bluuebunny/crossref_metadata_2025_split huggingface dataset:
Environmental Factors Contributing to Antibiotic Resistance
Authors: Phillips Ian 
Published: August 2016

AbstractThe genetic determinants of antibiotic resistance originate as a result of random events, affected only by those physical and chemical agents that stimulate mutation. It is the selection and spread, within and between species, of new genetic material that is influenced by environmental factors, though the intrinsic antibiotic resistance of many opportunistic pathogens remains to be explained.Depending on the frequency of genetic change, the biochemical resistance mechanism, the efficiency of selection (including access of antibiotic to relevant bacteria), and the opportunity for person-to-person spread, resistance may present in a number of ways. The use of an antibiotic in any individual may give rise to resistance, among pathogens or normal flora, to that antibiotic alone, to some or all members of its class, or to additional unrelated antibacterials, or to the acquisition of new bacteria, from a variety of sources (humans, animals, inanimate environment). A resistant organism may occasionally have other advantages that enable it to spread in the absence of the initial selective agents.In the absence of controlled experiments, which are difficult or perhaps impossible, the only evidence of the truth of these hypotheses comes from the clinical use of antibiotics. A wise observer will conclude that the emergence of resistance is a rare event in an individual patient, but is commoner but by no means universal in populations, especially those that are closed. He will note the reports of diminished resistance in the presence of increased usage.The role of academic infection control is to explain all the phenomena observed, and to formulate methods for identifying and countering the actual as opposed to the imagined hazards.
Hygienic Hand Disinfection
Authors: Rotter M.L. 
Published: August 2016

AbstractThe purpose of hygienic hand disinfection is to render hands safe after contact with pathogens. Comparing effects of disinfection procedures on infection ratios is too difficult for routine purposes but the degerming efficacy may be determined in laboratory tests with volunteers. In the Vienna test model the efficacy of a specific procedure being tested is compared to that of a standard disinfection (rubbing into hands 3 ml of iso-propanol 60% v/v, 30 seconds, twice) tested in parallel with the same volunteers. This ensures standardization, thus comparability of results between laboratories, and provides the investigator with a yardstick for efficacy. The model includes artificial contamination, assessment of the release of test bacteria (E. ColiATCC 11229) before and after disinfection by the finger tip method, and addition of neutralizers to sampling fluids. Alcohols in appropriate concentrations are highly effective (log reductions: >4.0) whereas procedures employing disinfectant detergents act like soap (log reductions: ≤ 3.2) and may cause dissemination of pathogens.
Pseudobacteremia Traced to Cross-Contamination by an Automated Blood Culture Analyzer
Authors: Craven Donald E. , Lichtenberg Deborah A. , Browne Kathleen F. , Coffey Donna M. , Treadwell Thomas L. , McCabe William R. 
Published: August 2016

AbstractTwenty-three episodes of pseudobacteremia occurring over a seven-month period were traced to cross-contamination by the automated blood culture analyzer (BACTEC 460) used in the microbiology laboratory. An epidemiologic investigation of an unusual cluster of three patients with pseudobacteremia caused by oxacillin-resistantStaphylococcus aureusled to the identification of the problem. Mock trials of the blood culture procedure confirmed that the blood culture analyzer was the source of contamination. After the needle sterilizer was replaced by the manufacturer, the problem of cross-contamination abated. Contamination of sterile blood cultures by an instrument intended to identify bacteremia rapidly may lead to incorrect diagnosis, unnecessary administration of antibiotics and prolonged hospitalization. Because of the widespread use of automated blood culture analyzers in the US, physicians, microbiologists, and infection control personnel should be alert to the possibility of cross-contamination and the subtle way in which it may present.
Recommendations for the Care of Automated Peritoneal Dialysis Machines: Can the Risk of Peritonitis Be Reduced?
Authors: Berkelman Ruth L. , Band Jeffery D. , Petersen Norman J. 
Published: August 2016

