bluuebunny/crossref_metadata_2025_split huggingface dataset:
Determining the Significance of Coagulase-Negative Staphylococci Isolated From Blood Cultures at a Community Hospital A Role for Species and Strain Identification
Authors: Kim Soon-Duck , McDonald L. Clifford , Jarvis William R. , McAllister Sigrid K. , Jerris Robert , Carson Loretta A. , Miller J. Michael 
Published: February 2006

AbstractObjectives:To determine the degree to which species identification or strain relatedness assessment of successive blood culture isolates of coagulase-negative staphylococci (CNS) may improve the clinical diagnosis of bloodstream infection (BSI).Setting:400-bed community hospital.Design:Prospective laboratory survey during which all CNS blood culture isolates obtained between mid-August 1996 and mid-February 1997 (study period) were saved and later identified to the species level; selected isolates were genotyped using pulsed-field gel electrophoresis at the Centers for Disease Control and Prevention (CDC). Retrospective review of medical records of 37 patients with multiple cultures positive for CNS.Results:During the study period, 171 patients had blood cultures positive for CNS; 130 had single positive cultures and 41 had ≥2 positive cultures. Of these 41, 23 (62%) were from patients with signs and symptoms of BSI according to CDC surveillance definitions. Species identification and strain clonality of CNS isolates from patients with ≥2 positives revealed 3 (13%) of the 23 patients did not have a consistent CNS species, and another 3 (13%) did not have a consistent genotype in the ≥2 positive cultures, suggesting that CNS from these patients probably were contaminants. Thus, species identification and strain clonality assessment reduced by 27% the number of patients with BSI diagnosed based on the presence of symptoms and ≥2 positive blood cultures.Conclusions:Routine species identification and selected strain genotyping of CNS may reduce the misinterpretation of probable contaminants among patients with ≥2 positive blood cultures.
Nosocomial Transmission of Tuberculosis (TB) Associated With Care of an Infant With Peritoneal TB
Authors: Matlow Anne G. , Harrison Alanna , Monteath Anne , Roach Peggy , Balfe J. Williamson 
Published: February 2006

AbstractNosocomial transmission of tuberculosis (TB) after exposure to infected peritoneal fluid has not been described. We report the exposure of 111 healthcare workers to infected dialysate from an infant with TB peritonitis. Two (5%) of 39 primary-care nurses, but no doctors or environmental service workers, had apparent tuberculin skin test conversions, raising the concern that patients with peritoneal TB may be a source for nosocomial transmission of TB.
Nosocomial Infections in Pediatric Patients A European, Multicenter Prospective Study
Authors: Raymond Josette , Aujard Yannick ,   European Study Group
Published: February 2006

Objectives.To determine the site and bacterial epidemiology of nosocomial infections (NIs) in children.Design:6-month prospective study with periodic chart review during hospitalization using a uniform prospective questionnaire in each unit, analyzed at a coordinating center.Setting:20 units in eight European countries: 5 pediatric intensive care units (PICUs), 7 neonatal units, 2 hematology-oncology units, 8 general pediatric units.Participants:All children hospitalized during the study period with an NI according to Centers for Disease Control and Prevention criteria.Results:The overall incidence of NI was 2.5%, ranging from 1% in general pediatric units to 23.6% in PICUs. Bacteria were responsible for 68% (gram-negative bacilli, 37%; gram-positive cocci, 31%),Candidafor 9%, and viruses for 22% of cases. The proportion of lower respiratory tract infections was 13% in general pediatric units and 53% in PICUs. Bloodstream infections were most frequent in neonatal units (71% of NIs) and were associated with a central venous catheter in 66% of cases. Coagulase-negativeStaphylococcus(CNS) was the main pathogen. Eleven percent of NI were urinary tract infections. Gastrointestinal infections were most commonly viral and accounted for 76% of NIs in general pediatric units.The prevalence of antimicrobial resistance depended on the type of unit. The highest rates were observed in PICUs: 26.3% ofStaphylococcus aureusand 89% of CNS were methicillin-resistant, and 37.5% ofKlebsiella pneumoniaehad an extended-spectrum β-lactamase. Mortality due to NI was 10% in PICUs and 17% in neonatal units.Conclusions:We found large differences in NI frequency and microbial epidemiology in this European study. Viruses were the main pathogens in general pediatrics units. Catheter-related sepsis and CNS were frequent in newborns. A high frequency of multiresistant bacteria was observed in some units. Clinical monitoring of NIs and bacterial resistance profiles are required in all pediatric units.
Comparison of Higher-Dose Intradermal Hepatitis B Vaccination to Standard Intramuscular Vaccination of Healthcare Workers
Authors: Henderson Elizabeth A. , Louie Thomas J. , Ramotar Karam , Ledgerwood Donna , Hope Karen Myrthu , Kennedy Agnes 
Published: February 2006

