident (OR, 1.53; CI95, 1.03-2.25) for all patients. Factors associated with nasal carriage varied somewhat by surgical specialty. In all groups, preoperative use of antimicrobial agents was independently associated with a lower risk of carrying S. aureus in the nares. Previously identified risk factors were not significantly associated with S. aureus nasal carriage in this large group of surgical patients.

Conclusion:

Male gender, obesity, and a history of a cerebrovascular accident were identified as risk factors for S. aureus nasal carriage. It remains to be seen whether preoperative weight loss would reduce the rate of nasal carriage. In addition, the value of screening this patient population for S. aureus nasal carriage merits further investigation.
Prevention of Infections Associated With Permanent Cardiac Antiarrhythmic Devices by Implementation of a Comprehensive Infection Control Program
Authors: Borer Abraham , Gilad Jacob , Hyam Eytan , Schlaeffer Francisc , Schlaeffer Pnina , Eskira Seada , Aloni Phany , Wagshal Abraham , Katz Amos
Published: April 2006

Objective:

To implement a comprehensive infection control (IC) program for prevention of cardiac device-associated infections (CDIs).

Design:

Prospective before-after trial with 2 years of follow-up.

Setting:

A tertiary-care, university-affiliated medical center.

Patients:

A consecutive sample of all adults undergoing cardiac device implantation between 1997 and 2002.

Intervention:

An IC program was implemented during late 2001 and included staff education, preoperative modification of patient risk factors, intraoperative control of strict aseptic technique, surgical scrubbing and attire, control of environmental risk factors, optimization of antibiotic prophylaxis, postoperative wound care, and active surveillance. The clinical endpoint was CDI rates.

Results:

Between 1997 and 2000, there were 7 CDIs among 725 procedures (mean annual CDI incidence, 1%). During the first 9 months of 2001, there were 7 CDIs among 167 procedures (4.2%; P = .007): CDIs increased from 7 among 576 to 3 among 124 following pacemaker implantation (P = .39) and from 0 among 149 to 4 among 43 following cardioverter-defibrillator implantation (P = .002). Of the 14 CDIs, 5 involved superficial wounds, 7 involved deep wounds, and 2 involved endocarditis. Following intervention, there were no cases of CDI among 316 procedures during 24 months of follow-up (4.2% reduction; P = .0005).

Conclusions:

We observed a high CDI rate associated with substantial morbidity. IC measures had an impact on CDI. Although the relative weight of each measure in the prevention of CDI remains unknown, our results suggest that implementation of a comprehensive IC program is feasible and efficacious in this setting.
A Protracted Outbreak of Staphylococcus epidermidis Infections Among Patients Undergoing Valve Replacement
Authors: Bou Ricardo , Peris Miguel , Perpiñán Javier , Ramos Pilar , Aguilar Angel
Published: April 2006

Objective:

To investigate a Staphylococcus epidermidis outbreak among patients undergoing cardiac surgery.

Design:

Retrospective cohort study.

Setting:

A 260-bed community referral center.

Patients:

Case-patients were patients with S. epidermidis mediastinals, endocarditis, or both after valve implantation at Hospital de La Ribera from January to June 2002. The study population included patients undergoing valve surgery at Hospital de La Ribera from January 2000 to June 2002.

Results:

From January to June 2002, 8 cases of mediastinals, endocarditis, or both occurred among 53 patients undergoing cardiac surgery. In the same months of 2000, there had been no cases among 22 patients, and in 2001, only 1 case among 47 patients (P = .095 and P = .034, respectively). In 2002, there were 4 cases of mediastinitis and endocarditis, 3 cases of medi-astinitis, and 1 case of endocarditis, all following aortic valve replacement. The epidemic curve suggested a protracted outbreak. Patients with chronic obstructive lung disease were sixfold more likely to be case-patients (95% confidence interval, 1.6-23.8). The mean duration of surgery tended to be longer in non-case-patients (161.4 ± 57.9 minutes) than in case-patients (123.7 ± 23.7 minutes) (P = .06).

