bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prevalence of Nosocomial Infection and Antibiotic Use at a University Medical Center in Malaysia
Authors: Hughes Andrew J. , Ariffin Norliza , Huat Tan Lien , Molok Habibah Abdul , Hashim Salbiah , Sarijo Juliana , Latif Nor Harlida Abd , Hanifah Yasmin Abu , Kamarulzaman Adeeba 
Published: April 2006

AbstractBackground and Objective:Most reports of nosocomial infection (NI) prevalence have come from developed countries with established infection control programs. In developing countries, infection control is often not as well established due to lack of staff and resources. We exMnined the rate of N1 in our institution.Methods:A point-prevalence study of N1 and antibiotic prescribing was conducted. On July 16 and 17, 2001, all inpatients were surveyed for N1, risk factors, pathogens isolated, and antibiotics prescribed and their indication. NIs were diagnosed according to CDC criteria. Cost of antibiotic acquisition was calculated by treatment indication.Setting:Tertiary-care referral center in Malaysia.Patients:All inpatients during the time of the study.Results:Five hundred thirty-eight patients were surveyed. Seventy-five had 103 NIs for a prevalence of 13.9%. The most common NIs were urinary tract infections (12.29-6), pneumonia (21.4%), laboratory-confirmed bloodstream infections (12.2%), deep surgical wound infections (11.2%), and clinical sepsis (22.4%).Pseudomonas aeruginosa, MRSA, and MSSA were the most common pathogens. Two hundred thirty-seven patients were taking 347 courses of antibiotics, for an overall prevalence of antibiotic use of 44%. N1 treatment accounted for 36% of antibiotic courses prescribed but 47% of antibiotic cost. Cost of antibiotic acquisition for N1 treatment was estimated to be approximately 2 million per year (Malaysian dollars).Conclusion:Whereas the rate of N1 is relatively high at our center compared with rates from previous reports, antibiotic use is among the highest reported in any study of this kind. Further research into this high rate of antibiotic use is urgently required.
Trends in Methicillin-ResistantStaphylococcus aureus(MRSA) Bloodstream Infections: Effect of the MRSA “Search and Isolate” Strategy in a Hospital in Italy with Hyperendemic MRSA
Authors: Pan Angelo , Carnevale Giuseppe , Catenazzi Patrizia , Colombini Paolo , Crema Luciano , Dolcetti Lucia , Ferrari Lucio , Mondello Placido , Signorini Liana , Tinelli Carmine , Roldan Eugenia Quiros , Carosi Giampiero 
Published: April 2006

AbstractObjective:To evaluate the secular trends in MRSA BSIs after the introduction of a nosocomial MRSA control intervention.Design:Before-after study.Setting:An 850-bed community hospital with an ICU and vascular surgery, neurosurgery, bone marrow transplantation, and AIDS units. MRSA is endemic at this hospital; the prevalence of methicillin resistance among patients withS. aureusinfection is greater than 50%.Patients:Among all inpatients, MRSA BSI was identified, its origin defined, and incidence rates calculated by ward and origin.Intervention:A MRSA control program was implemented based on active surveillance cultures to identify MRSA-colonized patients, followed by isolation using contact precautions. Incidence rates of MRSA BSI during the intervention (ie, July 1, 1997, to December 31, 2001) and preintervention (ie, January 1, 1996, to June 30, 1997) periods were compared.Results:Sixty-nine MRSA BSIs were identified. When compared with the preintervention period, the incidence rate of MRSA BSI was reduced from 0.64 to 0.30 per 1,000 admissions (RR, 0.46; CI95, 0.25–0.87;P= .02) during the intervention period. The impact was greater in the ICU, with an 89% reduction (RR, 0.11; CI95, 0.01–0.98;P= .03), and for CVC-associated MRSA BSIs, with an 82% decrease (RR, 0.17; CI95, 0.05–0.55;P= .002). Methicillin resistance amongS. aureusblood isolates decreased from 46% to 17% (RR, 0.36; CI95, 0.22–0.62;P= .0002).Conclusion:A reduction in MRSA bacteremia is achievable through use of the MRSA “search and isolate” intervention even in a hospital with high rates of endemic MRSA.
Management of Inpatients Colonized or Infected With Antimicrobial-Resistant Bacteria in Hospitals in the United States
Authors: Sunenshine Rebecca H. , Liedtke Laura A. , Fridkin Scott K. , Strausbaugh Larry J. ,   The Infectious Diseases Society of America Emerging Infections Network
Published: April 2006

