bluuebunny/crossref_metadata_2025_split huggingface dataset:
A Protracted Outbreak of Staphylococcus epidermidis Infections Among Patients Undergoing Valve Replacement
Authors: Bou Ricardo , Peris Miguel , Perpiñán Javier , Ramos Pilar , Aguilar Angel 
Published: April 2006

AbstractObjective:To investigate a Staphylococcus epidermidis outbreak among patients undergoing cardiac surgery.Design:Retrospective cohort study.Setting:A 260-bed community referral center.Patients:Case-patients were patients with S. epidermidis mediastinals, endocarditis, or both after valve implantation at Hospital de La Ribera from January to June 2002. The study population included patients undergoing valve surgery at Hospital de La Ribera from January 2000 to June 2002.Results:From January to June 2002, 8 cases of mediastinals, endocarditis, or both occurred among 53 patients undergoing cardiac surgery. In the same months of 2000, there had been no cases among 22 patients, and in 2001, only 1 case among 47 patients (P = .095 and P = .034, respectively). In 2002, there were 4 cases of mediastinitis and endocarditis, 3 cases of medi-astinitis, and 1 case of endocarditis, all following aortic valve replacement. The epidemic curve suggested a protracted outbreak. Patients with chronic obstructive lung disease were sixfold more likely to be case-patients (95% confidence interval, 1.6-23.8). The mean duration of surgery tended to be longer in non-case-patients (161.4 ± 57.9 minutes) than in case-patients (123.7 ± 23.7 minutes) (P = .06).Conclusion:The cause of this protracted outbreak was likely multifactorial. Reemphasis of existing policies was associated with resolution of the outbreak.
Improving Outcomes of Coronary Artery Bypass Graft Infections With Multiple Interventions Putting Science and Data to the Test
Authors: Lutarewych Michael , Morgan Sandra P. , Hall Melanie M. 
Published: April 2006

AbstractIn 2001, 7.58% of our coronary artery bypass graft (CABG) patients developed surgical-site infection (SSI) as compared with 3.57% in National Nosocomial Infections Surveillance System hospitals from January 1992 to June 2001. Seven new preventive measures were implemented and in 2002, the rate was 3.47%. Implementing evidence-based measures improved patient outcomes.
Safety-Engineered Device Implementation: Does It Introduce Bias in Percutaneous Injury Reporting?
Authors: Sohn SeJean , Eagan Janet , Sepkowitz Kent A. 
Published: April 2006

AbstractObjective:To examine whether implementation of safety-engineered devices in 2001 had an effect on rates of percutaneous injury (PI) reported by HCWs.Design:Before-and-after intervention trial comparing 3-year preintervention (1998–2001) and 2-year postintervention (2001–2002) periods. PI data from anonymous, self-administered surveys were prospectively entered into CDC NaSH software.Setting:A 427-bed, tertiary-care hospital in Manhattan.Participants:HCWs who attended state-mandated training sessions and completed the survey (1,132 preintervention; 821 postintervention).Intervention:Implementation of a “safer-needle system” composed of various safety-engineered devices for needle-safe TV delivery-insertion, blood collection, and intramuscular-subcutaneous injection.Results:Preintervention, the overall annual rate of PIs self-reported on the survey was 36.5 per 100 respondents, compared with 13.9 per 100 respondents postintervention (P < .01). The annual rate of formally reported PIs decreased from 8.3 to 3.1 per 100 respondents (P < .01). Report rates varied by occupational group (P ≤ .02). The overall rate did not change between study periods (22.7% to 22.3%), although reporting improved among nurses (23.6% to 44.4%, P = .03) and worsened among building services staff (90.5% to 50%, P = .03). HCWs with greater numbers of Pis self-reported on the survey were less likely to formally report injuries (P < .01). The two most common reasons for nonreport (ie, thought injury was low risk or believed patient was low risk for blood-borne disease) did not vary from preintervention to postintervention.Conclusions:Safety-engineered device implementation decreased rates of Pis formally reported and self-reported on the survey. However, this intervention, with concomitant intensive education, had varying effects on reporting behavior by occupation and a minimal effect on overall reporting rates.
Evaluating Infection Control Practices Among Dentists in Vâlcea, Romania, in 1998
Authors: Duffy Rosemary E. , Cleveland Jennifer L. , Hutin Yvan J. , Cardo Denise 
Published: April 2006

