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Volume 21 - Issue 10 - October 2000

Contents

Page 1 of 2

Letters to the Editor

  • Failure of a PCR Screening Method to Detect MRSA
  • Zafar Hussain, Michael A. John
  • Published online by Cambridge University Press: 02 January 2015, pp. 627-628
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  • Déjà Vu … All Over Again? The Importance of Instrument Drying
  • Lawrence F. Muscarella
  • Published online by Cambridge University Press: 02 January 2015, pp. 628-629
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Medical News

  • Triclosan and Antibiotic Resistance in S aureus
  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press: 02 January 2015, p. 629
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Editorial

  • Gene Therapy and Infection Control: More Light on the Way
  • Published online by Cambridge University Press: 02 January 2015, pp. 630-632
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Original Articles

  • Applicability of Two Surgical-Site Infection Risk Indices to Risk of Sepsis in Surgical Patients
  • Concepción Fariñas-Álvarez, M. Carmen Fariñas, Dolores Prieto, Miguel Delgado-Rodríguez
  • Published online by Cambridge University Press: 02 January 2015, pp. 633-638
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    Objective:

    To compare the ability of the Study of the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infection Surveillance (NNIS) indices to predict the development of nosocomial sepsis in subjects undergoing surgery.

    Design:

    1-year prospective case-control study.

    Setting:

    A tertiary-care center in Spain.

    Patients:

    Cases were surgical patients with nosocomial sepsis defined using the criteria of the Consensus Conference on Sepsis, identified by daily prospective surveillance.

    Methods:

    Controls were randomly selected from the daily list of surgical inpatients. Data were prospectively collected. To determine whether either index added explanatory information to the other, two methods were used. The first method involved computing a set of residuals for both variables. Residuals and primary variables were introduced in logistic regression models. The second method evaluated both indices with the Goodman-Kruskal (G) nonparametric coefficient.

    Results:

    99 cases and 97 controls were included. After controlling for confounders, both the SENIC index (P<.001) and the NNIS index (P=.04) showed a significant trend. Residuals of the SENIC index added discriminating ability to the NNIS index, whereas residuals of the NNIS index did not improve the prediction ability of the SENIC index. Similar results were yielded by the G statistic: the SENIC index showed higher predictive power than the NNIS index (G=0.56 vs G=0.41).

    Conclusions:

    Both indices performed about equally well for discriminating risk of nosocomial sepsis. The SENIC index had a somewhat better ability than the NNIS index only when the number of discharge diagnoses (not truly a predictive factor) were involved in the calculation of the SENIC index.

Medical News

  • Fatal Arenavirus Infections in California
  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press: 02 January 2015, p. 638
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Original Articles

  • Epidemiological Differences Between Sepsis Syndrome With Bacteremia and Culture-Negative Sepsis
  • Concepción Fariñas-Álvarez, M. Carmen Fariñas, Carlos Fernández-Mazarrasa, Javier Llorca, Miguel Delgado-Rodríguez
  • Published online by Cambridge University Press: 02 January 2015, pp. 639-644
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    Objective:

    To explore the association of putative disease markers and potential risk factors with the nosocomial sepsis syndrome.

    Design:

    Prospective case-control study matched for gender, age, and length of preinfection hospital stay.

    Setting:

    1,200-bed tertiary-care center in Spain.

    Patients:

    Cases were selected using the sepsis syndrome criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference and were divided into three groups: sepsis with bacteremia (109 cases), sepsis with positive culture other than blood (122 cases), and sepsis with negative culture (115 cases without documented infection but with sepsis syndrome, clinically suspected infection, and empirical antibiotic treatment). Controls were randomly selected from the daily list of inpatients. Data were collected prospectively. Crude and multiple-risk-factor-adjusted odds ratios and their 95% confidence intervals were computed using conditional logistic regression analysis.

    Results:

    Presence of coma in the 48 hours before sepsis, intensive care unit (ICU) stay, and decreased serum albumin levels at admission were common epidemiological markers identified for the three groups of cases. Having a central venous catheter was the main healthcare-related risk factor for bacteremia. ICU stay and nasogastric tube were the main risk factors for sepsis with positive culture other than blood. Coma within 48 hours before sepsis and the need of intensive care were the only two markers identified for culture-negative sepsis.

