bluuebunny/crossref_metadata_2025_split huggingface dataset:
Antibiotic-Stewardship Practices at Top Academic Centers Throughout the United States and at Hospitals Throughout Massachusetts
Authors: Barlam Tamar F. , DiVall Margarita 
Published: June 2006

Objective.Improvements in antibiotic prescribing to reduce bacterial resistance and control hospital costs is a growing priority, but the way to accomplish this is poorly defined. Our goal was to determine whether certain antibiotic stewardship interventions were universally instituted and accepted at top US academic centers and to document what interventions, if any, are used at both teaching and community hospitals within a geographic area.Design.Two surveys were conducted. In survey 1, detailed phone interviews were performed with the directors of antibiotic stewardship programs at 22 academic medical centers that are considered among the best for overall medical care in the United States or as leaders in antibiotic stewardship programs. In survey 2, teaching and community hospitals throughout Massachusetts were surveyed to ascertain what antibiotic oversight program components were present.Results.In survey 1, each of the 22 participating hospitals had instituted interventions to improve antibiotic prescribing, but none of the interventions were universally accepted as essential or effective. In survey 2, of 97 surveys that were mailed to prospective participants, a total of 54 surveys from 19 teaching hospitals and 35 community hospitals were returned. Ninety-five percent of the teaching hospitals had a restricted formulary, compared with 49% of the community hospitals, and 89% of teaching hospitals had an antibiotic approval process, compared with 29% of community hospitals.Conclusion.There was great variability among the approaches to the oversight of antibiotic prescribing at major academic hospitals. Antibiotic management interventions were lacking in more than half of the Massachusetts community hospitals surveyed. More research is needed to define the best antibiotic stewardship interventions for different hospital settings.
Comparison of UV C Light and Chemicals for Disinfection of Surfaces in Hospital Isolation Units
Authors: Andersen B. M. , Bånrud H. , Bøe E. , Bjordal O. , Drangsholt F. 
Published: June 2006

Objective.To determine the bactericidal effect on surfaces of ceiling- and wall-mounted UV C (UVC) light (wavelength, 254 nm) in isolation units, compared with standard hospital environmental cleaning and chemical disinfection during final disinfection after patients are treated for infections.Design.Microbial samples were obtained from surfaces in isolation units (patient room, anteroom, and bathroom) before and after irradiation with UVC, chloramine disinfection, and standard hospital environmental cleaning. Samples were tested using standard contact plates.Setting.Four identical, negative air-pressure isolation units (patient room, anteroom, and bathroom) with a defined number of ceiling-and wall-mounted UVC light units. The UVC distribution was monitored in one isolation unit after irradiation for approximately 40 minutes, corresponding to doses ranging from 160 J/m2in a shadowed area to 19,230 J/m2at the mostly highly exposed site (which is high enough to inactivate most bacterial organisms, including spores).Results.UVC disinfection significantly reduced the number of bacteria on surfaces directly or indirectly exposed to UVC to a very low number, as did 5% chloramine disinfection alone (P<.001 for both). Completely shadowed areas in the isolation unit (eg, the bed rail, lockers, and mattresses) still required disinfection by chemicals.Conclusion.Disinfection with UVC light may significantly reduce environmental bacterial contamination and thereby protect the next patient housed in an isolation room. UVC disinfection may not be used alone but is a good addition to chemical disinfection.
The Importance of Addressing Multidrug Resistance and Not Assuming Single-Drug Resistance in Case-Control Studies
Authors: D'Agata Erika M. C. , Cataldo Maria Adriana , Cauda Roberto , Tacconelli Evelina 
Published: June 2006