AbstractObjectives:To evaluate infection control knowledge and practices, provide training on universal-standard precautions (USP), and improve infection control knowledge and practices among dentists.Setting:Private and public dental offices in Vâlcea, Romania.Methods:Information about the use of hepatitis B vaccine, knowledge of and training in USP, perceived risks of disease transmission, and infection control practices was gathered from a sample of dentists through interviews, direct observations, and a survey administered during a training session.Results:Interviews among dentists and direct observations of infection control practices revealed that resources were often scarce in public clinics; however, availability of supplies in private or public clinics often did not correlate with adherence to proper infection control. Of 125 registered dentists, 46 (37%) attended the session and completed the survey. Of these, 75% worked in public clinics, 40% in private practices, and a few in both. More than 50% believed that the prevalence of hepatitis B virus (HBV) was low in their patients compared with the Romanian population. Only 26% of dentists had received hepatitis B vaccine. Dentists reported a mean of six percutaneous injuries a year. Most (89%) reported that gloves were effective in preventing HBV transmission; 24% wore them for every patient. Most used dry heat sterilization; however, chemical disinfectants were also used.Conclusions:Resources were limited, receipt of hepatitis vaccine was low, and infection control knowledge and practices varied. Training and education are needed regarding the importance of USP, hepatitis B vaccination, and alternative practices when resources are insufficient.
Risk to Cancer Patients From Nosocomial Hepatitis C Virus
Authors: Sepkowitz Kent A. 
Published: April 2006

AbstractNosocomial transmission of hepatitis C virus (HCV) among dialysis patients is a well-described phenomenon. In addition, spread of HCV in outpatient medical clinic settings has recently been reported. In the past decade, nosocomial spread of hepatitis C among hospitalized patients being treated for cancer has increasingly been reported. The cause or source of transmission is unknown. Infection control practitioners should be aware of this potential risk to oncology patients.
Transmission of Hepatitis C Virus Between Hemodialysis Patients Sharing the Same Machine
Authors: Sartor Catherine , Brunet Philippe , Simon Sophie , Tamalet Catherine , Berland Yvon , Drancourt Michel 
Published: April 2006

AbstractAfter a patient acquired hepatitis C virus (HCV) infection in our unit, we performed epidemiologic and virologic investigations, including genotyping and phylogenetic analyses. The results provided evidence for HCV transmission between two patients sharing the same machine and suggested possible transmission via accidental contamination of the venous pressure monitoring system.
Smallpox Vaccine: “Non-Take” Responses in Previously Vaccinated Adults
Authors: Thomas Georgia , Frenzel Elizabeth , Hanna Hend 
Published: April 2006

AbstractThis small, retrospective study of laboratory workers who received smallpox vaccine showed a strong correlation between “non-take” reactions and the presence of prior vaccination scars. Although we cannot exclude technique and vaccine potency as causes, the association we observed may indicate that these workers are displaying residual immunity to smallpox.
Has the Epidemiology of Nosocomial Candidemia Changed?
Authors: Puzniak Laura , Teutsch Steven , Powderly William , Polish Louis 
Published: April 2006

AbstractObjective:To assess changes in the epidemiology of nosocomial candidemia in the post-fluconazole era among hospitalized patients using a case–control study design.Design:Candidemia case-patients were matched 1:1 on diagnosis, age, and length of stay with control-patients. Conditional logistic regression was used to determine predictors and outcomes of candidemia. Treatment regimens and compliance with national practice guidelines were compared among case-patients.Setting:Barnes-Jewish Hospital, a 1,278-bed, tertiary-care center affiliated with Washington University School of Medicine, St. Louis, Missouri.Participants:Patients admitted from January 1 to December 31, 2000. Case-patients were identified through the hospital microbiological surveillance system and matched with control-patients.Results:Predictors of candidemia included Hickman catheters (odds ratio [OR], 9.53; 95% confidence interval [CI95], 1.34 to 68.01), gastric acid suppressants (OR, 6.38; CI95, 2.33 to 17.43), nasogastric tubes (OR, 3.69; CI95, 1.27 to 10.78), antibiotics (OR, 1.46; CI95,1.15 to 1.86), and admission to the intensive care unit (OR, 6.40; CI95, 2.12 to 19.31). The crude case-fatality rate was 40%. Seventeen (15%) of the case-patients received the recommended treatment regimen according to recently published practice guidelines.Conclusions:The epidemiology of candidemia has changed little at our hospital during the past decade and remains a significant cause of mortality. Further studies on the benefits of preventive therapy will be essential to improve the outcome of this infection.
Genetic Relatedness Among Candida tropicalis Isolates From Sporadic Cases of Fungemia in Two University Hospitals in Korea
Authors: Shin Jong Hee , Kim Mi-Na , Shin Dong Hyeon , Jung Sook-In , Kim Kwang Jin , Cho Duck , Kee Seung Jung , Shin Myung Geun , Suh Soon Pal , Ryang Dong Wook 
Published: April 2006

