bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antiretroviral Drug Resistance in Human Immunodeficiency Virus–Infected Source Patients for Occupational Exposures to Healthcare Workers
Authors: Beltrami Elise M. , Cheingsong Rachanee , Heneine Walid M. , Respess Richard A. , Orelien Jean G. , Mendelson Meryl H. , Stewart Mari A. , Koll Brian S. , Sulis Carol A. , Cardo Denise M. ,   Occupational HIV Exposure Study Group
Published: March 2006

AbstractObjective:To assess the prevalence of HIV antiretroviral resistance among source patients for occupational HIV exposures.Design:Blood and data (eg, stage of HIV, previous antiretroviral drug therapy, and HIV RNA viral load) were collected from HIV-infected patients who were source patients for occupational exposures.Setting:Seven tertiary-care medical centers in five U.S. cities (San Diego, California; Miami, Florida; Boston, Massachusetts; Albany, New York; and New York, New York [three sites]) during 1998 to 1999.Participants:Sixty-four HIV-infected patients who were source patients for occupational exposures.Results:Virus from 50 patients was sequenced; virus from 14 patients with an undetectable (ie, < 400 RNA copies/mL) viral load could not be sequenced. Overall, 19 (38%) of the 50 patients had primary eenotypic mutations associated with resistance to reverse transcriptase or protease inhibitors. Eighteen of the 19 viruses with primary mutations and 13 wild type viruses were phenotyped by recombinant assays; 19 had phenotypic resistance to at least one antiretroviral agent. Of the 50 source patients studied, 26 had taken antiretroviral agents in the 3 months before the occupational exposure incident. Sixteen (62%) of the 26 drug-treated patients had virus that was phenotypically resistant to at least one drug. Four (17%) of 23 untreated patients had phenotypically resistant virus. No episodes of HIV transmission were observed among the exposed HCWs.Conclusions:There was a high prevalence of drug-resistant HIV among source patients for occupational HIV exposures. Healthcare providers should use the drug treatment information of source patients when making decisions about postexposure prophylaxis.
Differences in Percutaneous Injury Patterns in A Multi-Hospital System
Authors: Babcock Hilary M. , Fraser Victoria 
Published: March 2006

AbstractObjective:Determine differences in patterns of percutaneous injuries (PIs) in different types of hospitals.Design:Case series of injuries occurring from 1997 to 2001.Setting:Large midwestern healthcare system with a consolidated occupational health database from 9 hospitals, including rural and urban, community and teaching (1 pediatric, 1 adult) facilities, ranging from 113 to 1,400 beds.Participants:Healthcare workers injured between 1997 and 2001.Results:Annual injury rates for all hospitals decreased during the study period from 21 to 16.5/100 beds (chi-square for trend = 22.7; P = .0001). Average annual injury rates were higher at larger hospitals (22.5 vs 9.5 Pis/100 beds; P = .0001). Among small hospitals, rural hospitals had higher rates than did urban hospitals (14.87 vs 8.02 PIs/100 beds; P = .0143). At small hospitals, an increased proportion of injuries occurred in the emergency department (13.7% vs 8.6%; P = .0004), operating room (32.3% vs 25.4%; P = .0002), and ICU (12.3% vs 9.4%; P = .0225), compared with large hospitals. Rural hospitals had higher injury rates in the radiology department (7.7% vs 2%; P = .0015) versus urban hospitals. Injuries at the teaching hospitals occurred more commonly on the wards (28.8% vs 24%; P = .0021) and in ICUs (11.4% vs 7.8%; P = .0006) than at community hospitals. Injuries involving butterfly needles were more common at pediatric versus adult hospitals (15.8% vs 6.5%; P = .0001). The prevalence of source patients infected with HIV and hepatitis C was higher at large hospitals.Conclusions:Significant differences exist in injury rates and patterns among different types of hospitals. These data can be used to target intervention strategies.
Prolonged Candidemia in Infants Following Surgery for Congenital Heart Disease
Authors: Chakrabarti Chandrama , Sood Sunil K. , Parnell Vincent , Rubin Lorry G. 
Published: March 2006