Background.Case-control studies analyzing antibiotic exposure as a risk factor for antimicrobial resistance usually assume single-drug resistance in the bacteria under study, even though resistance to multiple antimicrobials may be present. Since antibiotic selection pressures differ depending on the susceptibility profile of the antimicrobial-resistant bacteria, an accurate assessment of whether exposure to an individual antimicrobial is a risk factor for the emergence of resistance should distinguish between single-drug–resistant and multidrug-resistant bacteria.Objective.To determine whether the exposures to individual antibiotics that were identified as independent risk factors in case-control studies differed depending on whether single-drug–resistant or multidrug-resistant bacteria were evaluated.Design.Two retrospective case-control studies were performed with data on patients harboringPseudomonas aeruginosastrains resistant only to ciprofloxacin (CRPA) and patients harboringP. aeruginosastrains resistant to ciprofloxacin and other antibiotics (multidrug-resistantP. aeruginosa[MDR-PA]). These 2 groups were compared with patients not harboringP. aeruginosa.Setting.Two tertiary care hospitals.Results.A total of 41 patients harboring CRPA and 151 patients harboring MDR-PA were identified and matched to 192 control subjects. By conditional logistic regression, independent risk factors associated with presence of CRPA were nonambulatory status (OR, 5.6 [95% confidence interval {CI}, 1.4-23];P= .02) and prior ciprofloxacin exposure (OR, 5.0 [95% CI, 1.2-21];P= .03). Independent risk factors for presence of MDR-PA were a Charlson score greater than 2 (OR, 3.3 [95% CI 1.8-6.0];P<.001) and exposure to quinolones (OR, 2.8 [95% CI, 1.2-5.0];P= .001), third- and fourth-generation cephalosporins (OR, 3.5 [95% CI, 1.7-7.1];P<.001), imipenem (OR, 3.8 [95% CI, 1.2-12.1];P= .02), and/or aminoglycosides (OR, 2.3 [95% CI, 1.04-5.1];P= .04).Conclusion.There were substantial differences in exposure to individual antimicrobials between patients harboring CRPA and patients harboring MDR-PA. Future case-control studies addressing risk factors for single-drug–resistant bacteria should consider the complete susceptibility profile of the bacteria under investigation.
Inaccurate Communications in Telephone Calls to an Antimicrobial Stewardship Program
Authors: Linkin Darren R. , Paris Sarah , Fishman Neil O. , Metlay Joshua P. , Lautenbach Ebbing 
Published: June 2006

Background.Antimicrobial stewardship programs (ASPs) decrease unnecessary antimicrobial use, decrease antimicrobial resistance, and improve patient outcomes. The effectiveness of a prior approval system—that is, the requirement that approval be obtained from ASP practitioners before certain antimicrobials can be used—depends on the accuracy of the patient data communicated from the primary service.Objectives.To determine the incidence of inaccurate communication of patient data during ASP interactions, describe examples of inaccurate communications, and identify risk factors for inaccurate communication.Design.We used a retrospective cohort design. We evaluated the communicated patient data for clinically important inaccuracies, using the patients' medical records as the gold standard.Setting.A tertiary care medical center that has a prior approval system for restricted antimicrobials.Patients.Inpatients discussed in telephone ASP interactions.Intervention.Observational study.Results.Of telephone calls requesting prior approval from ASP practitioners, 39% (95% confidence interval [CI], 31%-48%) contained an inaccuracy in at least 1 type of patient data (eg, current antimicrobial therapy); the incidence varied widely between data types. Examples of inaccuracies are given to demonstrate their clinical relevance. In multivariable analysis, inaccurate communications were more common for telephone calls from surgical services (versus calls from nonsurgical services: odds ratio, 2.1 [95% CI, 1.1-3.9]) and for calls received by Infectious Diseases fellows (versus pharmacists: odds ratio, 2.0 [95% CI, 1.1-3.8]).Conclusions.A high proportion of ASP calls requesting prior approval included patient data inaccuracies, which have the potential to affect the prescribing of antimicrobials. Although risk factors were identified, these communication errors were common across the different types of ASP interactions. Inaccurate communications may compromise the utility of ASPs that use a prior approval system for optimizing antimicrobial use.
Acquisition of Multidrug-Resistant Organisms Among Hospital Patients Hospitalized in Beds Adjacent to Critically Ill Patients
Authors: Cohen Matan J. , Anshelevich Olga , Raveh David , Broide Ellen , Rudensky Bernard , Yinnon Amos M. 
Published: June 2006

