Patient Safety

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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

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Hemophilia growth and development study. Design, methods, and entry data

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Abstract

PURPOSE: The study design, research questions, and baseline data are presented from a multicenter longitudinal epidemiologic investigation of the impact of human immunodeficiency virus (HIV) infection on three areas of functioning in children and adolescents with hemophilia: physical growth and sexual maturation, immune function, and neurological and neuropsychological functioning.… 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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Outbreak of Pseudomonas cepacia bacteremia in oncology patients

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Abstract

In 1991, an outbreak of Pseudomonas cepacia bacteremia (PCB) occurred among patients at an oncology clinic in Alabama. A case-patient was defined as any patient at Alabama Oncology Hematology Associates (AOHA) who had at least one blood culture positive for P.… 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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Anaphylactoid reactions associated with reuse of hollow-fiber hemodialyzers and ACE inhibitors

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Abstract

From July 18 through November 27, 1989, 12 anaphylactoid reactions (ARs) occurred in 10 patients at a hemodialysis center in Virginia. One patient required hospitalization; no patients died. ARs occurred within minutes of initiating dialysis and were characterized by peripheral numbness and tingling, laryngeal edema or angioedema, facial or generalized sensation of warmth, and/or nausea or vomiting.… Read more

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A prospective study of pyrogenic reactions in hemodialysis patients using bicarbonate dialysis fluids filtered to remove bacteria and endotoxin

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Abstract

Pyrogenic reactions (PR) are a well-recognized complication of hemodialysis and have been associated with dialyzer reuse, high-flux dialysis, and bicarbonate dialysate. However, the roles of bacteria and endotoxin in dialysate for producing PR are not well defined. To determine the effect of removing most bacteria and endotoxin from the dialysate on the incidence of PR, a cohort of chronic hemodialysis patients receiving high-flux, high-efficiency, or conventional hemodialysis at three centers with bicarbonate dialysis fluids that had been filtered with a polysulfone high-flux hemodialyzer was prospectively studied.… Read more

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Hospital outbreak of multidrug-resistant Mycobacterium tuberculosis infections. Factors in transmission to staff and HIV-infected patients

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Abstract

OBJECTIVE: To describe transmission of multidrug-resistant (MDR) Mycobacterium tuberculosis infection among patients and health care workers (HCWs) in a ward and clinic for human immunodeficiency virus (HIV)-infected patients in a hospital, four studies were conducted.

METHODS: Case patients and control patients were persons who had been treated in the HIV ward or clinic, whose clinical course was consistent with tuberculosis and who had at least one positive culture for M tuberculosis between January 1, 1988, and January 31, 1990, resistant to at least isoniazid and rifampin (case patients), or whose isolates were susceptible to all drugs tested (control patients).… Read more

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Outbreak of surgical wound infections associated with total hip arthroplasty

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Abstract

OBJECTIVES: Describe an outbreak of surgical wound infections associated with total hip arthroplasty; identify risk factors for surgical wound infection during the pre-outbreak and outbreak periods.

SETTING: A 100-bed hospital. From May 1 to September 30, 1988, 7 of 15 patients who underwent total hip arthroplasty developed surgical wound infections from Staphylococcus aureus (5), Enterobacter cloacae (1), beta-hemolytic streptococci (1), enterococci (1), coagulase-negative staphylococci (1), and Escherichia coli (1) (attack rate = 46.7%).… Read more

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Tuberculin skin testing of hospital employees during an outbreak of multidrug-resistant tuberculosis in human immunodeficiency virus (HIV)-infected patients

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Abstract

Tokars JI, Jarvis WR, Edlin BR, Dooley SW, Grieco MH, Gilligan ME, Schneider N, Montonez M, Williams J

Infect Control Hosp Epidemiol 1992 Sep;13(9):509-10

PMID: 1430996… 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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Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis. A risk to patients and health care workers

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Abstract

OBJECTIVE: To determine the factors associated with the development of multidrug-resistant tuberculosis among patients at a New York City Hospital and to investigate possible nosocomial transmission.

DESIGN: A retrospective case-control study and tuberculin skin test survey.

PATIENTS: Twenty-three patients with tuberculosis whose isolates were resistant to at least isoniazid and rifampin (case patients) were compared with patients with tuberculosis whose isolates were susceptible to all agents tested (controls).… Read more

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Nosocomial transmission of tuberculosis in a hospital unit for HIV-infected patients

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Abstract

OBJECTIVE: To assess nosocomial transmission of tuberculosis (TB).

DESIGN: A historical cohort study of hospitalized patients with the human immunodeficiency virus (HIV) and a purified protein derivative (PPD) tuberculin skin test survey of health care workers (HCWs).

