NOSOCOMIAL
INFECTION
(Diagnosis, Diagnostics, Immunodiagnosis,
Immunodiagnostics, Pathogenesis, Vaccines
& Drugs)
1824.
Cohen J. Meningococcal disease as a model to evaluate
novel anti-sepsis strategies. Critical Care Medicine. 28(9 Suppl):S64-7, 2000 Sep.
Abstract
OBJECTIVE: To consider
the appropriateness of meningococcemia as a clinical entity for the evaluation
of anti-endotoxin agents. DATA SOURCES: English language published literature
concerning meningococcemia, sepsis, and endotoxin. STUDY SELECTION: The purpose
of this work is to consider some of the
practical and scientific issues that arise in designing clinical trials to evaluate anti-endotoxin
agents. A selected review of recently
published articles was undertaken. DATA EXTRACTION AND SYNTHESIS: Relevant literature has been cited to
support factual statements in the text.
CONCLUSION: Meningococcemia as a paradigm of endotoxin-mediated Gram-negative sepsis has many advantages. It
is a homogeneous population, and it
represents a single, measurable, bacterial target that is unequivocally implicated in the pathogenesis
of the disease. However, it is an uncommon disease that may develop so quickly
that attempts to intervene may be too late to have an effect. There is
considerable morbidity, but how best to measure the outcome and the extent to
which the results can be extrapolated to adult populations with sepsis
secondary to nosocomial infection remain unclear. [References: 28]
1825.
Palomino MA. Larranaga
C. Avendano LF.
Hospital-acquired adenovirus 7h infantile
respiratory infection in Chile. Pediatric Infectious Disease Journal. 19(6):527-31, 2000 Jun.
Abstract
BACKGROUND: Adenoviruses are the second most common cause of viral
acute lower respiratory tract infection (ALRI) requiring hospitalization
in Chile. Little information is
available with respect to nosocomial
infection rate by adenovirus. This issue is important because of
its potential severity and long term
sequelae. METHODS: Infants hospitalized
for ALRI were studied to determine the rate of nosocomial
cross-infection with respiratory
adenovirus and its corresponding genome type. The group studied included all cases younger than 2
years of age admitted to a seven crib
ward in the Roberto del Rio Children's Hospital (Santiago, Chile) between May, 1995, and October, 1996.
Nasopharyngeal aspirates for
immunofluorescence assay and viral isolation were obtained on
admission and the next day. On
identification of a positive case for adenovirus, samples were obtained from contacts for 2 consecutive days and
twice weekly thereafter for 2 weeks.
RESULTS: Fifteen index positive cases for
adenovirus and their 65 contacts were identified. Secondary attack
rate for adenoviral cross-infection was
55%, most of which were diagnosed by
viral isolation. Mortality occurred in 4 cases; 3 had underlying
diseases. Four secondary cases presented mild respiratory infection after
acquiring the cross-infection, and 16 patients developed a moderate and severe
ALRI. Twelve patients required supplemental oxygen and 4 needed mechanical
respiratory support. Genome types for the 10 index cases and 19 contacts were
obtained. All of these corresponded to adenovirus 7h. CONCLUSIONS: The high
secondary attack rate observed, stresses the importance of adequate isolation
of patients and the need for rapid and sensitive viral diagnosis.
2364. No abstract
2365. No abstract
2366. No abstract
2367. No abstract
2368. No abstract
2369. No abstract
2370. No abstract
2371. No abstract
2372. No abstract
2373. No abstract
2374. No abstract
2375. No abstract
2376. No abstract
2377. Koksal N. Hacimustafaoglu M. Bagci S. Celebi S. Meropenem in neonatal severe infections due to multiresistant gram-negative bacteria. Indian Journal of Pediatrics. 68(1):15-9, 2001 Jan.
