bluuebunny/crossref_metadata_2025_split huggingface dataset:
Investigation of a Nosocomial Outbreak Due toSerratia marcescensin a Maternity Hospital
Authors: Berthelot Philippe , Grattard Florence , Amerger Colette , Frery Marie-Claude , Lucht Frédéric , Pozzetto Bruno , Fargier Philippe 
Published: February 2006

AbstractObjectives:To investigate an outbreak ofSerratia marcescensin a maternity hospital (November 1994 to May 1995).Design:Retrospective analysis of epidemiological data and prospective study of systematic bacteriological samples from patients and environment, with genotyping of strains by arbitrarily primed polymerase chain reaction.Setting:A private maternity hospital, Saint-Etienne, France.Results:In the neonatal unit, 1 newborn developed a bacteremia, and 36 were colonized in stools with Smarcescens.As the colonization of some newborns was shown to occur only a few hours after delivery, the inquiry was extended to other maternity wards, where 8 babies and 4 mothers were found to be colonized. Environmental sampling led to the isolation of Smarcescensfrom a bottle of enteral feed additive in the neonatal unit and from the transducers of two internal tocographs in the delivery rooms. The genotyping of 27 strains showed two different profiles: a major epidemic profile shared by 22 strains (18 from babies of the neonatal unit, 2 from babies of other units, and 2 from breast milk) and another profile shared by 5 strains (2 from transducers of internal tocographs, 2 from babies, and 1 from a mother). The strain isolated from lipid enteral feeding was not available for typing. Although this source of contamination was removed soon from the neonatal unit, the outbreak stopped only when infection control measures were reinforced in the delivery rooms, including the nonreuse of internal tocographs.Conclusions:In delivery rooms, the quality of hygiene needs to be as high as in surgery rooms to prevent nosocomial colonization or infection of neonates at birth.
Bloodstream Infections in a Neonatal Intensive-Care Unit: 12 Years' Experience With an Antibiotic Control Program
Authors: Cordero Leandro , Sananes Mercedes , Ayers Leona W. 
Published: February 2006

AbstractObjective:To assess the prevalence of gram-positive coccal (GPC), gram-negative bacillary (GNB), and fungal bloodstream infections (BSIs) during a 12-year period in which a consistent antibiotic treatment protocol was in place; to evaluate the efficacy of these antibiotic policies in relation to treatment, to the emergence of bacterial or fungal resistance, and to the occurrence of infection outbreaks or epidemics.Study Design:Case series.Methods:Demographic, clinical, and bacteriological information from 363 infants born during 1986 through 1991 and 1992 through 1997 who developed 433 blood-culture-proven BSIs was analyzed. Early-onset BSIs were defined as those infections discovered within 48 hours of birth, and late-onset BSIs as those that occurred thereafter. Suspected early-onset BSIs were treated with ampicillin and gentamicin, and suspected late-onset BSIs with vancomycin and gentamicin. Antibiotics were changed on the basis of organism antimicrobial susceptibility.Results:Early-onset BSIs were noted in 52 of 21,336 live births and 40 of 20,402 live births during 1986 through 1991 and 1992 through 1997, respectively. GPC (83% due to group B streptococcus [GBS]) accounted for approximately one half of early-onset BSI cases and GNB (68%Enterobacteriaceae)for the remainder. Early-onset GBS declined from 24 to 11 cases (P=.04) and late-onset BSI increased from 111 to 230 cases (P<.01) from the first to the last study period. Sixty-eight percent of late-onset BSIs were due to GPC (primarily coagulase-negativeStaphylococcus), 18% to GNB, and 14% to fungus. Over the study period,Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, andPseudomonas aeruginosaisolated from the newborn intensive-care unit (unlike those strains from other hospital units) remained fully susceptible to ceftazidime and gentamicin. Although the hospitalwide prevalence of methicillin-resistantStaphylococcus aureusincreased, all 17 newborn BSI cases were due to methicillin-sensitive strains. Prevalence of methicillin-resistant coagulase-negativeStaphylococcusincreased, although all strains remained vancomycin-susceptible, as did the 16Enterococcus faecalisisolates. All fungi recovered (from 48 patients) were susceptible to amphotericin.Conclusion:We observed a decrease in the prevalence of early-onset BSIs due to GBS and an increase in late-onset BSIs due to GPC, GNB, and fungi. The combination of ampicillin and gentamicin for suspected early-onset BSIs and vancomycin and gentamicin for late-onset BSIs has been successful for treatment of individual patients without the occurrence of infection outbreaks or the emergence of resistance. Controlled antibiotic programs and periodic evaluations based on individual unit and not on hospitalwide antibiograms are advisable.
An Outbreak of Acute Gastroenteritis in a Geriatric Long-Term–Care Facility: Combined Application of Epidemiological and Molecular Diagnostic Methods
Authors: Marx Arthur , Shay David K. , Noel Jacqueline S. , Brage Carol , Bresee Joseph S. , Lipsky Sherry , Monroe Stephan S. , Ando Tamie , Humphrey Charles D. , Alexander E. Russell , Glass Roger I. 
Published: February 2006

