Illustration(s) pertain to the topic addressed in this publication, not the specific research or data presented in the publication

Comparison of serum and cell-specific cytokines in humans

Abstract

Cytokines function at the cellular, microenvironmental level, but human cytokine assessment is most commonly done at the macro level, by measuring serum cytokines. The relationships between serum and cellular cytokines, if there are any, are undefined. In a study of hospitalized patients in Malawi, we compared cytometrically assessed, cell-specific cytokine data to serum interleukin 2 (IL-2), IL-4, IL-6, IL-8, IL-10, gamma interferon (IFN-gamma), and tumor necrosis factor alpha (TNF-alpha) levels in 16 children and 71 (IL-2, -4, -6, -10) or 159 (IL-8, IFN-gamma, and TNF-alpha) adults, using Wilcoxon rank sum tests and Pearson’s (r(p)) and Spearman’s (r(s)) rank correlations.… Read more

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Physician preferences for continuing medical education with a focus on the topic of antimicrobial resistance: Society for Healthcare Epidemiology of America

Abstract

OBJECTIVE: To determine the type of media preferred for continuing medical education (CME) and to assess the factors that affect physician preferences for CME in general and on the special topic of antimicrobial resistance.

DESIGN: A voluntary survey of the membership of the Society for Healthcare Epidemiology of America, Inc.… Read more

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Vancomycin-resistant enterococci colonization in patients at seven hemodialysis centers

Abstract

BACKGROUND: Vancomycin-resistant enterococci (VRE) are increasing in prevalence at many institutions, and are often reported in dialysis patients. We studied the prevalence of and risk factors for VRE at seven outpatient hemodialysis centers (three in Baltimore, MD, USA, and four in Richmond, VA, USA).… Read more

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Nosocomial outbreak of Microbacterium species bacteremia among cancer patients

Abstract

To date, only 6 sporadic Microbacterium species (formerly coryneform Centers for Disease Control and Prevention [CDC] groups A-4 and A-5) infections have been reported. The source, mode of transmission, morbidity, mortality, and potential for nosocomial transmission of Microbacterium species remain unknown.… Read more

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Occupational transmission of Mycobacterium tuberculosis to health care workers in a university hospital in Lima, Peru

Abstract

From November 1996 through March 1997, presumptive active pulmonary tuberculosis (TB) was detected in 44 health care workers (HCWs) at a university hospital in Lima, Peru. To further assess the magnitude of the outbreak and determine risk factors for occupational Mycobacterium tuberculosis transmission, we identified HCWs in whom active pulmonary TB was diagnosed from January 1994 through January 1998, calculated rates by year and hospital work area, and conducted a tuberculin skin test (TST) survey.… Read more

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Cytokines and malaria parasitemia

Abstract

The balance between pro- and antiinflammatory cytokines may be important in malaria presentation and outcome. Malaria tends to be more severe in children than in adults, presumably because partial immunity develops with age. However, the full nature of, and age-related differences in, anti-malarial immunity are unknown.… Read more

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Risk factors for candidal bloodstream infections in surgical intensive care unit patients: the NEMIS prospective multicenter study. The National Epidemiology of Mycosis Survey

Abstract

To assess risk factors for development of candidal blood stream infections (CBSIs), a prospective cohort study was performed at 6 sites that involved all patients admitted to the surgical intensive care unit (SICU) for 48 h over a 2-year period.… Read more

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Use and efficacy of tuberculosis infection control practices at hospitals with previous outbreaks of multidrug-resistant tuberculosis

Abstract

OBJECTIVE: To evaluate the implementation and efficacy of selected Centers for Disease Control and Prevention guidelines for preventing spread of Mycobacterium tuberculosis.

DESIGN: Analysis of prospective observational data.

SETTING: Two medical centers where outbreaks of multidrug-resistant tuberculosis (TB) had occurred.… Read more

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Costs and savings associated with infection control measures that reduced transmission of vancomycin-resistant enterococci in an endemic setting

Abstract

OBJECTIVE: To determine the costs and savings of a 15-component infection control program that reduced transmission of vancomycin-resistant enterococci (VRE) in an endemic setting.

DESIGN: Evaluation of costs and savings, using historical control data.

