Age-related variations in care have been identified for HIV-associated Pneumocystis carinii pneum... more Age-related variations in care have been identified for HIV-associated Pneumocystis carinii pneumonia (PCP) in both the 1980s and 1990s. We evaluated if age-related variations affected all aspects of HIV-specific and non-HIV-specific care for HIV-infected individuals with PCP or community-acquired pneumonia (CAP), or whether age-related variations were primarily limited to HIV-specific aspects of care. Subjects were HIV-infected persons with PCP (n = 1855) or CAP (n = 1415) hospitalized in 8 cities from 1995 to 1997. Nine percent of our study patients had received protease inhibitors and 39% had received any type of antiretroviral therapy prior to hospitalization. Data were abstracted from medical records and included severity of illness, HIV-specific aspects of care (initiation of PCP medications), general measures of care [initiation of CAP medications, intubation, and intensive care units (ICU)], and inpatient mortality. Compared to younger patients, pneumonia patients 50 years of age or older were significantly more likely to: be severely ill (PCP, 20.4% vs. 10.4%; CAP, 27.5% vs. 14.9%; each p = 0.001), receive ICU care (PCP, 22.0% vs. 12.8%, p = 0.002; CAP: 15.1% vs. 9.4%; p = 0.02), and be intubated (PCP, 14.6% vs. 8.4%, p = 0.01; CAP, 9.9% vs. 5.6%, p = 0.03). Compared to younger patients, older patients (>/=50 years) had similar rates of timely medications for CAP (48.5% vs. 50.8%) but had lower rates of receiving anti-PCP medications (85.8% vs. 92.9%, p = 0.002). Differences by age in timely initiation of PCP medications, ICU use, and intubation were limited to the nonseverely ill patients. Older hospitalized patients were more likely to die (PCP, 18.3% vs. 10.4%; CAP, 13.4% vs. 8.5%; each p < 0.05). After adjustment for disease severity and timeliness of antibiotic use, mortality rates were similar for both age groups. Physicians should develop strategies that increase awareness of the possibility of HIV infection in older individuals.
ABSTRACT Vancomycin-Resistantenterococcus Outbreak andContainment in a Neonatal ICU Tricia Thomso... more ABSTRACT Vancomycin-Resistantenterococcus Outbreak andContainment in a Neonatal ICU Tricia Thomson,MD, Julie Venci, MD, Jorge P. Parada, MD, MPH, Paul Schreckenberger, PhD, MarcWeiss, MD, Alexander Tomich, MSN, RN, Patricia Hester-Lund, RN, VioletaRekasius, MT(ASCP), Malliswari Challapalli, MD Loyola UniversityMedical Center, Maywood, IL, USA Background: Vancomycin-resistant enterococcus (VRE) is an uncommon cause ofinfection in neonates. In our neonatal ICU (NICU) we only had 1 case annuallyfrom 2005-2007. However, starting in May of 2009 we encountered 2 infants withVRE infections within 7 weeks of each other. This prompted surveillance cultures(SC) on all neonates in the NICU to determine the possibility, magnitude, andscope of an outbreak. Objective: Todetermine the extent and scope of a VRE outbreak in our NICU and to preventfurther spread. Methods: After thesecond case of VRE, we began SC of all neonates in our NICU at an approximately1 month interval (7/9/09, 9/1/09, 9/30/09, 11/10/09). SC were obtained viarectal swabs which were plated on selective agar containing vancomycin (Campyblood agar) and then incubated at 35-37C. Positive isolates were run throughrepetitive sequence-based PCR (rep-PCR) to determine strain type. Colonizedneonates were placed on contact isolation and cohorted in a separate room ofthe NICU. In addition, we obtained environmental swabs from frequently touchedsurfaces around the neonates (including monitors, isolettes, oxygen blenders,IV pumps) to look for possible sources of spread. All staff was re-educated onthe importance of strict hand-washing and strict implementation of barrierprecautions was emphasized. Efforts at environmental cleaning were redoubledwith use of bleach-containing solutions. Results: InitialSC obtained on 7/9/09 detected VRE in 9 of31 infants. On subsequent cultures, 3 of 33 infants on 9/1/09 and 4 of 29 on9/30/09 were colonized with VRE. The most recent cultures, on 11/10/09,revealed no VRE in any of the 23 infants. Of those colonized infants 8 of 9from the first screen, 2 of 3 from the second, and 1 of 4 on the third screenhad the outbreak strain. In total, there were 4 different strains of VREisolated through SC (1 of which was the outbreak strain). Of the 37 environmentalcultures 1 was positive for VRE (an isolette). Most of the affected infantsseem to have been located next to each other or in the same aisle as eachother. Conclusions: Throughstrict adherence to hand-washing protocols, implementation of barrierprecautions, segregation of colonized infants to a separate room, assignment ofseparate personnel to care for these infants, and thorough environmentalcleaning, VRE clinical infection and widespread colonization in the NICUappeared to be contained 4 months after the initial outbreak. The presence of4 distinct strains of VRE in our NICU suggests that vertical transmission maybe a possible source of VRE introduction into the NICU.