AbstractObjectives:To describe a group of infants with complex congenital heart disease (CCHD) who had candidemia postoperatively and to perform a case–control study of risk factors.Design:Descriptive and case–control study.Setting:Tertiary-care medical centers.Patients:Infants with CCHD who underwent cardiac surgery and developed candidemia. Controls were matched for congenital heart disease lesions, age, and postoperative hospital stay.Results:Of 95 infants younger than 6 months with CCHD who underwent cardiac surgery between January 1999 and April 2001, 6 (6.3%) developed candidemia with 5 different species. The candidemia was prolonged (range, 12 to 32 days; median, 17 days). The interval between cardiac surgery and onset of candidemia was 12 to 57 days (median, 24 days). All had a central venous catheter inserted 8 to 50 days prior to the onset of candidemia. The mortality rate was 83%, compared with 13% for the group without candidemia. A univariate analysis of the potential risk factors revealed that duration of total parenteral nutrition (TPN), duration of antibiotics, intraoperative cardiopulmonary bypass time, and documentation of an intravascular thrombus were associated with candidemia. In multivariate analysis, long duration of TPN and documentation of a thrombus were associated with candidemia.Conclusions:Candidemia following cardiac surgery for infants with CCHD was persistent and associated with high mortality. The variety of species indicates that this was not a common-source outbreak. Risk factors associated with candidemia were duration of TPN and documentation of an intravascular thrombus.
Biocides Currently Used for Bronchoscope Decontamination Are Poorly Effective Against Free-Living Amoebae
Authors: Greub Gilbert , Raoult Didier 
Published: March 2006

AbstractFree-living amoebae may be pathogenic and harbor several agents of pneumonia. We tested the susceptibility of amoebal cysts and trophozoites to currently used biocides for bronchoscope decontamination. We showed that two particular biocides are inadequate for disinfecting bronchoscopes, asAcanthamoeba polyphagasurvived 3 hours of exposure to these undiluted agents.
Utility of Dual Skin Tests to Evaluate Tuberculin Skin Test Reactions of 10 to 14 mm in Healthcare Workers
Authors: Marsh Bryan J. , Vicente Joshua San , von Reyn C. Fordham 
Published: March 2006

AbstractObjective:To define the utility of 10- to 14-mm reactions to a Mycobacterium tuberculosis purified protein derivative (PPD) skin test for healthcare workers (HCWs).Design:Blinded dual skin testing, using PPD and M. avium sensitin, of HCWs at a single medical center who had a 10-to 14-mm reaction to PPD when tested by personnel from the Occupational Health Department as part of routine annual screening.Setting:A single tertiary-care academic medical center.Participants:Employees of the medical center who underwent routine annual PPD screening and were identified by the Occupational Health Department as having a reaction of 10 to 14 mm to PPD.Results:Nineteen employees were identified as candidates and 11 underwent dual skin testing. Only 4 (36%) had repeat results for PPD in the 10- to 14-mm range, whether read by Occupational Health Department personnel or study investigators. For only 5 (45%) of the subjects did the Occupational Health Department personnel and study investigators concur (± 3 mm) on the size of the PPD reaction. Two of the 4 subjects with reactions of 10 to 14 mm as measured by the study investigators were M. avium sensitin dominant, 1 was PPD dominant, and 1 was nondominant.Conclusion:A reaction of 10 to 14 mm to PPD should not be used as an indication for the treatment of latent tuberculosis (TB) infection in healthy HCWs born in the United States with no known exposure to TB.
Impact of a Program of Intensive Surveillance and Interventions Targeting Ventilated Patients in the Reduction of Ventilator-Associated Pneumonia and Its Cost-Effectiveness
Authors: Lai Kwan Kew , Baker Stephen P. , Fontecchio Sally A. 
Published: March 2006

AbstractObjective:We hypothesized that a program of prospective intensive surveillance for ventilator-associated pneumonia (VAP) and concomitant implementations of multimodal, multidisciplinary preventive and intervention strategies would result in a reduction in the incidence of VAP and would be cost-effective.Setting:Medical and surgical intensive care units (ICUs) in a university teaching hospital.Interventions:All ventilated patients in the medical and surgical ICUs were monitored for VAP from January 1997 through December 1998. Interventions including elevation of the head of the bed, use of sterile water and replacement of stopcocks with enteral valves for nasogastric feeding tubes, and prolongation of changing of in-line suction catheters from 24 hours to as needed were implemented.Results:The rates of VAP decreased by 10.8/1,000 ventilator-days in the medical ICU (CI95, 4.65-16.91) and by 17.2/1,000 ventilator-days in the surgical ICU (CI95> 2.85-31.56) when they were compared for 1997 and 1998. With the use of the estimated cost of a VAP of $4,947 from the literature, the reduction resulted in cost savings of $178,092 and $148,410 in the medical and surgical ICUs, respectively, for a total of $326,482. In addition, $25,497 was saved due to the lengthening of the time for the change of in-line suction catheters, resulting in a cost savings of $351,979. This total cost savings of $351,979 minus the cost of enteral valves of $2,100 resulted in total net savings of $349,899.Conclusion:Intensive surveillance and interventions targeted at ventilated patients resulted in reduction of VAP and appeared to be cost-effective.
Ventilator-Associated Pneumonia at a Tertiary-Care Center in a Developing Country: Incidence, Microbiology, and Susceptibility Patterns of Isolated Microorganisms
Authors: Kanafani Zeina A. , Kara Layla , Hayek Shady , Kanj Souha S. 
Published: March 2006

