bluuebunny/crossref_metadata_2025_split huggingface dataset:
Healthcare-Associated Infections Among Neonates in Brazil
Authors: Pessoa-Silva Carmem Lúcia , Richtmann Rosana , Calil Roseli , Santos Rosana Maria Rangel , Costa Maria Luiza M. , Frota Ana Cristina Cisne , Wey Sergio Barsanti 
Published: April 2006

AbstractObjective:To describe the epidemiology of healthcare-associated infections (HAIs) among neonates.Design:Prospective surveillance of HAIs was conducted during 2 years. Infections beginning within 48 hours of birth were defined as HAIs of maternal origin. Death occurring during an active episode of HAI was considered related to HAI.Setting:Seven neonatal units located in three Brazilian cities.Patients:All admitted neonates were included and observed until discharge.Results:Twenty-two percent of 4,878 neonates had at least one HAI. The overall incidence density was 24.9 per 1,000 patient-days, and 28.1% of all HAIs were maternally acquired. HAI rates ranged from 12.3% in the group with a birth weight (BW) of more than 2,500 g to 51.9% in the group with a BW of 1,000 g or less. The main HAIs were bloodstream infection (BSI) and pneumonia. Coagulase-negative staphylococci, Enterobacter species, Staphylococcus aureus, and Klebsiella pneumoniae were the main pathogens. Forty percent of all deaths were related to HAI. Central venous catheter (CVC)-associated BSIs per 1,000 CVC-days ranged from 17.3 (BW, 1,501 to 2,500 g; device utilization [DU], 0.11) to 34.9 (BW, ≤ 1,000 g; DU, 34.92). Ventilator-associated pneumonia per 1,000 ventilator-days ranged from 7.0 (BW, ≤ 1,000 g; DU, 0.34) to 9.2 (BW, 1,001 to 1,500 g; DU, 0.14).Conclusions:The high proportion of HAIs of maternal origin highlights perinatal care issues in Brazil and the need to improve the diagnosis of neonatal HAIs. The very low BW group and device-associated infections should be priorities for prevention strategies in this population.
Pediatric Risk of Mortality and Hospital Infection
Authors: Arantes Aglai , Carvalho Eduardo da Silva , Medeiros Eduardo A. S. , Farhat Calil Kairalla , Mantese Orlando Cesar 
Published: April 2006

AbstractWe studied the association of Pediatric Risk of Mortality scores with nosocomial infections among 341 critically ill patients admitted to a pediatric intensive care unit between June 1998 and December 2000. Through stepwise logistic regression analysis, the best predictors for nosocomial infections were device utilization ratio, antimicrobial therapy, and length of stay.
Survey of Tuberculin Skin Test Positivity Among Israeli Pediatric Hospital Workers
Authors: Finkelstein Yaron , Elenberg Henia , Chodick Gabriel , Hoffer Vered , Shalit Itamar , Garty Ben-Zion 
Published: April 2006

AbstractTuberculin skin test (TST) was performed in 374 healthcare workers. TST results of induration of 10 mm or more and 20 mm or more were noted in 44.9% and 10.4%, respectively. Positive TST (> 10 mm) was found to be significantly associated with age, country of origin, and duration of employment.
Three Surveillance Strategies for Vancomycin-Resistant Enterococci in Hospitalized Patients: Detection of Colonization Efficiency and a Cost-Effectiveness Model
Authors: Lee Todd A. , Hacek Donna M. , Stroupe Kevin T. , Collins Susan M. , Peterson Lance R. 
Published: April 2006

AbstractObjective:To evaluate the cost-effectiveness and detection sensitivity associated with three active surveillance strategies for the identification of patients harboring vancomycin-resistant enterococci (VRE) to determine which is the most medically and economically useful.Design:Culture for VRE from 200 consecutive stool specimens submitted forClostridium difficileculture. Following this, risk factors were assessed for patients whose culture yielded VRE, and a cost-effectiveness evaluation was performed using a decision analytic model with a probabilistic analysis.Setting:A 688-bed, tertiary-care facility in Chicago, Illinois, with approximately 39,000 annual admissions, 7,000 newborn deliveries, 56,000 emergency department visits, and 115,000 home care and 265,000 outpatient visits.Subjects:All stool specimens submitted to the clinical microbiology laboratory forC. difficileculture from hospital inpatients.Results:From 200 stool samples submitted forC. difficiletesting, we identified 5 patients with VRE in non-high-risk areas not screened as part of our routine patient surveillance. Medical record review revealed that all 5 had been hospitalized within the prior 2 years. Three of 5 had a history of renal impairment. The strategy that would involve screening the greatest number of patients (all those with a history of hospital admission in the prior 2 years) resulted in highest screening cost per patient admitted ($2.48), lower per patient admission costs ($480), and the best survival rates.Conclusion:An expanded VRE surveillance program that encompassed all patients hospitalized within the prior 2 years was a cost-effective screening strategy compared with a more traditional one focused on high-risk units.
A Pilot Study of Antibiotic Cycling in the Community Hospital Setting
Authors: Bruno-Murtha Lou Ann , Brusch John , Bor David , Li Wenjun , Zucker Deborah 
Published: April 2006

