bluuebunny/crossref_metadata_2025_split huggingface dataset:
Variation in the Use of Procedures to Monitor Antimicrobial Resistance in U.S. Hospitals
Authors: Flach Stephen D. , Diekema Daniel J. , Yankey Jon W. , BootsMiller Bonnie J. , Vaughn Thomas E. , Ernst Erika J. , Ward Marcia M. , Doebbeling Bradley N. 
Published: April 2006

AbstractBackground:Antimicrobial resistance is a growing clinical and public health crisis. Experts have recommended measures to monitor antimicrobial resistance; however, little is known regarding their use.Objective:We describe the use of procedures to detect and report antimicrobial resistance in U.S. hospitals and the organizational and epidemiologic factors associated with their use.Methods:In 2001, we surveyed laboratory directors (n = 108) from a random national sample of hospitals. We studied five procedures to monitor antimicrobial resistance: (1) disseminating antibiograms to physicians at least annually, (2) notifying physicians of antimicrobial-resistant infections, (3) reporting susceptibility results within 24 hours, (4) using automated testing procedures, and (5) offering molecular typing. Explanatory variables included organizational characteristics and patterns of antimicrobial resistance for oxacillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, quinolone-resistant Escherichia coli, and extended-spectrum beta-lactamase-producing Klebsiella species. Generalized estimating equations accounting for the correlation among outcomes at the facility level were used to identify predictors of the five outcomes.Results:Use of the procedures ranged from 85% (automated testing) to 33% (offering molecular typing) and was related to teaching hospital status (OR, 3.1; CI95, 1.5–6.5), participation of laboratory directors on the infection control committee (OR, 1.7; CI95, 1.1–2.8), and having at least one antimicrobial-resistant pathogen with a prevalence greater than 10% (OR, 2.2; CI95, 1.4–3.3).Conclusion:U.S. hospitals underutilize procedures to monitor the spread of antimicrobial resistance. Use of these procedures varies and is related to organizational and epidemiologic factors. Further efforts are needed to increase their use by hospitals.
Evaluating Vancomycin Use at a Pediatric Hospital: New Approaches and Insights
Authors: Bolon Maureen K. , Arnold Alana D. , Feldman Henry A. , Rehkopf David H. , Strong Emily F. , Goldmann Donald A. , Wright Sharon B. 
Published: April 2006

AbstractObjectives:To characterize vancomycin use at a pediatric tertiary-care hospital, to discriminate between initial (≤ 72 hours) and prolonged (> 72 hours) inappropriate use, and to define patient characteristics associated with inappropriate use.Design:Vancomycin courses were retrospectively reviewed using an algorithm modeled on HICPAC guidelines. Data were collected regarding patient demographics, comorbidities, other medication use, and nosocomial infections. The association between each variable and the outcome of inappropriate use was determined by longitudinal regression analysis. A multi-variable model was constructed to assess risk factors for inappropriate initial and prolonged vancomycin use.Setting:A pediatric tertiary-care medical center.Patients:Children older than 1 year who received intravenous vancomycin from November 2000 to June 2001.Results:Three hundred twenty-seven vancomycin courses administered to 260 patients were evaluated for appropriateness. Of initial courses, 114 (35%) were considered inappropriate. Of 143 prolonged courses, 103 (72%) were considered inappropriate. Multivariable risk factor analysis identified the following variables as significantly associated with inappropriate initial use: admission to the surgery service, having a malignancy, receipt of a stem cell transplant, and having received a prior inappropriate course of vancomycin. No variables were identified as significant risk factors for inappropriate prolonged use.Conclusions:Substantial inappropriate use of vancomycin was identified. Prolonged inappropriate use was a particular problem. This risk factor analysis suggests that interventions targeting patients admitted to certain services or receiving multiple courses of vancomycin could reduce inappropriate use.
Increased Mortality Associated With a Clonal Outbreak of Ceftazidime-ResistantKlebsiella pneumoniae: A Case–Control Study
Authors: Qavi Abdul , Segal-Maurer Sorana , Mariano Noriel , Urban Carl , Rosenberg Carl , Burns Janice , Chiang Tom , Maurer James , Rahal James J. 
Published: April 2006

