bluuebunny/crossref_metadata_2025 huggingface dataset:
Spread of Methicillin-ResistantStaphylococcus aureus(MRSA) Among Household Contacts of Individuals With Nosocomially Acquired MRSA
Authors: Calfee David P. , Durbin Lisa J. , Germanson Teresa P. , Toney Denise M. , Smith Elise B. , Farr Barry M.
Published: March 2006

Objective:

To determine the frequency with which methicillin-resistantStaphylococcus aureus(MRSA) is spread from colonized or infected patients to their household and community contacts.

Design:

Retrospective cohort study.

Setting:

University hospital.

Participants:

Household and community contacts of MRSA-colonized or -infected patients for whom MRSA screening cultures were performed.

Results:

MRSA was isolated from 25 (14.5%) of 172 individuals. Among the contacts of index patients who had at least one MRSA-colonized contact, those with close contact to the index patient were 7.5 times more likely to be colonized (53% vs 7%; 95% confidence interval, 1.1 to 50.3;P= .002). An analysis of antimicrobial susceptibility and DNA fingerprint patterns suggested person-to-person spread.

Conclusions:

MRSA colonization occurs frequently among household and community contacts of patients with nosocomially acquired MRSA, suggesting that transmission of nosocomially acquired MRSA outside of the healthcare setting may be a substantial source of MRSA colonization and infection in the community.
Epidemiology of Methicillin-Resistant Staphylococcus aureus at a Children's Hospital
Authors: Campbell Andrew L. , Bryant Kristina A. , Stover Beth , Marshall Gary S.
Published: March 2006

Objective:

To describe the relative contribution of and risk factors for both community-acquired and nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections.

Design:

Retrospective cohort study.

Setting:

270-bed, tertiary-care children's hospital.

Participants:

All MRSA-infected children from whom MRSA was recovered between October 1, 1999, and September 30, 2001.

Methods:

Demographic, clinical, and risk factor data were abstracted from medical records. Categorical variables were analyzed using the chi-square or Fisher's exact test and continuous variables were analyzed using the Mann-Whitney test.

Results:

Of the 62 patients with new MRSA infection, 37 had community-acquired MRSA and 25 had nosocomial MRSA. Most community-acquired MRSA infections were of the skin and soft tissue, the middle ear, and the lower respiratory tract. Nosocomial MRSA infections occurred in the lower respiratory tract, the skin and soft tissue, and the blood. Risk factors for infection, including underlying medical illness, prior hospitalization, and prior surgery, were similar for patients with community-acquired MRSA and nosocomial MRSA. History of central venous catheterization and previous endotracheal intubation was more common in patients with nosocomial MRSA. Only 3 patients with community-acquired MRSA had no identifiable risk factor other than recent antibiotic use. Resistance for clindamycin, erythromycin, and levofloxacin was similar between strains of community-acquired MRSA and nosocomial MRSA.

Conclusions:

Similarities in patient risk factors and resistance patterns of isolates of both community-acquired and nosocomial MRSA suggest healthcare acquisition of most MRSA. Thus, classifying MRSA as either community acquired or nosocomial underestimates the amount of healthcare-associated MRSA.
Changing Epidemiology of Community-Onset Methicillin-Resistant Staphylococcus aureus Bacteremia
Authors: Johnson Leonard B. , Bhan Arti , Pawlak Joan , Manzor Odette , Saravolatz Louis D.
Published: March 2006

Objectives:

To review cases of community-onset Staphylococcus aureus bacteremia and to evaluate whether the risk factors and epidemiology of methicillin-resistant S. aureus (MRSA) bacteremia have changed from early reports.

Design:

Retrospective case-comparison study of community-onset MRSA (n - 26) and methicillin-susceptible S. aureus (MSSA) (n = 26) bacteremias at our institution.

Setting:

A 600-bed urban academic medical center.

Patients:

Twenty-six patients with community-onset MRSA bacteremia were compared with 26 patients with community-onset MSSA bacteremia. Molecular analysis was performed on S. aureus isolates from the 26 MRSA cases as well as from 13 cases of community-onset S. aureus bacteremia from 1980 and 9 cases of nosocomial S. aureus bacteremia from 2001.

Results:

The two groups were similar except that patients with MRSA bacteremia were more likely to have presented from a long-term-care facility (26.9% vs 4%; P = .05) and to have had multiple admissions within the preceding year (46% vs 15%; P = .03). Clamped homogeneous electric fields analysis of MRSA isolates from 1982 revealed predominantly that one clone was the epidemic strain, whereas there were 14 unique strains among current community-onset isolates. Among current nosocomial isolates, 3 patterns were identified, all of which were present in the community-onset cases.

Conclusions:

Previously described risk factors for MRSA acquisition may not be helpful in predicting disease due to the polyclonal spread of MRSA in the community. Unlike early outbreaks of MRSA in patients presenting from the community, current acquisition appears to be polyclonal and is usually related to contact with the healthcare system.
Prevalence of and Risk Factors for Colonization With Methicillin-ResistantStaphylococcus aureusat the Time of Hospital Admission
Authors: Jernigan John A. , Pullen Amy L. , Flowers Laura , Bell Michael , Jarvis William R.
Published: March 2006

Objectives:

To determine the prevalence of methicillin-resistantStaphylococcus aureus(MRSA) colonization among patients presenting for hospital admission and to identify risk factors for MRSA colonization.

