bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Comparison of Multifaceted VersusClostridium difficile-Focused VRE Surveillance Strategies in a Low-Prevalence Setting
Authors: Kate Kevin C. , Gardam Michael A. , Burt JoAnne , Conly John M. 
Published: February 2006

AbstractWe compared our current screening strategy for vancomycin-resistantEnterococcus(VRE) with a focused strategy that screens all stool samples sent forClostridium difficiletoxin assay but limits rectal swab screening to wards with new VRE cases detected viaC difficilesamples. The proposed strategy detects 72.7% of new VRE cases, with substantial cost savings.
Assessing Excess Nurse Work Load Generated by Multiresistant Nosocomial Bacteria in Intensive Care
Authors: Saulnier Fabienne F. , Hubert Hervé , Onimus Thierry M. , Beague Sébastien , Nseir Saad , Grandbastien Bruno , Renault Catherine Y. , Idzik Myrian , Erb Martine P. , Durocher Alain V. 
Published: February 2006

AbstractObjective:To compare three methods for assessing the excess nurse work load related to recommended procedures for managing nosocomial infections (NI) due to multiresistant bacteria (MRB): two activity scores, the Omega score and the Projet de Recherche en Nursing (PRN) system, and a specific evaluation based on functional analysis of nursing procedures.Setting:10 beds in a medical intensive care unit (MICU).Patients:Patients admitted from November 15,1995, to June 15, 1996, were included and divided in two groups based on presence of MRB colonization or infection (MRB+ and MRB− groups).Methods:Data were collected regarding length of stay (LOS) in days; Omega score for the entire stay; PRN score for the entire stay and per day; and time required to perform correctly four nursing procedures related to MRB NI, as evaluated specifically by the nursing staff, using a detailed functional analysis document that described all elementary nursing tasks in chronological order and all material needed to carry out those tasks.Results:The LOS and total Omega and PRN scores were higher in the MRB+ group than in the MRB− group: LOS, 23±20.6 versus 12±15.3 days, (P<.001); Omega score, 164±103.4 versus 123±93.7 points (P<.001); PRN score, 3,606±3,187 versus 1,854±2,356 points (P<.001), respectively. The daily PRN score was also higher in MRB+ group (PRN, 160±25 vs 146±34 points in the MRB− group; P<.028). Four nursing procedures made necessary by MRB acquisition were identified: isolation precautions, with two levels according to whether the risk of contamination was mild-moderate or high; bathing the patient with antiseptic solution;, bedpan management; and microbiological screening. The functional analysis indicated that the time needed to carry out these four procedures correctly was 245 minutes per patient per day, as compared to 85 minutes according to the PRN system.Conclusions:Our data confirm that MRB NIs are responsible for an increase in nurse work load, as estimated by LOS, Omega, and PRN scores. However, the daily excess nurse work load related directly to recommended procedures for managing MRB NIs in MICUs is underestimated by these activity scores, as compared to a specific functional analysis of nursing tasks. This may be of importance in evaluating potential links between nurse work load and MRB NIs and in determining the number of nurse hours needed to comply with infection control recommendations.
Outbreak of Vancomycin-ResistantEnterococcus faeciumin a Neonatal Intensive Care Unit
Authors: Rupp Mark E. , Marion Nedra , Fey Paul D. , Bolam David L. , Iwen Peter C. , Overfelt Christine M. , Chapman Lucinda 
Published: February 2006

AbstractAn outbreak of vancomycin-resistantEnterococcus faeciuminvolving 28 infants in a neonatal intensive care unit was observed. Successful control of the outbreak was achieved following use of patient and staff cohorting, contact isolation precautions, patient and environmental surveillance cultures, environmental decontamination, molecular typing, introduction of an alcohol-based hand disinfectant, and decreased use of vancomycin.
The Emerging Nosocomial PathogensCryptosporidium, Escherichia coli0157: H7,Helicobacter pylori, and Hepatitis C: Epidemiology, Environmental Survival, Efficacy of Disinfection, and Control Measures
Authors: Weber David J. , Rutala William A. 
Published: February 2006