AbstractObjectives:To determine risk factors for ceftazidime-resistantKlebsiella pneumoniaeinfection and the effect of cef-tazidime-resistantK. pneumoniaeinfection on mortality during an isolated outbreak.Design:Case–control investigation using clinical and molecular epidemiology and prospective analysis of infection control interventions.Setting:Surgical intensive care unit of a university-affiliated community hospital.Patients:Fourteen case-patients infected with ceftazidime-resistantK. pneumoniaeand 14 control-patients.Results:Ten of 14 case-patients had identical strains by pulsed-field gel electrophoresis. Broad-spectrum antibiotic therapy before admission to the unit was strongly predictive of subsequent ceftazidime-resistantK. pneumoniaeinfection. In addition, patients with ceftazidime-resistantK. pneumoniaeinfection experienced increased mortality (odds ratio, 3.77).Conclusions:Cephalosporin restriction has been shown to decrease the incidence of nosocomial ceftazidime-resistantK. pneumoniae. However, isolated clonal outbreaks may occur due to lapses in infection control practices. Reinstatement of strict handwashing, thorough environmental cleaning, and repeat education led to termination of the outbreak. A distinct correlation between ceftazidime-resistantK. pneumoniaeinfection and mortality supports the important influence of antibiotic resistance on the outcome of serious bacterial infections.
Spread of a Methicillin-Resistant Staphylococcus aureus ST80-IV Clone in a Danish Community
Authors: Urth Tinna , Juul Gitte , Skov Robert , Schønheyder Henrik C. 
Published: April 2006

AbstractObjective:We report a community cluster of methicillin-resistant Staphylococcus aureus (MRSA) in Denmark with emphasis on routes of transmission and infection control measures. The objective is to extend knowledge of MRSA in a community setting where a nosocomial link could effectively be ruled out.Design:Population-based observational study from November 1997 until June 2003.Setting:North Jutland County, with approximately 495,000 inhabitants.Subjects:The cluster encompassed 46 individuals and 26 households.Interventions:Infection control measures included repeated visits to affected households by an infection control nurse who undertook screening for carriage among all household members and provided a program for decolonization.Results:The causal strain was identical to a newly described international clone, ST80; SSCmec type IV; and Panton–Valentine leukocidin positive. Plausible routes of transmission included household contact and contact at work, kindergarten, and school. We did not detect a nosocomial source or any secondary cases in hospitals. Transmission by healthcare contact outside the hospital was plausible for three cases. We found evidence that the clone was introduced on more than one occasion to immigrant families from the Middle East. A 5-day decolonization program was successful at first attempt in 15 of 16 households that could be evaluated.Conclusions:Despite the described infection control measures, we continued to see new cases, underlining a need for a national policy to contain MRSA in the community.
Prevalence and Nosocomial Spread of Methicillin-ResistantStaphylococcus aureusin a Long-Term-Care Facility in Slovenia
Authors: Cretnik Tjasa Zohar , Vovko Petra , Retelj Matjaz , Jutersek Borut , Harlander Tatjana , Kolman Jana , Gubina Marija 
Published: April 2006

AbstractObjectives:To determine the prevalence and incidence of methicillin-resistantStaphylococcus aureus(MRSA) colonization among residents and healthcare workers (HCWs) of a long-term-care facility (LTCF), to assess possible routes of nosocomial spread, and to determine genetic relatedness of the isolates.Setting:A 351-bed community LTCF for the elderly.Design and Participants:Study investigators made two visits, approximately 3 months apart, to the facility. Samples for cultures were obtained from 107 residents during the first visit, 91 residents during the second visit, and 38 HCWs.Results:The prevalence of MRSA colonization among residents was 9.3% during the first visit and 8.8% during the second visit. During the first visit, two HCWs were colonized. During the second visit, no HCWs were colonized. The colonization of HCWs suggested a potential role in the transmission of MRSA. Molecular typing showed that two of three roommates in one room had the same strain, whereas two in another room differed from one another. All isolates, except one, belonged to two related clonal groups. It seems that the clonal group to which most isolates belonged had the greatest potential for spreading among both residents and HCWs.Conclusions:Similar prevalence rates of MRSA colonization have been found in other European countries, but such studies have usually involved residents with better functional status than that of the participants in this study. Nosocomial spread of MRSA occurred in the facility examined, but not frequently. More attention should be focused on the hand hygiene of HCWs.
A Large Outbreak ofClostridium difficile–Associated Disease with an Unexpected Proportion of Deaths and Colectomies at a Teaching Hospital Following Increased Fluoroquinolone Use
Authors: Muto Carlene A. , Pokrywka Marian , Shutt Kathleen , Mendelsohn Aaron B. , Nouri Kathy , Posey Kathy , Roberts Terri , Croyle Karen , Krystoflak Sharon , Patel-Brown Sujata , Pasculle A. William , Paterson David L. , Saul Melissa , Harrison Lee H. 
Published: April 2006

