bluuebunny/crossref_metadata_2025_split huggingface dataset:
Epidemiology of Methicillin-SusceptibleStaphylococcus Aureusin the Neonatal Intensive Care Unit
Authors: Graham Philip L. , Morel Anne-Sophie , Zhou Juyan , Wu Fann , Della-Latta Phyllis , Rubenstein David , Saiman Lisa 
Published: February 2006

Objective:When the incidence of methicillin-susceptibleStaphylococcus aureus(MSSA) infection or colonization increased in our neonatal intensive care unit (NICU), we sought to further our understanding of the relationship among colonization with MSSA, endemic infection, and clonal spread.Design:A retrospective cohort study was used to determine risk factors for acquisition of a predominant clone of MSSA (clone “B”).Setting:A 45-bed, university-affiliated, level III-IV NICU.Patients:Infants hospitalized in the NICU from October 1999 to September 2000.Interventions:Infection control strategies included surveillance cultures of infants, cohorting infected or colonized infants, contact precautions, universal glove use, mupirocin treatment of the anterior nares of all infants in the NICU, and a hexachlorophene bath for infants weighing 1,500 g or more.Results:During the 1-year study period, three periods of increased incidence of MSSA colonization or infection, ranging from 6.4 to 13.5 cases per 1,000 patient-days per month, were observed. Molecular typing using pulsed-field gel electrophoresis demonstrated two predominant clones, clone “B” and clone “G,” corresponding to two periods of increased incidence. Multivariate analysis demonstrated that length of stay (OR, 1.035; 95% confidence interval [CI95], 1.008 to 1.062;P= .010) (increased risk per day) and the use of H2-blockers (OR, 20.44; CI95, 2.48 to 168.26;P= .005) were risk factors for either colonization or infection with clone “B,” and that the use of peripheral catheters was protective (OR, 0.06; CI95, 0.01 to 0.43;P= .005).Conclusions:Control of MSSA represents unique challenges as colonization is expected, endemic infections are tolerated, and surveillance efforts generally focus on multidrug-resistant pathogens. Future studies should address cost-effective surveillance strategies for endemic infections.
Effectiveness of Pharmacy Policies Designed to Limit Inappropriate Vancomycin Use: A Population-Based Assessment
Authors: Thomas Ann R. , Cieslak Paul R. , Strausbaugh Larry J. , Fleming David W. 
Published: February 2006

Objective:In Oregon in 1994, a population-based study of 66 nonpsychiatric hospitals indicated that 40% of vancomycin orders were inappropriate according to Centers for Disease Control and Prevention guidelines. We repeated the study to determine whether vancomycin use had been affected by pharmacy policies implemented following the 1994 study.Methods:We surveyed pharmacists in nonpsychiatric hospitals in Oregon regarding vancomycin use policies in their hospitals. Using pharmacy records, we identified and abstracted the charts of all patients in Oregon hospitals receiving vancomycin during a 3-week period to determine appropriate use of vancomycin.Results:Thirteen (20%) of 64 hospitals had implemented a vancomycin restriction policy since 1994; none of the remaining hospitals in the study had a policy. In 1999, hospitals with vancomycin restriction policies had substantially decreased rates of inappropriate vancomycin use compared with hospitals without such policies (1.0 vs 1.8 orders per 1,000 patient-days; P = .01). Compared with 1994 baseline rates of inappropriate use, hospitals that adopted policies experienced a decrease (from 1.5 orders per 1,000 patient-days in 1994 to 1.0 in 1999; P= .13), whereas hospitals without policies experienced a statistically significant increase (from 0.9 orders per 1,000 patient-days in 1994 to 1.8 in 1999; P =
.001). Restriction policies were most effective at reducing rates of inappropriate use for treatment of confirmed gram-positive infections and prophylaxis.Conclusion:Vancomycin restriction policies were associated with a decrease in inappropriate therapeutic and prophylactic vancomycin use, but had no effect on inappropriate empiric use. Hospitals considering limits regarding inappropriate use should consider implementation of institution-based vancomycin restriction policies as part of an overall strategy.
Chlorhexidine Resistance in Antibiotic-Resistant Bacteria Isolated From the Surfaces of Dispensers of Soap Containing Chlorhexidine
Authors: Brooks Steven E. , Walczak Mary A. , Hameed Rizwanullah , Coonan Patrick 
Published: February 2006

