Infectious Diseases

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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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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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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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Nocardia farcinica sternotomy site infections in patients following open heart surgery

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Abstract

Although Nocardia farcinica surgical site infection outbreaks have been reported (though rarely), no source for these has been identified. From May 1992 through June 1993, 5 patients contracted N. farcinica sternotomy site infections following open heart surgery at hospital A.… 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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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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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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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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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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Patient density, nurse-to-patient ratio and nosocomial infection risk in a pediatric cardiac intensive care unit

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Abstract

BACKGROUND: An investigation of a Serratia marcescens outbreak in a pediatric cardiac intensive care unit (CICU) suggested that understaffing or overcrowding might have been underlying risk factors.

OBJECTIVE: To assess the effect of fluctuations in CICU nurse staffing levels and patient census on CICU nosocomial infection rate (NIR).… 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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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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Postoperative Serratia marcescens wound infections traced to an out-of-hospital source

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Abstract

From 25 August to 28 September 1994, 7 cardiovascular surgery (CVS) patients at a California hospital acquired postoperative Serratia marcescens infections, and 1 died. To identify the outbreak source, a cohort study was done of all 55 adults who underwent CVS at the hospital during the outbreak.… 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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Outbreak investigations

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Abstract

Epidemic nosocomial infections are defined as hospital-acquired infections that represent an increase in incidence over expected rates. Epidemic-associated infections usually are clustered temporally or geographically, suggesting that the infections are from a common source or are secondary to increased person-to-person transmission.… 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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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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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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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 effects of mitogens, IL-2 and anti-CD3 antibody on the T-cell receptor V beta repertoire

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Abstract

Phytohaemagglutinin (PHA), Concanavalin A (Con A), interleukin-2 (IL-2), and monoclonal antibodies to CD3 (CD3MoAbs) are used for the assessment of the T-cell receptor (TCR) BV gene family expression in autoimmune disorders and multiple sclerosis, and to produce clones for assessment of cytokine profiles in progressive human immunodeficiency virus infection.… 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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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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Nosocomial outbreak of Candida albicans sternal wound infections following cardiac surgery traced to a scrub nurse

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Abstract

From August 1988 through October 1989, 15 patients at 1 hospital developed Candida albicans sternal wound infections after cardiac surgery. An investigation found that case-patients were more likely than cardiac surgery patients without sternal wound infections to have surgeries lasting 165 min (11/15 vs.… 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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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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Respirators, recommendations, and regulations: the controversy surrounding protection of health care workers from tuberculosis

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Abstract

Recent nosocomial outbreaks of tuberculosis have increased concern about the occupational acquisition of tuberculosis by health care workers. The Centers for Disease Control and Prevention (CDC), Department of Health and Human Services, and the Occupational Safety and Health Administration, Department of Labor, have issued recommendations and regulations in an effort to decrease health care workers’ risk for exposure to patients with infectious tuberculosis.… 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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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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Infectious diseases and death among nursing home residents: results of surveillance in 13 nursing homes

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Abstract

An increasing proportion of the U.S. population resides in nursing homes (NHs). No surveillance system exists for infections in these facilities. To determine the incidence and types of infections in NH residents, and to identify predictors of death among residents with infections, we initiated a surveillance system at 13 NHs in California during a 6-month period from October 1989 through March 1990.… 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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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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Infectious diseases and mortality among US nursing home residents

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Abstract

Data collected in the 1985 National Nursing Home Survey were analyzed to identify risk factors for infections and mortality and to explore their relationship in US nursing homes. An infection was recorded in 166,609 (14%) discharges. Risk of pneumonia was found to be higher among bedbound patients (54.5 vs 13.1 per 100 discharges); urinary tract and other infections were most frequent among residents with indwelling catheters (6.6 vs 1.0 per 100 discharges).… Read more

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Addressing the public’s concerns about human immunodeficiency virus transmission in health-care settings

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Abstract

BACKGROUND: The 1990 report of a cluster of patients infected with the human immunodeficiency virus (HIV) associated with a Florida dentist with acquired immunodeficiency syndrome attracted considerable media coverage and legislative attention. A number of polls found that the public favored mandatory HIV-antibody testing of health-care workers.… Read more

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Educating Young Adults About HIV and AIDS: the Impact of Direct Response Television Public Service Advertising

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ABSTRACT Limited resources combined with a desire to reach as many people as possible often make direct response public service announcements an important tool in educational campaigns. To understand the impact of direct-response TV PSAs, and find ways to increase their effectiveness, this study examined 1) the effects of a highly targeted HIV prevention message on young adults’ knowledge, perceptions, and intentions; and 2) whether altering two PSA elements, the telephone number used and the length of time it was displayed, would affect viewers’ recall and intention responses.  … Read more