SETTING: A large public teaching hospital in San Juan, Puerto Rico.… Read more

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A cluster of severe postoperative bleeding following open heart surgery

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Abstract

OBJECTIVE: To investigate a cluster of postoperative bleeding following open heart surgery.

DESIGN: A cohort and case/control study.

SETTING: Palo Alto Veterans Administration Medical Center, Palo Alto, California.

PARTICIPANTS: Six (21.4%) of 28 patients undergoing open heart surgery who developed severe, nonsurgical, postoperative bleeding from July 1 through August 30, 1988 (outbreak period).… Read more

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Outbreak of pseudoinfection with Tsukamurella paurometabolum traced to laboratory contamination: efficacy of joint epidemiological and laboratory investigation

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Abstract

From January 1988 to May 1989, one hospital in South Carolina reported 12 isolates of Tsukamurella paurometabolum from 10 patients. There were no common risk factors among the patients. Case-control studies revealed that the positive specimens were significantly more likely to have been processed in the TB/fungal room, to have been tissue samples, and to have been handled by one technician.… Read more

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Risk factors for epidemic Xanthomonas maltophilia infection/colonization in intensive care unit patients

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Abstract

OBJECTIVE: To determine risk factors for and modes of transmission of Xanthomonas maltophilia infection/colonization.

DESIGN: Surveillance and cohort study.

SETTING: A 470-bed tertiary trauma-referral community hospital.

PATIENTS: From January 1, 1988 to March 17, 1989, 106 intensive care unit patients developed X maltophilia infection/colonization.… Read more

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Pyrogenic reactions in patients receiving conventional, high-efficiency, or high-flux hemodialysis treatments with bicarbonate dialysate containing high concentrations of bacteria and endotoxin

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Abstract

High-efficiency (HE) and high-flux (HF) hemodialysis are becoming increasingly popular methods for treating patients with chronic renal failure because they reduce the time required for dialysis treatment. HF and HE dialyzers require bicarbonate dialysate, often prepared from concentrates that can support bacterial growth with endotoxin production.… Read more

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Bacteriologic and endotoxin analysis of salvaged blood used in autologous transfusions during cardiac operations

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Abstract

Autologous blood transfusion is a common method of reducing the need for heterologous blood transfusion during cardiac operations. Recently we investigated an outbreak of severe, nonsurgical postoperative bleeding among patients undergoing heart operations and receiving intraoperative transfusion of blood from a cell conservation device (Cell Saver System, Haemonetics Corp.,… Read more

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Aspergillus fumigatus sternal wound infections in patients undergoing open heart surgery

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Abstract

During a 21-month period (July 1986-April 1988), six patients who underwent open heart surgery at Holston Valley Hospital and Medical Center in Kingsport, Tennessee, developed sternal would infections caused by Aspergillus fumigatus. All patients required sternectomy, reconstructive surgery, and long term amphotericin B therapy; no patient died.… Read more

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Illness in hemodialysis patients after exposure to chloramine contaminated dialysate

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Abstract

In September 1987, patients at an outpatient dialysis center were exposed to chloramine contaminated dialysate when the carbon filter in a recently modified water treatment system failed. Forty-one patients required transfusion to treat the resultant hemolytic anemia. Epidemiologic investigation demonstrated that the mortality rate among dialysis center patients increased during the 5 months after chloramine exposure when compared with the 12 months before chloramine exposure, but no deaths could be attributed to the exposure.… 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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Comparison of rates of nosocomial infections in neonatal intensive care units in the United States. National Nosocomial Infections Surveillance System

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Abstract

To determine nosocomial infection (NI) rates among neonatal intensive care units (NICUs) that are useful for interhospital comparison, we analyzed data reported in 1986-1990 from 35 hospitals that have level III NICUs and used standard National Nosocomial Infections Surveillance protocols and NI site definitions.… 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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Serratia marcescens surgical wound infection following breast reconstruction

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Abstract

Surgical wound infections due to gram-negative bacilli have been rarely reported following breast implant surgery. From April to November 1989, four patients from one plastic surgeon’s practice developed Serratia marcescens surgical wound infection (SWI) following breast reconstruction procedures with implantation of six expandable mammary implants.… Read more

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Analysis of risk factors for surgical wound infections following vascular surgery

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Abstract

Although surgical wound infections (SWI) following implantation of prosthetic devices can be catastrophic and often require removal of the prosthesis, few studies have identified risk factors for these infections. We conducted a prospective multicenter study to identify risk factors for SWI.… Read more

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Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System