AbstractObjective:To assess the feasibility of a quarterly antibiotic cycling program at two community hospitals and to evaluate its safety and impact on antibiotic use, expenditures, and resistance.Design:Nonrandomized, longitudinal cohort study.Setting:Two community hospitals, one teaching and one non-teaching.Patients:Adult medical and surgical inpatients requiring empiric antibiotic therapy.Intervention:We developed and implemented a treatment protocol for the empiric therapy of common infections. Between July 2000 and June 2002, antibiotics were cycled quarterly; quinolones, beta-lactam–inhibitor combinations, and cephalosporins were used. Protocol adherence, adverse drug events, nosocomial infections, antibiotic use and expenditures, resistance among clinical isolates, and length of stay were assessed during eight quarters.Results:Physicians adhered to the protocol for more than 96% of 2,494 eligible patients. No increases in nosocomial infections or adverse drug events were attributed to the cycling protocol. Antibiotic acquisition costs increased 31%; there was a 14.7% increase in antibiotic use. Length of stay declined by 1 day. Quarterly variability in the prevalence of vancomycin-resistant enterococci and ceftazidime resistance among combined gram-negative organisms were noted.Conclusions:Implementation of an antibiotic cycling program is feasible in a community hospital setting. No adverse safety concerns were identified. Antibiotic cycling was more expensive, partly due to an increase in antibiotic use to optimize initial empiric therapy. Quarterly antibiogram patterns suggested that antibiotic cycling may have impacted resistance, although the small number of isolates precluded statistical analysis. Further assessment of this approach is necessary to determine its relationship to antimicrobial resistance.
Clinical Epidemiology of Ciprofloxacin Resistance and Its Relationship to Broad-Spectrum Cephalosporin Resistance in Bloodstream Infections Caused by Enterobacter Species
Authors: Kang Cheol-In , Kim Sung-Han , Park Wan Beom , Lee Ki-Deok , Kim Hong-Bin , Kim Eui-Chong , Oh Myoung-don , Choe Kang-Won 
Published: April 2006

AbstractObjectives:To evaluate the clinical features of ciprofloxacin-resistant Enterobacter bacteremia and to examine the risk factors for ciprofloxacin resistance in Enterobacter species isolates causing bacteremia.Design:A case-control study.Setting:A 1,500-bed, tertiary-care university hospital and referral center.Patients:All patients older than 16 years with Enterobacter species isolated from blood were enrolled. The medical records of 183 patients with clinically significant Enterobacter bacteremia from January 1998 to December 2002 were identified. We compared patients with bacteremia caused by ciprofloxacin-susceptible isolates with patients with bacteremia caused by ciprofloxacin-resistant isolates.Results:Twenty-three (12.6%) of the patients had bacteremia caused by isolates resistant to ciprofloxacin. There were no significant differences in age, gender, underlying diseases, primary site of infection, or Acute Physiology and Chronic Health Evaluation II score between the ciprofloxacin-resistant and the ciprofloxacin-susceptible groups. Broad-spectrum cephalosporin resistance, defined as resistance to cefotaxime or ceftazidime in vitro, was detected in 21 (91.3%) of 23 ciprofloxacin-resistant isolates compared with 65 (40.6%) of 160 ciprofloxacin-susceptible isolates (P < .001). Multivariate analysis revealed that independent risk factors for ciprofloxacin resistance were the prior receipt of fluoroquinolones (P < .001) and broad-spectrum cephalosporin resistance (P < .001).Conclusions:In Enterobacter species isolates causing bacteremia, ciprofloxacin resistance was closely associated with the prior receipt of fluoroquinolones and broad-spectrum cephalosporin resistance. The close relationship between ciprofloxacin resistance and broad-spectrum cephalosporin resistance is particularly troublesome because it severely restricts the therapeutic options for Enterobacter species infection.
Assessment of Knowledge, Attitudes, and Practices Regarding Isolation Precautions Among Iranian Healthcare Workers
Authors: Askarian Mehrdad , Mirzaei Kamran , Mundy Linda M. , McLaws Mary-Louise 
Published: April 2006