Abstract
Recently, new broad spectrum carbapenem has been investigated on a world-wide scale for the treatment of moderate to severe infections. In the neonatal intensive care units the extensive use of third generation cephalosporins for therapy of neonatal sepsis may lead to rapid emergence of multiresistant gram-negative organisms. We report the use of meropenem in 35 infants with severe infections due to Acinetobacter baumanii and Klebsiella pneumoniae. All gram negative bacteria were resistant to ampicillin, amoxicillin, ticarcilin, cefazoline, cefotaxime, ceftazidime, ceftriaxone and aminoglycosides. Eighty two percent of the cases (29/35) were born prematurely. Assisted ventilation was needed in 85.7% (30/35). All infants deteriorated during their conventional treatment and were changed to meropenem monotherapy. Six percent (2/35) died. The incidence of drug-related adverse events (mostly a slight increase in liver enzymes) was 8.5%. No adverse effects such as diarrhea, vomiting, rash, glossitis, oral or diaper area moniliasis, thrombocytosis, thrombocytopenia, eosinophilia and seizures were observed. At the end of therapy, overall satisfactory clinical and bacterial response was obtained in 33/35 (94.3%) of the newborns treated with meropenem. Clinical and bacterial response rates for meropenem were 100% for sepsis and 87.5% for nosocomial pneumonia. This report suggests that meropenem may be a useful antimicrobial agent in neonatal infections caused by multiresistant gram negative bacilli. Further studies are needed to confirm these results: Meropenem, newborn, sepsis and nosocomial infection.
2378. No abstract
2379. No abstract
2380. No abstract
2381. No abstract
2382. No abstract
2383. No abstract
2384. No abstract
2385. No abstract
2386. Napolitano LM. Greco ME. Rodriguez A. Kufera JA. West RS. Scalea TM. Gender differences in adverse outcomes after blunt trauma. Journal of Trauma-Injury Infection & Critical Care. 50(2):274-80, 2001 Feb.
Abstract
BACKGROUND: High testosterone and low estradiol levels induce immunosuppression and adverse outcome after trauma in male animals. Gender-based outcome differences in human trauma have not been investigated. In order to test our hypothesis that female gender is associated with improved outcome after trauma, we conducted an inception cohort study at the R. Adams Cowley Shock Trauma Center, the adult trauma resource center for the state of Maryland. METHODS: All were blunt trauma patients (18,892) admitted from 1983 to 1995, stratified by Injury Severity Score (ISS) and age. Gender differences in mortality; nosocomial infection; and preinjury diabetes and cardiac, pulmonary, and liver diseases were determined. RESULTS: No significant differences in preinjury diseases were identified. Death and gender were independent variables in all groups except for patients who developed pneumonia. Male patients had a higher incidence of pneumonia in all groups except age 18 to 45, with an ISS < 15. The association between male gender and pneumonia was strongest in the age 46 to 65, ISS > 30 subgroup (p < 0.01). Among those with pneumonia, female patients were at 2.8 to 5.6 times higher risk for death than were male patients. CONCLUSION: These data suggest that gender has no relation to mortality in blunt trauma patients who do not develop pneumonia. In contrast, male gender was significantly associated with an increased incidence of pneumonia after injury, and female patients with pneumonia were at significantly higher risk for mortality.
2387. No abstract
2388. No abstract
2389. No abstract
2390. No abstract
2391. No abstract
2392. No abstract
2393. No abstract
2394. No abstract
2395. No abstract
2396. No abstract
2397. Slota M. Green M. Farley A. Janosky J. Carcillo J. The role of gown and glove isolation and strict handwashing in the reduction of nosocomial infection in children with solid organ transplantation. [see comments]. Critical Care Medicine. 29(2):405-12, 2001 Feb.