Design:

Surveillance cultures were performed at the time of hospital admission to identify patients colonized with S.aureus.A case-control study was performed to identify risk factors for MRSA colonization.

Setting:

A tertiary-care academic medical center.

Patients:

Adults presenting for hospital admission (N = 974).

Results:

S.aureuswas isolated from 205 (21%) of the patients for whom cultures were performed. Methicillin-sensitive S.aureuswas isolated from 179 (18.4%) of the patients, and MRSA was isolated from 26 (2.7%) of the patients. All 26 MRSA-colonized patients had been admitted to a healthcare facility in the preceding year, had at least one chronic illness, or both. In multivariate analyses comparing MRSA-colonized patients with control-patients, admission to a nursing home (odds ratio [OR], 16.5; 95% confidence interval [CI95], 1.4 to 192.1;P= .025) or a hospitalization of 5 days or longer during the preceding year (OR, 3.91; CI95, 1.1 to 13.9;P= .035) were independent predictors of MRSA colonization.

Conclusions:

Patients colonized with MRSA admitted to this hospital likely acquired the organism during previous encounters with healthcare facilities. There was no evidence that MRSA colonization occurs commonly among low-risk individuals in this community. These data suggest that evaluation of recent healthcare exposures is essential if true community acquisition of MRSA is to be confirmed.
Community-Acquired Methicillin-Resistant Staphylococcus aureus: An Emerging Pathogen
Authors: Saïd-Salim Battolili , Mathema Barun , Kreiswirth Barry N.
Published: March 2006

The prevalence of MRSA in the nosocomial setting has been well studied, and its control remains a challenge for infection control professionals. Complicating this problem is the increasing number of reports on the spread of community-acquired MRSA (CA-MRSA). CA-MRSA strains differ from hospital-acquired MRSA (HA-MRSA) strains in that they are generally susceptible to most antibiotics. These strains share the presence of staphylococcal cassette chromosome mec (SCCwec) type IV in their genomes, are frequently virulent, and predominantly cause skin and soft tissue infections. The genome sequence of the prototypic CA-MRSA strain, MW2, revealed the presence of additional virulence factors not commonly present in other S. aureus strains.

We determined the genetic relatedness of 30 geographically diverse CA-MRSA isolates clustered based on SCCmec type IV by sequence analysis of the polymorphic repeat region of the protein A gene (spa typing). These results indicated that most strains shared a common spa type (131), identical to MW2. Because this group tends to infect healthy individuals with no known risk factors for nosocomial acquisition of MRSA, we refer to it as CA-MRSA without risk factors. A second group, CA-MRSA with risk factors, consists of two related genotypes, spa types 1 and 7, which differ by one nucleotide change. These strains have caused severe infections in HIV-positive patients in Los Angeles and New York.

Although CA-MRSA strains share genetic determinants, they are not clonal but rather are derived from different genetic backgrounds. The genetic characteristics and the epidemiology of CA-MRSA with and without risk factors are discussed.
Incidence and Prevalence of Methicillin-ResistantStaphylococcus aureusNasal Carriage Among Healthcare Workers in Geriatric Departments: Relevance to Preventive Measures
Authors: Scarnato Fabien , Mallaret Marie Reine , Croizé Jacques , Kouabenan Dongo Rémi , Dubois Michel , Maitre Anne , DeGaudemaris Régis
Published: March 2006

Methicillin-resistantStaphylococcus aureus(MRSA) nasal carriage was assessed among healthcare workers caring for elderly patients in contact precautions in geriatric departments. Monthly incidence ranged from 0% to 3.3%. Carriage was observed only among nurses and nursing assistants. MRSA was thus infrequently acquired using precautions and carriage was usually transient.
Toxic Epidermal Necrolysis After Topical Intranasal Application of Mupirocin
Authors: Praz Sophie-Maria , de Torrenté Antoine , Zender Hervé , Schmied Edmond , Schleppy Charles-André , Genné Daniel
Published: March 2006

We describe a case of toxic epidermal necrolysis after intranasal application of mupirocin in a 76-year-old woman. The drug was given for eradication of methicillin-resistant Staphylococcus aureus.
Transmission of Methicillin-ResistantStaphylococcus aureusin the Neonatal Intensive Care Unit From a Patient With Community-Acquired Disease
Authors: Eckhardt Christiane , Halvosa Jesse S. , Ray Susan M. , Blumberg Henry M.
Published: March 2006

Abstbact

Methicillin-resistantStaphylococcus aureus(MRSA) has traditionally been a nosocomial pathogen. However, several recent studies have noted community-acquired MRSA among young, healthy patients with no risk factors or healthcare system exposure. We report the transmission of a strain of community-acquired MRSA in our neonatal intensive care unit.
A Pseudo-Outbreak of Vancomycin-ResistantEnterococcus faecium
Authors: Grinbaum Renato Satovschi , Guimarães Thaís , Kusano Elisa , Hosino Nair , Sader Helio , Cereda Rosangela Ferraz
Published: March 2006

Five VRE isolates were reported from sterile samples. No infections were diagnosed among the patients, who were on different wards. PFGE showed that all five isolates were clonal. All samples were manipulated by the same worker, but the source could not be found. Contamination was probably related to manipulation of a source specimen in the laboratory.
Reducing Central Venous Catheter–Associated Primary Bloodstream Infections in Intensive Care Units Is Possible: Data From The German Nosocomial Infection Surveillance System
Authors: Zuschneid Irina , Schwab Frank , Geffers Christine , Rüden Henning , Gastmeier Petra
Published: March 2006

Background And Objective:

The German Nosocomial Infection Surveillance System (KISS) began in 1997 as a nationwide surveillance project for voluntary registration of nosocomial infections in intensive care units (ICUs). This study investigates trends in the rates of central venous catheter (CVC)–associated primary bloodstream infections (BSIs) in ICUs since participation in KISS.

