bluuebunny/crossref_metadata_2025 huggingface dataset:
Candidiasis
Authors: Stratton Charles W. , Gregory David W.
Published: August 2016

Candidaspecies were once largely regarded merely as causes of aggravating, but rarely life-threatening mucocutaneous infections such as thrush, vulvovaginitis, and intertrigo. Now, however,Candidaspecies have assumed the role of major nosocomial pathogens. This change has paralleled the advent of aggressive cancer chemotherapy, the widespread use of parenteral nutrition, and the practice of advanced surgical techniques including cardiovascular procedures.

Candidais a heterogeneous genus presently grouped with the Fungi Imperfecti (Deuteromycetes). There are over 80 species ofCandida; only seven, however, have been recovered from humans:Candida albicans, Candida tropicalis, Candida pseudotropicalis, Candida guilliermondi, Candida krusei, Candida parapsilosis, andCandida stellatoidea. Approximately 90% the systemicCandidainfections are due toC. albicans; most of the remaining infections are due toC. tropicalis. Candidaspecies are normal commensals of humans. They are commonly found on the skin, in the gastrointestinal tract, sputum, the female genital tract, and urine from catheterized bladders.C. albicansis found only in human beings and in animal reservoirs. In other sites, such as hospital environments,Candidaprobably represents contamination by human excreta. OtherCandidaspecies may be cultured from soil and other environmental locations. UnlikeAspergillusspecies,Candidaspecies are uncommon laboratory contaminants.
Infections in Burned Patients
Authors: Mayhall C. Glen , Polk Ronald E. , Haynes Boyd W.
Published: August 2016

Prevention and treatment of burn wound infection requires knowledge of the epidemiology of such infections. Prevention of infection rests on removal of reservoirs or sources of microorganisms from the burn patient's environment and interruption of transfer of microorganisms to the surface of the wound. When prevention fails and burn wound infection develops, successful therapy may depend on an understanding of the epidemiology of the burn wound during therapy. Contrary to the oft stated concept that antibiotics penetrate the avascular burn wound poorly, our study demonstrated that gentamicin and tobramycin achieved therapeutic concentrations in burn wound tissue. As in other types of infections, susceptible microorganisms were eradicated and resistant microorganisms persisted. Of most importance was the observation that resistant microorganisms may repopulate the wound within four days of starting therapy. It would appear that failure of therapy is not due to failure of antibiotics to penetrate the burn wound but rather to rapid development of superinfection during therapy.
Infections in Organ Transplant Recipients
Authors: Garibaldi Richard A.
Published: August 2016

Since the introduction and widespread performance of transplant surgery in the 1950s and 1960s, infectious complications have been a major cause of morbidity and mortality. The risks of infection are directly related to the potency and duration of immunosuppressive therapies, organ-donor selection, surgical techniques, and postoperative exposures to invasive procedures or treatments.

Despite impressive advancements to decrease the risks of infection, between 40% and 80% of renal transplant patients become infected within the first two or three postoperative years. Infections that occur during the first month following transplantation are often caused by common nosocomial pathogens and are secondary to invasive procedures or therapies. Infections that occur between one and six months post-surgery are often caused by opportunistic pathogens. Symptomatic and subclinical cytomegalovirus (CMV) infections are common during this time and may contribute to a further impairment of host defenses. Late infections involve both opportunistic and conventional pathogens; opportunistic infections occur in patients with poor transplant function who require high levels of immunosuppression and conventional infections occur in patients who require little immunosuppression.

During the past two decades, there has been a significant decrease in deaths from infectious complications among renal transplant recipients. Further reductions in morbidity and mortality will occur with the development of more specific approaches for immunosuppressive therapy, new strategies to prevent CMV infections and methods to eliminate sources of nosocomial infections.
Rationale and Testing of Degerming Procedures
Authors: Reber Hans
Published: August 2016

The rationale of degerming procedures is the elimination of undesirable microorganisms from sites serving as potential starting points for the transmission of infections, eg, secretions, excretions, and vehicles. The significance of transmission of infection is well-established for some sites, such as the hands, but debatable for others such as surfaces. No general agreement exists on the efficacy of the different procedures used to prevent hospital infections. Since frequently multiple factors intervene and the final effect is due to the interaction of several preventative measures, it is very difficult to ascertain the efficacy of any given procedure. However, to prevent the formation of germ depots outside the organism is a classical postulate of hygiene not yet invalidated.

Rationale and testing of degerming procedures are closely linked. From tests one expects an answer, if and to what extent a degerming procedure fulfills the requirement fixed by the rationale.

It is essential to distinguish between the degerming agent as the active principle and the degerming procedure, which is comprised of additional factors in the application.
Training of Personnel for Infection Control
Authors: Crow Sue
Published: August 2016

The overall objectives for implementing an infection control program are to make hospital personnel aware of nosocomial infections and to educate these persons in their role in decreasing the risk of these infections. The infection control practitioner (ICP) implements these objectives by performing surveillance to determine problem areas and by developing policies and procedures that prevent and control nosocomial infections. Appropriate qualities for an ICP include initiative, leadership, communication skills, commitment, and charisma. Expertise in patient care practices, aseptic principles, sterilization practices, education, research, epidemiology, microbiology, infectious diseases, and psychology are acquired skills.

