bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total and Attributable Costs of Surgical-Wound Infections at a Canadian Tertiary-Care Center
Authors: Zoutman Dick , McDonald Shirley , Vethanayagan Dilini 
Published: September 2009

ABSTRACTOBJECTIVE: To determine the total and attributable costs of surgical-wound infections in a Canadian teaching hospital.DESIGN: Retrospective incidence series study with chart review and examination of resource utilization attributable to wound infection. The charts of inpatients with wound infections were examined using the Appropriateness Evaluation Protocol (AEP), a validated chart review instrument designed to determine appropriateness of care, modified for wound infections.SETTING: A university referral center in Canada.PATIENTS: Medical records were abstracted from patients with wound infections who underwent an inpatient clean or clean-contaminated procedure during 1991.MEASUREMENTS: During the wound-infection treatment period, the hospital costs associated with providing care were tabulated for all inpatient days and for outpatient and emergency visits. Costs taken into account included nursing salary and benefits, nonphysician professional services, operating room time, laboratory, pharmacy, supplies, ancillary tests, and hotel costs.RESULTS: We identified 108 wound infections. Twenty-two patients required 28 surgical procedures related to a wound infection. Inpatient days totalled 1,116, costing $394,337. Fifty-five emergency and 42 clinic visits occurred, costing $27,193. By applying the AEP to the inpatient days, 833 days, or 10.2 days per case, were directly attributable to the wound infection. The hospital costs for inpatient care attributable to wound infections were $321,533 in total, or $3,937 per infection. Costs were distributed as follows: nursing, 51%; hotel, 14%; pharmacy, 10%; laboratory, 9%; emergency and outpatient clinic, 6%; professional services, 5%; operating room, 3%; and ancillary tests, 2%.CONCLUSIONS: Wound infections contribute markedly to extra days of hospitalization and related costs. The AEP method is applied easily to determine attributable days of care and costs of wound infections, which are necessary to calculate the cost-benefit of infection control programs.
Statistical Quality Control Methods in Infection Control and Hospital Epidemiology, Part II: Chart Use, Statistical Properties, and Research Issues
Authors: Birnbaum David , Benneyan James C. 
Published: September 2009

ABSTRACTThis is the second in a two-part series discussing and illustrating the application of statistical process control (SPC) in hospital epidemiology. The basic philosophical and theoretical foundations of statistical quality control and their relation to epidemiology are emphasized in order to expand the mutual understanding and cross-fertilization between these two disciplines. Part I provided an overview of the philosophy and general approach of SPC, illustrated common types of control charts, and provided references for further information or statistical formulae. Part II now discusses alternate possible SPC approaches, statistical properties of control charts, chart-design issues and optimal control limit widths, some common misunderstandings, and more advanced issues. The focus of both articles is mostly nonmathematical, emphasizing important concepts and practical examples rather than academic theory and exhaustive calculations.
Epidemiology of Methicillin-Resistant Staphylococcus aureus in Three Canadian Tertiary-Care Centers
Authors: Suh Kathryn , Toye Baldwin , Jessamine Peter , Chan Francis , Ramotar Karam 
Published: September 2009

