Patient Safety

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Epidemic of Serratia marcescens bacteremia in a cardiac intensive care unit

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Abstract

From 16 July through 27 September 1988, seven cases of nosocomial Serratia marcescens bacteremia occurred in a cardiac care unit. In all seven case patients, S. marcescens was isolated from blood cultures. Two of the seven had other microorganisms identified in the blood culture in which S.… Read more

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Epidemic iatrogenic Acinetobacter spp. meningitis following administration of intrathecal methotrexate

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Abstract

We report the first outbreak of Acinetobacter species meningitis in a group of children with acute leukaemia following the administration of intrathecal chemotherapy. Eight of twenty patients receiving methotrexate injections on a single day developed signs and symptoms of meningitis within 18 h of treatment, and cases were clustered by time of administration.… Read more

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Duration of human immunodeficiency virus infection before detection of antibody

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Abstract

To estimate the duration and frequency of the period of HIV infection without detectable antibody, modelling techniques were applied to results of detection of HIV DNA by means of the polymerase chain reaction (PCR) and to data from cases in published reports.  … Read more

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Growth and endotoxin production of Yersinia enterocolitica and Enterobacter agglomerans in packed erythrocytes

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Abstract

Since 1987, the Centers for Disease Control investigated six cases of transfusion-associated sepsis. All six patients developed septic shock after receiving units of packed erythrocytes (PRBCs) contaminated with Yersinia enterocolitica (five patients) and Enterobacter agglomerans (one patient); three of the blood recipients died.… Read more

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Risk of developing AIDS in HIV-infected cohorts of hemophilic and homosexual men

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Abstract

The latency period and/or incidence of the acquired immunodeficiency syndrome (AIDS) may differ in persons infected with the human immunodeficiency virus by different routes or having different “cofactors.” We compared 79 hemophilic men in Pennsylvania and 117 homosexual and bisexual men in California, all having known dates of infection and long postinfection observation periods, to examine these hypotheses.… Read more

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Sex practice correlates of human immunodeficiency virus transmission and acquired immunodeficiency syndrome incidence in heterosexual partners and offspring of U.S. hemophilic men

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Abstract

We assessed the risk of human immunodeficiency virus (HIV) transmission from heterosexual seropositive hemophilic men to their female sex partners through an HIV serosurvey and questionnaire study conducted during 1984-1987. Five percent of 21 female partners of asymptomatic men and 11% of 35 partners of HIV-symptomatic (acquired immunodeficiency syndrome [AIDS], AIDS-related complex [ARC], peripheral generalized lymphadenopathy [PGL]) hemophilic men had been infected when first tested.… Read more

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Epidemic bloodstream infections associated with pressure transducers: a persistent problem

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Abstract

Twenty-four outbreaks of nosocomial bloodstream infection (BSI) were investigated by the Centers for Disease Control from Jan 1, 1977 to Dec 31, 1987. Intravascular pressure monitoring devices (transducers) were the most commonly identified source of bacterial and fungal BSI outbreaks and were implicated as the source of infection in eight (33%) outbreaks.… Read more

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Pyrogenic reactions associated with the reuse of disposable hollow-fiber hemodialyzers

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Abstract

We investigated 18 pyrogenic reactions (PRs) that occurred between July 1 and 13, 1987, in 16 patients receiving long-term hemodialysis at one dialysis center in Illinois. We defined a case of PR as the onset of chills or fever (oral temperature, greater than or equal to 37.8 degrees C) in a patient who was afebrile and had no signs or symptoms of infection before a dialysis treatment.… Read more

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Mycobacterium chelonae causing otitis media in an ear-nose-and-throat practice

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Abstract

Seventeen cases of otitis media caused by Mycobacterium chelonae were detected among patients seen at a single ear-nose-and-throat (ENT) office (Office A) in Louisiana between May 5 and September 15, 1987. All the patients had a tympanotomy tube or tubes in place or had one or more tympanic-membrane perforations, with chronic otorrhea that was unresponsive to standard therapy with antimicrobial agents.… Read more

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Human immunodeficiency virus infection in hemophilic children