AbstractAutomated peritoneal dialysis systems have helped make intermittent peritoneal dialysis an alternative to hemodialysis for long-term management of patients with end-stage renal disease. However, if not cleaned and maintained properly, these machines provide a reservoir for pathogens. The microbiologic barriers in these machines are not impenetrable, but sterile dialy-sate fluid can be produced if the machines are adequately cleaned and disinfected. Potential shortcomings of the microbiologic barriers are discussed, and guidelines to prevent contamination of the internal parts of a machine are suggested.
Multidose Medication Vial Sterility: An In-Use Study and a Review of the Literature
Authors: Longfield Robert , Longfield Jenice , Smith L. Patrick , Hyams K. Craig , Strohmer M. Elena 
Published: August 2016

AbstractContaminated multiple-dose medication vials (MDV) have been implicated in transmission of bacterial infections. It has been suggested that MDV be discarded after 24 hours or even after a single use. At our hospital, we cultured 1,223 weekly samples from 864 MDV in-use over a three-month period. Medications included xylocaine, insulin, heparin, immunizations, and miscellaneous agents. None of the samples was culture-positive. The duration of use was 9.5d (median), 18d (mean), and 1-402d (range) with 13% of vials in-use for more than 30 days. The mean duration of use was significantly shorter for medicine wards, emergency room, and outpatient clinics than for surgery and obgyn wards (p<0.05). Heparin and insulin MDV were in-use for significantly less time than xylocaine and miscellaneous agents (p<0.05), and insulin MDV were more regularly dated (p=0.001). The percentage of undated MDV declined significantly by month during die study (p=0.003). These results lend support to our current guideline that MDV should be dated upon opening and that, unless visible or suspected contamination occurs, vials are discarded either when empty or at the manufacturer's expiration date.
The Pharmacology of Aminoglycosides—I. Considered as a Group
Authors: Norris Sandra M. , Ravdin Jonathan I. 
Published: August 2016

This review of aminoglycoside pharmacology will appear in two parts. The first segment summarizes general information applicable to all agents, such as aspects of absorption, distribution, and clearance. The subsequent article will focus on specific agents currently in use in clinical practice: gentamicin, tobramycin, netilmicin, amikacin, streptomycin, and kanamycin, highlighting toxicities and pharmacokinetic-based dosing strategies.Embedded in the history of antimicrobial agents with the discovery of streptomycin in 1944, the aminoglycosides remain a mainstay of contemporary antibiotic therapy. Noteworthy features include rapid bactericidal activity against aerobic gram-negative organisms as well as additive or synergistic activity when coadministered with beta-lactam agents. These positive attributes are offset by limited penetration into various body fluids and tissues, and dose (concentration) related renal and ototoxicity. Despite the proliferation of safer beta-lactam compounds with expanded antimicrobial spectrums, the aminoglycosides are still initial drugs of choice for most life-threatening, aerobic, gram-negative infections. Used in combination with anti-pseudomonal penicillins, the aminoglycosides are the agents of choice for empiric therapy of fever in the neutropenic host or documented tissue infection withPseudomonas aeruginosa.
Nosocomial Respiratory Infections
Authors: Dixon Richard E. 
Published: August 2016

AbstractNosocomial respiratory tract infections are major causes of excessive morbidity and mortality in US hospitals, affecting an estimated five to ten of every 1,000 patients. Patients with serious underlying diseases have an especially high risk of acquiring these infections, and that risk is magnified by exposure to respiratory therapy. Until recently, contaminated respiratory care devices were a major cause of infection, but procedures for the management of these devices have decreased their role substantially. Now, aspiration of oropharyngeal flora appears to be responsible for most cases of bacterial respiratory infections. Therefore, techniques to alter the flora of the oropharynx and to diminish the risk of aspiration are important priorities for infection control. Exposure to intensive care units (ICUs) is also a major risk factor for nosocomial pulmonary infection, and person-to-person spread of microorganisms within ICUs seems to be responsible for some of these infections.Increasing numbers of pulmonary infections are being caused by newly identified or previously uncommon pathogens, and this shift requires that traditional control techniques be reevaluated to assure that they remain relevant.Few new techniques have been developed recently to alter host susceptibility, prevent acquisition of virulent pathogens, or eradicate infectious organisms from their sources, but effective infection control programs in hospitals appear to reduce the incidence of nosocomial pulmonary infection, and implementation of these programs deserves serious consideration in all hospitals.
Effect of Antiseptic Agents on Skin Flora of the Perineum of Men with Spinal Cord Injury
Authors: Gilmore Donna S. , Montgomerie John Z. , Graham Irene E. , Schick Donald G. , Jimenez Enes M. 
Published: August 2016

