bluuebunny/crossref_metadata_2025 huggingface dataset:
Transmission of Hepatitis B Virus From a Surgeon to his Patients During High-Risk and Low-Risk Surgical Procedures During 4 Years
Authors: Spijkerman Ingrid J. B. , van Doorn Leen-Jan , Janssen Maria H. W. , Wijkmans Clementine J. , Bilkert-Mooiman Marijke A. J. , Coutinho Roel A. , Weers-Pothoff Gezina
Published: February 2006

Objective:

We investigated cases of acute hepatitis B in The Netherlands that were linked to the same general surgeon who was infected with hepatitis B virus (HBV).

Design:

A retrospective cohort study was conducted of 1,564 patients operated on by the surgeon. Patients were tested for serologic HBV markers. A case–control study was performed to identify risk factors.

Results:

The surgeon tested positive for hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg) with a high viral load. He was a known nonresponder after HBV vaccination and had apparently been infected for more than 10 years. Forty-nine patients (3.1%) were positive for HBV markers. Transmission of HBV from the surgeon was confirmed in 8 patients, probable in 2, and possible in 18. In the remaining 21 patients, the surgeon was not implicated. Two patients had a chronic HBV infection. One case of secondary transmission from a patient to his wife was identified. HBV DNA sequences from the surgeon were completely identical to sequences from 7 of the 28 patients and from the case of secondary transmission. The duration of the operation and the occurrence of complications during or after surgery were identified as independent risk factors. Although the risk of HBV infection during high-risk procedures was 7 times higher than that during low-risk procedures, at least 8 (28.6%) of the 28 patients were infected during low-risk procedures.

Conclusions:

Transmission of HBV from surgeons to patients at a low rate can remain unnoticed for a long period of time. Prevention requires a more stringent strategy for vaccination and testing of surgeons and optimization of infectious disease surveillance. Policies allowing HBV-infected surgeons to perform presumably low-risk procedures should be reconsidered.
High Prevalence of Hepatitis C Infection Among Patients Receiving Hemodialysis at an Urban Dialysis Center
Authors: Sivapalasingam Sumathi , Malak Sharp F. , Sullivan John F. , Lorch Jonathan , Sepkowitz Kent A.
Published: February 2006

Objective:

To determine the seroprevalence and risk factors for hepatitis C virus (HCV) infection among patients at an urban outpatient hemodialysis center.

Methods:

This was a cross-sectional study of 227 patients undergoing hemodialysis at the Rogosin Kidney Center on December 15, 1998, with a response rate of 90% (227 of 253). Laboratory records were used to retrieve the total number of blood transfusions received and serologic study results. Univariate and multivariate analyses were used to examine the relationship among HCV serostatus, patient demographics, and HCV risk factors (eg, intravenous drug use [IVDU], intranasal cocaine use, multiple sexual partners, comorbidities, length of time receiving hemodialysis, and total number of blood transfusions received).

Results:

The seroprevalence of antibody to HCV (anti-HCV) was 23.3% (53 of 227) in the population. In univariate analysis, factors associated with HCV seropositivity included male gender, younger age, history of IVDU, history of intranasal cocaine use, history of multiple sexual partners, human immunodeficiency virus coinfection, increased time receiving dialysis, history of renal transplant, and positive antibody to hepatitis B core antigen. Multivariate logistic regression analysis showed that longer duration receiving dialysis and a history of IVDU were the only risk factors that remained independently associated with HCV seropositivity.

Conclusions:

HCV is markedly more common in our urban cohort of patients receiving hemodialysis compared with patients receiving dialysis nationally and is associated with a longer duration of receiving dialysis and a history of IVDU. Stricter and more frequent enforcement of universal precautions may be required in hemodialysis centers located in areas with a high prevalence of HCV infection or IVDU among the general population.
Occupational Risk of Blood-Borne Viruses in Healthcare Workers: A 5-Year Surveillance Program
Authors: Baldo Vincenzo , Floreani Annarosa , Vecchio Luigino Dal , Cristofoletti Marco , Carletti Maristella , Majori Silvia , Tommaso Angela Di , Trivello Renzo
Published: February 2006

Objective:

This study presents the results of a 5-year surveillance program involving the prospective follow-up of health-care workers (HCWs) in the Veneto region of Italy exposed to blood-borne viruses.

Design:

All HCWs who reported an occupational exposure to blood-borne infection joined the surveillance program. Both HCWs and patients were tested for viral markers (hepatitis B surface antigen [HBsAg], antibody to hepatitis B surface antigen [anti-HBs], antibody to hepatitis B core antigen [anti-HBc], antibody to hepatitis C virus [anti-HCV], HCV RNA, and antibody to human immunodeficiency virus [HIV]) and had these markers plus transaminases assayed at 3, 6, and 12 months and then yearly thereafter. Moreover, a program of hepatitis B virus (HBV) prophylaxis was offered to those whose anti-HBs levels were less than 10 IU/mL.

Participants:

Two hundred forty-five HCWs (156 women and 89 men) with a mean age of 37 (± 10) years who reported occupational exposure during the 5-year period.

Results:

At the time of exposure, 1HCW was positive for HBsAg (0.4%) and 2 were positive for HCV RNA (0.8%). Among the patients involved, 28 (11.4%) were positive for HBsAg, 68 (27.8%) were positive for HCV RNA, 6 (2.4%) were positive for HIV, and 147 (60.0%) were negative for all viral markers (4 patients were positive for both HCV and HIV). During the follow-up period after exposure (mean, 2.7 [± 1.6] years), there was no increase in transaminases or seroconversions to any of the viral markers.

