bluuebunny/crossref_metadata_2025_split huggingface dataset:
Klebsiella pneumoniaeBloodstream Infections Among Neonates in a High-Risk Nursery in Cali, Colombia
Authors: Richards Chesley , Alonso-Echanove Juan , Caicedo Yolanda , Jarvis William R. 
Published: April 2006

AbstractObjectives:To determine the cause of an outbreak ofKlebsiella pneumoniaebloodstream infections (BSIs) among neonates in a high-risk nursery and to institute control measures.Design:During the on-site investigation, a cohort study to identify risk factors forK. pneumoniaeBSI, a point-prevalence study to assessK. pneumoniaecolonization, a maternal cohort study to determine maternalK. pneumoniaecolonization, and an observational study to evaluate healthcare worker (HCW) compliance with infection control practices were conducted.Patients And Setting:Neonates in a 40-bed high-risk nursery in a 700-bed university hospital in Cali, Colombia.Intervention:Cohorting of neonates colonized withK. pneumoniae.Results:The overallK. pneumoniaeBSI attack rate was 10 of 105 (9.5%). In the retrospective cohort study, the number of blood transfusions (OR, 3.1 per transfusion;P= .02; CI95,1.4–9.7) and intravenous injections (OR, 1.2 per injection;P =.04; CI95, 1.0–1.5) were independently associated withK. pneumoniaeBSI. The overall prevalence ofK. pneumoniaecolonization was 61% among neonates and 7% among mothers. During the HCW assessment, suboptimal intravenous therapy practices were observed. A cohorting intervention resulted in a significant reduction inK. pneumoniaecolonization (12% vs 61%; RR, 0.19;P< .001). During the intervention period, noK. pneumoniaeBSIs occurred.Conclusions:This investigation suggested that the outbreak probably occurred due to widespread colonization and suboptimal infection control and intravenous therapy practices. Cohorting successfully reduced the overall prevalence ofK. pneumoniaecolonization and, along with improved infection control practices, probably preventedK. pneumoniaeBSIs.
Epidemic Parenteral Exposure to Volatile Sulfur-Containing Compounds at a Hemodialysis Center
Authors: Selenic Dejana , Alvarado-Ramy Francisco , Arduino Mathew , Holt Stacey , Cardinali Fred , Blount Benjamin , Jarrett Jeff , Smith Forrest , Altman Neil , Stahl Charlotte , Panlilio Adelisa , Pearson Michele , Tokars Jerome 
Published: April 2006

AbstractObjective:To determine the cause of acute illness on August 30, 2000, among patients at an outpatient dialysis center (center A).Design:We performed a cohort study of all patients receiving dialysis on August 30, 2000; reviewed dialysis procedures; and analyzed dialysis water samples using microbiologic and chemical assays.Setting:Dialysis center (center A).Patients:A case-patient was defined as a patient who developed chills within 5 hours after starting hemodialysis at center A on August 30, 2000.Results:Sixteen (36%) of 44 patients at center A met the case definition. All case-patients were hospitalized; 2 died. Besides chills, 15 (94%) of the case-patients experienced nausea; 12 (75%), vomiting; and 4 (25%), fever. Illness was more frequent on the second than the first dialysis shift (16 of 20 vs 0 of 24, P < .001); no other risk factors were identified. The center's water treatment system had received inadequate maintenance and disinfection and a sulfurous odor was noted during sampling of the water from the reverse osmosis (RO) unit. The water had elevated bacterial counts. Volatile sulfur-containing compounds (ie, methanethiol, carbon disulfide, dimethyldisulfide, and sulfur dioxide) were detected by gas chromatography and mass spectrometry in 8 of 12 water samples from the RO unit and in 0 of 28 samples from other areas (P < .001). Results of tests for heavy metals and chloramines were within normal limits.Conclusions:Parenteral exposure to volatile sulfur-containing compounds, produced under anaerobic conditions in the RO unit, could have caused the outbreak. This investigation demonstrates the importance of appropriate disinfection and maintenance of water treatment systems in hemodialysis centers.
Prevalence of and Risk Factors for Nasal Colonization With Staphylococcus aureus Among Human Immunodeficiency Virus-Positive Outpatients in Singapore
Authors: Villacian J. S. , Barkham T. , Earnest A. , Paton N. I. 
Published: April 2006

