Epidemiology

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Enterobacter cloacae bloodstream infections traced to contaminated human albumin

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Abstract

In August 1996, a patient in Kansas developed an Enterobacter cloacae bloodstream infection (BSI) shortly after receiving Albuminar, a brand of human albumin. Albuminar contamination was suspected. A case-control study of patients with primary gram-negative bacterial BSIs showed that patients with E.… Read more

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Vancomycin use in pediatric neurosurgery patients

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Abstract

OBJECTIVE: The objective of this article is to describe a pediatric neurosurgery patient population receiving vancomycin and examine the indications for and appropriateness of vancomycin use.

METHODS: A cross-sectional study was performed on the pediatric neurosurgery patients at Egleston Children’s Hospital who received vancomycin from January 1 through December 31, 1996.… Read more

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Proficiency in detecting vancomycin resistance in enterococci among clinical laboratories in Santiago, Chile

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Abstract

Labarca JA, McDonald LC, Pinto ME, Palavecino E, González P, Cona E, Fernández A, Giglio MS, Jarvis WR

Emerging Infect. Dis. 1999 Nov-Dec;5(6):839-40

PMID: 10603228… Read more

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Emerging Issues in Nosocomial Fungal Infections

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Abstract

Nosocomial fungal infections remain a serious cause of morbidity and mortality. As immunodeficient populations increase, the incidence of nosocomial fungal infections continues to rise. Although a wide variety of new and emerging fungi can cause nosocomial infections, Candida species remain the major etiologic agent.… Read more

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Reporting of vancomycin-resistant enterococci in Connecticut: implementation and validation of a state-based surveillance system

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Abstract

OBJECTIVE: To assess state-based surveillance for isolation from a sterile site of vancomycin-resistant enterococci (VRE) in Connecticut.

DESIGN: Clinical laboratory reporting (passive surveillance) of VRE isolates to the Connecticut Department of Public Health (CDPH) was followed by state-initiated validation, laboratory proficiency testing, and review of hospital demographic characteristics.… Read more

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Unrecognised Mycobacterium tuberculosis bacteraemia among hospital inpatients in less developed countries

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Abstract

BACKGROUND: Nosocomial transmission of Mycobacterium tuberculosis is a global public-health concern. Although early clinical recognition of M. tuberculosis in hospital inpatients is critical for effective infection control, such recognition may be difficult in patients with HIV infection. To find out whether M.… Read more

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A pseudoepidemic of postoperative scleritis due to misdiagnosis

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Abstract

OBJECTIVE: To describe a pseudoepidemic of infectious scleritis following eye surgery.

METHODS: Retrospective cohort study with selected procedural and laboratory investigations.

RESULTS: Twenty-one patients with postoperative scleritis were identified during a 2-month outbreak. Neither an infectious etiology nor a causative pre-, intra-, or postoperative exposure was found.… Read more

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Proficiency of clinical laboratories in Spain in detecting vancomycin-resistant Enterococcus spp. The Spanish VRE Study Group

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Abstract

Studies in a variety of U.S. clinical laboratories have demonstrated difficulty in detecting intermediate and low-level vancomycin-resistant enterococci (VRE). The misclassification of “at least intermediate resistant isolates” as vancomycin susceptible may have both clinical implications and a negative impact on measures to control the spread of VRE.… Read more

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Guideline for Prevention of Surgical Site Infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee

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Abstract

EXECUTIVE SUMMARY The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention (CDC)’s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.1,2 Part I, “Surgical Site Infection: An Overview,” describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs.… 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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Proficiency of clinical laboratories in and near Monterrey, Mexico, to detect vancomycin-resistant enterococci

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Abstract

Early detection of vancomycin-resistant enterococci is important for preventing its spread among hospitalized patients. We surveyed the ability of eight hospital laboratories in and near Monterrey, Mexico, to detect vancomycin resistance in Enterococcus spp. and found that although laboratories can reliably detect high-level vancomycin resistance, many have difficulty detecting low-level resistance.… Read more

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EMERGEncy ID NET: an emergency department-based emerging infections sentinel network. The EMERGEncy ID NET Study Group

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Abstract

Acute infectious disease presentations among many at-risk patient groups (eg, uninsured, homeless, and recent immigrants) are frequently seen in emergency departments. Therefore EDs may be useful sentinel sites for infectious disease surveillance. This article describes the background, development, and implementation of EMERGE ncy ID NET, an interdisciplinary, multicenter, ED-based network for research of emerging infectious diseases.… Read more