Methods:

Eighty-four ICUs that had participated in KISS for at least 24 months were considered for more detailed analysis. Monthly rates of primary BSI for the 84 ICUs were pooled for the 24 months. The best model for describing the curve of reduction was sought. Additionally, incidence densities were compared using the z test.

Results:

For the 212 ICUs participating, a relative 25.7% decrease (from 2.1 to 1.6 primary BSIs per 1,000 CVC-days) was observed from January 1997 to June 2001. The 84 ICUs that participated in KISS for a minimum of 24 months accumulated 552,359 patient-days and 404,897 CVC-days during their 24 months. A linear regression model was selected to explain the curve of primary BSI reduction in the 84 ICUs. It showed a decrease from 2.1 to 1.5 primary BSIs per 1,000 CVC-days, meaning an overall relative reduction of 28.6% during the 2-year observation period. These results were significant (Student's t test for the monthly reduction coefficient; P = .04). The reduction of primary BSIs was shown for both clinical sepsis and laboratory-confirmed, CVC-associated primary BSIs.

Conclusion:

Performing surveillance with KISS was associated with a reduction of the rates of CVC-associated primary BSIs in ICU patients (Infect Control Hosp Epidemiol 2003;24:501-505).
Reported Measures of Hygiene and Incidence Rates for Hospital-Acquired Diarrhea in 31 French Pediatric Wards: Is There Any Relationship?
Authors: Jusot Jean-François , Vanhems Philippe , Benzait Fatima , Berthelot Philippe , Patural Hugues , Teyssier Georges , Fabry Jacques , Pozzetto Bruno
Published: March 2006

Objective:

To investigate the relationship between hygienic measures reported for the prevention of hospital-acquired diarrhea and incidence rates of hospital-acquired diarrhea.

Design:

A survey of hospital-acquired diarrhea was conducted between January 1 and March 31, 1999. Multivariate analysis of reported measures of hygiene according to the observed incidence rates of hospital-acquired diarrhea was performed.

Setting:

Thirty-one pediatric or neonatal wards located in hospitals in the southeast of France, selected as a convenience sample of wards volunteering to participate.

Patients:

A total of 6,726 children younger than 5 years.

Results:

The overall incidence rate of hospital-acquired diarrhea was 3.6%. Rotavirus was responsible for 69% of the cases of hospital-acquired diarrhea. Among the hygienic measures reported by the wards for preventing hospital-acquired diarrhea were using a single room or cohorting (77.4%), washing hands (83.9%), wearing gowns (80.6%), and wearing disposable single-use gloves for diapering a patient (51.6%). By multivariate analysis, the variables statistically associated with a lower incidence of hospital-acquired diarrhea were restricting the patient's mobility outside his or her room, keeping the patient's door closed, and having fewer than 20 beds in the ward, with adjusted odds ratios of 0.34 (95% confidence interval [CL95], 0.18 to 0.65), 0.33 (CI95, 0.23 to 0.47), and 0.42 (CI95, 0.30 to 0.60), respectively.

Conclusion:

Simple preventive measures can decrease the rate of hospital-acquired diarrhea in pediatric wards (Infect Control Hosp Epidemiol 2003;24:520-525)
Influence of Building Construction Work On Aspergillus Infection in a Hospital Setting
Authors: Cooper E. E. , O'Reilly M. A. , Guest D. I. , Dharmage S. C.
Published: March 2006

Background And Objective:

Aspergillus fumigatus is a major pathogen causing nosocomial infections. Hospital outbreaks of invasive aspergillosis have been associated with the renovation and construction of buildings. Building construction work for fire safety upgrading was undertaken during a 16-week period in 2001 at Box Hill Hospital. This study was designed to examine the effect of construction on invasive aspergillosis when using standard and additional protective measures.

Methods:

Baseline air sampling was conducted in 18 areas. The validity of the air sampling was assessed by comparing the ability of two air samplers to detect Aspergillus conidia. Surveillance of nosocomial Aspergillus infection was conducted by reviewing the records of patients with a sputum culture positive for Aspergillus and those prescribed amphotericin or itraconazole for the period of construction activity and the same period the previous year.

Results:

Aspergillus was isolated infrequently and there was no statistically significant difference in the levels of viable pathogenic fungi between areas where construction work was undertaken and areas where it was not undertaken. A moderate agreement was observed between the two air samplers (kappa = 0.4; P < .05). There was no difference in the incidence of invasive aspergillosis between 2000 and 2001 (incidence density ratio, 1.2; 95% confidence interval, 0.3 to 4.1).

Conclusion:

The influence of construction work performed with protective measures needs to be examined in an environment with higher levels of airborne fungi to confirm the findings of this study (Infect Control Hosp Epidemiol 2003;24:472-476).
Increasing Pneumococcal Vaccination Rates Among Hospitalized Patients
Authors: Nowalk Mary Patricia , Middleton Donald B. , Zimmerman Richard K. , Hess Mary M. , Skledar Susan J. , Jacobs Marjorie A.
Published: March 2006

Objective:

To increase the proportion of inpatients vaccinated against pneumococcal infection.