Conclusion:

The cause of this protracted outbreak was likely multifactorial. Reemphasis of existing policies was associated with resolution of the outbreak.
Improving Outcomes of Coronary Artery Bypass Graft Infections With Multiple Interventions Putting Science and Data to the Test
Authors: Lutarewych Michael , Morgan Sandra P. , Hall Melanie M.
Published: April 2006

In 2001, 7.58% of our coronary artery bypass graft (CABG) patients developed surgical-site infection (SSI) as compared with 3.57% in National Nosocomial Infections Surveillance System hospitals from January 1992 to June 2001. Seven new preventive measures were implemented and in 2002, the rate was 3.47%. Implementing evidence-based measures improved patient outcomes.
Safety-Engineered Device Implementation: Does It Introduce Bias in Percutaneous Injury Reporting?
Authors: Sohn SeJean , Eagan Janet , Sepkowitz Kent A.
Published: April 2006

Objective:

To examine whether implementation of safety-engineered devices in 2001 had an effect on rates of percutaneous injury (PI) reported by HCWs.

Design:

Before-and-after intervention trial comparing 3-year preintervention (1998–2001) and 2-year postintervention (2001–2002) periods. PI data from anonymous, self-administered surveys were prospectively entered into CDC NaSH software.

Setting:

A 427-bed, tertiary-care hospital in Manhattan.

Participants:

HCWs who attended state-mandated training sessions and completed the survey (1,132 preintervention; 821 postintervention).

Intervention:

Implementation of a “safer-needle system” composed of various safety-engineered devices for needle-safe TV delivery-insertion, blood collection, and intramuscular-subcutaneous injection.

Results:

Preintervention, the overall annual rate of PIs self-reported on the survey was 36.5 per 100 respondents, compared with 13.9 per 100 respondents postintervention (P < .01). The annual rate of formally reported PIs decreased from 8.3 to 3.1 per 100 respondents (P < .01). Report rates varied by occupational group (P ≤ .02). The overall rate did not change between study periods (22.7% to 22.3%), although reporting improved among nurses (23.6% to 44.4%, P = .03) and worsened among building services staff (90.5% to 50%, P = .03). HCWs with greater numbers of Pis self-reported on the survey were less likely to formally report injuries (P < .01). The two most common reasons for nonreport (ie, thought injury was low risk or believed patient was low risk for blood-borne disease) did not vary from preintervention to postintervention.

Conclusions:

Safety-engineered device implementation decreased rates of Pis formally reported and self-reported on the survey. However, this intervention, with concomitant intensive education, had varying effects on reporting behavior by occupation and a minimal effect on overall reporting rates.
Evaluating Infection Control Practices Among Dentists in Vâlcea, Romania, in 1998
Authors: Duffy Rosemary E. , Cleveland Jennifer L. , Hutin Yvan J. , Cardo Denise
Published: April 2006

Objectives:

To evaluate infection control knowledge and practices, provide training on universal-standard precautions (USP), and improve infection control knowledge and practices among dentists.

Setting:

Private and public dental offices in Vâlcea, Romania.

Methods:

Information about the use of hepatitis B vaccine, knowledge of and training in USP, perceived risks of disease transmission, and infection control practices was gathered from a sample of dentists through interviews, direct observations, and a survey administered during a training session.

Results:

Interviews among dentists and direct observations of infection control practices revealed that resources were often scarce in public clinics; however, availability of supplies in private or public clinics often did not correlate with adherence to proper infection control. Of 125 registered dentists, 46 (37%) attended the session and completed the survey. Of these, 75% worked in public clinics, 40% in private practices, and a few in both. More than 50% believed that the prevalence of hepatitis B virus (HBV) was low in their patients compared with the Romanian population. Only 26% of dentists had received hepatitis B vaccine. Dentists reported a mean of six percutaneous injuries a year. Most (89%) reported that gloves were effective in preventing HBV transmission; 24% wore them for every patient. Most used dry heat sterilization; however, chemical disinfectants were also used.