AbstractObjective:To compare the epidemiology and genetic relatedness of Candida tropicalis isolates causing bloodstream infection (BSI) in two hospitals.Setting:Two tertiary-care hospitals in Korea.Methods:A retrospective molecular epidemiologic analysis using pulsed-field gel electrophoresis (PFGE) was performed with 49 C. tropicalis isolates from sporadic cases of BSI. The isolates were collected from 27 patients at Chonnam National University Hospital (CUH) during a 6-year period and 22 patients at Asan Medical Center (AMC) during a 2-year period.Results:Based on the PFGE patterns, the average similarity value (SAB) for the 27 isolates from CUH was 0.84 ± 0.08, which was significantly higher than that for the 22 isolates from AMC (0.78 ± 0.06; P < .001). Of the 49 strains from patients at the 2 hospitals, 9 isolates were placed into 3 subtypes with SAB values of 1.0, which indicated that they were identical. All 9 of these strains were isolated from CUH patients, and each type strain was isolated sporadically during a period ranging from 4 months to 3 years. On comparison of the clinical characteristics of the patients of the 2 hospitals, the CUH strains were isolated more frequently from non-neutropenic patients and patients with central venous catheter–related fungemia; cases from CUH had a better outcome than those from AMC (P < .05).Conclusions:These data show that the clinical and epidemiologic characteristics of C. tropicalis fungemia may differ markedly among hospitals and that some cases of C. tropicalis fungemia may be caused by endemic strains within a hospital.
Routine Changing of Intravenous Administration Sets Does Not Reduce Colonization or Infection in Central Venous Catheters
Authors: Rickard Claire M. , Lipman Jeff , Courtney Mary , Siversen Rosemary , Daley Peter 
Published: April 2006

AbstractObjective:To determine the effect of routine intravenous (IV) administration set changes on central venous catheter (CVC) colonization and catheter-related bacteremia.Design:Prospective, randomized, controlled trial.Setting:Eighteen-bed intensive care unit (ICU) in a large metropolitan hospital.Participants:Two hundred fifty-one patients with 404 chlorhexidine gluconate and silver sulfadiazine–coated multilumen CVCs.Interventions:CVCs inserted in the ICU and in situ on day 4 were randomized to have their IV administration sets changed on day 4 (n = 203) or not at all (n = 201). Use of fluid containers and blood product administration sets was limited to 24 hours. CVCs were removed when not required, infection was suspected, or in place on day 7. Catheter cultures were performed on removal by blinded laboratory staff. Catheter-related bacteremia was diagnosed by a blinded intensivist using strict definitions. Data were collected regarding catheter duration, site, Acute Physiology and Chronic Health Evaluation (APACHE) II score, patient age, diagnosis, hyperglycemia, hypoalbuminemia, immune status, number of fluid containers and IV injections, and administration of propofol, blood, total parenteral nutrition, or lipid infusion.Results:There were 10 colonized CVCs in the group receiving a set change and 19 in the group not receiving one. This difference was not statistically significant on Kaplan–Meier survival analysis. There were 3 cases of catheter-related bacteremia per group. Logistic regression found that burns diagnosis and increased ICU stay significantly predicted colonization.Conclusion:IV administration sets can be used for 7 days in patients with short-term, antiseptic-coated CVCs.
Povidone-Iodine Ointment and Gauze Dressings Associated With Reduced Catheter-Related Infection in Seriously Ill Neurosurgical Patients
Authors: Fukunaga Atsushi , Naritaka Heiji , Fukaya Raita , Tabuse Masanao , Nakamura Tsuneo 
Published: April 2006