Conclusion:

Our accurate postexposure follow-up revealed a lack of transmission of HBV, HCV, and HIV.
Low Rate of False-Positive Results with Use of A Rapid HIV Test
Authors: Salgado Cassandra D. , Flanagan Heidi L. , Haverstick Doris M. , Farr Barry M.
Published: February 2006

Background:

Occupational exposure to human immunodeficiency virus (HIV) is an important threat to healthcare workers. Centers for Disease Control and Prevention guidelines recommend prompt institution of prophylaxis. This requires (1) immediate prophylaxis after exposure, pending test results that may take more than 24 hours in many hospitals; or (2) performance of a rapid test. The Single Use Diagnostic System (SUDS)® HIV-1 Test is used to screen rapidly for antibodies to HIV type 1 in plasma or serum, with a reported sensitivity of more than 99.9%. We used this test from January 1999 until September 2000, when it was withdrawn from the market following reports claiming a high rate of false-positive results.

Methods:

We reviewed the results of postexposure HIV testing during 21 months.

Results:

A total of 884 SUDS tests were performed on source patients after occupational exposures (883 negative results, 1 reactive result). The results of repeat SUDS testing on the reactive specimen were also reactive, but the results of enzyme immunoassay and Western blot testing were negative. A new specimen from the same patient showed a negative result on SUDS testing. This suggested a specificity of 99.9%. In the 4 months after SUDS testing was suspended, there was 1 false-positive result on enzyme immunoassay for 1 of 132 source patients (presumed specificity, 99.2%).

Conclusion:

Use of the SUDS test facilitated rapid and accurate evaluation of source specimens, obviating unnecessary prophylaxis.
Patient-to-Patient Transmission of Nosocomial Malaria in Italy
Authors: Moro Maria Luisa , Romi Roberto , Severini Carlo , Casadio Gian Paolo , Sarta Giovanni , Tampieri Guido , Scardovi Antonio , Pozzetti Cinzia ,   Malaria Outbreak Group
Published: February 2006

Objective:

To describe nosocomial transmission of malaria from patient to patient via blood exposure.

Patients:

A 56-year-old man was admitted to an Italian hospital with fever and Plasmodium falciparum parasitemia, but with no risk factors for malaria. Twenty days earlier, he had been admitted for bronchopulmonary disease to the hospital's intensive care unit, where a woman with P. falciparum malaria acquired abroad was present.

Methods:

We reviewed both patients' medical records and searched for mosquitoes in the hospital and on the grounds. We interviewed the staff about patient care practices potentially involving contact with blood. The genetic identities of strains were determined by genotyping of the DNA extracted from blood.

Results:

Molecular genotyping showed that the two strains were identical. The only invasive procedures performed on both patients by the same staff on the same shift were capillary blood sampling by finger stick, intravenous drug administration, and substitution of total parenteral nutrition bags and intravenous sets. The flngerstick device used was designed to prevent person-to-person transmission of blood-borne infections, and the staff interviews did not reveal any incorrect use of aseptic techniques. The likely source of infection was identified during a training course 6 months later: a nurse reported that, when collecting blood, she placed patients' fingers directly on the blood glucose meter, a practice she had learned from a poster advertising the device.

Conclusions:

A nosocomial case of malaria was ascertained, which was likely due to patient-to-patient transmission via a contaminated blood glucose meter. Incomplete instructions for the meter seem to have played a role in this case.
Risk of Hepatitis C After Immunoadsorption
Authors: Kaiser Rolf , Geulen Oliver , Matz Bertfried , Brackmann Hans H. , Spengler Ulrich , Kramer Michael H. , Exner Martin , Nettekoven Wilhelm , Ko You-Dschun , Zeitler Heike , Vetter Hans
Published: February 2006

An episode of acute hepatitis in a patient with hemophilia during immunoadsorption therapy initially was misinterpreted as a reactivated hepatitis C virus (HCV) infection, but ultimately was shown to be an exogenous reinfection during cohort treatment with another HCV-positive patient. This incident illustrates that policies for the prevention of nosocomial transmission of blood-borne pathogens, especially in cohort treatment units, may need to be reassessed.
Transmission of Drug-Resistant HIV After an Occupational Exposure Despite Postexposure Prophylaxis With a Combination Drug Regimen
Authors: Beltrami Elise M. , Luo Chi-Cheng , Torre Nicolas de la , Cardo Denise M.
Published: February 2006

We documented a case of occupational human immunodeficiency virus (HIV) despite postexposure prophylaxis (PEP) with a combination drug regimen after percutaneous injury with a needle from a sharps disposal container in the hospital room of an HIV-infected patient. This failure of PEP with a combination drug regimen may have been related to antiretroviral drug resistance, other factors, or both. This case highlights the importance of preventing injury to prevent occupational transmission of HIV.
Use of Censored Data to Monitor Surgical-Site Infections
Authors: Thibon Pascal , Parienti J. J. , Borgey F. , Le Prieur A. , Bernet C. , Branger B. , Le Coutour X.
Published: February 2006

Objective:

To take into account the proportion of patients lost to follow-up when calculating surgical-site infection (SSI) rates.

Design:

A multicenter SSI monitoring network in Basse-Normandie, France, using the definitions for SSI of the National Nosocomial Infections Surveillance System of the Centers for Disease Control and Prevention.

Patients:

Between January 1, 1998, and December 31, 1999, 3,705 patients were operated on in 25 units of 10 institutions.