Local, state, and national organizations, as well as universities, are responsible for ICP training. In the US the Centers for Disease Control have established a training program for the beginning ICP and the Association of Practitioners in Infection Control (APIC) has developed a study guide for developing infection control skills. The ultimate responsibility for education is an individual obligation, however. Certification of the ICP would insure a minimum level of knowledge, thereby standardizing and upgrading the practice of infection control.
Three Clusters of Bacillus Pseudobacteremia Related to a Radiometric Blood Culture Analyzer
Authors: Gurevich Inge , Tafuro Patricia , Krystofiak Sharon P. , Kalter Robert D. , Cunha Burke A.
Published: August 2016

During a ten-month period from September 1981 to July 1982 three episodes of pseudobacteremia due to Bacillus species occurred at this 550-bed institution. The first involved eight isolates, the second 11, and the third seven isolates of the organism, all with the same antibiogram.

The patients involved did not exhibit clinical signs of septicemia, and in only one case was more than one specimen per patient positive when multiple blood samples were obtained. Occasional blood cultures of Bacillus species identified in between clusters revealed a different antibiogram.

Extensive epidemiologic investigation of patient locations, phlebotomists, and time of cultures yielded no common source. Components involved in the transport and processing of blood cultures, including the radiometric blood culture processor, were also sampled but without recovery of the organism. After the last episode, a layer of dust was noted inside the machine, and culture of this dust grew Bacillus spp. with the same antibiogram as those found in the blood cultures. The filter from an air conditioning unit in close proximity to the machine grew several species of Bacillus.

It is presumed that Bacillus spores in the dust were introduced into the blood culture bottles following the heat sterilization of the gas sampling (inoculation/removal) needles.

Modification of the cover of the machine was undertaken to prevent access of dust bearing microbes to the inside of the machine. In addition, maintenance now includes regular disinfection/cleaning of the “floor” of the machine, and more frequent changes of the air conditioner filter.
AIDS—Safety Practices for Clinical and Research Laboratories
Authors: Federico John V. , Gershon Robyn R.M.
Published: August 2016

Acquired immunodeficiency syndrome, or AIDS, is currently a significant public health problem receiving widespread interest as both cause and treatment are sought. Indications are that a transmissible agent is involved. Both clinical and research laboratories are receiving greater numbers of specimens from AIDS patients as both prevalence of the condition increases and research efforts intensify. Until such time as the causative agent is identified, prudent practice warrants that a high level of precaution be observed. The Division of Occupational and Environmental Health Services of the Yale University Health Services presents a set of safety procedures and guidelines for use by personnel of both clinical and research laboratory facilities. These exceed previously suggested containment recommendations.
Rubella in Hospital Employees
Authors: Strassburg Marc A. , Stephenson Timothy G. , Habel Laurie A. , Fannin Shirley L.
Published: August 2016

In early 1982, 15 hospitals in Los Angeles County reported one or more serologically confirmed rubella cases among their employees. Secondary cases occurred at eight hospitals; overall, 56 cases were identified among employees, of which 28 were serologically confirmed. Testing of 2,061 employees revealed 1,770 (86%) with detectable antibody. A survey of 83 hospitals offering obstetrical services indicated only 42% (33 of 78) had an established rubella screening policy. Based on the results of this survey, the Los Angeles County Department of Health Services published recommendations for hospital rubella screening and immunization policies.
Brief Report: Nosocomial Infection Rates in a Cancer Treatment Center
Authors: Robinson Gayle V. , Tegtmeier Bernard R. , Zaia John A.
Published: August 2016

This report describes the results of a prospective study of nosocomial infection in 7,714 patients hospitalized during a 24-month period at a cancer treatment center. An overall nosocomial infection rate of 9.3% was observed with site-specific infection rates of 2.6% for urinary tract, 1.9% for surgical wound, 2.2% for bacteremia and 1.9% for respiratory tract infection. Within specific patient groups, the overall nosocomial infection rates observed were: 8.2% in medical patients, 14.9% in surgical patients and 1.5% in pediatric patients. Despite the markedly elevated nosocomial infection rate in surgical patients (P < 0.001), surgical wound infection rates were not unlike those observed in general hospitals: clean—2.4%, clean contaminated—5.8%, contaminated—13.2%, and dirty—11.8%. These observations provide evidence that institutions which provide medical care predominantly for cancer patients can expect to observe higher nosocomial infection rates than general care hospitals.
Risks and Benefits of Vaccinations
Authors: Wiedermann Gerhard , Ambrosch Franz , Kollaritsch Herwig , Kundi Matthias
Published: August 2016

Any medical intervention is expected to prevent sickness and complications of a disease rather than to induce them. This is true for therapy as well as prophylaxis. Special formulas have been developed to calculate the risks and benefits of vaccinations simply but with sufficient accuracy. The risk ratio (Q) tells how many times the risk of contracting certain complications or even death from a disease is greater in unvaccinated than in vaccinated individuals. The risk difference (D) directly expresses the number of complications or deaths that may be prevented by a certain vaccination. It is even possible to evaluate the epidemiologic trend of a disease and to calculate or estimate the point of time when the risks of disease and vaccination are just balanced, ie, when a vaccination has lost its beneficial effect. Vaccinations against measles, poliomyelitis and tick borne encephalitis in Austria are highly beneficial. BCG vaccination is still beneficial on a low level in Austria as far as protection against tuberculosis is concerned. This effect will persist for the rest of this century. The benefit of pertussis vaccination depends on the local epidemiologic situation. It has expired for non-risk groups in Austria since 1976 but continues to persist in the US.
Evaluation of Skin Antisepsis Prior to Blood Culture in Neonates
Authors: Champagne Sylvie , Fussell Susan , Scheifele David
Published: August 2016