Conclusions:

Resources were limited, receipt of hepatitis vaccine was low, and infection control knowledge and practices varied. Training and education are needed regarding the importance of USP, hepatitis B vaccination, and alternative practices when resources are insufficient.
Risk to Cancer Patients From Nosocomial Hepatitis C Virus
Authors: Sepkowitz Kent A.
Published: April 2006

Nosocomial transmission of hepatitis C virus (HCV) among dialysis patients is a well-described phenomenon. In addition, spread of HCV in outpatient medical clinic settings has recently been reported. In the past decade, nosocomial spread of hepatitis C among hospitalized patients being treated for cancer has increasingly been reported. The cause or source of transmission is unknown. Infection control practitioners should be aware of this potential risk to oncology patients.
Transmission of Hepatitis C Virus Between Hemodialysis Patients Sharing the Same Machine
Authors: Sartor Catherine , Brunet Philippe , Simon Sophie , Tamalet Catherine , Berland Yvon , Drancourt Michel
Published: April 2006

After a patient acquired hepatitis C virus (HCV) infection in our unit, we performed epidemiologic and virologic investigations, including genotyping and phylogenetic analyses. The results provided evidence for HCV transmission between two patients sharing the same machine and suggested possible transmission via accidental contamination of the venous pressure monitoring system.
Smallpox Vaccine: “Non-Take” Responses in Previously Vaccinated Adults
Authors: Thomas Georgia , Frenzel Elizabeth , Hanna Hend
Published: April 2006

This small, retrospective study of laboratory workers who received smallpox vaccine showed a strong correlation between “non-take” reactions and the presence of prior vaccination scars. Although we cannot exclude technique and vaccine potency as causes, the association we observed may indicate that these workers are displaying residual immunity to smallpox.
Has the Epidemiology of Nosocomial Candidemia Changed?
Authors: Puzniak Laura , Teutsch Steven , Powderly William , Polish Louis
Published: April 2006

Objective:

To assess changes in the epidemiology of nosocomial candidemia in the post-fluconazole era among hospitalized patients using a case–control study design.

Design:

Candidemia case-patients were matched 1:1 on diagnosis, age, and length of stay with control-patients. Conditional logistic regression was used to determine predictors and outcomes of candidemia. Treatment regimens and compliance with national practice guidelines were compared among case-patients.

Setting:

Barnes-Jewish Hospital, a 1,278-bed, tertiary-care center affiliated with Washington University School of Medicine, St. Louis, Missouri.

Participants:

Patients admitted from January 1 to December 31, 2000. Case-patients were identified through the hospital microbiological surveillance system and matched with control-patients.

Results:

Predictors of candidemia included Hickman catheters (odds ratio [OR], 9.53; 95% confidence interval [CI95], 1.34 to 68.01), gastric acid suppressants (OR, 6.38; CI95, 2.33 to 17.43), nasogastric tubes (OR, 3.69; CI95, 1.27 to 10.78), antibiotics (OR, 1.46; CI95,1.15 to 1.86), and admission to the intensive care unit (OR, 6.40; CI95, 2.12 to 19.31). The crude case-fatality rate was 40%. Seventeen (15%) of the case-patients received the recommended treatment regimen according to recently published practice guidelines.

Conclusions:

The epidemiology of candidemia has changed little at our hospital during the past decade and remains a significant cause of mortality. Further studies on the benefits of preventive therapy will be essential to improve the outcome of this infection.
Genetic Relatedness Among Candida tropicalis Isolates From Sporadic Cases of Fungemia in Two University Hospitals in Korea
Authors: Shin Jong Hee , Kim Mi-Na , Shin Dong Hyeon , Jung Sook-In , Kim Kwang Jin , Cho Duck , Kee Seung Jung , Shin Myung Geun , Suh Soon Pal , Ryang Dong Wook
Published: April 2006

Objective:

To compare the epidemiology and genetic relatedness of Candida tropicalis isolates causing bloodstream infection (BSI) in two hospitals.

Setting:

Two tertiary-care hospitals in Korea.