Design:

Pre- and post-intervention study.

Setting:

University medical center–affiliated, suburban community teaching hospital.

Patients:

Unvaccinated inpatients 65 years and older and those 2 to 64 years old who had chronic medical conditions predisposing them to invasive pneumococcal infection.

Intervention:

The nursing staff screened newly admitted patients for eligibility based on age, diagnosis, or medications from a computer-generated admissions list and placed a pre-printed order form for the pneumococcal polysaccharide vaccine (PPV) on the charts of eligible patients. Following the physician's order, the nursing staff administered the PPV and recorded it. Ongoing quality improvements including admission vaccination screening and computer-based record keeping were initiated to identify unvaccinated eligible patients and track vaccination status.

Results:

Efforts resulted in rates of in-hospital vaccination ranging from 3.1% to 7.9% (mean, 5.2% ± 1.7% [standard deviation]) and significant improvements in the assessment of previous vaccination status, reaching 54% of eligible patients after 1 year. Ascertainment of a previous vaccination increased significantly following the initiation of the use of admission forms that specifically assessed vaccination status and a system to permanently record vaccination status in an electronic medical record (P < .05).

Conclusion:

Concerted efforts using electronic medical records significantly improved the assessment and documentation of inpatient vaccination status. Greater improvement of the rates of in-hospital vaccination will require healthcare system–wide efforts such as a standing order policy for vaccinating all eligible patients. Standing orders for inpatient immunization supported by effective assessment and tracking systems have the potential to raise vaccination rates to the goals of Healthy People 2010 (Infect Control Hosp Epidemiol 2003;24:526-531)
Evaluation of the Antimicrobial Efficacy of Urinary Catheters Impregnated With Antiseptics in an In Vitro Urinary Tract Model
Authors: Gaonkar Trupti A. , Sampath Lester A. , Modak Shanta M.
Published: March 2006

Objectives:

To evaluate the long-term efficacy of urinary Foley catheters (latex and silicone) impregnated with (1) chlorhexidine and silver sulfadiazine (CXS) and (2) chlorhexidine, silver sulfadiazine, and triclosan (CXST) in inhibiting extra-luminal bacterial adherence and to compare their efficacy with that of silver hydrogel latex (SH) and nitrofurazone-treated silicone (NF) catheters.

Design:

The antimicrobial spectrum of these catheters was evaluated using a zone of inhibition assay. A novel in vitro urinary tract model was developed to study the potential in vivo efficacy of antimicrobial catheters in preventing extraluminal bacterial colonization. The “meatus” was inoculated daily withStaphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Enterococcus faecalis, Pseudomonas aeruginosa,andCandida albicans. The “bladder” portion of the model was cultured daily to determine bacterial growth.

Results:

Both CXS and CXST catheters had a broader antimicrobial spectrum than SH and NF catheters. In the in vitro model, CXST latex and silicone catheters exhibited significantly better efficacy (3 to 25 days) against uropathogens, compared with CXS (1 to 14 days) and control (0 to 5 days) catheters (P= .01). CXST latex catheters exhibited significantly longer protection againstStaphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, andPseudomonas aeruginosa, compared with SH catheters (P= .01). CXST silicone catheters resisted colonization withStaphylococcus aureusandStaphylococcus epidermidisfor a significantly longer period (23 to 24 days) than did NF catheters (9 to 11 days) (P= .01).

Conclusion:

Catheters impregnated with synergistic combinations of chlorhexidine, silver sulfadiazine, and triclosan exhibited broad-spectrum, long-term resistance against microbial colonization on their outer surfaces (Infect Control Hosp Epidemiol2003;24:506-513)
Efficacy of Environmental Measures in Reducing Potentially Infectious Bioaerosols During Sputum Induction
Authors: Menzies Dick , Adhikari Neill , Arietta Marie , Loo Vivian
Published: March 2006

Objective:

To evaluate the airborne viable bacterial concentrations generated during sputum induction and their reduction with exhaust ventilation, ultraviolet germicidal irradiation (UVGI), or both.

Methods:

Exhaust ventilation, upper air UVGI lights, and a portable UVGI unit were operated independently or in combination while and after sputum induction was performed for 58 patients suspected of having active tuberculosis. Viable airborne bacteria were sampled with volumetric air samplers, grown on blood agar, and identified with standard techniques.

Results:

During and immediately after sputum induction, concentrations of airborne bacteria, particularly respiratory tract or oropharyngeal organisms, increased rapidly, regardless of environmental conditions. The subsequent rate of reduction of airborne bacteria was most rapid with the portable UVGI unit, followed by upper air UVGI with air mixing. Exhaust ventilation achieved high air changes per hour, but efficacy in reducing airborne bacterial concentrations was low. However, the continuous entrainment of bacteria-laden air from the hallway outside may have resulted in underestimation. The efficacy of a wall-mounted upper air UVGI fixture was significantly less if there was no air mixing. The irradiation from this fixture was of adequate germicidal intensity only in a narrow horizontal plane 2.5 m above the floor.