AbstractObjective:Ventilator-associated pneumonia (VAP) complicates the course of up to 24% of intubated patients. Data from the Middle East are scarce. The objective of this study was to evaluate the incidence, microbiology, and antimicrobial susceptibility patterns of isolated microorganisms in VAP in a developing country.Design:Prospective observational cohort study.Setting:The American University of Beirut Medical Center, a tertiary-care center that serves as a major referral center for Lebanon and neighboring countries.Patients:All patients admitted to the intensive care and respiratory care units from March to September 2001, and who had been receiving mechanical ventilation for at least 48 hours, were included in the study. Results of samples submitted for culture were recorded and antimicrobial susceptibility testing of isolated pathogens was performed.Results:Seventy patients were entered into the study. The incidence of VAP was 47%. Gram-negative bacilli accounted for 83% of all isolates. The most commonly identified organism was Acinetobacter anitratus, followed by Pseudomonas aeruginosa. Fifty percent of all gram-negative bacterial isolates were classified as antibiotic resistant. Compared with patients without VAP, patients with VAP remained intubated for a longer period and stayed in the intensive care unit longer. VAP was not associated with an increased mortality rate.Conclusion:Compared with other studies, the results from this referral center in Lebanon indicate a higher incidence of VAP and a high prevalence of resistant organisms. These data are relevant because they direct the choice of empiric antibiotic therapy for VAP.
Risk of Acquiring Influenza A in a Nursing Home From a Culture-Positive Roommate
Authors: Drinka Paul J. , Krause Peggy , Nest Lori , Goodman Brian M. , Gravenstein Stefan 
Published: March 2006

AbstractInfluenza A was cultured in 62 double rooms. The roommate was infected in 12 (19.4%). During 3,294 resident-seasons, influenza was cultured in 208 single rooms (6.3%). Those who lived in double rooms with a culture-positive roommate had a 3.07 relative risk (CI95, 1.61-5.78) of acquiring influenza.
Absence of Excess Mortality in Critically Ill Patients With Nosocomial Escherichia coli Bacteremia
Authors: Blot Stijn , Vandewoude Koenraad , Hoste Eric , Waele Jan De , Kint Kathleen , Rosiers Fanny , Vogelaers Dirk , Colardyn Francis 
Published: March 2006

AbstractObjective:To evaluate excess mortality in critically ill patients with Escherichia coli bacteremia after adjustment for severity of illness.Design:Retrospective (1992-2000), pairwise-matched (1:2), risk-adjusted cohort study.Setting:Fifty-four-bed ICU in a university hospital including a medical and surgical ICU, a unit for care after cardiac surgery, and a burns unit.Patients:ICU patients with nosocomial E. coli bacteremia (defined as cases; n = 64) and control-patients without nosocomial bloodstream infection (n = 128).Methods:Case-patients were matched with control-patients on the basis of the Acute Physiology and Chronic Health Evaluation (APACHE) II system: an equal APACHE II score (± 2 points) and diagnostic category. In addition, control-patients were required to have an ICU stay at least as long as that of the respective case-patients prior to onset of the bacteremia.Results:The overall rate of appropriate antibiotic therapy in patients with E. coli bacteremia was high (93%) and such therapy was initiated soon after onset of the bacteremia (0.6 ± 1.0 day). ICU patients with E. coli bacteremia had more acute renal failure. No differences were noted between case-patients and control-patients in incidence of acute respiratory failure, hemodynamic instability, or age. No differences were observed in length of mechanical ventilation or length of ICU stay. In-hospital mortality rates for cases and controls were not different (43.8% and 45.3%, respectively; P = .959).Conclusion:After adjustment for disease severity and acute illness and in the presence of adequate antibiotic therapy, no excess mortality was found in ICU patients with E. coli bacteremia.
Effect of Nurse Staffing and Antimicrobial-Impregnated Central Venous Catheters on the Risk for Bloodstream Infections in Intensive Care Units
Authors: Alonso-Echanove Juan , Edwards Jonathan R. , Richards Michael J. , Brennan Patrick , Venezia Richard A. , Keen Janet , Ashline Vivian , Kirkland Kathy , Chou Ellen , Hupert Mark , Veeder Abigail V. , Speas Janice , Kaye Judy , Sharma Kailash , Martin Aliki , Moroz V. Dianne , Gaynes Robert P. 
Published: March 2006