Background: Community-associated Methicillin Resistant Staphylococcus aureus (CA-MRSA) infections... more Background: Community-associated Methicillin Resistant Staphylococcus aureus (CA-MRSA) infections are increasing in frequency. Nasal MRSA colonization rates amongst pregnant women and the incidence of MRSA transmission to newborn infants is not well characterized. Objective: To determine the incidence of nasal MRSA colonization rates amongst pregnant women and the incidence of transmission to the newborns of colonized mothers. Methods: All pregnant women admitted to Labor and Delivery (L & D) and their newborn infants admitted to nursery from 12/1/07 to 8/31/09 were screened for nasal MRSA colonization by using the Cepheid GeneXpert rapid PCR. Microbiology laboratory data were also reviewed to detect any MRSA invasive infections in newborn infants less than 48 hours of age. Results: A total of 2254 pregnant women were admitted to L & D from 12/1/07 to 8/31/09. Nasal MRSA surveillance screens were ordered in 1819 (compliance rate of 81%). 39 of the 1819 pregnant women screened were p...
Age-related variations in care have been identified for HIV-associated Pneumocystis carinii pneum... more Age-related variations in care have been identified for HIV-associated Pneumocystis carinii pneumonia (PCP) in both the 1980s and 1990s. We evaluated if age-related variations affected all aspects of HIV-specific and non-HIV-specific care for HIV-infected individuals with PCP or community-acquired pneumonia (CAP), or whether age-related variations were primarily limited to HIV-specific aspects of care. Subjects were HIV-infected persons with PCP (n = 1855) or CAP (n = 1415) hospitalized in 8 cities from 1995 to 1997. Nine percent of our study patients had received protease inhibitors and 39% had received any type of antiretroviral therapy prior to hospitalization. Data were abstracted from medical records and included severity of illness, HIV-specific aspects of care (initiation of PCP medications), general measures of care [initiation of CAP medications, intubation, and intensive care units (ICU)], and inpatient mortality. Compared to younger patients, pneumonia patients 50 years of age or older were significantly more likely to: be severely ill (PCP, 20.4% vs. 10.4%; CAP, 27.5% vs. 14.9%; each p = 0.001), receive ICU care (PCP, 22.0% vs. 12.8%, p = 0.002; CAP: 15.1% vs. 9.4%; p = 0.02), and be intubated (PCP, 14.6% vs. 8.4%, p = 0.01; CAP, 9.9% vs. 5.6%, p = 0.03). Compared to younger patients, older patients (>/=50 years) had similar rates of timely medications for CAP (48.5% vs. 50.8%) but had lower rates of receiving anti-PCP medications (85.8% vs. 92.9%, p = 0.002). Differences by age in timely initiation of PCP medications, ICU use, and intubation were limited to the nonseverely ill patients. Older hospitalized patients were more likely to die (PCP, 18.3% vs. 10.4%; CAP, 13.4% vs. 8.5%; each p < 0.05). After adjustment for disease severity and timeliness of antibiotic use, mortality rates were similar for both age groups. Physicians should develop strategies that increase awareness of the possibility of HIV infection in older individuals.