AbstractWe studied the prevalence of and risk factors for Staphylococcus aureus nasal colonization in HIV-positive outpatients in Singapore. Overall prevalence was 23% (45 of 195), with 3% (6 of 195) being MRSA. Recent antibiotic use and hospitalization were independent predictors of MRSA colonization. Isolates were genotypically identical to our hospital's inpatient circulating strain.
Longitudinal Trends in Antimicrobial Susceptibilities Across Long-Term–Care Facilities: Emergence of Fluoroquinolone Resistance
Authors: Viray Melissa , Linkin Darren , Maslow Joel N. , Stieritz Donald D. , Carson Lesley S. , Bilker Warren B. , Lautenbach Ebbing 
Published: April 2006

AbstractBackgroundAntibiotic resistance in the long-term-care facility (LTCF) setting is of increasing concern due to both the increased morbidity and mortality related to infections in this debilitated population and the potential for transfer of resistant organisms to other healthcare settings. Longitudinal trends in antibiotic resistance in LTCFs have not been well described.Design:Correlational longitudinal survey study.Setting:Four LTCFs in Pennsylvania.Subjects:All clinical cultures of residents of the participating LTCFs (700 total beds) from 1998 through 2003. We assessed the annual prevalence of resistance to various antimicrobials of interest for the following organisms: Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus, and enterococcus species.Results:A total of 4,954 clinical isolates were obtained during the study. A high prevalence of antimicrobial resistance was noted for many organism-drug combinations. This was especially true for fluoroquinolone susceptibility among the Enterobacteriaceae (susceptibility range, 51.3% to 92.2%). In addition, the prevalence of resistance to various agents differed significantly across study sites. Finally, significant increasing trends in resistance were noted over time and were most pronounced for fluoroquinolone susceptibility among the Enterobacteriaceae.Conclusions:The prevalence of antimicrobial resistance has increased significantly in LTCFs, although trends have varied substantially across different institutions. These trends have been particularly pronounced for fluoroquinolone resistance among the Enterobacteriaceae. These findings demonstrate that antimicrobial resistance is widespread and increasing in LTCFs, highlighting the need for future studies to more clearly elucidate the risk factors for, and potential interventions against, emerging resistance in these settings.
Spread of Clones of Multidrug-Resistant, Coagulase-Negative Staphylococci Within a University Hospital
Authors: Monsen Tor , Karlsson Carina , Wiström Johan 
Published: April 2006

AbstractObjective:To detect putative clonal dissemination of multidrug-resistant, coagulase-negative staphylococci (CNS) in a university hospital in northern Sweden.Methods:All consecutive routine clinical samples from our hospital were screened during two periods (November and December 2001 and September and October 2002) for the presence of multidrug-resistant (defined as resistant to oxacillin, clindamycin, co-trimoxazole, gentamicin, and fusidic acid, but susceptible to vancomycin) isolates of CNS. Genetic similarity between isolates was analyzed using pulsed-field gel electrophoresis (PFGE) and a computer program.Results:Seventy multidrug-resistant isolates from 62 patients were identified, 28 during the 2001 period and 42 during the 2002 period. All isolates except one, which wasStaphylococcus haemolyticus, were identified asS. epidermidis. Multidrug-resistant CNS were isolated in samples obtained from 24 different wards. Two subgroups (group A and group B) ofS. epidermidisthat differed by approximately 40% in PFGE band similarity were identified. Group A consisted of 44 isolates with a PFGE band similarity of greater than 70% that included 6 subgroups consisting of 3 to 16 isolates that expressed a 100% similarity. These isolates were identified during both sampling periods in cultures performed in 18 different wards. A clonal origin could not be excluded for some of the remaining 26 isolates belonging to group B, but none had identical PFGE patterns, suggesting a more diverse origin.Conclusion:The results of this study suggest clonal spread of multidrug-resistant CNS within our hospital and that some clones are endemic in the hospital environment.
High Rate of Coadministration of Di- or Tri-valent Cation-Containing Compounds With Oral Fluoroquinolones: Risk Factors and Potential Implications
Authors: Barton Todd D. , Fishman Neil O. , Weiner Mark G. , LaRosa Lori A. , Lautenbach Ebbing 
Published: April 2006