AbstbactPovidone-iodine ointment and gauze covered by transparent dressings were compared with transparent dressings alone in historical controls (both changed twice weekly) in neurosurgical patients needing catheter placement for prolonged periods. Colonization and bloodstream infection were both reduced with the new method (P<.01 and P= .062, respectively).
Antimicrobial Use and the Influence of Inadequate Empiric Antimicrobial Therapy on the Outcomes of Nosocomial Bloodstream Infections in a Neonatal Intensive Care Unit
Authors: Apisarnthanarak Anucha , Holzmann-Pazgal Galit , Hamvas Aaron , Olsen Margaret A. , Fraser Victoria J. 
Published: April 2006

AbstractObjective:To evaluate antimicrobial use and the influence of inadequate empiric antimicrobial therapy on the outcomes of nosocomial bloodstream infections (BSIs).Design:Prospective cohort study with nested case-control analysis.Setting:Neonatal intensive care unit (NICU).Methods:All patients weighing 2,000 g or less were enrolled. Data collection included risk factors for nosocomial BSI, admission severity of illness, microbiology, antimicrobial therapy, and outcomes. Inadequate empiric antimicrobial therapy was defined as the use of antibiotics for more than 48 hours after the day that blood cultures were performed that did not cover the microorganisms causing the bacteremia or administration of antibiotics that failed to cover resistant microorganisms.Results:Two hundred twenty-nine patients were enrolled. Forty-five developed nosocomial BSIs. The BSI rates were 11.2, 2.8, and 0 per 1,000 catheter-days for patients weighing 1,000 g or less, between 1,001 and 1,500 g, and between 1,501 and 2,000 g, respectively. After adjustment for severity of illness, the mortality in patients with nosocomial BSI receiving inadequate empiric antimicrobial therapy was higher than in those receiving adequate therapy (adjusted odds ratio [AOR], 5.3; 95% confidence interval [CI95], 1.2-23.2). By multivariate analysis, nosocomial BSI attributed to Candida species (AOR, 6.3; CI95, 1.4-28.0) and invasive procedure prior to onset of BSI (AOR, 6.4; CI95, 1.0-39.0) were associated with administration of inadequate empiric antimicrobial therapy.Conclusions:Administration of inadequate empiric antimicrobial therapy among NICU patients with nosocomial BSI was associated with higher mortality. Additional studies on the role of inadequate empiric antimicrobial therapy and the outcomes of BSIs among NICU patients are needed.
Risk Factors for Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae in a Neonatal Intensive Care Unit
Authors: Linkin Darren R. , Fishman Neil O. , Patel Jean Baldus , Merrill Jeffrey D. , Lautenbach Ebbing 
Published: April 2006

AbstractRisk factors for colonization or infection with extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae during an outbreak in a neonatal intensive care unit (NICU) included low gestational age and exposure to third-generation cephalosporins. We also reviewed the existing medical literature regarding the clinical epidemiology of ESBLs in NICUs.
Impact of Surveillance Rounds on Adherence to Infection Control Policies and Procedures at a Children's Hospital
Authors: Chatterjee Archana , Heybrock Brenda , Plummer Sharon , Eischen Kay 
Published: April 2006

AbstractAdherence to written infection control policies and procedures was studied and on-site education was provided for 1 year at a children's hospital. There was significant improvement in sharp objects disposal, hazardous waste handling, availability of personal protective equipment, isolation precautions, and staff knowledge regarding location of the exposure control plan.
Nosocomial Infection and Multidrug-Resistant Bacteria Surveillance in Intensive Care Units: A Survey in France
Authors: L'Hériteau François , Alberti Corinne , Cohen Yves , Troché Gilles , Moine Pierre , Timsit Jean-François 
Published: April 2006