AbstractMale patients with spinal cord injury are frequently colonized withP. aeruginosaandK. pneumoniaeon the perineum. Regular bathing with bar soap has not influenced this colonization. We have attempted to remove these bacteria using antiseptic agents. The number ofP. aeruginosa,K. pneumoniaeand total aerobic bacteria on the perineum and the penile shaft was determined before and after cleaning with bar soap, chlorhexidine, povidone-iodine and pHresh. Povidone-iodine and chlorhexidine had no advantage over bar soap or pHresh in the removal ofP. aeruginosaorK. pneumoniaefrom the perineum of patients with spinal cord injury.
Permeability of the Thermometer Sheath When Taking Oral Temperatures
Authors: Soltero Donald J. , Sommers Earl E. , Truelove Edmond L. 
Published: August 2016

Abstract Oral mercury-in-glass thermometers are contaminated with each use and must be decontaminated prior to reuse. It has been shown that the application of a thermometer sheath prevents contamination of the rectal thermometer. The purpose of the present study is to evaluate sheathed thermometers for contamination after oral use on dentulous patients. One hundred sterile sheathed thermometers were distributed into four groups and subjected to in vitro and in vivo conditions.After clinical use 80% of the sheathed thermometers became contaminated, while not one of those exposed to microorganisms in vitro was contaminated. The cause for contamination was shown to be perforation of the sheath by the dentition. Thus the thermometer sheath is ineffective in preventing contamination of the mercury-in-glass thermometer when used for obtaining oral temperatures from dentulous patients. Sheathed mercury-in-glass thermometers should be decontaminated after each oral use.
Prevalence of Cytomegalovirus Antibody in Nursing Personnel
Authors: Lipscomb Jane A. , Linnemann Calvin C. , Hurst Pei Fung , Myers Martin G. , Stringer William , Moore Peggy , Hammond Jean 
Published: August 2016

AbstractTo evaluate the risk to nurses of childbearing age of acquiring cytomegalovirus (CMV) infection during the care of patients at high risk of the infection, 374 female hospital employees (288 nursing personnel) were interviewed and screened for antibody to CMV. Fifty-six percent of the population surveyed had antibody to CMV as measured by an immunofluorescent assay. Among nursing personnel, analysis of antibody prevalence by job title, work area, and duration of work showed no association between seropositivity and either current or past exposure to “high-risk” patients, such as infants and immunosuppressed individuals. Age, race (non-white), and the number of pregnancies reported by participants were significantly associated with the presence of antibody. Among 73 employees of a children's hospital, the prevalence of CMV antibody was 41%. This survey suggests that hospital nursing is not a major risk factor for acquiring CMV infection. However, this finding needs further evaluation in a prospective study of seroconversion rates among seronegative nurses.
A Nursery Outbreak of Multiple-Aminoglycoside-ResistantEscherichia coli
Authors: Gaynes Robert R , Simpson Diane , Reeves Sally A. , Noble Robert C. , Thornsberry Clyde , Culver David , Allen James R. , Martone William J. 
Published: August 2016

AbstractIn the neonatal intensive care unit (NICU) of one hospital, 16 infants became colonized or infected with multiply-resistantEscherichia coli(MR-E.coli) over an 8-month period. Isolates were obtained from blood, urine, and sputum of three patients and from rectal surveillance cultures of 13 patients. The one patient with the blood isolate died. A matched case-control study identified continuous feeding (nine of 16 cases vs. one of 16 controls, p ≤ 0.001) and receipt of aminoglycosides (p ≤ 0.03) as risk factors. For case-babies not exposed to continuous feeding, duration of bolus feeding was significantly greater than for their controls (cases, 22 days; controls, 7 days; p ≤ 0.02). All 16 isolates were the same serotype and were resistant to amikacin, tobramycin, kanamycin, and gentamicin. The epidemiologic investigation suggested that MR-E. colimay have spread from person-to-person on the hands of personnel and that MR-E. colipersisted in the NICU for 8 months until effective control measures were instituted.
Bacteriological Sampling of Telephones and Other Hospital Staff Hand-Contact Objects
Authors: Rafferty Karen M. , Pancoast Stephen J. 
Published: August 2016

