bluuebunny/crossref_metadata_2025_split huggingface dataset:
A New Surgical-Site Infection Risk Index Using Risk Factors Identified by Multivariate Analysis for Patients Undergoing Coronary Artery Bypass Graft Surgery
Authors: Russo Philip L. , Spelman Denis W. 
Published: February 2006

Objectives:To develop a new, simple, and practical risk index for patients undergoing coronary artery bypass graft (CABG) surgery, to develop a preoperative risk index that is predictive of surgical-site infection (SSI), and to compare the new risk indices with the National Nosocomial Infections Surveillance (NNIS) System risk index.Design:Potential risk factor and infection data were collected prospectively and analyzed by multivariate analysis. Two new risk indices were constructed and then compared with the NNIS System risk index for predictive power for SSI.Setting:Alfred Hospital is a 350-bed, university-affiliated, tertiary-care referral center. The cardiothoracic unit performs approximately 650 CABG procedures per year.Patients:All patients undergoing CABG surgery within the cardiothoracic unit at Alfred Hospital between December 1, 1996, and September 29, 2000, were included.Results:Potential risk factor data were complete for 2,345 patients. There were 199 SSIs. Obesity (odds ratio [OR], 1.78; 95% confidence interval [CI95], 1.24 to 2.55), peripheral or cerebrovascular disease (OR, 1.64; CI95, 1.16 to 2.33), insulin-dependent diabetes mellitus (OR, 2.29; CI95, 1.15 to 4.54), and a procedure lasting longer than 5 hours (OR, 1.75; CI95,1.18 to 2.58) were identified as independent risk factors for SSI. With the use of a different combination of these risk factors, two risk indices were constructed and compared using the Goodman-Kruskal nonparametric correlation coefficient (G). Risk index B had the highest G value (0.3405; CI95, 0.2245 to 0.4565), compared with the NNIS System risk index G value (0.3142; CI95, 0.1462 to 0.4822). The G value for risk index A constructed from preoperative variables only, was 0.3299 (CI95 0.2039 to 0.4559).Conclusion:Two new risk indices have been developed. Both indices are as predictive as the NNIS System risk index. One of the new risk indices can also be applied preoperatively.
An Outbreak of Mediastinitis Among Heart Transplant Recipients Apparently Related to a Change in the United Network for Organ Sharing Guidelines
Authors: Samuel Rafik , Axelrod Peter , John Keith St. , Fekete Thomas , Alexander Sharon , McCarthy James , Truant Allan , Todd Barbara , Furukawa Satoshi , Eisen Howard , Spotnitz William 
Published: February 2006

Objective:To describe an outbreak of mediastinitis in heart transplant recipients.Design:Retrospective and contemporaneous cohort study.Setting:Urban tertiary-care university hospital with a large cardiac transplantation program.Patients:Heart transplant recipients.Interventions:Modifications of donor harvest technique; procedures aimed at decreasing skin and mucosal bacterial colonization; strict aseptic technique in the intensive care unit; and aggressive policing of established infection control practices.Results:In April 1999, mediastinitis rates among heart transplant recipients increased abruptly from a baseline of 6 cases per 100 procedures to sequential quarterly rates of 22, 31, and 50 cases per 100 procedures, whereas infection rates in other cardiac operations were unchanged. Bacteria causing these infections were multidrug-resistant "nosocomial" organisms. The epidemic occurred 2 months after a change in the United Network for Organ Sharing organ allocation algorithm. This change resulted in an increase in the duration of preoperative hospitalization from a median of 52 to 79 days (P= .008) and may have promoted prolonged hospitalization of patients with high illness severity. Aggressive multidisciplinary interventions were temporally associated with a return to preoperative mediastinitis rates without changing length of hospitalization prior to transplantation.Conclusions:Changes in organ allocation for transplant that prolong waiting time in the hospital and alter illness acuity may lead to increased rates of postoperative infection. Measures to limit bacterial colonization may be a helpful countervailing strategy.
Prevalence of Surgical-Site Infections and Patterns of Antimicrobial Use in a Large Tertiary-Care Hospital in Ho Chi Minh City, Vietnam
Authors: Sohn Annette H. , Parvez Farah M. , Vu Tien , Hai Hoang H. , Bich Nguyen N. , Thu Le Thi A. , Hoa Le Thi T , Thanh Nguyen H. , Viet Truong V. , Archibald Lennox K. , Banerjee Shailen N. , Jarvis William R. 
Published: February 2006