AbstractNew and emerging infectious diseases pose a threat to public health and may be responsible for nosocomial outbreaks.Cryptosporidium parvumandEscherichia coliare gastrointestina pathogens that have caused nosocomial infections via person-to-person transmission, environmental contamination, or contaminated water or food.Helicobacter pylorihas been transmitted via inadequately disinfected endoscopes. Finally, hepatitis C may be acquired by healthcare personnel by percutaneous or mucous membrane exposure to blood or between patients by use of contaminated blood products or via environmental contamination. Rigorous adherence to Standard Precautions, Contact Precautions for patients with infectious diarrhea, disinfection of environmental surfaces, and appropriate disinfection of endoscopes are adequate to prevent nosocomial acquisition of these pathogens.
Factors Associated With Postoperative Infection
Authors: Scott James D. , Forrest Alan , Feuerstein Steve , Fitzpatrick Paul , Schentag Jerome J. 
Published: February 2006

AbstractObjective:We have developed and analyzed a large surgical prophylaxis database and now report the factors significantly associated with early infection, readmission due to infection, and death within 28 days of surgery. This study is intended to be a stepping-stone for further studies using our clinical database.Design and Setting:A computerized database of 9,016 surgical patients from a 400-bed community hospital was examined. Multivariate logistic regression and tree-based modeling were used to identify factors associated with the outcomes. Factors considered included surgical procedure, prophylactic antibiotic, age, gender, serum creatinine, and albumin.Results:12.6% had an early infection, 2.5% were read-mitted due to infection, and 2.5% died within 28 days. Most combination prophylactic antibiotics were associated with an increased probability of an early infection. Decreased albumin and increased age were associated with an increased probability of an early infection. Tracheostomy and amputations were associated with an increased probability of an early infection, whereas gallbladder and orthopedic procedures involving the arm were associated with a decreased probability. Factors associated with readmission due to infection included dialysis shunt, vascular repair, and an early infection. Factors associated with increased probability of death within 28 days included age, albumin, serum creatinine, and an early infection. Gallbladder procedures and obstetric-gynecologic procedures were associated with a decreased probability of death within 28 days.Discussion:Older patients and those with a decreased albumin were most likely to have an early infection. To the extent that an early infection was a significant risk factor for readmission due to infection, the impact of age and albumin on the probability of readmission due to infection is demonstrated by their effects on early infections. Interestingly, albumin and age were significantly associated with death within 28 days, in addition to early infection, showing the predictive association between these factors and early death.
Microbiology and Risk Factors for Catheter Exit-Site and -Hub Colonization in Neonatal Intensive Care Unit Patients
Authors: Mahieu Ludo M. , De Dooy Jozef J. , De Muynck Aimé O. , Van Melckebeke Guillaume , Ieven Margareta M. , Van Reempts Patrick J. 
Published: February 2006

AbstractObjective:To identify risk factors and describe the microbiology of catheter exit-site and hub colonization in neonates.Design:During a period of 2 years, we prospectively investigated 14 risk factors for catheter exit-site and hub colonization in 862 central venous catheters in a cohort of 441 neonates. Cultures of the catheter exit-site and hub were obtained using semiquantitative techniques at time of catheter removal.Setting:A neonatal intensive care unit at a university hospital.Results:Catheter exit-site colonization was found in 7.2% and hub colonization in 5.3%. Coagulase-negative staphylococci were predominant at both sites. Pathogenic flora were found more frequently at the catheter hub (36% vs 14%;P<.05). Through logistic regression, factors associated with exit-site colonization were identified as umbilical insertion (odds ratio [OR], 8.1; 95% confidence interval [CI95], 2.35-27.6;P<.001), subclavian insertion (OR, 54.6; CI95, 12.2-244;P<.001), and colonization of the catheter hub (OR, 8.9; CI95,3.5-22.8;P<.001). Catheter-hub colonization was associated with total parenteral nutrition ([TPN] OR for each day of TPN, 1.056; CI95,1.029-1.083;P<.001) and catheter exit-site colonization (OR, 6.11; CI95, 2.603-14.34;P<.001). No association was found between colonization at these sites and duration of catheterzation and venue of insertion, physician's experience, postnatal age and patient's weight, ventilation, steroids or antibiotics, and catheter repositioning.Conclusion:These data support that colonization of the catheter exit-site is associated with the site of insertion and colonization of the catheter hub with the use of TPN. There is a very strong association between colonization at both catheter sites.
The Epidemiology of Invasive Pulmonary Aspergillosis at a Large Teaching Hospital
Authors: Pegues Clare F. , Daar Eric S. , Murthy A. Rekha 
Published: February 2006