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Abstract

The following groups were compared: (1) children less than 18 years old who have hemophilia-associated acquired immunodeficiency syndrome (AIDS) with other children with AIDS and with adults who have hemophilia-associated AIDS and (2) asymptomatic HIV-infected hemophilic children with asymptomatic HIV-infected hemophilic adults.… Read more

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Comparative evaluation of selective media for isolation of Pseudomonas cepacia from cystic fibrosis patients and environmental sources

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Abstract

Pseudomonas cepacia has recently emerged as an important pathogen affecting cystic fibrosis (CF) patients. We evaluated three selective media to assess their comparative potential for identification of patients colonized with P. cepacia and for efficacy of detection of P. cepacia in environmental fluids.… Read more

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Description of case-mix adjusters by the Severity of Illness Working Group of the Society of Hospital Epidemiologists of America (SHEA)

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Abstract

Hospitals, insurance companies, and federal and state governments are increasingly concerned about reducing patient cost expenditures while maintaining high quality patient care. One method of reducing expenditures has been to tie hospital reimbursement with a prospective payment system based on diagnosis-related groups (DRGs).… Read more

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Racial differences in care of patients with hemophilia

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Abstract

Hemophilia treatment centers were first established in the mid­-1970s to provide optimal and coordinated medical care to patients with the disorder. Our study suggests that blacks with hemophilia may be receiving less coordinated care and less appropriate blood­ product therapy than whites with hemophilia.… Read more

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Hemophilia-associated AIDS in the United States, 1981 to September 1987

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Abstract

Between January 1, 1981 and September 4, 1987, 407 cases of hemophilia-associated acquired immunodeficiency syndrome (AIDS) had been reported to the Centers for Disease Control. The number of cases diagnosed each year nearly doubled, except in 1986, when cases increased only 50 per cent.… Read more

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Potential effect of revising the CDC surveillance case definition for AIDS

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Abstract

The Centers for Disease Control (CDC) revised the surveillance case definition for acquired immunodeficiency syndrome (AIDS) in August, 1987. To determine the impact of this revision, information was extracted from the medical charts of the 630 patients receiving comprehensive medical care as of 1980 at 6 haemophilia treatment centres, and who were therefore likely to have been infected with human immunodeficiency virus (HIV).… Read more

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The epidemiology of Pseudomonas cepacia in patients with cystic fibrosis

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Abstract

Pseudomonas cepacia has emerged as an important nosocomial pathogen colonizing and infecting the respiratory tract of patients with cystic fibrosis (CF). Although assessment of outcomes associated with P. cepacia colonization has been difficult, controlled studies have shown that colonized patients experience more adverse outcomes compared with those not colonized.… Read more

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The Epidemiology of AIDS

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Abstract

Cases of the acquired immune deficiency syndrome (AIDS) were first reported in June and July of 1981, as clusters of Kaposi’s sarcoma and Pneumocystis carinii pneumonia among homosexual men. Since then, epidemiologic surveillance has been used by investigators and public health professionals to identify that an outbreak existed, to characterize the outbreak, and to determine and predict its extent and course.… Read more

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Hemophiliac patient’s knowledge and educational needs concerning acquired immunodeficiency syndrome

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Abstract

The Patient Knowledge Assessment Study (PKAS) was conducted among 107 male hemophilic patients, aged 15 to 67 years, at 19 hemophilia treatment centers (HTC). Participants were given a 30-item questionnaire concerning the cause of acquired immunodeficiency syndrome (AIDS), the groups at risk, and modes of transmission.… Read more

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The epidemiology of nosocomial Pseudomonas cepacia infections: endemic infections

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Abstract

Pseudomonas cepacia has recently emerged as an important nosocomial pathogen. We analyzed a national nosocomial infections database, the National Nosocomial Infections Surveillance (NNIS) system, to describe the epidemiology of endemic nosocomial P. cepacia infections. Between 1980 and 1985, the P.… Read more

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The epidemiology of nosocomial epidemic Pseudomonas cepacia infections

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Abstract

Pseudomonas cepacia has occasionally been identified as an epidemic and endemic nosocomial pathogen. In outbreaks, usually one clinical site predominates but many may be involved. Detailed investigations have usually implicated a contaminated liquid reservoir or moist environmental surface as the source.… Read more

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Mycobacterium chelonae wound infections after plastic surgery employing contaminated gentian violet skin-marking solution

