bluuebunny/crossref_metadata_2025_split huggingface dataset:
Association Between Mucositis Severity and Vancomycin-Resistant Enterococcal Bloodstream Infection in Hospitalized Cancer Patients
Authors: Kuehnert Matthew J. , Jernigan John A. , Pullen Amy L. , Rimland David , Jarvis William R. 
Published: February 2006

AbstractObjective:To determine the role of mucositis severity in the development of vancomycin-resistant enterococcal (VRE) bloodstream infection (BSI).Setting:A tertiary-care university medical center.Participants:Hematology-oncology-unit inpatients.Design:Patients with VRE BSI (case-patients) were compared with VRE-colonized (control) patients from September 1994 through August 1997. Oral mucositis severity was recorded on the day of VRE BSI for case-patients and on hospital day 22 (median day of hospitalization of case-patient VRE BSI) for controls. There were 19 case-patients and 31 controls.Results:In univariate analysis, case-patients were significantly more likely than controls to have a higher mucositis severity score, diarrhea, or a higher severity of illness score. In multivariate analysis, only mucositis remained as an independent risk factor, and increasing mucositis score was significantly associated with VRE BSI.Conclusions:Mucositis severity was independently associated with an increasing risk for VRE BSI. Interventions to alter mucositis severity may help to prevent VRE BSI in hospitalized cancer patients.
Enteric Carriage of Vancomycin-ResistantEnterococcus faeciumin Patients Tested forClostridium difficile
Authors: Garbutt Jane M. , Littenberg Benjamin , Evanoff Bradley A. , Sahm Daniel , Mundy Linda M. 
Published: February 2006

AbstractObjective:To identify independent risk factors for enteric carriage of vancomycin-resistantEnterococcus faecium(VREF) in hospitalized patients tested forClostridium difficiletoxin.Design:Retrospective case-cohort study.Setting:Tertiary-care teaching hospital.Patients:Convenience sample of 215 adult inpatients who had stool tested forC difficilebetween January 29 and February 25,1996.Results:41 (19%) of 215 patients had enteric carriage of VREF. Five independent risk factors for enteric VREF were identified: history of priorC difficile(odds ratio [OR], 15.21; 95% confidence interval [CI95], 3.30-70.10;P<.001), parenteral treatment with vancomycin for ≥5 days (OR, 4.06; CI95, 1.54-10.73;P=.005), treatment with antimicrobials effective against gram-negative organisms (OR, 3.44; CI95, 1.20-9.87;P=.021), admission from another institution (OR, 2.95; CI95, 1.21-7.18;P=.017), and age >60 years (OR 2.57; CI95, 1.13-5.82;P=.024). These risk factors for enteric VREF were independent of the patient's currentC difficilestatus.Conclusions:Antimicrobial exposures are the most important modifiable independent risk factors for enteric carriage of VREF in hospitalized patients tested forC difficile.
Reporting of Vancomycin-Resistant Enterococci in Connecticut: Implementation and Validation of a State-Based Surveillance System
Authors: Dembek Zygmunt F. , Kellerman Scott E. , Ganley Lisa , Capacchione Constance M. , Tenover Fred C. , Cartter Matthew L. , Van Kruiningen Herbert J. , Jarvis William R. , Hadler James L. 
Published: February 2006

AbstractObjective:To assess state-based surveillance for isolation from a sterile site of vancomycin-resistant enterococci (VRE) in Connecticut.Design:Clinical laboratory reporting (passive surveillance) of VRE isolates to the Connecticut Department of Public Health (CDPH) was followed by state-initiated validation, laboratory proficiency testing, and review of hospital demographic characteristics.Settings:All 45 clinical laboratories and all 37 (36 for 1995 and 1996) acute-care hospitals in Connecticut were included in the study.Main Outcome Measures:The outcome measures included determination of the statewide incidence of VRE and the accuracy of passive reporting, determination of clinical laboratory proficiency in detecting VRE, and analysis of hospital characteristics that might be associated with an increased incidence of VRE.Results:During 1994 through 1996, 29 (78%) of 37 hospital-affiliated clinical laboratories and 1 (11%) of 9 commercial or other laboratories in Connecticut reported to the CDPH the isolation of VRE from sterile sites; 158 isolates were reported for these 3 years. Based on verification, we discovered that these laboratories actually detected 58 VRE isolates in 1994, 104 in 1995, and 104 in 1996 (total, 266). The age-standardized incidence rate of VRE was 14.1 cases per million population in 1994 and 26.8 cases per million population for both 1995 and 1996. Laboratory proficiency testing revealed that high-level vancomycin resistance was identified accurately and that low- and moderate-level resistance was not detected. The incidence of VRE isolates was three times greater in hospitals with over 300 beds compared with categories of hospitals with fewer beds. Increases in the number of VRE isolates were at least twice as likely in hospitals located in areas with a higher population density, or with a residency program or trauma center in the hospital.Conclusions:Passive reporting of VRE isolates from sterile sites markedly underestimated the actual number of isolates, as determined in a statewide reporting system. Statewide passive surveillance systems for routine or emerging pathogens must be validated and laboratory proficiency ensured if results are to be accurate and substantial underreporting is to be corrected.
Comparative in Vitro Activity of Antiseptics and Disinfectants Versus Clinical Isolates ofCandida Species
Authors: Silverman Jan , Vazquez Jose A. , Sobel Jack D. , Zervos Marcus J. 
Published: February 2006