AbstractBacterial contamination with pan-resistant Acinetobacter and Klebsiella, multidrug-resistant Pseudomonas, and methicillin-resistant Staphylococcus aureus (MRSA) was noted on the surfaces of dispensers of hand soap with 2% chlorhexidine. Gram-negative isolates could multiply in the presence of 1% chlorhexidine. In contrast, MRSA was inhibited in vitro by chlorhexidine at concentrations as low as 0.0019%.
Surveillance of Hemodialysis-Associated Primary Bloodstream Infections: The Experience of Ten Hospital-Based Centers
Authors: Dopirak Margaret , Hill Connie , Oleksiw Marylee , Dumigan Diane , Arvai Jean , English Ellen , Carusillo Evelyn , Malo-Schlegel Susan , Richo Jeana , Traficanti Karen , Welch Bobbie , Cooper Brian 
Published: February 2006

Objective:To determine baseline rates of primary bloodstream infection (BSI) among a large pool of patients receiving hemodialysis using standardized surveillance tools and methodology.Design:Prospective, descriptive analysis of primary BSI rates.Setting:Ten hospital-based hemodialysis centers in Connecticut.Patients:All patients receiving long-term hemodialysis in the participating facilities.Results:A total of 158 BSIs occurred during 142,525 dialysis sessions within a 12-month study period. Of the BSIs, 15.2% occurred in patients with fistula or graft access and 84.8% in patients with central venous catheter access (P< .001). Rates per 100 patient-years in centers ranged from 0 to 30.8, with a mean of 16.6. Rates per 1,000 dialysis sessions ranged from 0 to 2.1, with a mean of 1.1. Coagulase-negative staphylococci andStaphylococcus aureus(including methicillin-resistantS. aureus) accounted for 61% andKlebsiellaorEnterobacterspecies for 14.6% of infections. Of the patients, 63.3% received vancomycin, 24.7% received cefazolin, and 41.7% received aminoglycosides. Rates declined in the second 6 months of the study from 1.4 to 0.8 infections per 1,000 dialysis sessions (P< .001).Conclusions:Primary BSI rates varied widely among participating centers and declined during the study period. BSIs were strongly associated with central venous catheter access. Further studies are needed to determine the reasons for variance in rates between centers and among various types of hemodialysis access.
An Outbreak of Bloodstream Infections in an Outpatient Hemodialysis Center
Authors: Price Connie S. , Hacek Donna , Noskin Gary A. , Peterson Lance R. 
Published: February 2006

Objectives:Investigate and control an increase in bloodstream infections (BSIs) in an outpatient hemodialysis center.Patients and Design:A retrospective cohort study was conducted for patients receiving dialysis at the center from February 2000 to April 2001. A case–control study compared microbiological data for all BSIs that occurred during the study period with those for BSIs that occurred during a baseline period Qanuary 1999 to January 2000). BSI rates before and after a 1-month intervention (May 2001) were assessed. A case was defined as a new BSI during the study period.Results:The outbreak was polymicrobial, with approximately 30 species. The baseline BSI rate was 0.7 per 100 patient-months. From February 2000 to April 2001, the BSI rate increased to 4.2 per 100 patient-months. Overall, 75% of the BSIs were associated with central venous catheters (CVCs), but CVC use did not fully explain the increase in BSIs. In January 2000, when the center changed ownership, prepackaged CVC dressing kits and biweekly infection control monitoring were discontinued. Beginning in May 2001, staff were educated on CVC care, chlorhexidine replaced povidone-iodine for cutaneous antisepsis, gauze replaced transparent dressings, antimicrobial ointments containing polyethylene glycol at CVC exit sites were discontinued, and patients with CVCs were educated on cutaneous hygiene. After the intervention period, by October 2001, rates decreased to less than 1 BSI per 100 patient-months.Conclusions:Proper cutaneous antisepsis and access site care is crucial in preventing BSIs in patients receiving hemodialysis. Infection control programs, staff and patient education, and use of optimal antisepsis agents or prepackaged kits are useful toward this end.
Weekly Transparent Dressing Changes Linked to Increased Bacteremia Rates
Authors: Curchoe Ruth M. , Powers Jeanette , El-Daher Nayef 
Published: February 2006

