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Meta-analysis on central line-associated bloodstream infections associated with a needleless intravenous connector with a new engineering design

Abstract

BACKGROUND: Intravenous needleless connectors (NCs) with a desired patient safety design may facilitate effective intravenous line care and reduce the risk for central line-associated bloodstream infection (CLA-BSI). We conducted a meta-analysis to determine the risk for CLA-BSI associated with the use of a new NC with an improved engineering design.… Read more

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Multicenter cohort study to assess the impact of a silver-alloy and hydrogel-coated urinary catheter on symptomatic catheter-associated urinary tract infections

Abstract

PURPOSE: The purpose of this study was to determine the effect of a silver-alloy hydrogel catheter on symptomatic catheter-associated urinary tract infections (CAUTIs).

DESIGN: Multicenter before-after non-randomized cohort study.

SUBJECTS AND SETTING: Seven acute care hospitals ranging in size from 124 to 607 beds participated in this study.… Read more

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Community-acquired, non-occupational needlestick injuries treated in US Emergency Departments

Abstract

BACKGROUND: The escalating number of persons self-injecting medications, predominantly insulin, has generated concerns that the public is at risk of acquiring blood-borne infections from discarded needles/syringes. Communities have developed disposal guidelines but a debate continues over the need for further legislation and/or at-home safety devices.… Read more

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Colonization pressure as a risk factor for colonization by multiresistant Acinetobacter spp and carbapenem-resistant Pseudomonas aeruginosa in an intensive care unit

Abstract

OBJECTIVE: To determine factors associated with colonization by carbapenem-resistant Pseudomonas aeruginosa and multiresistant Acinetobacter spp.

METHODS: Surveillance cultures were collected from patients admitted to the intensive care unit at admission, on the third day after admission and weekly until discharge.… Read more

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Socioeconomic impact on device-associated infections in pediatric intensive care units of 16 limited-resource countries: international Nosocomial Infection Control Consortium findings

Abstract

OBJECTIVES: We report the results of the International Nosocomial Infection Control Consortium prospective surveillance study from January 2004 to December 2009 in 33 pediatric intensive care units of 16 countries and the impact of being in a private vs. public hospital and the income country level on device-associated health care-associated infection rates.… Read more

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National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at United States health care facilities, 2010

Abstract

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most prevalent multidrug-resistant organisms causing health care-associated infections. Limited data are available about how the prevalence of MRSA has changed over the past several years and what MRSA prevention practices have been implemented since the 2006 Association for Professionals in Infection Control and Epidemiology, Inc, MRSA survey.… Read more

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Health care-associated infection outbreak investigations by the Centers for Disease Control and Prevention, 1946-2005

Abstract

Since 1946, Centers for Disease Control and Prevention (CDC) personnel have investigated outbreaks of infections and adverse events associated with delivery of health care. CDC Epidemic Intelligence Service officers have led onsite investigations of these outbreaks by systematically applying epidemiology, statistics, and laboratory science.… Read more

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Socioeconomic impact on device-associated infections in limited-resource neonatal intensive care units: findings of the INICC

Abstract

PURPOSE: To evaluate the impact of country socioeconomic status and hospital type on device-associated healthcare-associated infections (DA-HAIs) in neonatal intensive care units (NICUs).

METHODS: Data were collected on DA-HAIs from September 2003 to February 2010 on 13,251 patients in 30 NICUs in 15 countries.… Read more

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Economic impact of use of chlorhexidine-impregnated sponge dressing for prevention of central line-associated infections in the United States

Abstract

BACKGROUND: The economic impact of adding chlorhexidine gluconate (CHG)-impregnated sponge dressing to standard care (ie, chg-impregnated sponge dressing + skin preparation and transparent film dressing vs skin preparation and transparent film dressing) for the prevention of central-line infections was evaluated.… Read more

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Polycystic ovary syndrome in the United States: clinical visit rates, characteristics, and associated health care costs

Abstract

Background:  There are no national data on polycystic ovary syndrome (PCOS), a hormonal disorder of reproductive-aged women and the most frequent cause of oligoovulatory infertility.