AbstractObjective:To evaluate the in vitro activity of antiseptics and detergents againstCandida.Design:One strain each ofCandida albicans, Candida tropicalis, Candida lusitaniae, Candida parapsilosis, Candida kefyr, Candida glabrata,and an American Type Culture Collection strain ofEscherichia coli(control) were studied. Clinical isolates were obtained from patients in a bone marrow unit of a large tertiary hospital. Antiseptic and disinfectant agents studied were used in the hospital where isolates were identified for cleaning of inanimate surfaces or hand washing. In vitro susceptibility was determined using a broth macrodilution method with exposure times to antiseptic or disinfectant agent of 15 seconds to 4 minutes and concentrations of agents that ranged from undiluted to 1:10,000 dilution.Setting:A 900-bed teaching hospital.Results:Of disinfectants tested, Vestal and Sparquat inhibited growth of all species at dilutions of ≤1:100 at all contact times for all species. Clorox showed inhibition of growth at 1:100 dilution after 30 seconds of contact time for all isolates. Of antiseptics studied, Hibiclens inhibited growth of all species exceptC tropicalisat dilutions of ≤1:100 at all contact times and for Ctropicalisafter 60 seconds. Clinidine inhibited growth of all species at dilutions of ≤1:100 at all contact times for all species with the exception ofC glabrataandC tropicalis,which grew at the undiluted concentration. Ultradex failed to demonstrate killing of any species for any dilutions tested.Conclusions:The results of this study show varying degrees of in vitro inhibition of growth by a variety of antiseptics and disinfectants against clinical isolates ofCandidaspecies from hospitalized patients.
Undetected Vancomycin-Resistant Enterococcus in Surgical Intensive Care Unit Patients
Authors: Zuckerman Richard A. , Steele Lynn , Venezia Richard A. , Tobin Ellis H. 
Published: February 2006

AbstractThe rates of vancomycin-resistant Enterococcus (VRE) in a high-risk population were investigated prospectively using an active surveillance method. The costs of conducting active surveillance were calculated. Among the 10 patients found to have VRE, routine cultures identified 3 (30%); thus, 70% of the VRE-colonized patients would have gone undetected in the absence of active surveillance. The total cost for 5 weeks of active surveillance was $2,234. Although active surveillance identified a high rate of VRE-colonized patients who otherwise may not have been identified, it remains to be determined if the additional costs are justified and result in reduced transmission.
Recovery of High-Level Streptomycin-Resistant Enterococci From Hemodialysis Water and Dialysate in 85 Greek Renal Units
Authors: Arvanitidou Malamatenia , Vayona Argiri , Pigadas Alkis , Tsakris Athanassios 
Published: February 2006

AbstractIn the 85 renal units of Greece, enterococci were recovered from 10 samples of tap water, 6 of treated hemodialysis water, and 21 of dialysate. Eleven isolates wereEnterococcus faecium,and 8 wereEnterococcus raffinosus;6 other additional enterococcal species were found. Twenty-two strains exhibited high-level resistance to streptomycin, 16 were resistant to rifampicin, and one to erythromycin. In our hemodialysis units, treated water and dialysate raise concern regarding transfer to patients of uncommon enterococcal species exhibiting high-level streptomycin resistance.
Methicillin-ResistantStaphylococcus aureusin the Community: A Hospital-Based Study
Authors: Goetz Angella , Posey Kathy , Fleming Jean , Jacobs Sharon , Boody Linda , Wagener Marilyn M. , Muder Robert R. 
Published: February 2006

