bluuebunny/crossref_metadata_2025 huggingface dataset:
Vergil's de Rerum Natura
Authors: Nethercut William R.
Published: August 2016

The first lines of Vergil's Georgics make clear the literary debt:
Vos, o clarissima mundilumina, labentem caelo quae ducitis annum;Liber et alma Ceres … (G.1.5-7)

(You, brightest lights of the firmament, who lead the year as it glides its course through the heavens, Bacchus and nurturing Ceres …)

The reader recalls immediately Lucretius' invocation to Venus:

Aeneadum genetrix hominum divumque voluptas

alma Venus caeli subter labentia signa …

(De Return Natura 1.1-2)

(Mother of Aeneas' sons, delight of gods and of men, nurturing Venus, who, beneath the gliding standards of the heavens …)

Parallels of subject are obvious. Lucretius' famous pessimism about the earth's ability to renew herself, at the conclusion of his second book, is behind Vergil's insistence, in Georgics I, that the farmer prepare all his resources to bolster a faltering soil; the famous picture of rustic celebration and the pleasures of soft grass and jovial interchange with which Georgics II ends is an elaboration of Lucretius' spring-time, when men stretch at leisure on greening grass inter se prostrati (‘relaxing with each other’); the hideous account of Athens' plague in Lucretius, Book VI, is matched by Vergil's description of Noricum at the end of his third book.
Classical Literature: The Critical Task Ramus Ten Years
Authors: Boyle A. J.
Published: August 2016

We shall not cease from exploration

And the end of all our exploring

Will be to arrive where we started

And to know the place for the first time.

T. S. Eliot, Little Gidding (1942)

It has been a busy decade. Approximately a hundred essays on Greek and Roman literature, from Homer to Nonnus, from Plautus to Claudian, a monograph on Euripides, thematic issues on Ancient Pastoral and Virgil's Georgics, work informed by a vigorous — and one hopes invigorating — sense of the humane value of classical literature and its analysis, but exhibiting in discussion of the ancient texts themselves considerable diversity of approach, emphasis, method. It would be obvious to the most casual reader that Ramus has eschewed the sterile path of the construction of its own methodological orthodoxy. The formal parameters for inclusion have been far more demanding — and important — than methodological consonance: substantiality of subject-matter and treatment; stringency, relevancy and coherence of argumentation; centrality and concentration of critical focus; significant and significantly original illumination of text; soundness of philological and historical scholarship; judiciousness of critical eye. The issue of critical focus, that is to say, of discrimination, merits emphasis. It is a truism to say that relegation of the peripheral to the peripheral, of the ancillary to the ancillary, are necessary conditions for the elucidation of any literary work. But it is a truism often ignored.
The Polis in Homer: A Definition and Interpretation
Authors: Scully Stephen
Published: August 2016

The position of thepolisin theIliadand theOdysseyis equivocal. Because there is a great span in time between the formal subject material of the poems (ca. 1250 BC) and the time of their composition (ca. 750-700 BC, by convention), the poems present a hybrid world picture with varying and occasionally contradictory systems of social organization. As much as the poems are part of a long epic and formulaic tradition which looks back to an ancestral Mycenaean past, they also have been adapted to the conditions of Homer's lifetime. In political organization, theIliadand theOdysseylook back through the small tribal groupings and warrior aristocracy of the Dark Ages, to a highly centralized and bureaucratic society governed by divinely ordained kings; but they also look forward to that form of social organization which Homer saw emerging about him — thepolis. With this wide disparity in socio-political orientation apparent in the poems, one scholar can say, ‘For Homer and his audience thepolisis regarded as the typical form of human community’, whereas another can argue that the significance of thepolisis masked and superseded by that of theoikos(the means of social unification preeminent in the Dark Ages). And even if the polis were agreed to be the typical form of human habitation, it is nevertheless argued that the focus in the poems upon the individualistic warrior aristocracy prevents thepolisfrom playing a significant dramatic role in the poems as a higher coercive power: ‘die Stadt habe für die fuhrende Schicht nur an der Peripherie des Daseins gestanden.’ More extensively the same critic writes (p. 164):

Der adlige Herr mag häufig in seinem Kreis besondere Formen des Lebens pflegen, an denen die übrige Menge keinen Teil hat, für ihn mag eine, nur ihm bemässe, ritterliche Ethik geben, der er sich verpflichtet fühlt, aberer kann sich im grund nicht von dem Boden der Stadt lösen, die seine Heimat ist.
Comment from the CDC
Authors: Bell David M.
Published: August 2016

Dr. Glatt makes some thoughtful observations, and his recommendations are similar in many respects to those developed by the Public Health Service (PHS) with advice from expert consultants. However, the PHS did not recommend that new antiretroviral drugs be used routinely to treat lower-risk exposures, because relatively limited data are available on the safety and tolerability of the newer drugs and because the overwhelming majority of workers with lower-risk exposures will not become infected. (The average risk of human immunodeficiency virus [HIV] transmission is 0.3% after a percutaneous exposure to HIV-infected blood and less than that for a mucous membrane or skin exposure.)
Methicillin-Resistant Staphylococcus Aureus: Interstate Spread of Nosocomial Infections with Emergence of Gentamicin-Methicillin Resistant Strains
Authors: Saroglou George , Cromer Margaret , Bisno Alan L.
Published: August 2016