In our Intensive Care Nursery, coagulase-negative staphylococcus is the most frequent blood culture isolate. As skin antisepsis is critical in preventing blood culture contamination, we examined the efficacy of the chlorhexidine tincture (CH) used in our nursery for this purpose.Staphylococcus epidermidiscolonized the forearms of 88% of infants tested, in a mean density of 104 organisms/cm2. Following a 60-second application of CH (0.5% in 70% ethanol), bacterial growth from forearm skin remained abundant in 15/38 infants (39.4%). Cleansing with 70% isopropyl alcohol, followed by CH as above, left abundant residual growth in only 1/37 infants (2.7%) (P<0.001). All 136S. epidermidistested were susceptible to CH (MIC<5(μg/ml) and 14 of 15 exposed to CH 0.02% were rapidly killed (≥98% fall in viable counts within 90 sec). We conclude that two-phase antisepsis using isopropanol followed by CH is a more effective preparation for blood culture in neonates than is CH alone.
A Multivariate Analysis of Risk Factors for Acquiring Bacteriuria in Patients With Indwelling Urinary Catheters for Longer Than 24 Hours
Authors: Shapiro Mervyn , Simchen Elisheva , Izraeli Shai , Sacks Theodore G.
Published: August 2016

Data related to risk factors for catheter-acquired bacteriuria were collected prospectively on 112 patients consecutively catheterized for >24 hours at the Hadassah University Hospital. Logistic regression analysis indicated that factors independently associated (p≤0.05) with a higher risk of catheter-acquired bacteriuria were as follows: hospitalization in orthopedics or urology, ethnic origin (Arabs > Jews), insertion of a catheter after the sixth day of hospitalization, catheterization outside the operating theaters, lack of administration of systemic antibiotics, unsatisfactory catheter care, and prolonged duration (≥7 days) of catheterization before infection occurred. The risk associated with catheterization outside the operating theater could be explained by its correlate, that is, catheterization for incontinence/obstruction as opposed to output measurement. Life-table analyses demonstrated that the daily risk for acquiring bacteriuria during the first six days of catheterization was higher among patients ultimately catheterized for ≥7 days than among those ultimately catheterized for < 7 days (P<0.05).
Infection Control and the Hospitalized AIDS Patient
Authors: Adams Audrey , Lowy Franklin D.
Published: August 2016

Acquired immunodeficiency syndrome (AIDS) has created new and difficult challenges for infection control services. Limited information on the pathogenesis and means of transmission coupled with the reported high mortality rates of this disease, have heightened public fears about the potential risks resulting from exposure to AIDS. Hospitalization of these patients, with the attendant responsibilities for their care by hospital personnel, has served to focus and amplify these public concerns in a relatively small and inter-related community. The result, in some hospitals, has been an increase in incidents which interfere with the proper care of AIDS patients. While a great deal has been written about the appropriate precautions recommended for the care of these patients, little attention has been focused on the practical problems encountered within the institution of these policies and within the education of the concerned and relatively uninformed hospital community. The success of such a program is essential to assure the proper care of these patients. The purpose of the present report is to summarize the experience at our institution and to outline the approach adopted by the Infection Control Unit to deal with these problems.
How Frequent Are Outbreaks of Nosocomial Infection in Community Hospitals?
Authors: Haley Robert W. , Tenney James H. , Lindsey James O. , Garner Julia S. , Bennett John V.
Published: August 2016

A statistical algorithm was used to identify potentially important clusters among nosocomial infections reported each month by 7 community hospitals. Epidemiologic review and on-site investigations distinguished outbreaks of clinical disease from factitious clusters. In 1 year, 8 outbreaks were confirmed. They involved 82 patients—approximately 2% of patients with nosocomial infections and 0.09% of all discharges. One true outbreak occurred for every 12,000 discharges—at least 1 outbreak per year for the average community hospital. Five (63%) outbreaks were recognized independently by the hospitals' infection control personnel. Four (50%) resolved spontaneously; the hospitals' own control measures were necessary in 2; and 2 resolved only after an outside investigation. Organized surveillance appears necessary to detect some outbreaks, and control measures are needed to stop many. Since, however, outbreaks account for such a small proportion of nosocomial infections, infection control programs should be sufficiently staffed and managed so that most of the effort is directed toward the surveillance and control of endemic infection problems, but with adequate resources remaining to respond to outbreaks when they occur.
Training of Personnel for Infection Control in Germany
Authors: Thimm Bernhard M.
Published: August 2016

Since the epochal observations of Ignaz Semmelweis in Vienna in 1847 that the hospital personnel are one of the major carriers and transmitters of hospital-acquired infections, and that relatively simple techniques and behavioral standards can prevent it, European physicians and nurses have fluctuated in the degree of importance they have given to hospital infection control.
Occupational Risk of Hepatitis B Infection in Hospital Workers
Authors: Hadler Stephen C. , Doto Irene L. , Maynard James E. , Smith Joseph , Clark Brian , Mosley James , Eickhoff Theodore , Himmelsbach Clifton K. , Cole William R.
Published: August 2016

To estimate the risk of hepatitis B virus (HBV) infection among hospital workers, we measured the prevalence of HBV infection in employees in five hospitals in different parts of the country and examined the effect of occupational and non-occupational factors on HBV prevalence. Among 5,697 persons studied, serologic markers of HBV infection were found in 807 (14%). Prevalence of infection was strongly related to race (Asian > Black > White), sex (male > female) and increasing age.

