William R. Jarvis, M.D.

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Mycobacterium chelonae infection among patients receiving high-flux dialysis in a hemodialysis clinic in California

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Abstract

Between July 1987 and January 1988, five patients dialyzed at a hemodialysis outpatient clinic developed systemic Mycobacterium chelonae abscessus (MCA) infections. Four of the five patients had arteriovenous graft infections, and two died during antimicrobial therapy. Case-patients were more likely than control-patients to have received high-flux dialysis during the 6 mo before their infection (100% vs.… Read more

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Outbreak of gram-negative bacteremia and pyrogenic reactions in a hemodialysis center

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Abstract

During the period from April 4, 1988, to April 20, 1988, nine pyrogenic reactions and five gram-negative bacteremias occurred in 11 patients undergoing dialysis. All pyrogenic reactions and gram-negative bacteremias occurred among patients in whom a reprocessed dialyzer was used.… Read more

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Epidemic of Serratia marcescens bacteremia in a cardiac intensive care unit

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Abstract

From 16 July through 27 September 1988, seven cases of nosocomial Serratia marcescens bacteremia occurred in a cardiac care unit. In all seven case patients, S. marcescens was isolated from blood cultures. Two of the seven had other microorganisms identified in the blood culture in which S.… Read more

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Epidemic iatrogenic Acinetobacter spp. meningitis following administration of intrathecal methotrexate

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Abstract

We report the first outbreak of Acinetobacter species meningitis in a group of children with acute leukaemia following the administration of intrathecal chemotherapy. Eight of twenty patients receiving methotrexate injections on a single day developed signs and symptoms of meningitis within 18 h of treatment, and cases were clustered by time of administration.… Read more

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Pseudomonas cepacia typing systems: collaborative study to assess their potential in epidemiologic investigations

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Abstract

To determine the utility of available Pseudomonas cepacia typing systems for confirming the relatedness of isolates, we applied these methods to isolates associated with previously investigated nosocomial outbreaks. We compared chromosome analysis, serologic reactions, biochemical tests, bacteriocin production and susceptibility, and antimicrobial susceptibility in their ability to determine outbreak relatedness.… Read more

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Growth and endotoxin production of Yersinia enterocolitica and Enterobacter agglomerans in packed erythrocytes

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Abstract

Since 1987, the Centers for Disease Control investigated six cases of transfusion-associated sepsis. All six patients developed septic shock after receiving units of packed erythrocytes (PRBCs) contaminated with Yersinia enterocolitica (five patients) and Enterobacter agglomerans (one patient); three of the blood recipients died.… Read more

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Cluster of Malassezia furfur pulmonary infections in infants in a neonatal intensive-care unit

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Abstract

Between 23 and 27 July 1987, three infants at one hospital developed severe bronchopneumonia associated with respiratory failure, thrombocytopenia, and leukocytosis. Two infants died; at postmortem examination, Malassezia furfur was identified in their lung tissues. M. furfur was isolated from cultures of blood, urine, and stool samples from the infant who survived.… Read more

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Epidemic bloodstream infections associated with pressure transducers: a persistent problem

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Abstract

Twenty-four outbreaks of nosocomial bloodstream infection (BSI) were investigated by the Centers for Disease Control from Jan 1, 1977 to Dec 31, 1987. Intravascular pressure monitoring devices (transducers) were the most commonly identified source of bacterial and fungal BSI outbreaks and were implicated as the source of infection in eight (33%) outbreaks.… Read more

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Pyrogenic reactions associated with the reuse of disposable hollow-fiber hemodialyzers

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Abstract

We investigated 18 pyrogenic reactions (PRs) that occurred between July 1 and 13, 1987, in 16 patients receiving long-term hemodialysis at one dialysis center in Illinois. We defined a case of PR as the onset of chills or fever (oral temperature, greater than or equal to 37.8 degrees C) in a patient who was afebrile and had no signs or symptoms of infection before a dialysis treatment.… Read more

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Mycobacterium chelonae causing otitis media in an ear-nose-and-throat practice

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Abstract

Seventeen cases of otitis media caused by Mycobacterium chelonae were detected among patients seen at a single ear-nose-and-throat (ENT) office (Office A) in Louisiana between May 5 and September 15, 1987. All the patients had a tympanotomy tube or tubes in place or had one or more tympanic-membrane perforations, with chronic otorrhea that was unresponsive to standard therapy with antimicrobial agents.… Read more

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Comparative evaluation of selective media for isolation of Pseudomonas cepacia from cystic fibrosis patients and environmental sources

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Abstract

Pseudomonas cepacia has recently emerged as an important pathogen affecting cystic fibrosis (CF) patients. We evaluated three selective media to assess their comparative potential for identification of patients colonized with P. cepacia and for efficacy of detection of P. cepacia in environmental fluids.… Read more

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Biotyping coagulase-negative staphylococci