A methicillin-resistant strain of Staphylococcus aureus (MRSA, phage type 84/85) was introduced into City of Memphis Hospital by a burn patient who had recently been treated for MRSA bacteremia in another institution 500 miles distant. Despite prompt recognition of the problem and institution of isolation procedures, six other patients developed secondary colonization during the ensuing six months, and five of these experienced clinically significant infections with MRSA. Three of the patients originally infected with MRSA, as well as two additional patients, subsequently developed colonization with staphylococcal strains of phage type 84/85 that were resistant to both methicillin and gentamicin (MRGRSA). Spread of the staphylococcal strains was most likely accomplished primarily via passive transfer from person to person. The hydrotherapy unit, which became contaminated with both MRSA and MRGRSA, may have played a secondary role. As illustrated by this outbreak, patients carrying potentially dangerous bacterial strains should be identified and informed of the problems posed by such carriage. It may be imprudent to admit such patients to hospitals that are free of the potential pathogen.

The outbreak described here exemplifies a number of potential problems associated with control of nosocomial staphylococcal infections: (a) interhospital spread of methicillin-resistant strains; (b) secondary patient-to-patient intrahospital spread; and (c) emergence of even more resistant strains, possibly associated with selective pressures exerted by widespread use of broad-spectrum antimicrobial agents.
Surveillance for Nosocomial Infections: Can the Sources of Data Be Reduced?
Authors: Gross Peter A. , Beaugard Amy , Antwerpen Carole Van
Published: August 2016

With the goal of achieving economy in infection control surveillance we tested the relative efficiency of the various surveillance sources for detecting nosocomial infections (NIs). We reviewed the initial and final surveillance sources of 415 NIs at Hackensack Hospital during an 11-month period; cultures were taken on most of the patients with NIs. Positive microbiology cultures were the initial sources in 64.8% of NIs and secondary sources in 23.6%. Chart review of patients with positive cultures added another 2.9%. Therefore, 91.3% of NIs could have been detected by positive culture reports. The remainder were discoverable by notification from nurses, or by studying admission cards or temperature rounds. Although the NIs missed by lack of a positive culture report often were significant infections, these alternate methods of surveillance did not help to detect any clusters of infections that could be traced to a particular source among the staff or the environment.
Nosocomial Klebsiella Infection in a Neonatal Unit: Identification of Risk Factors for Gastrointestinal Colonization
Authors: Mayhall C. Glen , Lamb V. Archer , Bitar Cynthia M. , Miller Kathy B. , Furse Elisabeth Y. , Kirkpatrick Barry V. , Markowitz Sheldon M. , Veazey James M. , Macrina Francis L.
Published: August 2016

Sequential outbreaks of infection due to gentamicin-resistantKlebsiella pneumoniae(GRKP) types 30 and 19 occurred in the neonatal intensive care unit (NICU) at the Medical College of Virginia in 1977 and 1978. The extensive epidemiologic investigation carried out included a case-control study, careful review of aseptic technique, and cultures from nursery staff and environment. The gastrointestinal (GI) tracts of the patients were the reservoirs for GRKP, and the epidemic strain was transmitted by hands of personnel. The case-control study showed a significant relationship between acquisition of GRKP by patients and oropharyngeal and GI instrumentation, including use of bag resuscitation, oropharyngeal suctioning, and use of nasogastric feeding tubes. The findings of the case-control study were supported by observation of the patient care techniques practiced by NICU staff. Institution of control measures based on results of the epidemiologic investigation of the first outbreak rapidly brought the second outbreak under control, even though cohorting or use of routine isolation was not possible. Whereas GI colonization and hand transmission have been described previously in outbreaks ofK. pneumoniaeinfections in NICUs, this study is the first to document the mode of inoculation of patients' GI tracts by contaminated hands of personnel.
Hospital-Acquired Myiasis
Authors: Jacobson Jay A. , Kolts Robert L. , Conti Marlyn , Burke John P.
Published: August 2016

In three years we encountered two patients with hospital-acquired myiasis, a rarely reported nosocomial problem. Both patients were elderly and had lengthy thoracic surgery in August in the same operating room. Larvae removed from the nares of one patient and from the chest incision of the other were of the same species, Phaenicia serricata. There was no evidence of tissue destruction or invasion in either case. Investigation revealed several factors that contributed to the presence of flies in the operating room. After a presumed environmental access site was closed and insecticide spraying was augmented, no additional cases occurred. This experience illustrates an unusual problem that may confront those responsible for infection control programs.
Two Epidemics of Pseudobacteremia Due to Staphylococcus aureus and Aerococcus viridans
Authors: Spivack Martin L. , Shannon Robert , Natsios George A. , Wood Jan
Published: August 2016

Two epidemics of pseudobacteremia are reported. The first, due to Staphyloccus aureus, was caused by a physician who had active staphylococcal skin infection and nasal colonization. Because the blood culture system in use at the time was open, and used screw cap bottles, we assume that the physician contaminated the bottles at the time of inoculation. The second outbreak, caused by Aerococcus viridans, was traced to contamination of the blood culture bottle tops as they were received from the manufacturer. We assume that there was inadequate disinfection of the bottle tops by the physicians prior to their use.
A Comparison of Methods for Surveillance of Nosocomial Infections
Authors: Larson Elaine
Published: August 2016