Risk related to health occupation, studied by examining the change in HBV prevalence with duration in occupational group, was most strongly correlated with frequency of contact with blood during work. Workers having frequent blood contact had the highest estimated infection rate (1.05 per 100 person-years) and those with moderate contact an intermediate infection rate, compared to a negligible infection rate in workers with no blood contact. Frequency of needle accidents had an independent, positive effect on HBV infection rates, while degree of patient contact had no effect. Infection risk was uniform among all hospitals for groups with frequent blood contact. Among different occupation groups, risk of HBV infection also correlated closely with degree of blood-needle contact during daily work. This study provides a general approach to assessing risk of HBV infection in hospital personnel, and indicates that risk may be most easily estimated by quantitating degree of blood-needle contact during daily work.
Resistance to Antibiotics in Clinical Isolates of Klebsiella pneumoniae
Authors: F. O'Brien Thomas , Mayer Kenneth H. , Hopkins John D. , Farrell John J. , Chao Lee , Kent Ralph L.
Published: August 2016

The antibiotic resistance of Klebsiella pneumoniae isolates from 12 medical centers worldwide, over a 1- to 6-year period, were tested. Clinical isolates of K. pneumoniae were resistant to ampicillin and carbenicillin. Resistance to other antibiotics was less frequent with isolates of K. pneumoniae from 5 of 6 US centers than with those from 6 centers outside the US. In nearly all of the centers, resistance to sulfamethoxazole-trimethoprim, gentamicin, tobramycin, or chloramphenicol was more frequent in isolates of K. pneumoniae than in those of Escherichia coli, while the reverse was true for resistance to tetracycline. Resistance to multiple antibiotics declined gradually in isolates of K. pneumoniae at one center, but rose abruptly again with dissemination of a new plasmid.
The Control of Infection in General Surgery: A Four-Year Prospective Study in Brazil
Authors: Ferraz Edmundo M. , Lima José F. Correa , Porfirio Lourdes , Kelner Salomão
Published: August 2016

Infection is an inherent complication in surgery. The high cost, the morbidity and the mortality to which it gives rise require that an effort be made to reduce its incidence. The control of the rates of infection constitutes today a parameter of the quality of the service provided by a hospital. In Brazil the unstructured nature of the vast majority of hospitals makes the recording of hospital infection and any attempt to control it a difficult task.

Isolated studies have appeared in the Brazilian literature such as those of Hultzler et al on data from the São Paulo University Hospital, Zanon et al2 from Ipanema Hospital, Rio de Janeiro, and Ferraz et al from the Federal University of Pernambuco Teaching Hospital. Hultzler et al reported in 1973 that the incidence of acquired infection in the patients admitted to the São Paulo University Hospital was 5.95%. The overall rate of post-operative infection in 4,746 operations performed was 6.59%, while that of wound infection was 3.08%.

In 1979 Zanon et al reported a 7.5% incidence of wound infection in the Division of General Surgery at Ipanema Hospital (Rio de Janeiro).

In 1980 the National Enquiry on Post-Operative Infection was organized under the auspices of the Brazilian College of Surgeons. A questionnaire was sent to 3,225 members of the College throughout the country. Of the 107 questionnaires duly completed and returned (3.31%) only 86 (2.66%) reported controlling infection, and of these, 61 (1.89%) included the outpatient department within the scope of their control of infection. Only 20 of the 107 questionnaires returned gave what were considered answers with regard to surgical wound infection.
A Randomized Study Comparing a Transparent Polyurethane Dressing to a Dry Gauze Dressing for Peripheral Intravenous Catheter Sites
Authors: Craven Donald E. , Lichtenberg Deborah A. , Kunches Laureen M. , McDonough Ann T. , Gonzalez Maria I. , Heeren Timothy C. , McCabe William R.
Published: August 2016

