bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiologic and Clinical Utility of Typing Systems for Differentiating Among Strains of Methicillin-Resistant Staphylococcus aureus
Authors: Mulligan Maury E. , Arbeit Robert D. 
Published: September 2009

AbstractTyping systems for differentiating among strains of methicillin-resistant Staphylococcus aureus (MRSA) can be valuable tools for the epidemiologist and the clinician. Specific criteria for evaluating such systems are typeability, reproducibility, and discriminatory power. An ideal typing system also would be rapid, inexpensive, technically simple, and readily available. Systems based on the detection of phenotypic variations include antimicrobial susceptibility testing, bacteriophage typing, multilocus enzyme electrophoresis, and electrophoretic methods such as protein eletrophoresis and immunoblotting. Systems that directly detect genotypic variations include plasmid profile analysis, restriction enzyme analysis of plasmid DNA, restriction enzyme analysis of chromosomal DNA, Southern blot analysis of specific restriction fragment length polymorphisms, and pulse field gel electrophoresis. in general, the more widely available typing systems based on phenotypic assays and plasmid analysis have limitations in typeability and/or discriminatory power.The chromosomal DNA-based techniques, although promising, are unproven approaches still under active investigation.
Treatment of Infection and Colonization Caused by Methicillin-Resistant Staphylococcus aureus
Authors: Chambers Henry F. 
Published: September 2009

AbstractThe mechanism of methicillin resistance confers resistance to all available B-lactam antibiotics; consequently, B-lactam antibiotics have no role in therapy of methicillin-resistant Staphylococcus aureus (MRSA) infections. Vancomycin remains the drug of choice. Teicoplanin and daptomycin are two investigational antibiotics related to vancomycin in structure and in spectrum of activity. In clinical trials employing relatively low doses, neither was as effective as vancomycin. Trials at higher doses are on-going. Quinolones, ciprofloxacin in particular, have been used successfully to treat infections caused by MRSA; however, the usefulness of quinolones may be limited by the tendency of resistance to emerge during therapy. Quinolones probably should be used only in combination with another active agent, such as rifampin, when treating serious infections caused by MRSA. Other agents may be active in vitro against MRSA, but clinical data showing their effectiveness are lacking. Rifampin combination regimens appear most effectively to eradicate colonization with MRSA.
Nursing Home Outbreak of Influenza A (H3N2): Evaluation of Vaccine Efficacy and Influenza Case Definitions
Authors: Taylor Jean Lin , Dwyer Diane M. , Coffman Thelma , Groves Carmela , Patel Jagdish , Israel Ebenezer 
Published: September 2009

AbstractObjectives:Describe an outbreak of influenza A (H3N2); provide an analysis of vaccine efficacy; measure the sensitivity specificity, and positive predictive value of 3 clinical case definitions of influenza.Setting:A nursing home in Washington County, Maryland. The outbreak involved 52 residents (attack rate = 47.7%) and at least 10 of 140 employees (minimum attack rate = 7.1%).Results:Twenty-five residents exhibited a 4-fold or greater increase in titer to influenza A/Sichuan/2/87. Vaccine efficacy was measured at -7.1%, suggesting that the influenza vaccine in 1988/1989 did not offer optimal protection against influenza A infection for the institutionalized elderly.Conclusions:The outbreak was a clear indicator of the need for rapid diagnosis. With the use of rapid diagnostic tests, influenza A could have been detected in time to use amantadine.
Introduction of a “Safety” Intravenous Catheter for Use in an Emergency Department: A Pediatric Hospital's Experience
Authors: Friedland Leonard R. , Brown Robert 
Published: September 2009