AbstractTo determine the proportion of methicillin-resistantStaphylococcus aureus(MRSA) among patients presenting for hospitalization and to assess risk factors for MRSA carriage, we conducted a study for 13 months at five Pittsburgh-area hospitals. Of 504S aureusidentified, 125 (25%) were MRSA Independent risk factors for MRSA included organ transplantation, employment in a healthcare facility, pressure sores, tube feeding, and hospitalization within the preceding year.
Do Influenza Epidemics Affect Patterns of Sickness Absence Among British Hospital Staff?
Authors: Nguyen-Van-Tam Jonathan , Granfield Ruth , Pearson James , Fleming Douglas , Keating Nicola 
Published: February 2006

AbstractInfluenza vaccination for healthcare workers is not recommended in Britain, but some hospitals offer vaccine to reduce sickness absence. However, in Nottingham, the influenza epidemics of 1993-94 and 1996-97 made no impact on staff absence. Annual vaccination of healthcare workers against influenza is unlikely to reduce absence most winters, but there may be gains in terms of preventing nosocomial infection.
Who Is at Risk of What?
Authors: Birnbaum David 
Published: February 2006

AbstractIf you have calculated the sample size required for an employee survey or an observational study of departmental practices but found that the number of observations required is larger than the number of employees, chances are the error is due to use of approximation formulae. Many of us unknowingly were taught to use approximations that fail to include the finite population correction factor. Depending on the objective of a study and the proportion of a population sampled, it may be necessary to consider this correction factor in order to estimate standard error and sample size accurately.
An Outbreak of Hospital-Acquired Hepatitis B Virus Infection Among Patients Receiving Chronic Hemodialysis
Authors: Hutin Yvan J.E , Goldstein Susan T. , Varma Jay K. , O'Dair Joan B. , Mast Eric E. , Shapiro Craig N. , Alter Miriam J. 
Published: February 2006

AbstractObjective:To investigate a cluster of hepatitis B virus (HBV) infections between December 1995 and May 1996 among chronic hemodialysis patients in one county.Setting:Two dialysis centers (A and B) and a hospital (C) in one county.Patients:Six case-patients who were dialyzed in one of two centers, A and B, and had all been hospitalized between January and February 1996 at hospital C.Methods:Patient 1, usually dialyzed in center A sero-converted to hepatitis B surface antigen (HBsAg) in December 1995 and could have been the source of infection for the others, who seroconverted between March and April 1996. Two cohort studies were conducted: one among patients dialyzed in center A to determine where transmission had occurred, and one among patients dialyzed at hospital C at the time patient 1 was hospitalized, to identify factors associated with infection.Results:Four (15%) of the 26 susceptible patients dialyzed at center A became infected with HBV. Hospitalization at hospital C when patient 1 was hospitalized was associated with infection (P=.002). A cohort study of the 10 susceptible patients dialyzed at hospital C during the time patient 1 was hospitalized did not identify specific risk factors for infection. However, supplies and multidose vials were shared routinely among patients, providing opportunities for transmission.Conclusion:When chronic hemodialysis patients require dialysis while hospitalized, their HBsAg status should be reviewed, and no instrument, supplies, or medications should be shared among them.
Safety of Peripheral Intravenous Catheters in Children
Authors: Shimandle Ruth B. , Johnson Daniel , Baker Mark , Stotland Naomi , Karrison Theodore , Arnow Paul M. 
Published: February 2006

AbstractObjectives:To determine the overall and per-day risk of complications of short peripheral intravenous (PIV) catheters placed for indefinite periods.Design:During 5 months, general pediatric patients receiving intravenous therapy through short PIV catheters were monitored. Patient and catheter characteristics were recorded, complications were noted, and rolled semiquantitative cultures of removed catheters were performed. Major endpoints were infection and phlebitis. Per-day risk of complications and catheter colonization (>15 colony-forming units) were calculated.Setting:University children's hospital.Patients:General pediatric ward inpatients with PIV.Results:We studied 642 Teflon catheters in place >24 hours (mean, 3.7 days) in 525 patients. There were no cases of catheter sepsis (0%; 95% confidence interval [CI95], 0%-0.6%), one possible insertion-site infection (0.2%; CI95, 0.004%-0.9%), and seven cases of phlebitis (1.1%; CI95, 0.4%-2.3%). Catheter colonization occurred in 92 (26%) of 348 catheters cultured. Neither the per-day risk of phlebitis nor of catheter colonization increased significantly with placement >3 days.Conclusion:Current guidelines recommend replacement of PIV catheters in adults within 2 to 3 days; no recommendations are made for children. Our findings and those of others indicate that the overall risk of PIV catheter complications in children is extremely low and would not be reduced substantially by routine catheter replacement.
“Pulse” Nasal Mupirocin Maintenance Regimen in Patients Undergoing Continuous Ambulatory Peritoneal Dialysis
Authors: Mylotte Joseph M. , Kahler Lucinda , Jackson Ellen 
Published: February 2006