AbstractOBJECTIVE:To describe the epidemiology and spread of methicillin-resistant Staphylococcus aureus (MRSA) in three tertiary-care centers in Ottawa, Ontario, Canada, where MRSA is encountered infrequently.DESIGN:Retrospective review over a 6-year period, from January 1, 1990, through December 31, 1995.SETTING:Three tertiary-care teaching hospitals in Ottawa.PARTICIPANTS:Patients and healthcare workers (HCWs) with MRSA isolated from any body site.METHODS:Patients and HCWs were identified retrospectively through hospital microbiology and infection control records. Patient charts were reviewed for clinical and epidemiological data, including age, gender, previous hospital admissions (where noted), and current and recent antibiotic use. MRSA isolates that were available were typed using pulsed-field gel electrophoresis (PFGE). Methicillin resistance was confirmed by standard methods and by polymerase chain reaction using mecA-specific primers.RESULTS:MRSA was identified in 53 patients and 2 HCWs. Three patients were excluded from further analysis because medical records were incomplete. Epidemiological data were collected on the remaining 52 individuals. Thirty-nine isolates from 31 patients and 2 HCWs were available for PFGE typing. Five epidemiologically linked nosocomial clusters involving 10 patients and 2 HCWs were identified and were confirmed by PFGE. MRSA isolates from a sixth cluster were not available for PFGE. In each cluster, nosocomial spread was minimized by standard infection control practices, including strict isolation of patients and screening of contacts. There was no evidence of secondary spread of MRSA involving the remaining 36 patients. Recent antibiotic use, surgery, admission to an intensive-care unit, and previous hospitalization were common among patients. There was no evidence of spread of MRSA among the three hospitals, and no endemic strains were apparent in any of these centers.CONCLUSIONS:MRSA remains an infrequent isolate in our centers, with no apparent interhospital spread. In institutions with little or no endemic MRSA, rigorous application of standard infection control practices is effective in limiting nosocomial transmission of this organism.
Spread of Vancomycin-Resistant Enterococci: Why Did It Happen in the United States?
Authors: Martone William J. 
Published: September 2009

AbstractThe question of why vancomycin-resistant enterococci (VRE) became epidemic in the United States can be answered on at least three basic levels: (1) molecular and genetic, (2) factors affecting host-microbe interactions, and (3) epidemiological. This article will address the epidemiological issues and seek to defend the assertion that, once VRE had evolved, its spread throughout hospitals in the United States was all but assured. Nosocomial VRE outbreaks were reported first in the mid- and late-1980s. Since that time, scientific reports of VRE have increased over 20-fold. Among hospitals participating in the National Nosocomial Infection Surveillance System from 1989 to 1997, the percentage of enterococci reported as resistant to vancomycin increased from 0.4% to 23.2% in intensive-care settings and from 0.3% to 15.4% in non-intensive-care settings. Factors leading to the spread of VRE in US hospitals include (1) antimicrobial pressure, (2) sub-optimal clinical laboratory recognition and reporting, (3) unrecognized “silent” carriage and prolonged fecal carriage, (4) environmental contamination and survival, (5) intrahospital and interhospital transfer of colonized patients, (6) introduction of unrecognized carriers from community settings such as nursing homes, and (7) inadequate compliance with hand washing and barrier precautions. Guidelines developed by the Centers for Disease Control and Prevention's Hospital Infection Control Practices Advisory Committee address each of these factors. The impact of these guidelines on the spread of VRE within individual institutions has been variable, and the overall impact of the guidelines nationally is unknown.
Spread of Vancomycin-Resistant Enterococci: Differences Between the United States and Europe
Authors: Goossens Herman 
Published: September 2009

AbstractThere are major differences in the epidemiology of vancomycin-resistant enterococci (VRE) between the United States and Europe. In contrast with Europe, VRE in the United States are resistant to many antibiotics, and there appears to be less genetic variability among these isolates. European VRE of human origin are usually susceptible to many other antibiotics and are highly polyclonal. These clinical isolates have the same susceptibility profiles as VRE isolated from animals.The differences in the spread of VRE between the United States and Europe might be explained by the overconsumption of glycopeptides and other antibiotics in hospitals in the United States and the use of avoparcin as a growth promotor in Europe.
Methicillin-Resistant Staphylococcus aureus and Its Relationship to Antimicrobial Use: Possible Implications for Control
Authors: Monnet Dominique L. 
Published: September 2009