AbstractObjective:To characterize the epidemiology of invasive pulmonary aspergillosis (IPA).Design:A retrospective case series.Setting:An 850-bed, academic, tertiary-care medical center.Participants:Adult inpatients, between January 1, 1990, and December 31, 1998, with either a histopathology report consistent with IPA or a discharge diagnosis of aspergillosis.Methods:We reviewed medical records and categorized case-patients as definitive or probable and acquisition of IPA as nosocomial, indeterminate, or community using standard definitions. To determine the rate of aspergillus respiratory colonization, we identified all inpatients who had a respiratory culture positive forAspergillusspecies without a histopathology report consistent with IPA or a discharge diagnosis of aspergillosis. Three study intervals were defined: interval 1,1990 to 1992; interval 2,1993 to 1995; and interval 3,1996 to 1998. Carpeting in rooms for patients following heart-lung and liver transplant was removed and ceiling tiles were replaced during interval 1; a major earthquake occurred during interval 2.Results:72 case-patients and 433 patients with respiratory colonization were identified. Acquisition was nosocomial for 18 (25.0%), indeterminate for 9 (12.5%), and community-acquired for 45 (62.5%) case-patients. Seventeen (23.6%) of the 72 case-patients had prior transplants, including 15 solid organ and 2 bone marrow. The IPA rate per 100 solid organ transplants (SOTs) decreased from 2.45 during interval 1 to 0.93 during interval 2 and to 0.52 during interval 3 (chi-square for trend, 5.44;P<.05). The hospitalwide IPA rate remained stable at 0.03 per 1,000 patient days.Conclusions:The SOT IPA rate decreased after intervals 1 and 2, although the hospitalwide IPA rate remained stable during the study period. Post-earthquake hospital demolition and construction occurring after interval 2 was not associated with an increase in the rate of IPA at our institution.
Isolation in Brazil of NosocomialStaphylococcus aureusWith Reduced Susceptibility to Vancomycin
Authors: Oliveira Geraldo A. , Dell'Aquila Adriana M. , Masiero Rita L. , Levy Carlos E. , Gomes Marcia S. , Cui Longzhu , Hiramatsu Keiichi , Mamizuka Elsa M. 
Published: February 2006

AbstractObjective:To evaluate the possible presence of vancomycin-resistantStaphylococcus aureus(VRSA) in a Brazilian hospital.Design:Epidemiological and laboratory investigation of nosocomial VRSAMethods:140 methicillin-resistantS aureusstrains isolated between November 1998 and October 1999 were screened for susceptibility to vancomycin. The screening was carried out by using brain-heart infusion agar (BHIA) supplemented with 4, 6, and 8 μg/mL of vancomycin. The minimum inhibitory concentration (MIC) determination was carried out as standardized by the National Committee for Clinical Laboratory Standards using the broth macrodilution, agar-plate dilution, and E-test methods.Patients:Hospitalized patients exposed to vancomycin.Results:5 of the 140 isolates had a vancomycin MIC of 8 μg/mL by broth macrodilution, agar plate dilution, and E-test methods. Four VRSA strains were isolated from patients in a burn unit who had been treated with vancomycin for more than 30 days, and one from an orthopedic unit patient who had received vancomycin treatment for 7 days. Pulsed-field gel electrophoresis characterized four of the VRSA strains as belonging to the Brazilian endemic clone. All five strains were negative forvanA,vanB, andvanC genes by polymerase chain reaction. Transmission electron microscopy of the five strains revealed significantly thickened cell walls. One patient died due to infection caused by the VRSA strain.Conclusions:This is the first report of isolation of VRSA in Brazil and the first report of isolation of multiple VRSA strains from one facility over a relatively short period of time. This alerts us to the possibility that VRSA may be capable of nosocomial transfer if adequate hospital infection control measures are not taken.
The Role of the Laboratory in Infection Prevention and Control Programs in Long-Term–Care Facilities for the Elderly
Authors: Simor Andrew E. 
Published: February 2006