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Epidemiology, appropriateness, and cost of vancomycin use

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Abstract

Pharmaceutical costs, which approach $40 billion annually, account for about 8% of health care costs. Prescription drugs represent 5% to 20% of the total hospital budget, and antimicrobials account for 20% to 50% of hospital pharmaceutical costs. At one university hospital, the percentage of patients receiving antimicrobials increased from 31.8% in 1988 to 53.1% in 1994.… Read more

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Nonperinatal nosocomial transmission of Candida albicans in a neonatal intensive care unit: prospective study

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Abstract

Nosocomial Candida albicans infections have become a major cause of morbidity and mortality in neonates in neonatal intensive care units (NICUs). To determine the possible modes of acquisition of C. albicans in hospitalized neonates, we conducted a prospective study at Grady Memorial Hospital, Atlanta, Ga.… Read more

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Kawasaki disease and the T-cell antigen receptor

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Abstract

We investigated the evidence for an infectious etiology of Kawasaki disease (KD), an acute vasculitis of unknown etiology, by assessing the effects of KD on the T cell antigen receptor variable beta region families (V beta). Using 3-color flow cytometry, we studied KD patients pre- and post-intravenous gamma globulin (IVIG) therapy and at > 40 days post therapy, additionally comparing them to matched pediatric control patients (PCC) and their own healthy parents (one parent/KD child).… Read more

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Respiratory distress and sudden death associated with receipt of a peripheral parenteral nutrition admixture

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Abstract

OBJECTIVE: To detect respiratory adverse reactions potentially related to receipt of peripheral parenteral nutrition (PPN) in hospitalized patients and to determine risk factors for their occurrence.

DESIGN: Retrospective cohort study.

SETTING: Federal tertiary-care hospital.

PATIENTS: Medical and pharmacy records of all patients who received PPN from October 1992 to February 1994 were abstracted for demographics, diagnoses, medications received, indications for and formulation of PPN, and severity of illness as measured by Acute Physiology and Chronic Health Evaluation II scores.… Read more

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Study to determine the ability of clinical laboratories to detect antimicrobial-resistant Enterococcus spp. in Buenos Aires, Argentina

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Abstract

Few reports of vancomycin-resistant enterococci have appeared outside the USA. Therefore, we evaluated the ability of five laboratories in Buenos Aires, Argentina, to perform susceptibility testing using the disk diffusion method. Laboratories had difficulty identifying the low- and intermediate-level vancomycin-resistant phenotypes.… Read more

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Immunoregulatory changes in Kawasaki disease

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Abstract

Kawasaki disease (KD) is an acute vasculitis of unknown etiology, occurring in young children and treated with intravenous gamma globulin (IVIG) to prevent significant cardiac morbidity and mortality. We studied KD patients pre- and post-IVIG therapy and at >40 days posttherapy, additionally comparing them with matched pediatric control patients and parents.… 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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Prevention of nosocomial transmission of Mycobacterium tuberculosis

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Abstract

The recent resurgence of TB together with the ongoing HIV epidemic has resulted in a larger number of infectious TB patients being admitted to US health care facilities. These patients have become a source for both nosocomial (patient-to-patient) and occupational (patient-to-health care worker) M.… Read more

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Epidemiology of vancomycin usage at a children’s hospital, 1993 through 1995

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Abstract

OBJECTIVE: To describe the epidemiology of vancomycin usage at a children’s hospital.

METHODS: A cohort study of patients at Egleston Children’s Hospital who were charged for the receipt of vancomycin from October, 1992, through October, 1995, was performed. Data were obtained from pharmacy charge records in the hospital’s medical records information system.… Read more

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Tracing patients exposed to health care workers with tuberculosis

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Abstract

OBJECTIVES: Following an outbreak of tuberculosis (TB) among health care workers at a public hospital, the study was undertaken to (a) locate all exposed patients and administer tuberculin skin tests (TSTs) to them, (b) provide clinical treatment or prophylaxis to infected patients, and (c) ascertain the risk of M.… Read more

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HIV antigens and T-cell receptor variable beta chain families

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Abstract

The authors investigated whether the human immunodeficiency virus (HIV) has restrictive effects on the variable region of the beta chain (V beta) of the T-cell antigen receptor (TCR), by in vitro cultivation of non-HIV-infected peripheral blood lymphocytes with one of six HIV antigens or heat-inactivated whole virus (HIV-HI).… Read more

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Pseudo-outbreak of Enterococcus durans infections and colonization associated with introduction of an automated identification system software update