AbstractThe control of methicillin-resistant Staphylococcus aureus (MRSA) is still an unresolved issue in numerous healthcare institutions worldwide. Guidelines for the control of MRSA in hospitals focus on measures to control cross-transmission and prevent colonization, but rarely specifically mention the control of antimicrobial use. We reviewed the different types of evidence for a causal relationship between MRSA and antimicrobial use by classifying them in four categories: consistent associations, dose-effect relationships, concomitant variations, and arguments to support a plausible biological model to explain this relationship. Although the relative participation of cross-transmission and antimicrobial selection pressure in the level of MRSA observed in a healthcare setting remains to be determined, we found lines of evidence to support the existence of a relationship between MRSA and antimicrobial use in each of the four categories. This review points out the relative lack of studies specifically designed to investigate this aspect of MRSA epidemiology and the need to implement such studies quickly. In the meantime, the results presented here should encourage the implementation of antimicrobial-use improvement programs in hospitals in addition to existing infection control measures, which are still a priority in countries with high MRSA prevalence.
Comparative and Library Epidemiological Typing Systems: Outbreak Investigations Versus Surveillance Systems
Authors: Struelens Marc J. , Gheldre Yves De , Deplano Ariane 
Published: September 2009

AbstractA number of high-resolution molecular typing systems have been developed in recent years. Their availability raises the new issues of selecting the method(s) best suited for a particular purpose and interpreting and communicating typing results. Most of the currently available methods are comparative only: they allow testing of a sample of isolates for delineation of those closely related from those markedly different in genomic backgrounds. This approach is adequate for outbreak investigation, allowing determination of clonal spread in a microenvironment and identification of the source of infection. Comparative methods with sufficient resolution for most pathogens include restriction fragment-length polymorphism (RFLP), pulsed-field gel electrophoresis (PFGE), and arbitrarily primed and randomly amplified polymorphic DNA-polymerase chain reaction (PCR) analysis. For surveillance systems, monitoring clonal spread and prevalence in populations over extended periods of time requires library typing systems. These must be standardized, must have a high throughput, and must use a uniform nomenclature. Promising or validated methods include serotyping, insertion sequence fingerprinting, ribotyping, PFGE, amplified fragment-length polymorphism (AFLP), infrequent-restriction-site amplification PCR, interrepetitive element PCR typing (rep-PCR) and PCR-RFLP of polymorphic loci. PCR methods generating arrays of size-specific amplicons (AFLP, rep-PCR) can be more reproducibly analyzed by using denaturing polyacrylamide gel or capillary electrophoresis with automated laser detection. Binary probe typing systems appear optimal and should be enhanced further through use of DNA chip technology. In these systems, amplification of polymorphic regions is followed by solid-phase hybridization with a reference panel of sequence-variant specific probes. The resulting binary type results allow determination of reproducible, numeric profiles. However, interpretation and nomenclature of typing results for large-scale surveillance purposes still require a better understanding of population structure and microevolution of most microbial pathogens.
Nosocomial Transmission of Opportunistic Infections
Authors: Gerberding Julie Louise 
Published: September 2009

AbstractImmunocompromised patients are at high risk for opportunistic infections. Traditionally, these infections were thought to arise from endogenous reactivation of previously acquired latent infections, and nosocomial transmission therefore was deemed to be so unlikely that no special infection control interventions were needed to prevent transmission in healthcare settings. However, new data have challenged this view and suggest that some opportunistic pathogens are transmissible from one immunosuppressed patient to another. Epidemiological investigations, molecular genotyping, animal studies, and air-sampling experiments lend support to the hypothesis that reinfection with opportunistic pathogens does occur, that airborne transmission is possible, and that nosocomial spread is a plausible explanation for case clusters. Taken together, these observations support the view that some opportunistic infections are exogenous in origin and that additional epidemiological investigations are needed to define the true risk of nosocomial spread and need for isolation.
Is Streptococcus pneumoniae a Nosocomially Acquired Pathogen?
Authors: Paradisi Franco , Corti Giampaolo 
Published: September 2009