ABSTRACT Vancomycin-Resistantenterococcus Outbreak andContainment in a Neonatal ICU Tricia Thomso... more ABSTRACT Vancomycin-Resistantenterococcus Outbreak andContainment in a Neonatal ICU Tricia Thomson,MD, Julie Venci, MD, Jorge P. Parada, MD, MPH, Paul Schreckenberger, PhD, MarcWeiss, MD, Alexander Tomich, MSN, RN, Patricia Hester-Lund, RN, VioletaRekasius, MT(ASCP), Malliswari Challapalli, MD Loyola UniversityMedical Center, Maywood, IL, USA Background: Vancomycin-resistant enterococcus (VRE) is an uncommon cause ofinfection in neonates. In our neonatal ICU (NICU) we only had 1 case annuallyfrom 2005-2007. However, starting in May of 2009 we encountered 2 infants withVRE infections within 7 weeks of each other. This prompted surveillance cultures(SC) on all neonates in the NICU to determine the possibility, magnitude, andscope of an outbreak. Objective: Todetermine the extent and scope of a VRE outbreak in our NICU and to preventfurther spread. Methods: After thesecond case of VRE, we began SC of all neonates in our NICU at an approximately1 month interval (7/9/09, 9/1/09, 9/30/09, 11/10/09). SC were obtained viarectal swabs which were plated on selective agar containing vancomycin (Campyblood agar) and then incubated at 35-37C. Positive isolates were run throughrepetitive sequence-based PCR (rep-PCR) to determine strain type. Colonizedneonates were placed on contact isolation and cohorted in a separate room ofthe NICU. In addition, we obtained environmental swabs from frequently touchedsurfaces around the neonates (including monitors, isolettes, oxygen blenders,IV pumps) to look for possible sources of spread. All staff was re-educated onthe importance of strict hand-washing and strict implementation of barrierprecautions was emphasized. Efforts at environmental cleaning were redoubledwith use of bleach-containing solutions. Results: InitialSC obtained on 7/9/09 detected VRE in 9 of31 infants. On subsequent cultures, 3 of 33 infants on 9/1/09 and 4 of 29 on9/30/09 were colonized with VRE. The most recent cultures, on 11/10/09,revealed no VRE in any of the 23 infants. Of those colonized infants 8 of 9from the first screen, 2 of 3 from the second, and 1 of 4 on the third screenhad the outbreak strain. In total, there were 4 different strains of VREisolated through SC (1 of which was the outbreak strain). Of the 37 environmentalcultures 1 was positive for VRE (an isolette). Most of the affected infantsseem to have been located next to each other or in the same aisle as eachother. Conclusions: Throughstrict adherence to hand-washing protocols, implementation of barrierprecautions, segregation of colonized infants to a separate room, assignment ofseparate personnel to care for these infants, and thorough environmentalcleaning, VRE clinical infection and widespread colonization in the NICUappeared to be contained 4 months after the initial outbreak. The presence of4 distinct strains of VRE in our NICU suggests that vertical transmission maybe a possible source of VRE introduction into the NICU.
Background: Community-associated Methicillin Resistant Staphylococcus aureus (CA-MRSA) infections... more Background: Community-associated Methicillin Resistant Staphylococcus aureus (CA-MRSA) infections are increasing in frequency. Nasal MRSA colonization rates amongst pregnant women and the incidence of MRSA transmission to newborn infants is not well characterized. Objective: To determine the incidence of nasal MRSA colonization rates amongst pregnant women and the incidence of transmission to the newborns of colonized mothers. Methods: All pregnant women admitted to Labor and Delivery (L & D) and their newborn infants admitted to nursery from 12/1/07 to 8/31/09 were screened for nasal MRSA colonization by using the Cepheid GeneXpert rapid PCR. Microbiology laboratory data were also reviewed to detect any MRSA invasive infections in newborn infants less than 48 hours of age. Results: A total of 2254 pregnant women were admitted to L & D from 12/1/07 to 8/31/09. Nasal MRSA surveillance screens were ordered in 1819 (compliance rate of 81%). 39 of the 1819 pregnant women screened were p...
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