Background:Few studies have been conducted in Vietnam on the epidemiology of healthcare-associated infections or antimicrobial use. Thus, we sought to determine the prevalence of and risk factors for surgical-site infections (SSIs) and to document antimicrobial use in surgical patients in a large healthcare facility in Vietnam.Methods:We conducted a point-prevalence survey of SSIs and antimicrobial use at Cho Ray Hospital, Ho Chi Minh City, a 1,250-bed inpatient facility. All patients on the 11 surgical wards and 2 intensive care units who had surgery within 30 days before the survey date were included.Results:Of 391 surgical patients, 56 (14.3%) had an SSI. When we compared patients with and without SSIs, factors associated with infection included trauma (relative risk [RR], 2.65; 95% confidence interval [CI95], 1.60 to 4.37; P < .001), emergency surgery (RR, 2.74; CI95, 1.65 to 4.55; P < .001), and dirty wounds (RR, 3.77; CI95, 2.39 to 5.96; P < .001). Overall, 198 (51%) of the patients received antimicrobials more than 8 hours before surgery and 390 (99.7%) received them after surgery. Commonly used antimicrobials included third-generation cephalosporins and aminoglycosides. Thirty isolates were identified from 26 SSI patient cultures; of the 25 isolates undergoing antimicrobial susceptibility testing, 22 (88%) were resistant to ceftriaxone and 24 (92%) to gentamicin.Conclusions:Our data show that (1) SSIs are prevalent at Cho Ray Hospital; (2) antimicrobial use among surgical patients is widespread and inconsistent with published guidelines; and (3) pathogens often are resistant to commonly used antimicrobials. SSI prevention interventions, including appropriate use of antimicrobials, are needed in this population.
Evaluation of Rapid Readout Biological Indicators for 132°C Gravity and 132°C Vacuum-Assisted Steam Sterilization Cycles Using a New Automated Fluorescent Reader
Authors: Alfa Michelle J. , Olson Nancy , DeGagne Pat , Jackson Michele 
Published: February 2006

Objective:The primary objective of this study was to evaluate fluorescent readout results of Attest 1291 Biological Indicators (Bis) (3M Health Care, St. Paul, MN) and Attest 1296 BI test packs (containing Attest 1292 Bis) using full and fractional cycles compared with the growth data when prolonged incubation (7 days) was included. Gravity displacement and vacuum-assisted steam sterilization cycles were evaluated. A secondary objective of this study was to evaluate the new automated rapid fluorescent reader (Attest 290 Auto Reader).Design:The rapid readout Bis for gravity displacement and vacuum-assisted steam autoclave cycles at 132° C were processed using full (4 minutes) and four fractional cycles that provided 30% to 80% positive results for growth after 24 hours of incubation (48 hours of incubation for Attest 1292 Bis from the Attest 1296 test packs). Sixty of each type of BI were tested for each cycle (300 of each BI type in total).Results:For all full steam sterilization cycles, results of the rapid fluorescent readout and the 24-hour, 48-hour, and 7-day growth tests were negative for all Attest 1291 and 1292 Bis tested. For all fractional cycles, the 24- and 48-hour growth results for the Attest 1291 and 1292 Bis, respectively, were the same as the 7-day growth results. The fractional cycle data indicated that fluorescent rapid readout was a more sensitive indicator than growth. There were rare (0.9%) false-negative results for Bis under fractional cycle conditions and these all correlated with short fractional cycle exposure times.Conclusions:The fluorescent rapid readout results of the 1291 Bis and 1296 BI test packs reliably predict both 24- and 48-hour and 7-day growth. These data support the value of rapid readout Bis for sterilizer monitoring for both the vacuum-assisted and the gravity displacement steam sterilization cycles. The new automated reader requires less manipulation of the BI and makes monitoring user friendly and less prone to user errors.
Skin Antisepsis Kits Containing Alcohol and Chlorhexidine Gluconate or Tincture of Iodine are Associated With Low Rates of Blood Culture Contamination
Authors: Trautner Barbara W. , Clarridge Jill E. , Darouiche Rabih O. 
Published: February 2006