AbstractObjective:To assess possible transmission modes of, and risk factors for, gastroenteritis associated with Norwalk-like viruses (NLVs) in a geriatric long-term-care facility.Methods:During a prolonged outbreak of acute gastroenteritis, epidemiological data on illness among residents and employees were collected in conjunction with stool, vomitus, and environmental specimens for viral testing. NLVs were identified by electron microscopy in stool and vomitus specimens, and further characterized by reverse-transcriptase polymerase chain reaction and nucleotide sequencing. Potential risk factors were examined through medical-record review, personal interview, and a self-administered questionnaire sent to all employees.Results:During the outbreak period, 52 (57%) of 91 residents and 34 (35%) of 90 employees developed acute gastroenteritis. Four case-residents were hospitalized; three residents died at the facility shortly after onset of illness. A point source was not identified; no association between food or water consumption and gastroenteritis was identified. A single NLV strain genetically related to Toronto virus was the only pathogen identified. Residents were at significantly higher risk of gastroenteritis if they were physically debilitated (relative risk [RR], 3.5; 95% confidence interval [CI95], 1.0-12.9), as were employees exposed to residents with acute gastroenteritis (RR, 2.6; CI95, 1.1-6.5) or ill household members (RR, 2.3; CI95, 1.4-3.6). Adherence to infection control measures among the nursing staff may have reduced the risk of gastroenteritis, but the reduction did not reach statistical significance.Conclusions:In the absence of evidence for food-borne or waterborne transmission, NLVs likely spread among residents and employees of a long-term-care facility through person-to-person or airborne droplet transmission. Rapid notification of local health officials, collection of clinical specimens, and institution of infection control measures are necessary if viral gastroenteritis transmission is to be limited in institutional settings
Enterococcal Bacteremia: Risk Factors for Vancomycin Resistance and Predictors of Mortality
Authors: Lautenbach Ebbing , Bilker Warren B. , Brennan Patrick J. 
Published: February 2006

Abstract

Objective:
To identify risk factors for vancomycin resistance and mortality in enterococcal bacteremia.

Design:
Historical cohort study.

Setting:
A large academic medical center with a high prevalence of vancomycin-resistant enterococci (VRE).

Patients:
Two hundred sixty patients with enterococcal bacteremia, of whom 72 (28%) had VRE.

Results:
Independent risk factors for infection with VRE were the mean number of antibiotic days (P&lt;.001), renal insufficiency (P&lt;.001), mean days of vancomycin use (P=.005), and neutropenia (P=.013). A trend toward a significant association between metronidazole use and VRE also was noted (P=.068). Mortality was attributable to the bacteremia in 96 patients (37%). Severity of illness (P&lt;.001) and age (P=.020) were independent risk factors for mortality. Vancomycin resistance was not, however, an independent predictor of mortality.

Conclusion:
These results suggest that restrictions on antibiotic use, particularly in patients with renal insufficiency and neutropenia, may help to combat the rising incidence of VRE. Although patients with VRE bacteremia demonstrated higher mortality rates than patients with infection due to susceptible isolates, vancomycin resistance was not an independent predictor of mortality in these patients and likely serves more as a marker of underlying severity of illness.
Trends in Compliance With the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis Among New Jersey Hospitals, 1989 to 1996
Authors: Manangan Lilia P. , Collazo Edgar R. , Tokars Jerome , Paul Sindy , Jarvis William R. 
Published: February 2006