Objective:  To assess the patient characteristics, treatment provided, and healthcare costs associated with PCOS medical visits in the United States.… Read more

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Risk factors and risk adjustment for surgical site infections in pediatric cardiothoracic surgery patients

Abstract

BACKGROUND: The complexity of congenital cardiac defects and the aggressive medical management required to support patients through their recovery place children at high risk for surgical site infection (SSI).

METHODS: We conducted a retrospective review of children undergoing cardiothoracic surgery at a tertiary care referral center between January 1, 2000, and June 30, 2001.… Read more

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Guidelines on blood cultures

Abstract

Just over one-third of sepsis patients have positive blood cultures, mainly due to inadequate sampling volumes (50% of adults have < 1.0 CFU/mL blood) and the prior use of antibiotics. However, 20-30% of sepsis patients are given inappropriate empirical antibiotics. The Clinical and Laboratory Standards Institute guidelines recommend paired culture sets to help discriminate between contaminant organisms and true pathogens; four 10-mL bottles (2 sets) should be used for the initial evaluation to detect about 90-95% of bacteremias and six 10-mL bottles (3 sets) should be used to detect about 95-99% of bacteremias. It has also been shown that the positivity rate increased by 15-35% with resin-based media in patients on antibiotics. For diagnosing catheter-related bloodstream infections, differential time-to-positivity is one method recommended to help determine whether the catheter is truly the source of infection. The proper training of personnel with regard to drawing an appropriate blood volume and the importance of clear labeling of culture bottles is also of critical importance. Furthermore, if the contamination rate is relatively high, hiring dedicated staff who are well-trained in order to get a lower blood culture contamination rate may be cost-effective. It is because high false-positive blood culture rates due to contamination are associated with significantly increased hospital and laboratory charges.

Towns ML, Jarvis WR, Hsueh PR

J Microbiol Immunol Infect 2010 Aug;43(4):347-9

PMID: 20688297… Read more

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Prevention of central venous catheter-associated bloodstream infections in pediatric intensive care units: a performance improvement collaborative

Abstract

OBJECTIVE: The goal of this effort was to reduce central venous catheter (CVC)-associated bloodstream infections (BSIs) in pediatric intensive care unit (ICU) patients by means of a multicenter evidence-based intervention.

METHODS: An observational study was conducted in 26 freestanding children’s hospitals with pediatric or cardiac ICUs that joined a Child Health Corporation of America collaborative.… Read more

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Healthcare-associated infection in Italy: annual point-prevalence surveys, 2002-2004

Abstract

OBJECTIVE: Healthcare-associated infections (HAIs) are an important cause of morbidity and mortality worldwide. During the period from 2002 through 2004, a group of Italian hospitals was recruited to conduct HAI point-prevalence surveys.

DESIGN: Three point-prevalence surveys.

METHODS: A total of 9,609 patients were surveyed.… Read more

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Gram-negative bloodstream infections in hematopoietic stem cell transplant patients: the roles of needleless device use, bathing practices, and catheter care

Abstract

BACKGROUND: Between August 1 and October 30, 1998 (outbreak period), an increased incidence of central venous catheter (CVC)-associated gram-negative bacterial bloodstream infection (GN-BSI) was detected in hematopoietic stem cell transplantation (HSCT) candidates and recipients in an outpatient HSCT unit. The objectives of the present study were to determine strategies for controlling the outbreak and identify risk factors for GN-BSI.… Read more

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National point prevalence of Clostridium difficile in US health care facility inpatients, 2008

Abstract

BACKGROUND: Recent published estimates of Clostridium difficile infection (CDI) incidence have been based on small numbers of hospitals or national hospital discharge data. These data suggest that CDI incidence is increasing.

