Bloodstream Infections

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Bloodstream infection associated with needleless device use and the importance of infection-control practices in the home health care setting

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Abstract

The influence of infection-control practices on bloodstream infection (BSI) risk was examined in a home health care setting in which three needleless devices were used consecutively. A case-control study and a retrospective cohort study were conducted. Risk factors for BSI included lower education level, younger age, having a central venous catheter (CVC) with multiple ports, or having a tunneled CVC.… Read more

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Immune determinants of organism and outcome in febrile hospitalized Thai patients with bloodstream infections

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Abstract

Opportunistic infections (OI) and the human immunodeficiency virus (HIV) cause significant morbidity and mortality in developing countries. Immune cell and cytokine profiles may be related to the type and course of OI and to the OI-HIV interaction. Examining cell-specific cytokine production ex vivo has only recently become feasible.… Read more

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Enterobacter cloacae and Pseudomonas aeruginosa polymicrobial bloodstream infections traced to extrinsic contamination of a dextrose multidose vial

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Abstract

OBJECTIVE: To identify risk factors for polymicrobial bloodstream infections (BSIs) in neonatal intensive care unit (NICU) patients during an outbreak of BSIs.

DESIGN: During an outbreak of BSIs, we conducted a retrospective cohort study, assessed NICU infection control practices and patient exposure to NICU healthcare workers (HCWs), and obtained cultures of the environment and HCW hands.… Read more

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Line-associated bloodstream infections in pediatric intensive-care-unit patients associated with a needleless device and intermittent intravenous therapy

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Abstract

OBJECTIVES: To determine risk factors for an increase in line-associated bloodstream infections (BSIs) in three pediatric intensive-care units at one hospital that recently had changed brands of needleless access device.

DESIGN: Retrospective case-control studies; review of the units’ infection control policies and procedures for accessing and replacing components of needleless access devices.… Read more

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Klebsiella pneumoniae bloodstream infections in neonates in a hospital in the Kingdom of Saudi Arabia

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Abstract

OBJECTIVE: To identify risk factors for Klebsiella pneumoniae bloodstream infections (BSI) in neonates in a hospital in the Kingdom of Saudi Arabia (KSA).

DESIGN: Two case-control studies among hospitalized neonates during February 15-May 14, 1991, and a procedural and microbiological investigation.… Read more

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Outbreak of Acinetobacter spp. bloodstream infections in a nursery associated with contaminated aerosols and air conditioners

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Abstract

BACKGROUND: Acinetobacter spp. are multidrug-resistant bacteria that grow well in water and cause infections with unexplained, increased summer prevalence. In August, 1996, eight infants acquired Acinetobacter spp. bloodstream infection (A-BSI) while in a nursery in the Bahamas; three infants died and an investigation was initiated.… Read more

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An epidemic of Malassezia pachydermatis in an intensive care nursery associated with colonization of health care workers’ pet dogs

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Abstract

BACKGROUND: Malassezia species are lipophilic yeasts that are emerging as nosocomial pathogens, particularly in low-birth-weight neonates who receive lipid emulsions. When a cluster of patients with Malassezia pachydermatis infection was identified in an intensive care nursery, we initiated an investigation.… Read more

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A cluster of bloodstream infections and pyrogenic reactions among hemodialysis patients traced to dialysis machine waste-handling option units

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Abstract

From June 17 through November 15, 1995, ten episodes of Enterobacter cloacae bloodstream infection and three pyrogenic reactions occurred in patients at a hospital-based hemodialysis center. In a case-control study limited to events occurring during October 1-31, 1995, seven dialysis sessions resulting in E.… Read more

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Use of an estimation method to derive an appropriate denominator to calculate central venous catheter-associated bloodstream infection rates

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Abstract

An outbreak investigation was conducted to determine if an increase in bloodstream infections (BSIs) in patients with central venous catheters (CVC) had occurred. Because other methods of obtaining CVC days were not feasible, we used an estimation method based on a random 5% sample of medical records to determine the proportion of days that a CVC was present for each of three patient units.… Read more

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Increased bloodstream infection rates in surgical patients associated with variation from recommended use and care following implementation of a needleless device

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Abstract

OBJECTIVE: To determine if an apparent increase in bloodstream infections (BSIs) in patients with central venous catheters (CVCs) was associated with the implementation of a needleless access device.

DESIGN: Retrospective cohort study using a derived CVC-days factor for estimating appropriate denominator data.… Read more

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Secular trends in bloodstream infection caused by antimicrobial-resistant bacteria in New Jersey hospitals, 1991 to 1995

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Abstract

INTRODUCTION: Antimicrobial resistance among bacteria is an increasing public health problem. In 1991, New Jersey was the first state to establish statewide, hospital-based surveillance for antimicrobial-resistant bacteria.

