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To evaluate the use of a perianal swab to detect CDI.
A perianal swab was collected from each inpatient with a positive stool sample for C. difficile (by polymerase chain reaction [PCR] test) and was tested for C. difficile by PCR and by culture. The variables evaluated included demographics, CDI severity, bathing before perianal swab collection, hours between stool sample and perianal swab, cycle threshold (Ct) to PCR positivity, and doses of CDI treatment before stool sample and before perianal swab.
Of 83 perianal swabs, 59 (71.1%) tested positive for C. difficile by PCR when perianal swabs were collected an average of 21 hours after the stool sample. Compared with the respective stool sample, the perianal sample was less likely to grow C. difficile (P=.005) and had a higher PCR Ct (P<.001). A direct, significant but weak correlation was detected between the Ct for a positive perianal sample and the respective stool sample (r=0.36; P=.006). An inverse dose relationship was detected between PCR positivity and CDI treatment doses before perianal swab collection (P=.27).
Perianal swabs are a simple method to detect C. difficile tcdB gene by PCR, with a sensitivity of 71%. These data were limited because stool samples and perianal swabs were not collected simultaneously. Compared with stool samples, the perianal Ct values and culture results were consistent with a lower bacterial load on the perianal sample due to the receipt of more CDI treatment before collection or unknown factors affecting perianal skin colonization.
We designed a prospective study to evaluate the effectiveness of an educational intervention designed to increase awareness and knowledge of pertussis among parents and grandparents of newborns. We also evaluated its effect on their willingness to receive the tetanus toxoid-diphtheria toxoid-acellular pertussis vaccine. There was a statistically significant (P < .05) increase in participants' knowledge about pertussis and in their willingness to receive vaccination after our education program. However, follow-up several months after participants underwent the intervention revealed that only 12 (8%) of 150 participants had been vaccinated.
Objectives: This study sought to identify potential
predictive variables of death within 6 months in patients with advanced
Methods: Investigators enrolled a consecutive series of
patients with advanced AIDS admitted to a skilled nursing facility in New
York City over a 1-year period. Demographic, clinical, laboratory, and
outcome data were abstracted from medical records using a standardized
data collection instrument.
Results: Of the 152 patients enrolled during the study
period, 61 patients (40%) died within 6 months from date of admission.
Serum albumin, percent deviation from ideal body weight, and number of
comorbidities at the time of admission proved to be the best combination
of predictors of death within 6 months.
Significance of results: The decrease in AIDS mortality over
the past decade, along with an increase in prevalence due to longer
survival, has been attributed primarily to the successful use of highly
active antiretroviral therapy (HAART). HAART regimens, however, can also
produce both short-term adverse effects and long-term complications. The
prognostic model developed by this study may be useful in guiding
treatment decisions in patients with advanced AIDS for whom a more
palliative care plan may be sought.
To determine the natural history of colonization with vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and resistant gram-negative bacilli among long-term–care facility (LTCF) residents.
Observational cohort study.
A 355-bed LTCF with a ventilator unit and a subacute unit.
Residents with colonization or infection with VRE, MRSA or resistant gram-negative bacilli housed at the LTCF between December 1,1999, and February 29, 2000.
Cultures of clinical and surveillance sites were performed at regular intervals. Charts were reviewed for clinical characteristics associated with clearance of colonization. Kaplan–Meier curves were constructed to analyze the number of days to clearance of colonization.
Forty-nine residents had 65 episodes of colonization (27 VRE, 30 MRSA and 8 resistant gram-negative bacilli). Eighteen (28%) of the episodes cleared. The clearance rate was 2.7 episodes per 1,000 person-days. Clearance occurred significantly more often with resistant gram-negative bacilli colonization compared with VRE or MRSA colonization (6 [75%] vs 12 [21%]; P = .007; relative risk, 4.17; 95% confidence interval, 1.26 to 11.8). There was a trend toward longer use of antimicrobial agents among residents with persistent colonization. Infections occurred most frequently with MRSA The urinary tract was the most common site of infection.
Among LTCF residents, colonization with resistant gram-negative bacilli is four times more likely to clear than colonization with VRE or MRSA. Performance of surveillance cultures at regular intervals may reduce the need for contact precautions for LTCF residents with resistant gram-negative bacilli colonization.
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