AbstractBackground:Although guidelines for multidrug-resistant organisms generally include recommendations for contact precautions and surveillance cultures, it is not known how frequently U.S. hospitals implement these measures on a routine basis and whether infectious diseases consultants endorse their use.Methods:The Emerging Infections Network surveyed its members, infectious diseases consultants, to assess their use of and support for contact precautions and surveillance cultures for routine management of multidrug-resistant organisms in their principal inpatient workplace. Specifically, members were asked about use of these strategies for methicillin-resistantStaphylococcus aureus, vancomycin-resistant enterococci, and multidrug-resistant, gram-negative bacilli on general wards, ICUs, and transplant units.Results:Overall, 400 (86%) of 463 respondents supported the routine use of contact precautions to control one or more multidrug-resistant organisms in at least one unit, and 89% worked in hospitals that use them. In contrast, 50% of respondents favored routine use of surveillance cultures to manage at least one multidrug-resistant organism in any unit, and 30% of respondents worked in hospitals that use them routinely in any unit. Members favored routine use of surveillance cultures significantly more in ICUs and transplant units than in general wards for each multidrug-resistant organism (P<.001).Conclusions:Most of the infectious diseases consultants endorsed the use of contact precautions for routine management of patients colonized or infected with multidrug-resistant organisms and work in hospitals that have implemented them. In contrast, infectious diseases consultants are divided about the role of routine surveillance cultures in multidrug-resistant organism management, and few work in hospitals that use them.
The Impact of Methicillin Resistance in Staphylococcus aureus Bacteremia on Patient Outcomes: Mortality, Length of Stay, and Hospital Charges
Authors: Cosgrove Sara E. , Qi Youlin , Kaye Keith S. , Harbarth Stephan , Karchmer Adolf W. , Carmeli Yehuda 
Published: April 2006

AbstractObjective:To evaluate the impact of methicillin resistance in Staphylococcus aureus on mortality, length of hospitalization, and hospital charges.Design:A cohort study of patients admitted to the hospital between July 1, 1997, and June 1, 2000, who had clinically significant S. aureus bloodstream infections.Setting:A 630-bed, urban, tertiary-care teaching hospital in Boston, Massachusetts.Patients:Three hundred forty-eight patients with S. aureus bacteremia were studied; 96 patients had methicillin-resistant S. aureus (MRSA). Patients with methicillin-susceptible S. aureus (MSSA) and MRSA were similar regarding gender, percentage of nosocomial acquisition, length of hospitalization, ICU admission, and surgery before S. aureus bacteremia. They differed regarding age, comorbidities, and illness severity score.Results:Similar numbers of MRSA and MSSA patients died (22.9% vs 19.8%; P = .53). Both the median length of hospitalization after S. aureus bacteremia for patients who survived and the median hospital charges after S. aureus bacteremia were significantly increased in MRSA patients (7 vs 9 days, P = .045; $19,212 vs $26,424, P = .008). After multivariable analysis, compared with MSSA bacteremia, MRSA bacteremia remained associated with increased length of hospitalization (1.29 fold; P = .016) and hospital charges (1.36 fold; P = .017). MRSA bacteremia had a median attributable length of stay of 2 days and a median attributable hospital charge of $6,916.Conclusion:Methicillin resistance in S. aureus bacteremia is associated with significant increases in length of hospitalization and hospital charges.
Dispersal ofStaphylococcus aureusInto the Air Associated With a Rhinovirus Infection
Authors: Bassetti Stefano , Bischoff Werner E. , Walter Mark , Bassetti-Wyss Barbara A. , Mason Lori , Reboussin Beth A. , D'Agostino Ralph B. , Gwaltney Jack M. , Pfaller Michael A. , Sherertz Robert J. 
Published: April 2006