Methods:

A retrospective molecular epidemiologic analysis using pulsed-field gel electrophoresis (PFGE) was performed with 49 C. tropicalis isolates from sporadic cases of BSI. The isolates were collected from 27 patients at Chonnam National University Hospital (CUH) during a 6-year period and 22 patients at Asan Medical Center (AMC) during a 2-year period.

Results:

Based on the PFGE patterns, the average similarity value (SAB) for the 27 isolates from CUH was 0.84 ± 0.08, which was significantly higher than that for the 22 isolates from AMC (0.78 ± 0.06; P < .001). Of the 49 strains from patients at the 2 hospitals, 9 isolates were placed into 3 subtypes with SAB values of 1.0, which indicated that they were identical. All 9 of these strains were isolated from CUH patients, and each type strain was isolated sporadically during a period ranging from 4 months to 3 years. On comparison of the clinical characteristics of the patients of the 2 hospitals, the CUH strains were isolated more frequently from non-neutropenic patients and patients with central venous catheter–related fungemia; cases from CUH had a better outcome than those from AMC (P < .05).

Conclusions:

These data show that the clinical and epidemiologic characteristics of C. tropicalis fungemia may differ markedly among hospitals and that some cases of C. tropicalis fungemia may be caused by endemic strains within a hospital.
Routine Changing of Intravenous Administration Sets Does Not Reduce Colonization or Infection in Central Venous Catheters
Authors: Rickard Claire M. , Lipman Jeff , Courtney Mary , Siversen Rosemary , Daley Peter
Published: April 2006

Objective:

To determine the effect of routine intravenous (IV) administration set changes on central venous catheter (CVC) colonization and catheter-related bacteremia.

Design:

Prospective, randomized, controlled trial.

Setting:

Eighteen-bed intensive care unit (ICU) in a large metropolitan hospital.

Participants:

Two hundred fifty-one patients with 404 chlorhexidine gluconate and silver sulfadiazine–coated multilumen CVCs.

Interventions:

CVCs inserted in the ICU and in situ on day 4 were randomized to have their IV administration sets changed on day 4 (n = 203) or not at all (n = 201). Use of fluid containers and blood product administration sets was limited to 24 hours. CVCs were removed when not required, infection was suspected, or in place on day 7. Catheter cultures were performed on removal by blinded laboratory staff. Catheter-related bacteremia was diagnosed by a blinded intensivist using strict definitions. Data were collected regarding catheter duration, site, Acute Physiology and Chronic Health Evaluation (APACHE) II score, patient age, diagnosis, hyperglycemia, hypoalbuminemia, immune status, number of fluid containers and IV injections, and administration of propofol, blood, total parenteral nutrition, or lipid infusion.

Results:

There were 10 colonized CVCs in the group receiving a set change and 19 in the group not receiving one. This difference was not statistically significant on Kaplan–Meier survival analysis. There were 3 cases of catheter-related bacteremia per group. Logistic regression found that burns diagnosis and increased ICU stay significantly predicted colonization.

Conclusion:

IV administration sets can be used for 7 days in patients with short-term, antiseptic-coated CVCs.
Povidone-Iodine Ointment and Gauze Dressings Associated With Reduced Catheter-Related Infection in Seriously Ill Neurosurgical Patients
Authors: Fukunaga Atsushi , Naritaka Heiji , Fukaya Raita , Tabuse Masanao , Nakamura Tsuneo
Published: April 2006

Abstbact

Povidone-iodine ointment and gauze covered by transparent dressings were compared with transparent dressings alone in historical controls (both changed twice weekly) in neurosurgical patients needing catheter placement for prolonged periods. Colonization and bloodstream infection were both reduced with the new method (P<.01 and P= .062, respectively).
Antimicrobial Use and the Influence of Inadequate Empiric Antimicrobial Therapy on the Outcomes of Nosocomial Bloodstream Infections in a Neonatal Intensive Care Unit
Authors: Apisarnthanarak Anucha , Holzmann-Pazgal Galit , Hamvas Aaron , Olsen Margaret A. , Fraser Victoria J.
Published: April 2006

Objective:

To evaluate antimicrobial use and the influence of inadequate empiric antimicrobial therapy on the outcomes of nosocomial bloodstream infections (BSIs).