AbstractObjective:To determine, among patients undergoing continuous ambulatory peritoneal dialysis (CAPD) who wereStaphylococcus aureusnasal carriers, if periodic brief “pulses” of nasal mupirocin calcium ointment 2% after completion of a mupirocin eradication protocol would maintain these patients free of carriage.Design:Noncomparative, nonblinded study with historical controls.Setting:A county medical center.Patients:Patients in a CAPD program during the period April 1996 to May 1998.Methods:All patients in the CAPD program had monthly nasal cultures forS aureus. After informed consent,S aureusnasal carriers were administered mupirocin to the nares twice a day for 5 days followed by nasal mupirocin twice monthly. Peritonitis and exit-site infection rates were monitored independently by CAPD nursing staff. Patients were monitored monthly for adverse effects of mupirocin and compliance with the maintenance regimen.Results:Twenty-four patients in the CAPD program were enrolled in the study and had a median duration of follow-up of 8.5 months. Fifteen (63%) of the 24 patients remained free of nasal carriage on follow-up cultures. Of the 9 patients with positive nasal cultures during the study, 8 had only one positive culture. There was no significant difference in the mean yearly peritonitis rate orS aureusperitonitis rate (January 1995-May 1998). However, there was a significant decrease in the mean yearly exit-site infection rates both overall (from 8.8 episodes per 100 patients dialyzed per month in 1995 to 4.0 in 1998;P=.008) and due toS aureus(from 5.6 in 1995 to 0.9 in 1998;P=.03). Adverse effects of nasal mupirocin were mild overall; 1 patient was removed from the study due to an allergic reaction to mupirocin.Conclusions:Among CAPD patients who wereS aureusnasal carriers, periodic brief treatment with nasal mupirocin after an initial eradication regimen kept them free of carriage, for the most part, with few adverse effects. The pulse mupirocin regimen offers simplicity and possibly better compliance, as well as minimizing exposure to this agent, thereby possibly reducing the risk of resistance. Further studies are warranted to compare this regimen to other commonly used mupirocin maintenance regimens in dialysis patients.
An Outbreak of Gram-Negative Bacteremia in Hemodialysis Patients Traced to Hemodialysis Machine Waste Drain Ports
Authors: Wang Susan A. , Levine Rachel B. , Carson Loretta A. , Arduino Matthew J. , Killar Teresa , Grillo F. Gregory , Pearson Michele L. , Jarvis William R. 
Published: February 2006

AbstractObjective:To investigate an outbreak of gram-negative bacteremias at a hemodialysis center (December 1, 1996-January 31, 1997).Design:Retrospective cohort study. Reviewed infection control practices and maintenance and disinfection procedures for the water system and dialysis machines. Performed cultures of the water and dialysis machines, including the waste-handling option (WHO), a drain port designed to dispose of saline used to flush the dialyzer before patient use. Compared isolates by pulsed-field gel electrophoresis.Setting:A hemodialysis center in Maryland.Results:94 patients received dialysis on 27 machines; 10 (11%) of the patients had gram-negative bacteremias. Pathogens causing these infections wereEnterobacter cloacae(n=6),Pseudomonas aeruginosa(n=4), andEscherichia coli(n=2); two patients had polymicrobial bacteremia. Factors associated with development of gram-negative bacteremias were receiving dialysis via a central venous catheter (CVC) rather than via an arterio-venous shunt (all 10 infected patients had CVCs compared to 31 of 84 uninfected patients, relative risk [RR] undefined;P<.001) or dialysis on any of three particular dialysis machines (7 of 10 infected patients were exposed to the three machines compared to 20 of 84 uninfected patients, RR=5.8;P=.005).E cloacae, P aeruginosa, or both organisms were grown from cultures obtained from several dialysis machines. WHO valves, which prevent backflow from the drain to dialysis bloodlines, were faulty in 8 (31%) of 26 machines, including 2 of 3 machines epidemiologically linked to case-patients. Pulsed-field gel electrophoresis patterns of available dialysis machine and patientE cloacaeisolates were identical.Conclusions:Our study suggests that WHO ports with incompetent valves and resultant backflow were a source of cross-contamination of dialysis bloodlines and patients' CVCs. Replacement of faulty WHO valves and enhanced disinfection of dialysis machines terminated the outbreak.
A Canadian Survey of Prophylactic Antibiotic Use Among Hip-Fracture Patients
Authors: Zoutman Dick , Chau Laurence , Watterson James , Mackenzie Thomas , Djurfeldt Marina 
Published: February 2006