Results:

Of the patients, 41.2% (range, 5.1% to 95.5%) were seen 30 days or more after their operation. The global SSI attack rate was 2.19% (95% confidence interval, 1.72% to 2.66%). With the use of the Kaplan–Meier method, the incidence rate was 3.11% (95% confidence interval, 3.06% to 3.16%). The difference between the attack rate and the Kaplan–Meier incidence rate for each unit varied according to the percentage of patients seen on or after day 30 postoperatively and the number of SSIs diagnosed in patients seen on or after day 30.

Conclusions:

Practice guidelines are needed for the international monitoring for postdischarge SSIs and the calculation of SSI rates. The proportion of patients seen 30 days after their operation is a major quality criterion for SSI monitoring and should be routinely given in monitoring reports, oral communications, and publications to compare results obtained by different teams.
A New Surgical-Site Infection Risk Index Using Risk Factors Identified by Multivariate Analysis for Patients Undergoing Coronary Artery Bypass Graft Surgery
Authors: Russo Philip L. , Spelman Denis W.
Published: February 2006

Objectives:

To develop a new, simple, and practical risk index for patients undergoing coronary artery bypass graft (CABG) surgery, to develop a preoperative risk index that is predictive of surgical-site infection (SSI), and to compare the new risk indices with the National Nosocomial Infections Surveillance (NNIS) System risk index.

Design:

Potential risk factor and infection data were collected prospectively and analyzed by multivariate analysis. Two new risk indices were constructed and then compared with the NNIS System risk index for predictive power for SSI.

Setting:

Alfred Hospital is a 350-bed, university-affiliated, tertiary-care referral center. The cardiothoracic unit performs approximately 650 CABG procedures per year.

Patients:

All patients undergoing CABG surgery within the cardiothoracic unit at Alfred Hospital between December 1, 1996, and September 29, 2000, were included.

Results:

Potential risk factor data were complete for 2,345 patients. There were 199 SSIs. Obesity (odds ratio [OR], 1.78; 95% confidence interval [CI95], 1.24 to 2.55), peripheral or cerebrovascular disease (OR, 1.64; CI95, 1.16 to 2.33), insulin-dependent diabetes mellitus (OR, 2.29; CI95, 1.15 to 4.54), and a procedure lasting longer than 5 hours (OR, 1.75; CI95,1.18 to 2.58) were identified as independent risk factors for SSI. With the use of a different combination of these risk factors, two risk indices were constructed and compared using the Goodman-Kruskal nonparametric correlation coefficient (G). Risk index B had the highest G value (0.3405; CI95, 0.2245 to 0.4565), compared with the NNIS System risk index G value (0.3142; CI95, 0.1462 to 0.4822). The G value for risk index A constructed from preoperative variables only, was 0.3299 (CI95 0.2039 to 0.4559).

Conclusion:

Two new risk indices have been developed. Both indices are as predictive as the NNIS System risk index. One of the new risk indices can also be applied preoperatively.
An Outbreak of Mediastinitis Among Heart Transplant Recipients Apparently Related to a Change in the United Network for Organ Sharing Guidelines
Authors: Samuel Rafik , Axelrod Peter , John Keith St. , Fekete Thomas , Alexander Sharon , McCarthy James , Truant Allan , Todd Barbara , Furukawa Satoshi , Eisen Howard , Spotnitz William
Published: February 2006

Objective:

To describe an outbreak of mediastinitis in heart transplant recipients.

Design:

Retrospective and contemporaneous cohort study.

Setting:

Urban tertiary-care university hospital with a large cardiac transplantation program.

Patients:

Heart transplant recipients.

Interventions:

Modifications of donor harvest technique; procedures aimed at decreasing skin and mucosal bacterial colonization; strict aseptic technique in the intensive care unit; and aggressive policing of established infection control practices.

Results:

In April 1999, mediastinitis rates among heart transplant recipients increased abruptly from a baseline of 6 cases per 100 procedures to sequential quarterly rates of 22, 31, and 50 cases per 100 procedures, whereas infection rates in other cardiac operations were unchanged. Bacteria causing these infections were multidrug-resistant "nosocomial" organisms. The epidemic occurred 2 months after a change in the United Network for Organ Sharing organ allocation algorithm. This change resulted in an increase in the duration of preoperative hospitalization from a median of 52 to 79 days (P= .008) and may have promoted prolonged hospitalization of patients with high illness severity. Aggressive multidisciplinary interventions were temporally associated with a return to preoperative mediastinitis rates without changing length of hospitalization prior to transplantation.

Conclusions:

Changes in organ allocation for transplant that prolong waiting time in the hospital and alter illness acuity may lead to increased rates of postoperative infection. Measures to limit bacterial colonization may be a helpful countervailing strategy.
Prevalence of Surgical-Site Infections and Patterns of Antimicrobial Use in a Large Tertiary-Care Hospital in Ho Chi Minh City, Vietnam
Authors: Sohn Annette H. , Parvez Farah M. , Vu Tien , Hai Hoang H. , Bich Nguyen N. , Thu Le Thi A. , Hoa Le Thi T , Thanh Nguyen H. , Viet Truong V. , Archibald Lennox K. , Banerjee Shailen N. , Jarvis William R.
Published: February 2006

Background:

Few studies have been conducted in Vietnam on the epidemiology of healthcare-associated infections or antimicrobial use. Thus, we sought to determine the prevalence of and risk factors for surgical-site infections (SSIs) and to document antimicrobial use in surgical patients in a large healthcare facility in Vietnam.

Methods:

We conducted a point-prevalence survey of SSIs and antimicrobial use at Cho Ray Hospital, Ho Chi Minh City, a 1,250-bed inpatient facility. All patients on the 11 surgical wards and 2 intensive care units who had surgery within 30 days before the survey date were included.