Design:

Prospective cohort study with nested case-control analysis.

Setting:

Neonatal intensive care unit (NICU).

Methods:

All patients weighing 2,000 g or less were enrolled. Data collection included risk factors for nosocomial BSI, admission severity of illness, microbiology, antimicrobial therapy, and outcomes. Inadequate empiric antimicrobial therapy was defined as the use of antibiotics for more than 48 hours after the day that blood cultures were performed that did not cover the microorganisms causing the bacteremia or administration of antibiotics that failed to cover resistant microorganisms.

Results:

Two hundred twenty-nine patients were enrolled. Forty-five developed nosocomial BSIs. The BSI rates were 11.2, 2.8, and 0 per 1,000 catheter-days for patients weighing 1,000 g or less, between 1,001 and 1,500 g, and between 1,501 and 2,000 g, respectively. After adjustment for severity of illness, the mortality in patients with nosocomial BSI receiving inadequate empiric antimicrobial therapy was higher than in those receiving adequate therapy (adjusted odds ratio [AOR], 5.3; 95% confidence interval [CI95], 1.2-23.2). By multivariate analysis, nosocomial BSI attributed to Candida species (AOR, 6.3; CI95, 1.4-28.0) and invasive procedure prior to onset of BSI (AOR, 6.4; CI95, 1.0-39.0) were associated with administration of inadequate empiric antimicrobial therapy.

Conclusions:

Administration of inadequate empiric antimicrobial therapy among NICU patients with nosocomial BSI was associated with higher mortality. Additional studies on the role of inadequate empiric antimicrobial therapy and the outcomes of BSIs among NICU patients are needed.
Risk Factors for Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae in a Neonatal Intensive Care Unit
Authors: Linkin Darren R. , Fishman Neil O. , Patel Jean Baldus , Merrill Jeffrey D. , Lautenbach Ebbing
Published: April 2006

Risk factors for colonization or infection with extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae during an outbreak in a neonatal intensive care unit (NICU) included low gestational age and exposure to third-generation cephalosporins. We also reviewed the existing medical literature regarding the clinical epidemiology of ESBLs in NICUs.
Impact of Surveillance Rounds on Adherence to Infection Control Policies and Procedures at a Children's Hospital
Authors: Chatterjee Archana , Heybrock Brenda , Plummer Sharon , Eischen Kay
Published: April 2006

Adherence to written infection control policies and procedures was studied and on-site education was provided for 1 year at a children's hospital. There was significant improvement in sharp objects disposal, hazardous waste handling, availability of personal protective equipment, isolation precautions, and staff knowledge regarding location of the exposure control plan.
Nosocomial Infection and Multidrug-Resistant Bacteria Surveillance in Intensive Care Units: A Survey in France
Authors: L'Hériteau François , Alberti Corinne , Cohen Yves , Troché Gilles , Moine Pierre , Timsit Jean-François
Published: April 2006

Objectives:

To evaluate nosocomial infection (NI) surveillance strategies in French ICUs and to identify similar patterns defining subsets within which comparisons can be made.

Design:

A questionnaire was sent to all French ICUs, and a random sample of nonresponders was interviewed.

Participants:

Three hundred ninety-five responder ICUs (69%) in France.

Results:

In 282 ICUs (71%), a dedicated ICU staff member was responsible for infection control activities. The microbiology laboratory was usually in the hospital (90%) and computerized (94%) but issued regular hospital microbiology records in only 48% of cases. Patients receiving mechanical ventilation, central venous catheterization, and urinary catheterization were 90%, 79%, and 60%, respectively. Patients were screened for carriage of mul-tidrug-resistant bacteria on admission and during the stay in 70% and 60% of ICUs, respectively, most often targeting MRSA. Quantitative cultures were used to diagnose ventilator-associated pneumonia (VAP) in 90% of ICUs, including distal specimens in 80% and bronchoscopy specimens in 60%. Quantitative central venous catheter (CVC)-segment cultures were used in 70% of ICUs. All CVCs were cultured routinely in 53% of the ICUs. Despite wide variations in infection control and surveillance strategies, multiple correspondence analysis identified 13 key points (4 structural variables and 9 variables concerning the diagnosis of VAP, the surveillance and diagnosis of catheter-related and urinary tract infections, and the mode of screening of MRSA carriers) that categorize the variability of French ICUs' approaches to NIs.