AbstractBackground and Objective:Fluoroquinolones have not been frequently implicated as a cause ofClostridium difficileoutbreaks. NosocomialC. difficileinfections increased from 2.7 to 6.8 cases per 1,000 discharges (P< .001). During the first 2 years of the outbreak, there were 253 nosocomialC. difficileinfections; of these, 26 resulted in colectomy and 18 resulted in death. We conducted an investigation of a largeC. difficileoutbreak in our hospital to identify risk factors and characterize the outbreak.Methods:A retrospective case-control study of case-patients withC. difficileinfection from January 2000 through April 2001 and control-patients matched by date of hospital admission, type of medical service, and length of stay; an analysis of inpatient antibiotic use; and antibiotic susceptibility testing and molecular subtyping of isolates were performed.Results:On logistic regression analysis, clindamycin (odds ratio [OR], 4.8; 95% confidence interval [CI95], 1.9-12.0), ceftriaxone (OR, 5.4; CI95, 1.8-15.8), and levofloxacin (OR, 2.0; CI95, 1.2-3.3) were independently associated with infection. The etiologic fractions for these three agents were 10.0%, 6.7%, and 30.8%, respectively. Fluoroquinolone use increased before the onset of the outbreak (P< .001); 59% of case-patients and 41% of control-patients had received this antibiotic class. The outbreak was polyclonal, although 52% of isolates belonged to two highly related molecular subtypes.Conclusions:Exposure to levofloxacin was an independent risk factor forC. difficile-associateddiarrhea and appeared to contribute substantially to the outbreak. Restricted use of levofloxacin and the other implicated antibiotics may be required to control the outbreak.
How Outbreaks Can Contribute to Prevention of Nosocomial Infection: Analysis of 1,022 Outbreaks
Authors: Gastmeier Petra , Stamm-Balderjahn Sabine , Hansen Sonja , Nitzschke-Tiemann Frauke , Zuschneid Irina , Groneberg Katrin , Rüden Henning 
Published: April 2006

AbstractObjective:To describe the epidemiology of nosocomial outbreaks published in the scientific literature.Design:Descriptive information was obtained from a sample of 1,022 published nosocomial outbreaks from 1966 to 2002.Methods:Published nosocomial outbreaks of the most important nosocomial pathogens were included in the database. A structured questionnaire was devised to extract information in a systematic manner on nosocomial outbreaks published in the literature. The following items were used: the reference, type of study (case reports or studies applying epidemiologic or fingerprinting methods), type of microorganism, setting, patients and personnel involved, type of infection, source of infection, mode of transmission, risk factors identified, and preventive measures applied.Results:Bloodstream infection was the most frequently identified type of infection (37.0%), followed by gastrointestinal infection (28.5%) and pneumonia (22.9%). In 37% of the outbreaks, the authors were not able to identify the sources. The most frequent sources were patients (25.7%), followed by medical equipment or devices (11.9%), the environment (11.6%), and the staff (10.9%). The mode of transmission remained unclear in 28.3% of the outbreaks. Transmission was by contact in 45.3%, by invasive technique in 16.1%, and through the air in 15.0%. The percentage of outbreaks investigated by case-control studies or cohort studies over the years was small (21% and 9%, respectively, for the whole time period).Conclusion:Outbreak reports in the literature are a valuable resource and should be used for educational purposes as well as for preparing outbreak investigations.
Estimation of the Cumulative Incidence of Hospital-Acquired Bacteremia From Prevalence Data: A Formula
Authors: Haore Houssein Gbaguidi , Muller Arno , Talon Daniel , Bertrand Xavier 
Published: April 2006

AbstractWe evaluated the validity of the formula of Rhame and Sudderth to estimate the cumulative incidence of nosocomial bacteremia from prevalence studies. The observed cumulative incidence was threefold higher than the calculated cumulative incidence. We do not recommend converting prevalence into incidence data for nosocomial bloodstream infections.
Medical Errors Detected and Corrected by a Pediatric Infectious Diseases Consultation Service
Authors: Sandora Thomas J. , Goldmann Donald A. 
Published: April 2006