SETTING: Adult oncology unit of a 650-bed hospital.… Read more

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Anesthesia-associated carbon monoxide exposures among surgical patients

Abstract

OBJECTIVE: To estimate the extent of, and evaluate risk factors for, elevated carboxyhemoglobin levels among patients undergoing general anesthesia and to identify the source of carbon monoxide.

DESIGN: Matched case-control study to measure carboxyhemoglobin levels.

SETTING: Large academic medical center.… Read more

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Observational study of the use of infection control interventions for Mycobacterium tuberculosis in pediatric facilities

Abstract

INTRODUCTION: Hospital transmission of Mycobacterium tuberculosis (TB) is a problem in US facilities where adults are treated. However, specific guidelines for facilities in which pediatric patients are cared for have never been defined, nor has any study attempted to assess pediatric health care worker (HCW) compliance with TB infection control (IC) guidelines.… Read more

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Nosocomial infection rates in US children’s hospitals’ neonatal and pediatric intensive care units

Abstract

BACKGROUND: Few data are available on nosocomial infections (NIs) in US children’s hospitals’ neonatal or pediatric intensive care units. The Pediatric Prevention Network (PPN) was established to improve characterization of NIs in pediatric patients and to develop and test interventions to decrease NI.… Read more

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A prospective study of vascular access infections at seven outpatient hemodialysis centers

Abstract

Vascular access infections are a major cause of morbidity and mortality in hemodialysis patients, and the use of antimicrobials to treat such infections contributes to the emergence and spread of antimicrobial-resistant bacteria. To determine the incidence of and risk factors for vascular access infections, we studied hemodialysis patients at 7 outpatient dialysis centers (4 in Richmond, VA, and 3 in Baltimore, MD) during December 1997 to July 1998.… Read more

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Serratia liquefaciens bloodstream infections from contamination of epoetin alfa at a hemodialysis center

Abstract

BACKGROUND: In a one month period, 10 Serratia liquefaciens bloodstream infections and 6 pyrogenic reactions occurred in outpatients at a hemodialysis center.

METHODS: We performed a cohort study of all hemodialysis sessions on days that staff members reported S. liquefaciens bloodstream infections or pyrogenic reactions.… Read more

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Control of vancomycin-resistant enterococcus in health care facilities in a region

Abstract

BACKGROUND: In late 1996, vancomycin-resistant enterococci were first detected in the Siouxland region of Iowa, Nebraska, and South Dakota. A task force was created, and in 1997 the assistance of the Centers for Disease Control and Prevention was sought in assessing the prevalence of vancomycin-resistant enterococci in the region’s facilities and implementing recommendations for screening, infection control, and education at all 32 health care facilities in the region.… Read more

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Utility of paired BACTEC MYCO/F LYTIC blood culture vials for detection of bacteremia, mycobacteremia, and fungemia

Abstract

In previous bloodstream infection studies in Malawi, we inoculated blood from a single venesection into a single BACTEC MYCO/F LYTIC (MFL) vial. Inoculation of one vial, however, would be expected to reduce the sensitivity of bloodstream pathogen detection with MFL vials.… Read more

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Infection control dogma: top 10 suspects

Abstract

As infection control evolved into an art and science through the years, many infection control practices have become infection control dogmas (principles, beliefs, ideas, or opinions). In this “Reality Check” session of the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections, we assessed participants’ perceptions of prevalent infection control dogmas.… Read more

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Serratia marcescens transmission in a pediatric intensive care unit: a multifactorial occurrence

Abstract

BACKGROUND: Fourteen patients in the pediatric cardiac intensive care unit (CICU) had or =1 positive culture for a single strain of Serratia marcescens from April through December 1995 (study period).

OBJECTIVES: To identify risk factors for S marcescens infection or colonization in a pediatric CICU.… Read more

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Reality check: should we use vancomycin for the prophylaxis of intravascular catheter-associated infections?