Little concern was given to the frequency of needlestick injuries in the workplace before the acquired immunodeficiency syndrome (AIDS) epidemic, despite the risk of acquiring more than 20 different infectious diseases from blood or body fluid-contaminated needlestick injuries. Reports of occupational human immunodeficiency virus (HIV) transmission after accidental needlestick injuries' have not only heightened healthcare worker awareness of this occupational hazard, but also galvanized industry to create safety devices designed to reduce this risk.We recently introduced a “safety” intravenous catheter for use in our emergency department at St. Christopher's Hospital for Children, Philadelphia, Pennsylvania. The catheter we chose is, to our knowledge, the only one readily available on the US market. This catheter is the Protectiv™ IV Catheter Safety System, marketed by Critikon, Inc., Tampa, Florida. The catheter's safety mechanism is an external plastic sheath that, as the user advances the catheter off the introducer needle, slides over the contaminated needle and locks it safely inside. The sheath acts as a needle cap, and the user's hands remain behind the introducer needle during all stages of operation. We prospectively evaluated our registered nurses’ acceptance and proficiency with this “safety” catheter.
Impact of Central Venous Catheter Removal on the Recurrence of Catheter-Related Coagulase-Negative Stahylococcal Bacteremia
Authors: Raad Issam , Davis Steve , Khan Asma , Tarrand Jeffrey , Elting Linda , Bodey Gerald P. 
Published: September 2009

AbstractObjective:To determine the impact of catheter management on the acute and long-term outcome of catheter-related coagulase-negative staphylococcal bacteremia.Design:Retrospective surveillance of catheter-related sepsis using quantitative blood and catheter cultures.Setting:University-affiliated tertiary cancer center.Patients and Methods:seventy patients with catheter-related coagulase-negative staphylococcal bacteremia were studied by retrospective chart review. The clinical characteristics of the patients and the management of the bacteremias were determined. The impact of immuno-suppressive risk factors, antibiotic therapy, and catheter management on the recurrence of the bacteremia was investigated.Results:Acute sepsis-related morbidity and mortality were not related to catheter management. However, during a 12-week followup period, the bacteremia recurred in 20% of the patients whose catheters remained in place, compared with only 3% of those whose catheters were removed (p<.05). By multivariate analysis, patients whose catheters remained in place were 2.9 times more likely to experience a recurrence than those whose catheters were removed (odds ratio = 2.9, 95% confidence interval = 1.2-8.8, p= .03). All other potential risk factors were equally distributed between patients, with and without a recurrence.Conclusions:Although patients with catheter-related coagulase-negative staphylococcal bacteremia could be treated successfully while the catheter remains in place with the majority remaining free of recurrence, catheter retention results in a significantly higher risk for the recurrence of the bacteremia.
Nosocomial Transmission of Salmonella Gastroenteritis to Laundry Workers in a Nursing Home
Authors: Standaert Steven M. , Hutcheson Robert H. , Schaffner William 
Published: September 2009

AbstractBackground:Outbreaks of salmonella gastroenteritis in nursing homes are common. Person-to-person transmission to nursing home personnel occurs occasionally, but infection of laundry staff as a result of handling soiled linen rarely has been reported.Objective:To examine the nosocomial transmission of infection to laundry staff during an outbreak of salmonellosis in a nursing home.Setting:A 250-bed nursing home in a rural Tennessee county.Methods:Residents and staff of the nursing home were interviewed and cultures of stool samples examined for enteric pathogens.Results:Stool cultures from 32 residents and 8 employees were positive for Salmonella hadar. Infection among the residents was food-borne, but infection among employees likely represented secondary transmission, as none of the employees ate food prepared in the kitchen and their onset of symptoms occurred seven to 10 days after that of ill residents. Three laundry personnel who had no contact with residents were infected. Most of the ill residents (81%) were incontinent, which led to an increase in both the degree of fecal soiling and the amount of soiled linen received by the laundry during the outbreak. Laundry personnel regularly ate in the laundry room, did not wear protective clothing, and did not wear gloves consistently while handling soiled laundry,Conclusions:This investigation implicates linen soiled with feces as the source of nosocomial S hadar infection in laundry workers and underscores the importance of using appropriate precautions when handling linen.
Epidemiology of Staphylococcus Aureus Infections in Patients on Hemodialysis
Authors: Ena J. , Boelaert J.R. , Boyken L.D. , Van Landuyt H.W. , Godard C.A. , Herwaldt LA. 
Published: September 2009