Results:

Of 391 surgical patients, 56 (14.3%) had an SSI. When we compared patients with and without SSIs, factors associated with infection included trauma (relative risk [RR], 2.65; 95% confidence interval [CI95], 1.60 to 4.37; P < .001), emergency surgery (RR, 2.74; CI95, 1.65 to 4.55; P < .001), and dirty wounds (RR, 3.77; CI95, 2.39 to 5.96; P < .001). Overall, 198 (51%) of the patients received antimicrobials more than 8 hours before surgery and 390 (99.7%) received them after surgery. Commonly used antimicrobials included third-generation cephalosporins and aminoglycosides. Thirty isolates were identified from 26 SSI patient cultures; of the 25 isolates undergoing antimicrobial susceptibility testing, 22 (88%) were resistant to ceftriaxone and 24 (92%) to gentamicin.

Conclusions:

Our data show that (1) SSIs are prevalent at Cho Ray Hospital; (2) antimicrobial use among surgical patients is widespread and inconsistent with published guidelines; and (3) pathogens often are resistant to commonly used antimicrobials. SSI prevention interventions, including appropriate use of antimicrobials, are needed in this population.
Evaluation of Rapid Readout Biological Indicators for 132°C Gravity and 132°C Vacuum-Assisted Steam Sterilization Cycles Using a New Automated Fluorescent Reader
Authors: Alfa Michelle J. , Olson Nancy , DeGagne Pat , Jackson Michele
Published: February 2006

Objective:

The primary objective of this study was to evaluate fluorescent readout results of Attest 1291 Biological Indicators (Bis) (3M Health Care, St. Paul, MN) and Attest 1296 BI test packs (containing Attest 1292 Bis) using full and fractional cycles compared with the growth data when prolonged incubation (7 days) was included. Gravity displacement and vacuum-assisted steam sterilization cycles were evaluated. A secondary objective of this study was to evaluate the new automated rapid fluorescent reader (Attest 290 Auto Reader).

Design:

The rapid readout Bis for gravity displacement and vacuum-assisted steam autoclave cycles at 132° C were processed using full (4 minutes) and four fractional cycles that provided 30% to 80% positive results for growth after 24 hours of incubation (48 hours of incubation for Attest 1292 Bis from the Attest 1296 test packs). Sixty of each type of BI were tested for each cycle (300 of each BI type in total).

Results:

For all full steam sterilization cycles, results of the rapid fluorescent readout and the 24-hour, 48-hour, and 7-day growth tests were negative for all Attest 1291 and 1292 Bis tested. For all fractional cycles, the 24- and 48-hour growth results for the Attest 1291 and 1292 Bis, respectively, were the same as the 7-day growth results. The fractional cycle data indicated that fluorescent rapid readout was a more sensitive indicator than growth. There were rare (0.9%) false-negative results for Bis under fractional cycle conditions and these all correlated with short fractional cycle exposure times.

Conclusions:

The fluorescent rapid readout results of the 1291 Bis and 1296 BI test packs reliably predict both 24- and 48-hour and 7-day growth. These data support the value of rapid readout Bis for sterilizer monitoring for both the vacuum-assisted and the gravity displacement steam sterilization cycles. The new automated reader requires less manipulation of the BI and makes monitoring user friendly and less prone to user errors.
Skin Antisepsis Kits Containing Alcohol and Chlorhexidine Gluconate or Tincture of Iodine are Associated With Low Rates of Blood Culture Contamination
Authors: Trautner Barbara W. , Clarridge Jill E. , Darouiche Rabih O.
Published: February 2006

Objective:

Skin preparation is an important factor in reducing the rate of blood culture contamination. We assessed blood culture contamination rates associated with the use of skin antisepsis kits containing either 2% alcoholic chlorhexidine gluconate or 2% alcoholic tincture of iodine.

Design:

Prospective, blinded clinical trial.

Setting:

Tertiary-care teaching hospital.

Patients:

Adult patients in medical wards, the medical intensive care unit, and the cardiac intensive care unit who needed paired, percutaneous blood cultures.

Interventions:

House officers, medical students, and healthcare technicians drew the blood for cultures. We prepared sacks containing all of the necessary supplies, including two different types of antiseptic kits. In each sack, one kit contained 2% chlorhexidine in 70% isopropyl alcohol and the other contained 2% tincture of iodine in ethyl alcohol and 70% isopropyl alcohol. Each patient received chlorhexidine at one site and tincture of iodine at the other.

Results:

Four (0.9%) of 430 blood culture sets from 215 patients were contaminated. The contamination rate when using alcohol and chlorhexidine (1 of 215, 0.5%) did not differ significantly from the contamination rate when using tincture of iodine (3 of 215,1.4%;P= .62, McNemar test). There was an 87% probability that the two interventions differed by less than 2% in their rate of contamination.

Conclusions:

Both of these antiseptic kits were highly effective for skin preparation prior to drawing blood for cultures. The use of these kits may have contributed to the low contamination rate observed in this study.
Clinical, Microbiological, and Economic Benefit of a Change in Antibiotic Prophylaxis for Cardiac Surgery
Authors: Spelman Denis , Harrington Glenys , Russo Phil , Wesselingh S.
Published: February 2006

Vancomycin and rifampicin replaced cephazolin as antibiotic prophylaxis for coronary artery bypass surgery at our institution. Following this intervention, there was a significant decrease (P< .001) in the surgical-site infection rate from 10.5 (95% confidence interval, 8.2 to 13.3) to 4.9 (95% confidence interval, 3.2 to 7.1) infections per 100 procedures. An estimated $576,655 (Australian) was saved between two 12-month periods.
Impact of Postdischarge Surveillance on Surgical-Site Infection Rates for Coronary Artery Bypass Procedures
Authors: Avato Joan L , Lai Kwan Kew
Published: February 2006

Objective:

To assess the influence of postdischarge infection surveillance on risk-adjusted surgical-site infection rates for coronary artery bypass graft (CABG) procedures.