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Abstract

From April 1 to October 31, 1985, postoperative surgical-wound infections due to rapidly growing mycobacteria developed in eight patients undergoing cosmetic plastic surgery performed by one surgeon. All infections followed either face-lift or augmentation-mammoplasty procedures performed in the surgeon’s office; no infections occurred after surgical procedures performed at the hospital or after other surgical procedures performed at the office.… Read more

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The course of the epidemic of acquired immunodeficiency syndrome in the United States hemophilia population

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Abstract

The time course of the epidemic of acquired immunodeficiency syndrome (AIDS) as it has occurred in the US hemophilia population is examined using surveillance data collected by the Centers for Disease Control (CDC). These data indicate that the epidemic course in hemophiliacs is distinguishable from that in the homosexual/bisexual and intravenous drug-using populations in at least one respect–the epidemic in the hemophilia population is characterized by a lack of consistent increase in the number of new AIDS cases in successive time intervals.… Read more

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Colonization of the respiratory tract with Pseudomonas cepacia in cystic fibrosis. Risk factors and outcomes

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Abstract

Between 1981 and 1983, some 85 patients with cystic fibrosis at Rainbow Babies and Childrens Hospital, Cleveland, developed colonization or infection of the respiratory tract with Pseudomonas cepacia. Twenty-nine (34 percent) of the colonized patients died; four were female patients with fulminant bacteremia with P cepacia prior to death.… Read more

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Laboratory proficiency test results on use of selective media for isolating Pseudomonas cepacia from simulated sputum specimens of patients with cystic fibrosis

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Abstract

Pseudomonas cepacia colonization of or infection in patients with cystic fibrosis (CF) has been associated with increased morbidity and premature death. However, current data on national incidence may be biased because of interlaboratory differences in the methods of culturing sputa of patients with CF.… Read more

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Effects of exposure to factor concentrates containing donations from identified AIDS patients. A matched cohort study

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Abstract

We compared recipients of eight lots of factors VIII and IX voluntarily withdrawn from distribution because one donor was known to have subsequently developed the acquired immunodeficiency syndrome with a nonexposed cohort matched by age, sex, and factor use. The factor VIII recipient cohorts did not differ in prevalence of antibody to human immunodeficiency virus (HIV) (exposed, 75%; nonexposed, 86%), T-cell subset numbers (median: exposed, 619 T-helper cells per cubic millimeter; nonexposed, 659 T-helper cells per cubic millimeter), T-helper to T-suppressor ratios, or immunoglobulin levels.… Read more

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The Role of Parvovirus B19 in Aplastic Crisis and Erythema Infectiosum (Fifth Disease)

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Abstract

In 1984, simultaneous outbreaks of aplastic crisis and erythema infectiosum occurred in northeastern Ohio. Sera were analyzed from 26 patients with aplastic crisis: 24 had IgM specific for parvovirus B19, five had Bl9-like particles by electron microscopy, and 13 had DNA from B19; no sera from 33 controls had evidence of recent infection with B19 (P< .0001).… Read more

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HTLV-III/LAV-seronegative, virus-negative sexual partners and household contacts of hemophiliacs

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Abstract

Public concern about the transmissibility of human T-cell lymphotropic virus type III/ lymphadenopathy-associated virus (HTLV-III/LAV) has been heightened by several reports suggesting the existence of an antibody-negative, virus-positive state in some asymptomatic sex partners of persons who are antibody-positive.  We recently evaluated 88 household members and/or sex partners of persons with hemophilia and found that only two nonhemophiliacs were HTLV-III/LAV antibody-positive.  … Read more

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Conjugal transmission of HTLV-III and lymphadenopathy in Christmas disease

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Abstract

The risk of conjugal transmission of the HTLV-III/LAV virus associated with the acquired immunodeficiency syndrome (AIDS) in patients with hemophilia is unknown.  To date, only a few   instances of proven exposure to HTLV-III have been reported among sexual or family contacts of   patients with hemophilia.  … Read more

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HTLV-III/LAV antibody and immune status of household contacts and sexual partners of persons with hemophilia

