bluuebunny/crossref_metadata_2025 huggingface dataset:
A novel GTPase, CRAG, mediates promyelocytic leukemia protein–associated nuclear body formation and degradation of expanded polyglutamine protein
Authors: Qin Qingyu , Inatome Ryoko , Hotta Azusa , Kojima Masaki , Yamamura Hirohei , Hirai Hirokazu , Yoshizawa Toshihiro , Tanaka Hirofumi , Fukami Kiyoko , Yanagi Shigeru
Published: February 2006

Polyglutamine diseases are inherited neurodegenerative diseases caused by the expanded polyglutamine proteins (polyQs). We have identified a novel guanosine triphosphatase (GTPase) named CRAG that contains a nuclear localization signal (NLS) sequence and forms nuclear inclusions in response to stress. After ultraviolet irradiation, CRAG interacted with and induced an enlarged ring-like structure of promyelocytic leukemia protein (PML) body in a GTPase-dependent manner. Reactive oxygen species (ROS) generated by polyQ accumulation triggered the association of CRAG with polyQ and the nuclear translocation of the CRAG–polyQ complex. Furthermore, CRAG promoted the degradation of polyQ at PML/CRAG bodies through the ubiquitin–proteasome pathway. CRAG knockdown by small interfering RNA in neuronal cells consistently blocked the nuclear translocation of polyQ and enhanced polyQ-mediated cell death. We propose that CRAG is a modulator of PML function and dynamics in ROS signaling and is protectively involved in the pathogenesis of polyglutamine diseases.
pXBP1(U) encoded in XBP1 pre-mRNA negatively regulates unfolded protein response activator pXBP1(S) in mammalian ER stress response
Authors: Yoshida Hiderou , Oku Masaya , Suzuki Mie , Mori Kazutoshi
Published: February 2006

Upon the accumulation of unfolded proteins in the mammalian endoplasmic reticulum (ER), X-box binding protein 1 (XBP1) premessenger RNA (premRNA) is converted to mature mRNA by unconventional splicing that is mediated by the endonuclease inositol-requiring enzyme 1. The transcription factor protein (p) XBP1 spliced (S), which is translated from mature XBP1 mRNA, contains the nuclear localization signal and the transcriptional activation domain and activates the transcription of target genes, including those encoding ER chaperones in the nucleus. We show that pXBP1 unspliced (U) encoded in XBP1 pre-mRNA was constitutively expressed and markedly accumulated at the recovery phase of ER stress. pXBP1(U) contained the nuclear exclusion signal instead of the transcriptional activation domain and shuttled between the nucleus and the cytoplasm. Interestingly, pXBP1(U) formed a complex with pXBP1(S), and the pXBP1(U)–pXBP1(S) complex was sequestered from the nucleus. Moreover, the complex was rapidly degraded by proteasomes because of the degradation motif contained in pXBP1(U). Thus, pXBP1(U) is a negative feedback regulator of pXBP1(S), which shuts off the transcription of target genes during the recovery phase of ER stress.
Yellow fever vaccine YF-17D activates multiple dendritic cell subsets via TLR2, 7, 8, and 9 to stimulate polyvalent immunity
Authors: Querec Troy , Bennouna Soumaya , Alkan Sefik , Laouar Yasmina , Gorden Keith , Flavell Richard , Akira Shizuo , Ahmed Rafi , Pulendran Bali
Published: February 2006

The live attenuated yellow fever vaccine 17D (YF-17D) is one of the most effective vaccines available, with a 65-yr history of use in >400 million people globally. Despite this efficacy, there is presently no information about the immunological mechanisms by which YF-17D acts. Here, we present data that suggest that YF-17D activates multiple Toll-like receptors (TLRs) on dendritic cells (DCs) to elicit a broad spectrum of innate and adaptive immune responses. Specifically, YF-17D activates multiple DC subsets via TLRs 2, 7, 8, and 9 to elicit the proinflammatory cytokines interleukin (IL)-12p40, IL-6, and interferon-α. Interestingly, the resulting adaptive immune responses are characterized by a mixed T helper cell (Th)1/Th2 cytokine profile and antigen-specific CD8+ T cells. Furthermore, distinct TLRs appear to differentially control the Th1/Th2 balance; thus, whilst MyD88-deficient mice show a profound impairment of Th1 cytokines, TLR2-deficient mice show greatly enhanced Th1 and Tc1 responses to YF-17D. Together, these data enhance our understanding of the molecular mechanism of action of YF-17D, and highlight the potential of vaccination strategies that use combinations of different TLR ligands to stimulate polyvalent immune responses.
Refinements of Environmental Assessment During an Outbreak Investigation of Invasive Aspergillosis in a Leukemia and Bone Marrow Transplant Unit
Authors: Thio Chloe L. , Smith Dottie , Merz William G. , Streifel Andrew J. , Bova Greg , Gay Lora , Miller Carole B. , Perl Trish M.
Published: February 2006

Objectives:

To investigate an outbreak of aspergillosis in a leukemia and bone marrow transplant (BMT) unit and to improve environmental assessment strategies to detectAspergillus.

Design:

Epidemiological investigation and detailed environmental assessment.

Setting:

A tertiary-care university hospital with a 37-bed leukemia and BMT unit.

Participants:

Leukemic or BMT patients with invasive aspergillosis identified through prospective surveillance and confirmed by chart review.