AbstractObjective:To study how surgical prophylactic antibiotics (SPAs) were utilized in the perioperative management of surgery for hip fractures.Design:Retrospective chart review of randomly selected medical records.Setting:Twenty-two hospitals (teaching, nonteaching, community, and large urban referral centers) from across Canada.Patients:Patients admitted in 1990 with a diagnosis of hip fracture.Methods:Complete medical records of 438 patients were examined; 352 cases who underwent surgical repair of a fractured hip with insertion of prosthetic material were included in analysis. Perioperative SPA use was assessed by abstracting the agent(s) chosen, dosages, time given with respect to the incision, and duration of postoperative use. Fourteen patient and process-of-care variables related to SPA were examined.Results:247 (70%) of 352 cases did not receive a dose of SPA 2 hours preoperatively. Ten percent of preoperative SPA was administered either too early or during the procedure. In 91 (39%) of 231 cases receiving SPA the first dose was not administered until the end of the procedure. Preoperative SPA consisted of a parenteral first-generation cephalosporin for 94% of cases. SPAs were continued more than 24 hours postoperatively in 78% of cases.Lack of a written order for SPA, being a nonteaching hospital, and shorter duration of surgical procedure were predictive of failure to receive SPA in an effective manner.Conclusions:Most hip-fracture-surgery patients did not receive effective antibiotic prophylaxis as required to prevent serious wound infections. This important variable can be included for surveillance, so that corrective measures can be taken to assure effective prophylactic antibiotic administration.
Usefulness of Pulsed-Field Gel Electrophoresis in Assessing Nosocomial Transmission of Pertussis
Authors: Nouvellon Michèle , Gehanno Jean-François , Pestel-Caron Martine , Weber Christian , Lemeland Jean-François , Guiso Nicole 
Published: February 2006

AbstractDuring a 2-week period, three infants with a cough lasting at least 8 days with whoops, were admitted to the pediatric unit; Bordetella pertussis was isolated from nasopharyngeal aspirates collected from the three infants. Approximately 1 week later, a nurse working on the same unit developed influenza-like symptoms followed by whooping cough; B pertussis was isolated. Isolates from the nurse and from one of the infants were shown to be indistinguishable by pulsed-field gel electrophoresis. These data demonstrate that B pertussis transmission to healthcare workers is possible and emphasize the need to use respiratory protection devices (Droplet Precautions) for healthcare workers having close contact with infected children.
A Case-Control Study to Detect Modifiable Risk Factors for Colonization With Vancomycin-Resistant Enterococci
Authors: Loeb Mark , Salama Suzette , Armstrong-Evans Maxine , Capretta Gina , Olde Jan 
Published: February 2006

AbstractA case-control study was conducted to determine the modifiable risk factors associated with vancomycin-resistant Enterococcus (VRE) colonization during a hospital outbreak. Cephalosporin use was identified as the only independent risk factor (odds ratio, 13.8; 95% confidence interval, 2.5-76.3; P=.01). Nursing work-load intensity was not associated with VRE colonization in this study.
Infection Control Programs in Long-Term-Care Facilities: Structure and Process
Authors: Goldrick Barbara A. 
Published: February 2006

AbstractDue to the rapid transfer of patients from the acute-care setting, the intensity of nursing care among residents in long-term-care facilities (LTCFs) has increased, transforming today's LTCFs into subacute healthcare facilities. Given the increased risk of infection among residents in LTCFs and the associated morbidity and mortality, evaluation of infection control programs in skilled nursing LTCFs is warranted. This article addresses the current structure and process of infection control programs in skilled nursing LTCFs.