AbstractIn an acute-care general hospital, 114 telephones, intercoms, dictaphones, and bedpan flusher handles were sampled in patient-care areas for type of bacterial contamination. Nine of these (7%) demonstrated potentially pathogenic bacteria including Klebsiella, Enterobacter, Pseudomonas and Aeromonas. Inanimate, environmental, staff hand-contact objects were only lightly contaminated, did not represent a significant reservoir of gram-negative organisms, and therefore, would be unlikely to be a vehicle of transmission of gram-negative bacteria from the hands of one staff member to another under routine circumstances. Surveillance and disinfection of telephones and related hand-contact items in the hospital appear unnecessary.
Cost-Effectiveness of the Two-Step Skin Test for Tuberculosis Screening of Employees in a Community Hospital
Authors: Lé Chinh T. 
Published: August 2016

AbstractTo assess the frequency of the booster effect as well as the need for and the cost effectiveness of the two-step skin test for tuberculosis screening at our medical center, we conducted a pilot study from June 1980 to March 1983 with hospital and clinic employees. Six (0.4%) of 1,521 employees tested by the two-step skin test demonstrated the booster effect. The mean age of these six employees was 35 years (range, 24 to 44 yr). During the study period, 10 employees converted to a positive skin test. The booster effect would have accounted for approximately 38% (6 of 16) of those converting if the two-step testing were not performed. At our medical center, the additional cost of the two-step skin test was low and justifiable for medical and epidemiologic reasons. We suggest that each hospital review the prevalence of tuberculosis among its patient and employee populations. The need for and cost effectiveness of the two-step skin test for new hospital employees must be re-examined on the basis of these data.
Bedside Resuscitation Bags: A Source of Bacterial Contamination
Authors: Thompson Anne C. , Wilder Barbara J. , Powner David J. 
Published: August 2016

AbstractResuscitation bags at the bedside of 12 intubated ICU patients with known culture positive sputum were evaluated as possible reservoirs of pathogenic bacteria. As oxygen was constantly flowing into the bags, sampling of gas continuously emitted from the exhalation valve assembly was sampled to detect if a bacteria-laden aerosol was being created. Positive cultures were obtained from 75% of the valves and 25% of the aerosol samples. In those patients with gram-negative bacteria in their sputum, 71% of the valves and 29% of the gas samples were positive for the same organisms. Various methods to control this possible contributing factor to nosocomial infection in the ICU are discussed.
Postoperative Wound Infections Following Cardiac Surgery: Significance of Contaminated Cases Performed in the Preceding 48 Hours
Authors: deSilva Malkanthie I. , Rissing J. Peter 
Published: August 2016

AbstractPostoperative wound infections following open heart cardiac surgery increased markedly after hospital relocation (7 of 77v; 4 of 320; p = .0007). Of the multiple identified risk factors, significant patient and procedural association included prolonged operative time of infected patients (384 minutes ± 115 SDv318 ± 67, p = .025) and operation in a room used within the previous 48 hours for a contaminated case (4/7 infectedv10/67 not infected; p = .023). Several defects were discovered in the air handling system. After appropriate changes, the infection rate decreased in the next 12 months (1 of 109; p < .02). Other concurrent surgical wound infection rates remained unchanged suggesting that defective air handling may have impacted only on the open heart cardiac surgery patients. Preceding contaminated surgery and prolonged operative time were associated with postoperative wound infections in cardiac surgery.
KlebsiellaMarker Systems
Authors: Rubin Sally Jo 
Published: August 2016

AbstractKlebsiellamarker systems include determination of susceptibility patterns, serotype, bacteriocin susceptibility, bacteriophage susceptibility, biotype, and plasmid content, size and endonuclease fragment size. Susceptibility patterns are useful only if unusual patterns (ie, aminoglycoside resistance) occur. Serotypes are stable, reproducible markers. Over 90% of isolates can be serotyped and epidemiologically unrelated strains are widely distributed among the 72 standard types. Antisera are not available commercially except to types 1 to 6 and serotyping is expensive and time-consuming. Bacteriocin susceptibility typing is easier and cheaper but reproducibility is sometimes poor. Depending on the producer strains used, between 67% and 96% of strains are typable. As a single typing method, bacteriophage typing is not very sensitive. Only 70% of strains are typable and 20% are of a single type. There are two major problems with most biotyping systems: poor reproducibility and poor sensitivity. A high percent of strains is the same type. Plasmid analysis is technically the most complicated but is important if strains are aminoglycoside resistant. No one method is ideal, and characterization of isolates from an outbreak is best done by using several different marker systems.
The Epidemiology of Nosocomial Infections Caused byKlebsiella pneumoniae
Authors: Jarvis William R. , Munn Van P. , Highsmith Anita K. , Culver David H. , Hughes James M. 
Published: August 2016