Objective.To compare the immunogenicity of hepatitis B vaccine administered via intradermal (ID) versus intramuscular (IM) route.Methods:Subjects chose either to specify the route of immunization or to undergo random allocation to vaccination by the ID (0.15 mL) or the IM (1.0 mL) route. Yeast-derived recombinant hepatitis B vaccine was given at 0, 30, and 180 days. Hepatitis B surface antibody (HBsAb) and hepatitis B core antibody (HBcAb) were measured by microparticle enzyme immunoassay.Results:763 subjects were enrolled. Baseline screening identified 65 subjects (8%) who were positive for HBsAb or HBcAb. Vaccination was completed by 590 (85%) of 698 enrollees (370 ID, 220 IM). Seroconversion rates (geometric mean titers [GMT]>0 IU/mL HBsAb) for those vaccinated ID were 99% and 96% for screening at 9 months and 1 year post-vaccination, respectively; subjects vaccinated intramuscularly had similar rates of 95% and 96%. Seropositivity rates (GMT ≥ 10 IU/mL HBsAb) showed a similar pattern, with 95%, 92%, and 73% at 9 months and 1 and 2 years, respectively, for those vaccinated ID, and 94%, 93%, and 81% for those having IM vaccination. GMT for HBsAb was significantly higher for individuals vaccinated IM than for those vaccinated ID (P<.0001). The GMT ratio for the IM and ID routes decreased over time, being 9.3 at 9 months, 7.8 at 1 year, and 5.9 at 2 years. An unanticipated side effect of intradermal vaccination was skin discoloration at injection sites, which persisted for at least 2 years postvaccination. Two thirds (112/166) of respondents reported that they would have selected the ID route despite the discoloration.Conclusions:Higher-dose ID vaccination (3 vs 1 μg per injection) uses one sixth of the dose required for standard IM vaccination. It is a cost-effective way to vaccinate populations against hepatitis B virus, but the long-term efficacy of the ID route must still be investigated.
O2 in Y2K Not An Airtight Case
Authors: Lee James T. 
Published: February 2006

During a bitterly cold Minnesota weekend, I holed up at home with two dogs and hot tea while reading and rereading the paper that “everyone is talking about.” The findings of Grief and coworkers now have received world-wide exposure. In consequence, anesthesiologists, surgeons, and infection control workers may be pondering how soon to start “putting everybody on 80% oxygen in the OR and recovery room.” The article is not perfect—it has some warts—yet it may stimulate timely reconsideration of four intertwined topics: the difficulty of detecting an incremental infection prevention effect in a clinical trial; the importance of designing such a trial so that the control-group treatment represents current best practice; the bittersweet vagaries of inductive inference that are inescapable whenever we generalize to our practices (non-research conditions) techniques reported from clinical trials (research conditions); and the absence of logical rules of engagement to follow at our own hospitals when a new infection control gimmick or gadget arrives on the scene.Of course, I have already submitted my e-mail letter to the editor of the New England Journal of Medicine. What I could not cover within the 400-word limit of that forum inspired this essay.The apparent effect of only a few hours' supplemental oxygen administration for colorectal surgical-incision infection prevention was astounding. The 50% reduction in infection risk seems almost too good to be true. There is a seductive charm when a single, simple, relatively cheap and safe process change gives that much outcome improvement.
The Clinical and Economic Consequences of Nosocomial Central Venous Catheter-Related Infection: Are Antimicrobial Catheters Useful?
Authors: Saint Sanjay , Veenstra David L. , Lipsky Benjamin A. 
Published: February 2006