AbstractObjective:To determine trends in compliance with the guidelines for preventing the transmission ofMycobacterium tuberculosisin healthcare facilities among New Jersey hospitals from 1989 through 1996.Design:A voluntary questionnaire was sent to all 96 New Jersey hospitals in 1992. The 53 that responded were resurveyed in 1996.Results:Of the 96 hospitals surveyed in 1992, 53 (55%) returned a completed questionnaire; 33 (64%) were community, nonteaching hospitals. In 1991, patients with tuberculosis (TB) were admitted at 38 (72%) of 53 hospitals, and from 1989 through 1991, patients with multidrug-resistant (MDR) TB were admitted at 15 (29%) of 52 hospitals. Twenty-nine (57%) of 51 reported having rooms meeting the Centers for Disease Control and Prevention (CDC) criteria for acid-fast bacilli (AFB) isolation. A nonfltted surgical mask was used as a respiratory protective device by healthcare workers (HCWs) at 28 (55%) of 51 hospitals. Attending physicians were included in tuberculin skin-testing (TST) programs at 5 (11%) of 45 hospitals. In the 1996 resurvey, 48 (94%) of 53 surveyed hospitals returned a completed questionnaire; 34 (81%) of 42 had TB patient admissions, and 4 (9%) of 43 had MDR TB patient admissions in 1996. Forty-five (96%) of 47 reported having rooms that met CDC criteria for AFB isolation. N95 respiratory devices were used by HCWs at 45 (94%) of 48 hospitals. Attending physicians were included in the TST programs at 22 (54%) of 41 hospitals.Conclusion:New Jersey hospitals have made improvements in availability of AFB isolation rooms, use of proper respiratory protective devices, and expansion of TST programs for HCWs from 1989 through 1996.
Lack of Transmission of Vancomycin-Resistant Enterococci in Three Long-Term–Care Facilities
Authors: Greenaway Christina A. , Miller Mark A. 
Published: February 2006

Abstract
Three patients colonized with vancomycin-resistant Enterococcus were admitted to one or more of three long-term-care facilities. Six point-prevalence surveys revealed no transmission of vancomycin-resistant Enterococcus after a total of 234 days of exposure during which moderately strict infection control measures were implemented. Four of 116 environmental cultures were positive.
Hospital Water Supply as a Source of Disseminated Mycobacterium fortuitum Infection in a Leukemia Patient
Authors: Kauppinen Juha , Nousiainen Tapio , Jantunen Esa , Mattila Rauni , Katila Marja-Leena 
Published: February 2006

AbstractNosocomial acquisition ofMycobacterium fortuitumled to a disseminated infection in a leukemia patient. A linkage to shower-head water was supported by molecular typing of clinical and environmental isolates. Contamination of the hospital water system with microbes that are relatively resistant to common sanitation processes poses an increased risk of infection to neutropenic patients.
Bacteremia Due to Persistent Strains of Coagulase-Negative Staphylococci in a Neonatal Intensive-Care Unit
Authors: Sung Lillian , Ramotar Karam , Samson Lindy M. , Toye Baldwin 
Published: February 2006

AbstractThis retrospective case-control study was performed to determine risk factors for bacteremia due to persistent coagulase-negative staphylococci in our neonatal intensive-care unit. Enteral nutrition and the presence of a nasogastric tube were identified as possible risk factors for coagulase-negative staphylococcal bacteremia involving one of the persistent strains.
Outbreak of Methicillin-Resistant Staphylococcus aureus in a German Tertiary-Care Hospital
Authors: Rüchel Reinhard , Mergeryan Hamparsum , Boger Olga , Langefeld Christiane , Witte Wolfgang 
Published: February 2006

AbstractA biphasic outbreak of methicillin-resistantStaphylococcus aureusin intensive-care units of a German tertiary-care hospital afflicted 89 patients within 4 years. The spread of the outbreak most likely was facilitated by the contamination of mobile radiograph equipment. The outbreak was controlled by measures of hospital hygiene.
Varicella Serological Status of Healthcare Workers as a Guide to Whom to Test or Immunize
Authors: Brunell Philip Alfred , Wood David 
Published: February 2006

Abstract
Only 1.6% of 1,331 hospital workers were seronegative for varicella-zoster virus (VZV), including 8.7% of those with a negative history and 0.5% of those with a positive history. Seronegativity was inversely related to age but unrelated to job category, exposure at work to VZV, country of origin, race, or gender.
Issues in the Management of Resistant Bacteria in Long-Term–Care Facilities
Authors: Bradley Suzanne F. 
Published: February 2006

AbstractThe prevalence of antibiotic-resistant bacteria in the long-term–care setting and the risk to nursing home residents is still unknown. Few studies have been done in community-based nursing homes, and most have focused on colonization rather than infection rates. Concerns about methicillin-resistantStaphylococcus aureusand vancomycin-resistant enterococci have been expressed most often, while relatively scant attention has been paid to the problem of antibiotic resistance in gram-negative bacilli. Antibiotic resistance precautions need to be developed for nursing homes that are simple, effective, inexpensive, and recognize the unique rehabilitative and long-term custodial missions of chronic-care facilities.
Attributable Morbidity and Mortality of Catheter-Related Septicemia in Critically Ill Patients: a Matched, Risk-Adjusted, Cohort Study
Authors: Soufir Lilia , Timsit Jean-François , Mahe Cédric , Carlet Jean , Regnier Bernard , Chevret Sylvie 
Published: February 2006