Data available for the monitoring of nosocomial infections, including mandatory state reports of communicable diseases,Morbidity and Mortality Weekly Report, National Nosocomial Infections Study reports, and ad hoc epidemiologic investigations are discussed in this article, and their usefulness, validity, limitations, and representativeness are compared. Problems with interpretation of hospital infection “rates” are described, and solutions are proposed.
Recurrent Meningococcal Meningitis Caused by Poly Groups X-W135: Importance of Chemoprophylaxis
Authors: Jacobs Richard F. , Yamauchi Terry
Published: August 2016

Presented is a case report and literature review of the causes of recurrent meningococcal meningitis. After all factors were analyzed, the cause of reinfection in this child was postulated to be ineffective chemoprophylaxis of close contacts following the initial episode. The efficacy of chemoprophylaxis in household members and close contacts in meningococcal disease, although not demonstrated in controlled trials, has been recommended since 1974 by the Meningococcal Disease Surveillance Group. Considering known carriage rates, reports of secondary infections in close contacts, reinfection in the same person, and a high case fatality ratio, chemoprophylaxis in such cases seems justified [Infect Control 1981; 2(4):312-4.]
Excessive Levels of Gram-Negative Bacteria in Hemodialysis Machines Because of Inadequate Cleaning Guidelines
Authors: Gurevich Inge , Williams Fay , Cunha Burke A.
Published: August 2016

The possibility of sepsis or pyrogenic reaction increases in hemodialysis patients as coliform or other gram-negative counts in the dialysis water reach levels ≥ 1000 colonies/ml. After the introduction of Cobe Century II dialysis machines (Cobe, Lakewood, Colorado), routine testing of dialysis water samples revealed gram-negative bacteria in concentrations up to 45,000 colonies/ml. An epidemiologic investigation was performed to determine the source of the bacterial contamination. The amounts of disinfectant solution were increased, but bacterial counts remained unacceptably high. A study of the fluid path within the machines revealed that part of that path was not reached at all by the disinfectant. In addition, the disinfectant was automatically and improperly diluted. Therefore, increased bacterial counts could not be reduced satisfactorily by using the manufacturer's disinfection guidelines.
Rubella Immunization of Hospital Personnel: A Debate
Authors: Evans Martin E. , Schaffner William
Published: August 2016

In recent months several advisory groups have issued recommendations urging hospitals to undertake comprehensive rubella control programs. The primary impetus for these suggestions has been the recognition that, despite a declining rubella incidence in the general population, pregnant women still are being exposed to this infection in hospitals.

In 1979 the Vanderbilt University Hospital initiated a limited rubella control program, encompassing new and current employees working in “traditional” high-risk areas of the hospital: obstetrics (wards and clinics), labor and delivery, nursery, pediatrics (wards and clinics), and the emergency department. Medical and nursing students also were included. All persons were tested serologically and immunization was offered to susceptibles, but was not required (except for students and house officers). The Infection Control Committee and hospital administration readily approved this program.
EpidemicSerratia marcescensin a Neonatal Intensive Care Unit: Importance of the Gastrointestinal Tract as a Reservoir
Authors: Christensen Gordon D. , Korones Sheldon B. , Reed Louise , Bulley Roderick , McLaughlin B. , Bisno Alan L.
Published: August 2016

Between March and December of 1979, an outbreak of infections due to multiply antibiotic resistantSerratia marcescenstook place in a 50-bed neonatal intensive care unit. Fifteen neonates suffered major infections (sepsis, meningitis and pneumonia) with one death, and 20 suffered minor infections (conjunctivitis, cystitis, wound infections). Epidemiologic investigation failed to reveal a common source;S. marcescens, however, was isolated from an employee's hand, emollient skin cleanser, suction tubing, and three in-use manual infant resuscitation bags. The skin cleanser and equipment-cleaning agents were ineffective againstS. marcescens. Asymptomatic, colonized infants were the major reservoir ofS. marcescens. These infants were identified by daily cultures of the nose, umbilicus and rectum. The rectal swab most commonly (76%) yielded first-positive cultures in previously uncolonized infants, and was ultimately positive in 92% of colonized infants. A control program was begun by: 1) removing all inanimate sources ofS. marcescens; and 2) cohorting patients and staff into aS. marcescens-exposed group and a new patient group. The new patient group of infants was surveyed by daily triple-site cultures for colonization and subsequent transfer to theS. marcescens-exposed group. After four months, the epidemic was controlled and the organism eradicated from the neonatal intensive care unit.
Q Fever Control Measures: Recommendations for Research Facilities Using Sheep
Authors: Bernard Kenneth W. , Parham Gregory L. , Winkler William G. , Helmick Charles G.
Published: August 2016