Objective.To assess whether patients hospitalized in beds physically adjacent to critically ill patients are at increased risk to acquire multidrug-resistant pathogens.Design.Cohort study.Setting.Shaare Zedek Medical Center, a 550-bed medical referral center.Patients.From April to September 2004, we enrolled consecutive newly admitted patients who were hospitalized in beds adjacent to either mechanically ventilated patients or patients designated as “do not resuscitate” (DNR). For each of these patients, we also enrolled a control patient who was not hospitalized in a bed adjacent to a critically ill patient. We collected specimens from the anterior nares, the oral cavity, and the perianal zone at the time of admission and subsequently at 3-day intervals until discharge or death. Specimens were cultured on selective media to detect growth of antibiotic-resistant pathogens, includingAcinetobacter baumannii, methicillin-resistantStaphylococcus aureus(MRSA), extended-spectrum β lactamase (ESBL)–producing Enterobacteriaceae, and vancomycin-resistant enterococci (VRE).Results.We enrolled 46 neighbor-control pairs. Among neighbors and controls, respectively, the incidence rates for isolation ofA. baumanniiwas 8.3 and 4 isolations per 100 patient-days (relative risk [RR], 2.1 [95% confidence interval {CI}, 0.8-5.2];P= .12), the incidence rates for MRSA were 1.4 and 2.6 isolations per 100 patient-days (RR, 0.6 [95% CI, 0.1-2.3];P= .45), the incidence rates for ESBL-producing Enterobacteriaceae were 10.5 and 9 isolations per 100 patient-days (RR, 1.2 [95% CI, 0.6-2.4];P= .84), the incidence rates for VRE were 4.3 and 4.8 isolations per 100 patient-days (RR, 0.9 [95% CI, 0.3-2.4];P= 1), and the composite incidence rate was 21.7 and 16.2 isolations per 100 patient-days (RR, 1.3 [95% CI, 0.8-2.3];P= 0.3).Conclusions.In this pilot study, we did not detect an increased incidence rate of isolation of multidrug-resistant pathogens among patients hospitalized in beds adjacent to critically ill patients. Further studies with larger samples should be conducted in order to generate valid data and provide patients, physicians, and policy makers with a sufficient knowledge base from which decisions can be made.
A Web-Based Course on Infection Control for Physicians in Training An Educational Intervention
Authors: Fakih Mohamad G. , Enayet Iram , Minnick Steven , Saravolatz Louis D. 
Published: June 2006

Objective.To evaluate the effectiveness of a Web-based course on infection control accessed by physicians in training.Design.Educational intervention.Setting.A 607-bed urban teaching hospital.Participants.A total of 55 physicians in training beginning their first postgraduate year (the iPGYl group) and 59 physicians completing their first, second, or third postgraduate year (the oPGY group).Intervention.Individuals in the iPGYl group took a Web-based course on infection control practices.Measurements.Persons in the iPGYl group who took the Web-based course completed an evaluation test consisting of 15 multiple-choice questions (total possible score, 15 points). The same test was given to persons in the oPGY group, who did not take the Web-based course. We compared scores of the Web-based test taken by subjects in the iPGYl group immediately after the course with scores of the test they took 3 months after the course and with test scores of subjects in the oPGY group.Results.The mean score (±SD) for subjects in the iPGYl group who took the Web-based course was 10.6 ± 2.2, compared with 8.0 ± 2.5 for subjects in the oPGY group (P<.001). The mean score (±SD) for subjects in the iPGYl group 3 months after completing the course decreased to 8.0 ± 2.4 (P< .001 by the paired f test). For the oPGY group, significant differences were found between the scores (±SD) for subjects in the internal medicine (9.9 ± 2.3), emergency medicine (8.4 ± 1.7), pediatrics (7.0 ± 1.7), and family medicine (5.8 ± 1.6) residency programs (P< .001); there were no significant differences in scores according to the year of residency.Conclusions.Web-based infection control courses are an attractive teaching tool for physicians in training and need to be considered for teaching infection control. The evaluation of information retention will help identify physicians in training who require further training.
A Multicenter Intervention to Prevent Catheter-Associated Bloodstream Infections
Authors: Warren David K. , Cosgrove Sara E. , Diekema Daniel J. , Zuccotti Gianna , Climo Michael W. , Bolon Maureen K. , Tokars Jerome I. , Noskin Gary A. , Wong Edward S. , Sepkowitz Kent A. , Herwaldt Loreen A. , Perl Trish M. , Solomon Steven L. , Fraser Victoria J. 
Published: June 2006