Objective:Skin preparation is an important factor in reducing the rate of blood culture contamination. We assessed blood culture contamination rates associated with the use of skin antisepsis kits containing either 2% alcoholic chlorhexidine gluconate or 2% alcoholic tincture of iodine.Design:Prospective, blinded clinical trial.Setting:Tertiary-care teaching hospital.Patients:Adult patients in medical wards, the medical intensive care unit, and the cardiac intensive care unit who needed paired, percutaneous blood cultures.Interventions:House officers, medical students, and healthcare technicians drew the blood for cultures. We prepared sacks containing all of the necessary supplies, including two different types of antiseptic kits. In each sack, one kit contained 2% chlorhexidine in 70% isopropyl alcohol and the other contained 2% tincture of iodine in ethyl alcohol and 70% isopropyl alcohol. Each patient received chlorhexidine at one site and tincture of iodine at the other.Results:Four (0.9%) of 430 blood culture sets from 215 patients were contaminated. The contamination rate when using alcohol and chlorhexidine (1 of 215, 0.5%) did not differ significantly from the contamination rate when using tincture of iodine (3 of 215,1.4%;P= .62, McNemar test). There was an 87% probability that the two interventions differed by less than 2% in their rate of contamination.Conclusions:Both of these antiseptic kits were highly effective for skin preparation prior to drawing blood for cultures. The use of these kits may have contributed to the low contamination rate observed in this study.
Clinical, Microbiological, and Economic Benefit of a Change in Antibiotic Prophylaxis for Cardiac Surgery
Authors: Spelman Denis , Harrington Glenys , Russo Phil , Wesselingh S. 
Published: February 2006

AbstractVancomycin and rifampicin replaced cephazolin as antibiotic prophylaxis for coronary artery bypass surgery at our institution. Following this intervention, there was a significant decrease (P< .001) in the surgical-site infection rate from 10.5 (95% confidence interval, 8.2 to 13.3) to 4.9 (95% confidence interval, 3.2 to 7.1) infections per 100 procedures. An estimated $576,655 (Australian) was saved between two 12-month periods.
Impact of Postdischarge Surveillance on Surgical-Site Infection Rates for Coronary Artery Bypass Procedures
Authors: Avato Joan L , Lai Kwan Kew 
Published: February 2006

Objective:To assess the influence of postdischarge infection surveillance on risk-adjusted surgical-site infection rates for coronary artery bypass graft (CABG) procedures.Design:Prospective surveillance of surgical-site infections after CABG.Setting:Tertiary-care referral hospital.Methods:Data on surgical-site infections were collected for 1,324 CABG procedures during 27 months. They were risk adjusted and analyzed according to the surgical surveillance protocol of the National Nosocomial Infections Surveillance (NNIS) System of the Centers for Disease Control and Prevention, with and without postdischarge data.Results:Data were available for 96% of the patients. Of the 88 surgical-site infections, 28% were identified prior to discharge and 72% postdischarge. More chest than harvest-site infections were identified (46% vs 11%) prior to discharge, and more harvest-site than chest infections were identified in the outpatient setting (42% vs 14%). The surgical-site infection rate for patients stratified under risk index 1, calculated without postdischarge surveillance, was 2.9%; when compared with that of the NNIS System, the P value was .29. When postdischarge surveillance was included, the surgical-site infection rate was 4.9% and statistically significant when compared with that of the NNIS System (P = .007). For patients stratified under risk index 2, the rates with and without postdischarge surveillance were 11.7% and 10.0%, respectively; when compared with the NNIS System rates, the P values were .000008 and .0006, respectively.Conclusions:Only 28% of the surgical-site infections would have been detected if surveillance had been limited to hospital stay. Postdischarge surveillance identified more surgical-site infections among risk index 1 patients. Hospitals with comprehensive postdischarge surveillance after CABG procedures are likely to record higher surgical-site infection rates than those that do not perform such surveillance.
A Prospective Study to Determine Whether Cover Gowns in Addition to Gloves Decrease Nosocomial Transmission of Vancomycin-Resistant Enterococci in an Intensive Care Unit
Authors: Srinivasan Arjun , Song Xiaoyan , Ross Tracy , Merz William , Brower Roy , Perl Trish M. 
Published: February 2006