AbstractBackground:The characteristics of fluoroquinolone use that increase the risk of selecting for fluoroquinolone resistance remain unclear. Exposure to subtherapeutic levels of fluoroquinolone promotes bacterial development of fluoroquinolone resistance. Oral fluoroquinolone absorption is significantly impaired by coadministration with many common di- or tri-valent cation-containing compounds (DTCCs), and this interaction has been associated with therapeutic failure. However, the prevalence of, and risk factors for, in-hospital coadministration of oral fluoroquinolones with DTCCs is unknown.Design:Case-control study.Setting:A 625-bed, tertiary-care medical center.Patients:All inpatients who were dispensed oral levofloxacin from July 1, 1999, to June 30, 2001, were included. Coadministration was defined by documented administration of any DTCC within 2 hours of levofloxacin. Complete coadministration was defined as coadministration complicating every dose of a course of levofloxacin.Results:A subset of 3,227 (41.0%) of 7,871 doses of levofloxacin that occurred during the same calendar day as any DTCC was selected for further review. Overall, 1,904 (77.1%) of 2,470 doses of oral levofloxacin reviewed were complicated by coadministration with at least one DTCC. On multivariable analysis, an increased number of prescribed medications was significantly associated with complete coadministration (per increase of one medication: OR, 1.05; CI95, 1.01–1.10;P= .036), whereas patient location in an ICU was protective (OR, 0.51; CI95, 0.30–0.87;P= .013). If our prevalence results are extrapolated to all patients receiving oral levofloxacin at our hospital, approximately one in three doses was complicated by coadministration.Conclusion:Coadministration of fluoroquinolones with DTCCs is extremely common and significantly associated with polypharmacy.
High Prevalence of Carriage of Methicillin-ResistantStaphylococcus aureusat Hospital Admission in Elderly Patients: Implications for Infection Control Strategies
Authors: Lucet Jean-Christophe , Grenet Karine , Armand-Lefevre Laurence , Harnal Marion , Bouvet Elisabeth , Regnier Bernard , Andremont Antoine 
Published: April 2006

AbstractBackground:Despite contact isolation precautions for patients with methicillin-resistantStaphylococcus aureus(MRSA), MRSA infections are increasing in many countries.Objective:To evaluate the role of a potential unrecognized reservoir of MRSA carried by patients in acute care wards, we determined the prevalence of MRSA at hospital admission, with special emphasis on screening-specimen yields.Setting:A 1,100-bed teaching hospital in Paris, France.Methods:Nasal screening cultures were performed at admission to a tertiary-care teaching hospital for patients older than 75 years.Results:MRSA was isolated from 63 (7.9%) of 797 patients. On the multivariate analysis, variables significantly associated with MRSA carriage were presence of chronic skin lesions (adjusted odds ratio [AOR], 5.10; 95% confidence interval [CI95], 2.52–10.33); transfer from a nursing home, rehabilitation unit, or long-term-care unit (AOR, 4.52; CI95, 2.23–9.18); and poor chronic health status (AOR, 1.80; CI95, 1.02–3.18). Without admission screening, 84.1% of MRSA carriers would have been missed at hospital admission and 76.2% during their hospital stay. Furthermore, 81.1% of days at risk for MRSA dissemination would have been spent without contact isolation precautions had admission screening not been performed.Conclusions:MRSA carriage at hospital admission is far more prevalent than MRSA-positive clinical specimens. This may contribute to failure of contact isolation programs. Screening cultures at admission help to identify the reservoir of unknown MRSA patients.
Molecular Surveillance of Clinical Methicillin-ResistantStaphylococcus aureusIsolates in Neonatal Intensive Care Units
Authors: Huang Yhu-Chering , Su Lin-Hui , Wu Tsu-Lan , Lin Tzuo-Yien 
Published: April 2006

AbstractBackground and Objective:Methicillin-resistantStaphylococcus aureus(MRSA) has become an important nosocomial pathogen in our neonatal intensive care units (NICUs) and accounts for almost allS. aureusclinical isolates. The objective of this study was to assess the relatedness of these MRSA strains.Design:MRSA clinical isolates were collected from infants hospitalized in our NICUs. Pulsed-field gel electrophoresis withSmaI digestion was used to fingerprint these isolates.Setting:Level-III NICUs in a university-affiliated children's hospital.Results:Between 1998 and 2000, a total of 122 MRSA clinical isolates were collected from 104 infants hospitalized in our NICUs. Fifteen infants had multiple isolates (range, 2 to 4 isolates). The sources of specimens included blood (72), pus (23), sputum (15), body fluids (3), and catheter tips (9). A total of 4 genotypes with 20 subtypes were identified. There were 2 genotypes in 1998, 2 genotypes in 1999, and 4 genotypes in 2000. All but 2 isolates belonged to either genotype A (63.1%; 7 subtypes) or genotype C (35.2%; 11 subtypes). Among the 15 infants with multiple isolates, the genotypes of the isolates from a single episode of MRSA infection were different in 2 of 12 cases, and reinfection with a new strain was noted in 3 of 5 cases with recurrent infections.Conclusions:Two predominant MRSA clones prevailed in our NICUs between 1998 and 2000. Polyclonal bacteremia and reinfection with a new strain were noted.
Risk Factors for Colonization With Methicillin-ResistantStaphylococcus aureusin a Long-Term-Care Facility in Slovenia
Authors: Vovko Petra , Retelj Matjaz , Cretnik Tjasa Zohar , Jutersek Borut , Harlander Tatjana , Kolman Jana , Gubina Marija 
Published: April 2006