Q fever (Query Fever) is a zoonosis caused by the rickettsiaCoxiella burnetii.Domestic ungulates such as sheep, cattle, and goats serve as the reservoir of infection for humans and shed the desiccation-resistant organism in urine, feces, milk, and especially in birth products. In humans the illness is generally mild; however, Q fever hepatitis is often seen and Q fever endocarditis is an uncommon, but frequently fatal complication. Q fever long has been recognized as an occupational hazard among persons working with animals or animal products, and in laboratories working withC. burnetii.Recently, Q fever outbreaks have occurred in medical research facilities using sheep as research animals. Recommendations are presented for reducing the risk of exposure to Q fever in persons not working with sheep in research facilities that use sheep. In addition, recommendations are presented for reducing the risk of infection in persons who work with sheep in research facilities.
Nosocomial Ultraviolet Keratoconjunctivitis
Authors: Sensakovic John W. , Smith Leon G.
Published: August 2016

A series of five successive cases of ultraviolet-induced erythroderma and keratoconjunctivitis, occurring over a one-month period and related to exposure to an improperly installed ultraviolet light are described. Although in this series, as well as others reviewed, the effects appeared self-limited, significant associated morbidity was observed.
Wound Infection: A Review of Diagnosis and Treatment
Authors: Simmons Richard L.
Published: August 2016

Surgical wounds can become infected by a variety of organisms, leading to a variety of clinical courses. In this article, several types of infections, therapies, prognoses and prophylaxes.are discussed. Skin and subcutaneous tissues infect with a range of gram-positive and gram-negative aerobic and anerobic bacteria. Gangrenous infections, whether necrotizing fasciitis or bacterial synergistic gangrene, can be devastating or fatal. Gangrenous infection in the muscle is also discussed, and various treatments outlined. The intention is to familiarize readers with the predisposing conditions, clinical manifestations and therapeutic alternatives for these surgical infections.
An Evaluation of Autopsy Review as a Technique for Infection Control: A Procedure of Questionable Value
Authors: Crossley Kent , Johnson Janice , Mudge Rebecca , Crossley Laura
Published: August 2016

Review of necropsy reports for evidence of undiagnosed antemortem infection is included by the Joint Commission on Accreditation of Hospitals as an element of an effective hospital infection control program. We reviewed records of 155 patients autopsied at St. Paul-Ramsey Medical Center between January 1, 1980 and March 31, 1981. In 13 patients (8%), there was a discrepancy between documentation of infection during the patient's hospitalization and at autopsy. However, in none of these cases was this information useful in our infection control program. We doubt the effectiveness of necropsy review as a tool for nosocomial infection control.
The Short- and Long-term Effects of a Handbook on Antimicrobial Prescribing Patterns of Hospital Physicians
Authors: D'Eramo James Earl , DuPont Herbert L. , Preston Gary A. , Smolensky Michael H. , Roht Lewis H.
Published: August 2016

This study evaluates the effect of a specially designed, physician-oriented handbook of antimicrobial use on the prescribing patterns of a group of 50 doctors at a university hospital. Data were evaluated over a period of one-and-one-half years, before and after the distribution of the handbook. For the purposes of this study, antimicrobial therapy was classified: 1) inappropriate if it violated one of a number of recognized principles of antimicrobial therapy, 2) appropriate if it agreed with specific recommendations or alternatives given in the distributed reference handbook, and 3) acceptable if it was neither inappropriate nor appropriate as defined by the handbook. An initial survey of antimicrobial prescribing patterns was made. Five months later the handbook was distributed. A two-week orientation program, consisting of the distribution and promotion of the problem-oriented, pocket-sized handbook of appropriate antimicrobial therapy, was conducted. The handbook, which was developed by the authors and reviewed and approved by a panel of infectious disease specialists, presented guidelines for appropriate and efficacious usage of antimicrobial agents as most currently accepted in common clinical infections. Subsequent surveys were then conducted two weeks, three months, and six months after distribution of the handbook. A statistically significant difference (p <0.01) in antimicrobial prescribing patterns was noted between the survey conducted two weeks after the introduction of the handbook and the other surveys. In this survey, while therapy classified inappropriate decreased from 45% to 28%, therapy considered appropriate as recommended increased from 33% to 53%. The findings of this study demonstrated that the introduction and promotion of the handbook decreased abuse and increased proper use of antimicrobial therapy, although the effect is sustainable for only a short duration—no longer than three months. These results indicate the need for a vigorous, updated program to achieve and maintain current appropriate antibiotic therapy in clinical medicine.
Risk Factors for Post-operative Wound Infection in Cardiac Surgery Patients
Authors: Simchen Elisheva , Shapiro Mervyn , Marin Gideon , Sacks Theodore , Michel Jacques
Published: August 2016

In a prospective study of 372 patients undergoing cardiac surgery, we evaluated the relative contribution of host factors and patient care variables to the risk of postoperative wound infection. Host factors studied were age, sex, country of origin, the diagnosis for which the operation was performed and, for coronary artery by-pass operations, the functional cardiac status according to modified New York Heart Association criteria. The performance of more than one operation during a single admission carried the highest risk for infection, followed by a coronary artery by-pass operation lasting for more than six hours or performed on patients 65 years or older. In patients undergoing coronary artery by-pass surgery, host factors (age and cardiac function) were associated with infections in the chest wound, while the length of the operation was found to affect the occurrence of infections at the “donor” site.
Control of Aminoglycoside Resistance by Barrier Precautions
Authors: Gaynes Robert P. , Weinstein Robert A. , Smith Judy , Carman Margaret , Kabins Sherwin A.
Published: August 2016