METHODS: We conducted a point prevalence survey of C difficile in inpatients at US health care facilities.… Read more

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Decision instrument for the isolation of pneumonia patients with suspected pulmonary tuberculosis admitted through US emergency departments

Abstract

STUDY OBJECTIVE: Many patients with pneumonia are admitted to respiratory isolation for possible tuberculosis (TB), but most do not have active TB. We created a decision instrument to predict which pneumonia patients do not need admission to a TB isolation bed.… Read more

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National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at US health care facilities, 2006

Abstract

BACKGROUND: Despite methicillin-resistant Staphylococcus aureus (MRSA) being endemic in virtually all US health care facilities, there are no data on the prevalence of MRSA in US health care facilities.

METHODS: We conducted a national prevalence survey of MRSA in inpatients at US health care facilities.… Read more

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Reduction in surgical site infections in neurosurgical patients associated with a bedside hand hygiene program in Vietnam

Abstract

OBJECTIVE: We conducted an intervention study to assess the impact of the use of an alcohol-chlorhexidine-based hand sanitizer on surgical site infection (SSI) rates among neurosurgical patients in Ho Chi Minh City, Vietnam.

DESIGN: A quasi-experimental study with an untreated control group and assessment of neurosurgical patients admitted to 2 neurosurgical wards at Cho Ray Hospital between July 11 and August 15, 2000 (before the intervention), and July 14 and August 18, 2001 (after the intervention).… Read more

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Nationwide outbreak of red eye syndrome associated with transfusion of leukocyte-reduced red blood cell units

Abstract

OBJECTIVE: To characterize red eye reactions occurring within 24 hours after receipt of units of leukocyte-reduced red blood cells, determine their etiology, and investigate their potential link to transfusion.

METHODS: We conducted a survey of transfusion facilities nationwide to determine the scope and magnitude of the reactions; performed case-control and cohort studies among transfused patients at the facility where most reactions occurred; and performed animal experiments, using cellulose acetate derivatives extracted from leukocyte-reduction filters and filter precursors, to reproduce reactions.… Read more

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Incidence of pediatric and neonatal intensive care unit-acquired infections

Abstract

OBJECTIVE: To compare the cumulative incidence of infections acquired in the pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU).

DESIGN: Estimation of the cumulative incidence of infections with data obtained from the Pediatric Prevention Network (PPN) point-prevalence survey and observed rates from the National Nosocomial Infections Surveillance (NNIS) system.… Read more

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Pyrogenic reactions in hemodialysis patients, Hanoi, Vietnam

Abstract

Of 33,111 patients admitted to a large hospital in Vietnam from November 2000 through July 2001, a total of 303 were undergoing hemodialysis and had pyrogenic reactions (ie, fever and/or rigors). Ten case patients (3.3%) had documented bacteremia; pathogens were largely waterborne microorganisms.… Read more

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Use of antimicrobial agents in United States neonatal and pediatric intensive care patients

Abstract

OBJECTIVE: Antimicrobial use contributes to the development of emergence and dissemination of antimicrobial-resistant bacteria among intensive care unit (ICU) patients. There are few published data on antimicrobial use in neonatal (NICU) and pediatric ICU (PICU) patients.

METHODS: Personnel at 31 Pediatric Prevention Network hospitals participated in point prevalence surveys on August 4, 1999 (summer) and February 8, 2000 (winter).… Read more

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Saline-filled breast implant contamination with Curvularia species among women who underwent cosmetic breast augmentation

Abstract

BACKGROUND: During December 2000-July 2001, black sediment was noted in saline-filled silicone breast implants of women who had undergone revision surgery at facility A. Curvularia fungus was isolated from implant saline.

