Infectious Diseases

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Age-related differences in cell-specific cytokine production by acutely ill Malawian patients

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Abstract

Age-related changes in human cell-specific cytokine responses to acute illness have not been well examined. We therefore evaluated age-related differences in T, B and natural killer (NK) peripheral blood lymphocyte cytokine responses of 309 acutely ill hospitalized people in Malawi, Africa, < 1 month-61 years of age.… Read more

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Feasibility of national surveillance of health-care-associated infections in home-care settings

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Abstract

This article examines the rationale and strategies for surveillance of health-care-associated infections in home-care settings, the challenges of nonhospital-based surveillance, and the feasibility of developing a national surveillance system.

Manangan LP, Pearson ML, Tokars JI, Miller E, Jarvis WR

Emerging Infect.… Read more

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The effects of iron deficiency on lymphocyte cytokine production and activation: preservation of hepatic iron but not at all cost

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Abstract

Worldwide, over 40% of children have iron deficiency anaemia, frequently associated with infections. Certain cytokines are involved in both immune activation/response to infection and iron transport/metabolism. We therefore assessed the relations among iron deficiency, cytokine production and lymphocyte activation markers in 142 hospitalized Malawian children.… Read more

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Nosocomial infections in a children’s hospital in Argentina: impact of a unique infection control intervention program

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Abstract

OBJECTIVE: To assess the efficacy of parental education and use of parents as nursing assistants on reducing nosocomial infections.

DESIGN: Prospective study.

METHODS: Active surveillance for nosocomial infections was performed on two wards. On ward A, parents were educated about infection control practices and assisted nursing staff with routine tasks, so that nursing personnel could focus their efforts on procedures with higher risk of infection.… Read more

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Prevalence of nosocomial infections in neonatal intensive care unit patients: Results from the first national point-prevalence survey

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Abstract

OBJECTIVES: Patients admitted to neonatal intensive care units (NICUs) are at high risk of nosocomial infection. We conducted a national multicenter assessment of nosocomial infections in NICUs to determine the prevalence of infections, describe associated risk factors, and help focus prevention efforts.… Read more

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Comparison of serum and cell-specific cytokines in humans

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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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Nosocomial outbreak of Microbacterium species bacteremia among cancer patients

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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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Intracellular cytokines in the acute response to highly active antiretroviral therapy

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Abstract

OBJECTIVES: Successful highly active antiretroviral therapy (HAART) is usually associated with a rapid decline in HIV plasma RNA levels and a gradual increase in CD4 T cells. We examined whether changes in cytokine production and profile precede other immunological changes and whether these might occur in temporal association with plasma HIV RNA changes.… Read more

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Cytokines and malaria parasitemia

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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

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

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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

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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

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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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Infection control dogma: top 10 suspects

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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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Modulation of CD8 and CD3 by HIV or HIV antigens

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Abstract

To investigate whether human immunodeficiency virus (HIV)-1 and HIV-1 antigens modulate surface and cytoplasmic CD8 or CD3, as well as CD4, we used cell permeabilization reagents, surface/cytoplasmic fluorescent staining, multiparameter flow cytometric techniques and an in vitro culture system in which relatively few lymphocytes are actively infected with HIV.… Read more

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

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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

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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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Emerging healthcare-associated problem pathogens in the United States

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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

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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

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

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

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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

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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?

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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

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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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Effects of HIV-1 peptides on T-cell receptor variable beta chain families

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Superantigens (SAGs) selectively stimulate expansion and then deletion of specific T cell antigen receptor (TCR) variable beta chain (Vbeta) families. We investigated six synthetically produced HIV-1-related peptides for evidence of SAG activity: three derived all or in part from the transmembrane gp41 protein and three from the genetic sequence of the tRNA binding region.… Read more

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

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

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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

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

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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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A prolonged outbreak of Pseudomonas aeruginosa in a neonatal intensive care unit: did staff fingernails play a role in disease transmission?

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Abstract

OBJECTIVES: To describe an outbreak of Pseudomonas aeruginosa bloodstream infection (BSI) and endotracheal tube (ETT) colonization in a neonatal intensive care unit (NICU), determine risk factors for infection, and make preventive recommendations.

DESIGN: A 15-month cohort study followed by a case-control study with an environmental survey and molecular typing of available isolates using pulsed-field gel electrophoresis.… Read more

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The influence of the composition of the nursing staff on primary bloodstream infection rates in a surgical intensive care unit

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Abstract

OBJECTIVES: To determine the risk factors for acquisition of nosocomial primary bloodstream infections (BSIs), including the effect of nursing-staff levels, in surgical intensive care unit (SICU) patients.

DESIGN: A nested case-control study.

SETTING: A 20-bed SICU in a 1,000-bed inner-city public hospital.… Read more

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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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Modifiable risk factors associated with deep sternal site infection after coronary artery bypass grafting

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Abstract

OBJECTIVE: Our objective was to identify risk factors for deep sternal site infection after coronary artery bypass grafting at a community hospital.

METHODS: We compared the prevalence of deep sternal site infection among patients having coronary artery bypass grafting during the study (January 1995-March 1998) and pre-study (January 1992-December 1994) periods.… Read more

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An outbreak of gram-negative bacteremia in hemodialysis patients traced to hemodialysis machine waste drain ports

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Abstract

OBJECTIVE: To investigate an outbreak of gram-negative bacteremias at a hemodialysis center (December 1, 1996-January 31, 1997).