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Abstract

The biochemical profiles obtained with Staph-Ident (Analytab Products, Plainview, N.Y.) panels were combined with the results of adherence and synergistic hemolysis tests to define biotypes among 1,064 clinical isolates representing eight species of coagulase-negative staphylococci. The 672 isolates of Staphylococcus epidermidis were aligned in 69 of 144 potential biotypes in our scheme because of 18 different biochemical profiles and the eight physiologic subtypes.… Read more

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Characteristics of coagulase-negative staphylococci that help differentiate these species and other members of the family Micrococcaceae

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Abstract

One hundred reference strains and 1,240 clinical isolates representing 26 species of the family Micrococcaceae were used to evaluate the potential of tests for synergistic hemolysis, adherence to glass, pyroglutamyl-beta-naphthylamide hydrolysis, and susceptibility to a set of five antimicrobial agents for differentiating these species and strains within the species.… Read more

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Description of case-mix adjusters by the Severity of Illness Working Group of the Society of Hospital Epidemiologists of America (SHEA)

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Abstract

Hospitals, insurance companies, and federal and state governments are increasingly concerned about reducing patient cost expenditures while maintaining high quality patient care. One method of reducing expenditures has been to tie hospital reimbursement with a prospective payment system based on diagnosis-related groups (DRGs).… Read more

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CDC definitions for nosocomial infections, 1988

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Abstract

The Centers for Disease Control (CDC) has developed a new set of definitions for surveillance of nosocomial infections. The new definitions combine specific clinical findings with results of laboratory and other tests that include recent advances in diagnostic technology; they are formulated as algorithms.… Read more

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Current status of Pseudomonas cepacia typing systems

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Abstract

Pseudomonas cepacia is an important nosocomial pathogen for which measures of isolate relatedness are being developed. Typing systems based on 4 different strain characteristics have been proposed: serologic reactions, biochemical reactions, plasmid profiles, and bacteriocin production and susceptibility. Serology and bacteriocins distinguish many types, but the sensitivity and specificity of these techniques have not been determined.… Read more

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The epidemiology of Pseudomonas cepacia in patients with cystic fibrosis

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Abstract

Pseudomonas cepacia has emerged as an important nosocomial pathogen colonizing and infecting the respiratory tract of patients with cystic fibrosis (CF). Although assessment of outcomes associated with P. cepacia colonization has been difficult, controlled studies have shown that colonized patients experience more adverse outcomes compared with those not colonized.… Read more

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Infectious diseases: preventable causes of infant mortality

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Abstract

After almost a century of improvement, the rate of decrease in US infant mortality rates began to level off during the period of 1982 to 1984. Rates actually increased in some states. Because much of the decline in infant mortality in this century can be attributed to advances in infectious disease treatment and prevention programs, we evaluated the current impact of infectious diseases on infant mortality.… Read more

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The epidemiology of nosocomial Pseudomonas cepacia infections: endemic infections

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Abstract

Pseudomonas cepacia has recently emerged as an important nosocomial pathogen. We analyzed a national nosocomial infections database, the National Nosocomial Infections Surveillance (NNIS) system, to describe the epidemiology of endemic nosocomial P. cepacia infections. Between 1980 and 1985, the P.… Read more

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The epidemiology of nosocomial epidemic Pseudomonas cepacia infections

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Abstract

Pseudomonas cepacia has occasionally been identified as an epidemic and endemic nosocomial pathogen. In outbreaks, usually one clinical site predominates but many may be involved. Detailed investigations have usually implicated a contaminated liquid reservoir or moist environmental surface as the source.… Read more

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Mycobacterium chelonae wound infections after plastic surgery employing contaminated gentian violet skin-marking solution

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Abstract

From April 1 to October 31, 1985, postoperative surgical-wound infections due to rapidly growing mycobacteria developed in eight patients undergoing cosmetic plastic surgery performed by one surgeon. All infections followed either face-lift or augmentation-mammoplasty procedures performed in the surgeon’s office; no infections occurred after surgical procedures performed at the hospital or after other surgical procedures performed at the office.… Read more

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Colonization of the respiratory tract with Pseudomonas cepacia in cystic fibrosis. Risk factors and outcomes

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Abstract

Between 1981 and 1983, some 85 patients with cystic fibrosis at Rainbow Babies and Childrens Hospital, Cleveland, developed colonization or infection of the respiratory tract with Pseudomonas cepacia. Twenty-nine (34 percent) of the colonized patients died; four were female patients with fulminant bacteremia with P cepacia prior to death.… Read more

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Laboratory proficiency test results on use of selective media for isolating Pseudomonas cepacia from simulated sputum specimens of patients with cystic fibrosis

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Abstract

Pseudomonas cepacia colonization of or infection in patients with cystic fibrosis (CF) has been associated with increased morbidity and premature death. However, current data on national incidence may be biased because of interlaboratory differences in the methods of culturing sputa of patients with CF.… Read more

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Nosocomial infection surveillance, 1984

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Abstract

Horan TC, White JW, Jarvis WR, Emori TG, Culver DH, Munn VP, Thornsberry C, Olson DR, Hughes JM