Conclusion:

Sputum induction was associated with a rapid and substantial increase in airborne bacteria despite the use of exhaust ventilation providing more than 30 air changes per hour, and the adjunct use of UVGI. This emphasizes that health-care workers involved in similar cough-inducing procedures performed for patients with suspected tuberculosis must wear appropriate personal respirators (Infect Control Hosp Epidemiol2003;24:483-489)
Management of Varicella-Vaccinated Patients and Employees Exposed to Varicella in the Healthcare Setting
Authors: Haiduven Donna J. , Hench Carmen P. , Simpkins Sandy M. , Scott Kathleen E. , Stevens David A.
Published: March 2006

Varicella exposures from patients, visitors, and staff continue to occur in healthcare facilities. In a recent report from the National Surveillance System for Health Care Workers, 9 participating hospitals reported 72 varicella exposures from 1996 to 1999, involving 1,111 health-care workers. Depending on the patient and employee demographics for any particular healthcare institution, the number of these exposures can vary. Many healthcare facilities follow the guidelines of the Hospital Infection Control Practices Advisory Committee for non-immune employees exposed to varicella. These guidelines recommend that such employees be excluded from duty from 8 to 21 days after exposure to varicella. There is no standard definition of what constitutes exposure to varicella, which can result in employees' being excluded from duty on one or more occasions without having contracted chickenpox. We previously reported our experience of allowing non-immune employees exposed to varicella to work while wearing masks, checking daily for prodromal symptoms, and excluding these employees from duty only if such symptoms occurred. Since our original report from 1994, we have continued this practice without adverse consequences.
Analysis of Three Outbreaks Due toKlebsiellaSpecies in a Neonatal Intensive Care Unit
Authors: Ayan Melek , Kuzucu Cigdem , Durmaz Riza , Aktas Elif , Cizmeci Zeynep
Published: March 2006

Objective:

To investigate the clinical, microbiological, and epidemiologic features of three outbreaks caused byKlebsielladuring 3 years.

Setting:

Neonatal intensive care unit of a university hospital.

Patients:

Thirty affected neonates.

Methods:

Data were collected through chart reviews and conversations with physicians. Screening samples were obtained from the staff, the neonates, and the environment. Antibiogram typing and arbitrarily primed polymerase chain reaction-based fingerprinting were used to type the strains.

Results:

The first outbreak had 13K. pneumoniaestrains isolated. The second outbreak had 10K. oxytocastrains isolated. The third outbreak had 20K. pneumoniaestrains isolated. More than half of the patients had low birth weights, were premature, and underwent mechanical ventilation and intravenous catheterization. Approximately three-fourths of the patients died. The isolates tested were completely susceptible to meropenem, cefoxitin, and ciprofloxacin and were resistant to cephalothin. More than half of these strains were resistant to many beta-lactam antibiotics, amikacin, and trimethoprim/sul-famethoxazole. Typing procedures yielded 3 antibiotypes and 3 genotypes among the isolates of the first outbreak, 3 antibiotypes with 1 subtype and 2 genotypes with 1 subtype in the second outbreak, and 2 antibiotypes and 2 genotypes in the third outbreak.

Conclusions:

Klebsiellaoutbreaks mainly affected premature neonates with intravenous catheters, mechanical ventilation, or both. The high mortality rate (76.7%) was notable. Resistance to multiple antibiotics, but mainly to broad-spectrum beta-lactam antibiotics, was observed, particularly inK. pneumoniaeisolates. Molecular typing indicated that the three outbreaks were not related to one other (Infect Control Hosp Epidemiol2003;24:495-500).
Take Two Orthogonals and Call Me in the Morning
Authors: Birnbaum David
Published: March 2006

Analysis of variance (ANOVA) is used to prevent inflated type I error when hypothesis testing involves comparing more than two groups. If an ANOVA result indicates a statistically significant difference exists somewhere within, the next task is to discover exactly which combination or combinations of those groups account for the significant difference. Among many methods available for that exploration, orthogonal contrasts and relatively simple graphs are noteworthy (Infect Control Hosp Epidemiol 2003;24:544-547).
An Outbreak of Epidemic Keratoconjunctivitis in a Pediatric Unit Due to Adenovirus Type 8
Authors: Chaberny Iris F. , Schnitzler Paul , Geiss Heinrich Konrad , Wendt Constanze
Published: March 2006

Objectives:

To investigate and control an outbreak of epidemic keratoconjunctivitis (EKC) occurring in a neonatal intensive care unit (NICU) and to determine signs specific for EKC in newborns.

Design:

Outbreak investigation and case–control study.

Setting:

NICU of a 1,600-bed university hospital in Heidelberg, Germany.

Patients:

Case-patients were defined as individuals who had adenoviral antigen detected by ELISA or by PCR from conjunctival swabs or who had clinical signs of conjunctivitis. Twelve newborns from the NICU who had EKC between October and November 1998 were compared with 11 who had bacterial conjunctivitis.

Intervention:

Control measures included cohorting patients in contact isolation, using gloves and gowns for patient care, and using a hand rub and disinfectants with virucidal activity.

Results:

Thirteen patients, 6 healthcare workers, and 11 relatives of the patients had EKC, according to our case definition. Case-patients were more likely than control-patients to develop lacrimal swelling (P< .001), eye redness (P= .004), and lacrimation (P= .037) involving both eyes (P= .002). Prior examination by an ophthalmologist was a significant risk factor for EKC (P= .004). For diagnosis or treatment of retinopathy, premature newborns were seen by an ophthalmologist from a nearby eye care center where an EKC outbreak was ongoing. No new cases were diagnosed more than 10 days after the implementation of control measures.