DESIGN: Retrospective cohort study. Reviewed infection control practices and maintenance and disinfection procedures for the water system and dialysis machines. Performed cultures of the water and dialysis machines, including the waste-handling option (WHO), a drain port designed to dispose of saline used to flush the dialyzer before patient use.… Read more

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Seasonal variation of Acinetobacter infections: 1987-1996. Nosocomial Infections Surveillance System

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To determine whether nosocomial infections due to Acinetobacter species have increased over the past 10 years and whether infections continue to have a pronounced seasonal variation, we analyzed infections reported by hospitals in the National Nosocomial Infections Surveillance System that performed adult and pediatric intensive care unit surveillance from 1987 through 1996.… Read more

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Emerging Issues in Nosocomial Fungal Infections

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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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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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Prospective evaluation of risk factors for bloodstream infection in patients receiving home infusion therapy

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Abstract

BACKGROUND: Intravenous therapy in the outpatient and home settings is commonplace for many diseases and nutritional disorders. Few data are available on the rate of and risk factors for bloodstream infection among patients receiving such therapy.

OBJECTIVE: To determine rates of and risk factors for bloodstream infection among patients receiving home infusion therapy.… Read more

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Infection-control measures reduce transmission of vancomycin-resistant enterococci in an endemic setting

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Abstract

BACKGROUND: Vancomycin-resistant enterococci (VRE) are nosocomial pathogens in many U. S. hospitals.

OBJECTIVE: To determine whether enhanced infection-control strategies reduce transmission of VRE in an endemic setting.

DESIGN: Prospective cohort study.

SETTING: Adult oncology inpatient unit.

PATIENTS: 259 patients evaluated during use of enhanced infection-control strategies and 184 patients evaluated during use of standard infection-control practices.… Read more

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Lessons from recent nosocomial epidemics

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Abstract

This review describes important examples of recent nosocomial infection epidemics. Current trends suggest that emerging problems in nosocomial infections include increased nosocomial epidemics in out-of-hospital settings, contamination of medical devices and products, and antimicrobial resistance. Increased attention should be focused on outbreak investigations in these areas.… Read more

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Antimicrobial resistance in Staphylococcus aureus

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Abstract

Recognized since 1883 as a common cause of infection, Staphylococcus aureus’ preantimicrobial-era bacteremia mortality rate was 82%. The mortality of that era threatens to return as evidence of growing vancomycin resistance undermines the utility of vancomycin therapy. Successful treatment of S.… Read more

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Fever and human immunodeficiency virus infection as sentinels for emerging mycobacterial and fungal bloodstream infections in hospitalized patients >/=15 years old, Bangkok

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To determine the etiology of bloodstream infections (BSIs) in hospitalized patients /=15 years old in Thailand, prospectively enrolled, consecutive febrile (/=38 degrees C) patients were admitted to one hospital during February-April 1997. After a patient history was taken and a physical examination was performed, blood was obtained for comprehensive culture and human immunodeficiency virus (HIV) testing.… Read more

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Selected global health care activities of the Hospital Infections Program, Centers for Disease Control and Prevention

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Abstract

Manangan LP, Archibald LK, Pearson ML, Duffy RE, Garrett DO, Alonso-Echanove JA, Richet HM, Parvez FM, Jarvis WR

Am J Infect Control 1999 Jun;27(3):270-4

PMID: 10358231… Read more

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Postsurgical Candida albicans infections associated with an extrinsically contaminated intravenous anesthetic agent

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Abstract

From 16 to 30 April 1990, four of 364 (1%) postsurgical patients at one hospital developed Candida albicans fungemia or endophthalmitis. The case patients’ surgeries were clustered on two days. To identify risk factors for C. albicans infections, we conducted a cohort study comparing these 4 patients with 67 control patients who had surgeries on the same days but did not acquire C.… 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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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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Emergence of vancomycin resistance in Staphylococcus aureus. Glycopeptide-Intermediate Staphylococcus aureus Working Group

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Abstract

BACKGROUND: Since the emergence of methicillin-resistant Staphylococcus aureus, the glycopeptide vancomycin has been the only uniformly effective treatment for staphylococcal infections. In 1997, two infections due to S. aureus with reduced susceptibility to vancomycin were identified in the United States.… Read more

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EMERGEncy ID NET: an emergency department-based emerging infections sentinel network

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Abstract

Talan DA, Moran GJ, Mower WR, Newdow M, Ong S, Slutsker L, Jarvis WR, Conn LA, Pinner RW

Clin. Infect. Dis. 1999 Feb;28(2):401-2

PMID: 10064261… Read more

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Increased expression of CD80 and CD86 in in vitro-infected CD3+ cells producing cytoplasmic HIV type 1 p24

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Abstract

Determining the effects of HIV infection on the expression of cell surface molecules has been limited by an inability to differentiate between productively infected cells and those without productive infection. We inoculated human peripheral blood mononuclear cells from healthy, human immunodeficiency virus type 1 (HIV) antibody-negative donors with HIV; noninoculated cells were also examined.… Read more