Interventions:

We verified the diagnosis of invasive fungal infection by reviewing medical charts of at-risk patients, performing a case-control study to determine risk factors for infection, instituting wet mopping to clean all floors, providing N95 masks to protect patients outside high-efficiency particulate air (HEPA)-filtered areas, altering traffic patterns into the unit, and performing molecular typing of selectedAspergillus flavusisolates. To assess the environment, we verified pressure relationships between the rooms and hallway and between buildings, and we compared the ability of large-volume (1,200 L) and small-volume (160 L) air samplers to detectAspergillusspores.

Results:

Of 29 potential invasive aspergillosis cases, 21 were confirmed by medical chart review. Risk factors for developing invasive aspergillosis included the length of time since malignancy was diagnosed (odds ratio [OR], 1.0;P=.05) and hospitalization in a patient room located near a stairwell door (OR, 3.7;P=.05). Two of fiveA flavuspatient isolates were identical to one of the environmental isolates. The pressure in most of the rooms was higher than in the corridors, but the pressure in the oncology unit was negative with respect to the physically adjacent hospital; consequently, the unit acted essentially as a vacuum that siphoned non-HEPA-filtered air from the main hospital. Of the 78 samples obtained with a small-volume air sampler, none grew anAspergillusspecies, whereas 10 of 40 cultures obtained with a large-volume air sampler did.

Conclusions:

During active construction,Aspergillusspores may have entered the oncology unit from the physically adjacent hospital because the air pressure differed. Guidelines that establish the minimum acceptable pressures and specify which pressure relationships to test in healthcare settings are needed. Our data show that large-volume air samples are superior to small-volume samples to assess forAspergillusin the healthcare environment.
Antimicrobial Activity of Home Disinfectants and Natural Products Against Potential Human Pathogens
Authors: Rutala William A. , Barbee Susan L. , Aguiar Newman C. , Sobsey Mark D. , Weber David J.
Published: February 2006

Objective:

To assess the efficacy of both natural products (vinegar, baking soda) and common commercial disinfectants (Vesphene Ilse, TBQ, Clorox, Lysol Disinfectant Spray, Lysol Antibacterial Kitchen Cleaner, Mr. Clean Ultra, ethanol) designed for home or institutional use against potential human pathogens, including selected antibiotic-resistant bacteria.

Design:

A quantitative suspension test was used to assess the efficacy of selected disinfectants following exposure times of 30 seconds and 5 minutes. Activity was assessed againstStaphylococcus aureus, Salmonella choleraesuis, Escherichia coli0157:H7, andPseudomonas aeruginosa. Selected disinfectants were also tested against poliovirus, vancomycin-susceptible and -resistantEnterococcusspecies, and methicillin-susceptible and -resistantS aureus.

Results:

The following compounds demonstrated excellent antimicrobial activity (>5.6-8.2 log10reduction) at both exposure times: TBQ, Vesphene, Clorox, ethanol, and Lysol Antibacterial Kitchen Cleaner. Mr. Clean eliminated 4 to >6 logs10and Lysol Disinfectant ~4 logs10of pathogenic microorganisms at both exposure times. Vinegar eliminated <3 logs10ofS aureusandE coli, and baking soda <3 logs10of all test pathogens. All tested chemical disinfectants completely inactivated both antibiotic-resistant and -susceptible bacteria at both exposure times. Only two disinfectants, Clorox and Lysol, demonstrated excellent activity (>3 log10reduction) against poliovirus.

Conclusions:

A variety of commercial household disinfectants were highly effective against potential bacterial pathogens. The natural products were less effective than commercial household disinfectants. Only Clorox and Lysol disinfectant were effective against poliovirus
Microbiological Evaluation of Central Venous Catheter Administration Hubs
Authors: Lucet Jean-Christophe , Hayon Jan , Bruneel Fabrice , Dumoulin Jean-Louis , Joly-Guillou Marie-Laure
Published: February 2006

We compared, in three intensive care units, colonization of hubs with hub protection boxes or hubs with needleless closed connectors; 137 central venous catheters and 451 hubs were randomized in two groups with similar characteristics. Catheter and hub colonization were not different between the two groups. Among 30 colonized catheters, the same isolate was found in only two hubs; hub contamination rarely is responsible for catheter colonization in short-term catheters. Further studies are required to evaluate the benefit of protected hubs compared with unprotected hubs.
The Threat of Biological Terrorism: A Public Health and Infection Control Reality
Authors: Leggiadro Robert J.
Published: February 2006

Bioterrorism is an emerging public health and infection control threat. Potential biological agents include smallpox, anthrax, plague, tularemia, botulinum toxin, brucellosis, Q fever, viral encephalitis, hemorrhagic fever, and staphylococcal enterotoxin B. An understanding of the epidemiology, clinical manifestations, and management of the more likely candidate agents is critical to limiting morbidity and mortality from a biological event. Effective response requires an increased index of suspicion for unusual diseases or syndromes, with prompt reporting to health authorities to facilitate recognition of an outbreak and subsequent intervention. Hospital epidemiology programs will play a crucial role in this effort.
Excessive Use of Vancomycin: A Successful Intervention Strategy at an Academic Medical Center
Authors: Hamilton Carol Dukes , Drew Richard , Janning Stephen W. , Latour Joanne Kure , Hayward Shelly
Published: February 2006