Conclusion:

In newborns, lacrimal swelling, eye redness, and lacrimation in both eyes should evoke suspicion of EKC. Ophthalmologists who have had contact with known EKC cases should use antiseptics and disinfectants with virucidal activity before contact with newborns or abstain from examining newborns (Infect Control Hosp Epidemiol2003;24:514-519)
Respiratory Syncytial Virus Pneumonia in an Adult Renal Transplant Patient: An Unexpected Nosocomial Infection
Authors: Morales Rodrigo , Kirkpatrick Michael , Browne Barry , Emovon Osemwegie
Published: March 2006

This article describes a case of respiratory syncytial virus pneumonia believed to have been acquired nosocomially in an adult renal transplant recipient. The mode of transmission, diagnosis, and prevention of infection due to this virus in the immunocompromised patient are discussed (Infect Control Hosp Epidemiol2003;24:548-550.
Molecular Epidemiology of Systemic Infection Caused byEnterobacter cloacaein a High-Risk Neonatal Intensive Care Unit
Authors: Kuboyama Rogerio Hakio , Oliveira Helenice Bosco de , Moretti-Branchini Maria Luiza
Published: March 2006

Objective:

To investigate the molecular epidemiology of systemic nosocomial infections caused byEnterobacter cloacae.

Setting:

Neonatal intensive care unit (NICU) of a tertiary-care university hospital.

Patients:

Forty-two high-risk neonates with systemic infections caused byE. cloacae.

Methods:

From 1995 to 1997, the variables associated with death in these patients were evaluated. The molecular epidemiology of the strains responsible for the systemic infections, and 14 unrelated strains, was studied using plasmid analysis and pulsed-field gel electrophoresis (PFGE).

Results:

The overall mortality rate for infection caused byE. cloacaewas 34%, whereas the crude mortality rate during the study period was 8.12% (P< .001). Gestational age (preterm neonates) and birth weight (small for gestational age) were not associated with a higher risk of death. Insertion of a venous catheter by dissection of a peripheral vein was the only invasive procedure related to death (P= .016) in this study. A molecular analysis showed that three outbreaks, each occurring in a different year, were caused by strains with distinctive DNA profiles. Only one outbreak was identified by the infection control service, in the NICU. Plasmid analysis and PFGE showed similar ability to discriminate control strains from theE. cloacaestrains isolated from the neonates.

Conclusions:

Systemic infections caused byE. cloacaein our NICU were associated with a high mortality rate and occurred as small, unrecognized outbreaks. These results may not be generalizable because the data were from a single center (Infect Control Hosp Epidemiol2003;24:490-494).
Invasive Pulmonary Aspergillosis Soon After Therapy With Infliximab, a Tumor Necrosis Factor-Alpha–Neutralizing Antibody: A Possible Healthcare-Associated Case?
Authors: Rosa Francesco G. De , Shaz David , Campagna Anthony C. , Dellaripa Paul F. , Khettry Urmila , Craven Donald E.
Published: March 2006

Background:

Infliximab is a chimeric monoclonal antibody against tumor necrosis factor (TNF)-alpha, used for the treatment of Crohn's disease and rheumatoid arthritis. Recently, an increased risk of infection due toMycobacterium tuberculosisand rare cases of invasive fungal disease have been reported following infliximab therapy.

Case Report:

A 73-year-old woman with chronic rheumatoid arthritis who had been treated with methotrexate, leflunomide, and prednisone was given the first of three doses of infliximab in June 2001. In July 2001, she presented with cough, and in August, she had a right upper lobe infiltrate that was treated with levofloxacin without improvement. In October, the patient had right upper and middle lobe infiltrates on a chest x-ray and computed tomography scan. At bronchoscopy, an endobronchial mass was biopsied, which demonstratedAspergillus fumigatus. Our patient had frequently accompanied her daughter on visits to another medical center following a stem cell transplant, where her daughter was instructed to wear a mask during all visits because of extensive building construction. We postulate that our patient may have acquired pulmonary aspergillosis during this period. Literature reviews on granulomatous diseases following infliximab therapy and hospital-acquired aspergillosis are presented.

Conclusion:

The temporal relationship between the administration of infliximab andA. fumigatusinfection in this patient suggests a causal relationship and possible healthcare-associated acquisition. These data underscore the importance of both patient and family education on prevention strategies when potent immune-modulating medications such as infliximab have been prescribed (Infect Control Hosp Epidemiol2003;24:477-482)
Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force
Authors: Boyce John M. , Pittet Didier
Published: March 2006

The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985.Infect Control1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings.Am J Infect Control1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
West Nile Virus Induced Vocal Fold Paralysis
Authors: Steele Natalie P. , Myssiorek David
Published: March 2006

Objective: West Nile virus has recently become a public health concern in the United States, after an outbreak in New York City in 1999. It is a mosquito‐borne virus that causes a spectrum of disease from flu‐like symptoms to encephalopathy, muscle weakness, and, in some cases, death.

Study Design: Case Report.

Methods: A patient infected with West Nile virus presented with progressive muscle weakness, and later developed bilateral vocal fold paresis. His clinical presentation, physical and laboratory examination findings, and course of illness will be discussed.

Results: After a prolonged hospital stay, and presumptive treatment for Guillain‐Barré, repeat CSF analysis revealed infection with the West Nile virus. The patient developed bilateral vocal fold paralysis during his hospital course. At long‐term follow‐up, the patient's left vocal fold paralysis persisted, while the right vocal fold paralysis had resolved.