Central venous catheters (CVCs) are essential for many hospitalized patients, but they are associated with important infectious complications. Recent studies have indicated that CVCs coated with antimicrobial agents reduce the incidence of catheter-related bloodstream infection (CR BSI). To estimate the clinical and economic consequences of short-term central venous catheter-related infection and the potential usefulness of antimicrobial-coated catheters, we reviewed and synthesized the available relevant literature. Statistical pooling was used to estimate the incidence of both catheter colonization and CR BSI. The attributable mortality of CR BSI was also evaluated. In addition, the economic consequences of both local and systemic catheter-related infection was estimated from literature reports that used micro-costing and other techniques.Among patients in whom standard, noncoated CVCs are in place for an average of 8 days, 24.7% are expected to develop catheter colonization (95% confidence interval [CI95], 22.0%-27.5%). Approximately 5.2% (CI953.9%-6.5%) will develop CR BSI. The attributable mortality of CR BSI remains unclear, but recent studies are consistent with a range from 4% to 20%. An episode of local catheter-related infection leads to an additional cost of approximately $400, whereas the additional cost of CR BSI ranges from approximately $6,005 to $9,738. Formal economic analyses indicate that CVCs coated with antibacterial agents (such as chlorhexidine-silver sulfadiazine or minocycline-rifampin) likely reduce infectious complications, yielding economic advantages. In light of the substantial clinical and economic burden of catheter-related infection, hospital personnel should adopt proven cost-effective methods to reduce this common and important nosocomial complication.
Skin Irritation and Dryness Associated With Two Hand-Hygiene Regimens: Soap-and-Water Hand Washing Versus Hand Antisepsis With an Alcoholic Hand Gel
Authors: Boyce John M. , Kelliher Susan , Vallande Nancy 
Published: February 2006

Objective:To compare the frequency of skin irritation and dryness associated with using an alcoholic–hand-gel regimen for hand antisepsis versus using soap and water for hand washing.Design:Prospective randomized trial with crossover design. Irritation and dryness of nurses' hands were evaluated by self-assessment and by visual assessment by a study nurse. Epidermal water content of the dorsal surface of nurses' hands was estimated by measuring electrical capacitance of the skin.Setting:Miriam Hospital, a 200-bed university-affiliated teaching hospital.Participants:Thirty-two nurses working on three hospital wards participated in the trial, which lasted 6 weeks.Results:Self-assessment scores of skin irritation and dryness decreased slightly during the 2 weeks when nurses used the alcoholic–hand-gel regimen (mean baseline score, 2.72; mean final score, 2.0; P=.08) but increased substantially during the 2 weeks when nurses used soap and water (mean baseline score, 2.0; mean final score, 4.8; P<.0001). Visual assessment scores by the study nurse of skin irritation and dryness did not change significantly when the alcoholic–hand-gel regimen was used (mean baseline and final scores were both 0.55), but scores increased substantially when nurses used soap and water (baseline score, 0.59; mean final score, 1.21; P=.05). Epidermal water content of the dorsal surface of nurses' hands changed little when the alcoholic–hand-gel regimen was used (mean ± standard deviation baseline electrical capacitance reading, 24.8±6.8; mean final reading, 25.7±7.3), but decreased significantly (skin became dryer) with soap-and-water hand washing (mean baseline, 25.9±7.5; mean final reading, 20.5±5.4; P=.0003).Conclusions:Hand antisepsis with an alcoholic–hand-gel regimen was well tolerated and did not result in skin irritation and dryness of nurses' hands. In contrast, skin irritation and dryness increased significantly when nurses washed their hands with the unmedicated soap product available in the hospital. Newer alcoholic hand gels that are tolerated better than soap may be more acceptable to staff and may lead to improved hand-hygiene practices.
Association of Antibiotic Utilization Measures and Control of Multiple-Drug Resistance inKlebsiella pneumoniae
Authors: Patterson Jan E. , Hardin Thomas C. , Kelly Cindy A. , Garcia Rosa C. , Jorgensen James H. 
Published: February 2006