AbstractWe conducted a survey of 1,048 healthcare workers (HCWs) at 8 Iranian hospitals regarding knowledge, attitudes, and practices related to isolation precautions. We found 75% below acceptable safety levels. Routine handwashing before and after glove use was reported by fewer than half of the HCWs.
Nosocomial Acquisition of Methicillin-ResistantStaphylococcus aureusDuring an Outbreak of Severe Acute Respiratory Syndrome
Authors: Poutanen Susan M. , Vearncombe Mary , McGeer Allison J. , Gardam Michael , Large Grant , Simor Andrew E. 
Published: April 2006

AbstractObjective:The four hospitals assessed in this study use active surveillance cultures for methicillin-resistantStaphylococcus aureus(MRSA) and contact precautions for MRSA-positive patients as part of routine infection control practices. The objective of this study was to determine whether nosocomial acquisition of MRSA decreased in these hospitals during an outbreak of severe acute respiratory syndrome (SARS) when barrier precautions were routinely used for all patients.Design:Retrospective cohort study.Setting:Three tertiary-care hospitals (a 1,100-bed hospital; a 500-bed hospital; and an 823-bed hospital) and a 430-bed community hospital, each located in Toronto, Ontario, Canada.Patients:All admitted patients were included.Results:The nosocomial rate of MRSA in all four hospitals combined during the SARS outbreak (3.7 per 10,000 patient-days) was not significantly different from that before (4.7 per 10,000 patient-days) or after (3.4 per 10,000 patient-days) the outbreak (P= .30 andP= .76, respectively). The nosocomial rate of MRSA after the outbreak was significantly lower than that before the outbreak (P= .003). Inappropriate reuse of gloves and gowns and failure to wash hands between patients on non-SARS wards were observed during the outbreak. Increased attention was paid to infection control education following the outbreak.Conclusions:Inappropriate reuse of gloves and gowns and failure to wash hands between patients may have contributed to transmission of MRSA during the SARS outbreak. Attention should be paid to training healthcare workers regarding the appropriate use of precautions as a means to protect themselves and patients.
Epidemiology and Clonality of Methicillin-Resistant and Methicillin-SusceptibleStaphylococcus aureusCausing Bacteremia in a Tertiary-Care Hospital in Spain
Authors: Chaves Fernando , García-Martínez Jesus , Miguel Sonia de , Sanz Francisca , Otero Joaquín R. 
Published: April 2006

AbstractObjectives:To describe the relative proportions of nosocomial and community-onsetStaphylococcus aureusbacteremia at our institution and the epidemiologic characteristics and clonal diversity ofS. aureusisolates, as determined by pulsed-field gel electrophoresis (PFGE) and antimicrobial resistance patterns.Design:Retrospective cohort study of all cases ofS. aureusbacteremia between October 2001 and October 2002.Setting:A 1,300-bed, tertiary-care hospital.Results:One hundred sixty-two unique episodes ofS. aureusbacteremia were identified. Forty-three cases (26.5%) were caused by methicillin-resistantS. aureus(MRSA). Most cases ofS. aureusbacteremia, whether MRSA or methicillin susceptible (MSSA), were nosocomial in origin (77.2%) or were otherwise associated with the healthcare system (16%). Only 11 (6.8%) of the cases (all MSSA) were strictly community acquired. Thirty-five unique macrorestriction patterns were identified among the 154 isolates that were typed by PFGE. Four major genotypes were defined among the isolates of MRSA, with 36 (85.7%) represented by a single PFGE type. Of the isolates within this major clone, all (100%) were ciprofloxacin resistant and 77.8% were erythromycin resistant. In contrast, the 112 isolates of MSSA comprised 31 different PFGE types, 3 of which represented 42.9% of all MSSA isolates and were associated with both nosocomial and community-onset bacteremia.Conclusions:Most cases ofS. aureusbacteremia in our healthcare region are nosocomial in origin or are acquired through contact with the healthcare system and are thus potentially preventable. To preclude dissemination of pathogenic clones, it is therefore necessary to redouble preventive measures in both the hospital and the community.
Detection and Treatment of Antibiotic-Resistant Bacterial Carriage in a Surgical Intensive Care Unit: A 6-Year Prospective Survey
Authors: Troché Gilles , Toly Luc-Marie , Guibert Michèle , Zazzo Jean-Fabien 
Published: April 2006