The project goal was to decrease excessive vancomycin use. Interventions included an educational chart note the first day of therapy, followed by pharmacists discussing the need for continued therapy with patients' physicians. Empirical vancomycin use improved from 20% to 90% compliance with guidelines within 6 months of the intervention
Outbreak of Nosocomial Multidrug-ResistantEnterobacter aerogenesin a Geriatric Unit: Failure of Isolation Contact, Analysis of Risk Factors, and Use of Pulsed-Field Gel Electrophoresis
Authors: Piagnerelli Michaël , Kennes Bernard , Brogniez Yvette , Deplano Ariane , Govaerts Danielle
Published: February 2006

We describe herein an outbreak ofEnterobacter aerogenesin a geriatric acute unit with failure of contact isolation that necessitated the temporary closure of the department. We emphasize the need for guidelines for the management of multiresistant bacteria.
Applicability of Two Surgical-Site Infection Risk Indices to Risk of Sepsis in Surgical Patients
Authors: Fariñas-Álvarez Concepción , Fariñas M. Carmen , Prieto Dolores , Delgado-Rodríguez Miguel
Published: February 2006

Objective:

To compare the ability of the Study of the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infection Surveillance (NNIS) indices to predict the development of nosocomial sepsis in subjects undergoing surgery.

Design:

1-year prospective case-control study.

Setting:

A tertiary-care center in Spain.

Patients:

Cases were surgical patients with nosocomial sepsis defined using the criteria of the Consensus Conference on Sepsis, identified by daily prospective surveillance.

Methods:

Controls were randomly selected from the daily list of surgical inpatients. Data were prospectively collected. To determine whether either index added explanatory information to the other, two methods were used. The first method involved computing a set of residuals for both variables. Residuals and primary variables were introduced in logistic regression models. The second method evaluated both indices with the Goodman-Kruskal (G) nonparametric coefficient.

Results:

99 cases and 97 controls were included. After controlling for confounders, both the SENIC index (P<.001) and the NNIS index (P=.04) showed a significant trend. Residuals of the SENIC index added discriminating ability to the NNIS index, whereas residuals of the NNIS index did not improve the prediction ability of the SENIC index. Similar results were yielded by the G statistic: the SENIC index showed higher predictive power than the NNIS index (G=0.56 vs G=0.41).

Conclusions:

Both indices performed about equally well for discriminating risk of nosocomial sepsis. The SENIC index had a somewhat better ability than the NNIS index only when the number of discharge diagnoses (not truly a predictive factor) were involved in the calculation of the SENIC index.
Clinical Infection Control in Gene Therapy: A Multidisciplinary Conference
Authors: Evans Martin E. , Jordan Craig T. , Chang Stephen M.W. , Conrad Carol , Gerberding Julie L. , Kaufman Howard L. , Mayhall C. Glen , Nolta Jan A. , Pilaro Anne M. , Sullivan Sean , Weber David J. , Wivel Nelson A.
Published: February 2006

Gene therapy is being studied for the treatment of a variety of acquired and inherited disorders. Retroviruses, adeno-viruses, poxviruses, adeno-associated viruses, herpesviruses, and others are being engineered to transfer genes into humans. Treatment protocols using recombinant viruses are being introduced into clinical settings. Infection control professionals will be involved in reviewing the safety of these agents in their clinics and hospitals. To date, only a limited number of articles have been written on infection control in gene therapy, and no widely available recommendations exist from federal or private organizations to guide infection control professionals. The goals of the conference were to provide a forum where gene therapy experts could share their perspectives and experience with infection control in gene therapy and to provide an opportunity for newcomers to the field to learn about issues specific to infection control in gene therapy. Recommendations for infection control in gene therapy were proposed.
Antibiotic Use in Long-Term–Care Facilities: Many Unanswered Questions
Authors: Loeb Mark
Published: February 2006

The extensive use of antibiotics in long-term–care facilities has led to increasing concern about the potential for the development of antibiotic resistance. Relatively little is known, however, about the quantitative relation between antibiotic use and resistance in this population. A better understanding of the underlying factors that account for variance in antibiotic use, unexplained by detected infections, is needed. To optimize antibiotic use, evidence-based standards for empirical antibiotic prescribing need to be developed. Limitations in current diagnostic testing for infection in residents of long-term–care facilities pose a substantial challenge to developing such standards.
Reintroduction of Influenza A to a Nursing Building
Authors: Drinka Paul J. , Gravenstein Stefan , Krause Peggy , Nest Lori , Dissing Margaret , Shult Peter
Published: February 2006

We report an outbreak of influenza A from a four-building veterans' facility in King, Wisconsin. Influenza was isolated in 154 of 721 residents over a 121-day period. Building A had 2 cases, no isolates for 40 days, followed by 27 cases. Building B had 25 cases, no isolates for 75 days, followed by 4 cases. Building C had 23 cases, no isolates for 14 days, followed by 17 cases. Influenza A may be reintroduced to a nursing building. Surveillance with contingency plans for restarting of prophylaxis must continue for the duration of influenza in the community.
Outbreak of NosocomialBurkholderia cepaciaInfection and Colonization Associated With Intrinsically Contaminated Mouthwash
Authors: Matrician Linda , Ange Gretehen , Burns Sonia , Fanning W. Lee , Kioski Clare , Cage Gary D. , Komatsu Kenneth K.
Published: February 2006

From August 1996 through June 1998, 69 ventilated, intensive care unit patients at two Arizona hospitals had nosocomial respiratory tract cultures positive forBurkholderia cepacia.Intrinsically contaminated alcohol-free mouthwash was identified by pulsed-field gel electrophoresis as the source of the outbreak
Should We Routinely Use Mupirocin to Prevent Staphylococcal Infections?
Authors: Roth Virginia R. , Murphy Cathryn , Perl Trish M. , DeMaria Alfred , Sohn Annette H. , Sinkowitz-Cochran Ronda L. , Jarvis William R.
Published: February 2006