METHODS: To identify risk factors for contamination with Curvularia species, we performed case-control, retrospective cohort, and laboratory studies and conducted procedural reviews.… Read more

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The state of the science of health care epidemiology, infection control, and patient safety, 2004

Abstract

Being aware and implementing the latest and best scientific evidence in infection control and health care epidemiology is critical to enhancing patient outcomes. In this review, the latest published scientific data in health care epidemiology and patient safety were reviewed for the period May 2003-May 2004.… Read more

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Improving influenza immunization rates among healthcare workers caring for high-risk pediatric patients

Abstract

OBJECTIVE: To assess influenza vaccination rates of healthcare workers (HCWs) in neonatal intensive care units (NICUs), pediatric intensive care units (PICUs), and oncology units in Pediatric Prevention Network (PPN) hospitals.

PARTICIPANTS: Infection control practitioners and HCWs in NICUs, PICUs, and oncology units.… Read more

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Clostridium infections associated with musculoskeletal-tissue allografts

Abstract

BACKGROUND: Allografts are commonly used in orthopedic reconstructive surgery. In 2001, approximately 875,000 musculoskeletal allografts were distributed by U.S. tissue banks. After the death from Clostridium sordellii sepsis of a 23-year-old man who had received a contaminated allograft from a tissue bank (Tissue Bank A), the Centers for Disease Control and Prevention initiated an investigation, including enhanced case finding, of the methods used for the recovery, processing, and testing of tissue.… Read more

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Emergence of vancomycin-resistant enterococci in San Francisco Bay area hospitals during 1994 to 1998

Abstract

OBJECTIVE: To determine the magnitude of vancomycin-resistant enterococci (VRE) in three counties in the San Francisco Bay area.

DESIGN: Active laboratory-based surveillance for VRE from January 1995 through December 1996 and a laboratory-based and hospital-based questionnaire survey for 1993 to 1994 and 1997 to 1998.… Read more

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Klebsiella pneumoniae bloodstream infections among neonates in a high-risk nursery in Cali, Colombia

Abstract

OBJECTIVES: To determine the cause of an outbreak of Klebsiella pneumoniae bloodstream infections (BSIs) among neonates in a high-risk nursery and to institute control measures.

DESIGN: During the on-site investigation, a cohort study to identify risk factors for K. pneumoniae BSI, a point-prevalence study to assess K.… Read more

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Clinical predictors of bloodstream infections and mortality in hospitalized Malawian children

Abstract

BACKGROUND: In sub-Saharan Africa, bloodstream infections (BSI) are a major cause of pediatric mortality. Because of limited resources and facilities in these developing countries, treatment often must be based solely on clinical observations and patient history and includes the use of broad spectrum antimicrobials, a factor in the emergence of antibiotic resistance.… Read more

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Controlling healthcare-associated infections: the role of infection control and antimicrobial use practices

Abstract

Healthcare-associated infections are a major cause of morbidity and mortality in pediatric patients in the United States and throughout the world. Overall rates of infection range widely depending on the pediatric population, with the highest rates being in patients in neonatal intensive care units, followed by those in pediatric intensive care units, immunocompromised patients, and those undergoing surgical procedures.… Read more

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Antibiotic use for emergency department patients with acute diarrhea: Prescribing practices, patient expectations, and patient satisfaction

Abstract

STUDY OBJECTIVE: Physicians commonly prescribe antibiotics to meet patient expectations, even when antimicrobials are unnecessary. We evaluated factors emergency physicians consider in prescribing antibiotics to patients with diarrhea and examined patient expectations, physician-perceived patient expectations, and patient satisfaction.

METHODS: Adults and children presenting with acute diarrhea to 1 of 10 academic emergency departments (EDs) were enrolled in this prospective observational cohort study.… Read more

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Improving water quality can reduce pyrogenic reactions associated with reuse of cardiac catheters

Abstract

OBJECTIVE: To report the results of our preintervention investigation and subsequent 19-month three-phase intervention study designed to reduce pyrogenic reactions among patients undergoing cardiac catheterization using reprocessed catheters.