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Abstract

We evaluated the human T-cell lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) antibody and immune status of 88 persons living with and/or sexual partners of 43 hemophiliacs, 12 of whom had AIDS, five of whom had AIDS-related complex (ARC), 17 of whom were clinically well but HTLV-III/LAV antibody positive, and nine of whom were well and HTLV-III/LAV antibody negative.… Read more

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HTLV-III exposure during cardiopulmonary resuscitation

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Abstract

To the Editor: There have been no confirmed occupation-related cases of AIDS in health care workers in the United States. We have been following two nurses who participated in mouth-to-mouth re­suscitation of a patient with the AIDS-related complex, who was positive for human T-cell lymphotropic virus Type- III/lymphade­nopathy-associated virus (HTLV-III/LAV), and we here report their seronegativity nine months after exposure.… Read more

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Methicillin-resistant Staphylococcus aureus at children’s hospitals in the United States

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Abstract

Although methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important pathogen in hospitalized adults in the United States, reports of MRSA in pediatric patients have been infrequent. To determine the frequency at which MRSA is isolated from children, we surveyed the directors of microbiology at all acute care children’s hospitals in the United States, and 57 of 67 (85%) laboratory directors responded to a mailed questionnaire.… Read more

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HTLV I/II and HTLV III seroprevalence in blood product recipients

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Abstract

Human T-cell leukemia virus type I (HTLV-I) has been strongly implicated as the etiology of adult T-cell leukemia (ATL), a T-cell type non-Hodgkin’s lymphoma with leukemic manifestations in Japan, the Caribbean, and the southeastern United States. The prevalence of serum antibody specific for one core antigen of HTLV-I, p24, has been found to be high in patients with ATL, and higher in relatives of these patients than in general population controls.… Read more

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Human T-cell leukemia virus (HTLV-I) p24 antibody in New York City blood product recipients

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Abstract

Human T-cell leukemia virus (HTLV-I)

is known to be associated with certain hematologic malignancies, and a related virus, HTLV-III/LAV, might be the cause of AIDS. Some persons with AIDS have had evidence of HTLV-I infection. Unrelated to these findings, it has been suggested that HTLV-I is transmitted via blood products.… Read more

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Lymphadenopathy-associated virus antibodies and T cells in hemophiliacs treated with cryoprecipitate or concentrate

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Abstract

Evidence for exposure to lymphadenopathy-associated virus (LAV) was investigated in 48 patients with hemophilia, 15 of whom had been treated exclusively with single-donor cryoprecipitate. The prevalence of antibodies to LAV in all patients was 53% in 1983 and 63% in 1984, while in patients treated only with cryoprecipitate, the prevalence was 31% in 1983 and 40% in 1984.… Read more

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Pseudomonas cepacia colonization in patients with cystic fibrosis: risk factors and clinical outcome

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Abstract

During the period of 1979 to 1983, 38 patients with cystic fibrosis (CF) at the CF center of St. Christopher’s Hospital for Children in Pennsylvania developed respiratory tract colonization with Pseudomonas cepacia. Seventeen (45%) of the patients with colonization died.… Read more

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HTLV-III/LAV antibody status of spouses and household contacts assisting in home infusion of hemophilia patients

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Abstract

Thirty-four adult and pediatric hemophilia A and B patients and 50 nonhemophilic members belonging to 28 families were enrolled in August 1984 in a study of human T cell lymphotropic virus type III/lymphadenopathy-associated virus (HTLV-III/LAV) antibody status and T cell subpopulation numbers.… Read more

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Human T-lymphotropic retrovirus type III/lymphadenopathy-associated virus antibody. Association with hemophiliacs’ immune status and blood component usage

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Abstract

We studied the human T-lymphotropic retrovirus type III/lymphadenopathy-associated virus (HTLV-III/LAV) antibody status of 234 factor VIII concentrate recipients, 36 factor IX concentrate recipients, 69 long-term recipients of frozen packed red blood cells, and 47 persons not receiving routine transfusion therapy.… Read more

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HTLV-I antibody status in hemophilia patients treated with factor concentrates prepared from U.S. plasma sources and in hemophilia patients with AIDS