Routine use of mupirocin to prevent staphylococcal infections is controversial. We assessed attitudes and practices of healthcare professionals attending the Fourth Decennial International Conference on Nosocomial and Healthcare-Associated Infections regarding mupirocin prophylaxis. Eighty percent of participants did not use mupirocin routinely. At the end of the session, 58% indicated they would consider increased use of mupirocin.
Influenza Vaccination Status of Healthcare Workers and the Extent of their Domestic Contact With Individuals at High Risk for Influenza-Related Complications
Authors: Ong Adrian K.Y. , Srimanunthiphol Jun , Frankel Richard I.
Published: February 2006

Many healthcare workers have frequent household contact with persons at high risk for influenza-related complications. Educating healthcare workers about the risk of domestic transmission of influenza may improve their acceptance of influenza vaccination. Concerns regarding vaccine efficacy and safety also need to be addressed.
Increasing Pneumococcal Vaccination Rates Among Residents of Long-Term–Care Facilities: Provider-Based Improvement Strategies Implemented by Peer-Review Organizations in Four Western States
Authors: Stevenson Kurt B. , McMahon John W. , Harris Jan , Hillman J. Richard , Helgerson Steven D.
Published: February 2006

Objective:

To evaluate collaborative efforts and intervention strategies by peer-review organizations (PROs) and long-term-care facilities (LTCFs) for improving pneumococcal vaccination rates among residents of LTCFs.

Design:

Prospective, before-after quality improvement project.

Setting:

133 LTCFs in Alaska, Idaho, Montana, and Wyoming.

Patients:

All residents of participating LTCFs.

Methods:

Baseline pneumococcal vaccination rates were determined by medical-record review, self-reporting by patient or family members, and review of Medicare claims information. Remeasurement of vaccination rates was accomplished from documentation of vaccination of eligible residents by each LTCF.

Results:

133 LTCFs with 7,623 residents from Alaska, Idaho, Montana, and Wyoming participated in this quality-improvement project. This accounted for 41% (133/321) of the potential nursing homes and resident population in the participating states. Baseline overall vaccination rates were 40% (3,050/7,589). The overall vaccination rate improved to 75% (5,720/7,623, P<.001). The number of facilities meeting the Healthy People 2000 vaccination goal of 80% improved from 18% (24/133) to 62% (83/133, P<.001). Initial use of chart stickers and implementation of standing orders led to similar increases in vaccination rates, but the standing-order strategy required commitment of fewer PRO resources at a statewide level. Remeasurement of vaccination rates in a subset of participating Idaho LTCFs 1 year after initial vaccination efforts demonstrated a sustained vaccination rate of 70% in facilities enforcing a standing-order policy.

Conclusions:

Simple and straightforward vaccination strategies implemented in LTCFs over a short period of time can have a significant impact on vaccination rates. Collaborative efforts between state PROs and LTCFs enhance implementation of these strategies and can result in the achievement of national vaccination objectives. Standing orders appear to be one intervention effective in sustaining successful vaccination efforts. Regardless of the specific interventions employed, PROs played a significant role in facilitating vaccination program development and intervention implementation.
Program Overview: The Reality Check Sessions at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections
Authors: Sohn Annette H. , Sinkowitz-Cochran Ronda L. , Jarvis William R.
Published: February 2006

The 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections provided a unique forum to assess opinions regarding current infection control controversies. The “Reality Check” sessions were a special portion of the conference where attendees expressed their opinions on these issues and heard varying viewpoints from noted experts. Using an Audience Response System (ARS), individual audience members cast their votes during seven different sessions. Although systems such as the ARS have been used during other conferences, there are no published accounts to date describing audience viewpoints on infection control topics. An overview of the “Reality Check” sessions follows.
Influenza Vaccination Levels and Influenza-Like Illness in Long-Term-Care Facilities for Elderly People in Niigata, Japan, During an Influenza A (H3N2) Epidemic
Authors: Oshitani Hitoshi , Saito Reiko , Seki Nao , Tanabe Naohito , Yamazaki Osamu , Hayashi Seiji , Suzuki Hiroshi
Published: February 2006

Surveys on influenza vaccination and illness in long-term-care facilities in Niigata Prefecture during an influenza A (H3N2) epidemic revealed that >20% of facilities had outbreaks and >10% of residents experienced influenza. Outbreaks and number of cases were significantly reduced by vaccination, which should be strongly recommended for institutionalized elderly people.
Control of Influenza A on a Bone Marrow Transplant Unit
Authors: Weinstock David M. , Eagan Janet , Malak Sharp Abdel , Rogers Maureen , Wallace Holly , Kiehn Timothy E. , Sepkowitz Kent A.
Published: February 2006

In January 1998, an outbreak of influenza A occurred on our adult bone marrow transplant unit. Aggressive infection control measures were instituted to halt further nosocomial spread. A new, more rigorous approach was implemented for the 1998/99 influenza season and was extremely effective in preventing nosocomial influenza at our institution.
Heat-and-Moisture Exchangers Used With Biweekly Circuit Tubing Changes: Effect on Costs and Pneumonia Rates
Authors: Salemi Charles , Padilla Sally , Canola Teresa , Reynolds David
Published: February 2006

In 1991, heat-and-moisture exchangers were introduced with biweekly ventilator circuit tubing changes, resulting in elimination of multiple pieces of respiratory equipment and reduced labor costs. The annual savings were $157,000, totalling $1.5 million since the onset of the program. There have been no increases in rates of ventilator-associated pneumonia.
An Outbreak of Pyodermas Among Neonates Caused by Ultrasound Gel Contaminated With Methicillin-SusceptibleStaphylococcus Aureus
Authors: Weist Klaus , Wendt Constanze , Petersen Lyle R. , Versmold Hans , Rüden Henning
Published: February 2006

Objective:

To investigate an outbreak of methicillin-susceptibleStaphylococcus aureus(MSSA); infections in a neonatal clinic.