Objective:To determine the attributable risk of death due to catheter-related septicemia (CRS) in critically ill patients when taking into account severity of illness during the intensive-care unit (ICU) stay but before CRS.Design:Pairwise-matched (1:2) exposed-unexposed study.Setting:10-bed medical-surgical ICU and an 18-bed medical ICU.Patients:Patients admitted to either ICU between January 1, 1990, and December 31, 1995, were eligible. Exposed patients were defined as patients with CRS; unexposed controls were selected according to matching variables.Methods:Matching variables were diagnosis at ICU admission, length of central catheterization before the infection, McCabe Score, Simplified Acute Physiologic Score (SAPS) II at admission, age, and gender. Severity scores (SAPS II, Organ System Failure Score, Organ Dysfunction and Infection Score, and Logistic Organ Dysfunction System) were calculated four times for each patient: the day of ICU admission, the day of CRS onset, and 3 and 7 days before CRS. Matching was successful for 38 exposed patients. Statistical analysis was based on nonparametric tests for epidemiological data and on Cox's models for the exposed-unexposed study, with adjustment on matching variables and prognostic factors of mortality.Results:CRS complicated 1.17 per 100 ICU admissions during the study period. Twenty (53%) of the CRS cases were associated with septic shock. CRS was associated with a 28% increase in SAPS II. Crude ICU mortality rates from exposed and unexposed patients were 50% and 21%, respectively. CRS remained associated with mortality even when adjusted on other prognostic factors at ICU admission (relative risk [RR], 2.01; 95% confidence interval [CI95], 1.08-3.73; P=.03). However, after adjustment on severity scores calculated between ICU admission and 1 week before CRS, the increased mortality was no longer significant (RR, 1.41; CI95, 0.76-2.61; P=.27).Conclusion:CRS is associated with subsequent morbidity and mortality in the ICU, even when adjusted on severity factors at ICU admission. However, after adjustment on severity factors during the ICU stay and before the event, there was only a trend toward CRS-attributable mortality. The evolution of patient severity should be taken into account when evaluating excess mortality induced by nosocomial events in ICU patients.
Risk Assessment for Surgical-Site Infections in Orthopedic Patients
Authors: Boer Annette S. de , Groot A. Joke Mintjes-de , Severijnen Antonius J. , van den Berg Jan Maarten J. , van Pelt Wilfrid 
Published: February 2006

Objective:To assess the relative importance of risk factors for surgical-site infections (SSIs) in orthopedic patients and thereby determine which risk factors to monitor in the national surveillance of SSI in The Netherlands.Design:Reanalysis of data on SSI and associated risk factors from two surveillance projects on nosocomial infections, carried out in 1992 and 1993 in The Netherlands: Project Surveillance Nosocomial Infections in the region of Utrecht (PSZU) and the first Project Surveillance Surgical Wound Infections (SWIFT-1). Odds ratios (ORs) were calculated for age, gender, preoperative stay, and the number of operations. In addition, in PSZU, other nosocomial infections, and, in SWIFT-1, prophylactic antibiotics, acute surgery, and wound contamination were studied.Participants:The study was confined to hospitalized orthopedic patients (PSZU, 4,872; SWIFT-1, 6,437).Results:In PSZU, the following ORs were significant in a multivariate model: age 0-44 years, 1.0; 45-64 years, 1.6; 65-74 years, 4.7; and 75-99 years, 6.0. For a preoperative stay over 4 days, the OR was 3.3 (95% confidence interval [CI95], 2.5-4.0), and for multiple surgery, 2.5 (CI95, 1.9-3.0). For females, the OR was 0.8 (not significant). The same model applied to SWIFT-1 gave similar ORs. Adjustment for additional nosocomial infections (PSZU) decreased the ORs for ages over 65 years remarkably. The OR for additional nosocomial infections in patients under 65 years of age was 15.6 (CI95, 4.3-57.4). Adjustment for prophylactic antibiotics, acute surgery, and wound-contamination class (SWIFT-1) did not influence the ORs of the original model, but showed that wound-contamination class was an important risk factor.Conclusions:Age, additional nosocomial infections, wound-contamination class, preoperative stay, and the number of operations were identified as important risk factors for SSI in Dutch orthopedic patients.
A Survey of Methods Used to Detect Nosocomial Legionellosis Among Participants in the National Nosocomial Infections Surveillance System
Authors: Fiore Anthony E. , Butler Jay C. , Emori T. Grace , Gaynes Robert P. 
Published: February 2006