We studied rates of peripheral intravenous (IV) catheter tip and insertion site colonization after randomly assigning patients to transparent polyurethane (TP) dressings (N=316) or dry gauze (DG) dressings (N=421). The study was conducted during both summer and fall seasons, in a facility which lacked air conditioning. All patients had a teflon plastic catheter inserted, maintained and cultured by a member of the IV therapy team; no antibiotic or antiseptic ointments were used. Colonization rates were higher in the summer than in the fall for both catheter tips (9.0% vs 3.5%, p=0.005) and sites (21.6% vs 7.0%, p=0.001). During the summer season, the rate of catheter tip colonization with TP dressings was nearly twice that of DG dressings (12.4% vs 6.8%, p=0.04). Logistic regression analysis indicated that catheter tip colonization was associated with the summer season (odds ratio=3.0, 95% CI 1.4-6.2) and TP dressings (odds ratio=1.8, 95% CI 1.1-3.2), and that site colonization was associated with both summer (odds ratio=4.0, 95% CI 2.2-7.1) and receipt of antibiotics (odds ratio=1.9, 95% CI 1.1-3.2). Coagulase-negative staphylococci were isolated from 55.5% of the colonized catheter tips and insertion sites. The data suggest that bacterial colonization of peripheral IV catheters is increased in summer, and that use of TP dressings may increase both tip colonization and cost nearly twofold.
Pool-Associated Pseudomonas aeruginosa Dermatitis and Other Bathing-Associated Infections
Authors: Jacobson Jay A.
Published: August 2016

The growing popularity of heated pools, especially whirlpools and hot tubs, has been accompanied by increasingly frequent oubreaks of an illness produced by Pseudomonas aeruginosa. The illness usually includes folliculitis, pruritic skin rash, and/or otitis externa and occasionally mastitis and systemic symptoms. Although usually self-limited, rare severe cases have been described. Motel and hotel whirlpools are most often implicated as the source of outbreaks. The relative importance of pool conditions and the bacteriology of P. aeruginosa in the pathogenesis of this illness remain to be elucidated. Implementing CDC Guidelines for public spas and hot tubs seem the most reasonable way of reducing the risk of large outbreaks. Prevention of cases arising from home hot tubs or whirlpools will be very difficult and may depend on extensive public education or the development of simple, inexpensive and effective disinfection systems.
Infection Control and Employee Health: AIDS Update Part 2
Authors: Valenti William M.
Published: August 2016

The Acquired Immune Deficiency Syndrome (AIDS) continues to perplex health care providers. As our knowledge has increased, so has the number of questions, especially those related to infection control and employee health. Since the last time AIDS was reviewed in this column, additional information has become available which elaborates on some of the infection control aspects of this disease.

The human T-cell lymphotropic retrovirus (HTLV-III) appears to be the cause of AIDS. Other names used for HTLV-III are lymphadenopathy-associated virus (LAV) and AIDS-associated retrovirus. So called co-factors may be necessary to initiate disease after an individual acquires HTLV-III infection. Agents such as cytomegalovirus, the Epstein-Barr virus and multiple exposures to HTLV-III have been suggested as possible cofactors. Only a relatively small percentage of individuals who acquire HTLV-III antibody eventually develop overt disease or “full-blown AIDS.” Studies to date have shown that after 1 to 5 years of follow-up, 4% to 19% of seropositives developed AIDS.

In addition, the spectrum of disease caused by HTLV-III appears to be broader than originally thought. An additional 25% of those with antibody may have developed AIDS-related diseases including neurological symptoms, fever, weight loss, diarrhea, oral candidiasis and lymphadenopathy during the follow-up period.
Topics in Clinical Microbiology: Pseudomonas cepacia
Authors: Stratton Charles W. , Gregory William J. , McNabb Paul C.
Published: August 2016

Pseudomonas cepaciawas first reported in the literature by Burkholder as a phytopathogen responsible for sour skin, a disease of onion bulbs. Similar bacteria were isolated from other sources and given various names includingPseudomonas multivorans, Pseudomonas kingii,and EO-1. The synonymy of these organisms withP. cepaciawas eventually established. The first descriptions of human disease due toPseudomonas cepaciawere two reports of infective endocarditis. Subsequently, a series of postoperative urinary tract infections secondary to contaminated disinfectant solution were reported andP. cepaciabecame identified as a cause of nosocomial infection.P. cepaciahas demonstrated a low level of virulence and invasiveness in the general population, but it has been shown to cause severe infection in patients with underlying diseases. Moreover, its nutritional versatility and ability to survive in antiseptic solutions make it a superb agent for causing hospital-acquired infection.
Clinical Pharmacology of Antibiotics: Review of Imipenem
Authors: Eggleston Mark , Park Soon-young , Parker Richard H.
Published: August 2016

Imipenem, a new carbapenem ß-lactam broad-spectrum antibiotic, is highly active in vitro against most aerobic and anaerobic gram-positive and gram-negative bacteria isolated from infectious diseases of human beings. Except for enterococci and methicillin-resistant staphylococci most gram-positive cocci are inhibited by <2 μg/ml. Although the MIC-90 of methicillin-resistant staphylococci may be <4 μg/ml, these bacteria are usually resistant to imipenem by modified testing methods. The enterococcus, S. faecalis, has an MIC-90 of <8 μg/ml but bactericidal concentration may be much higher. Most Enterobacteriaceae are highly susceptible to imipenem with MIC-90 of 0.5 to 2.0 μg/ml. Proteus species are less susceptible with MICs of 4 to 8 μg/ml. Isolates of P. aeruginosa have variable susceptibility with MICs ranging from 0.25 to 16 μg/ml. Pseudomonas maltophilia and P. cepacia are usually resistant to imipenem. Except for Clostridium species, most strict anaerobes are susceptible to <1.0 μg/ml of imipenem. When combined with cilastatin (1:1 ratio), the renal elimination of the active form is increased. The serum half-life in normal renal function is about 1 hour and increases to 3.4 hours in anuria. Major adverse effects are similar to those of cephalosporins except for seizures in some patients. Colonization with fungi and drug-resistant bacteria occurs in about 5% of imipenem-treated patients. Clinical studies have demonstrated efficacy in 79% to 96% of patients treated.
Wound Infection After Cesarean Section
Authors: Pelle Hedvig , Jepsen Ole B. , Larsen Severin O. , Bo Jens , Christensen Flemming , Dreisler Anne , Jørgensen Per J. , Kirstein Annette , Kjøller Morten , Lange Aksel , Laursen Kjeld , Nickelsen Carsten N.A. , Osler Mogens , Rasmussen Helen
Published: August 2016