Objective:To study the association of antibiotic-utilization measures and control of multidrug-resistant (MDR)Klebsiella pneumoniaeafter emergence in two hospitals in our medical center.Design and Setting:Rates of MDRK pneumoniaeat two hospitals were compared before and after acute interventions, including emphasis on Contact Precautions and education in antibiotic utilization. Antipseudomonal β-lactam antibiotic use was measured before and after the interventions at both hospitals. Pulsed-field gel electrophoresis of whole cell DNA was used as a marker of strain identity.Results:Clonal strain dissemination was the major mechanism of emergence at hospital A; emergence was polyclonal at hospital B. Antibiotic-utilization interventions at both institutions included physician education regarding the association of ceftazidime use and MDRK pneumoniae. At hospital A, ceftazidime use decreased from 4,301 g in the preintervention period, to 1,248 g in the postintervention period. Piperacillin-tazobactam use increased from 12,455 g to 17,464 g. Ceftazidime resistance in Kpneumoniae decreased from 110 (22%) of 503 isolates to 61 (15%) of 407 isolates (P<.05); piperacillin-tazobactam resistance decreased from 181 (36%) of 503 to 77 (19%) of 407 isolates (P<.05). At hospital B, ceftazidime use decreased from 6,533 g in the preintervention period to 4,792 g in the postintervention period. Piperacillin-tazobactam use increased from 58,691 g to 67,027 g. Ceftazidime resistance inK pneumoniaedecreased from 42 (10%) of 415 isolates to 19 (5%) of 383 isolates (P<.05). Piperacillin-tazobactam resistance decreased from 91 (22%) of 415 isolates to 54 (14%) of 383 isolates (P<.05). Follow-up data showed continued decrease in piperacillin-tazobactam resistance despite increased use at both hospitals.Conclusions:Antibiotic-use measures may be particularly important for control of MDRK pneumoniae, whether emergence is clonal or polyclonal.
The Epidemiology of Mupirocin Resistance Among Methicillin-ResistantStaphylococcus aureusat a Veterans' Affairs Hospital
Authors: Vasquez Jose E. , Walker Elaine S. , Franzus Bettylene W. , Overbay Barbara K. , Reagan David R. , Sarubbi Felix A. 
Published: February 2006

Objective:To describe the clinical and molecular epidemiology of mupirocin-resistant (MR) and mupirocin-susceptible (MS) methicillin-resistantStaphylococcus aureus(MRSA) at a Veterans' Affairs hospital and to assess risk factors associated with the acquisition of MR MRSA.Design:All clinical MRSA isolates for the period October 1990 through March 1995 underwent susceptibility testing to mupirocin. Mupirocin resistance trends were measured, and MS MRSA and MR MRSA isolates underwent typing by pulsed-field gel electrophoresis (PFGE). A retrospective case-control study was conducted to evaluate risk factors for having MR versus MS MRSA.Setting:The James H. Quillen Veterans' Affairs Medical Center in Mountain Home, Tennessee, included a 324-bed acute-care hospital, a 120-bed nursing home, and a 525-bed domiciliary. Colonizations and infections with MRSA were endemic, and mupirocin ointment was commonly used.Patients:Inpatients and outpatients at the facility.Results:MS MRSA was recovered from 506 patients and MR MRSA from 126. Among MR MRSA isolates, 58% showed low-level mupirocin resistance (minimum inhibitory concentration [MIC] ≥4 to 256 μg/mL), and 42% showed high-level mupirocin resistance (MIC ≥512 μg/mL). A significant increase (P=.002) in the number of high-level MR isolates occurred during the 1993 to 1995 period. A case-control study showed that presence of a decubitus ulcer correlated with high-level resistant isolates (P<.05). The distribution of PFGE patterns did not differ for MR and MS MRSA.Conclusions:Use of mupirocin ointment in a program aimed at managing endemic MRSA infection or colonization resulted in a significant increase in the recovery of high-level MR MRSA isolates. These isolates appeared to emerge from our existing MRSA pool. A case-control study provided few clues concerning patients likely to harbor MR MRSA We confirmed the position that the extended use of mupirocin ointment should be avoided in settings where MRSA is endemic.
Activity of an Alcohol-Based Hand Gel Against Human Adeno-, Rhino-, and Rotaviruses Using the Fingerpad Method
Authors: Sattar Syed A. , Abebe Makonnen , Bueti Angela J. , Jampani Hanuman , Newman Jerry , Hua Steven 
Published: February 2006

Objective:To assess the activity against three non-enveloped viruses (an adeno-, a rhino- and a rotavirus) of a gel containing 60% ethanol, using experimentally contaminated thumb- and fingerpads of 12 panelists, as per standard procedure E-1838-96 of the American Society of Testing and Materials.Design:Each digit received 10 μL of the test virus suspension. The inocuLum from the thumbs was eluted immediately with 990 μL of Earle's balanced salt solution (EBSS) to assess the amount of virus on each digit (0-minute control). The inoculum on the fingers was allowed to dry (20-25 minutes), and virus was eluted from two fingerpads to determine the loss in virus infectivity upon drying (baseline titer). Then the dried inoculum on randomly selected fingers was exposed to 1 mL of the test product or standard hard water (200-ppm calcium carbonate) for 20 seconds. The virus remaining was eluted with 1 mL of EBSS, titrated to determine the amounts eliminated, and compared to the baseline titer.Results:Each digit received at least 104 plaque-forming units of virus in 10 μL The amounts of adeno-, rhino-, and rotaviruses surviving the drying were 30%, 75%, and 42%, respectively. The product reduced the infectivity titers of the three viruses by 3 to >4 log10when compared to a reduction of ≤ 1 log10for the hard-water rinse.Conclusion:The level of virus reduction by gel was statistically significantly higher than that seen with the water control. Evidence for such activity against non-enveloped viruses supports further investigation of the benefits of this product.
Comparison of Systematic Versus Selective Screening for Methicillin-Resistant Staphylococcus aureus Carriage in a High-Risk Dermatology Ward
Authors: Girou Emmanuelle , Azar Joyce , Wolkenstein Pierre , Cizeau Florence , Brun-Buisson Christian , Roujeau Jean-Claude 
Published: February 2006