Design:

Prospective surveillance of surgical-site infections after CABG.

Setting:

Tertiary-care referral hospital.

Methods:

Data on surgical-site infections were collected for 1,324 CABG procedures during 27 months. They were risk adjusted and analyzed according to the surgical surveillance protocol of the National Nosocomial Infections Surveillance (NNIS) System of the Centers for Disease Control and Prevention, with and without postdischarge data.

Results:

Data were available for 96% of the patients. Of the 88 surgical-site infections, 28% were identified prior to discharge and 72% postdischarge. More chest than harvest-site infections were identified (46% vs 11%) prior to discharge, and more harvest-site than chest infections were identified in the outpatient setting (42% vs 14%). The surgical-site infection rate for patients stratified under risk index 1, calculated without postdischarge surveillance, was 2.9%; when compared with that of the NNIS System, the P value was .29. When postdischarge surveillance was included, the surgical-site infection rate was 4.9% and statistically significant when compared with that of the NNIS System (P = .007). For patients stratified under risk index 2, the rates with and without postdischarge surveillance were 11.7% and 10.0%, respectively; when compared with the NNIS System rates, the P values were .000008 and .0006, respectively.

Conclusions:

Only 28% of the surgical-site infections would have been detected if surveillance had been limited to hospital stay. Postdischarge surveillance identified more surgical-site infections among risk index 1 patients. Hospitals with comprehensive postdischarge surveillance after CABG procedures are likely to record higher surgical-site infection rates than those that do not perform such surveillance.
Infection Control and Cost Control in the Era of Managed Care
Authors: Calfee David P. , Farr Barry M.
Published: February 2006

During the past several years, major changes have occurred in the way in which health care is provided and financed. One of the outcomes of these changes has been a greater emphasis on providing quality health care at a low cost. This has led many healthcare facilities to question the necessity of all expenditures and to reduce spending when at all possible. Many healthcare facilities have solicited the services of consulting groups to provide recommendations regarding cost-containment strategies appropriate for their particular institution.
A Prospective Study to Determine Whether Cover Gowns in Addition to Gloves Decrease Nosocomial Transmission of Vancomycin-Resistant Enterococci in an Intensive Care Unit
Authors: Srinivasan Arjun , Song Xiaoyan , Ross Tracy , Merz William , Brower Roy , Perl Trish M.
Published: February 2006

Background:

Vancomycin-resistant enterococci (VRE) remain a significant nosocomial pathogen. Current guidelines of the Hospital Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) recommend the use of gowns and gloves for some interactions with VRE-infected or -colonized patients to prevent nosocomial transmission of VRE.

Objective:

To assess the effect of disposable cover gowns on preventing nosocomial transmission of VRE.

Design and Setting:

Prospective study in a 16-bed medical intensive care unit of a university teaching hospital.

Patients:

All patients who were at risk to acquire VRE, were admitted to the intensive care unit from August 1998 to January 1999, and had at least two perirectal cultures were included in the analysis of VRE acquisition.

Intervention:

VRE isolation precautions were changed from gowns and gloves to gloves alone.

Main Outcome Measure:

VRE acquisition rates and risk factors for VRE acquisition.

Results:

The VRE acquisition rate was 1.80 cases per 100 days at risk in the gown and gloves period compared with 3.78 in the gloves only period (P= .04). In a proportional hazards model adjusted for length of stay, gloves only precautions with a hazard ratio of 2.5 (P= .02; 95% confidence interval, 1.2 to 5.3) were the only independent risk factor for VRE acquisition.

Conclusion:

Our data lend support to current HICPAC recommendations for the use of cover gowns to decrease nosocomial transmission of VRE.
Recurrence of Vancomycin-ResistantEnterococcusStool Colonization During Antibiotic Therapy
Authors: Donskey Curtis J. , Hoyen Claudia K. , Das Sarbani M. , Helfand Marion S. , Hecker Michelle T.
Published: February 2006

Objective:

To test the hypothesis that antibiotic therapy may promote recurrence of vancomycin-resistantEnterococcus(VRE) stool colonization in patients who have previously had three consecutive negative stool cultures obtained at least 1 week apart.

Design:

One-year prospective cohort study examining the effect of antibiotic therapy on recurrence and density of VRE stool colonization in patients who have cleared colonization. Pulsed-field gel electrophoresis (PFGE) was performed to determine whether recurrent VRE strains were the same clone as the previous colonizing strain.

Setting:

A Department of Veterans Affairs medical center including an acute care hospital and nursing home.

Patients:

All patients with at least one stool culture positive for VRE who subsequently had three consecutive negative stool cultures obtained at least 1 week apart.

Results:

Of the 16 patients who cleared VRE colonization, 13 received antibiotic therapy during the study period. Eight (62%) of the 13 patients who received antibiotics developed recurrent high-density VRE stool colonization (range, 4.9 to 9.1 log10colony-forming units per gram) during a course of therapy. Five patients had VRE strains available for PFGE analysis; recurrent strains were unrelated to the prior strain in 3 patients, closely related in 1 patient, and indistinguishable in 1 patient.