Design:

Prospective chart review, environmental sampling, and genotyping by two independent methods: pulsed-field gel electrophoresis (PFGE) and randomly amplified polymorphic DNA polymerase chain reaction (RAPD-PCR). A case-control study was performed with 31 controls from the same clinic.

Setting:

A German 1,350-bed tertiary-care teaching university hospital.

Results:

There was a significant increase in the incidence of pyodermas with MSSA 10 neonates in good physical condition with no infection immediately after birth developed pyodermas. A shared spatula and ultrasound gel were the only identified infection sources. The gel contained MSSA and was used for hip-joint sonographies in all neonates. PFGE and RAPD-PCR patterns from 6 neonates and from the gel were indistinguishable and thus genetically related clones. The case-control study revealed no significant risk factor with the exception of cesarean section (P=.006). The attack rate by days of hip-joint sonography between April 15 and April 27, 1994, was 11.8% to 40%.

Conclusions:

Inappropriate hygienic measures in connection with lubricants during routine ultrasound scanning may lead to nosocomialS aureusinfections of the skin. To our knowledge this source ofS aureusinfections has not previously been described.
Pyrogenic Reactions Associated With Single Daily Dosing of Intravenous Gentamicin
Authors: Buchholz Udo , Richards Chesley , Murthy Rekha , Arduino Matthew , Pon Doreen , Schwartz Wayne , Fontanilla Elsie , Pegues Clare , Boghossian Noemy , Peterson Carol , Kool Jacob , Mascola Laurene , Jarvis William R.
Published: February 2006

Objective:

To identify risk factors associated with an unexpected outbreak of pyrogenic reactions (PR) following intravenous gentamicin.

Design:

We conducted two cohort studies. PRs were defined as chills, rigors, or shaking within 3 hours after initiating the gentamicin infusion during the preepidemic (December 1, 1997-January 15,1998) or epidemic (May 1-June 15,1998) periods. We tested gentamicin vials for endotoxin using the limulus amebocyte lysate assay.

Setting:

Inpatient services of a large community hospital in Los Angeles, California.

Results:

During the epidemic period, 22 (15%) of 152 patients developed documented PRs following intravenous gentamicin. PRs were more likely among patients receiving single daily dosing (SDD) than multiple daily dosing gentamicin (20/73 [27%] vs 2/79 [3%]; relative risk, 10.8; 95% confidence interval, 2.644.7). Laboratory analysis of gentamicin vials found endotoxin levels that were higher among Fujisawa-brand gentamicin (implicated brand) than gentamicin used after the outbreak terminated (non-implicated brand). Although endotoxin levels in the vials did not exceed US Pharmacopeia limits (1.7 endotoxin units/mg gentamicin), the use of SDD gentamicin may place patients at greater risk of receiving doses of endotoxin above the threshold for PRs in humans.

Conclusions:

Reassessment of the acceptable amounts of endotoxin in gentamicin and other parenteral products should be considered when dosing intervals used in clinical practice change.
Antibiotic-Use Screening Evaluations (ABUSE) for Physicians and Patients: Featuring Prizes and Penalties for Physicians
Authors: Lettau Ludwig A.
Published: February 2006

The excessive use of antibiotics in the United States has been well documented and is a result of the knowledge base and behaviors of not only prescribing physicians but also patients and caregivers. An antibiotic-use screening evaluation (ABUSE) was developed for each group to promote better awareness among all parties as to ways that they may be overusing antibiotics. The ABUSE questionnaires also serve as tools for confidential self-scoring evaluation of the extent of personal antibiotic misuse.
Comparison of Three Methods to Recover Vancomycin-Resistant Enterococci (VRE) From Perianal and Environmental Samples Collected During A Hospital Outbreak of VRE
Authors: Reisner Barbara S. , Shaw Stephanie , Huber Mary E. , Woodmansee Carla E. , Costa Silvia , Falk Pamela S. , Mayhall C. Glen
Published: February 2006

Objective:

To establish an efficient and sensitive technique for recovering vancomycin-resistant enterococci (VRE) from perianal and environmental samples collected during implementation of control measures for an outbreak of VRE.

Design:

Perianal and environmental samples were collected in triplicate on sterile swabs. One swab was used to inoculate a selective broth medium containing 6 μg of vancomycin and 8 μg of ciprofloxacin per mL, one to inoculateCampylobacteragar containing 10 μg/mL of vancomycin, and one to inoculate Enterococcosel agar containing 8 μg/mL of vancomycin.

Setting:

Samples were collected in the intensive care units of a 600-bed university hospital over a period of 2 months.

Sample Selection:

Patients and their immediate environment were sampled if they resided in a ward with a patient known to be colonized or infected with VRE.