Conclusion:

This study revealed profound differences in N1 surveillance strategies across ICUs, indicating a need for caution when using N1 surveillance data for comparisons and benchmarking.
Implementation of Strategies to Prevent and Control the Emergence and Spread of Antimicrobial-Resistant Microorganisms in U.S. Hospitals
Authors: Ward Marcia M. , Diekema Daniel J. , Yankey Jon W. , Vaughn Thomas E. , BootsMiller Bonnie J. , Pendergast Jane F. , Doebbeling Bradley N.
Published: April 2006

Objective:

To examine the extent to which the strategies recommended by the National Foundation for Infectious Diseases (NFID)-Centers for Disease Control and Prevention (CDC) co-sponsored workshop, Antimicrobial Resistance in Hospitals: Strategies to Improve Antimicrobial Use and Prevent Nosocomial Transmission of Antimicrobial-Resistant Microorganisms, have been implemented and the relationship between the degree of implementation and hospital culture, leadership, and organizational factors.

Design:

Survey.

Setting:

A representative sample of U.S. hospitals stratified by teaching status, bed size, and geographic region.

Participants:

Infection control professionals.

Results:

Surveyed hospitals had implemented strategies to optimize the use of antimicrobials and to detect, report, and prevent transmission of antimicrobial-resistant microorganisms. Multivariate analyses found that hospitals with a greater degree of implementation of the NFID–CDC strategic goals were more likely to have management support, education of staff, and interdisciplinary groups specifically to address these issues; they were also more likely to engage in benchmarking on broader quality of care indicators.

Conclusions:

Most surveyed hospitals had implemented some measures to address the NFID–CDC recommendations; however, hospitals need to do much more to improve antimicrobial use and to increase their efforts to detect, report, and control the spread of antimicrobial resistance. A supportive hospital administration must foster a culture of ongoing support, education, and interdisciplinary work groups focused on this important issue to successfully accomplish these goals.
Concurrent Outbreak of Multidrug-Resistant and Susceptible Subclones of Acinetobacter baumannii Affecting Different Wards of a Single Hospital
Authors: Maslow Joel N. , Glaze Thomas , Adams Pamela , Lataillade Max
Published: April 2006

Background and Objective:

Acinetobacter baumannii has emerged as an opportunistic pathogen among acutely ill patients, especially those with thermal injury. A prospective 8-month study was conducted to describe the clinical and molecular epidemiology of multidrug-resistant A. baumannii affecting a single hospital.

Methods:

Univariate analysis comparing Smal macrorestriction patterns of A. baumannii generated by pulsed-field gel electrophoresis (PFGE) versus clinical and demographic risk factors.

Results:

A total of 200 isolates from 76 patients were collected, of which 185 isolates from 76 patients were analyzed by PFGE. A total of 17 distinct PFGE clonal types were identified. One clonal type (strain A) represented 129 isolates from 49 patients. A group of related clonal types (strain A variants) were identified as 40 isolates from 20 patients. The only risk factor other than geographic location associated with the presence of strain A was prior treatment with antibiotics active against gram-negative bacteria (P = .0015). The two clonal types differed in antibiotic resistance profiles: 25% of strain A isolates, the dominant strain in the burn unit, were susceptible to at least one antibiotic tested. In contrast, approximately 80% of the other strain types were susceptible to at least one antibiotic and were cultured from patients admitted elsewhere in the hospital. No combination of antibiotics was observed to yield additive or synergistic activity.