AbstractObjective:To determine whether healthy adult nasal carriers ofStaphylococcus aureuscan disperseS. aureusinto the air after rhinovirus infection.Design:We investigated the “cloud” phenomenon among adult nasal carriers ofS. aureusexperimentally infected with a rhinovirus. Eleven volunteers were studied for 16 days in an airtight chamber wearing street clothes, sterile garb, or sterile garb plus surgical mask; rhinovirus inoculation occurred on day 2. Daily quantitative air, nasal, and skin cultures forS. aureus; cold symptom assessment; and nasal rhinovirus cultures were performed.Setting:Wake Forest University School of Medicine, Winston-Salem, North Carolina.Participants:Wake Forest University undergraduate or graduate students who had persistent nasal carriage ofS. aureusfor 4 or 8 weeks.Results:After rhinovirus inoculation, dispersal ofS. aureusinto the air increased 2-fold with peak increases up to 34-fold. Independent predictors ofS. aureusdispersal included the time period after rhinovirus infection and wearing street clothes (P< .05). Wearing barrier garb but not a mask decreased dispersal ofS. aureusinto the air (P< .05).Conclusion:Virus-induced dispersal ofS. aureusinto the air may have an important role in the transmission ofS. aureusand other bacteria.
An Outbreak of Methicillin-ResistantStaphylococcus aureusSurgical-Site Infections Initiated by a Healthcare Worker With Chronic Sinusitis
Authors: Faibis Frederic , Laporte Cedric , Fiacre Alain , Delisse Chantal , Lina Gerard , Demachy Marie-Claude , Botterel Françoise 
Published: April 2006

AbstractAn investigation was performed following two methicillin-resistantStaphylococcus aureussurgical-site infections in a 946-bed French general hospital. The investigation revealed that the outbreak involved 7 patients in 2 surgical wards and that infections were probably contracted in the operating theater from a healthcare worker suffering from chronic sinusitis.
Persistence of Fluoroquinolone-Resistant, Multidrug-ResistantStreptococcus pneumoniaein a Long-Term–Care Facility Efforts to Reduce Intrafacility Transmission
Authors: Fry Alicia M. , Udeagu Chi Chi N. , Soriano-Gabarro Montse , Fridkin Scott , Musinski Diana , LaClaire Leslie , Elliott John , Cook Debra J. P. , Kornblum John , Layton Marcelle , Whitney Cynthia G. 
Published: April 2006

AbstractObjective:We describe an effort to reduce transmission of a multidrug-resistantStreptococcus pneumoniae(MDRSP) in a long-term-care facility (LTCF).Design:Longitudinal cross-sectional study.Setting:An LTCF in New York City with ongoing disease due to an MDRSP strain among residents with AIDS since a 1995 outbreak. The MDRSP outbreak strain was susceptible to vancomycin but not to other antimicrobials tested, including fluoroquinolones.Participants:Residents and staff members of the LTCF during 1999 through 2001.Intervention:Implementing standard infection control measures, and developing and implementing "enhanced standard" infection control measures, modified respiratory droplet prevention measures to reduce inter-resident transmission.Results:Before the intervention, nasopharyngeal carriage of the MDRSP outbreak strain was detected in residents with AIDS and residents with tracheostomies who were not dependent on mechanical ventilation. The prevalence of nasopharyngeal carriage of the MDRSP outbreak strain was 7.8% among residents who had AIDS and 14.6% among residents with tracheostomies. After training sessions on standard and enhanced standard infection control measures, the staff appeared to have good knowledge and practice of the infection control measures. After the intervention, new transmission among residents with tracheostomies was prevented; however, these residents were prone to persistent tracheal carriage and needed ongoing enhanced standard infection control measures. Ongoing transmission among residents with AIDS, a socially active group, was documented, although fewer cases of disease due to the outbreak strain occurred.Conclusions:Infection control contributed to less transmission of MDRSP in the LTCF. Additional strategies are needed to reduce transmission and carriage among certain resident populations.
Compliance with Hand Hygiene and Glove Use in a University-Affiliated Hospital
Authors: Kuzu Nevin , Özer Fadime , Aydemir Semra , Yalcin Ata Nevzat , Zencir Mehmet 
Published: April 2006

AbstractObjective:The hands of healthcare workers often transmit pathogens causing nosocomial infections. This study examined compliance with handwashing and glove use.Setting:A university-affiliated hospital.Design:Compliance was observed covertly. Healthcare workers' demographics, hand hygiene facilities, indications for hand hygiene, compliance with handwashing and glove use in each procedure, and duration of handwashing were recorded.Results:Nine nurses and 33 assistant physicians were monitored during the study. One researcher recorded 1,400 potential opportunities for handwashing during 15-minute observation periods. The mean duration of handwashing was 10 + 2 seconds. Most healthcare workers (99.3%) used liquid soap during handwashing, but 79.8% did not dry their hands. For all indications, compliance with handwashing was 31.9% and compliance with glove use was 58.8%. Compliance with handwashing varied inversely with both the number of indications for hand hygiene and the number of patient beds in the hospital room. Compliance with handwashing was better in dirty high-risk situations.Conclusion:Compliance with handwashing was low, suggesting the need for new motivational strategies such as supplying feedback regarding compliance rates.
Influence of Matching for Exposure Time on Estimates of Attributable Mortality Caused by Nosocomial Bacteremia in Critically Ill Patients
Authors: Blot Stijn , De Bacquer Dirk , Hoste Eric , Depuydt Pieter , Vandewoude Koenraad , De Waele Jan , Benoit Dominique , De Schuijmer Johan , Colardyn Francis , Vogelaers Dirk 
Published: April 2006