Conclusions: Although several viruses have been associated with recurrent laryngeal nerve injury, this is the first report of West Nile virus induced vocal fold paralysis.
Comparison of Biomechanical Properties of Alloderm and Enduragen as Static Facial Sling Biomaterials
Authors: Vural Emre , McLaughlin Nathan , Hogue William R. , Suva Larry J.
Published: March 2006

Background: Static slings are one of the most commonly used surgical rehabilitation methods in the management of chronic facial paralysis. Acellular human cadaveric dermis (Alloderm; Life Cell Corp., Branchburg, NJ) is used for this purpose; however, it has variable stretching properties that may necessitate additional “tuning‐up” procedure(s). Acellular porcine dermis (Enduragen; Tissue Sciences Laboratories, plc., Aldershot, U.K.) was recently introduced as a biologic implant and it is compositionally similar to Alloderm. However, no data currently exist regarding its biomechanical properties and potential use as an alternative implant to Alloderm in static facial sling procedures.

Objective: The objective of this study was to compare the biomechanical properties of Alloderm and Enduragen for static facial sling procedures in the management of the paralytic face.

Study Design: This study consisted of an in vitro prospective study in an academic medical research setting.

Methods: Same size and thickness Alloderm and Enduragen samples were tested with MTS 858 Bionix materials test system for load‐to‐failure, displacement under increasing and constant stress, and stiffness.

Results: Enduragen showed significantly less elongation under increasing stress and at the beginning of constant stress. Load‐to‐failure and stiffness were significantly higher in Alloderm; however, both biomaterials have adequate stiffness and load‐to‐failure for a static facial sling procedure.

Conclusions: Enduragen may serve as another potential static facial sling material, because it stretches significantly less than Alloderm under stress. Clinical experience is needed with Enduragen to determine its potential use as a static facial sling material.
EGFR Regulates the Side Population in Head and Neck Squamous Cell Carcinoma
Authors: Chen Jocelyn S. , Pardo Francisco S. , Wang‐Rodriguez Jessica , Chu Theresa S. , Lopez Jay Patrick , Aguilera Joseph , Altuna Xabier , Weisman Robert A. , Ongkeko Weg M.
Published: March 2006

Objective: To identify the presence of side population (SP) cells in established head and neck squamous carcinoma cell (HNSCC) lines and to determine the role of EGFR in the regulation of the side population of these cells.

Methods: SP cells were identified using flow cytometry analysis by the ability of these cells to extrude the Hoechst 33342 dye via the drug transporter BCRP1/ABCG2. Effect of EGFR on the side population was determined also by difference in Hoechst extrusion and by immunofluorescence. Immunohistochemical staining was performed to show the presence of the BCRP1/ABCG2 transporter and the phosphorylated form of EGFR in HNSCC tissue.

Results: SP cells are present in HNSCC cell lines. With the Hoechst 33342 extrusion assay, SP cells were found to comprise an average of 0.69% of the UMSCC10B cells and 0.91% of HN12 cells. Addition of the EGF ligand increased the SP population while inactivation of the EGFR kinase by Iressa significantly decreased SP.

Conclusion: In established head and neck squamous cell carcinoma cell lines, SP cells were found using methods that determine expression and function of the drug transporter BCRP1/ABCG2. Activation of EGFR, a gene implicated in tumorigenesis in HNSCC leads to increased SP, and conversely, inhibition of EGFR leads to decrease in SP. This finding could help explain the role of EGFR in regulating cancer stem cells and thus tumorigenesis in HNSCC.
Microvessel Density in Head and Neck Squamous Cell Carcinoma Primary Tumors and Its Correlation with Clinical Staging Parameters
Authors: Lentsch Eric J. , Goudy Steven , Sosnowski Jeffrey , Major Scott , Bumpous Jeffrey M.
Published: March 2006

Objective: Our objective was to assess angiogenesis in head and neck squamous cell primary tumors and measure its correlation with tumor site and clinical and pathologic staging parameters.

Study Design: Patients from the tumor registries of the University of Louisville and affiliated hospitals who had biopsy‐proven head and neck squamous cell carcinoma were retrospectively assessed over a 5‐year period (1995–2000).

Methods: Patient records were reviewed for tumor site, TNM staging, surgical treatment, and tumor pathologic staging data. Cell blocks were obtained for each of the study patients, and CD31 staining was used to measure microvessel density (MVD) in areas of primary tumor hot spots.

Results: Twenty‐eight consecutive patients met inclusion criteria and had adequate cell blocks for evaluation. MVD for T3 staged (41.2 MVD, mean) and T4 staged (36.4 MVD, mean) tumors were higher than earlier staged T1 staged (31.3 MVD, mean) and T2 staged (24.9 MVD, mean) tumors. Laryngeal T3 and T4 tumors had MVDs as high as 43.4 MVD (mean) and 40.4 MVD (mean), respectively, compared with a 23.9 MVD for T2 tumors. This difference was statistically significant (P < .01). Our report indicates a trend toward increasing MVD with N‐stage.