METHODS: Each month, all 96 nonfederal New Jersey hospital laboratories complete a form listing the species identity and drug susceptibility results for selected antimicrobial-resistant bacteria isolated from blood cultures from hospital inpatients.… Read more

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Staphylococcus aureus bloodstream infections among patients undergoing electroconvulsive therapy traced to breaks in infection control and possible extrinsic contamination by propofol

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Abstract

Infectious complications associated with electroconvulsive therapy (ECT) are extremely unusual. When five of nine patients undergoing ECT at one facility on June 20, 1996 developed Staphylococcus aureus bloodstream infection (BSI), an investigation was initiated. A retrospective cohort study, a procedure review, and observational and microbiologic studies were performed.… Read more

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Detecting pediatric nosocomial infections: how do infection control and quality assurance personnel compare?

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Abstract

OBJECTIVE: To compare how well infection control (IC) and quality assurance (QA) personnel in a specialty setting identify the presence, type (nosocomial or community-acquired), and (if nosocomial) site of infection.

METHODS: In 1994, we mailed a survey that included 21 pediatric case histories to IC and QA personnel in pediatric settings in the United States (children’s hospitals and medical school-affiliated hospitals with pediatric wards of 30 beds).… Read more

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Candida parapsilosis bloodstream infections in neonatal intensive care unit patients: epidemiologic and laboratory confirmation of a common source outbreak

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Abstract

BACKGROUND: Candida parapsilosis is a common cause of sporadic and epidemic infections in neonatal intensive care units (NICUs). When a cluster of C. parapsilosis bloodstream infections occurred in NICU patients in a hospital in Louisiana, it provided us with the opportunity to conduct an epidemiologic investigation and to apply newly developed molecular typing techniques.… Read more

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Bloodstream infections in home infusion patients: the influence of race and needleless intravascular access devices

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Abstract

OBJECTIVES: To determine the cause of increased central venous catheter-associated (CVC) bloodstream infection (BSI) rates in a cohort of pediatric hematology /oncology patients receiving home health care (HHC).

METHODS: A retrospective cohort study of hematology/oncology patients with CVCs receiving HHC from January 1992 through November 1994.… Read more

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Nosocomial infections among neonates in high-risk nurseries in the United States. National Nosocomial Infections Surveillance System

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Abstract

BACKGROUND: Nosocomial infections result in considerable morbidity and mortality among neonates in high-risk nurseries (HRNs).

PURPOSE: To examine the epidemiology of nosocomial infections among neonates in level III HRNs.

METHODS: Data were collected from 99 hospitals with HRNs participating in the National Nosocomial Infections Surveillance system, which uses standard surveillance protocols and nosocomial infection site definitions.… Read more

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Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention

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Abstract

Approximately 2 million nosocomial infections occur annually in the United States. These infections result in substantial morbidity, mortality, and cost. The excess duration of hospitalization secondary to nosocomial infections has been estimated to be 1 to 4 days for urinary tract infections, 7 to 8.2 days for surgical site infections, 7 to 21 days for bloodstream infections, and 6.8 to 30 days for pneumonia.… Read more

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Bloodstream infections with vancomycin-resistant enterococci

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Abstract

OBJECTIVES: To describe the population in whom bloodstream infections with vancomycin-resistant enterococci occur and the clinical and microbiologic features of infection.

METHODS: From June 1, 1991, to January 31, 1994, 73 patients with bloodstream infections with vancomycin-resistant enterococci were identified by retrospective review of hospital charts and microbiology records.… Read more

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The role of understaffing in central venous catheter-associated bloodstream infections

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Abstract

OBJECTIVE: To determine risk factors for central venous catheter-associated bloodstream infections (CVC-BSI) during a protracted outbreak.

DESIGN: Case-control and cohort studies of surgical intensive care unit (SICU) patients.

SETTING: A university-affiliated Veterans Affairs medical center.

PATIENTS: Case-control study: all patients who developed a CVC-BSI during the outbreak period (January 1992 through September 1993) and randomly selected controls.… Read more

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Epidemiology and mortality risk of vancomycin-resistant enterococcal bloodstream infections

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Abstract

Risk factors for vancomycin-resistant enterococcal (VRE) bloodstream infection (BSI) were studied at a tertiary-care hospital by comparing 46 patients with VRE-BSI with 46 randomly selected patients with vancomycin-susceptible enterococcal (VSE) BSI. Among patients with an enterococcal BSI, risk factors for mortality were determined.… Read more

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Bloodstream infections associated with a needleless intravenous infusion system in patients receiving home infusion therapy

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Abstract

OBJECTIVE: To determine risk factors for bloodstream infections (BSIs) in an outbreak among patients receiving home intravenous infusion therapy.

DESIGN: Case-control and retrospective cohort studies.

SETTING: Home health agency.