AbstractErrors occur frequently in healthcare and can adversely affect outcomes. This prospective study demonstrates that pediatric consultants can detect a broad range of errors in the course of routine work. Many of these errors have the potential to cause harm and can be corrected by the intervention of an infectious diseases consultant.
Hospital-Related Determinants For Surgical-Site Infection Following Hip Arthroplasty
Authors: Geubbels Eveline L. P. E. , Wille Jan C. , Nagelkerke Nico J. D. , Vandenbroucke-Grauls Christina M. J. E. , Grobbee Diederick E. , de Boer Annette S. 
Published: April 2006

AbstractObjective:To determine hospital-related risk factors for surgical-site infection (SSI) following hip arthroplasty.Design:Prospective, multicenter cohort study based on surveillance data and data collected through a structured telephone interview. With the use of multilevel logistic regression, the independent effect of hospital-related characteristics on SSI was assessed.Setting:Thirty-six acute care hospitals in the Dutch surveillance network for nosocomial infections (PREZIES), from 1996 to 2000.Patients:Thirteen thousand six hundred eighty patients who underwent total or partial hip arthroplasty.Results:A high annual volume of operations was associated with a reduced risk of SSI (risk-adjusted risk ratio [RR] per 50 extra operations, 0.85; 95% confidence interval [CI95], 0.74–0.97). With each extra full-time–equivalent infection control staff member per 250 beds available for prevention of SSI, the risk for SSI was decreased (RR, 0.48; CI95, 0.16–1.44), although the decrease was not statistically significant. Hospital size, teaching status, university affiliation, and number of surgeons and their years of experience showed no important association with the risk of SSI.Conclusion:Undergoing surgery in a hospital with a low volume of operations increases a patient's risk of SSI.
Rates of Surgical-Site Infection: An International Comparison
Authors: Moro Maria Luisa , Morsillo Filomena , Tangenti Marilena , Mongardi Maria , Pirazzini Maria Cristina , Ragni Pietro ,   ICN Regional Group
Published: April 2006

AbstractObjectives:To quantify the occurrence of surgical-site infections (SSIs) in an Italian region and to estimate the proportion of potentially avoidable infections through benchmarking comparison.Design:Prospective study during 1 month based on a convenience sample of surgical patients admitted to 31 public hospitals. All of the patients undergoing an intervention included among the 44 operative procedures of the National Nosocomial Infections Surveillance (NNIS) System were enrolled. Ninety-five percent of the patients were actively observed after discharge for up to 30 days for all of the operations and for up to 1 year for operations involving implantation.Results:Among the 6,167 operative procedures studied, 290 infections were recorded (4.7 per 100 procedures), 206 (71%) of which were SSIs (3.3 per 100 procedures; 95% confidence interval, 2.9–3.9). One hundred thirty-five SSIs (65.5%) were superficial infections, 53 (25.7%) were deep infections, and 12 (5.8%) were organ–space infections; in 6 cases (2.9%), the type of SSI was not recorded. The frequency of SSIs observed in this study was significantly higher for several procedures than that expected when the NNIS System rates (standardized infection ratio [SIR] ranging from 1.77 to 6.42) or the Hungarian rates (SIR ranging from 1.28 to 3.04) were applied to the study population.Conclusions:The high intensity of postdischarge surveillance can in part explain the differences observed. To allow for meaningful benchmarking comparison, in addition to intrinsic patient risk, data on the intensity of postdischarge surveillance should be included in published reports.
Molecular Characterization ofStreptococcus PyogenesIsolates to investigate an outbreak of Puerperal Sepsis
Authors: Raymond Josette , Schlegel Laurent , Garnier Fabien , Bouvet Anne 
Published: April 2006

AbstractObjective:To describe microbiological characteristics and epidemiologic features of an outbreak of postpartum endometritis.Methods:Various markers were investigated in five patients and three throat carriage isolates ofStreptococcus pyogenesobtained during an outbreak of endometritis occurring in a 13-week period. Molecular characterization included biotyping, T-serotyping,emmgene sequence and restriction, pulsed-field gel electrophoresis (PFGE), and random amplified polymorphic DNA (RAPD) analysis.Results:Biotype, T-serotype, and genotypic data (emmanalysis, PFGE, and RAPD analysis) revealed a close relationship among the isolates from three patients, suggesting that cross-contamination had occurred. These isolates were biotype 1, T type 28, andemmtype 28. The isolates from one patient and one carrier differed from those of the index patient by minor variations of theemmamplicon restriction pattern, PFGE pattern, or RAPD pattern. The remaining isolates were phenotypically and genetically different.Conclusion:Identification of different isolates demonstrated that different strains may circulate simultaneously during a true outbreak and that the predominant strain might persist for several months.
Evaluation of Hospital and Patient Factors that Influence the effective Administration of Surgical Antimicrobial Prophylaxis
Authors: Turnbull Bruce R. R. , Zoutman Dick E. , Lam Mui 
Published: April 2006