Background:In 2000, the rate of primary bloodstream infections (BSIs) was double that in 1999 for intensive care unit (ICU) patients with triple lumen catheters, pulmonary artery catheters, or both. In December 1999, changes in products and practices related to site care were implemented as a cost-saving initiative.Objective:To determine the factors contributing to an increase of BSIs after cost-saving measures for site care had been introduced.Design:Epidemiologic study involving prospective identification of infection.Setting:A community teaching hospital.Participants:Patients in a 20-bed, medical-surgical ICU identified as having triple lumen catheters, pulmonary artery catheters, or both and a primary BSI during 2000 and 2001.Methods:Alcohol swab sticks were reintroduced and the frequency of transparent dressing changes and site care was increased. Inservice presentations were conducted on aseptic technique and posters were placed reviewing site care protocol for physicians and nurses.Results:The incidence of primary BSIs decreased significantly (P = .003) during a 3-month intervention and this decrease was sustained through the following 12 months.Conclusions:Prolonging the interval between the change of transparent dressings from 3 times weekly to once weekly and switching from alcohol swab sticks to pads was associated with an increase in BSIs, which was controlled after returning to the original policy (Infect Control Hosp Epidemiol 2002;23:730-732)
SerratiaBacteremia in a Large University Hospital: Trends in Antibiotic Resistance During 10 Years and Implications for Antibiotic Use
Authors: Choi Sang-Ho , Kim Yang Soo , Chung Jin-Won , Kim Tae Hyong , Choo Eun Ju , Kim Mi-Na , Kim Baek-Nam , Kim Nam Joong , Woo Jun Hee , Ryu Jiso 
Published: February 2006

Objective:To identify antibiotic resistance trends and risk factors for resistance ofSerratiaspecies to third-generation cephalosporins.Design:Retrospective survey of medical records.Setting:A 2,200-bed, tertiary-care hospital.Patients:One hundred twenty-two patients withSerratiabacteremia between January 1991 and June 2001.Methods:Infectious disease physicians collected data from medical records regarding patient demographics, underlying disease or condition, portal of entry, microorganism, antibiogram, complications, antibiotics received, and outcome.Results:Among 122Serratiaisolates, 117 (95.9%) wereSerratiamarcescens and 110 (90.2%) were of nosocomial origin. During the study period, the 122 isolates showed a high rate of resistance to third-generation cephalosporins (45.9%) and extended-spectrum penicillins (56.6%). The resistance rate to ciprofloxacin was 32.0%. The resistance rate to third-generation cephalosporins increased from 31.7% for 1991 to 1995 to 54.9% for 1996 to 1998 and 50.0% for 1999 to 2001. In the multivariate analysis, prior use of a second-generation cephalosporin (adjusted odds ratio [OR], 5.90; 95% confidence interval [CI95], 1.41 to 24.6;P= .015) or a third-generation cephalosporin (OR, 3.26; CI95, 1.20 to 8.87;P= .020) was a strong independent risk factor for resistance to third-generation cephalosporins. The overall case-fatality rate was 25.4% (Serratiabacteremia-related case-fatality rate, 13.1%).Conclusion:Prior use of a second- or third-generation cephalosporin was the most important risk factor for bacteremia withSerratiaresistant to third-generation cephalosporins, suggesting the need for antibiotic control. The potential role of patient-to-patient spread could not be fully evaluated in this retrospective study.
Prevention of Bloodstream Infections With Central Venous Catheters Treated With Anti-Infective Agents Depends on Catheter Type and Insertion Time: Evidence From a Meta-Analysis
Authors: Walder Bernhard , Pittet Didier , Tramèr Martin R. 
Published: February 2006