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Abstract

To perform a valid comparison of rates among surgeons, among hospitals, or across time, surgical wound infection (SWI) rates must account for the variation in patients’ underlying severity of illness and other important risk factors. From January 1987 through December 1990, 44 National Nosocomial Infections Surveillance System hospitals reported data collected under the detailed option of the surgical patient surveillance component protocol, which includes definitions of eligible patients, operations, and nosocomial infections.… Read more

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The National Nosocomial Infections Surveillance System: plans for the 1990s and beyond

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Abstract

The National Nosocomial Infections Surveillance (NNIS) System is an ongoing collaborative surveillance system among the Centers for Disease Control (CDC) and United States hospitals to obtain national data on nosocomial infections. This system provides comparative data for hospitals and can be used to identify changes in infection sites, risk factors, and pathogens, and develop efficient surveillance methods.… Read more

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Microbial growth and endotoxin production in the intravenous anesthetic propofol

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Abstract

OBJECTIVE: In this study, we measured microbial growth and endotoxin production in the intravenous anesthetic propofol using 10 different microbial strains; 6 isolated from outbreak cases and 4 from laboratory stock cultures.

DESIGN: In each trial, endotoxin-free glass tubes containing 10 ml propofol were inoculated with 10(0)-10(3) CFU/ml of the test organism and incubated at 30 degrees C for 72 hours.… Read more

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Use of tap water and disinfection practices in outpatient settings. A survey of otolaryngologists

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Abstract

A survey of otolaryngologists belonging to the American Academy of Otolaryngology-Head and Neck Surgery was conducted to estimate the frequency of tap water use during otologic examinations and to assess methods used for disinfection of otologic instruments in outpatient settings.… Read more

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Economic impact of diagnosis-related groups and severity of illness on reimbursement for central nervous system infections

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Abstract

Because the federal government’s diagnosis-related group (DRG) classification system for prospective payment has not been widely applied to hospitalized pediatric patients, we analyzed the effectiveness of one DRG category (central nervous system infections) for a single year at a medium-sized children’s hospital to control for patients’ severity of illness and for hospital reimbursement.… Read more

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Prevalence and incidence of human immunodeficiency virus among patients undergoing long-term hemodialysis. The Cooperative Dialysis Study Group

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Abstract

PURPOSE: The purpose of this voluntary multicenter study was to estimate the prevalence and incidence of human immunodeficiency virus (HIV) infection and the risk of nosocomial transmission of HIV in hemodialysis patients in the United States.

PATIENTS AND METHODS: In June 1986, we began collecting epidemiologic data, risk factor information, and serum for HIV antibody testing from long-term hemodialysis patients on entry into the study and 1 year later.… Read more

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Blood contacts during surgical procedures

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Abstract

Operating room personnel are at risk for infection with blood-borne pathogens through blood contact. To describe the nature and frequency of blood contact and its risk factors, trained observers monitored a sample of operations performed by six surgical services at Grady Memorial Hospital, Atlanta, Ga, for 6 months.… Read more

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Risk factors for candidemia in patients with acute lymphocytic leukemia

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Abstract

Between 1983 and 1987 the overall incidence of candidemia at the Institut Gustave Roussy, a tertiary care referral hospital for patients with cancer, increased from 0.1% (7 of 6,801) to 0.32% (24 of 7,515) (P = .009). Because acute lymphocytic leukemia (ALL) was the most common underlying disease in patients with candidemia, risk factors for candidemia were analyzed in this subset of patients.… Read more

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National nosocomial infections surveillance system (NNIS): description of surveillance methods

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Abstract

The National Nosocomial Infections Surveillance System (NNIS) is an ongoing collaborative surveillance system sponsored by the Centers for Disease Control (CDC) to obtain national data on nosocomial infections. The CDC uses the data that are reported voluntarily by participating hospitals to estimate the magnitude of the nosocomial infection problem in the United States and to monitor trends in infections and risk factors.… Read more

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Mycobacterium gordonae pseudoinfection associated with a contaminated antimicrobial solution

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Abstract

At Yale-New Haven Hospital, 46 specimens submitted for mycobacterial culture during an 8-week period in 1989 were positive for Mycobacterium gordonae, a nontuberculous acid-fast bacterium (AFB) of low pathogenicity. The specimens were submitted from 34 patients who came from various inpatient and outpatient services.… Read more

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Epidemic bacteremia due to Acinetobacter baumannii in five intensive care units

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Abstract

From March 5, 1986 to September 4, 1987, Acinetobacter baumannii (AB) was isolated from blood or vascular catheter-tip cultures of 75 patients in five intensive care units at a hospital in New Jersey. To identify risk factors for AB bacteremia in the intensive care units, a case-control study was conducted.… Read more