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Abstract

Serum samples from 85 Austrian hemophilia patients treated with lyophilized factor concentrates prepared from U.S. plasma sources, 24 hemophilia patients from Georgia on a home therapy program with factor concentrates, and 10 U.S. hemophilia patients with acquired immunodeficiency syndrome (AIDS) were analyzed by two different methods for the presence of antibodies to the major internal antigen of human T-cell leukemia virus I (HTLV-I) p24.… Read more

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Immune status of blood product recipients

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Abstract

Persons with hemophilia are at risk of the acquired immunodeficiency syndrome (AIDS), and clinically asymptomatic hemophiliacs have shown a high incidence of AIDS-like immune abnormalities, facts leading to speculation that many hemophiliacs have been exposed to the AIDS agent through their blood products.… Read more

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The epidemiology of nosocomial infections caused by Klebsiella pneumoniae

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Abstract

Klebsiella pneumoniae causes serious epidemic and endemic nosocomial infections. We conducted a literature review to characterize the epidemiology of epidemic K. pneumoniae outbreaks. Eighty percent of the outbreaks (20/25) involved infections of the bloodstream or urinary tract. Person-to-person spread was the most common mode of transmission, and nearly 50% of the outbreaks occurred in neonatal intensive care units.… Read more

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Acquired immunodeficiency syndrome (AIDS) in hemophiliacs

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Abstract

From mid-1977 to mid-1983 the Centers for Disease Control (CDC) has received reports of more than 2,100 cases of acquired immunodeficiency syndrome (AIDS). These cases had either biopsy-confirmed Kaposi’s sarcoma or a biopsy or culture confirmed life-threatening opportunistic infection, without an identifiable cause of immunosuppression.… Read more

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Perspective comprehension of AIDS

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Evatt BL, Jason J

Proc 4th Int Symp HT 1984; p 97‑102.… Read more

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Clostridium difficile. Colonization and toxin production in a cohort of patients with malignant hematologic disorders

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Abstract

We examined 45 (80%) of 56 consecutive adult patients with malignant hematologic disorders who were hospitalized during a 15-week period at Emory University Hospital, Atlanta. Stool samples for Clostridium difficile culture and cytotoxin assay were obtained on admission and then weekly during each patient’s hospitalization.… Read more

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Acquired immunodeficiency syndrome (AIDS) associated with transfusions

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Abstract

Of 2157 patients with the acquired immunode­ficiency syndrome (AIDS) whose cases were reported to the Centers for Disease Control by August 22, 1983, 64 (3 per cent) with AIDS and Pneumocystis carinii pneumonia had no recognized risk factors for AIDS.… Read more

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Acquired immunodeficiency syndrome (AIDS) in hemophiliacs

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Abstract

From mid-1977 to mid-1983 the Centers for Disease Control (CDC) has received reports of more than 2,100 cases of acquired immunodeficiency syndrome (AIDS). These cases had either biopsy confirmed Kaposi’s sarcoma

or a biopsy or culture confirmed life-threatening opportunistic infection, without an identifiable cause of immunosuppression.… Read more

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Pseudomonas fluorescens bacteremia from blood transfusion

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Abstract

In October 1980, two units of blood contaminated with Pseudomonas fluorescens caused septic transfusion reactions in two recipients at a Chicago hospital; one patient died. Both units had been purchased from the same blood center. Investigation at the blood center and at other hospitals it supplied revealed another fatal case of P.… Read more

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Significance of viral infections in severe combined immunodeficiency disease

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Abstract

An analysis of a prospective study of viral infections in 12 patients with severe combined immunodeficiency is presented. Infections of viral etiology were common, with pulmonary and gastrointestinal infections being most frequent. Fourteen of 25 infections (56%) were nonsocomially acquired and 10 of 25 (40%) were community-acquired.… Read more

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Sexual child abuse

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Abstract

The Centers for Disease Control are currently formulating recommendations for treatment of children suspected of being sexually abused. Until this process is completed, we suggest that recommendations for adults be followed for sexually abused children.

Gonorrhea prophylaxis should be given only if the abuser is known to have a gonococcal infection. … Read more

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Recommended precautions for patients with Legionnaires’ Disease

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Abstract

As diagnostic techniques for the identification of Legionella species have become readily available, recognition of the pneumonic form of Legionellosis has increased. In particular, cases of hospital-acquired Legionella pneumophila are being identified and this has led to concern over possible person-to-person transmission.… Read more