AbstractHospital infection prevention and control programs rely extensively on diagnostic microbiology laboratory testing. However, specimens for microbiological evaluation are less likely to be obtained from elderly residents of long-term–care facilities (LTCFs). In this article, issues regarding laboratory utilization and the potential role of the microbiology laboratory in infection prevention and control programs in LTCFs are reviewed. The role of the laboratory in infection surveillance, in the management of antimicrobial resistance, and in outbreak investigation are highlighted.
Tuberculosis and Tuberculin Quality: Best Intentions, Misleading Results
Authors: Rangel-Frausto M. Sigfrido , Ponce-de-León-Rosales Samuel , Martinez-Abaroa Claudia , Hasløv Kaare 
Published: February 2006

Abstract

Objective:

To compare the performance of three purified protein derivative (PPD) formulations: Tubersol (Connaught); RT23, Statens Serum Institut (SSI); and RT23, Mexico, tested in Mexican populations at low and high risk for tuberculosis (TB).

Design:

A double-blinded clinical trial.

Setting:

A university hospital in Mexico City.

Participants:

The low-risk population was first or second-year medical students with no patient contact; the high-risk population was healthcare workers at a university hospital.

Methods:

Each of the study subjects received the three different PPD preparations. Risk factors for TB, including age, gender, occupation, bacille Calmette-Guerin (BCG) status, and TB exposure, were recorded. A 0.1-mL aliquot of each preparation was injected in the left and right forearms of volunteers using the Mantoux technique. Blind readings were done 48 to 72 hours later. Sensitivity and specificity were calculated at 10 mm of induration using Tubersol as the reference standard. The SSI tested the potency of the different PPD preparations in previously sensitized guinea pigs.

Results:

The low-risk population had a prevalence of positive PPD of 26%. In the low-risk population, RT23 prepared in Mexico, compared to the 5 TU of Tubersol, had a sensitivity of 51%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 86%. The RT23 prepared at the SSI had a sensitivity of 69%, a specificity of 99%, a positive predictive value of 95%, and a negative predictive value of 90%. In the high-risk population, the prevalence of positive PPD was 57%. The RT23 prepared in Mexico had a sensitivity of 33%, a specificity of 100%, and a positive predictive value of 53%; the RT23 prepared at the SSI had a sensitivity of 91%, a specificity of 98%, a positive predictive value of 98%, and a negative predictive value of 89%. RT23 used in Mexico had a potency of only 23% of that of the control. There was no statistical association among those with a positive PPD, irrespective of previous BCG vaccination (relative risk, 0.97; 95% confidence interval, 0.76-1.3; P=.78).

Conclusions:

Healthcare workers had twice the prevalence of positive PPD compared to medical students. RT23 prepared in Mexico had a low sensitivity in both populations compared to 5 TU of Tubersol and RT23 prepared at the SSI. Previous BCG vaccination did not correlate with a positive PPD. Low potency of the RT23 preparation in Mexico was confirmed in guinea pigs. Best intentions in a TB program are not enough if they are not followed by high-quality control.
Postdischarge Nosocomial Infections in Primary Care
Authors: Letrilliart Laurent , Guiguet Marguerite , Hanslik Thomas , Flahault Antoine 
Published: February 2006