MMWR CDC Surveill Summ 1986;35(1):17SS-29SS

PMID: 3086701… Read more

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Methicillin-resistant Staphylococcus aureus at children’s hospitals in the United States

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Abstract

Although methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important pathogen in hospitalized adults in the United States, reports of MRSA in pediatric patients have been infrequent. To determine the frequency at which MRSA is isolated from children, we surveyed the directors of microbiology at all acute care children’s hospitals in the United States, and 57 of 67 (85%) laboratory directors responded to a mailed questionnaire.… Read more

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The epidemiology of nosocomial infections caused by Klebsiella pneumoniae

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Abstract

Klebsiella pneumoniae causes serious epidemic and endemic nosocomial infections. We conducted a literature review to characterize the epidemiology of epidemic K. pneumoniae outbreaks. Eighty percent of the outbreaks (20/25) involved infections of the bloodstream or urinary tract. Person-to-person spread was the most common mode of transmission, and nearly 50% of the outbreaks occurred in neonatal intensive care units.… Read more

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Klebsiella pneumoniae: selected virulence factors that contribute to pathogenicity

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Abstract

Klebsiella pneumoniae infections occur in humans of all ages, however the highest risk groups appear to be infants, the elderly and the immunocompromised. One or more virulence factors may contribute to pathogenicity in humans. In this article we review three factors that may mediate virulence: cell wall receptors, capsular polysaccharide, and endotoxin.… Read more

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Clostridium difficile. Colonization and toxin production in a cohort of patients with malignant hematologic disorders

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Abstract

We examined 45 (80%) of 56 consecutive adult patients with malignant hematologic disorders who were hospitalized during a 15-week period at Emory University Hospital, Atlanta. Stool samples for Clostridium difficile culture and cytotoxin assay were obtained on admission and then weekly during each patient’s hospitalization.… Read more

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Pseudomonas fluorescens bacteremia from blood transfusion

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Abstract

In October 1980, two units of blood contaminated with Pseudomonas fluorescens caused septic transfusion reactions in two recipients at a Chicago hospital; one patient died. Both units had been purchased from the same blood center. Investigation at the blood center and at other hospitals it supplied revealed another fatal case of P.… Read more

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Bacterial growth and endotoxin production in lipid emulsion

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Abstract

Klebsiella pneumoniae serotypes 21 and 24 and Enterobacter cloacae were responsible for an outbreak of polymicrobial bacteremia associated with the receipt of lipid emulsion. Since it is recommended that lipid emulsion be kept refrigerated between uses, we undertook a study to determine the growth characteristics of these organisms in lipid emulsion at 5 and 25 degrees C and to examine the use of alternative measurements (pH and endotoxin) to determine contamination by viable and nonviable microorganisms.… Read more

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Significance of viral infections in severe combined immunodeficiency disease

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Abstract

An analysis of a prospective study of viral infections in 12 patients with severe combined immunodeficiency is presented. Infections of viral etiology were common, with pulmonary and gastrointestinal infections being most frequent. Fourteen of 25 infections (56%) were nonsocomially acquired and 10 of 25 (40%) were community-acquired.… Read more

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Polymicrobial bacteremia associated with lipid emulsion in a neonatal intensive care unit

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Abstract

Polymicrobial bacteremia developed in 5 of 20 infants in a neonatal intensive care unit during a 48-hour period; 2 infants died. Klebsiella pneumoniae serotypes 21 and 24 and Enterobacter cloacae were isolated from four infants, and K. pneumoniae serotype 24 and E.… Read more

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Recommended precautions for patients with Legionnaires’ Disease

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Abstract

As diagnostic techniques for the identification of Legionella species have become readily available, recognition of the pneumonic form of Legionellosis has increased. In particular, cases of hospital-acquired Legionella pneumophila are being identified and this has led to concern over possible person-to-person transmission.… Read more

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Precautions for Creutzfeldt-Jakob disease

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Abstract

Creutzfeldt-Jakob disease (CJD) is a rapidly progressive, fatal disease of the central nervous system. Premortem diagnosis may or may not be conclusive. Because the etiologic agent is virulent, definition of necessary precautions for medical staff associated with such patients is needed.… Read more

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Echovirus type 7 meningitis in young children

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Abstract

Clinical and virological features are presented of an epidemic of aseptic meningitis in children caused by echovirus type 7. The majority of patients were younger than 1 year of age. Symptoms varied according to age. The degree of CSF pleocytosis was inversely related to age and was significantly greater in infants 7 months of age and younger than in those older than 7 months.… Read more

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Pasteurella multocida. Osteomyelitis following dog bites

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Abstract

Two cases of Pasteurella multocida osteomyelitis occurred following dog bit injuries. Difficulties exist in diagnosis and treatment. The role of P Multocida and other dog mouth flora in the pathogenesis of infectious complications following dog bites is discussed. we urge a flexible antimicrobial approach based on culture results.… Read more