Objective:To test the evidence that the risk of infection related to central venous catheters (CVCs) is decreased by anti-infective coating or cuffing.Design:Systematic review of randomized, controlled trials comparing anti-infective with inactive (control) CVCs.Interventions:Average insertion times were taken as a measurement of the length of insertion. Dichotomous data were combined using a fixed effect model and expressed as odds ratio (OR) with 95% confidence interval (CI95).Results:Two trials on antibiotic coating (343 CVCs) had an average insertion time of 6 days; the risk of BSI decreased from 5.1% with control to 0% with anti-infective catheters. There were no trials with longer average insertion times. In three trials on silver collagen cuffs (422 CVCs), the average insertion time ranged from 5 to 8.2 days (median, 7 days); the risk of BSI was 5.6% with control and 3.2% with anti-infective catheters. In another trial on silver collagen cuffs (101 CVCs), the average insertion time was 38 days; the risk of BSI was 3.7% with control and 4.3% with anti-infective catheters. In five trials on chlorhexidine-silver sulfadiazine coating (1,269 CVCs), the average insertion time ranged from 5.2 to 7.5 days (median, 6 days); the risk of BSI decreased from 4.1% with control to 1.9% with anti-infective catheters. In five additional trials on chlorhexidine–silver sulfadiazine coating (1,544 CVCs), the average insertion time ranged from 7.8 to 20 days (median, 12 days); the risk of BSI was 4.5% with control and 4.2% with anti-infective catheters.Conclusions:Antibiotic and chlorhexidine–silver sulfadiazine coatings are anti-infective for short (approximately 1 week) insertion times. For longer insertion times, there are no data on antibiotic coating, and there is evidence of lack of effect for chlorhexidine-silver sulfadiazine coating. For silver-impregnated collagen cuffs, there is evidence of lack of effect for both short- and long-term insertion.
Central Venous Catheter–Related Infection: A Prospective, Observational Study to Assess the Incidence Rate at a Teaching Hospital in Argentina
Authors: Bantar Carlos , Bustos José Luis , Vesco Eduardo , Morera Graciana ,   The Residence of Internal Program
Published: February 2006

AbstractOne hundred fifty-one central venous catheters (CVCs) were observed for development of infection. The infection rate was higher for CVCs with a duration of less than 6 days than for those with a longer duration. Our data suggest that scheduled replacement of CVCs is not necessary.
Molecular Epidemiology of Methicillin–ResistantStaphylococcus Aureusin a Veterans Administration Medical Center
Authors: Herwaldt Loreen A. , Pottinger Jean M. , Coffman Stacy , Tjaden Jean 
Published: February 2006

Objectives:To determine whether patients who were colonized or infected with methicillin-resistantStaphylococcus aureus(MRSA) persistently carried the same strain and to identify the extent of strain variation within a population of patients.Design:Molecular typing by pulsed-field gel electrophoresis (PFGE) of stored MRSA isolates.Setting:A Veterans Administration Medical Center with 288 hospital, 45 intermediate-care, and 75 extended-care beds.Isolates:Between January 1991 and March 1993, 91 patients had MRSA identified in routine cultures. One hundred isolates from 57 patients (63%) were available for typing.Results:Before 1988, only occasional MRSA isolates were identified. By 1993, 50% ofS. aureusisolates from unique patients were resistant to methicillin. PFGE identified 7 MRSA strains, 3 of which were identified in specimens from 1 patient each. The most common strains were SD4 (20 patients), SD1 (12 patients), SD2 (12 patients), and SD5a (5 patients). Twenty patients had 2 or more isolates obtained at least 1 week apart (mean, 30.7 weeks; range, 1 to 102 weeks). Of these patients, 12 were colonized or infected with only one strain (mean time observed, 25.1 weeks; range, 1 to 82 weeks). Eight patients had at least 2 different strains (mean time observed, 39 weeks; range, 2 to 102 weeks).Conclusion:Numerous MRSA strains circulated in tiiis endemic setting; 40% of patients observed over time were colonized or infected witii more than one strain. Molecular typing was an essential tool for evaluating the epidemiology of MRSA in this setting.
Routine Screening for Methicillin-ResistantStaphylococcus AureusAmong Patients Newly Admitted to an Acute Rehabilitation Unit
Authors: Manian Farrin A. , Senkel Diane , Zack Jeanne , Meyer Lynn 
Published: February 2006