Abstract
OBJECTIVE: Nosocomial infection is an important contributor to morbidity and mortality in pediatric solid organ transplantation. The relative effect of protective gown and glove isolation was compared with strict handwashing in pediatric intensive care unit (PICU) patients with solid organ transplantation. DESIGN/SETTING: A prospective, randomized design was used; children in a 23-bed PICU with solid organ transplantation were enrolled into a gown and glove protective isolation protocol or a strict handwashing protocol. PATIENTS: All children admitted to the PICU immediately after solid organ transplantation, excluding renal transplantation, and at subsequent readmissions to the PICU were eligible for the study. Children with current infection or known exposure to varicella were excluded from the study initially or at readmission. INTERVENTIONS: By using a block randomization design based on organ transplanted, age, and initial admission vs. readmission, each patient was randomized to either strict handwashing or protective gown and glove isolation intervention groups. MEASUREMENTS: We analyzed demographics, infection outcomes (defined according to Centers for Disease Control criteria), and monitoring of patient contacts in compliance with protocols. RESULTS: The infection rate in the overall PICU population did not change significantly from the year before the study compared with during the study (2.1 per 100 vs. 1.95 per 100 patient days; p =.4) The infection rate in the gown and glove group (2.3 per 100 patient days) was reduced significantly compared with the prestudy infection rate in the transplant population (4.9 per 100 patient days; p =.0008). Strict handwashing also significantly reduced the infection rate in the transplant population (3.0 per 100 patient days; p =.008). Compliance with gowning and gloving was 82% and compliance with handwashing was 76% (compared with 22% before study [p <.0001] and 52% after the study [p <.0001]). Despite an increased mean length of stay in the PICU in the gown and glove group (p =.014), there was a trend toward reduction in the incidence of infection (Fisher's exact test, p =.07; odds ratio,.76) in the gown and glove group. CONCLUSIONS: Increased compliance with handwashing was associated with a reduction in nosocomial infections, and gown and glove isolation appeared to have an additional protective effect. Some nosocomial infections may be preventable in the pediatric solid organ transplantation population.
2398. No abstract
2399. No abstract
2400. No abstract
2401. No abstract
2402. No abstract
2403. No abstract
2404. No abstract
2405. No abstract
2876.
Kaye
KS. Sands K. Donahue JG. Chan KA. Fishman P.
Platt R. Preoperative drug
dispensing as predictor of surgical site infection. Emerging Infectious
Diseases. 7(1):57-65, 2001 Jan-Feb.
Abstract
The system used by the National Nosocomial
Infection Surveillance (NNIS) program to measure risk of surgical site
infection uses a score of 3 on the American Society of Anesthesiologists
(ASA)-physical status scale as a measure of underlying illness. The chronic
disease score measures health status as a function of age, sex, and 29 chronic
diseases, inferred from dispensing of prescription drugs. We studied the
relationship between the chronic disease score and surgical site infection and
whether the score can supplement the NNIS risk index. In a retrospective
comparison of 191 patients with surgical site infection and 378 uninfected
controls, the chronic disease score and ASA score were highly correlated. The
chronic disease score improved prediction of infection by the NNIS risk index
and augmented the ASA score for risk adjustment.
2877.
Oren
I. Haddad N. Finkelstein R. Rowe JM.
Invasive pulmonary aspergillosis in neutropenic patients during hospital
construction: before and after chemoprophylaxis and institution of HEPA
filters. American Journal of Hematology.
66(4):257-62, 2001 Apr.
Abstract
Between September 1993 and December 1993,
during extensive hospital construction and indoor renovation, a nosocomial
outbreak of invasive pulmonary aspergillosis occurred in acute leukemia
patients treated in a regular ward that has only natural ventilation. The
observed infection rate was 50%. Chemoprophylaxis with intravenous continuous
low-dose amphotericin B was then instituted as a preventive measure. During the
next 18 months invasive pulmonary aspergillosis developed in 43% of acute
leukemia patients. After that period a new hematology ward was opened with an
air filtration system through high-efficiency particulate air filtration (HEPA)
filters, and a bone marrow transplantation program was started on the
hematology service. During the following three years, none of the acute
leukemia or bone marrow transplantation patients who were hospitalized
exclusively in the hematology ward developed invasive pulmonary aspergillosis,
although 29% of acute leukemia patients who were housed in a regular ward,
because of shortage of space in the new facility, still contracted invasive
pulmonary aspergillosis. Overall, 31 patients were diagnosed with invasive
pulmonary aspergillosis during almost five years: 74% of patients recovered
from invasive pulmonary aspergillosis, and 42% are long-term survivors; 26% of
patients died of resistant leukemia with aspergillosis, but no one died of
invasive pulmonary aspergillosis alone. In conclusion, during an on-going
construction period, an extremely high incidence rate of invasive pulmonary
aspergillosis in acute leukemia patients undergoing intensive chemotherapy was
observed. Institution of low-dose intravenous amphotericin B prophylaxis marginally
reduced the incidence rate of invasive pulmonary aspergillosis. Keeping
patients in a special ward with air filtration through a HEPA system eliminated
invasive pulmonary aspergillosis completely. Among patients who developed
invasive pulmonary aspergillosis, early diagnosis and treatment are probably
the explanation for the favorable outcome. Copyright 2001 Wiley-Liss, Inc.