Conclusion:

Clonally related strains of Acinetobacter that differ in susceptibility patterns may coexist within a single hospital, dependent on the selective pressure related to antibiotic exposure.
Prevalence of Nosocomial Infection and Antibiotic Use at a University Medical Center in Malaysia
Authors: Hughes Andrew J. , Ariffin Norliza , Huat Tan Lien , Molok Habibah Abdul , Hashim Salbiah , Sarijo Juliana , Latif Nor Harlida Abd , Hanifah Yasmin Abu , Kamarulzaman Adeeba
Published: April 2006

Background and Objective:

Most reports of nosocomial infection (NI) prevalence have come from developed countries with established infection control programs. In developing countries, infection control is often not as well established due to lack of staff and resources. We exMnined the rate of N1 in our institution.

Methods:

A point-prevalence study of N1 and antibiotic prescribing was conducted. On July 16 and 17, 2001, all inpatients were surveyed for N1, risk factors, pathogens isolated, and antibiotics prescribed and their indication. NIs were diagnosed according to CDC criteria. Cost of antibiotic acquisition was calculated by treatment indication.

Setting:

Tertiary-care referral center in Malaysia.

Patients:

All inpatients during the time of the study.

Results:

Five hundred thirty-eight patients were surveyed. Seventy-five had 103 NIs for a prevalence of 13.9%. The most common NIs were urinary tract infections (12.29-6), pneumonia (21.4%), laboratory-confirmed bloodstream infections (12.2%), deep surgical wound infections (11.2%), and clinical sepsis (22.4%).Pseudomonas aeruginosa, MRSA, and MSSA were the most common pathogens. Two hundred thirty-seven patients were taking 347 courses of antibiotics, for an overall prevalence of antibiotic use of 44%. N1 treatment accounted for 36% of antibiotic courses prescribed but 47% of antibiotic cost. Cost of antibiotic acquisition for N1 treatment was estimated to be approximately 2 million per year (Malaysian dollars).

Conclusion:

Whereas the rate of N1 is relatively high at our center compared with rates from previous reports, antibiotic use is among the highest reported in any study of this kind. Further research into this high rate of antibiotic use is urgently required.
Trends in Methicillin-ResistantStaphylococcus aureus(MRSA) Bloodstream Infections: Effect of the MRSA “Search and Isolate” Strategy in a Hospital in Italy with Hyperendemic MRSA
Authors: Pan Angelo , Carnevale Giuseppe , Catenazzi Patrizia , Colombini Paolo , Crema Luciano , Dolcetti Lucia , Ferrari Lucio , Mondello Placido , Signorini Liana , Tinelli Carmine , Roldan Eugenia Quiros , Carosi Giampiero
Published: April 2006

Objective:

To evaluate the secular trends in MRSA BSIs after the introduction of a nosocomial MRSA control intervention.

Design:

Before-after study.

Setting:

An 850-bed community hospital with an ICU and vascular surgery, neurosurgery, bone marrow transplantation, and AIDS units. MRSA is endemic at this hospital; the prevalence of methicillin resistance among patients withS. aureusinfection is greater than 50%.

Patients:

Among all inpatients, MRSA BSI was identified, its origin defined, and incidence rates calculated by ward and origin.

Intervention:

A MRSA control program was implemented based on active surveillance cultures to identify MRSA-colonized patients, followed by isolation using contact precautions. Incidence rates of MRSA BSI during the intervention (ie, July 1, 1997, to December 31, 2001) and preintervention (ie, January 1, 1996, to June 30, 1997) periods were compared.

Results:

Sixty-nine MRSA BSIs were identified. When compared with the preintervention period, the incidence rate of MRSA BSI was reduced from 0.64 to 0.30 per 1,000 admissions (RR, 0.46; CI95, 0.25–0.87;P= .02) during the intervention period. The impact was greater in the ICU, with an 89% reduction (RR, 0.11; CI95, 0.01–0.98;P= .03), and for CVC-associated MRSA BSIs, with an 82% decrease (RR, 0.17; CI95, 0.05–0.55;P= .002). Methicillin resistance amongS. aureusblood isolates decreased from 46% to 17% (RR, 0.36; CI95, 0.22–0.62;P= .0002).

Conclusion:

A reduction in MRSA bacteremia is achievable through use of the MRSA “search and isolate” intervention even in a hospital with high rates of endemic MRSA.