Objective:To help define the scope of nosocomial legionnaire's disease (LD) and to assess use of recommended diagnostic methods and transmission control practices.Methods:We surveyed 253 hospitals participating in the National Nosocomial Infections Surveillance (NNIS) System. The anonymous survey included questions about episodes of nosocomial LD, environmental sampling practices, maintenance of hospital water systems, and diagnostic techniques.Results:Of 192 hospitals that responded, 29% reported at least one episode of nosocomial ID from 1990 through 1996, and 61% of these reported at least two episodes. Of 79 hospitals with transplant programs, 42% reported nosocomial LD, compared with 20% of hospitals without transplant programs. Environmental sampling had been conducted by 55% of hospitals, including 79% of those reporting nosocomial LD.Legionellawere isolated in 34% that sampled potable water and 19% that sampled cooling system reservoirs. Supplemental potable-water decontamination systems were installed in 20% of hospitals. Only 19% routinely performed testing for legionellosis among patients at high risk for nosocomial LD.Conclusions:Nosocomial LD is relatively common among NNIS hospitals, especially those performing organ transplants. Environmental sampling forLegionellais a common practice among NNIS hospitals, andLegionellaoften are isolated from sampled hospital cooling towers and hospital potable-water systems. Hospitals have responded to suspected nosocomial LD infection with a variety of water sampling and control strategies; some have not attempted to sample or decontaminate water systems despite identified transmission.
Nosocomial Tuberculosis Exposure in an Outpatient Setting Evaluation of Patients Exposed to Healthcare Providers With Tuberculosis
Authors: Bock Naomi N. , Sotir Mark J. , Parrott Patricia L. , Blumberg Henry M. 
Published: February 2006

Objective:To evaluate the risk of tuberculosis (TB) transmission to patients potentially exposed to two healthcare providers who worked in outpatient settings for several weeks prior to being diagnosed with acid-fast bacilli smear-positive pulmonary TB.Design:Potentially exposed patients were notified by letter and television reports of the recommended evaluation for TB infection or disease and availability of free screening at the hospital. Prevalence of infection in the screened patients and the incidence rate of TB over the subsequent 2 years were compared to those of a control group of unexposed outpatients.Setting:An urban inner-city hospital.Patients:1,905 patients with potential exposure to the ill healthcare workers; 487 (25%) presented for evaluation. Controls consisted of 951 unexposed patients.Results:361 potentially exposed patients had their tuberculin test read; 97 (27%) had a purified protein derivative ≥10 mm. In the comparison group, 148 (25%) of 600 with test readings had a ≥10-mm reaction (risk ratio, 1.18; 95% confidence interval, 0.86-1.60). In multivariate analysis, male gender, non-white race, and older age were significantly associated with a positive tuberculin test; exposure was not. No TB cases were identified during screening. Two years after the exposure, 7 TB cases had been reported to the state registry among 1,905 potentially exposed patients (184 cases/100,000 person-years) versus 4 cases in the comparison group of 951 (210 cases/100,000 person-years).Conclusions:Evaluation of patients exposed to health-care workers with TB disease in ambulatory settings of an inner-city hospital revealed no evidence of transmission ofMycobacterium tuberculosisdue to the exposure.
Effect of Zidovudine Postexposure Prophylaxis on the Development of HIV-Specific Cytotoxic T-Lymphocyte Responses in HIV-Exposed Healthcare Workers
Authors: D'Amico Ronnie , Pinto Ligia A. , Meyer Peter , Landay Alan L. , Harris Alan A. , Clerici Mario , Berzofsky Jay A. , Shearer Gene M. , Kessler Harold A. 
Published: February 2006

AbstractWe evaluated the effects of zidovudine postexposure prophylaxis (PEP) on the development of human immunodeficiency virus (HIV) envelope-specific cytotoxic T-lymphocyte responses in 20 healthcare workers with occupational exposures to HIV. Seven healthcare workers were treated with zidovudine PER Only 1 of 7 treated, versus 6 of 13 not treated, developed an HIV envelope-specific cytotoxic T-lymphocyte response. These data suggest that zidovudine abrogated HIV-specific cytotoxic T-lymphocyte responses. HIV-specific cytotoxic T-lymphocyte responses may be useful as a surrogate marker of HIV replication in the evaluation of new regimens for PEP of occupational HIV exposures.