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To describe the incidence of recovery of both vancomycin-resistant enterococci (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) from culture of a single clinical specimen, to describe the clinical characteristics of patients from whom these specimens were recovered, and to identify the risk factors of these patients.
A retrospective cohort and case-control study.
A tertiary care university hospital and referral center in Seoul, Korea.
We identified 61 case patients for whom a single clinical specimen yielded both VRE and MRSA on culture, and 122 control patients for whom any clinical specimen yielded only VRE on culture. The control patients were selected by matching 2 :1 with the case patients for age, sex, and first date of sampling that led to isolation of VRE or both VRE and MRSA among 1,536 VRE-colonized patients from January 1, 2003, through December 31, 2006. To identify patient risk factors for the recovery of both VRE and MRSA in a single clinical specimen, we performed univariate comparisons between the 2 groups and then multivariate logistic regression analysis.
The incidence of recovery of both VRE and MRSA from culture of a single clinical specimen was 3.97% (for 61 of 1,536 VRE-colonized patients) over 4 years. Among these 82 single clinical specimens, the most common type was wound specimens (26.8%), followed by lower respiratory tract specimens (18.3%), urine specimens (17.1%), and catheter tips (15.9%). Of the 61 case patients, 14 (23.0%) had 2 or more single clinical specimens that yielded both VRE and MRSA on culture, and the longest interval from the first sampling that yielded both organisms to the last sampling that yielded both was 174 days. Independent patient risk factors for the presence of both VRE and MRSA in a single clinical specimen were chronic renal disease (odds ratio [OR], 7.00; P = .012), urinary catheterization (OR, 3.36; P = .026), and longer total cumulative duration of hospital stay within the previous year (OR, 1.03; P < .001).
We confirmed that the recovery of VRE and MRSA from a single clinical specimen occurs continually. Because prolonged cell-to-cell contact can facilitate transfer of vanA, close observation and surveillance for vancomycin-resistant S. aureus, especially among patients with risk factors for the recovery of both VRE and MRSA from a single clinical specimen, should be continued.
The adhesion force of pad and alumina were experimentally and theoretically investigated in slurry solutions of different pHs. The isoelectric point (IEP) of pad particles was measured to be around pH 3. The wafer surfaces showed negative zeta potentials in the investigated pH ranges with exception of FSG and Ta. Cu and Ta showed higher interaction forces than dielectric materials. The lowest adhesion force was measured between pad particle and wafer surfaces in a slurry solution of pH 11. The magnitude of adhesion force of pad particles was lower than alumina particles.
The interaction between Cu surface and abrasive particles in slurry solution was characterized. The adsorption behavior of the citrate ions was dependent on the pH of the slurry and the concentration of the citric acid. The adsorption of citrate ions generated a highly negative charge on the alumina surface and shifted isoelectric point (IEP) to lower pH values. The Cu removal rate of alumina slurry was higher than that of colloidal silica based slurry in the investigated pH ranges. Although lower friction forces of Cu were observed in alumina based slurry of pH 4, 6 and 8, a higher friction force was observed at pH 2. This high friction force was attributed to the positive zeta potential and greater adhesion force of particle. It indicates that the magnitudes of particle adhesions on Cu surfaces in slurries can be directly related to the frictional behavior during CMP process.
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