AbstractKlebsiella pneumoniaecauses serious epidemic and endemic nosocomial infections. We conducted a literature review to characterize the epidemiology of epidemicK. pneumoniaeoutbreaks. Eighty percent of the outbreaks (20/25) involved infections of the bloodstream or urinary tract. Person-to-person spread was the most common mode of transmission, and nearly 50% of the outbreaks occurred in neonatal intensive care units. No one serotype predominated, and no association was found between serotype and either the site of infection or the antimicrobial susceptibility pattern.We used data reported to the Centers for Disease Control (CDC) by hospitals participating in the National Nosocomial Infections Study (NNIS) to describe the epidemiology of endemicK. pneumoniaeinfections. In die 8-year period from 1975 through 1982 the nosocomialK. pneumoniaeinfection rate was 16.7 infections per 10,000 patients discharged. The rate of infection at medical school-affiliated hospitals was significantly greater than at nonaffiliated hospitals; furthermore, the rate of infection at large affiliated hospitals was greater than at small affiliated hospitals. The rate of infection varied by service, with the highest rate found on the medicine service. During the 8-year period, 184 deaths were caused by nosocomialK. pneumoniaeinfections (184 deaths/16,969 infections, case-fatality ratio 1.1%), with higher ratios in pediatrics (5%) where there was a 12% mortality in children infected with an aminoglycoside-resistant strain.
Lack of Nosocomial Spread ofVaricellain a Pediatric Hospital with Negative Pressure Ventilated Patient Rooms
Authors: Anderson John D. , Bonner Mavis , Scheifele David W. , Schneider B. Christof 
Published: August 2016

AbstractAll patients at the new British Columbia's Children's Hospital with chickenpox orHerpes zosterare nursed with appropriate precautions in single-bed rooms provided with negative pressure ventilation. Over a period of 1 year, no nosocomial infections were detected on follow-up of 110 susceptible patients who had been on wards at the same time as six cases of chickenpox and one immunocompromised patient with cutaneous dissemination ofVaricella zoster. In a preceding study at the previous hospital, with similar staff, control measures, and patient population, in an isolation facility without negative pressure ventilation, nosocomial infections occurred in seven out of 41 susceptible patients who were on the same ward as two patients with chickenpox. These findings suggest that a simple negative pressure ventilation system without air locks is a useful adjunct in the control of cutaneousVaricellainfections.
Isolation ofLegionella pneumophilafrom the Cold Water of Hospital Ice Machines: Implications for Origin and Transmission of the Organism
Authors: Stout Janet E. , Yu Victor L. , Muraca Paul 
Published: August 2016

AbstractAlthough the mode of transmission ofL. pneumophilais as yet unclear, the hot water distribution system has been shown to be the reservoir for Legionella within the hospital environment. In this report we identify a previously unrecognized reservoir forL. pneumophilawithin the hospital environment, ie, the cold water dispensers of hospital ice machines. The cold water dispensers of 14 ice machines were cultured monthly over a 1-year period. Positive cultures were obtained from 8 of 14 dispensers, yielding from 1 to 300 CFU/plate. We were able to link the positivity of these cold water sites to the incoming cold water supply by recoveringL. pneumophilafrom the cold water storage tank, which is directly supplied by the incoming municipal water line. This was accomplished by a novel enrichment experiment designed to duplicate the conditions (temperature, sediment, stagnation, and continuous seeding) of the hot water system. Our data indicate that significant contamination of cold water outlets withL. pneumophilacan occur. Although no epidemiologic link to disease was made, the fact that the primary source of a patient's drinking water is from the ice machines warrants further investigation of these water sources as possible reservoirs.