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Abstract

Enterococci are an important cause of hospital-acquired infections. Since 1989, there has been an increase in the number of nosocomial enterococcal infections caused by strains resistant to vancomycin in the United States. Although many enterococcal species can colonize humans, only Enterococcus faecalis, E.… Read more

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Epidemiology of nosocomial fungal infections

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Abstract

This paper briefly reviews the current knowledge of the epidemiology and modes of transmission of nosocomial fungal infections and some of the therapeutic options for treating these diseases. In the mid-1980s, many institutions reported that fungi were common pathogens in nosocomial infections.… 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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Status of tuberculosis infection control programs at United States hospitals, 1989 to 1992. APIC. Association for Professionals in Infection Control and Epidemiology

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Abstract

BACKGROUND: Recent nosocomial outbreaks have raised concern about the risk of Mycobacterium tuberculosis transmission in United States hospitals.

METHODS: To determine current tuberculosis (TB) infection control practices, we surveyed a sample of approximately 3000 acute care facilities about the number of patients with drug-susceptible or multidrug-resistant TB (MDR-TB), health care worker (HCW) tuberculin skin test (TST) results, and compliance with the 1990 Centers for Disease Control and Prevention (CDC) TB guidelines.… 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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Acremonium kiliense endophthalmitis that occurred after cataract extraction in an ambulatory surgical center and was traced to an environmental reservoir

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Abstract

During October and November 1993, four patients contracted Acremonium kiliense endophthalmitis at one ambulatory surgical center. We hypothesized that the source was environmental and conducted a matched case-control study, environmental evaluation, and observational studies. Case and control patients were similar in clinical characteristics.… Read more

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The epidemiology of colonization

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Abstract

Colonization is the presence of a microorganism in or on a host, with growth and multiplication but without any overt clinical expression or detected immune response in the host at the time it is isolated. Normal colonization in humans begins during the birth process and through subsequent contacts with the inanimate or animate environments until a delicately balanced “normal” flora is established; subsequently, the precise components of this flora evolve.… Read more

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Evidence for a shift from a type I lymphocyte pattern with HIV disease progression. Hemophilia Growth and Development Study

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Abstract

Whether a shift from a type I (cell mediated) immune profile occurs with progressive HIV-related immune dysfunction is a matter of heated debate.

We analyzed data for 333 HIV antibody-positive (HIV+) and -negative (HIV-) hemophilic children/adolescents, to examine whether the relationships among immunologic parameters and vaccine-related serology supported a shift with advancing HIV infection.… 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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Epidemic aluminum intoxication in hemodialysis patients traced to use of an aluminum pump

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Abstract

This study was designed to identify the source, risk factors, and clinical consequences of an outbreak of aluminum intoxication in hemodialysis patients using case-control and cohort studies. In 1991, a dialysis center in Pennsylvania [Dialysis Center A (DCA)] identified a number of patients with elevated serum aluminum levels.… Read more

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Epidemiology of nosocomial fungal infections, with emphasis on Candida species

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Abstract

Currently, about 180 hospitals participate in the National Nosocomial Infections Surveillance (NNIS) system. From January 1980 through April 1990, 27,200 fungal isolates causing nosocomial infections were reported from these hospitals; Candida species accounted for 19,621 (72.1%) of these isolates. Immunocompromised patients are at particularly high risk for candidemia.… Read more

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Epidemic nosocomial pneumonia in the intensive care unit

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Abstract

The changing and expanding spectrum of pathogens associated with nosocomial pneumonia (NP) will require modification in our approach to both endemic and epidemic NP in the ICU. Knowledge of specific pathogens, modes of transmission, and sources or reservoirs of epidemic NP is crucial to the recognition, control, and prevention of these infections in ICU patients.… Read more

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SHEA-CDC TB survey, Part II: Efficacy of TB infection control programs at member hospitals, 1992. Society for Healthcare Epidemiology of America

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Abstract

OBJECTIVE: To assess the efficacy of current Mycobacterium tuberculosis control measures.

DESIGN: Voluntary questionnaire to members of the Society for Healthcare Epidemiology of America.