AbstractObjective:To evaluate risk factors associated with methicillin-resistantStaphylococcus aureus(MRSA) colonization in a long-term-care facility (LTCF) for the elderly in Slovenia.Setting:A 351-bed community LTCF for the elderly.Design and Participants:This was a case-control study. MRSA carriage was identified in 102 of 127 residents of the facility's nursing unit. Two swabs were taken: one from the anterior nares and one from the largest skin lesion. If no skin lesions were present, the axillae and the groin area were swabbed. Data were collected regarding gender, age, length of stay in the facility, underlying conditions, functional status, presence of wounds or pressure sores, presence of catheters, antibiotic treatments, and hospital admissions.Results:We detected MRSA in 12 participants. Risk factors independently and significantly associated with MRSA colonization on the multivariate analysis were antibiotic treatments within 1 month before the investigation (odds ratio, 5.087; 95% confidence interval, 1.02 to 25.48;P= .048) and multiple hospital admissions in the 3 months before the investigation (odds ratio, 6.277; 95% confidence interval, 1.31 to 30.05;P= .022).Conclusions:This is the first assessment of risk factors for colonization with MRSA in an LTCF in Slovenia. MRSA poses a problem in this LTCF. Our observations may be valuable in implementing active surveillance cultures in infection control programs in Slovenian LTCFs.
Standardized Infection Surveillance in Long-Term Care Interfacility Comparisons From a Regional Cohort of Facilities
Authors: Stevenson Kurt B. , Moore James , Colwell Holly , Sleeper Barbara 
Published: April 2006

AbstractObjectives:To measure infection rates in a regional cohort of long-term-care facilities (LTCFs) using standard surveillance methods and to analyze different methods for interfacility comparisons.Setting:Seventeen LTCFs in Idaho.Design:Prospective, active surveillance for LTCF-acquired infections using standard definitions and case-finding methods was conducted from July 2001 to June 2002. All surveillance data were combined and individual facility performance was compared with the aggregate employing a variety of statistical and graphic methods.Results:The surveillance data set consisted of 472,019 resident-days of care with 1,717 total infections for a pooled mean rate of 3.64 infections per 1,000 resident-days. Specific infections included respiratory (828; rate, 1.75), skin and soft tissue (520; rate, 1.10), urinary tract (282; rate, 0.60), gastrointestinal (77; rate, 0.16), unexplained febrile illnesses (6; rate, 0.01), and bloodstream (4; rate, 0.01). Initially, methods adopted from the National Nosocomial Infections Surveillance System were used comparing individual rates with pooled means and percentiles of distribution. A more sensitive method appeared to be detecting statistically significant deviations (based on chi-square analysis) of the individual facility rates from the aggregate of all other facilities. One promising method employed statistical process control charts (U charts) adjusted to compare individual rates with aggregate monthly rates, providing simultaneous visual and statistical comparisons. Small multiples graphs were useful in providing images valid for rapid concurrent comparison of all facilities.Conclusion:Interfacility comparisons have been demonstrated to be valuable for hospital infection control programs, but have not been studied extensively in LTCFs.
Failure to Control an Outbreak of Multidrug-ResistantStreptococcus pneumoniaein a Long-Term–Care Facility Emergence and Ongoing Transmission of a Fluoroquinolone-Resistant Strain
Authors: Carter Rosalind J. , Sorenson Genevieve , Heffernan Richard , Kiehlbauch Julia A. , Kornblum John S. , Leggiadro Robert J. , Nixon Lucia J. , Wertheim William A. , Whitney Cynthia G. , Layton Marcelle ,   MDRSP Working Group
Published: April 2006