The efficacy of antibiotic resistance (barrier) precautions for control of aminoglycoside resistance was evaluated from 1978 to 1981. Despite increasing aminoglycoside use and a 13-fold increase in aminoglycoside-resistant isolates on a newly opened oncology unit, the hospital-wide frequency of aminoglycoside resistantEnterobacteriaceaeremained low, supporting the continued value of barrier precautions which were initiated in our hospital in 1974. This control enabled us to focus on exceptions to the effectiveness of barrier precautions. These were traced to environmental reservoirs, very chronic and heavily infected patients, asymptomatic carriers of Serratia, and oncology patients receiving oral non-absorbable aminoglycosides. In addition, resistance inPseudomonas aeruginosaparalleled aminoglycoside use and, as in our prior experience, continued to rise. With increasing adoption of barrier precautions by others such exceptions should be anticipated.
Mechanisms of Antibiotic Resistance and Their Dissemination of Resistance Genes in the Hospital Environment
Authors: Wiedemann Bernd
Published: August 2016

The dissemination of resistance determinants among bacterial populations depends on ecological and epidemiological properties as well as additional factors: 1) the mechanism of resistance or its specificity toward a certain drug, and 2) the genetic basis in relation to the mobility of the genetic material and its survival in bacteria. From two resistance mechanisms directed toward old-fashioned drugs, namely sulfonamides (Su) and streptomycin (Sin), we can deduce that a resistance mechanism is encoded by a special sort of genetic material. Thus the linked SmSu resistance mediated by a sulfonamide-resistant dihydropteroatsynthetase II and the aminoglycoside phosphotransferase APH-(3") is always located on very small pBPl-like plasmids. Such plasmids survive without selective pressure of drugs in Enterobacteriaceae in the bowel flora of humans and animals. Both resistance determinants can be mediated by a transposon which codes for the production of a dihydropteroatsynthetase I in connection with an aminoglycoside adenylyltransferase AAD-(3"). These two mechanisms are genetically linked as well. The basic structure is a transposon designated Tn2411, which belongs to a whole family of transposons, all including the basic structure; however, their genetic exchange and substitution leads to structures coding for many different enzymatic characters: ANT-(2") (Gentamicin resistance), CAT (Chlo-ramphenicol resistance), AAC-(6') (resistance to all modern aminoglycosides), TEM-1, OXA-1, OXA-2, or PSE (β-lactam resistance). Resistance to the modern (β-lactamase-stable antibiotics is mediated by mutation in the regulatory genes of chromosomally-determined (β-lactamases. A spread of these resistance mechanisms can be avoided as long as the responsible genes are not located on sufficient structures like small plasmids or efficient transposons.
Infections in Compromised Hosts An Overview
Authors: Schaffner William
Published: August 2016

Much has been written recently concerning the new and growing occurrence of infections in compromised hosts. During the almost four decades since the end of World War II scientific investigation has produced extraordinary advances in diagnosis and treatment. This has resulted in two changes which have implications for this discussion. First, the classical acute community-acquired infections now are recognized quickly and treated effectively with antibiotics. Indeed, many such infections are managed quite effectively by physicians in the office or clinic and no longer require admission to the hospital. (For example, it has been years since I have seen mastoiditis or streptococcal erysipelas in my hospital consulting practice.) We have abandoned our “pneumonia ward” which once housed patients in various stages of life-threatening pneumococcal infection. Similarly, intensive immunization of our population has virtually eliminated poliomyelitis, diphtheria, tetanus, and measles; once common, these classical infectious diseases now are absent from our hospital.

The second effect of medical progress has been the opportunity to offer patients with certain diseases, previously untreatable, the hope of increased survival and even cure. The list here is long and includes premature infants, children with congenital immune deficiency disorders, individuals with leukemia, lymphoma, aplastic anemia, burns, renal and other organ failure, and many others. Thus, the numbers of such patients in our hospitals have increased. These patients are at an increased risk of acquiring a complicating infection because of their underlying disease or because of our diagnostic and therapeutic interventions.
Summary of the International Workshop: New Agents Causing Nosocomial Infections
Authors: Gröschel Dieter H.M.
Published: August 2016

Dr. Phillips introduced his discussion about resistant staphylococci with the statement that nosocomial Staphylococcus aureus infections have steadily declined in England over the past two decades. The peak of infections with multiply antibiotic-resistant S. aureus strains was in the early 1960s. Toward the end of the 1960s, penicillin-resistance decreased and methicillin-resistance increased. Generally, resistant strains were found less frequently in the 1970s. No major outbreaks of cross-infection were seen in the United Kingdom since 1977 although Staphylococcus aureus did emerge from time to time, for example, in the recent epidemic of toxic shock syndrome, previously known to clinicians as staphylococcal scarlatina. In contrast, Staphylococcus epidermidis is in ascendency. In the early 1960s this organism was occasionally seen in stitch abscesses but then it appeared with increasing frequency in urinary tract infections and infections associated with intravascular devices. Dr. Phillips summarized his presentation with the statement that Staphylococcus aureus has lost its will to spread and, probably, to become resistant. Despite extreme provocations by medical procedures, only sporadic episodes of emergence seem to occur. Staphylococcus epidermidis, on the other hand, never had the will to spread but is more able to develop resistance. This organism is an example of the classic opportunist who receives a lot of help (from plastics!). During the discussion, several questions about staphylococcal taxonomy and methods of antimicrobial susceptibility testing were raised. Reference was made to the situation of staphylococcal infections in other countries; for example, the cyclic appearance of methicillin-resistant Staphylococcus aureus in the US.
Longitudinal Analysis of Endemic Gentamicin- and Tobramycin-Resistant Gram-Negative Bacilli in a Community Hospital
Authors: Magnussen C. Richard , Jacobson Maria T.
Published: August 2016