Results:

Of the 88 perianal samples obtained from 63 patients, 37 were positive for VRE by broth culture, with 36 also recovered on both types of solid media (sensitivity, 97.3%; negative predictive value, 98.1%). Of the initial samples collected from each of the 63 patients, 20 were positive for VRE by all methods. Of the 500 environmental samples cultured, 139 were positive for VRE in broth, with only 33 recovered onCampylobacteragar (sensitivity, 23.7%; negative predictive value, 77.2%) and 22 on Enterococcosel agar (sensitivity, 15.8%; negative predictive value, 75.2%).

Conclusions:

Our data indicate that, when performing surveillance cultures during an outbreak of VRE, use of an enrichment broth medium is required to recover VRE contaminating environmental surfaces; however, direct inoculation to selective solid medium is adequate to recover VRE in patient perianal specimens.
Choice of Antibiotic and Risk of Colonization With Vancomycin-Resistant Enterococcus Among Patients Admitted for Treatment of Community-Acquired Pneumonia
Authors: Manzella John , Benenson Ronald , Pellerin Gene , Kellogg James , Bell Theodore , Robertson Michelle , Pope Doris
Published: February 2006

A time-series prospective study of patients admitted to the hospital for treatment of community-acquired pneumonia was undertaken to determine vancomycin-resistant enterococcal perianal colonization rates among patients who received ceftriaxone with or without erythromycin versus those who received levofloxacin. A colonization rate of 16% (8/51) was found in the ceftriaxone-erythromycin group versus 0% (0/52) in the levofloxacin group.
Experience of Healthcare Workers Taking Postexposure Prophylaxis After Occupational HIV Exposures: Findings of the HIV Postexposure Prophylaxis Registry
Authors: Weber David , Wang Susan A. , Panlilio Adelisa L. , Doi Peggy A. , White Alice D. , Stek Michael , Saah Alfred ,   HIV PEP Registry Group
Published: February 2006

Objective:

To collect information about the safety of taking antiretroviral drugs for human immunodeficiency virus (HIV) postexposure prophylaxis (PEP).

Design:

A voluntary, confidential registry.

Setting:

Hospital occupational health clinics, emergency departments, private physician offices, and health departments in the United States.

Results:

492 healthcare workers (HCWs) who had occupational exposures to HIV, were prescribed HIV PEP, and agreed to be enrolled in the registry by their healthcare providers were prospectively enrolled in the registry. Three hundred eight (63%) of 492 of the PEP regimens prescribed for these HCWs consisted of at least three antiretroviral agents. Of the 449 HCWs for whom 6-week follow-up was available, 195 (43%) completed the PEP regimen as initially prescribed. Forty-four percent (n=197) of HCWs discontinued all PEP drugs and did not complete a PEP regimen. Thirteen percent (n=57) discontinued ≥1 drug or modified drug dosage or added a drug but did complete a course of PEP. Among the 254 HCWs who modified or discontinued the PEP regimen, the two most common reasons for doing so were because of adverse effects attributed to PEP (54%) and because the source-patient turned out to be HIV-negative (38%). Overall, 340 (76%) HCWs with 6-week follow-up reported some symptoms while on PEP: nausea (57%), fatigue or malaise (38%), headache (18%), vomiting (16%), diarrhea (14%), and myalgias or arthralgias (6%). The median time from start of PEP to onset of each of the five most frequently reported symptoms was 3 to 4 days. Only 37 (8%) HCWs with 6-week follow-up were reported to have laboratory abnormalities; review of the reported abnormalities revealed that most were unremarkable. Serious adverse events were reported to the registry for 6 HCWs; all but one event resolved by the 6-month follow-up visit. Fewer side effects were reported by HCWs taking two-drug PEP regimens than by HCWs taking three-drug PEP regimens.

Conclusions:

Side effects from HIV PEP were very common but were rarely severe or serious. The nature and frequency of HIV PEP toxicity were consistent with information already available on the use of these antiretroviral agents. Clinicians prescribing HIV PEP need to counsel HCWs about PEP side effects and should know how to manage PEP toxicity when it arises.
Does the Centers for Disease Control’s NNIS System Risk Index Stratify Patients Undergoing Cardiothoracic Operations by Their Risk of Surgical-Site Infection?
Authors: Roy Marie-Claude , Herwaldt Loreen A. , Embrey Richard , Kuhns Kristen , Wenzel Richard P. , Perl Trish M.
Published: February 2006

Background:

In 1991, the Centers for Disease Control and Prevention devised the National Nosocomial Infection Surveillance (NNIS) System risk index to stratify populations of surgical patients by the risk of acquiring surgical-site infections (SSIs).

Objective:

To determine whether the NNIS risk index adequately stratifies a population of cardiothoracic surgery patients by the risk of developing SSI.

Design:

Casecontrol study.

Setting:

The University of Iowa Hospitals and Clinics, a 900-bed, midwestern, tertiary-care hospital.

Patients:

201 patients with SSIs identified by prospective infection control surveillance and 398 controls matched by age, gender, type of procedure, and date of procedure. All patients underwent cardiothoracic operative procedures between November 1990 and January 1994.

Results:

The SSI rate was 7.8%. Seventy-four percent of cases and 80% of controls had a NNIS risk index score of 1; 24% of cases and 16% of controls had a score of 2 (P=.05). Patients with a NNIS risk score ≥2 were 1.8 times more likely to develop an SSI than those with a NNIS score <2 (odds ratio, 1.83; 95% confidence interval, 1.14-2.94,P=.01). The duration of the procedure was the only component of the index that stratified the population by risk of SSI.