AbstractObjective:To analyze and model the patient and healthcare system factors that may interfere with the appropriate administration of surgical antimicrobial prophylaxis.Design:Between 1994 and 1998, surgical-site surveillance data were collected prospectively for a cohort of eligible surgical patients. For all cases, and each individual procedure (cardiothoracic, colonic, gynecologic, orthopedic, or vascular), forward stepwise multiple logistic regression was applied to relate key hospital and patient factors to an effective first prophylactic dose (ie, appropriate administration time, dose, route, and drug).Setting:A 450-bed, tertiary-care teaching hospital in Canada.Patients:A total of 4,835 patients admitted for surgical procedures who required antimicrobial prophylaxis.Results:Factors positive for an effective first prophylactic dose for all cases were when an order was written (OR, 19.7; CI95, 9.1–42.7; P < .001) and given in the operating room (OR, 13.9; Cl95, 7.5–25.6; P < .001). Factors negative for an effective first prophylactic dose were beta-lactam allergy (OR, 0.49; CI95, 0.4–0.61; P < .001) and same-day surgery (OR, 0.57; CI95, 0.4–0.82; P < .001).Conclusions:With few exceptions, the four factors included in the procedure models showed that when a preoperative order was written or the antibiotic was given in the operating room, a patient was more likely to receive an effective first prophylactic dose. Conversely, when a patient had a beta-lactam allergy or the surgery was performed on the day the patient was admitted, the administration of an effective first prophylactic dose was less likely.
An Outbreak ofPichia anomalaFungemia in a Brazilian Pediatric Intensive Care Unit
Authors: Pasqualotto Alessandro Comarú , Sukiennik Teresa Cristina Teixeira , Severo Luiz Carlos , Amorim Cledja Soares de , Colombo Arnaldo Lopes 
Published: April 2006

AbstractObjective:To report an outbreak ofPichia anomalafungemia that occurred in a Brazilian pediatric intensive care unit (ICU) from October 2002 to January 2004.Design:Unmatched case-control study.Methods:We randomly selected four control-patients for each case-patient from a list of all patients admitted to the ICU for at least 48 hours during the outbreak. A second control group was composed of all consecutive patients with nosocomial candidemia in the ICU during the outbreak. An environmental study was performed, and genetic relatedness among the clinical isolates was characterized by randomly amplified polymorphic DNA assay.Results:During the study period, 1,046 children were admitted to the pediatric ICU, 17 of whom developedP. anomalafungemia (attack rate, 1.6%). The median age was 1.1 years, and the main underlying conditions were congenital malformations (35.3%) and neoplastic diseases (11.8%). The overall mortality rate was 41.2%. Two patients received no antifungal treatment; all of the others were treated with amphotericin B. On multivariate analysis, only the presence of a central venous catheter was significantly associated withP. anomalafungemia. The yeast was not found on healthcare workers' hands or in the environment. Molecular studies showed that the outbreak was caused by a single strain. The distribution of risk factors was similar between patients withP. anomalafungemia and control-patients with candidemia.Conclusions:This study highlights the importance ofP. anomalaas an emerging nosocomial fungal pathogen. Patients withP. anomalafungemia seem to have risk factors in common with those who have candidemia.
Dragon Promoter Mapper (DPM): a Bayesian framework for modelling promoter structures
Authors: Chowdhary Rajesh , Tan Sin Lam , Ali R. Ayesha , Boerlage Brent , Wong Limsoon , Bajic Vladimir B 
Published: April 2006

AbstractSummary: Dragon Promoter Mapper (DPM) is a tool to model promoter structure of co-regulated genes using methodology of Bayesian networks. DPM exploits an exhaustive set of motif features (such as motif, its strand, the order of motif occurrence and mutual distance between the adjacent motifs) and generates models from the target promoter sequences, which may be used to (1) detect regions in a genomic sequence which are similar to the target promoters or (2) to classify other promoters as similar or not to the target promoter group. DPM can also be used for modelling of enhancers and silencers.Availability:Contact: vlad@sanbi.ac.zaSupplementary information: Manual for using DPM web server is provided at