AbstractObjective:To evaluate the influence of matching on exposure time on estimates of attributable mortality of nosocomial bacteremia as assessed by matched cohort studies.Design:Two retrospective, pairwise-matched (1:2) cohort studies.Setting:A 54-bed intensive care unit (ICU) in a university hospital.Patients:Patients with nosocomial Escherichia coli bacteremia (n = 68) and control-patients without nosocomial bacteremia (n = 136 for each matched cohort study).Intervention:In both matched cohort studies, the same set of bacteremic patients was matched with control-patients using the APACHE II system. In the first study, control-patients were required to have an ICU stay at least as long as the respective bacteremic patient prior to onset of bacteremia (matching on exposure time). In the second study, control-patients were required to have an ICU stay shorter than the stay prior to the development of bacteremia in the respective bacteremic patient (no matching on exposure time).Results:For bacteremic patients, the mean ICU stay before onset of the bacteremia was 9 days (median, 6 days). In the first matched cohort study, hospital mortality was not different between bacteremic patients and control-patients (44.1% vs 43.4%; P = .999). In the second study, mortality of bacteremic patients and control-patients was also not different (44.1% vs 47.8%; P = .657). Mortality rates between control groups were not different (43.4% vs 47.8%; P = .543).Conclusion:Matching or not matching on exposure time did not alter the estimate of attributable mortality for ICU patients with E. coli bacteremia.
Assessment of the Value of Repeated Point-Prevalence Surveys for Analyzing the Trend in Nosocomial Infections
Authors: Sartor Catherine , Delchambre Anne , Pascal Laurence , Drancourt Michel , De Micco Philippe , Sambuc Roland 
Published: April 2006

AbstractObjective:To assess the value of repeated point-prevalence surveys in measuring the trend in nosocomial infections after adjustment for case mix.Setting:A 3,500-bed teaching facility composed of 4 acute care hospitals.Methods:From May 1992 to June 1996, eight point-prevalence surveys of nosocomial infections were performed in the hospitals using a sampling process. The trend of adjusted nosocomial infection rates was studied for the four surveys that collected data on indwelling catheters. Adjusted rates were calculated using a logistic regression model and a direct standardization method.Results:From 1992 to 1996, a total of 20,238 patients were included in the 8 point-prevalence surveys. The nosocomial infection rate decreased from 8.6% in 1992 to 5% in 1996 (P< .001). The analysis of adjusted nosocomial infection rates included 9,600 patients. Four independent risk factors were identified; length of stay greater than 12 days, hospitalization in an intensive care unit, presence of an indwelling urinary catheter, and history of a surgical procedure. After adjustment for case mix, the nosocomial infection rate still showed a downward trend (from 7.2% in 1993 to 5.1% in 1996;P= .02).Conclusion:Adjusted prevalence rates of nosocomial infections showed a significant downward trend during the period of this study.
The Wound Care Team: A New Source of Group A Streptococcal Nosocomial Transmission
Authors: Felkner Marilyn , Pascoe Neil , Shupe-Ricksecker Kathleen , Goodman Edward 
Published: April 2006