AbstractStreptococcus pneumoniae is most prominently a major cause of community-acquired infections of the respiratory tract, central nervous system, and bloodstream, but there is an increasing interest in its role in the epidemiology of hospital-acquired infections. Penicillin-resistant pneumococcal strains appeared 3 decades ago and now are present worldwide, often displaying multiple resistance due to antibiotic selective pressure. Horizontal spread can cause either sporadic cases or hospital outbreaks, primarily in younger children and elderly patients. Pneumococcal transmission from one patient to another can be documented by polymerase chain reaction or pulsed-field gel electrophoresis typing. Nosocomial acquisition of infection, along with pediatric age, previous hospitalization, and previous β-lactam therapy, are the main risk factors significantly associated with penicillin-resistant pneumococcal infections. Nosocomial acquisition also is associated with higher mortality from pneumo-coccal disease. The importance of penicillin resistance as a risk factor significantly associated with higher mortality from pneumococcal infection is found in some studies, but not in others. Mortality from pneumococcal pneumonia is approximately the same for human immunodeficiency virus (HIV)-infected patients without acquired immunodeficiency syndrome (AIDS) as for HIV-negative subjects, but it is significantly higher in AIDS patients. Penicillin-resistant strains are involved in the vast majority of hospital outbreaks, whether presenting as clinically manifest infection or a simple colonization. Pneumococcal vaccination is recommended universally in order to lower the incidence of invasive infection, although a number of problems can limit its effectiveness.
Increasing Bacteremia Due to Coagulase-Negative Staphylococci: Fiction or Reality?
Authors: Thylefors Joakim D. , Harbarth Stephan , Pittet Didier 
Published: September 2009

AbstractBACKGROUND:The role of coagulase-negative staphylococci (CNS) in bacteremias continues to be controversial. Until the 1970s, CNS were mostly recognized as contaminants, being part of the cutaneous flora. Since then, several studies have reported increasing incidence and severity of infections due to CNS.PURPOSE:To review the literature concerning the epidemiology of CNS bacteremia in the United States and Europe with reference to the multiple definitions of infection versus contamination, considering the effect of potential biases influencing the validity of the reported results.METHODS:Literature search of the MEDLINE database from January 1980 to February 1998. Studies with fewer than 500 episodes of bloodstream infections or fewer than 100 episodes of CNS bacteremia were not included in the pooled analysis.RESULTS:(1) CNS remain the most frequent contaminants (58%-83% of positive blood cultures); (2) the proportion of all bloodstream infections caused by CNS is increasing (R=.51); (3) the overall incidence of true CNS bacteremia is increasing (R=.54, P=.0014); (4) comparing the United States to Europe, there is an increasing trend in the incidence of nosocomial bacteremia due to CNS in the United States (R=.82, P=.0006), but no trend is seen in European studies; (5) the mortality associated with true CNS bacteremia varies between 4.9% and 28%.DISCUSSION:This review confirms the increasing importance of CNS bacteremias, measured both as a proportion and as an incidence of bloodstream infections. The contributions of several possible explanations for the incidence increase and the difference between the United States and Europe need further evaluation: (1) increased recognition and awareness of CNS infections among clinicians; (2) a gradual change in the definition of true bacteremia from an obligatory two positive blood cultures to one positive blood culture associated with a clinical picture compatible with infection; (3) a change in blood culture practices and techniques; (4) an increase in the numbers of blood cultures performed, which is reported both in the United States and in Europe; (5) a shift toward more elderly patients with increasingly severe underlying illnesses; and (6) increasing use of intravascular devices.CONCLUSIONS:The apparent trend of increasing CNS bacteremia seems to be valid. Whether there is a real difference between the United States and Europe concerning the increase of CNS bacteremia is difficult to establish due to the large number of confounding factors. Few studies take into account the number of blood cultures performed or the use of intravascular devices to adjust for the observed trends. Further on-site surveillance studies are needed to investigate the phenomenon more extensively.
Strategies for Prevention of Infection in Short-Duration Neutropenia
Authors: Fenelon Lynda 
Published: September 2009