A prospective multicenter study of 1,032 cesarean sections was performed to identify risk factors for postoperative wound infection. The overall rate of wound infection was 6.6% (3.8% in elective cases and 7.5% following nonelective operations), with considerable interhospital variation. Obesity was recognized as a patient-related risk factor, while risk factors inherent to the obstetric situation were duration of ruptured membranes prior to operation, fetal and labor monitoring by intrauterine devices, and omission of the use of plastic draping and redisinfection of the skin before closure. Logistic regression analysis was used to estimate the influence of these factors on the probability of wound infection. Certain risk factors associated with and overrepresented in nonelective operations would explain the increased infection rates in these, and the observed interhospital variations did not differ from the expected rates when the distribution of other risk factors was considered.
Plasmid Analysis of Simultaneous Nosocomial Outbreaks of Methicillin-ResistantStaphylococcus aureus
Authors: Kozarsky Phyllis E. , Rimland David , Terry Pamela M. , Wachsmuth Kaye
Published: August 2016

A large outbreak of infections caused by methicillin and aminoglycoside resistantStaphylococcus aureusprovided the opportunity to evaluate mechanisms of resistance and compare the usefulness of typing systems. Between January 1979 and December 1980, 63 patients developed infections with Saureusresistant to multiple antibiotics, including methicillin and tobramycin. All isolates had an identical antibiogram and were phage type 47/54/75/77/83A. Beginning in January 1981, a superimposed outbreak caused by Saureusof the same phage type but with a resistance pattern now including gentamicin occurred. The two strains contained different aminoglycoside inactivating enzymes. The initial strain contained a single plasmid of 21.5 mDa molecular weight, whereas the subsequent strain which had acquired gentamicin resistance contained this plasmid plus a heavier one of 33 mDa. Plasmid analysis complements the analysis of antibiograms and phage types and aids in defining epidemiologic patterns of transmission.
Other Approaches to the Prevention of Aspergillosis
Authors: Speller David C.E.
Published: August 2016

Disseminated aspergillosis in the compromised host is an important and intractable problem in Great Britain, having a general incidence, when post-mortem data are included, approaching that quoted for the United States. It emerges as a most important cause of death in units where prolonged granulocytopenia accompanies treatment.

Rhame has presented a persuasive account of the environmental origin of aspergillus infection and the possibility of its control by environmental measures. This is an important issue for those involved in the planning of new units, for the use of protective isolation is under criticism as failing to provide significant benefit, and even general provision of filtered air to the unit may be beyond the budget allowed. We have to consider the minimum necessary measures to reduce the risk. Providing HEPA-filtered air to the unit may not be sufficient in itself; British heart transplant patients have died of aspergillosis (A. fumigatus), in some cases initiated soon after surgery, despite nursing in rooms with filtered ventilation (Newsom SWB, personal communication); and respiratory ventilators have been suspected as one source within such a unit. We also have to consider other approaches to the problem. Is there an endogenous element in the production of aspergillosis? Is there any prospect of successful chemoprophylaxis?
Group B Streptococcus
Authors: Easmon Charles S.F.
Published: August 2016

Over the past 25 years group B streptococci have become established as one of the main bacterial pathogens of the neonate in Western Europe and the United States. The attack rate of 0.25/1,000 live births found by Mayon White in Great Britain1 appears typical of many European countries. However, in some centers in the United States attack rates can be over 10 times higher.

Two types of neonatal group B streptococcus (GBS) diseases exist, “early” and “late” onset. Early onset disease usually presents within the first few days of life. Often the most serious infections are present at birth or seen within a few hours. Early onset disease presents with pneumonia, respiratory distress and shock. Bacteremia is normally present and meningitis may occur. Mortality is high (50% to 75%). The portal of entry is probably the respiratory tract. Infants normally acquire the infecting organism from their mothers. Heavy maternal and infant colonization, prolonged rupture of membranes, prematurity, and obstetric complications are all risk factors.