Background:Vancomycin-resistant enterococci (VRE) remain a significant nosocomial pathogen. Current guidelines of the Hospital Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) recommend the use of gowns and gloves for some interactions with VRE-infected or -colonized patients to prevent nosocomial transmission of VRE.Objective:To assess the effect of disposable cover gowns on preventing nosocomial transmission of VRE.Design and Setting:Prospective study in a 16-bed medical intensive care unit of a university teaching hospital.Patients:All patients who were at risk to acquire VRE, were admitted to the intensive care unit from August 1998 to January 1999, and had at least two perirectal cultures were included in the analysis of VRE acquisition.Intervention:VRE isolation precautions were changed from gowns and gloves to gloves alone.Main Outcome Measure:VRE acquisition rates and risk factors for VRE acquisition.Results:The VRE acquisition rate was 1.80 cases per 100 days at risk in the gown and gloves period compared with 3.78 in the gloves only period (P= .04). In a proportional hazards model adjusted for length of stay, gloves only precautions with a hazard ratio of 2.5 (P= .02; 95% confidence interval, 1.2 to 5.3) were the only independent risk factor for VRE acquisition.Conclusion:Our data lend support to current HICPAC recommendations for the use of cover gowns to decrease nosocomial transmission of VRE.
Recurrence of Vancomycin-ResistantEnterococcusStool Colonization During Antibiotic Therapy
Authors: Donskey Curtis J. , Hoyen Claudia K. , Das Sarbani M. , Helfand Marion S. , Hecker Michelle T. 
Published: February 2006

Objective:To test the hypothesis that antibiotic therapy may promote recurrence of vancomycin-resistantEnterococcus(VRE) stool colonization in patients who have previously had three consecutive negative stool cultures obtained at least 1 week apart.Design:One-year prospective cohort study examining the effect of antibiotic therapy on recurrence and density of VRE stool colonization in patients who have cleared colonization. Pulsed-field gel electrophoresis (PFGE) was performed to determine whether recurrent VRE strains were the same clone as the previous colonizing strain.Setting:A Department of Veterans Affairs medical center including an acute care hospital and nursing home.Patients:All patients with at least one stool culture positive for VRE who subsequently had three consecutive negative stool cultures obtained at least 1 week apart.Results:Of the 16 patients who cleared VRE colonization, 13 received antibiotic therapy during the study period. Eight (62%) of the 13 patients who received antibiotics developed recurrent high-density VRE stool colonization (range, 4.9 to 9.1 log10colony-forming units per gram) during a course of therapy. Five patients had VRE strains available for PFGE analysis; recurrent strains were unrelated to the prior strain in 3 patients, closely related in 1 patient, and indistinguishable in 1 patient.Conclusions:Antibiotic therapy may be associated with recurrent high-density VRE stool colonization in many patients who have previously had three consecutive negative stool cultures. These patients should be screened for recurrent stool colonization when antibiotic therapy is administered.
An Outbreak of Multidrug-ResistantPseudomonas AeruginosaAssociated with Increased Risk of Patient Death in an Intensive Care Unit
Authors: Bukholm Geir , Tannæs Tone , Kjelsberg Anne Britt Bye , Smith-Erichsen Nils 
Published: February 2006

Objective:To investigate an outbreak of multidrug-resistantPseudomonas aeruginosain an intensive care unit (ICU).Design:Epidemiologic investigation, environmental assessment, and ambidirectional cohort study.Setting:A secondary-care university hospital with a 10-bed ICU.Patients:All patients admitted to the ICU receiving ventilator treatment from December 1,1999, to September 1, 2000.Results:An outbreak in an ICU with multidrug-resistant isolates ofP. aeruginosabelonging to one amplified fragment-length polymorphism (AFLP)–defined genetic cluster was identified, characterized, and cleared. Molecular typing of bacterial isolates with AFLP made it possible to identify the outbreak and make rational decisions during the outbreak period. The outbreak included 19 patients during the study period. Infection with bacterial isolates belonging to the AFLP cluster was associated with reduced survival (odds ratio, 5.26; 95% confidence interval, 1.14 to 24.26). Enhanced barrier and hygiene precautions, cohorting of patients, and altered antibiotic policy were not sufficient to eliminate the outbreak. At the end of the study period (in July), there was a change in the outbreak pattern from long (December to June) to short Quly) incubation times before colonization and from primarily tracheal colonization (December to June) to primarily gastric or enteral Quly) colonization. In this period, the bacterium was also isolated from water taps.Conclusion:Complete elimination of the outbreak was achieved after weekly pasteurization of the water taps of the ICU and use of sterile water as a solvent in the gastric tubes.
Molecular Characterization of Methicillin-Resistant Coagulase-Negative Staphylococci from a Neonatal Intensive Care Unit
Authors: Bogado Isabel , Limansky Adriana , Sutich Emma , Marchiaro Patricia , Marzi Marta , Putero Juan , Viale Alejandro 
Published: February 2006