AbstractObjective:To describe, during a 6-year period, multidrug-resistant bacterial carriage in an intensive care unit (ICU).Design:Prospective survey of 2,235 ICU patients with methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL-E).Setting:A surgical ICU in a tertiary-care teaching hospital.Patients:All admitted patients.Interventions:Nasal and rectal swabs were performed at admission and weekly thereafter. There was nasal application of mupirocin for MRSA carriers and selective digestive decontamination with local antibiotics for ESBL-E carriers.Results:The swab compliance rate was 82% at admission and 51% during ICU stay. The rates of MRSA carriage or infection were 4.2 new cases per 100 admissions and 7.9 cases per 1,000 patient-days during ICU stay. The rates of ESBL-E carriage or infection were 0.4 new case per 100 admissions and 3.9 cases per 1,000 patient-days during ICU stay. Importation of MRSA increased significantly over time from 3.2 new cases per 100 admissions during the first 3 years to 5.5 during the last 3 years. The rate of ICU-acquired ESBL-E decreased from 5.5 cases per 1,000 patient-days during the first 3 years to 1.9 cases during the last 3 years. Nasal and digestive decontamination had low efficacy in eradicating carriage.Conclusions:MRSA remained poorly controlled throughout the hospital and was not just a problem in the ICU. MRSA thus requires more effective measures throughout the hospital. ESBL-E was mainly an ICU pathogen and our approach resulted in a clear decrease in the rate of acquisition in the ICU over time.
Healthcare-AssociatedStaphylococcus aureusBacteremia and the Risk for Methicillin Resistance: Is the Centers for Disease Control and Prevention Definition for Community-Acquired Bacteremia Still Appropriate?
Authors: Lesens Olivier , Hansmann Yves , Brannigan Eimar , Hopkins Susan , Meyer Pierre , O'Connel Brian , Prévost Gilles , Bergin Colm , Christmann Daniel 
Published: April 2006

AbstractObjective:To evaluate a new classification for bloodstream infections that differentiates hospital acquired, healthcare associated, and community acquired in patients with blood cultures positive forStaphylococcus aureus.Design:Prospective, observational study.Setting:Three tertiary-care, university-affiliated hospitals in Dublin, Ireland, and Strasbourg, France.Patients:Two hundred thirty consecutive patients older than 18 years with blood cultures positive forS. aureus.Methods:S. aureusbacteremia (SAB) was defined as hospital acquired if the first positive blood culture was performed more than 48 hours after admission. Other SABs were classified as healthcare associated or community acquired according to the definition proposed by Friedman et al. When available, strains of methicillin-resistantStaphylococcus aureus(MRSA) were analyzed by pulsed-field gel electrophoresis (PFGE).Results:Eighty-two patients were considered as having community-acquired bacteremia according to the Centers for Disease Control and Prevention (CDC) classification. Of these 82 patients, 56% (46) had healthcare-associated SAB. MRSA prevalence was similar in patients with hospital-acquired and healthcare-associated SAB (41% vs 33%;P> .05), but significantly lower in the group with community-acquired SAB (11%;P< .03). PFGE of MRSA strains showed that most community-acquired and healthcare-associated MRSA strains were similar to hospital-acquired MRSA strains. On multivariate analysis, Friedman's classification was more effective than the CDC classification for predicting MRSA.Conclusion:These results support the call for a new classification for community-acquired bacteremia that would account for healthcare received outside the hospital by patients with SAB.
Clustering of Multiple Endemic Strains of Methicillin-ResistantStaphylococcus aureusin a Nursing Home: An 8-Year Study
Authors: Drinka Paul J. , Stemper Mary E. , Gauerke Cathy D. , Miller Janice E. , Goodman Brian M. , Reed Kurt D. 
Published: April 2006

AbstractPFGE was performed on residents' first clinical MRSA isolate (n = 94) during 8 years. Sixty-one percent of the isolates were clustered in time (P< .05) and space (P< .05) (ie, 2 separate statistically significant tests). Isolates from individual units were genetically related, with only the occasional unrelated isolate.
A Norovirus Gastroenteritis Epidemic in a Long-Term–Care Facility
Authors: Cooper Elizabeth , Blarney Stephen 
Published: April 2006