AbstractObjective:To compare two strategies for screening methicillin-resistant Staphylococcus aureus (MRSA) carriers in a high-risk dermatology ward: systematic screening of all admitted patients versus selective screening of patients at risk.Design:The two strategies were applied prospectively during two consecutive periods. In period A (8.5 months), only patients transferred from other wards, or with a history of prior hospitalization, or presenting chronic wounds or disease with denuded skin were considered at high risk of MRSA carriage and sampled. In period B (7.5 months), all admitted patients were systematically screened. End-points were the number of patients having a MRSA-positive screening sample on admission during period B and having none of the risk factors used in period A, the rate of imported MRSA cases, and the rate of acquired cases.Setting:A 1,032-bed university hospital with a 19-bed inpatient dermatology ward, a referral center for toxic epidermal necrolysis and severe extensive dermatoses.Patients:The study included 729 dermatology inpatients (370 in period A and 359 in period B).Results:During period A, screening samples were obtained on admission for 30% of patients (77% of the patients at risk) and identified 25 MRSA carriers. During period B, 90.5% of admitted patients were screened, and 26 MRSA carriers were detected on admission; all of these patients belonged to at least one predefined category at risk for carriage. Overall rates of imported and acquired cases were similar between the two periods (6.8% vs 7.5%, and 2.9% vs 2.4%, respectively).Conclusions:A screening strategy targeted to patients at risk of harboring MRSA has similar sensitivity and is more cost-effective than a strategy of systematic screening to identify MRSA carriers on admission.
Surveillance for Nosocomial and Central Line-Related Infections Among Pediatric Hematology-Oncology Patients
Authors: Simon Arne , Fleischhack Gudrun , Hasan Carola , Bode Udo , Engelhart Steffen , Kramer Michael H. 
Published: February 2006

AbstractObjective:To determine the incidence of all nosocomial infections (NIs) in pediatric hematology-oncology patients, as well as central venous access device (CVAD)-associated infections acquired during home care.Design:Prospective surveillance study.Setting:The Pediatric Hematology and Oncology Department at the University Hospital Bonn.Patients:All patients admitted from January through October 1998 (surveillance period).Methods:Standardized surveillance system based on the Centers for Disease Control and Prevention's National Nosocomial Infections Surveillance System.Results:A total of 143 patients were hospitalized for 3,701 days (776 admissions) during the surveillance period. Of the 40 NIs detected, 26 were CVAD-related, with 21 bloodstream infections (BSIs) and 5 local infections. Four were Clostridium difficile-associated diarrheal illnesses, 3 were pneumonias, and 7 were other infections. The incidence of NIs was 10.8 per 1,000 patient-days (5.2 NIs/100 admissions). The overall CVAD-related BSI rate was 7.4 per 1,000 utilization days, without a significant difference between implanted infusion ports and tunneled catheters. In addition, 7 CVAD-related infections occurred during home care. All 8 BSIs associated with tunneled catheters and 13 (76%) of the 17 BSIs associated with ports were acquired nosocomially. For inpatients and outpatients combined, the exit sites of tunneled catheters were more likely to become locally infected than were the needle entry sites of ports (relative risk, 8.0; P=.007). In 30 (75%) of the 40 NIs, the affected patients had severe neutropenia (<500/mm3) at the time of infection.Conclusions:Most NIs in the pediatric hematology-oncology patients were associated with CVAD devices. Although many infections in this high-risk population may not be preventable through infection control measures, the careful evaluation of specific infection rates permits the identification of risk factors that may be targeted by infection control programs. Prospective surveillance for NIs on pediatric oncology units is an indispensable tool for this internal quality control.