Conclusions:

Antibiotic therapy may be associated with recurrent high-density VRE stool colonization in many patients who have previously had three consecutive negative stool cultures. These patients should be screened for recurrent stool colonization when antibiotic therapy is administered.
An Outbreak of Multidrug-ResistantPseudomonas AeruginosaAssociated with Increased Risk of Patient Death in an Intensive Care Unit
Authors: Bukholm Geir , Tannæs Tone , Kjelsberg Anne Britt Bye , Smith-Erichsen Nils
Published: February 2006

Objective:

To investigate an outbreak of multidrug-resistantPseudomonas aeruginosain an intensive care unit (ICU).

Design:

Epidemiologic investigation, environmental assessment, and ambidirectional cohort study.

Setting:

A secondary-care university hospital with a 10-bed ICU.

Patients:

All patients admitted to the ICU receiving ventilator treatment from December 1,1999, to September 1, 2000.

Results:

An outbreak in an ICU with multidrug-resistant isolates ofP. aeruginosabelonging to one amplified fragment-length polymorphism (AFLP)–defined genetic cluster was identified, characterized, and cleared. Molecular typing of bacterial isolates with AFLP made it possible to identify the outbreak and make rational decisions during the outbreak period. The outbreak included 19 patients during the study period. Infection with bacterial isolates belonging to the AFLP cluster was associated with reduced survival (odds ratio, 5.26; 95% confidence interval, 1.14 to 24.26). Enhanced barrier and hygiene precautions, cohorting of patients, and altered antibiotic policy were not sufficient to eliminate the outbreak. At the end of the study period (in July), there was a change in the outbreak pattern from long (December to June) to short Quly) incubation times before colonization and from primarily tracheal colonization (December to June) to primarily gastric or enteral Quly) colonization. In this period, the bacterium was also isolated from water taps.

Conclusion:

Complete elimination of the outbreak was achieved after weekly pasteurization of the water taps of the ICU and use of sterile water as a solvent in the gastric tubes.
Molecular Characterization of Methicillin-Resistant Coagulase-Negative Staphylococci from a Neonatal Intensive Care Unit
Authors: Bogado Isabel , Limansky Adriana , Sutich Emma , Marchiaro Patricia , Marzi Marta , Putero Juan , Viale Alejandro
Published: February 2006

Objective:

To evaluate clonal dissemination of methicillin-resistant coagulase-negative staphylococci (CNS).

Setting:

Neonatal intensive care unit of a 180-bed, university-affiliated general hospital.

Patients:

Neonates admitted to the neonatal intensive care unit between March 1999 and October 2000, from whom CNS were isolated as a unique pathogen. Patients from other wards from whom epidemiologically unrelated staphylococci strains were obtained served as control-patients.

Methods:

Conventional methods were used for phenotypic characterization of CNS. Methicillin resistance was determined bymecA polymerase chain reaction (PCR) amplification. Genotypic characterization was done by random amplification of DNA with degenerated primers (RAPD) and repetitive element sequence-based PCR (rep-PCR).

Results:

Forty methicillin-resistant CNS isolates obtained from neonates were characterized asStaphylococcus epidermidis(33),S. hominis(5),S. warneri(1), andS. auricularis(1). Both RAPD and rep-PCR indicated the presence of 4 different clones among the 33S. epidermidisisolates. In turn, the 4 randomly selected, epidemiologically unrelated methicillin-resistant CNS strains obtained from control-patients showed 3 new profiles by RAPD and 2 by rep-PCR, which differed from the corresponding patterns mentioned earlier. Persistence ofS. hominisin a neonate could be assessed by both genotypic techniques.

Conclusions:

The molecular characterization of the methicillin-resistant CNS studied indicated dissemination of one particular methicillin-resistant CNS clone among the neonates in the ward studied. Although RAPD showed a superior power to discriminate among methicillin-resistant CNS isolates, both RAPD and rep-PCR detected intraspecific and interspecific genomic diversity.
Risk Factors for Infection and Molecular Typing in Patients in the Intensive Care Unit Colonized with NosocomialEnterobacter Aerogenes
Authors: Piagnerelli Michael , Carlier Eric , Deplano Ariane , Lejeune Philippe , Govaerts Danielle
Published: February 2006

Objectives:

To determine the frequency of colonization byEnterobacter aerogenesin patients in the intensive care unit (ICU) for more than 48 hours and to evaluate the risk factors for infection in patients colonized by this bacteria.

Design:

An 8-month prospective study.

Setting:

A 12-bed medical–surgical ICU in a 450-bed, university-affiliated, tertiary-care hospital in Belgium.

Method:

Pulsed-field gel electrophoresis was used to determine the genotypes ofE. aerogenesisolates.

Results:

We observed two major clones ofE. aerogenesin the ICU. Interestingly, 87.5% of infected patients had the same genomic profile for colonization and infection. Risk factors for infection in this particular population included younger age, prolonged hospital stay, mechanical ventilation, and bronchoscopy.

Conclusions:

Colonization is a major prerequisite for infection. The identification of risk factors for infection in colonized patients can optimize the quality of treatment in the ICU.
Nosocomial Outbreak ofSerratia Marcescensin a Neonatal Intensive Care Unit
Authors: Assadian Ojan , Berger Angelika , Aspöck Christoph , Mustafa Stefan , Kohlhauser Christina , Hirschl Alexander M.
Published: February 2006

Objectives:

To investigate and describe an outbreak ofSerratia marcescensin a neonatal intensive care unit (NICU) and to report the interventions leading to cessation of the outbreak.

Setting:

A 2,168-bed, tertiary-care, university teaching hospital in Vienna, Austria, with an 8-bed NICU.

Design:

We conducted a case–control study to identify risk factors for colonization and infection withS. marcescens. A case-patient was defined as any neonate in the NICU with a positive culture forS. marcescensbetween October 1, 2000, and February 28, 2001. Polymerase chain reaction was applied to type isolates.