Conclusion: Our series demonstrates that there is a strong correlation between MVD in primary tumor hot spots and tumor T‐stage, which implies that tumor angiogenesis may be a factor in tumor progression.
Advantages of a Targeted Approach in Minimally Invasive Radioguided Parathyroidectomy Surgery for Primary Hyperparathyroidism
Authors: Grady Jennifer A. , Bumpous Jeffrey M. , Fleming Muffin M. , Flynn Michael B. , Turbiner Elliott , Lentsch Eric J. , Ziegler Craig H.
Published: March 2006

Objective: In a large series of patients, we associated the need for preoperative parathyroid hormone (PTH) and calcium levels as a vital component in our approach to the radioguided minimally invasive parathyroidectomy (MIRP) procedure. Our objective was to determine whether these preoperative levels indeed complemented the procedure. Our study also included a postoperative assessment of excised gland volume and length of operation.

Study Design: This was a prospective cohort study.

Methods: One hundred seventy‐three patients with primary hyperparathyroidism enrolled in our radioguided MIRP protocol. Patients were divided into groups based on the results of sestamibi scans. Comparisons were made between these results and the assessed preoperative PTH and calcium levels and the postoperative excised gland volume and length of operation.

Results: PTH and calcium levels did not statistically relate with the likelihood of having a “positive,” “equivocal,” or “negative” sestamibi scan, but the volume of excised gland was significantly different among the three groups (P < .01). There was no significant difference between positive and equivocal scans (P = .40). Operative time was significantly different between positive and equivocal scans (P < .01), positive and negative scans (P < .01), and equivocal and negative scans (P < .01).

Conclusions: Routine preoperative PTH and calcium levels are necessary for the biologic diagnosis of hyperparathyroidism, but they do not appear to relate to the outcome of a sestamibi scan and therefore do not complement the radioguided MIRP procedure. Because the size of the affected gland, however, did correlate with a positive sestamibi scan, we conclude that as the volume of the gland increases, so does the likelihood of a successfully chosen minimally invasive surgical approach.
Olfactory Function and Olfactory Bulb Volume in Patients with Postinfectious Olfactory Loss
Authors: Rombaux Philippe , Mouraux André , Bertrand Bernard , Nicolas Georges , Duprez Thierry , Hummel Thomas
Published: March 2006

Objective: The study aimed to investigate whether the degree of postinfectious olfactory loss is reflected in volume of the olfactory bulb (OB).

Study Design: Retrospective study of 26 patients with postinfectious olfactory loss.

Materials and Methods: Olfactory function was assessed with the “Sniffin Sticks” test kit, and the magnetic resonance imaging study focused on OB volume and the olfactory sulcus.

Results: The study revealed that 1) OB volume varies with regard to olfactory function, 2) OB volume decreases with duration of olfactory loss, and 3) patients with parosmia had smaller OB volumes than patients who did not report such smell distortions, although their overall olfactory function was not significantly different from each other.

Conclusion: The study emphasizes that OB volume is a gauge of olfactory function.
Pediatric Epistaxis
Authors: Damrose John F. , Maddalozzo John
Published: March 2006

Objectives/Hypothesis: Otolaryngologists are frequently consulted for the evaluation and treatment of pediatric epistaxis. There is a lack of consensus as to the optimal approach to this problem. This study evaluated an approach used to evaluate and treat patients referred on an outpatient basis.

Study Design: Retrospective study.

Methods: Charts from 90 patients referred for the treatment of epistaxis were reviewed.

Results: Anemia was identified in 22% of patients. An abnormal coagulation study was identified in 7.8% of patients. Computed tomography (CT) imaging of the sinuses was obtained in nearly 90% of patients and revealed no suspicious masses. Opacification of the sinuses consistent with sinusitis was commonly seen. The majority of cases were resolved by the first follow‐up visit with a topical nasal emollient.

Conclusions: The outpatient evaluation of epistaxis should include a screen for anemia and coagulopathy. Routine CT imaging of the sinuses is unhelpful and is not recommended. The majority of cases are easily treated with rehydration of the nasal mucosa. Consideration should be given to rhinosinusitis as a co‐existing factor in patients with epistaxis.
Can Mitomycin C Really Prevent Airway Stenosis?
Authors: Roh Jong‐Lyel , Lee Yong‐Won , Park Chan Il
Published: March 2006

Background/Objectives: Mitomycin C (MMC) is used in the prevention of upper airway stenosis. However, the efficacy of MMC is still debatable, and the potential complications of MMC use have been scarcely reported. We evaluated the efficacy and early complications of MMC in a wound model of the subglottis.

Study Design: A randomized animal study.

Methods: Sixty rabbits underwent a full‐thickness injury to the posterior subglottis by diode laser. The animals were randomly assigned to three groups according to the different topical treatments of MMC 0.4 or 10 mg/mL or saline alone for 5 minutes. Animals were killed at 4 weeks, and gross and histologic findings were compared among different groups and 10 age‐matched, nonwound, normal controls.

Results: Thirty‐two of the 60 (53%) animals died mainly of acute airway obstruction by necrotic debris, sloughs on, or cartilage collapse of the unhealed posterior subglottis during early weeks after wounding, higher in the MMC‐treated animals (67%) than in the wound controls (25%) (P = .007). This resulted from the significant delay of wound healing in the MMC‐treated groups compared with the wound controls (P = .012). The degree of subglottic stenosis was comparable among different groups (P > .8), although collagen deposition was significantly lower in the MMC‐treated groups compared with the untreated controls (P = .036).

Conclusions: There was a significant risk of acute airway obstruction from delayed wound healing in rabbits that received subglottic laser wounding and MMC treatment. This risk should be considered in the use of MMC in clinical practice.