Objective:To evaluate clonal dissemination of methicillin-resistant coagulase-negative staphylococci (CNS).Setting:Neonatal intensive care unit of a 180-bed, university-affiliated general hospital.Patients:Neonates admitted to the neonatal intensive care unit between March 1999 and October 2000, from whom CNS were isolated as a unique pathogen. Patients from other wards from whom epidemiologically unrelated staphylococci strains were obtained served as control-patients.Methods:Conventional methods were used for phenotypic characterization of CNS. Methicillin resistance was determined bymecA polymerase chain reaction (PCR) amplification. Genotypic characterization was done by random amplification of DNA with degenerated primers (RAPD) and repetitive element sequence-based PCR (rep-PCR).Results:Forty methicillin-resistant CNS isolates obtained from neonates were characterized asStaphylococcus epidermidis(33),S. hominis(5),S. warneri(1), andS. auricularis(1). Both RAPD and rep-PCR indicated the presence of 4 different clones among the 33S. epidermidisisolates. In turn, the 4 randomly selected, epidemiologically unrelated methicillin-resistant CNS strains obtained from control-patients showed 3 new profiles by RAPD and 2 by rep-PCR, which differed from the corresponding patterns mentioned earlier. Persistence ofS. hominisin a neonate could be assessed by both genotypic techniques.Conclusions:The molecular characterization of the methicillin-resistant CNS studied indicated dissemination of one particular methicillin-resistant CNS clone among the neonates in the ward studied. Although RAPD showed a superior power to discriminate among methicillin-resistant CNS isolates, both RAPD and rep-PCR detected intraspecific and interspecific genomic diversity.
Risk Factors for Infection and Molecular Typing in Patients in the Intensive Care Unit Colonized with NosocomialEnterobacter Aerogenes
Authors: Piagnerelli Michael , Carlier Eric , Deplano Ariane , Lejeune Philippe , Govaerts Danielle 
Published: February 2006

Objectives:To determine the frequency of colonization byEnterobacter aerogenesin patients in the intensive care unit (ICU) for more than 48 hours and to evaluate the risk factors for infection in patients colonized by this bacteria.Design:An 8-month prospective study.Setting:A 12-bed medical–surgical ICU in a 450-bed, university-affiliated, tertiary-care hospital in Belgium.Method:Pulsed-field gel electrophoresis was used to determine the genotypes ofE. aerogenesisolates.Results:We observed two major clones ofE. aerogenesin the ICU. Interestingly, 87.5% of infected patients had the same genomic profile for colonization and infection. Risk factors for infection in this particular population included younger age, prolonged hospital stay, mechanical ventilation, and bronchoscopy.Conclusions:Colonization is a major prerequisite for infection. The identification of risk factors for infection in colonized patients can optimize the quality of treatment in the ICU.
Nosocomial Outbreak ofSerratia Marcescensin a Neonatal Intensive Care Unit
Authors: Assadian Ojan , Berger Angelika , Aspöck Christoph , Mustafa Stefan , Kohlhauser Christina , Hirschl Alexander M. 
Published: February 2006

Objectives:To investigate and describe an outbreak ofSerratia marcescensin a neonatal intensive care unit (NICU) and to report the interventions leading to cessation of the outbreak.Setting:A 2,168-bed, tertiary-care, university teaching hospital in Vienna, Austria, with an 8-bed NICU.Design:We conducted a case–control study to identify risk factors for colonization and infection withS. marcescens. A case-patient was defined as any neonate in the NICU with a positive culture forS. marcescensbetween October 1, 2000, and February 28, 2001. Polymerase chain reaction was applied to type isolates.Methods:During unannounced observations, the NICU was examined and existing policies were reviewed. Staff were reinstructed in hand antisepsis and gloving policies. Admissions were halted on December 27. During previously planned technical maintenance of the ward, the NICU was closed for 10 days and thorough aldehyde-based disinfection of the NICU was performed.Results:Ten neonates met the case definition: 6 with infections (among them 3 with cerebral abscesses) and 4 with asymptomatic colonization. Previous antibiotic treatment of the mothers with cefuroxime was the single significant risk factor for colonization or infection (P= .028; odds ratio, 17; 95% confidence interval, 1.3 to 489.5).Conclusions:S. marcescenscan cause rapidly spreading outbreaks associated with fatal infections in NICUs. With aggressive infection control measures, such outbreaks can be stopped at an early stage. Affected neonates themselves may well be the source of cross-infection to other patients on the ward. Antibiotic treatment of mothers should be reevaluated to avoid unnecessary exposure to antibiotics with the potential of overgrowth of resistant organisms.