Methods:

During unannounced observations, the NICU was examined and existing policies were reviewed. Staff were reinstructed in hand antisepsis and gloving policies. Admissions were halted on December 27. During previously planned technical maintenance of the ward, the NICU was closed for 10 days and thorough aldehyde-based disinfection of the NICU was performed.

Results:

Ten neonates met the case definition: 6 with infections (among them 3 with cerebral abscesses) and 4 with asymptomatic colonization. Previous antibiotic treatment of the mothers with cefuroxime was the single significant risk factor for colonization or infection (P= .028; odds ratio, 17; 95% confidence interval, 1.3 to 489.5).

Conclusions:

S. marcescenscan cause rapidly spreading outbreaks associated with fatal infections in NICUs. With aggressive infection control measures, such outbreaks can be stopped at an early stage. Affected neonates themselves may well be the source of cross-infection to other patients on the ward. Antibiotic treatment of mothers should be reevaluated to avoid unnecessary exposure to antibiotics with the potential of overgrowth of resistant organisms.
Patients in the Intensive Care Unit are Exposed to Amoeba-Associated Pathogens
Authors: Scola Bernard La , Mezi Liazyd , Auffray Jean-Pierre , Berland Yvon , Raoult Didier
Published: February 2006

Objective:

To study the role of amoeba-associated alpha Proteobacteria as infecting agents in intensive care units (ICUs).

Design:

Amoeba-associated alpha Proteobacteria were isolated from water samples taken from ICU taps and general hospital reservoir tanks using an amoebal co-culture procedure. Isolates were identified by 16S rDNA gene sequence comparison, and one isolate of each species was used as an antigen in a microimmunofluorescence assay to test the sera of the patients in the ICUs and compare them with those of control subjects.

Setting:

The four university hospitals in Marseilles, France.

Patients:

The sera of 85 patients in the ICUs with nosocomial pneumonia were tested.

Results:

We isolated 64 bacterial strains that were identified asAfipiaspecies or close relatives within the Rhizobiaceae subgroup of alpha Proteobacteria. These bacteria were assigned to 8 different species. Eleven patients were found to have an elevated antibody titer to eitherAfipiagenospecies 1, or 3 still unnamed bacteria. No specific antibodies were detected in 100 control subjects (P<.01).

Conclusion:

These preliminary results support the hypothesis that ICU patients are exposed to amoeba-associated alpha Proteobacteria.
Prevalence and Acquisition of Vancomycin-Resistant Enterococci in a Medical Intensive Care Unit
Authors: Gardiner David , Murphey Sheila , Ossman Elizabeth , Jungkind Donald
Published: February 2006

Patients admitted to a medical intensive care unit during 21 days had rectal and urine samples cultured for vancomycin-resistant enterococci (VRE). The prevalence rate was 55.3%. Only enteral feedings were associated with acquisition of VRE. One-quarter of VRE transmission resulted from acquisition in the study unit, 35% arrived from other units, and 15% from other hospital.
An Outbreak of Vancomycin-Resistant Enterococci in a Hematology–Oncology Unit: Control by Patient Cohorting and Terminal Cleaning of the Environment
Authors: Sample Mary Lu , Gravel Denise , Oxley Cathy , Toye Baldwin , Garber Gary , Ramotar Karam
Published: February 2006

We describe the impact of enhanced infection control interventions on controlling the spread of vancomycin-resistant enterococci (VRE) in our hematology–oncology unit. Between April and September 1998, 13 patients on this unit were identified as having VRE. In addition to contact precautions, other measures that were needed to control the outbreak included closure of the unit to new admissions, creation of a cohort of VRE-positive patients and staff, and thorough cleaning of patients' rooms with 0.5% sodium hypochlorite.
Impact of Infection by Vancomycin-Resistant Enterococcus on Survival and Resource Utilization for Patients With Leukemia
Authors: Bach Peter B. , Malak Sharp F. , Jurcic Joseph , Gelfand Sarah E. , Eagan Janet , Little Claudia , Sepkowitz Kent A.
Published: February 2006

We estimated the impact of vancomycin-resistant Enterococcus (VRE) infection on the outcomes of patients with leukemia in a case-control study. Compared with their matched controls (n = 45), cases (n = 23) had 22% greater total charges and shorter survival (P= .04). These findings substantiate the need for aggressive interventions to prevent VRE transmission.
Undetected Vancomycin-Resistant Enterococcus Stool Colonization in a Veterans Affairs Hospital Using a Clostridium difficile–Focused Surveillance Strategy
Authors: Ray Amy J. , Hoyen Claudia K. , Das Sarbani M. , Eckstein Elizabeth C. , Donskey Curtis J.
Published: February 2006

We examined the point prevalence of undetected vancomycin-resistant Enterococcus (VRE) stool colonization in an institution that screens stool samples submitted for Clostridium difficile testing. Of 112 patients not known to be colonized, 10 (9%) had rectal VRE colonization. A prospective algorithm was effective for identification of colonized patients.
Completely Resistant Acinetobacter baumannii Strains
Authors: Mahgoub Siham , Ahmed Jimi , Glatt Aaron E.
Published: February 2006

Nosocomially acquired completely resistant Acinetobacter baumannii strains are a major clinical concern. We identified completely resistant A. baumannii in 6 (4.9%) of 122 A. baumannii isolates in a retrospective chart review at two teaching hospitals. All of these patients had received broad-spectrum antibiotics and had severe underlying comorbid illnesses, long hospitalizations, or recent surgical procedures; 3 had been in the intensive care unit. Five (83%) of the 6 patients were older than 70 years. Only one death occurred. Strict infection control measures may limit further spread.
Purity of equivalued affine Springer fibers
Authors: Goresky Mark , Kottwitz Robert , MacPherson Robert
Published: February 2006