AbstractBackground:In Victoria, Australia, from July to December 2002, 126 outbreaks of viral and suspected viral gastroenteritis were reported in healthcare institutions. Norovirus was found to account for at least 77 of the 126 outbreaks.Methods:In October 2002, the infection control unit investigated an outbreak of acute gastroenteritis on three wards in a 500-bed, long-term-care facility in Melbourne, Victoria, Australia. Cohorting and other infection control measures were initiated.Results:The outbreak was controlled 32 days after the first symptoms of acute gastroenteritis were identified. Fifty-two patients and 11 staf f members were affected. Norovirus genotype 2 was detected on two of the three wards. Norovirus was not isolated in the third ward but was suspected to be the causative organism.Conclusions:Outbreaks of viral gastroenteritis can cause significant morbidity in a long-term-care facility, affecting both patients and staff. In addition, the transmission of viral pathogens can be well established before there is recognition of an outbreak.
Impact of an Outbreak of Norovirus Infection on Hospital Resources
Authors: Zingg Walter , Colombo Carlo , Jucker Thomas , Bossart Walter , Ruef Christian 
Published: April 2006

AbstractObjective:To describe a nosocomial norovirus outbreak, its management, and its financial impact on hospital resources.Design:A matched case-control study and microbiological investigation.Methods:We compared 16 patients with norovirus infection with control-patients matched by age, gender, disease category, and length of stay. Bed occupancy-days during the peak incidence period of the outbreak were compared with the corresponding periods in 2001 and 2002. Expenses due to increased workload were calculated based on a measuring system that records time spent for nursing care per patient per day.Results:The attack rates were 13.9% among patients and 29.5% among healthcare workers. The median number of occupied beds was significantly lower due to bed closure during the peak incidence in 2003 (29) compared with the median number of occupied beds in 2001 and 2002 combined (42.5). Based on this difference and a daily charge of $562.50 per patient, we calculated a revenue loss of S37.968. Additional expenses totaled $10,300 for increased nursing care. Extra costs for microbiological diagnosis totaled $2,707. Lost productivity costs due to healthcare workers on sick leave totaled $12,807. The expenses for work by the infection control team totaled $1,408. The financial impact of this outbreak on hospital resources comprising loss of revenue and extra costs for microbiological diagnosis but without lost productivity costs, increased nursing care, and expenses for the infection control team totaled $40,675.Conclusions:Nosocomial norovirus outbreaks result in significant loss of revenue and increased use of resources. Bed closures had a greater impact on hospital resources than increased need for nursing care.
Evaluation of the Impact of the Source (Patient Versus Staff) on Nosocomial Norovirus Outbreak Severity
Authors: Mattner Frauke , Mattner Lutz , Borck Hans Ulrich , Gastmeier Petra 
Published: April 2006

AbstractObjective:To study the dependence of infection risk and outbreak size on the type of index case (ie, patient or staff).Methods:Nosocomial outbreaks were reviewed and categorized into those started by patients and those started by staff. Infection risks and outbreak sizes were evaluated taking into account the index case category.Results:Of the 30 nosocomial outbreaks of norovirus with person-to-person transmission, 20 (67%) involved patients as the index cases. Patient-indexed outbreaks affected significantly more patients than did staff-indexed outbreaks (difference in means, 16.25; 95% confidence interval [CI95], 5.1 to 27.0). For the numbers of affected staff, no dependence on the index case category was detectable (difference in means, -1.05; CI95, -9.0 to 6.9). For patients exposed during patient-indexed outbreaks, the risk of acquiring a norovirus infection was approximately 4.8 times as high as the corresponding risk for patients exposed during staff-indexed outbreaks (odds ratio [OR], 4.79; CI95,1.82 to 8.28). The infection risk for exposed staff during patient-indexed outbreaks was approximately 1.5 times as high as the corresponding risk during staff-indexed outbreaks (OR, 1.51; CI95, 0.92 to 2.49).Conclusions:Patient-indexed norovirus outbreaks generally affect more patients than do staff-indexed outbreaks. Staff appear to be similarly affected by both outbreak index category groups. This study demonstrates the importance of obtaining complete outbreak data, including the index case classification as staff or patient, during norovirus outbreak investigations. Such information may be useful for further targeting prevention measures.