AbstractObjective:To determine the epidemiology of Staphylococcus aureus infections in hemodialysis patients.Method:S aureus isolates from surveillance cultures and from sites of infection were evaluated by both bacteriophage typing and restriction endonuclease digestion of plasmid DNA.Setting:A hemodialysis unit in Brugge, Belgium.Organisms:S aureus isolates from 11 chronic hemodialysis patients who had participated in the placebo arm of a previously reported placebo-mupirocin comparative study.Results:Of 75 S aureus isolates evaluated, 63 were from cultures of nares and 12 from infections (three arteriovenous fistula infections, four wound infections, and five bacteremias). All isolates were typed by bacteriophages and 56 (75%) had plasmids. Three patients developed 12 infections. Eleven infections were caused by isolates previously identified in surveillance cultures. Only one infection was caused by a strain not identified previously in surveillance cultures.Conclusion:These results support the hypothesis that S aureus isolates causing infections in hemodialysis patients are of endogenous origin.
Predominance of Gram-Positive Microorganisms as a Cause of Septicemia in Patients with Hematological Malignancies
Authors: Rubio M. , Palau L. , Vivas J. Romero , del Potro E. , Diaz-Mediavilla J. , Alvarez A. , Martinez R. , Picazo J.J. 
Published: September 2009

AbstractObjective:To ascertain the etiology and outcome of episodes of bacteremia and fungemia over a three-year period (1990-1992) in patients with hematological malignancies.Design:Retrospective study.Setting:Hematology service of a 1,500-bed Spanish university hospital.Results:Of a total of 178 episodes of significant bacteremia or fungemia in 101 patients, 53% affected patients with acute leukemia. Grampositive microorganisms were found to be the cause in 70% of the monomicrobial episodes. The most frequently isolated microorganism was coag-ulase-negative Staphylococcus (35%), followed by Staphylococcus aureus (11%). Most bloodstream infections occurred during an episode of neutropenia (59%). A total of 34 patients died during hospitalization; in 14, infection was the cause of death.Conclusions:A marked increase in the incidence of bacteremias caused by grampositive microorganisms has been observed in our hospital over the last 10 years, especially in patients with hematological malignancies. The mortality due to bacteremia is similar to that found by other authors in series of bacteremia in hematological patients, and we have not found significant differences in the mortality due to bacteremia between neutropenic and non-neutropenic patients.
Risk factor for Central Venous Catheter-Related Infections in Surgical and Intensive Care Units
Authors: Moro Maria Luisa , Vigano Egidio Franco , Lepri Alessandro Cozzi ,   The Central Venous Catheter-Related Infections Study Group
Published: September 2009

AbstractObjective:To identify avoidable risk factors for central venous catheter (CVC) infections in patients undergoing short-term catheterization.Design:Prospective multicenter cohort study.Setting:Two university teaching hospitals and five large nonteaching hospitals.Patients:Patients admitted to intensive care units or surgical units and exposed to short-term CVCs.Results:Of 623 catheterization episodes, 9.3% were associated with catheter-related infections (CRI). The skin at the catheter site was frequently colonized (16.2%) and was the potential source of infection in 56.1% of the cases, mostly local infections. The hub was colonized less frequently (3.5%) but was responsible for systemic infections more frequentlyThe following variables were independently associated with CRI: duration of catheterization (for 7 to 14 days, odds ratio [OR], 3.9; 95% confidence interval [CI]95, 1.4 to 10.7; and for >14 days, OR, 5.1; CI95, 1.7 to 15.4), coronary care unit service (OR, 6.7; CI95, 1.1 to 42.9) or surgery service (OR, 4.4; CI95, 1.03 to 18.5), second episode of catheterization (OR, 7.6; CI95, 1.8 to 32.3), skin colonization at the insertion site (OR, 56.5; CI95, 10.8 to 296), and hub colonization (OR, 17.9; CI95, 2.4 to 132).The risk associated with skin colonization varied with use of jugular access or simultaneous colonization of the hub. When only symptomatic CRI was considered, the risk associated with hub colonization was consistently higher (OR, 36.6; 7 to 190) than that associated with skin colonization (OR, 3.2; CI95, 0.7 to 14).Age, transparent dressing, jugular insertion, male gender, duration of catheterization, and hub colonization were independent risk factors for skin colonization. The effect of age varied by type of dressing and vice versa; the effect of jugular access varied by sex; and the effect of transparent dressing varied by length of catheter-ization and vice versa.Total parenteral nutrition and skin colonization were independently associated with an increased risk of hub colonization.Conclusions:Skin and hub colonization are the two major determinants for endemic CRIs; colonization of the hub, however, is more frequently associated with more severe infections. In order to reduce CRIs, more efforts should be focused on understanding which factors increase the risk of colonization both of the skin and of the hub.
Ultraviolet Air Disinfection: Rationale for Whole Building Irradiation
Authors: Riley Richard L. 
Published: September 2009