Delayed onset disease, as its name suggests, presents after the first week of life, primarily with bacteremia and meningitis. Mortality is much lower than for the early onset form, but still appreciable for a bacterial infection (14% to 18%). Its epidemiology is uncertain.
A Study on the Incidence of Postoperative Infections and Surgical Sepsis in a University Hospital
Authors: Ortona Luigi , Federico Giovanni , Fantoni Massimo , Pallavicini Federico , Ricci Francesco , Antinori Andrea
Published: August 2016

Reported are the results of a study on the incidence of nosocomial surgical infections in ten wards of the university hospital A. Gemelli, Rome. One thousand, five hundred five patients were studied and the overall incidence of surgical infections was 8.7%. Factors that influenced infection rates included age, immunosuppressive diseases, and immunosuppressive therapy. We assessed the inutility of antibiotic prophylaxis in clean operations and its usefulness in clean operations with insertion of prostheses or other devices. The importance of the duration of preoperative hospitalization and of the length of the operation were also noted. The most frequent etiological agents proved to be Pseudomonas aeruginosa, Staphylococcus aureus, and Escherichia coli. The average hospital stay for patients with surgical infection was more than double that of patients with no infection (25.7 days v 11.7 days).
Hospital Infection Control in Sweden
Authors: Nyström Bertil
Published: August 2016

Sweden is divided into 23 counties, each governed by a county council. Among many other things the county council is by law responsible for health, medical, and dental care for the inhabitants of the county, which means that virtually all hospitals are owned and run by the counties. There are very few private hospitals. The counties also run primary care outpatient centers. There are private practitioners in the larger cities, but only some 5% of physicians work full-time in private practice. However, more than 50% of dentists are in private practice.
“The Coccus-Conscious” or “The Conscious Careful”
Authors: Brown Albert F. , Otterman Joan L.
Published: August 2016

Staphylococcus aureus continues to be a resilient and persistent problem for hospital infection control programs. Now methicillin-resistant S. aureus (MRSA) is emerging as an even more formidable foe, bringing with it controversies in laboratory reporting, treatment, and isolation strategies.

History suggests that the best solution to the hospital bacteria problem may well lie in the realm of spirit more than material methods. So, in the manner of Dickens' Christmas Carol fantasy, let us travel with three spirits— the Spirit of Conscience Past, the Spirit of Conscience Present, and the Spirit of Conscience to Come.
Impact of a Rigid, Puncture Resistant Container System Upon Needlestick Injuries
Authors: Ribner Bruce S. , Landry Martha N. , Gholson Gail L. , Linden Lisa A.
Published: August 2016

Needlestick injuries in a 720-bed tertiary care hospital were analyzed before and after the introduction of a rigid, puncture resistant, needle disposal system. Following implementation of the system, disposal-related injuries decreased from 0.9 per 100 full-time equivalent employees/year to 0.3 per 100 full-time equivalent employees/year (p <.005). However, needlesticks associated with procedures (2.2 vs. 4.4 per 100 full-time equivalent employees/year, p <.0005), and those resulting from loose needles (0.5 vs. 1.9 per 100 full-time equivalent employees/year, p <.0005), increased. Injuries occurring during needle recapping or the carrying of needles were not significantly altered. Total needlestick injuries increased from 6.0 to 8.7 per 100 full-time equivalent employees/year (p <.0005).

We concluded that a rigid, puncture resistant, needle disposal system can reduce disposal-related needlestick injuries, but must also be perceived as convenient to impact substantially upon needlesticks associated with other activities.
The Hygienic Situation in 56 German, 33 Austrian, and 25 Belgian Intensive Care Units
Authors: Benzer H. , Brühl P. , Dietzel W. , Kilian J. , Lackner F. , Reybrouck G. , Rotter M. , Werner G.
Published: August 2016

The intensive care unit (ICU) creates the unique situation of subjecting highly susceptible patients to a variety of invasive procedures that are concentrated in a small unit. Effectively providing life-saving care is considered more important than other measures, such as infection control. Nevertheless, it is frustrating to lose a patient due to a sepsis that could have been prevented by simple hygienic arrangements, the application of aseptic techniques, and infection control measures. There is some confusion about the necessity and efficacy of many of these prescriptions, and some of them must certainly be considered rituals: only controlled studies demonstrating the influence of the specific measure on the infection rate will give a decisive answer about usefulness. Most factors determining the occurrence and transmission of infections lie with the patient's resistance and treatment, but technical, diagnostic, and curative measures may also influence the infection rate. Facilities, techniques followed, and prescribed procedures may differ from hospital to hospital. If we want to draw a conclusion from the comparison of infection rates in different ICUs, it is desirable to compare not only the different preventive measures in nursing procedures and techniques, but also the organization and structure of the units. Therefore, our committee decided to study the hygienic situation of ICUs before elaborating a practicable and valuable system for the registration of nosocomial infections. The study was not limited to the small group of interested teaching hospitals with high standards, but rather, was extended to all Austrian (A) ICUs and a significative sample of German (D) and Belgian (B) ICUs.
Agents for the Treatment of Pseudomonas aeruginosa Infections
Authors: Eggleston Mark
Published: August 2016

Pseudomonas aeruginosa is the most common pathogen of Pseudomonas species. One of the most virulent organisms pathogenic to man, P aeruginosa can cause a variety of infections in humans. Despite the introduction of many new antimicrobial agents with enhanced activity against P aeruginosa, the high mortality rate associated with the organism over the past two decades continues.
Surveillance Objectives: Descriptive Epidemiology
Authors: Rhame Frank S.
Published: August 2016

This paper addresses the problems associated with defining and classifying events as nosocomial infections, discusses the methods by which rates of nosocomial infection are calculated and their rationales, and presents some specific rates useful in nosocomial epidemiology. Previously unpublished data demonstrate important differences between antibiotic susceptibility tallies produced by clinical laboratories and similar tallies derived from nosocomial infection surveillance data.