AbstractObjectives:To evaluate nosocomial infection (NI) surveillance strategies in French ICUs and to identify similar patterns defining subsets within which comparisons can be made.Design:A questionnaire was sent to all French ICUs, and a random sample of nonresponders was interviewed.Participants:Three hundred ninety-five responder ICUs (69%) in France.Results:In 282 ICUs (71%), a dedicated ICU staff member was responsible for infection control activities. The microbiology laboratory was usually in the hospital (90%) and computerized (94%) but issued regular hospital microbiology records in only 48% of cases. Patients receiving mechanical ventilation, central venous catheterization, and urinary catheterization were 90%, 79%, and 60%, respectively. Patients were screened for carriage of mul-tidrug-resistant bacteria on admission and during the stay in 70% and 60% of ICUs, respectively, most often targeting MRSA. Quantitative cultures were used to diagnose ventilator-associated pneumonia (VAP) in 90% of ICUs, including distal specimens in 80% and bronchoscopy specimens in 60%. Quantitative central venous catheter (CVC)-segment cultures were used in 70% of ICUs. All CVCs were cultured routinely in 53% of the ICUs. Despite wide variations in infection control and surveillance strategies, multiple correspondence analysis identified 13 key points (4 structural variables and 9 variables concerning the diagnosis of VAP, the surveillance and diagnosis of catheter-related and urinary tract infections, and the mode of screening of MRSA carriers) that categorize the variability of French ICUs' approaches to NIs.Conclusion:This study revealed profound differences in N1 surveillance strategies across ICUs, indicating a need for caution when using N1 surveillance data for comparisons and benchmarking.
Implementation of Strategies to Prevent and Control the Emergence and Spread of Antimicrobial-Resistant Microorganisms in U.S. Hospitals
Authors: Ward Marcia M. , Diekema Daniel J. , Yankey Jon W. , Vaughn Thomas E. , BootsMiller Bonnie J. , Pendergast Jane F. , Doebbeling Bradley N. 
Published: April 2006

AbstractObjective:To examine the extent to which the strategies recommended by the National Foundation for Infectious Diseases (NFID)-Centers for Disease Control and Prevention (CDC) co-sponsored workshop, Antimicrobial Resistance in Hospitals: Strategies to Improve Antimicrobial Use and Prevent Nosocomial Transmission of Antimicrobial-Resistant Microorganisms, have been implemented and the relationship between the degree of implementation and hospital culture, leadership, and organizational factors.Design:Survey.Setting:A representative sample of U.S. hospitals stratified by teaching status, bed size, and geographic region.Participants:Infection control professionals.Results:Surveyed hospitals had implemented strategies to optimize the use of antimicrobials and to detect, report, and prevent transmission of antimicrobial-resistant microorganisms. Multivariate analyses found that hospitals with a greater degree of implementation of the NFID–CDC strategic goals were more likely to have management support, education of staff, and interdisciplinary groups specifically to address these issues; they were also more likely to engage in benchmarking on broader quality of care indicators.Conclusions:Most surveyed hospitals had implemented some measures to address the NFID–CDC recommendations; however, hospitals need to do much more to improve antimicrobial use and to increase their efforts to detect, report, and control the spread of antimicrobial resistance. A supportive hospital administration must foster a culture of ongoing support, education, and interdisciplinary work groups focused on this important issue to successfully accomplish these goals.
Concurrent Outbreak of Multidrug-Resistant and Susceptible Subclones of Acinetobacter baumannii Affecting Different Wards of a Single Hospital
Authors: Maslow Joel N. , Glaze Thomas , Adams Pamela , Lataillade Max 
Published: April 2006

AbstractBackground and Objective:Acinetobacter baumannii has emerged as an opportunistic pathogen among acutely ill patients, especially those with thermal injury. A prospective 8-month study was conducted to describe the clinical and molecular epidemiology of multidrug-resistant A. baumannii affecting a single hospital.Methods:Univariate analysis comparing Smal macrorestriction patterns of A. baumannii generated by pulsed-field gel electrophoresis (PFGE) versus clinical and demographic risk factors.Results:A total of 200 isolates from 76 patients were collected, of which 185 isolates from 76 patients were analyzed by PFGE. A total of 17 distinct PFGE clonal types were identified. One clonal type (strain A) represented 129 isolates from 49 patients. A group of related clonal types (strain A variants) were identified as 40 isolates from 20 patients. The only risk factor other than geographic location associated with the presence of strain A was prior treatment with antibiotics active against gram-negative bacteria (P = .0015). The two clonal types differed in antibiotic resistance profiles: 25% of strain A isolates, the dominant strain in the burn unit, were susceptible to at least one antibiotic tested. In contrast, approximately 80% of the other strain types were susceptible to at least one antibiotic and were cultured from patients admitted elsewhere in the hospital. No combination of antibiotics was observed to yield additive or synergistic activity.Conclusion:Clonally related strains of Acinetobacter that differ in susceptibility patterns may coexist within a single hospital, dependent on the selective pressure related to antibiotic exposure.