AbstractObjectives:To characterize risk factors associated with pneumococcal disease and asymptomatic colonization during an outbreak of multidrug-resistantStreptococcus pneumoniae(MDRSP) among AIDS patients in a long-term–care facility (LTCF), evaluate the efficacy of antimicrobial prophylaxis in eliminating MDRSP colonization, and describe the emergence of fluoroquinolone resistance in the MDRSP outbreak strain.Design:Epidemiologic investigation based on chart review and characterization of SP strains by antimicrobial susceptibility testing and PFGE and prospective MDRSP surveillance.Setting:An 80-bed AIDS-care unit in an LTCF.Participants:Staff and residents on the unit.Results:From April 1995 through January 1996, 7 cases of MDRSP occurred. A nasopharyngeal (NP) swab survey of all residents (n = 65) and staff (n = 70) detected asymptomatic colonization among 6 residents (9%), but no staff. Isolates were sensitive only to rifampin, ofloxacin, and vancomycin. A 7-day course of rifampin and ofloxacin was given to eliminate colonization among residents: NP swab surveys at 1, 4, and 10 weeks after prophylaxis identified 1 or more colonized residents at each follow-up with isolates showing resistance to one or both treatment drugs. Between 1996 and 1999, an additional 6 patients were diagnosed with fluoroquinolone-resistant (FQ-R) MDRSP infection, with PFGE results demonstrating that the outbreak strain had persisted 3 years after the initial outbreak was recognized.Conclusions:Chemoprophylaxis likely contributed to the development of a FQ-R outbreak strain that continued to be transmitted in the facility through 1999. Long-term control of future MDRSP outbreaks should rely primarily on vaccination and strict infection control measures.
An Outbreak of Norovirus Infection in a Long-Term-Care Unit in Spain
Authors: Navarro Gemma , Sala Rosa M. , Segura Ferran , Arias César , Varela Pilar , Peña Pilar , Llovet Teresa , Sanfeliu Isabel , Canals Maria , Serrate Guadalupe , Nogueras Antonio 
Published: April 2006

AbstractBackground:Norovirus belongs to the Caliciviridae family and causes outbreaks of infectious enteritis by fecal-oral transmission. In Spain, there have been few outbreaks reported due to this virus. We describe an outbreak on a long-term-care hospital ward.Methods:Cases were classified as probable, confirmed, and secondary. Stool cultures were performed. Polymerase chain reaction detection of norovirus was also performed.Results:The outbreak occurred from December 7 to 28, 2001, involving 60 cases (32 patients, 19 staff members, 8 patients' relatives, and 1 relative of a staff member). Most (82%) of the cases were female. The most frequently involved ages were 20 to 39 years for staff members and 70 to 89 years for patients. The incubation period of secondary cases in patients' families had a median of 48 hours (range, 1 to 7 days). Clinical symptoms included diarrhea (85%), vomiting (75%), fever (37%), nausea (23%), and abdominal pain (12%). Median duration of the disease was 48 hours (range, 1 to 7 days). All cases resolved and the outbreak halted with additional hygienic measures. Stool cultures were all negative for enteropathogenic bacteria and rotaviruses. In 16 of 23 cases, the norovirus genotype 2 antigen was detected.Conclusion:This outbreak of gastroenteritis due to norovirus genotype 2 affected patients, staff members, and their relatives in a long-term-care facility and was controlled in 21 days.
Health and Economic Consequences of an Outbreak of Pertussis Among Healthcare Workers in a Hospital in France
Authors: Ward Alexandra , Caro Jaime , Bassinet Laurence , Housset Bruno , O'Brien Judith A. , Guiso Nicole 
Published: April 2006

AbstractBackground:Bordetella pertussisis highly contagious, and because immunity wanes after vaccination, it continues to be a cause of cough among adults.Objective:To describe the healthcare services used and productivity losses accrued by healthcare workers (HCWs) missing work due to pertussis.Methods:After 3 pertussis cases were confirmed among HCWs, all hospital employees and patients with a cough were screened between November 2000 and March 2001. Each potential case underwent diagnostic tests and received antibiotics (spiramycin or azithromycin) when appropriate. Symptomatic employees were not allowed to return to work until they received an antibiotic for at least 5 days. Services used (physician visits and calls, antibiotics, diagnostic tests, hospitalization, and treatment provided to their contacts) were combined with cost estimates (in 2002 euros) for these services in France.Results:Ninety-one potential cases were identified (77 HCWs, 12 patients, and 2 family members). Of them, 89% received antibiotics and 22% had at least one contact who was also treated. Approximately half (55%) of the HCWs who were cases missed 5 days of work. Four patients were admitted to the hospital as a result of the infection. The average medical cost was 297 euros per potential case: diagnostic tests accounted for 32% and hospitalization for 31%. Total cost (medical and productivity) was 46,661 euros for 91 cases, 42% from productivity losses. An investigation to identify these potential cases also accrued additional costs.Conclusion:Serious adverse health and economic consequences arose from transmission of pertussis among HCWs, their families, and patients.