Abstract

The use of intravascular catheters is associated with increased risk of bloodstream infections, principally caused by coagulase-negative staphylococci. This “Reality Check” session, held at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections, focused on the question of whether, and in what manner, vancomycin should be used for the prophylaxis of these infections

Grohskopf LA, Maki DG, Sohn AH, Sinkowitz-Cochran RL, Jarvis WR, Goldmann DA

Infect Control Hosp Epidemiol 2001 Mar;22(3):176-9

PMID: 11310698… Read more

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Colonization of skilled-care facility residents with antimicrobial-resistant pathogens

Abstract

OBJECTIVES: To determine the frequency of and risk factors for colonization of skilled-care unit residents by several antimicrobial-resistant bacterial species, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), or extended-spectrum-beta-lactamase-producing (ESBL-producing) (ceftazidime resistant) Klebsiella pneumoniae or Escherichia coli.

DESIGN: Point-prevalence survey and medical record review.… Read more

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Building communication networks: international network for the study and prevention of emerging antimicrobial resistance

Abstract

The global nature of antimicrobial resistance and the failure to control the emergence of resistant organisms demand the implementation of a global surveillance program involving both developed and developing countries. Because of the urgent need for infection control interventions and for rapid distribution of information about emerging organisms, we initiated the International Network for the Study and Prevention of Emerging Antimicrobial Resistance (INSPEAR).… Read more

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Infection control and changing health-care delivery systems

Abstract

In the past, health care was delivered mainly in acute-care facilities. Today, health care is delivered in hospital, outpatient, transitional care, long-term care, rehabilitative care, home, and private office settings. Measures to reduce health-care costs include decreasing the number of hospitals and the length of patient stays, increasing outpatient and home care, and increasing long-term care for the elderly.… Read more

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Reality check: should we try to detect and isolate vancomycin-resistant enterococci patients?

Abstract

Antimicrobial resistance, including vancomycin resistance in enterococci (VRE), is a growing problem in healthcare facilities. This “Reality Check” session focused on the question of whether we should try to detect and isolate patients colonized or infected with VRE.

Ostrowsky B, Steinberg JT, Farr B, Sohn AH, Sinkowitz-Cochran RL, Jarvis WR

Infect Control Hosp Epidemiol 2001 Feb;22(2):116-9

PMID: 11232874… Read more

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Evaluation of a successful vancomycin-resistant Enterococcus prevention intervention in a community of health care facilities

Abstract

BACKGROUND: In April 1997, vancomycin-resistant enterococci (VRE) emerged in several health care facilities in the Siouxland region and a VRE Task Force was formed. From 1997 through 1999, an evaluation of VRE prevalence at 30 facilities was performed.

METHODS: In 1999, we conducted a survey and focus groups of health care workers to address initial reactions to VRE, feasibility of the Task Force recommendations, and lessons learned.… Read more

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Emerging healthcare-associated problem pathogens in the United States

Abstract

Healthcare-associated infections are a major cause of morbidity and mortality. Dramatic changes in the delivery of healthcare during the past decade have changed the definition of healthcare-associated infections. Healthcare delivery changes include a reduction in the number of general hospital beds, an increase in the proportion of patients who are in intensive care units, a larger proportion of surgical procedures performed as outpatient procedures, a marked increase in patients cared for in outpatient settings, and an increase in the delivery of healthcare in the home setting.… Read more

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Seasonal variation in the etiology of bloodstream infections in a febrile inpatient population in a developing country

Abstract

OBJECTIVES: Published data suggest that Streptococcus pneumoniae, non-typhi Salmonella species, and Mycobacterium tuberculosis are the predominant causes of bloodstream infection (BSI) in hospitalized populations in sub-Saharan Africa. This study was conducted during the wet season to ascertain the etiology and prevalence of BSI among febrile inpatients in a hospital where the dry season BSI profile in a similar study population had already been documented.… Read more

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Management of occupational exposures to hepatitis C virus: current practice and controversies

Abstract

Unlike hepatitis B virus and human immunodeficiency virus, there currently are no immunization or chemoprophylactic interventions available to prevent infection after an occupational exposure to hepatitis C virus (HCV). A “Reality Check” session was held at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections to gather information on current practices related to management of occupational exposures to HCV, generate discussion on controversial issues, and identify areas for future research.… Read more

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Invasive aspergillosis outbreak on a hematology-oncology ward