The epidemiology of endemic gentamicin- and tobramycin-resistant gram-negative bacilli at a community hospital was analyzed over a one-year period three years following an original analysis at the same hospital. The frequency and distribution of resistant organisms remained stable over the time spanning the two studies. Only 2.8% of all gram-negative bacilli were resistant to gentamicin or tobramycin, and the majority of resistant isolates were non-Enterobacteriaceae. The respiratory and urinary tracts remained the body sites most prone to harbor resistant organisms. Risk analysis using a matched comparison group again revealed prior treatment with an aminoglycoside to be the only significant factor pre-disposing to acquisition of resistant gram-negative bacilli. This analysis indicates that community hospitals may not be important reservoirs of endemic aminoglycoside-resistant gram-negative bacilli, and reconfirms the observation that each hospital must define its own pattern of aminoglycoside resistance and unique risk factors.
A Prevalence Survey of Infections in a Combined Acute and Long-Term Care Hospital
Authors: Standfast Susan J. , Michelsen Phyllis B. , Baltch Aldona L. , Smith Raymond P. , Latham Ethel K. , Spellacy Ann B. , Venezia Richard A. , Andritz Mary H.
Published: August 2016

A prevalence survey of infections among 572 acute and long-term care patients in the Albany Veterans Administration Medical Center was conducted in September 1979. Presence of infection was determined by patient examination and chart review. Urine specimens from 94% of patients were cultured. The total number of clinically significant infections was 178; 117 were nosocomial (20.5 per 100 patients). The prevalence rate of nosocomial infections was highest on the Intermediate Service (long-term medical care) followed by the Surgical and Medical Services. Sites with the highest nosocomial infection rates were urinary tract (10.7), skin and subcutaneous tissues (5.1), and surgical wounds (3.0) per 100 patients. Nosocomial infections increased with age and length of hospital stay which partially explained the higher rate on the Intermediate Service. Patients using condom drainage and Foley catheters showed similarly high rates of bacteriuria. Antimicrobial drug use was 17% for acute care patients and 4% for long-term and psychiatry patients. Excepting Providencia stuartii urinary tract infection confined to the Intermediate Service, the bacterial isolates and their antibiotic susceptibilities were similar for the acute and long-term care services.
Antibiotic Resistance in Intensive Care Unit Areas
Authors: Daschner F. , Langmaack H. , Wiedemann B.
Published: August 2016

The incidence of nosocomial infections and antimicrobial resistance rates of nosocomial pathogens vary considerably among countries and even among intensive care units (ICUs) within one hospital. Such differences might be partly due to the selection pressure exerted by certain antibiotics, since intensive care patients are given more antimicrobials than any other group of patients. We therefore compared resistance rates of four important nosocomial pathogens (Staphylococcus aureus, E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa) isolated from patients in general wards and ICUs. There were few trends toward higher resistance of ICU isolates, and most differences were found with Klebsiella pneumoniae.

We also tried to relate antibiotic use in ICUs and frequency of antibiotic resistance of five selected nosocomial pathogens. The ampicillin and cephalosporin resistance of E. coli and Klebsiella pneumoniae arose along with an increase in usage of both drugs. Decreasing prescription of cotrimoxazole was not reflected by decrease in resistance of Staphylococcus aureus and Staphylococcus epidermidis. Increasing prescriptions of tetracyclines were followed by an increasing resistance of E. coli, but not of Staphylococci. The oxacillin resistance of Staphylococcus epidermidis almost paralleled the consumption, the opposite was true for Staphylococcus aureus. There seemed to be a rather close relationship between the incidence of resistant Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa strains and the quantities of gentamicin, tobramycin and azlocillin prescribed.

The increase or decrease of prescriptions of certain antimicrobials increased or decreased their resistance rate to the respective drugs of only certain bacterial strains in one ICU, but not in the other. The findings in our hospital cannot necessarily be applied to other hospitals. Restriction of antimicrobial usage however decreased resistance rates in most situations.
Nosocomial Infections in a Developing Middle East Hospital
Authors: McCormack Joseph G. , Barnes Mary
Published: August 2016

The prevalence and pattern of nosocomial infections in a new hospital in the United Arab Emirates is presented. During an 18-month period in which there were 6,544 discharges, 379 nosocomial infections occurred in 310 patients, representing an attack rate of 4.7%. The commonest site of infection was the urinary tract which accounted for 42.2% of the total. This was followed by surgical wound infections, cutaneous infections, bloodstream infections, lower and upper respiratory infections, infected burns and gastrointestinal infections. The most common organisms were Escherichia coli (22.7% of isolates), Pseudomonas species (17.5%) and Staphylococcus aureus (16.7%). Escherichia coli was the most common cause of urinary tract infections and bacteremia; Staphylococcus aureus was the most common cause of surgical wound and cutaneous infections. There was only one Serratia marcescens infection. We observed a high incidence of Pseudomonas infections, particularly of the urinary tract, and Staphylococcal surgical wound and other cutaneous infections, but otherwise our data are similar to nosocomial infection data from US hospitals.
Bacterial Infection from Intravascular Monitoring Devices
Authors: Stratton Charles W. , Hawley H. Bradford
Published: August 2016