Background:Following an outbreak of methicillin-resistantStaphylococcus aureus(MRSA) infection in our acute rehabilitation unit in 1987, all patients except in-house transfers (because of their low prevalence of MRSA colonization) underwent MRSA screening cultures on admission.Objectives:To better characterize the current profile of patients with positive MRSA screening cultures at the time of admission to our acute rehabilitation unit, and to determine the relative yield of nares, perianal, and wound screening cultures in this population.Methods:Prospective chart review with ongoing active surveillance for infections associated with the acute rehabilitation unit.Results:The rate of MRSA isolation from one or more body sites increased significantly from 5% (1987–1988) to 12% (1999–2000) (P= .0009) for newly admitted patients and from 0% to 7% (P< .0001) for in-house transfers. A negative nares culture was highly predictive (98%) of a negative perianal culture. Prior history of MRSA infection or colonization and transfer from outside sources were independently associated with positive MRSA screening cultures.Conclusion:The rate of MRSA isolation from screening cultures of newly admitted patients, including in-house transfers, has increased significantly during the past decade in our acute rehabilitation unit. When paired with nares cultures, perianal cultures were of limited value in this patient population.
The Ability of Hospital Ventilation Systems to FilterAspergillusand Other Fungi Following a Building Implosion
Authors: Srinivasan Arjun , Beck Christopher , Buckley Timothy , Geyh Allison , Bova Greg , Merz William , Perl Trish M. 
Published: February 2006

Objectives:To assess the ability of hospital air handling systems to filterAspergillus, other fungi, and particles following the implosion of an adjacent building; to measure the quantity and persistence of airborne fungi and particles at varying distances during a building implosion; and to determine whether manipulating air systems based on the movement of the dust cloud would be an effective strategy for managing the impact of the implosion.Design:Air sampling study.Setting:A 976-bed teaching hospital in Baltimore, Maryland.Methods:Single-stage impactors and particle counters were placed at outdoor sites 100, 200, and 400 m from the implosion and in five locations in the hospital: two oncology floors, the human immunodeficiency virus unit, the cardiac surgical intensive care unit, and the ophthalmology unit. Air handling systems would operate normally unless the cloud approached the hospital.Results:Wind carried the bulk of the cloud away from the hospital.Aspergilluscounts rose more than tenfold at outdoor locations up to 200 m from the implosion, but did not increase at 400 m. Total fungal counts rose more than sixfold at 100 and 200 m and twofold at 400 m. Similar toAspergillus, particle counts rose several-fold following the implosion at 100 and 200 m, but did not rise at 400 m. No increases in any fungi or particles were measured at indoor locations.Conclusion:Reacting to the movement of the cloud was effective, because normal operation of the hospital air handling systems was able to accommodate the modest increase inAspergillus, other fungi, and particles generated by the implosion.Aspergillusmeasurements were paralleled by particle counts.
Efficacy of High-Efficiency Particulate Air Filtration in Preventing Aspergillosis in Immunocompromised Patients With Hematologic Malignancies
Authors: Hahn Theresa , Cummings K. Michael , Michalek Arthur M. , Lipman Brian J. , Segal Brahm H. , McCarthy Philip L. 
Published: February 2006

Objectives:To describe and investigate the cause of an outbreak of 10 cases of nosocomial invasive infection withAspergillus flavusin a hematologic oncology patient care unit.Design:A retrospective cohort study.Setting:The hematologic oncology unit of a comprehensive cancer center.Patients:Ninety-one patients admitted to the hematologic oncology service between January 1 and December 31,1992, for 4 or more consecutive days were included in the study.Results:Ten (18%) of 55 patients admitted from July to December 1992 were diagnosed as having invasive aspergillosis compared with 0 (0%) of 36 patients admitted from January to June 1992 to the same patient care units. Patient characteristics, mortality rate, autopsy rate, and admitting location did not change significantly during the course of the year to result in a sudden increase in the number of aspergillosis cases. The source of the outbreak was the high counts ofAspergillusconidia determined from air sampling in the non–bone marrow transplant wing during the outbreak. After high-efficiency particulate air (HEPA) filters were installed as an infection control measure, there were only two additional cases of nosocomial aspergillosis in the 2 years following the outbreak.Conclusions:This outbreak occurred among hematologic oncology patients with prolonged granulocytopenia housed in an environment with neither HEPA filters nor laminar air flow units. Our data demonstrate that in the setting of an outbreak of aspergillosis, HEPA filters are protective for highly immunocompromised patients with hematologic malignancies and are effective at controlling outbreaks due to air contamination withAspergillusconidia.