Background.Education-based interventions can reduce the incidence of catheter-associated bloodstream infection. The generalizability of findings from single-center studies is limited.Objective.To assess the effect of a multicenter intervention to prevent catheter-associated bloodstream infections.Design.An observational study with a planned intervention.Setting.Twelve intensive care units and 1 bone marrow transplantation unit at 6 academic medical centers.Patients.Patients admitted during the study period.Intervention.Updates of written policies, distribution of a 9-page self-study module with accompanying pretest and posttest, didactic lectures, and incorporation into practice of evidence-based guidelines regarding central venous catheter (CVC) insertion and care.Measurements.Standard data collection tools and definitions were used to measure the process of care (ie, the proportion of non-tunneled catheters inserted into the femoral vein and the condition of the CVC insertion site dressing for both tunneled and nontunneled catheters) and the incidence of catheter-associated bloodstream infection.Results.Between the preintervention period and the postintervention period, the percentage of CVCs inserted into the femoral vein decreased from 12.9% to 9.4% (relative ratio, 0.73; 95% confidence interval [CI], 0.61-0.88); the total proportion of catheter insertion site dressings properly dated increased from 26.6% to 34.4% (relative ratio, 1.29; 95% CI, 1.17-1.42), and the overall rate of catheter-associated bloodstream infections decreased from 11.2 to 8.9 infections per 1,000 catheter-days (relative rate, 0.79; 95% CI, 0.67-0.93). The effect of the intervention varied among individual units.Conclusions.An education-based intervention that uses evidence-based practices can be successfully implemented in a diverse group of medical and surgical units and reduce catheter-associated bloodstream infection rates.
AcinetobacterSkin Colonization of US Army Soldiers
Authors: Griffith Matthew E. , Ceremuga Julia M. , Ellis Michael W. , Guymon Charles H. , Hospenthal Duane R. , Murray Clinton K. 
Published: June 2006

Objective.To evaluate whether skin colonization withAcinetobacter calcoaceticus-baumanniicomplex exists in a population of healthy, nondeployed US Army soldiers and, if present, how it might relate to the infections seen in current war casualties.Design.We sampled various skin sites of soldiers to test for the presence ofA. calcoaceticus-baumanniicomplex and to establish the prevalence of colonization. We then used ribotyping and antimicrobial susceptibility profiles to compare the isolates we recovered withA. calcoaceticus-baumanniicomplex isolates from injured soldiers.Setting.Fort Sam Houston, Texas.Participants.A population of healthy, nondeployed US Army soldiers in training.Results.A total of 17% of healthy soldiers were found to harborA. calcoaceticus-baumanniicomplex. However, the strains differed from those recovered from injured soldiers.Conclusions.Skin carriage ofA. calcoaceticus-baumanniicomplex exists among soldiers before deployment. However, the difference in the strains isolated from healthy soldiers, compared with the strains from injured soldiers, makes it difficult to identify skin colonization as the source of infection.
Control of an Outbreak of Multidrug-ResistantAcinetobacter baumannii-calcoaceticusColonization and Infection in an Intensive Care Unit (ICU) Without Closing the ICU or Placing Patients in Isolation
Authors: Wilks Mark , Wilson Anne , Warwick Simon , Price Elizabeth , Kennedy Daniel , Ely Andrew , Millar Michael R. 
Published: June 2006

Objective.To describe the control of multidrug-resistantAcinetobacter baumannii-calcoaceticus(MDRABC) colonization and infection in an intensive care unit (ICU).Setting.An 18-bed ICU in a large tertiary care teaching hospital in London.Interventions.After recognition of the outbreak, a range of infection control measures were introduced over several months that were primarily aimed at reducing environmental contamination with the outbreak strain. Strategies included use of a closed tracheal suction system for all patients receiving mechanical ventilation, use of nebulized colistin for patients with evidence of mild to moderate ventilator-associated pneumonia, improved availability of alcohol for hand decontamination, and clearer designation of responsibilities and strategies for cleaning equipment and the environment in the proximity of patients colonized or infected with MDRABC.Results.The outbreak lasted from June 2001 through November 2002 and involved 136 new cases of MDRABC infection or colonization. The number of newly diagnosed cases per month reached a maximum of 15 in February 2002, and the number of new cases slowly decreased over the next 9 months.Conclusion.This outbreak was controlled by emphasizing the control of environmental reservoirs and did not require recourse to ward closure or placement of affected patients in isolation.
Retrospective Analysis of Multidrug-ResistantAcinetobacter baumanniiStrains Isolated During a 4-Year Period in a University Hospital
Authors: Fillaux Judith , Dubouix Anne , Conil Jean-Marie , Laguerre Jacky , Marty Nicole 
Published: June 2006