AbstractBackground:Defining risk factors for central venous catheter (CVC)-associated bloodstream infections (BSIs) is critical to establishing prevention measures, especially for factors such as nurse staffing and antimicrobial-impregnated CVCs.Methods:We prospectively monitored CVCs, nurse staffing, and patient-related variables for CVC-associated BSIs among adults admitted to eight ICUs during 2 years.Results:A total of 240 CVC-associated BSIs (2.8%) were identified among 4,535 patients, representing 8,593 CVCs. Antimicrobial-impregnated CVCs reduced the risk for CVC-associated BSI only among patients whose CVC was used to administer total parenteral nutrition (TPN, 2.6 CVC-associated BSIs per 1,000 CVC-days vs no TPN, 7.5 CVC-associated BSIs per 1,000 CVC-days;P= .006). Among patients not receiving TPN, there was an increase in the risk of CVC-associated BSI in patients cared for by “float” nurses for more than 60% of the duration of the CVC. In multivariable analysis, risk factors for CVC-associated BSIs were the use of TPN in non-antimicrobial-impregnated CVCs (P= .0001), patient cared for by a float nurse for more than 60% of CVC-days (P= .0019), no antibiotics administered to the patient within 48 hours of insertion (P= .0001), and patient unarousable for 70% or more of the duration of the CVC (P= .0001). Peripherally inserted central catheters (PICCs) were associated with a lower risk for CVC-associated BSI (P= .0001).Conclusions:Antimicrobial-impregnated CVCs reduced the risk of CVC-associated BSI by 66% in patients receiving TPN. Limiting the use of float nurses for ICU patients with CVCs and the use of PICCs may also reduce the risk of CVC-associated BSI.
Improving Water Quality Can Reduce Pyrogenic Reactions Associated With Reuse of Cardiac Catheters
Authors: Duffy Rosemary E. , Couto Braulio , Pessoa Jussara M. , Starling Carlos , Pinheiro Silma , Pearson Michele L. , Arduino Matthew J. , Mattson Barbara J. , Jarvis William R. 
Published: March 2006

AbstractObjective:To report the results of our preintervention investigation and subsequent 19-month three-phase intervention study designed to reduce pyrogenic reactions among patients undergoing cardiac catheterization using reprocessed catheters.Design:A case-control study for the preintervention period and a prospective cohort study for the intervention period.Setting:A 400-bed hospital in Belo Horizonte, Brazil.Participants:Any patient undergoing cardiac catheterization in the hospital.Interventions:Three intervention phases were implemented to improve the quality of the water supplied to the cardiac catheter reprocessing laboratory. Standard operating procedures for reprocessing cardiac catheters were established and reprocessing staff were trained and educated.Results:The rate of pyrogenic reactions decreased significantly during the intervention phases, from 12.8% (159 of 1,239) in phase 1 to 5.3% (38 of 712) in phase 2 to 0.5% (4 of 769) in phase 3 (chi-square test for linear trend, 97.5;P< .001).Conclusion:Improving water quality and using standard operating procedures for reprocessing catheters can prevent pyrogenic reactions in hospitalized patients.
Clinical Experience With Minocycline and Rifampin-Impregnated Central Venous Catheters in Bone Marrow Transplantation Recipients: Efficacy and Low Risk of Developing Staphylococcal Resistance
Authors: Chatzinikolaou Ioannis , Hanna Hend , Graviss Linda , Chaiban Gassan , Perego Cheryl , Arbuckle Rebecca , Champlin Richard , Darouiche Rabih , Samonis George , Raad Issam 
Published: March 2006