PATIENTS: Patients receiving home intravenous infusion therapy from Rhode Island Home Therapeutics (RIHT) from January through December 1993.… Read more

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An outbreak of gram-negative bloodstream infections in chronic hemodialysis patients

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Abstract

Six chronic hemodialysis patients acquired bloodstream infections (BSIs) with Klebsiella pneumoniae of the same serotype and similar plasmid profile during an 11-day period. The 6 case-patients were more likely than noncase-patients to have received dialysis during the fourth shift (p < 0.05) and to have their dialyzers reprocessed for reuse after those of the noncase-patients (p = 0.05). Investigation identified a patient during the same shift with an arteriovenous fistula infected with K. pneumoniae. The dialyzer reprocessing technician did not change gloves between contacting patients and their dialyzers in the treatment area and reprocessing the case-patients' dialyzers at the end of the fourth shift. We conclude that the outbreak of BSIs was caused by cross-contamination of the case-patients' dialyzers with bacteria from the gloves of the reprocessing technician and by inadequate dialyzer disinfection. After revised dialyzer reprocessing techniques and glove-changing policies were instituted, no further clusters of BSIs occurred.

Welbel SF, Schoendorf K, Bland LA, Arduino MJ, Groves C, Schable B, O’Hara CM, Tenover FC, Jarvis WR

Am.… Read more

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Nosocomial Malassezia pachydermatis bloodstream infections in a neonatal intensive care unit

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Abstract

Malassezia pachydermatis, a lipophilic yeast, has been described to cause sporadic nosocomial bloodstream infections (BSI). Nosocomial outbreaks of M. pachydermatis BSI have never been described. A cluster of M. pachydermatis BSIs in the neonatal intensive care unit at Louisiana State University Medical Center, University Hospital provided the opportunity to investigate the epidemiology of this organism and apply molecular epidemiologic typing techniques.… Read more

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Secular trends in the epidemiology of nosocomial fungal infections in the United States, 1980-1990. National Nosocomial Infections Surveillance System

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Abstract

To identify pathogens causing nosocomial fungal infections and the secular trend in their incidence in US hospitals, data from the National Nosocomial Infections Surveillance System, 1980-1990, were analyzed. During that period, 30,477 fungal infections were reported. The rate rose from 2.0 to 3.8 infections/1000 discharges.… Read more

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Nosocomial infections in surgical patients in the United States, January 1986-June 1992. National Nosocomial Infections Surveillance (NNIS) System

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Abstract

OBJECTIVES: To describe the distribution of nosocomial infections among surgical patients by site of infection for different types of operations, and to show how the risk of certain adverse outcomes associated with nosocomial infection varied by site, type of operation, and exposure to specific medical devices.… Read more

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Antimicrobial susceptibility patterns of common and unusual species of enterococci causing infections in the United States. Enterococcal Study Group

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Abstract

We collected 705 isolates of enterococci (1 per patient) from cultures of a variety of anatomic sites from patients at eight tertiary-care hospitals in six geographic regions of the United States. A total of 632 (90%) Enterococcus faecalis, 58 (8%) E.… Read more

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Predominant pathogens in hospital infections

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Abstract

To determine the distribution of pathogens causing nosocomial infections in United States hospitals, we analysed data from the National Nosocomial Infections Surveillance (NNIS) System. From October 1986 to December 1990, amongst hospitals conducting hospital-wide surveillance, the five most commonly reported pathogens were Escherichia coli (13.7%), Staphylococcus aureus (11.2%), enterococci (10.7%), Pseudomonas aeruginosa (10.1%), and coagulase-negative staphylococci (9.7%).… Read more

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Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989. National Nosocomial Infections Surveillance System

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Abstract

More than 25,000 primary bloodstream infections (BSIs) were identified by 124 National Nosocomial Infections Surveillance System hospitals performing hospital-wide surveillance during the 10-year period 1980-1989. These hospitals reported 6,729 hospital-months of data, during which time approximately 9 million patients were discharged.… Read more

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Nosocomial infections in elderly patients in the United States, 1986-1990. National Nosocomial Infections Surveillance System

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Abstract

We analyzed 101,479 nosocomial infections in 75,398 adult patients (greater than 15 years) that were reported to the National Nosocomial Infections Surveillance (NNIS) system between 1986 and 1990 by 89 hospitals using the NNIS hospital-wide surveillance component. Overall, 54% of the infections occurred in elderly patients (greater than or equal to 65 years).… Read more

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Nosocomial infection rates in adult and pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System

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Abstract

To determine which intensive care unit (ICU) infection rate may be best for interhospital and intrahospital comparisons and to assess the influence of invasive devices and type of ICU on infection rates, we analyzed data from the National Nosocomial Infections Surveillance System.… 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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Infectious disease-related deaths of low birth weight infants, United States, 1968 to 1982

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Abstract

Infant mortality rates in the United States are higher than in any other developed country. Low birth weight (LBW) is the primary determinant of infant mortality.

 

Despite city, state, and federal programs to prevent LBW, decreases in infant mortality in the 1980s appear to be largely secondary to improved survival of LBW infants rather than to a decline in the rate of LBW births.… 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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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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An historical perspective on controversy surrounding the international code of marketing of breast‑milk substitutes

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Jason JM, McGrady GA.

In: Clinical Obstetrics – A Public Health Perspective.  B P Sachs & D Acker (eds).  PSG, Inc. Boston, MA, 1985.

ISBN 0-88416-513-2… 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