During the past decade intravascular monitoring has become commonplace in hospital critical care areas. Early reports, such as that of Gardner et al, reassured us that these devices were safe. In fact, Gardner and associates noted not a single local or systemic infection that could be definitely related to radial artery monitoring catheters in 531 patients. Results of a more recent study by Band and Maki are more sobering. They found a 4% incidence of septicemia and an 18% incidence of local infection when they prospectively studied 130 arterial catheters in 95 patients. There were many differences between these two studies, but perhaps the two most important factors leading to the higher incidence of infection in the later study were increased duration of catheter placement and placement of the catheter by surgical cutdown or in a femoral artery.
The Role of the Laboratory in Control of Nosocomial Infection
Authors: McGowan John E.
Published: August 2016

Nosocomial (hospital-associated) infection continues to represent a major problem for hospitals. Gram-negative aerobic bacilli continue to be identified most frequently as etiologic agents, but a number of new pathogens now are recognized to play a role. The persons responsible for infection control efforts and in charge of the clinical microbiology laboratory (frequently the same person) must cooperate closely to attack this problem. The role of the laboratory in attempts to minimize occurrence of nosocomial infection involves six aspects: 1) accurate identification of responsible organisms, 2) timely reporting of laboratory data, 3) provision of additional studies, when necessary, to establish similarity or difference of organisms, 4) provision, on occasion, of microbiologic studies of the hospital environment, 5) training of infection control personnel, and 6) participation in activities of the hospital infection control committee.
Assessment of Catheter-Associated Infection Risk with the Hickman Right Atrial Catheter
Authors: Fuchs Peter C. , Gustafson Marie E. , King James T. , Goodall Patrick T.
Published: August 2016

One hundred fifty Hickman right atrial catheters were inserted into 143 patients and were followed prospectively until removal. Primary indications for their use were: cancer chemotherapy (45), parenteral nutrition (35), antibiotic therapy (63), and miscellaneous (7). The overall catheter-associated infection rate was 12.0%. Since the mean duration of catheterization was 125 days, the infection/duration rate was 1.0/1,000 days of use. The risk of infection differed significantly according to the primary indication for catheterization: parenteral nutrition > antibiotic therapy > cancer chemotherapy. The increased risk of catheter-associated infection attributable to duration of catheterization was additive, and the per day risk of such infections remained constant regardless of duration. Nearly two-thirds of patients were discharged home with catheters in place, without adversely affecting infection risk.
A Maternal-Neonatal Outbreak of Infections Due to an Unusual Group A β-Hemolytic Streptococcus
Authors: Wiesenthal Andrew M.
Published: August 2016

An outbreak of group A β-hemolytic streptococcal infections involving three parturients, three newborns, and a nursery RN is reported. Six of six organisms available for serotyping were M-untypable, T-11, serum opacity reaction-negative. Propagation of the outbreak may have been fostered by the common use of a single sitz bath, although the evidence to support this is weak. The outbreak was rapidly controlled via strict cohorting, appropriate treatment and isolation of cases, and the routine use of triple dye for umbilical cord care.
Influence of Ethanol With and Without Chlorhexidine on the Bacterial Colonization of the Umbilicus of Newborn Infants
Authors: Bygdeman S. , Hambraeus A , Henningsson A. , Nyström B. , Skoglund C. , Tunell R.
Published: August 2016

The effect of daily treatments with 70% ethanol and with 0.5% Chlorhexidine in 70% ethanol, respectively, on navel colonization in newborns has been studied in 624 infants in two maternity wards during a four-month period. Staphylococcus aureus, group B and G streptococci, E. coli and anaerobes were significantly less often isolated from newborns whose umbilical cord was treated with Chlorhexidine in ethanol than from those treated with ethanol only. Staphylococcus epidermidis and enterococci, on the other hand, were significantly more often isolated from the chlorhexidine-ethanol than from the ethanol group. More infants without colonization of the umbilicus on their fourth day of life were found in the Chlorhexidine in ethanol than in the ethanol group. The infants in the ethanol group were colonized with significantly more bacterial species than the infants in the other group. Signs of dissemination of group B and group G streptococci between babies were seen more often in the group of infants treated with ethanol than in the one treated with chlorhexidine-ethanol.
Employee Health Guidelines From the American Occupational Medical Association
Authors: Brown Torrey C. , Kreider Sidney D. , Lange W. Robert
Published: August 2016

For many years the American Occupational Medical Association (AOMA) has had a committee on medical center employee occupational health services. This committee has met periodically to discuss common problems and issues related to occupational health matters in health-care facilities. Two years ago a task force met to develop guidelines for employee health services which would be the official AOMA statement on this matter. The guidelines were published recently in the Journal of Occupational Medicine and have been reprinted here.
Lack of Utility of Routine Screening Tests for Early Detection of Peritonitis in Patients Requiring Intermittent Peritoneal Dialysis
Authors: Cooper Glenn L. , White Julie A. , D'Elia John A. , DeGirolami Paola C. , Arkin Charles , Kaldany Antoine , Piatt Richard
Published: August 2016