Abstract

An outbreak of invasive aspergillosis occurred in a community hospital in temporal association with construction activity. Epidemiological investigation showed that patients who are at highest risk comprise a small group and are readily identifiable. Clinicians should strive to protect these patients, following guidelines published by the Centers for Disease Control and Prevention.… Read more

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Reality check: how should we control antimicrobial use? Current practices and controversies

Abstract

The infectious diseases community shares a wide consensus about the need for control of antimicrobial use. However, current practices toward this goal remain controversial. This “Reality Check” session assessed attendees of the 4th Decennial Conference regarding their knowledge and practices about control of antimicrobial use in hospitals.… Read more

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Pyrogenic reactions associated with single daily dosing of intravenous gentamicin

Abstract

OBJECTIVE: To identify risk factors associated with an unexpected outbreak of pyrogenic reactions (PR) following intravenous gentamicin.

DESIGN: We conducted two cohort studies. PRs were defined as chills, rigors, or shaking within 3 hours after initiating the gentamicin infusion during the preepidemic (December 1, 1997-January 15, 1998) or epidemic (May 1-June 15, 1998) periods.… Read more

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The Internet: a practical example of the use of new technology in the assessment of vancomycin use in pediatrics. The Pediatric Prevention Network

Abstract

BACKGROUND: The rapid emergence of both new infections and new technologies has revolutionized health care during the past 50 years. Increased use of the Internet has enabled health care professionals to educate, interact, and collaborate throughout the world in ways never before possible.… Read more

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Status of infection surveillance and control programs in the United States, 1992-1996. Association for Professionals in Infection Control and Epidemiology, Inc

Abstract

BACKGROUND: Nosocomial infections have been recognized as a source of morbidity and mortality throughout the world for several decades. In the United States, an estimated 2.1 million nosocomial infections occur annually in acute care hospitals alone. Infection surveillance and control programs (ISCPs) play a vital role in addressing this problem, but no national studies have described the status and composition of these programs since the 1970s.… Read more

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Should we routinely use mupirocin to prevent staphylococcal infections?

Abstract

Routine use of mupirocin to prevent staphylococcal infections is controversial. We assessed attitudes and practices of healthcare professionals attending the Fourth Decennial International Conference on Nosocomial and Healthcare-Associated Infections regarding mupirocin prophylaxis. Eighty percent of participants did not use mupirocin routinely.… Read more

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Program overview: the reality check sessions at the 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections

Abstract

The 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections provided a unique forum to assess opinions regarding current infection control controversies. The “Reality Check” sessions were a special portion of the conference where attendees expressed their opinions on these issues and heard varying viewpoints from noted experts.… Read more

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Physician preferences for educational media

Abstract

BACKGROUND: Although educational media have expanded in variety, information on physicians’ preferences for types of educational media remains limited.

METHOD: An assessment form was distributed to 14 medical societies evaluating their members’ medical education media preferences and society antimicrobial-resistance educational offerings.… Read more

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An epidemic of corneal destruction caused by plasma gas sterilization. The Toxic Cell Destruction Syndrome Investigative Team

Abstract

BACKGROUND: Toxic endothelial cell destruction (TECD) syndrome after intraocular ophthalmic surgery is rare and can result from exposure to a variety of toxins. During January 8 to 14, 1998, 6 patients developed TECD with corneal edema associated with unreactive or dilated pupils at Hospital A.… Read more

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Natural T, gammadelta, and NK cells in mycobacterial, Salmonella, and human immunodeficiency virus infections

Abstract

NK cells, gammadelta T cell antigen receptor chain-positive cells, and CD3(+)CD16/56(+) (natural T [NT]) cells are involved in innate immunity and immunoregulation; however, their role in clinical infection is not well defined. Cytofluorometric analysis was used to examine peripheral blood from bacteremic, nonbacteremic, and healthy human immunodeficiency virus (HIV)-positive and -negative persons in Malawi, Africa.… Read more

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Transfusion-related sepsis due to Serratia liquefaciens in the United States

Abstract

BACKGROUND: Severe, often fatal, transfusion reactions due to bacterial contamination of blood components continue to occur. Serratia liquefaciens, an unusual human pathogen, is a recently recognized potential cause of transfusion-related sepsis.