Conclusions:

The risk of SSI after cardiothoracic operations increases as the NNIS risk index score increases. However, this index only dichotomized the patient population on the basis of the procedure duration. More research is needed to develop a risk index that adequately stratifies the risk of SSI after cardiothoracic operations.
Identification of Factors That Disrupt Negative Air Pressurization of Respiratory Isolation Rooms
Authors: Pavelchak Nicholas , DePersis Ronald P. , London Matthew , Stricof Rachel , Oxtoby Margaret , DiFerdinando George , Marshall Elizabeth
Published: February 2006

Objectives:

To investigate the airflow characteristics of respiratory isolation rooms (IRs) and to evaluate the use of visible smoke as a monitoring tool.

Methods:

Industrial hygienists from the New York State Department of Health evaluated 140 designated IRs in 38 facilities within New York State during 1992 to 1998. The rooms were located in the following settings: hospitals (59%), correctional facilities (40%), and nursing homes (1%). Each room was tested with visible smoke for directional airflow into the patient room (ie, negative air pressure relative to adjacent areas). Information was obtained on each facility's policies and procedures for maintaining and monitoring the operation of the IRs.

Results:

Inappropriate outward airflow was observed in 38% of the IRs tested. Multiple factors were associated with outward airflow direction, including ventilation systems not balanced (54% of failed rooms), shared anterooms (14%), turbulent airflow patterns (11%), and automated control system inaccuracies (10%). Of the 140 tested rooms, 38 (27%) had either electrical or mechanical devices to monitor air pressurization continuously. The direction of airflow at the door to 50% (19/38) of these rooms was the opposite of that indicated by the continuous monitors at the time of our evaluations. The inability of continuous monitors to indicate the direction of airflow was associated with instrument limitations (74%) and malfunction of the devices (26%). In one facility, daily smoke testing by infection control staff was responsible for identifying the malfunction of a state-of-the-art computerized ventilation monitoring and control system in a room housing a patient infectious with drug-resistant tuberculosis.

Conclusion:

A substantial percentage of IRs did not meet the negative air pressure criterion. These failures were associated with a variety of characteristics in the design and operation of the IRs. Our findings indicate that a balanced ventilation system does not guarantee inward airflow direction. Devices that continuously monitor and, in some cases, control the pressurization of IRs had poor reliability. This study demonstrates the utility of using visible smoke for testing directional airflow of IRs, whether or not continuous monitors are used. Institutional tuberculosis control programs should include provisions for appropriate monitoring and maintenance of IR systems on a frequent basis, including the use of visible smoke.
NosocomialSerratia marcescensInfections Associated With Extrinsic Contamination of a Liquid Nonmedicated Soap
Authors: Sartor Catherine , Jacomo Véronique , Duvivier Cédric , Tissot-Dupont Hervé , Sambuc Roland , Drancourt Michel
Published: February 2006

Objective:

To determine the role of nonmedicated soap as a source ofSerratia marcescensnosocomial infections (NIs) in hospital units with endemicS marcescensNI and to examine the mechanisms of soap colonization.

Setting:

University-affiliated tertiary-care hospitals.

Methods:

A prospective case-control study and an environmental investigation were performed to assess the relationship betweenS marcescensNIs in hospital units andS marcescens-contaminated soap. Soap-bottle use and handwashing practices were reviewed. Cultures of healthcare workers’ (HCWs) hands were obtained before and after hand washing with soap.

Results:

5 of 7 hospital units withS marcescensNIs had soap bottles contaminated withS marcescens, compared to 1 of 14 other units (P=.006). After hand washing with anS marcescens-contaminated soap pump, HCWs' hands were 54 times more likely to be contaminated withS marcescens(P<.001).

Conclusions:

Extrinsic contamination of a non-medicated liquid soap byS marcescensresulted in handborne transmission ofS marcescensNIs by HCWs in our setting. This finding led to the application of strict guidelines for nonmedicated soap use and to the reinforcement of alcoholic hand disinfection.
Outbreak of Pseudomonas aeruginosa Ventriculitis Among Patients in a Neurosurgical Intensive Care Unit
Authors: Trick William E. , Kioski Clare M. , Howard Kathleen M. , Cage Gary D. , Tokars Jerome I. , Yen Bertina M. , Jarvis William R.
Published: February 2006

Objective:

To determine the cause of an outbreak of Pseudomonas aeruginosa cerebral ventriculitis among eight patients at a community hospital neurosurgical intensive care unit. All had percutaneous external ventricular catheters (EVCs) to monitor cerebrospinal fluid (CSF) pressure.

Methods:

Cohort study of all patients who had EVCs placed during the epidemic period (August 8-October 22, 1997). A case-patient was any patient with P aeruginosa ventriculitis during the epidemic period. Pulsed-field gel electrophoresis (PFGE) was performed on all isolates.

Results:

P aeruginosa was significantly more likely to be isolated from CSF per EVC placed in the epidemic than pre-epidemic (January 1-August 7, 1997) periods (8/61 [13%] vs 2/131 [1.5%], P = 002). During the epidemic period, ventriculitis was significantly more likely after EVC placement in the operating room than in other units (8/24 vs 0/22, P = .004). EVC placement technique differed for EVCs placed in the operating room (little hair was removed, preventing application of an occlusive dressing) versus other hospital units (more hair was removed, and an occlusive dressing was applied). Among patients who had operating room EVC placement, contact with one healthcare worker was statistically significant (7/13 vs 0/8, P = .02). Hand cultures of this worker were negative. All isolates had closely related PFGE patterns.