Objective.To describe the epidemiology ofAcinetobacter baumanniiinfection during 2000-2003 and to determine whether the multidrug-resistant strains were already present in our Toulouse hospital before the 2003 French national outbreak.Design.Descriptive molecular and clinical epidemiologic study ofA. baumanniiisolates using a combination of antibiotyping and pulsed-field gel electrophoresis (PFGE).Setting.A 1,000-bed university hospital in Toulouse, France.Methods.All clinical samples that had tested positive forA. baumanniibetween January 1, 2000, and December 31, 2003, were collected. Multidrug-resistant isolates ofA. baumanniiwere then submitted to PFGE, and clinical characteristics of the source patients were noted.Results.A total of 1,277A. baumanniisamples were identified, 791 of which had not been previously identified; 148 were positive for multidrug-resistant strains. These strains were more likely to have been isolated in the intensive care unit (ICU) than were susceptible strains (P<.001; relative hazard, 3.77). The positive clinical samples were of various types (eg, nonprotected respiratory samples [43%] and blood [5%]), but no difference in type of source was seen between resistant and susceptible strains. A simultaneous analysis of pulsotypes and antibiotypes proved that the outbreak in the ICU in 2003 could be linked to an initially endemic clone that had been isolated in 2001. Furthermore, a second clone responsible for an extended-spectrum β-lactamase phenotype was sporadically present in our institution. Although the strains isolated in the burn unit were also genetically related one to another, the specific responsible clone only appeared in 2003.Conclusion.Several multidrug-resistant clones can coexist endemically for several years and can be detected during an outbreak by close survey of epidemic sources.
Intraoperative Tidal Volume as a Risk Factor for Respiratory Failure after Pneumonectomy
Authors: Fernández-Pérez Evans R. , Keegan Mark T. , Brown Daniel R. , Hubmayr Rolf D. , Gajic Ognjen 
Published: June 2006

Background
Respiratory failure is a leading cause of postoperative morbidity and mortality in patients undergoing pneumonectomy. The authors hypothesized that intraoperative mechanical ventilation with large tidal volumes (VTs) would be associated with increased risk of postpneumonectomy respiratory failure.

Methods
Patients undergoing elective pneumonectomy at the authors' institution from January 1999 to January 2003 were studied. The authors collected data on demographics, relevant comorbidities, neoadjuvant therapy, pulmonary function tests, site and type of operation, duration of surgery, intraoperative ventilator settings, and intraoperative fluid administration. The primary outcome measure was postoperative respiratory failure, defined as the need for continuation of mechanical ventilation for greater than 48 h postoperatively or the need for reinstitution of mechanical ventilation after extubation.

Results
Of 170 pneumonectomy patients who met inclusion criteria, 30 (18%) developed postoperative respiratory failure. Causes of postoperative respiratory failure were acute lung injury in 50% (n = 15), cardiogenic pulmonary edema in 17% (n = 5), pneumonia in 23% (n = 7), bronchopleural fistula in 7% (n = 2), and pulmonary thromboembolism in 3% (n = 1). Patients who developed respiratory failure were ventilated with larger intraoperative VT than those who did not (median, 8.3 vs. 6.7 ml/kg predicted body weight; P < 0.001). In a multivariate regression analysis, larger intraoperative VT (odds ratio, 1.56 for each ml/kg increase; 95% confidence interval, 1.12-2.23) was associated with development of postoperative respiratory failure. The interaction between larger VT and fluid administration was also statistically significant (odds ratio, 1.36; 95% confidence interval, 1.05-1.97).

Conclusion
Mechanical ventilation with large intraoperative VT is associated with increased risk of postpneumonectomy respiratory failure.