CASE REPORTS: Five episodes of transfusion-related sepsis and endotoxic shock due to S.… Read more

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Risk factors for acquisition of vancomycin-resistant enterococci among patients on a renal ward during a community hospital outbreak

Abstract

BACKGROUND: During an outbreak of vancomycin-resistant enterococcal (VRE) infection and colonization at a community hospital in Indianapolis, Indiana, we performed a case-control study of patients on the hospital’s renal unit to determine risk factors for acquisition of VRE among this potentially high-risk patient population.… Read more

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Comparison of BACTEC MYCO/F LYTIC and WAMPOLE ISOLATOR 10 (lysis-centrifugation) systems for detection of bacteremia, mycobacteremia, and fungemia in a developing country

Abstract

In less-developed countries, studies of bloodstream infections (BSI) have been hindered because of the difficulty and costs of culturing blood for bacteria, mycobacteria, and fungi. During two study periods (study period I [1997] and study period II [1998]), we cultured blood from patients in Malawi by using the BACTEC MYCO/F LYTIC (MFL), ISOLATOR 10 (Isolator), Septi-Chek AFB (SC-AFB), and Septi-Chek bacterial (SC-B) systems.… Read more

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Association between implementation of CDC recommendations and ventilator-associated pneumonia at selected US hospitals

Abstract

BACKGROUND: To assess whether selected recommendations in the Centers for Disease Control and Prevention “Guideline for Prevention of Nosocomial Pneumonia” were being implemented and having an impact on the occurrence of ventilator-associated pneumonia (VAP) at US hospitals, we surveyed hospitals participating in the National Nosocomial Infections Surveillance (NNIS) system.… Read more

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Acute onset of decreased vision and hearing traced to hemodialysis treatment with aged dialyzers

Abstract

CONTEXT: A recent event in which 7 patients at 1 hospital developed decreased vision and hearing, conjunctivitis, headache, and other severe neurologic symptoms 7 to 24 hours after hemodialysis drew attention to the issue of the long-term integrity of dialysis machines and materials.… Read more

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A hospital-based prevalence survey of bloodstream infections in febrile patients in Malawi: implications for diagnosis and therapy

Abstract

The etiology of bloodstream infections (BSIs) in febrile (or =37.5 degrees C) adults (or =18 years old) in one Malawi hospital were determined during August and September 1997. After clinical evaluation, blood was drawn for comprehensive culture, human immunodeficiency virus (HIV) type 1 testing, and malaria smear.… Read more

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Outbreaks of infection and/or pyrogenic reactions in dialysis patients

Abstract

These dialysis-related outbreaks demonstrate the ongoing potential for infection-related morbidity and mortality among dialysis patients. Many of these outbreaks could have been prevented by adequate water treatment, proper disinfection of water systems and dialysis machines, adherence to recommended reprocessing protocols in centers reusing dialyzers, and more stringent quality control monitoring.… Read more

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Determining the significance of coagulase-negative staphylococci isolated from blood cultures at a community hospital: a role for species and strain identification

Abstract

OBJECTIVES: To determine the degree to which species identification or strain relatedness assessment of successive blood culture isolates of coagulase-negative staphylococci (CNS) may improve the clinical diagnosis of bloodstream infection (BSI).

SETTING: 400-bed community hospital.

DESIGN: Prospective laboratory survey during which all CNS blood culture isolates obtained between mid-August 1996 and mid-February 1997 (study period) were saved and later identified to the species level; selected isolates were genotyped using pulsed-field gel electrophoresis at the Centers for Disease Control and Prevention (CDC).… Read more

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Outbreak of Pseudomonas aeruginosa ventriculitis among patients in a neurosurgical intensive care unit

Abstract

OBJECTIVE: To determine the cause of an outbreak of Pseudomonas aeruginosa cerebral ventriculitis among eight patients at a community hospital neurosurgical intensive care unit. All had percutaneous external ventricular catheters (EVCs) to monitor cerebrospinal fluid (CSF) pressure.

METHODS: Cohort study of all patients who had EVCs placed during the epidemic period (August 8-October 22, 1997).… Read more