AbstractAlthough infection continues to be a major cause of morbidity and mortality in neutropenic patients, newer strategies have resulted in a shorter duration of neutropenia. The prime risk to patients with short-duration neutropenia (defined as neutropenia of less than 14 days) is bacterial infection, which is reduced by the administration of prophylactic antibiotics, and possibly by the use of clean food, sterile water, and protection against transmission of organisms from healthcare workers' hands.
Occult Nosocomial Infections
Authors: Petignat Christiane , Blanc Dominique S. , Francioli Patrick 
Published: September 2009

AbstractEven with a good surveillance program, nosocomial infections may be not recognized because of several reasons: absence of symptoms or prolonged incubation period (eg, viral bloodborne infections, tuberculosis); problems with the microbiological diagnosis, because adequate specimens may be difficult to obtain or special methods should be used (eg, fungal infections, virus, new agents); shorter hospital stays (eg, surgical-site infections); difficulty in distinguishing between nosocomial and community-acquired infections (eg, influenza); and failure to detect clinically relevant colonization (eg, multiresistant microorganisms). Because of the important potential consequences of occult nosocomial infections, specific surveillance programs should be designed to address these problems.
TagDust—a program to eliminate artifacts from next generation sequencing data
Authors: Lassmann Timo , Hayashizaki Yoshihide , Daub Carsten O. 
Published: September 2009

AbstractMotivation: Next-generation parallel sequencing technologies produce large quantities of short sequence reads. Due to experimental procedures various types of artifacts are commonly sequenced alongside the targeted RNA or DNA sequences. Identification of such artifacts is important during the development of novel sequencing assays and for the downstream analysis of the sequenced libraries.Results: Here we present TagDust, a program identifying artifactual sequences in large sequencing runs. Given a user-defined cutoff for the false discovery rate, TagDust identifies all reads explainable by combinations and partial matches to known sequences used during library preparation. We demonstrate the quality of our method on sequencing runs performed on Illumina's Genome Analyzer platform.Availability: Executables and documentation are available from http://genome.gsc.riken.jp/osc/english/software/.Contact: timolassmann@gmail.com
Elevated serum uric acid levels following heart transplantation predict all‐cause and cardiac mortality
Authors: Arora Satish , Aukrust Pål , Ueland Thor , Broch Kaspar , Simonsen Svein , Gude Einar , Fiane Arnt E. , Geiran Odd , Wergeland Ragnhild , Andreassen Arne K. , Gullestad Lars 
Published: September 2009

AimsWe evaluated the relationship between elevated serum uric acid (SUA) and mortality as well as cardiac allograft vasculopathy (CAV) among 184 heart transplant (HTx) recipients. We also measured inflammatory, neurohormonal, and oxidative stress markers to explore pathophysiological mechanisms.Methods and resultsThere were 28 (15%) deaths, patients with SUA ≥502 µmol/L (upper quartile) at 1 year post‐HTx had an increased risk of total mortality (adjusted HR 2.21, P = 0.03) and cardiac mortality (adjusted HR 4.38, P = 0.03). Elevated SUA was a significant risk factor for development of moderate/severe angiographic CAV (adjusted HR 4.79, P = 0.01). A smaller decline in SUA (<97 µmol/L) during the first year post‐HTx was also associated with an increased risk of mortality (P = 0.02). Patients with elevated SUA had significantly higher levels of high‐sensitivity C‐reactive protein (P = 0.008) and N‐terminal probrain natriuretic peptide (P = 0.022), but there was no significant difference in oxidative stress parameters.ConclusionElevated SUA at 1 year post‐HTx, or a modest rather than a marked decline in SUA levels during the first year post‐HTx, is associated with an increased risk of mortality. Although the pathophysiological mechanism is unclear, our data indicate a potential relationship between SUA and inflammation which should be explored further.