2878.
Raveh
D. Levy Y. Schlesinger Y. Greenberg
A. Rudensky B. Yinnon AM. Longitudinal surveillance of
antibiotic use in the hospital.
QJM. 94(3):141-52, 2001 Mar.
Abstract
We evaluated antimicrobial use in our
hospital by department, including indications for use, source of infections,
use of the microbiology laboratory, and appropriateness of prescribing, in a
prospective, comparative, non-interventional study of all patients receiving
antimicrobial agents. We excluded departments where antimicrobial use was
negligible. The other 19 departments were followed for 3 (n=4) or 4 (n=15)
months, including 2 consecutive months in the spring-summer and either 1 or 2
in the autumn-winter. Antimicrobial therapy was followed from initiation,
through possible adaptations, and possible change from intravenous to oral
therapy, until discontinuation of treatment. Overall, 6376 antibiotics were
given to 2306 patients. Of the surveyed hospitalized patients, 62%+/-22%
received antibiotics, with a range of 4-100% per department. Antibiotics were
prescribed for infections acquired in the community (3037 instances, 47%), in
the hospital (2182, 34%), in a nursing home (575, 9%), and for prophylaxis
continued post-operatively (582, 9%). The most common indications for
antimicrobial use were: respiratory tract infection (1729, 27%), urinary tract
infection (955, 15%), sepsis (701, 11%), intra-abdominal infections (663, 10%),
prophylaxis 582 (9%), soft-tissue infection (572, 9%), and surgical site
infection (319, 5%). Univariate indicators for appropriateness of treatment
were: age, department, site of infection, source of infection, antimicrobial drug
and serum creatinine (all p<0.001). Forty-nine antimicrobials were
prescribed in 279 combinations, 58% as single agent and 42% as drug
combinations. Half of all antimicrobial use consisted of four agents:
cefuroxime (19.1%), metronidazole (11.3%), gentamicin (10.6%) and ampicillin
(10.2%), which together accounted for 20% of expenditure on antibiotics.
Although use of as many as 53% of antimicrobials (26/49) surveyed was
restricted, use in this category accounted for only 29% of all antimicrobial
courses. Of 6376 antibiotic courses, 4101 (64%) were given intravenously and
2275 (36%) orally. Appropriateness of use of restricted drugs was lower (70%)
than of unrestricted ones (84%, p<0.001). Of 24571 defined daily doses (DDD)
given orally, 4587 (19%) were restricted, compared to 7264 (34%) of 21602 DDDs
given intravenously (p<0.001). Antibiotic treatment in our hospital appears
to be substantial and increasing, justifying efforts to improve appropriateness
of therapy and improve clinical and financial results.
2879.
Shankar
KR. Brown D. Hughes J. Lamont GL. Losty PD.
Lloyd DA. van Saene HK. Classification and risk-factor analysis
of infections in a surgical neonatal unit. Journal of Pediatric Surgery. 36(2):276-81, 2001 Feb.