AbstractBackground:In August 2001, the Centers for Disease Control and Prevention (CDC) notified the Texas Department of Health (TDH) of an unusually high number of wounds infected with group A streptococci (GAS) in an acute care facility. The TDH initiated an investigation, ultimately identifying 28 cases of non-pharyngeal, non-community-acquired GAS that had occurred between December 2000 and August 2001 and resulted in 3 deaths and 4 nonfatal cases of invasive disease. Ten specimens were sent to the CDC foremmtyping; all isolates wereemmtype 114. However, the source of the outbreak could not be confirmed through laboratory testing at that time.Methods:A case–control study was conducted comparing the 10 case-patients with 52 control-patients with wounds that were not infected with GAS. Age, gender, type of wound, underlying medical conditions, and treatment by the wound care team were examined for association with GAS infection.Results:The odds of having wound care team treatment versus not having it were 424.2 (95% confidence interval, 19.0 to 9,495.2) among case-patients when compared with control-patients. No other risk factor showed this magnitude of association.Conclusions:This study provided overwhelming epidemiologic evidence that the wound care team was the means of transmission. One year later, when two patients receiving wound care were concurrently diagnosed as having GAS, a member of the wound care team was found to be GAS positive for the matchingemmtype. This is the first report of a GAS hospital outbreak linked to a wound care team.
Surgical-Site Infection After Cardiac Surgery: Incidence, Microbiology, and risk Factors
Authors: Lepelletier Didier , Perron Stéphanie , Bizouarn Philippe , Caillon Jocelyne , Drugeon Henri , Michaud Jean-Luc , Duveau Daniel 
Published: April 2006

AbstractObjective:To identify risk factors associated with surgical-site infection according to the depth of infection, the cardiac procedure, and the National Nosocomial Infections Surveillance System risk index.Design:Prospective survey conducted during a 12-month period.Setting:A 48-bed cardiac surgical department in a teaching hospital.Patients:Patients admitted for cardiac surgery between February 2002 and January 2003.Results:Surgical-site infections were diagnosed in 3% of the patients (38 of 1,268). Of the 38 surgical-site infections, 20 were superficial incisional infections and 18 were mediastinitis for incidence rates of 1.6% and 1.4%, respectively. Cultures were positive in 28 cases and the most commonly isolated pathogen wasStaphylococcus. A National Nosocomial Infections Surveillance System risk index score of 2 or greater was associated with a risk of surgical-site infection (relative risk, 2.4;P< .004). Heart transplantation, mechanical circulatory assistance, coronary artery bypass graft with the use of internal mammary artery, and reoperation for cardiac tamponade or pericard effusion were independent risk factors associated with surgical-site infection.Conclusions:Data surveillance using incidence rates stratified by cardiac procedure and type of infection is relevant to improving infection control efforts. Risk factors in patients who developed superficial infection were different from those in patients who developed mediastinitis. Coronary artery bypass graft using internal mammary artery was associated with a high risk of surgical-site infection, and independent factors such as reoperation for cardiac tamponade or pericard effusion increased the risk of infection.
Colonization Status and Appropriate Antibiotic Therapy for Nosocomial Bacteremia Caused by Antibiotic-Resistant Gram-Negative Bacteria in an Intensive Care Unit
Authors: Blot Stijn , Depuydt Pieter , Vogelaers Dirk , Decruyenaere Johan , Waele Jan De , Hoste Eric , Peleman Renaat , Claeys Geert , Verschraegen Gerda , Colardyn Francis , Vandewoude Koenraad 
Published: April 2006

AbstractObjective:Timely initiation of antibiotic therapy is crucial for severe infection. Appropriate antibiotic therapy is often delayed for nosocomial infections caused by antibiotic-resistant bacteria. The relationship between knowledge of colonization caused by antibiotic-resistant gram-negative bacteria (ABR-GNB) and rate of appropriate initial antibiotic therapy for subsequent bacteremia was evaluated.Design:Retrospective cohort study.Setting:Fifty-four-bed intensive care unit (ICU) of a university hospital. In this unit, colonization surveillance is performed through routine site-specific surveillance cultures (urine, mouth, trachea, and anus). Additional cultures are performed when presumed clinically relevant.Patients:ICU patients with nosocomial bacteremia caused by ABR-GNB.Results:Infectious and microbiological characteristics and rates of appropriate antibiotic therapy were compared between patients with and without colonization prior to bacteremia. Prior colonization was defined as the presence (detected ≥ 2 days before the onset of bacteremia) of the same ABR-GNB in colonization and subsequent blood cultures. During the study period, 157 episodes of bacteremia caused by ABR-GNB were suitable for evaluation. One hundred seventeen episodes of bacteremia (74.5%) were preceded by colonization. Appropriate empiric antibiotic therapy (started within 24 hours) was administered for 74.4% of these episodes versus 55.0% of the episodes that occurred without prior colonization. Appropriate therapy was administered within 48 hours for all episodes preceded by colonization versus 90.0% of episodes without prior colonization.Conclusion:Knowledge of colonization status prior to infection is associated with higher rates of appropriate therapy for patients with bacteremia caused by ABR-GNB (Infect Control Hosp Epidemiol 2005;26:575-579).