    Conclusion:

    Culture-negative sepsis does not behave like culture-positive sepsis, and this may imply that implementation of preventive measures to decrease the risk of bacteremia may not decrease the risk of sepsis syndrome.

  • Nosocomial Methicillin-Resistant Staphylococcus aureus Bacteremia: Is It Any Worse Than Nosocomial Methicillin-Sensitive Staphylococcus aureus Bacteremia?
  • Linda A. Selvey, Michael Whitby, Barbara Johnson
  • Published online by Cambridge University Press: 02 January 2015, pp. 645-648
  • View abstract
    Objective:

    To determine the comparative virulence of methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-sensitive S aureus (MSSA) by consideration of predisposing factors and outcomes in patients infected with these organisms in the healthcare setting.

    Design:

    Analysis of an historical cohort of 504 bacteremic patients (316 MSSA and 188 MRSA), examining factors associated with mortality.

    Setting:

    A 916-bed, university-affiliated, tertiary referral hospital.

    Results:

    Risk factors for the development of MRSA include male gender, admission due to trauma, immunosuppression, presence of a central vascular line or an indwelling urinary catheter, and a past history of MRSA infection. Overall mortality was 22%. Death due to bacteremia was significantly greater in the MRSA group (risk ratio, 1.68; P<.05), although these patients were not found to be more likely to die due to underlying disease during treatment of bacteremia. In those patients who recovered from bacteremia, no significant differences for the outcome of death could be determined between the MRSA and MSSA groups.

    Conclusions:

    There is a general consensus in the published literature that MRSA bacteremia is more likely to be associated with death, and we confirm this conclusion. However, in contrast to other studies, our MRSA cohort does not appear to be more at risk of death due to underlying disease during treatment for bacteremia. Similarly, the general consensus that MRSA patients have an increased overall mortality was not confirmed in our study. Differences in comorbidities of patients may provide some explanation of these conflicting results, while an alternate explanation is that MRSA strains are more virulent than MSSA in some centers. Perhaps the most plausible explanation is that treatment is provided earlier and in a more aggressive fashion in some centers, leading to an overall lower mortality rate in all staphylococcal bacteremias in these institutions.

Concise Communications

Medical News

  • First Responders Not at Occupational Risk of HCV
  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press: 02 January 2015, p. 658
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Special Report

Topics in Long-Term Care

  • The Burden of Infection in Long-Term Care
  • Larry J. Strausbaugh, Carol L. Joseph
  • Published online by Cambridge University Press: 02 January 2015, pp. 674-679
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    Available data, although fragmentary, indicate that infections impose a large burden on long-term–care facilities (LTCFs) in the United States. Endemic infections occur with frequencies estimated to range between 1.64 and 3.83 million per year. These estimates rival or exceed the annual tally for nosocomial infections in acute-care settings. Infections associated with outbreaks caused by respiratory, gastrointestinal, and antimicrobial-resistant pathogens burden LTCFs even further. As judged by antimicrobial use, transfers to hospital, and mortality figures, infections in LTCFs are not trivial. Moreover, annual costs associated with these infections appear to exceed $1 billion. Recognition of the burden associated with infection in LTCFs helps to identify research priorities for this rapidly growing area of healthcare.

  • Antibiotic Use in Long-Term–Care Facilities: Many Unanswered Questions
  • Mark Loeb
  • Published online by Cambridge University Press: 02 January 2015, pp. 680-683
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    The extensive use of antibiotics in long-term–care facilities has led to increasing concern about the potential for the development of antibiotic resistance. Relatively little is known, however, about the quantitative relation between antibiotic use and resistance in this population. A better understanding of the underlying factors that account for variance in antibiotic use, unexplained by detected infections, is needed. To optimize antibiotic use, evidence-based standards for empirical antibiotic prescribing need to be developed. Limitations in current diagnostic testing for infection in residents of long-term–care facilities pose a substantial challenge to developing such standards.

Medical News

  • CDC Offers Web Site on Antimicrobial Resistance
  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press: 02 January 2015, p. 684
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  • Barrier Cream and Oil-Containing Lotion Protects Hand, Promotes Hand Washing
  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press: 02 January 2015, p. 684
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  • Increased Mortality With Inappropriate Treatment of Bloodstream Infections
  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press: 02 January 2015, pp. 684-685
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  • Disinfectant Contaminated With Klebsiella oxytoca—Source of Sepsis in Babies
  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press: 02 January 2015, p. 685
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