The danger of exposure to tuberculosis (TB) exists primarily in facilities in which people with TB are likely to mingle with uninfected susceptible people. Such places include, among others, healthcare facilities in areas where TB is prevalent, shelters for the homeless in large cities, drug treatment centers, and prisons. If a given facility is identified as hazardous, an effective method for interrupting airborne transmission of TB is air disinfection with ultraviolet germicidal irradiation (UVGI). In this article, implementation of this method will be discussed: where, within a given building, UVGI fixtures should be installed; and what fixture design should be chosen for each location.Where to install ultraviolet (UV) fixtures depends on where the hazard of airborne TB exists, and that depends on the behavior of infected people and the behavior of infectious airborne particles. Patients with known active TB normally are sequestered in isolation rooms where special precautions are taken to avoid transmission of infection. However, as stated succinctly in 1967 in a document accepted by the National Tuberculosis Association Board of Directors: “It should be made clear that the greatest risk of infection arises from the individual with undiagnosed or unsuspected tuberculosis.” Such people usually are unaware that they are infectious. They may be seated in clinic waiting rooms, walking the hospital corridors, or visiting in patients' rooms. If the unsuspected case is a member of the housekeeping or healthcare staff, he or she may be found anywhere in the building. The behavior of infectious airborne particles is equally unpredictable.
Postexposure Varicella Management of Nonimmune Personnel: An Alternative Approach
Authors: Haiduven Donna J. , Hench Carmen I? , Stevens David A. 
Published: September 2009

Varicella exposures in the hospital setting cause problems of management of nonimmune employees. There has been a great deal written about the number of varicella exposures and the problems created by them but few practical recommendations for prevention or management of such exposures, including management of exposed nonimmune employees.In 1983, the Centers for Disease Control and Prevention (CDC) published Guidelines for Infection Control in Hospital Personnel. The CDC is quite clear on their recommendations for personnel exposed to varicella or zoster and state (as a Category I recommendation): “After exposure to varicella or zoster, personnel not known to be immune to varicella (by history or serology) should be excluded from work beginning on the tenth day after exposure and remain away from work for the maximum incubation period of varicella (21 days). Personnel who have onset of varicella should be excluded from work at least until all lesions have dried and crusted.” The CDC suggests it may be useful to screen those personnel who have a negative or equivocal history of varicella for the presence of serum antibodies to varicella zoster virus (VZV) to document susceptibility or immunity.
Molecular Epidemiology of Endemic Ciprofloxacin-Susceptible and -Resistant Enterobacteriaceae
Authors: Yee Y.C. , Muder RR , Hsieh M.H. , Lee T.C. 
Published: September 2009

