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Volume 21 - September 2000

Contents

Page 9 of 20

Letters to the Editor

Medical News

  • Epidemic of Pneumonia Associated With Mechanical Ventilation

  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press:
    02 January 2015, p. 221
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  • Skin Hygiene and Infection Prevention: More of the Same or Different Approaches?

  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press:
    02 January 2015, pp. 32-34
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Letters to the Editor

Medical News

  • Decrease in Nosocomial Infections During 3-Year Period in Norwegian Hospitals

  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press:
    02 January 2015, p. 323
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Concise Communications

Medical News

  • Bacterial Contamination of Tube Feedings

  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press:
    02 January 2015, p. 269
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Readers' Forum

Concise Communications

Medical News

  • Low Prevalence of MRSA in Community: New York City

  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press:
    02 January 2015, p. 596
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From the Risk and Prevention Conference

Reviews

  • Toward New Biomaterials

  • Béatrice Montdargent, Didier Letourneur
  • Published online by Cambridge University Press:
    02 January 2015, pp. 404-410

  • Polymers are widely used for a large range of medical devices used as biomaterials on a temporary, intermittent, and long-term basis. It is now well accepted that the initial rapid adsorption of proteins to polymeric surfaces affects the performance of these biomaterials. However, protein adsorption to a polymer surface can be modulated by an appropriate design of the interface. Extensive study has shown that these interactions can be minimized by coating with a highly hydrated layer (hydrogel), by grafting on the surface different biomolecules, or by creating domains with chemical functions (charges, hydrophilic groups). Our laboratory has investigated the latter approach over the past 2 decades, in particular the synthesis and the biological activities of polymers to improve the biocompatibility of blood-contacting devices. These soluble and insoluble polymers were obtained by chemical substitution of macromolecular chains with suitable groups able to develop specific interactions with biological components. Applied to compatibility with the blood and the immune systems, this concept has been extended to interactions of polymeric biomaterials with eukaryotic and prokaryotic cells. The design of new biomaterials with low bacterial attachment is thus under intensive study. After a brief overview of current trends in the surface modifications of biocompatible materials, we will describe how biospecific polymers can be obtained and review our recent results on the inhibition of bacterial adhesion using one type of functionalized polymer obtained by random substitution. This strategy, applied to existing or new materials, seems promising for the limitation of biomaterial-associated infections.

Special Report

Concise Communications

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

  • 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.

Original Articles

  • Investigation of an Outbreak of Gram-Negative Bacteremia Among Hematology-Oncology Outpatients

  • Scott R. Penzak, Paul O. Gubbins, Shawna L. Stratton, Elias J. Anaissie
  • Published online by Cambridge University Press:
    02 January 2015, pp. 597-599
  • Objective:

    To identify risk factors associated with an outbreak of gram-negative bacteremia (GNB).

    Setting:

    A university hospital.

    Patients:

    Hematology-oncology outpatients.

    Design:

    Retrospective case-control study.

    Results:

    Thirty-eight patients developed GNB; 13 patients experienced more than one episode, and eight blood cultures grew more than one gram-negative organism. The most frequently isolated organisms were Stenotrophomonas maltophilia, Klebsiella pneumoniae, Acinetobacter baumannii, and Acinetobacter johnsonii. When the GNB patients (cases) were compared with randomly selected hematology-oncology patients (controls), central venous catheter (CVC) self-care (71% vs 39%; P=.02), and duration of recent hospital stay (median, 15 vs 4 days; P=.01) were identified as risk factors. In a logistic regression model, duration of recent hospital stay was the only risk factor significantly associated with GNB (odds ratio, 1.05; 95% confidence interval, 1.01-1.08; P<.02).

    Conclusions:

    Hematology-oncology patients providing their own CVC care who have recently been hospitalized for more than 2 weeks may be at increased risk of GNB. CVCs should be protected from possible environmental contamination in hematology-oncology patients. Patients providing their own CVC care should undergo continued rigorous education regarding proper CVC care.

Medical News

  • CDC Satellite Broadcast on HIV Prevention

  • Gina Pugliese, Martin S. Pavero
  • Published online by Cambridge University Press:
    02 January 2015, p. 741
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Concise Communications

Original Articles

  • Identifying Outliers of Antibiotic Usage in Prevalence Studies on Nosocomial Infections

  • Petra Gastmeier, Dorit Sohr, Dietmar Forster, Gabriele Schulgen, Martin Schumacher, Franz Daschner, Henning Rüden
  • Published online by Cambridge University Press:
    02 January 2015, pp. 324-328
  • Objective:

    To investigate whether the correlation between patients' antibiotic treatment (yes/no) and patients' infections (yes/no) in each hospital department, described by Pearson's correlation coefficient (ρ) for binary data as a measure for adequate use of antibiotics, is an appropriate quality indicator.

    Design:

    Comparison of the results of repeated prevalence studies in different hospitals with the data of a national prevalence study, comparing the hospital (ρ) and reference (ρNIDHP[Nosokomiale Infektionen in Deutschland: Erfassung und Prävention]) correlation coefficients for “use of antibiotics/ presence of infections.”

    Setting:

    The data of 5,377 surgical patients were separated from the total data of a national prevalence study in 72 representative hospitals to create a reference correlation coefficient (ρNIDEP) with a reference range. Nine additional prevalence studies, involving a total of 4,984 patients, were repeatedly performed in the surgical departments of 8 other hospitals during a 12-month period, whereby the correlation coefficients ρn for every prevalence investigation were determined.

    Results:

    In the national prevalence study, 15.3% of the surgical patients received antibiotics on the study day. Surgical patients had a 3.8% prevalence of nosocomial infections and a 7.0% prevalence of community-acquired infections. Pearson's correlation coefficient ρNIDEP for correlation between patients' binary data use of antibiotics and presence of infection was 0.62. To compare the correlation coefficient of each department with the appropriate reference range, the coefficients of the single departments were plotted against the number of patients; in these plots, three lines indicated the value ρNIDEP and the upper and lower reference ranges, depending on the number of patients. Seven of eight surgical departments investigated during the repeated prevalence studies were found to be within the reference range, near the reference value, in the majority of prevalence studies; only one of the departments was identified as an outlier as regards antibiotic use.

    Conclusion:

    The correlation between patients' antibiotic treatment (yes/no) and patients' infections (yes/no) in hospitals or departments, as described by Pearson's correlation coefficient ρ for binary data with a definitive reference range depending on the number of patients, is useful for quality management in identifying the overall necessity for evaluating the indications for antibiotic use in one's own hospital.

Medical News

  • Reminder Systems Improve Immunization Rates

  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press:
    02 January 2015, p. 799
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Page 9 of 20