AbstractIn this retrospective evaluation of the 4-year clinical use of minocycline and rifampin-impregnated catheters in bone marrow transplantation (BMT) patients, we report low risk of development of staphylococcal resistance to the antibiotics coating the catheters and efficacy in preventing primary staphylococcal bloodstream infections.
RoseomonasInfection Associated With a Left Ventricular Assist Device
Authors: Singal Amit , Malani Preeti N. , Day Larry J. , Pagani Francis D. , Clark Nina M. 
Published: March 2006

AbstractRoseomonasspecies have been increasingly noted as causes of human infection. We present what we believe is the first case of left ventricular assist device (LVAD) infection secondary toRoseomonas. The clinical characteristics ofRoseomonasinfection and the pertinent features of LVAD infection are reviewed.
Zinc Supplementation in Acute Diarrhea is Acceptable, Does Not Interfere with Oral Rehydration, and Reduces the Use of Other Medications
Authors:   INCLEN Childnet Zinc Effectiveness for Diarrhea (IC‐ZED) Group
Published: March 2006

ABSTRACTObjective:Assess the impact of zinc supplementation with locally developed culturally specific educational statements (messages) on oral rehydration solution (ORS) and antibiotics or antidiarrheal use in children with acute watery diarrhea as well as to assess adherence and side effects of zinc.Methods:This was a randomized effectiveness trial conducted in outpatient health facilities of six sites in five countries, namely, Fortaleza (Brazil), Addis Adaba (Ethiopia), Cairo (Egypt), Lucknow and Nagpur (India), and Manila (Philippines). Participants were 2,002 children aged 2 to 59 months. Intervention was zinc (20 mg orally, once daily for 14 days) with ORS (zinc group) compared with ORS alone (control group). Primary outcomes were ORS use on day 3 to 5; adherence to zinc; and any use of an antibacterial/antidiarrheal up to day 14.Results:One thousand ten and 992 children enrolled in zinc and control groups, respectively. Loss to follow‐up on days 3 to 5 and 15 to 17 was 1.2% and 2.8% in the zinc group and 0.8% and 1.7% in the control group. In five of six sites, ORS use in cases with continued diarrhea on days 3 to 5 was the same in the two groups or higher in zinc group. Overall adherence to zinc supplementation was 83.8% (95% confidence interval [CI] 81‐86). There was no difference in vomiting by group. In consideration of the six countries overall, less antibiotic/antidiarrheal use occurred in the zinc group (absolute difference, 3.8% [95% CI 1.7‐5.9]).Conclusions:In the management of acute watery diarrhea, zinc plus ORS along with culturally appropriate, site‐specific messages in local language does not affect overall ORS use generally and decreases antibiotic/antidiarrheal use; children had good adherence without side effects.
Double‐Blind, Placebo‐Controlled Trial Comparing Effects of Supplementation with Two Different Combinations of Micronutrients Delivered as Sprinkles on Growth, Anemia, and Iron Deficiency in Cambodian Infants
Authors: Giovannini Marcello , Sala Debora , Usuelli Michele , Livio Luca , Francescato Gaia , Braga Marta , Radaelli Giovanni , Riva Enrica 
Published: March 2006

AbstractObjectives:To assess and compare efficacy of two micronutrient sprinkle supplementation on growth, anemia, and iron deficiency in Cambodian infants.Methods:A total of 204 infants aged 6 months and living in Kompong Chhnang Province, Cambodia were randomly assigned to receive daily supplements of either iron (12.5 mg) plus folic acid (150 μg) plus zinc (5 mg) (MMN, n = 68), or iron (12.5 mg) plus folic acid (150 μg) alone (FFA, n = 68), or placebo (n = 68) for a 12 month period in powder form as sprinkles. Anthropometrics was evaluated bimonthly. Biochemical assessment was performed at baseline and at the end of intervention period.Results:At baseline, the overall mean (SD) of hemoglobin concentration was 101 g/L. No difference among groups was found for growth pattern. Significant decline was observed for weight‐for‐age and height‐for‐age z‐scores in any group (P < 0.0001). The rate of recovery from anemia was significant (P < 0.001) and comparable between MMN (54%) and FFA (53%) groups and higher than in the placebo group (22%, P < 0.0001). Through the study period, no significant change in the rate of iron deficiency was found in MMN and FFA groups, whereas it increased in the placebo group (31%, baseline vs. 52%, end of study; P < 0.0001).Conclusion:Both MMN and FFA supplements were effective for preventing or treating anemia in Cambodian infants and stabilizing plasma levels of ferritin. Use of micronutrients in a controlled home setting, as sprinkled daily supplements, may be promising in preventing and treating anemia in developing countries.