DESIGN: A case-control study for the preintervention period and a prospective cohort study for the intervention period.… Read more

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Benchmarking for prevention: the Centers for Disease Control and Prevention’s National Nosocomial Infections Surveillance (NNIS) system experience

Abstract

Healthcare-associated infections are a major cause of morbidity and mortality at hospitals in the United States. Surveillance of these infections identifies secular trends and provides data upon which prevention interventions can be based in order to improve patient safety. National surveillance of healthcare-associated infections was initiated in the United States in 1970.… Read more

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Vancomycin use in hospitalized pediatric patients

Abstract

OBJECTIVES: To assess vancomycin utilization at children’s hospitals, to determine risk factors for vancomycin use and length of therapy, and to facilitate adapting recommendations to optimize vancomycin prescribing practices in pediatric patients.

METHODS: Two surveys were conducted at Pediatric Prevention Network hospitals.… Read more

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Multi-society guideline for reprocessing flexible gastrointestinal endoscopes. Society for Healthcare Epidemiology of America

Abstract

Flexible gastrointestinal endoscopy is a valuable diagnostic and therapeutic tool for the care of patients with gastrointestinal and pancreaticobiliary disorders. Compliance with accepted guidelines for the reprocessing of gastrointestinal endoscopes between patients is critical to the safety and success of their use.… Read more

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Prevalence of and risk factors for colonization with methicillin-resistant Staphylococcus aureus at the time of hospital admission

Abstract

OBJECTIVES: To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization among patients presenting for hospital admission and to identify risk factors for MRSA colonization.

DESIGN: Surveillance cultures were performed at the time of hospital admission to identify patients colonized with S.… Read more

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Prevalence of and risk factors for colonization with methicillin-resistant Staphylococcus aureus in an outpatient clinic population

Abstract

OBJECTIVES: To determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization in an outpatient population and to identify risk factors for MRSA colonization.

DESIGN: Surveillance cultures were performed during outpatient visits to identify S. aureus colonization. A case-control study was performed to identify risk factors for MRSA colonization.… Read more

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Are there regional variations in the diagnosis, surveillance, and control of methicillin-resistant Staphylococcus aureus?

Abstract

OBJECTIVE: To assess the way healthcare facilities (HCFs) diagnose, survey, and control methicillin-resistant Staphylococcus aureus (MRSA).

DESIGN: Questionnaire.

SETTING: Ninety HCFs in 30 countries.

RESULTS: Evaluation of susceptibility testing methods showed that 8 laboratories (9%) used oxacillin disks with antimicrobial content different from the one recommended, 12 (13%) did not determine MRSA susceptibility to vancomycin, and 4 (4.5%) reported instances of isolation of vancomycin-resistant S.… Read more

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SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and enterococcus

Abstract

BACKGROUND: Infection control programs were created three decades ago to control antibiotic-resistant healthcare-associated infections, but there has been little evidence of control in most facilities. After long, steady increases of MRSA and VRE infections in NNIS System hospitals, the Society for Healthcare Epidemiology of America (SHEA) Board of Directors made reducing antibiotic-resistant infections a strategic SHEA goal in January 2000.… Read more

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Epidemiological and microbiological characterization of infections caused by Staphylococcus aureus with reduced susceptibility to vancomycin, United States, 1997-2001

Abstract

Infections caused by Staphylococcus aureus with reduced vancomycin susceptibility (SA-RVS; minimum inhibitory concentration [MIC], or=4 microg/mL), including vancomycin-intermediate S. aureus (VISA; MIC, 8 microg/mL), are a new clinical and public health dilemma. Prospective surveillance and a nested case-control study of patients in the United States infected with SA-RVS was conduced from March 1999 through December 2000.… Read more

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Peripheral blood cell-specific cytokines in persons with untreated HIV infection in Malawi, Africa