The affine Springer fiber corresponding to a regular integral equivalued semisimple element admits a paving by vector bundles over Hessenberg varieties and hence its homology is “pure".
CAM for Pediatric Pain: What is State‐of‐the‐Research?
Authors: Tsao Jennie C. I.
Published: February 2006

Previously, we reviewed the evidence for the efficacy of CAM approaches for pediatric pain (volume 2; issue 2; 2005) using criteria developed by the American Psychological Association Division 12 Task Force. Our review focused on CAM modalities that had been tested with at least one controlled trial or multiple baseline study. In addition, only those trials in which children comprised the study sample were included. Thus, several CAM modalities were not included in our review. Key ethical and other reasons for the limited literature on CAM for pediatric pain as well as directions for future studies are discussed.
Brazilian Green Propolis Protects against Retinal Damage In Vitro and In Vivo
Authors: Inokuchi Yuta , Shimazawa Masamitsu , Nakajima Yoshimi , Suemori Shinsuke , Mishima Satoshi , Hara Hideaki
Published: February 2006

Propolis, a honeybee product, has gained popularity as a food and alternative medicine. Its constituents have been shown to exert pharmacological (anticancer, antimicrobial and anti‐inflammatory) effects. We investigated whether Brazilian green propolis exerts neuroprotective effects in the retina in vitro and/or in vivo. In vitro, retinal damage was induced by 24 h hydrogen peroxide (H2O2) exposure, and cell viability was measured by Hoechst 33342 and YO‐PRO‐1 staining or by a resazurin–reduction assay. Propolis inhibited the neurotoxicity and apoptosis induced in cultured retinal ganglion cells (RGC‐5, a rat ganglion cell line transformed using E1A virus) by 24 h H2O2 exposure. Propolis also inhibited the neurotoxicity induced in RGC‐5 cultures by staurosporine. Regarding the possible underlying mechanism, in pig retina homogenates propolis protected against oxidative stress (lipid peroxidation), as also did trolox (water‐soluble vitamin E). In mice in vivo, propolis (100 mg kg−1; intraperitoneally administered four times) reduced the retinal damage (decrease in retinal ganglion cells and in thickness of inner plexiform layer) induced by intravitreal in vivo N‐methyl‐d‐aspartate injection. These findings indicate that Brazilian green propolis has neuroprotective effects against retinal damage both in vitro and in vivo, and that a propolis‐induced inhibition of oxidative stress may be partly responsible for these neuroprotective effects.
Analysis of the Interactions of Botanical Extract Combinations Against the Viability of Prostate Cancer Cell Lines
Authors: Adams Lynn S. , Seeram Navindra P. , Hardy Mary L. , Carpenter Catherine , Heber David
Published: February 2006

Herbal medicines are often combinations of botanical extracts that are assumed to have additive or synergistic effects. The purpose of this investigation was to compare the effect of individual botanical extracts with combinations of extracts on prostate cell viability. We then modeled the interactions between botanical extracts in combination isobolographically. Scutellaria baicalensis, Rabdosia rubescens, Panax-pseudo ginseng, Dendranthema morifolium, Glycyrrhiza uralensis and Serenoa repens were collected, taxonomically identified and extracts prepared. Effects of the extracts on cell viability were quantitated in prostate cell lines using a luminescent ATP cell viability assay. Combinations of two botanical extracts of the four most active extracts were tested in the 22Rv1 cell line and their interactions assessed using isobolographic analysis. Each extract significantly inhibited the proliferation of prostate cell lines in a time‐ and dose‐dependent manner except repens. The most active extracts, baicalensis, D. morifolium, G. uralensis and R. rubescens were tested as two‐extract combinations. baicalensis and D. morifolium when combined were additive with a trend toward synergy, whereas D. morifolium and R. rubescens together were additive. The remaining two‐extract combinations showed antagonism. The four extracts together were significantly more effective than the two‐by‐two combinations and the individual extracts alone. Combining the four herbal extracts significantly enhanced their activity in the cell lines tested compared with extracts alone. The less predictable nature of the two‐way combinations suggests a need for careful characterization of the effects of each individual herb based on their intended use.
Comparative crystallographic and hydrogen-bonding analysis of cholestane derivatives
Authors: Rajnikant  , Dinesh  , Bhavnaish Chand
Published: February 2006

A crystallographic comparison comprised of some geometrical and structural features for a series of steroids (cholestane derivatives) is made in the present paper. Selected bond distances and bond angles of interest are discussed in detail. Conformations of individual ring systems in a series of 28 cholestane derivatives are calculated and discussed. Graphical presentations of ring conformations are made for all the five- and six-membered rings to show the frequency of their occurrence. X—H...A intra- and intermolecular interactions in the identified molecules are discussed with the standard distance and angle cut-off criteria. Distance–angle scatter plots for both kinds of interactions are presented for better understanding of packing interactions existing in cholestane molecules.
Distinction of magnetic non-ferroelastic domains
Authors: Litvin D. B. , Janovec V.
Published: February 2006

It is shown that there always exists a coordinate system in which components of property tensors that distinguish between the domains of a magnetic non-ferroelastic domain pair differ solely in the two domains by a change in sign. The 309 classes of twin laws of magnetic non-ferroelastic domain pairs are listed and the twin laws, which are given in a coordinate system where the tensor distinction is provided by a change in sign of tensor components, are specified. If the twin law is not given in such a coordinate system, then a new coordinate system, related by a rotation, is specified.