Abstract
BACKGROUND/PURPOSE: Nosocomial infection may
result in significant morbidity in surgical neonates. Traditionally, nosocomial
infections are classified using time cut-off points. Gastrointestinal carriage
of microorganisms has not been used as a criterion for classifying infection in
surgical neonates. The aims of the study were to (1) determine the overall
infection rate, (2) distinguish between nosocomial and community acquired
infections using a 48-hour postadmission cutoff and the carrier state
criterion, and (3) determine risk factors for clinical infection. METHODS: A
1-year prospective observational cohort study was undertaken in a regional
neonatal surgical unit between 1997 and 1998. All infants residing for >/=3
days in the unit were included in the study (n = 167). Patient demographics,
including illness severity (PRISM score), were recorded for all infants.
Surveillance throat and rectal swabs were obtained on admission and twice
weekly thereafter to determine carrier status. Carriage was defined as
isolation of the same microorganism from at least 2 consecutive surveillance
samples. Infective episodes were diagnosed if a clinical diagnosis of local or
general inflammation was microbiologically proven. RESULTS: A total of 167
infants responsible for 174 admissions were studied. Median gestational age was
38 weeks (range, 24 to 42), median birth weight was 3 kg (range, 1 to 3.6),
median age on admission was 8 days (range, 0 to 142), median length of hospital
stay was 8 days (range, 3 to 95). The diagnoses were gastrointestinal disorders
(n = 96), abdominal wall defects (n = 22), neural tube defects and
hydrocephalus (n = 17), thoracic disorders (n = 16), urologic disorders (n =
12), and abdominal tumours (n = 4). Twenty-five infants had 33 episodes of
infection giving an overall infection rate of 14.9%. The predominant infecting
organism was Stapylococcus aureus (n = 11); others were enterococcus, coagulase
negative staphylococcus, Candida spp, Gram-negative bacilli, and anaerobes. A
total of 27 of 33 infective episodes were caused by microorganisms carried by
the infants on admission (primary endogenous). Only 6 children had
"true" nosocomial infections. Using a traditional 48 hour cutoff, 87%
of the infections were classed as nosocomial. Birth weight, presence of central
venous line, PRISM score, and length of stay were identified as significant
risk factors for developing clinical infection. CONCLUSIONS: (1) Carriage
allowed us to identify the true nosocomial infection rate (microorganisms
acquired in the unit), which was only 18%. In contrast, using a traditional 48
hour cutoff, 87% of the infections would have been classed as nosocomial and
warranted unnecessary cross-infection investigations. (2) The results of this
study confirm that birth weight, illness severity (PRISM score), presence of
central venous catheter, and length of hospital stay were independent risk
factors associated with clinical infection in surgical neonates.
2880.
Southwick
KL. Hoffmann K. Ferree K.
Matthews J. Salfinger M. Cluster
of tuberculosis cases in North Carolina: possible association with atomizer
reuse. American Journal of Infection Control.
29(1):1-6, 2001 Feb.
Abstract
BACKGROUND: Three patients with identical
strains of M tuberculosis (TB) underwent bronchoscopy on the same day at
hospital A. METHODS: We reviewed each patient's clinical history, hospital A's
infection control practices for bronchoscopies, and specimen and isolate
handling at each of 3 laboratories involved. We searched for possible community
links between patients. Restriction fragment length polymorphism was performed
on TB isolates. RESULTS: The first patient who underwent bronchoscopy had
biopsy-confirmed granulomatous pulmonary TB. A sputum sample collected from the
third patient 6 weeks after the bronchoscopy produced an isolate with an
identical restriction fragment length polymorphism pattern to isolates
collected during the bronchoscopies. No evidence existed for community
transmission or laboratory contamination; the only common link was the bronchoscopy.
Different bronchoscopes were used for each patient. Hospital ventilation and
wall-suctioning were functioning well. Respiratory technicians reported
sometimes reusing the nozzles of atomizers on more than one patient. A possible
mechanism for transmission was contamination from the first patient of the
atomizer if it was used to apply lidocaine to the pharynx and nasal passages of
other patients. CONCLUSIONS: A contaminated atomizer may have caused TB
transmission during bronchoscopy. Hospital A changed to single-use atomizers
after this investigation.
2881. Stephenson J. Researchers describe latest
strategies to combat antibiotic-resistant microbes. JAMA. 285(18):2317-8,
2001 May 9.