RESULTS: Healthcare worker (HCW) tuberculin skin-test (TST) conversion rates were significantly higher in larger hospitals (or = 437 beds) (0.9% versus 0.6%; P < 0.05), or in hospitals reporting > or = 6 TB patients in 1992 (1.2% versus 0.6%; P < 0.05). Among larger hospitals or those hospitals surveyed reporting > or = 6 TB patients, those without at least three of the four criteria suggested in the 1990 Centers for Disease Control and Prevention (CDC) TB guidelines for acid-fast bacilli (AFB) isolation (specifically, a single-patient room; negative pressure; and air exhausted directly outside) had significantly higher annual TST conversion rates than those with these criteria (1.8% versus 0.6%; P < 0.05). Respiratory therapist or bronchoscopist TST conversion rates were significantly lower in hospitals compliant with the exhaust criteria (1.2% versus 2.8%; P < 0.05). Regardless of hospital characteristic, HCW TST conversion rates did not differ between hospitals in which HCWs used surgical masks or used disposable particulate respirators.

CONCLUSION: Among larger hospitals or hospitals reporting or = 6 TB patients per year, failure to comply with the 1990 CDC TB recommendations for AFB isolation room guidelines was associated with higher HCW TST conversion rates.… Read more

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SHEA-CDC TB survey, Part I: Status of TB infection control programs at member hospitals, 1989-1992. Society for Healthcare Epidemiology of America

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Abstract

OBJECTIVE: To determine trends in Mycobacterium tuberculosis infection in healthcare workers, tuberculosis (TB) control measures, and compliance with the 1990 Centers for Disease Control and Prevention (CDC) guideline for preventing transmission of TB in healthcare facilities.

DESIGN: Voluntary questionnaire sent to all members of the Society for Healthcare Epidemiology of America, representing 359 hospitals.… Read more

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Latex sensitivity among perioperative nurses

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Abstract

To estimate the prevalence, risk factors, and clinical spectrum of adverse reactions to natural rubber latex-containing products among a national sample of perioperative nurses, the investigators administered a self-reporting questionnaire to a convenience sample of 2,200 members of the Association of Operating Room Nurses, Inc.… Read more

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Usefulness of molecular epidemiology for outbreak investigations

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Abstract

We conducted a retrospective review of nosocomial outbreak investigations conducted by the Hospital Infections Program, Centers for Disease Control and Prevention, from January 1991 through March 1994. Selected outbreaks have demonstrated the utility of molecular methods such as plasmid analysis, plasmid restriction endonuclease analysis, ribotyping, restriction fragment polymorphism, pulsed-field gel electrophoresis, and polymerase chain reaction in confirming the clonality of the outbreak and in confirming the source of the outbreak implicated in the epidemiologic investigation.… Read more

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Immune and serologic profiles of HIV-infected and noninfected hemophilic children and adolescents. Hemophilia Growth and Development Study Group

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Abstract

OBJECTIVES: To assess relationships among the effects of HIV on hemophilic children and adolescents’ immunologic parameters and vaccine-related serology.

METHODS: We analyzed data from extensive baseline immunologic evaluations of 207 HIV antibody-positive (HIV+) and 126 HIV antibody-negative (HIV-) hemophilic children and adolescents.… Read more

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Bacterial contamination of platelets at a university hospital: increased identification due to intensified surveillance

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Abstract

BACKGROUND: A cluster of bacterial contamination of platelets occurred at a university hospital in a one-month period. This unusual clustering allowed us to examine the likely mechanism of contamination and clinical sequelae.

METHODS: We reviewed medical records of patients receiving random donor platelet transfusions to determine numbers of platelets transfused, reactions reported, and episodes of bacterial contamination.… 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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How common is latex allergy? A survey of children with myelodysplasia

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Abstract

To estimate the prevalence of latex allergy among children with myelodysplasia, describe the spectrum of associated clinical symptoms and evaluate potential risk factors for the development of latex sensitization, the authors conducted a survey at a regional spina bifida center.… Read more

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Cluster of Enterobacter cloacae pseudobacteremias associated with use of an agar slant blood culturing system

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Abstract

From 1 February through 12 October 1990, 27 blood cultures processed at Shiprock Hospital were positive for Enterobacter cloacae; only 3 had been reported in the preceding 12 months. Twenty (74%) of the cultures were obtained from patients without clinical evidence of gram-negative septicemia.… Read more

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Potential use of mass media to reach urban intravenous drug users with AIDS prevention messages

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Abstract

To access the potential of using the mass media to reach urban intravenous drug users (IVDUs) with AIDS prevention messages,

we: 1) questioned 353 participants in a Baltimore IVDU cohort study on their media use and sources of AIDS information, 2) analyzed data on Baltimore AIDS public service announcement (PSA) airings during a 3-month period, and 3) discussed with media executives their willingness to air a variety of potential AIDS messages.… Read more