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Relationship of partially purified factor concentrates to immune tests and AIDS. The Hemophilia-AIDS. Collaborative Study Group

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Abstract

We evaluated those members of a cohort of 203 hemophilic men providing all necessary information at their 1984 and 1985 evaluations, to determine whether non-heated or less than 80 degrees C dry heat-treated partially purified factor products were associated with 1) the development of AIDS in human immunodeficiency virus (HIV)-infected persons or 2) abnormal immune test results in participants seroconverting or remaining HIV seronegative.… Read more

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Concordance of polymerase chain reaction with human immunodeficiency virus antibody detection

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Abstract

To evaluate the correlation of detection of human immunodeficiency virus (HIV) by polymerase chain reaction (PCR) with detection of HIV antibody, 271 simultaneous serum and peripheral blood mononuclear cell samples were examined from 242 persons whose activities placed them at increased risk for HIV infection: 142 from homosexual men, 86 from hemophilic men, and 43 from heterosexual partners of HIV-infected persons.… Read more

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Age and human immunodeficiency virus infection in persons with hemophilia in California

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Abstract

Thirteen hemophilia centers provide comprehensive care to approximately 90 percent of persons with hemophilia in California. For 1987, these centers reported patient human immunodeficiency virus (HIV) antibody status, age group, level of clotting factor deficiency, and hemophilia type on 1,438 persons with hemophilia A and B; HIV serologic status was known for 860 persons (59.8 percent) of whom 537 (62.4 percent) were HIV-antibody-positive.… Read more

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Risk factors for wound infections after total knee arthroplasty

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Abstract

Wound infections are an infrequent but serious complication of total knee arthroplasty. Between January 1984 and November 1987, 20 of 243 (8.2%) patients at two affiliated hospitals developed surgical wound infections following 259 total knee arthroplasty procedures performed in clean-air operating rooms.… Read more

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Pregnancies in human immunodeficiency virus-infected sex partners of hemophilic men. The Hemophilia-AIDS Collaborative Study Group

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Abstract

We investigated 24 completed pregnancies of 20 healthy, human immunodeficiency virus (HIV)-seropositive sex partners of 20 seropositive hemophilic men. One woman had recurrent herpes simplex type 2 infection; no woman was known to use illicit drugs or to have other purported cofactors for vertical HIV transmission.… Read more

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Hemolysis associated with hydrogen peroxide at a pediatric dialysis center

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Abstract

Patients receiving hemodialysis therapy risk exposure to disinfectants used to reduce bacterial burdens in hemodialysis equipment and to reprocess hemodialyzers. From April 29 through May 9, 1988, 3 patients undergoing hemodialysis treatments at a single center were exposed to dialysis fluid that was inadvertently contaminated with hydrogen peroxide (HP).… Read more

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Epidemic hypotension in a dialysis center caused by sodium azide

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Abstract

The water used for dialysate (dialysis fluid) in hemodialysis centers is produced by water treatment systems (WTS), which require careful and frequent monitoring. On November 3, 1988, nine patients receiving hemodialysis treatments at a single dialysis center suddenly developed hypotension within 30 minutes of onset of dialysis.… Read more

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

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Abstract

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

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

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Abstract

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

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Absence of human T-cell lymphotropic virus type I coinfection in human immunodeficiency virus-infected hemophilic men

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Abstract

Concern for transmission of human T-cell lymphotropic virus, type 1 (HTLV-1) infection to recipients of infected cellular blood products has prompted development of tests to eliminate blood units with HTLV-I antibodies. Most hemophilic men from the United States became infected with human immunodeficiency virus (HIV) before HIV donor screening and before blood products were processed to inactivate the virus.… Read more

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Prevalence of human immunodeficiency virus type 1 DNA in hemophilic men and their sex partners. Hemophilia-AIDS Collaborative Study Group

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Abstract

Polymerase chain reaction (PCR) was used to detect human immunodeficiency virus (HIV)-1 DNA in peripheral blood mononuclear cells to assess in hemophilic men whether any were HIV-seropositive but uninfected or seronegative but infected and in seronegative sex partners of seropositive hemophilic men whether any were infected.… Read more

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Geographic variability of hemophilia-associated AIDS in the United States: effect of population characteristics. Hemophilia-Associated AIDS Study Group

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Abstract

National AIDS surveillance suggests that approximately 3.5% of all hemophilic patients in the United States have developed AIDS as of February 1988; however, the cumulative incidence of AIDS among seropositive patients at individual hemophilia treatment centers (HTCs) has been reported to be as high as 12%.… Read more