Abstract

Human immunodeficiency virus (HIV) infection is the primary cause of morbidity and mortality in Malawi, Africa, because of its many effects on the immune system. Immune cells communicate through cytokines; therefore, we examined the relationships between HIV serostatus and cell-specific cytokine production for 40 asymptomatic, employed adults and 312 acutely ill, hospitalized patients in Malawi.… Read more

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Demographic and immune correlates of human herpesvirus 8 seropositivity in Malawi, Africa

Abstract

BACKGROUND: In the USA, human herpesvirus 8 (HHV-8) is associated with Kaposi’s sarcoma (KS) and HIV infection. We examined HHV-8 seroprevalence in a Malawian cohort, and assessed its relationship with HIV, KS, demographic characteristics, and immune findings.

METHODS: In 1997 and 1998, blood samples were obtained from 272 hospitalized Malawian patients, for whom demographic information was obtained, and 24 healthy volunteers without demographic data.… Read more

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Clinical and immune impact of Mycobacterium bovis BCG vaccination scarring

Abstract

The World Health Organization recommends Mycobacterium bovis BCG vaccination in areas of high tuberculosis prevalence. BCG’s clinical and immune effects, not necessarily Mycobacterium tuberculosis specific, are unclear. BCG vaccine scarring often is used as a surrogate marker of vaccination or of effective vaccination.… Read more

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Risk factors for Burkholderia cepacia complex colonization and infection among patients with cystic fibrosis

Abstract

OBJECTIVES: To determine risk factors for acquiring Burkholderia cepacia complex among patients with cystic fibrosis (CF).

STUDY DESIGN: A case-control study was conducted with active surveillance for B cepacia complex colonization/infection among patients at 21 CF centers from April 1986 to March 1989 (study period).… Read more

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Infection due to extended-spectrum beta-lactamase-producing Salmonella enterica subsp. enterica serotype infantis in a neonatal unit

Abstract

OBJECTIVE: To describe the investigation and control of an outbreak of extended-spectrum beta-lactamase producing Salmonella enterica subsp. enterica serotype Infantis in a neonatal unit in Brazil.

METHODS: A case-control study for risk factors for Salmonella Infantis systemic infection, environmental cultures, and evaluation of staffing and overcrowding and an assessment of infection control practices were performed.… Read more

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Spontaneous cytokine production and its effect on induced production

Abstract

Cytokines regulate cellular immune activity and are produced by a variety of cells, especially lymphocytes, monocytes, and macrophages. Multiparameter flow cytometry is often used to examine cell-specific cytokine production after in vitro phorbol 12-myristate 13-acetate and ionomycin induction, with brefeldin A or other agents added to inhibit protein secretion.… Read more

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Prevalence of surgical-site infections and patterns of antimicrobial use in a large tertiary-care hospital in Ho Chi Minh City, Vietnam

Abstract

BACKGROUND: Few studies have been conducted in Vietnam on the epidemiology of healthcare-associated infections or antimicrobial use. Thus, we sought to determine the prevalence of and risk factors for surgical-site infections (SSIs) and to document antimicrobial use in surgical patients in a large healthcare facility in Vietnam.… Read more

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Serratia marcescens bacteremia traced to an infused narcotic

Abstract

BACKGROUND: From June 30, 1998, through March 21, 1999, several patients in the surgical intensive care unit of a hospital acquired Serratia marcescens bacteremia. We investigated this outbreak.

METHODS: A case was defined as the occurrence of S. marcescens bacteremia in any patient in the surgical intensive care unit during the period of the epidemic.… Read more

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Vitamin A levels and immunity in humans

Abstract

In animal studies, vitamin A deficiency induces a shift from type 2 (humoral, Th2) to type 1 (cellular, Th1) cytokines; there are no similar data for humans. Control of human immunodeficiency virus (HIV) and Mycobacterium tuberculosis infections requires type 1 cytokine (cellular) immunity.… Read more