Conversion of real world events into categorical data presents formidable difficulties. Surveillance personnel must classify a given series of clinical events as 0,1, or more infections and make a determination as to whether each infection is nosocomial or community acquired. High-quality research studies to validate these efforts should compare the sensitivity and specificity of methods used to some “gold standard.” The gold standard is usually a review of medical records or patients by an infectious diseases physician. But even the standard is flawed. In clinical practice this flaw presents less of a problem because therapy for infectious diseases is generally quite safe and may be instituted when the probability of infection is 10%, 5%, or even lower. For surveillance purposes a higher standard is required, which is particularly important when surveillance information is used to provide feedback data to physicians who understandably bridle at overestimates of infection rates in their patients. The overestimation of infections based on weak evidence under-cuts feedback efforts.
Lessons Learned from Implementing Clostridium difficile-Focused Antibiotic Stewardship Interventions
Authors: Ostrowsky B. , Ruiz R. , Brown S. , Chung P. , Koppelman E. , van Deusen Lukas C. , Guo Y. , Jalon H. , Sumer Z. , Araujo C. , Sirtalan I. , Brown C. , Riska P. , Currie B.
Published: August 2016

Objective.

To determine whether controlling the prescription of targeted antibiotics would translate to a measurable reduction in hospital-onset Clostridium difficile infection (CDI) rates.

Design.

A multicenter before-and-after intervention comparative study.

Setting/Participants.

Ten medical centers in the greater New York region. Intervention group comprised of 6 facilities with early antimicrobial stewardship programs (ASPs). The 4 facilities without ASPs made up the nonintervention group.

Interventions/Methods.

Intervention facilities identified target antibiotics using case-control studies and implemented ASP-based strategies to control their use. Pre- and postintervention hospital-onset CDI rates and antibiotic consumption were compared for a 20-month period from June 2010 to January 2012. Antibiotic usage was compared using defined daily dose, days of therapy, and number of courses prescribed. Comparisons used bivariate and regression techniques.

Results.

Intervention facilities identified piperacillin/tazobactam, fluoroquinolones, or cefepime (odds ratio, 2.0-9.8 in CDI case patients compared with those without CDI) as intervention targets and selected several interventions (all included a component of audit and feedback). Varying degrees of success were observed in reducing antibiotic consumption over time. Total target antibiotic use significantly decreased (P < .05) when measured by days of therapy and number of courses but not by defined daily dose. Intravenous moxifloxacin and oral ciprofloxacin use showed significant reduction when measured by defined daily dose and days of therapy (P ≤ .01). Number of courses with all forms of these antibiotics was reduced (P ≤ .005). Intervention hospitals reported fewer hospital-onset CDI cases (2.8 rate point difference) compared with nonintervention hospitals; however, we were unable to show statistically significant decreases in aggregate hospital-onset CDI either between intervention and nonintervention groups or within the intervention group over time.

Conclusions.

Although decreases in target antibiotic consumption did not translate into reductions of hospital-onset CDI in this study, many valuable lessons (including implementation strategies and antibiotic consumption measures) were learned. The findings can inform potential policy decisions regarding incorporating control of CDI and ASP as healthcare quality measures.
Manual Methods Are Suboptimal Compared With Automated Methods for Cleaning of Single-Use Biopsy Forceps
Authors: Alfa M. J. , Nemes R. , Olson N. , Mulaire A.
Published: August 2016

Objective.

Most reusable biopsy forceps and all of the currently available single-use biopsy forceps do not have a port that allows fluid flow down the inner tubular shaft of the device. Reusable biopsy forceps are widely used and reprocessed in healthcare facilities, and single-use biopsy forceps are reprocessed either in-house (eg, in Canada and Japan) or by third-party reprocessors (eg, in the United States). The objective of this study was to determine the cleaning efficacy of automated narrow-lumen sonic irrigation cleaning, sonication-only cleaning, and manual cleaning for biopsy forceps.

Design.

A simulated-use study was performed by inoculating the inner channel of single-use biopsy forceps with artificial test soil containing both Enterococcus faecalis and Geobacillus stearothermophilus at concentrations of 106 colony-forming units per milliliter. The cleaning methods evaluated were manual cleaning, sonication-only cleaning, and “retroflush” cleaning by an automated narrow-lumen irrigator. Bioburden and organic soil reduction after washing was evaluated. Forceps used in biopsies of patients were also tested to determine the worst-case soiling levels.

Results.

Only retroflush irrigation cleaning could effectively remove material from within the shaft portion of the biopsy forceps: it achieved an average reduction of more than 95% in levels of protein, hemoglobin, carbohydrate, and endotoxin. However, even this method of cleaning was not totally effective, as only a 2 log10 reduction in bioburden could be achieved, and there were low residual levels of hemoglobin and carbohydrate.

Conclusion.

The data from this evaluation indicate that manual and sonication-only cleaning methods for biopsy forceps were totally ineffective in removing material from within the biopsy forceps. Even the use of retroflush cleaning was not totally effective. These findings suggest that in-hospital reprocessing of biopsy forceps with currently available equipment and cleaning methods is suboptimal.