Conclusions:

These data suggest that a single healthcare worker may have contaminated EVC insertion sites, resulting in an outbreak of P aeruginosa ventriculitis. Affected patients were unlikely to have had an occlusive dressing at the EVC insertion site. Application of a sterile occlusive dressing may decrease the risk of ventriculitis in patients with EVCs.
Genotyping by Restriction Endonuclease Analysis Compared to Phenotyping by Antibiogram for Typing Methicillin-ResistantStaphylococcus aureusStrains Colonizing Patients in a Nursing Home
Authors: Lee Yee-Lean , Thrupp Lauri
Published: February 2006

Objectives:

To assist in defining patterns of methicillin-resistantStaphylococcus aureus(MRSA) colonization in a skilled nursing facility (SNF), we compared genotyping by field-inversion gel electrophoresis (FIGE) restriction endonuclease digestion analysis (REA) with phenotyping by antibiogram for defining strain relatedness among MRSA isolates from SNF patients.

Design:

Prospective screening culture surveillance for MRSA among patients in a community SNE

Methods:

Nares and stool swab cultures were obtained from newly admitted patients and from all patients quarterly. MRSA were isolated by oxacillin screening agar. Antibiograms were determined by the disk-diffusion method, and genotyping was by FIGE REA.

Results:

It was shown that, among isolates with the same genotypes, many had different antibiograms; among isolates with the same antibiograms, many had different genotypes; and the discriminatory indices for isolates of MRSA by FIGE REA and by antibiogram were 0.56 and 0.78, respectively.

Conclusion:

Our study demonstrated that, in patients from one SNF, genotyping by FIGE REA identified two prevalent REA DNA types, but with variability of antibiogram patterns within each DNA type; the antibiogram also identified prevalent patterns with variability of REA DNA type within each antibiogram pattern. The discriminatory index of antibiograms alone, or of genotypes alone as determined by FIGE REA, was poor for strains of MRSA isolated from the SNF patients in our study.
Increase in Community-Acquired Methicillin-Resistant Staphylococcus aureus at a Naval Medical Center
Authors: Kallen Alexander J. , Driscoll Timothy J. , Thornton Scott , Olson Patrick E. , Wallace Mark R.
Published: February 2006

A retrospective review of methicillin-resistant Staphylococcus aureus isolates from the Naval Medical Center, San Diego, for the years 1994 through 1997, found that the annual number of community-acquired MRSA isolates increased during the period. These outpatient isolates were more likely than inpatient isolates to be sensitive to a greater number of antibiotics.
Control of Nosocomial Clostridium difficile Transmission in Bone Marrow Transplant Patients
Authors: Hanna Hend , Raad Issam , Gonzalez Virginia , Umphrey Jan , Tarrand Jeffrey , Neumann Joyce , Champlin Richard
Published: February 2006

This is a report of six cases of Clostridium difficile-associated diarrhea (CDAD) that occurred among cancer patients undergoing bone marrow transplantation in a tertiary-care cancer hospital. Specific infection control measures that were taken to minimize the nosocomial spread of CDAD also are discussed.
Practices to Improve Antimicrobial Use at 47 US Hospitals the Status of the 1997 SHEA/IDSA Position Paper Recommendations
Authors: Lawton Rachel M. , Fridkin Scott K. , Gaynes Robert P. , McGowan John E. ,   Intensive Care Antimicrobial Resistance Epidemiology (ICARE) Hospitals
Published: February 2006

Objective.

To determine the status of programs to improve antimicrobial prescribing at select US hospitals.

Design:

Cross-sectional survey.

Participants and Setting:

Pharmacy and infection control staff at all 47 hospitals participating in phase 3 of Project Intensive Care Antimicrobial Resistance Epidemiology.

Results:

All 47 hospitals had some programs to improve antimicrobial use, but the practices reported varied considerably. All used a formulary, and 43 (91%) used it in conjunction with at least one of the other three antimicrobial-use policies evaluated: stop orders, restriction, and criteria-based clinical practice guidelines (CPGs). CPGs were reported most commonly (70%), followed by stop orders (60%) and restriction policies (40%). Although consultation with an infectious disease physician (70%) or pharmacist (66%) was commonly used to influence initial antimicrobial choice, few (40%) reported a system to measure compliance with these consultations.

Conclusions:

In most hospitals surveyed, practices to improve antimicrobial use, although present, were inadequate based on recommendations in a Society for Healthcare Epidemiology of America and Infectious Disease Society of America joint position paper. There is room to improve antimicrobial-use stewardship at US hospitals.
Diagnostic Tests Distinguishing Good Tests From Bad and Even Ugly Ones
Authors: Birnbaum David , Farr Barry M. , Shapiro David E.
Published: February 2006

This article focuses on the selection and interpretation of diagnostic tests, emphasizing the importance of understanding how their mathematical parameters affect the information they provide in various settings. The utility and limitations of sensitivity, specificity, predictive value, and receiver operating characteristic (ROC) curves are discussed using catheter-related bloodstream infections as an example. ROC curves have been used for selecting optimal cutoff values for a positive result and for selecting among several alternative diagnostic tests. For example, 16 different tests have been proposed for diagnosis of catheter-related bloodstream infection; ROC analysis provides an effective way to determine which test offers the best overall performance.