A prospective study was undertaken to examine the clinical presentation of peritonitis in patients maintained on intermittent peritoneal dialysis and to determine the value of qualitative and quantitative dialysate cultures, gram stain, neutrophil counts, and a semiquantitative leukocyte test strip for case detection. Seven cases of peritonitis developed among 30 patients who underwent 553 dialyses. In most cases, neutrophil counts, cultures, and leukocyte test strip determinations were done within 48 hours prior to the clinical onset of peritonitis and in all instances failed to provide clues for incipient infection. Peritonitis was associated with a dialysate neutrophil count of >500/mm3 and leukocyte test strips were highly sensitive and specific for the detection of this quantity of neutrophils. A total of 16 dialysate cultures was positive in asymptomatic patients who did not have peritonitis. None of these patients subsequently developed peritonitis with the same organism. Dialysate gram stains, cultures, neutrophil counts or leukocyte test strips did not provide an early diagnosis of peritonitis and their use in the absence of symptoms is therefore not recommended.
Serratia marcescansContamination of Antiseptic Soap Containing Triclosan: Implications for Nosocomial Infection
Authors: Barry M. Anita , Craven Donald E. , Goularte Theresa A. , Lichtenberg Deborah A.
Published: August 2016

During a recent investigation in our surgical intensive care unit, we found that several bottles of the antiseptic handwashing soap, OR Scrub®, were contaminated withSerratia marcescens. OR Scrub® contains 1% triclosan, lanolin, and detergents. The antimicrobial efficacy of OR Scrub® was examined in vitro using serial two-fold dilutions of soap inoculated with various concentrations of different nosocomial pathogens. The minimal bactericidal concentration (MBC) of OR Scrub® againstPseudomonas aeruginosaand several strains ofS. marcescenswas ≤1:2 By comparison, a non-antiseptic soap from the same manufacturer (Wash®) and 4% chlorhexidine (Hibiclens®) had MBCs for all strains tested of at least 1:64. Time-kill curves confirmed the findings of the initial experiments.

This is the first report of extrinsic contamination of antiseptic soap containing triclosan. No infections could be attributed to the contaminated soap, but sporadic outbreaks ofSerratiahave occurred in the intensive care unit with no identifiable source. Although there have been few studies on the impact of antiseptic soap in reducing nosocomial infection, we question whether a soap with the limitations of OR Scrub® should be used in intensive care units or operating rooms.
The Cephalosporin Antibiotic Agents—I. Considered as a Group
Authors: Marsh T. Donald
Published: August 2016

This review of the cephalosporin antibiotic family will appear in three parts. The first part will provide general information on the cephalosporins as a class, highlighting the history, chemistry, pharmacokinetics, toxicity, and the segregation of these agents into “generations.” The second segment will discuss the antimicrobial spectra of activity of the first- and second-generation agents, while the last article will focus on the third-generation and investigational cephalosporins under evaluation.

Despite a confusing, and somewhat overwhelming array of cephalosporin antimicrobial agents presently available to the clinician, more are on the way. Since 1962 and the introduction of cephalothin, the first agent in this family, there has been a constant parade of new cephalosporins from various pharmaceutical manufacturers. Drug manufacturers are attempting to develop a more effective drug with attractive pharmacokinetic features and less toxicity by modifying the basic cephalosporin molecule.
Aeromonas
Authors: Schoch Paul E. , Cunha Burke A.
Published: August 2016

The genera Aeromonas and Plesiomonas are gram-negative, cytochrome oxidase-positive, asporogenous, facultatively anaerobic rods that ferment carbohydrates with the production of acid or acid and gas. They are members of the family Vibrionaceae. Members of these genera are motile by means of polar flagella but in many other ways, resemble organisms belonging to the Enterobacteriaceae. Three species of Aeromonas are currently recognized in the eighth edition ofBergey's Manual, based on the studies of Schubert.A. salmonicida, a pathogen in fish which is non-motile and incapable of growing at 37°C,A. punctata, an aquatic environmental isolate possessing two subspecies andA. hydrophila, an organism associated with a wide range of clinical manifestations including wound cellulitis, septicemia, acute diarrheal disease, urinary tract infections and rarely, endocarditis, neonatal meningitis, otitis, peritonitis and osteomyelitis. In 1976, Popoff and Vern described a new species of AeromonasA. sobria, which while motile, differed fromA. hydrophilaby a lack or significant decrease in the presence of several enzymes such as elastase, lipase and B-glucosidase. This organism represented a minority of environmental strains in a survey conducted by Seidler but seemed to predominate in a series of clinical isolates reviewed by Daily and colleagues in which the majority of Aeromonas isolates studied wereA. sobria, characteristically cytotoxic, enterotoxigenic and lethal for mice. Unfortunately, since many clinical laboratories have not differentiatedA. sobriafromA. hydrophilain the past, the true incidence of this organism in human infections is largely unknown. Taxonomic studies performed by Maclnnes and Trust suggested thatA. sobriashould be included as a biotype ofA. hydrophila.