AbstractObjective:To study both surgical and nonsurgical nosocomial infections (NIs) seen by primary-care physicians (general practitioners [GPs]) in France.Design:Ongoing surveillance of postdischarge NIs by an organized group of GPs, from August 1997 to July 1999. Both the GP who personally examined the case spontaneously presenting with NI and the responsible hospital physician or surgeon were interviewed by telephone.Setting:305 general practices from all French regions.Results:2,199 (29%) of 7,540 patients referred for hospitalization reconsulted the GP within 30 days of discharge. In 21 (1%) of the 2,199 cases, an NI was diagnosed by the GP and confirmed as plausible by the responsible hospital physician. We diagnosed an NI in 8 (1.3%) of the post-surgical patients and in 13(0.8%)of the non-surgical cases within the cohort We saw eight urinary tract infections, seven surgical-site infections, three soft-tissue infections, two respiratory tract infections, and one primary bloodstream infection. In 19 patients (90%), clinical signs of NI appeared within 7 days of discharge. Assuming that all 5,431 patients who were missed for follow-up did not experience any NI, an attack rate of 0.3 per 100 admissions may be estimated for the whole group.Conclusion:We diagnosed 1% of NIs following discharge from a hospital in a cohort of 2,199 patients, of which 1.3% were seen post-surgery and 0.8% following nonsurgical admissions. The percentage of postdischarge visits that were for an NI in nonsurgical patients warrants a major effort with feedback to the hospital physician to reduce infection rates.
Quinolone Use as a Risk Factor for Nosocomial Clostridium difficile-Associated Diarrhea
Authors: Yip Clarwyn , Loeb Mark , Salama Suzette , Moss Lorraine , Olde Jan 
Published: February 2006

AbstractObjective:To determine modifiable risk factors for nosocomial Clostridium difficile-associated diarrhea (CDAD).Design:Case-control study.Setting:300-bed tertiary-care hospital.Participants:Hospital inpatients present during the 3-month study period.Methods:Case-patients identified with nosocomial CDAD over the study period were compared to two sets of control patients: inpatients matched by age, gender, and date of admission; and inpatients matched by duration of hospital stay. Variables including demographic data, comorbid illnesses, antibiotic exposure, and use of gastrointestinal medications were assessed for case- and control-patients. Conditional logistic regression was performed to identify risk factors for nosocomial CDAD.Results:27 case-patients were identified and were compared to the two sets of controls (1:1 match for each comparison set). For the first set of controls, use of ciprofloxacin (odds ratio [OR], 5.5; 95% confidence interval [CI95], 1.2-24.8; P=.03) was the only variable that remained significant in the multivariable model. For the second set of controls, prior exposure to cephalosporins (OR, 6.7; CL,5, 1.3-33.7; P=.02) and to ciprofloxacin (OR, 9.5; CI95, 1.01-88.4; P=.05) were kept in the final model.Conclusions:Along with cephalosporins, prior quinolone use predisposed hospitalized patients to nosocomial CDAD. Quinolones should be used judiciously in acute-care hospitals, particularly in those where CDAD is endemic.
Molecular Typing and Antimicrobial Susceptibility of Vancomycin-ResistantEnterococcus faeciumin Brazil
Authors: Cereda Rosangela F. , Gales Ana C. , Silbert Suzane , Jones Ronald N. , Sader Helio S. 
Published: February 2006

AbstractObjectives:To characterize vancomycin-resistant enterococci (VRE) isolates and to evaluate the mode of dissemination of this pathogen in Brazil.Design:We collected 22 vancomycin-resistantEnterococcus faeciumisolates from 6 medical centers in Sao Paulo, Brazil, and 1 isolate from a medical center in Curitiba, Brazil.Participants:All Brazilian hospitals that had identified vancomycin-resistantE. faeciumup to the beginning of this study (late 1999) contributed isolates to the study.Methods:The isolates were susceptibility tested using the broth microdilution method and the E-test. The presence of vancomycin resistance genes (vanA,vanB,vanC1,vanC2-3, andvanD) was evaluated by polymerase chain reaction; molecular typing was performed by pulsed-field gel electrophoresis (PFGE).Results:ThevanA gene was demonstrated in all vancomycin-resistantE. faecium, except for 1 isolate. None of the vancomycin resistance genes cited above was detected in the isolate from Curitiba, which was the first vancomycin-resistantE. faeciumdescribed in Brazil. All isolates were resistant to ampicillin and teicoplanin. The main clone remains susceptible to doxycycline and chloramphenicol, but intermediate to quinupristin-dalfopristin. PFGE analysis demonstrated 7 major PFGE patterns. A unique PFGE pattern with 4 subtypes was detected in 17 isolates from 4 different hospitals.Conclusion:The results of our study indicate the occurrence of intra- and interhospital dissemination of VRE in Sao Paulo, Brazil.