AbstractObjectives:To elucidate the epidemiology of widespread ciprofloxacin resistance in our Veterans Affairs medical center using whole cell DNA analysis.Design:In vitro study of ciprofloxacin resistant and susceptible Enterobacteriaceae isolated during the course of a clinical epidemiologic study of quinolone resistance.Setting:Veterans Affairs Medical Center with acute care and long-term care divisions.Results:We examined 40 ciprofloxacin-resistant strains of Serratia marcescens, Proteus mirabilis, and Providencia stuartii using restriction endonuclease analysis of whole cell DNA and compared them with concomitantly isolated ciprofloxacin sensitive strains. We sought to determine whether resistant strains were identical to susceptible strains, indicating in vivo emergence of resistant strains from susceptible strains, and whether resistant strains were shared among patients. All 26 ciprofloxacin-resistant S marcestens isolates shared a single ecoRI restriction pattern. Multiple patterns were seen in the ciprofloxacin-susceptible S marcescens isolates; however, several isolates had a pattern matching that of the resistant isolates. Similar results were seen among the P mirabilis isolates. Three different ecoRI patterns were found among the ciprofloxacin-resistant P stuartii isolates; none matched those found among the susceptible isolates. The frequency of spontaneous emergence of ciprofloxacin resistance in susceptible S marcescens strains with restriction pattern matching that of the resistant strains was significantly higher than that of nonmatching strains.Conclusions:Ciprofloxacin-resistant strains of Enterobacteriaceae became widespread within a short period of time. Resistant strains of S marcestens and P mirabilis arose from endemic susceptible strains. The resistant strain of S marcescens appeared to arise from a susceptible strain with a relatively high frequency of spontaneous ciprofloxacin resistance.
Intrinsic water‐use efficiency of temperate seminatural grassland has increased since 1857: an analysis of carbon isotope discrimination of herbage from the Park Grass Experiment
Authors: KÖHLER IRIS H. , POULTON PAUL R. , AUERSWALD KARL , SCHNYDER HANS 
Published: September 2009

AbstractA 150‐year‐long record of intrinsic water‐use efficiency (Wi) was derived from community‐level carbon isotope discrimination (13Δ) in the herbage of the unfertilized, unlimed control treatment (plot 3) of the Park Grass Experiment at Rothamsted (England) between 1857 and 2007. 13Δ during spring growth (first cut harvested in June) averaged 21.0‰ (±0.5‰ SD) and has not shown a long‐term trend (P=0.5) since 1857. 13Δ of summer/autumn growth (second cut harvested between September and November) increased from 21.3‰ to 22.0‰ (P < 0.001) between 1875 and 2007. Wi during spring growth has therefore increased by 33% since the beginning of the experiment, and Wi of summer/autumn growth has increased by 18%. The variation in 13Δ was mainly related to weather conditions. Plant available soil water explained 51% and 40% of the variation in spring growth 13Δ and summer/autumn growth 13Δ, respectively. In the 1857–2007 period yields have not increased, suggesting that community‐level photosynthesis has not increased either. Therefore, the increased Wi probably resulted from a decreased stomatal conductance. Vapour pressure deficit (VPD) during spring growth (March–June) has not changed since 1915, meaning that instantaneous water‐use efficiency (Wt) in spring time has increased and transpiration has probably decreased, provided that leaf temperature followed air temperature. Conversely, VPD in the months between the first and second cut has increased by 0.07 kPa since 1915, offsetting the effect of increased Wi on Wt during summer and early autumn. Our results suggest that vegetation has adjusted physiologically to elevated CO2 by decreasing stomatal conductance in this nutrient‐limited grassland.
Relative influence of fisheries and climate on the demography of four albatross species
Authors: ROLLAND VIRGINIE , WEIMERSKIRCH HENRI , BARBRAUD CHRISTOPHE 
Published: September 2009

AbstractWorldwide ecosystems are modified by human activities and climate change. To be able to predict future changes, it is necessary to understand their respective role on population dynamics. Among the most threatened species are top predators because of their position in the food web. Albatross populations are potentially affected by both human activities, especially longline fisheries, and climatic fluctuations. Based on long‐term data (1985–2006), we conducted through a comparative approach a demographic analysis (adult survival and breeding success) on four albatross species breeding on the Indian Ocean sub‐Antarctic Islands to assess the relative impact of climate and fisheries during and outside the breeding season. The study revealed that adult survival of almost all species was not affected by climate, and therefore probably canalized against climatic variations, but was negatively affected by tuna longlining effort in three species. Breeding success was affected by climate, with contrasted effects between species, with Southern Oscillation Index having an impact on all species but one. Differences in demographic responses depended on the foraging zone and season. In order to predict population trajectories of seabirds such as albatrosses, our results show the importance of assessing the relative influence of fishing and climate impacts on demography.