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Biomedical subjects

G J Moran

Publications and source records attributed to G J Moran.

At least 19 recordsLinked to original sources
PubMed2001

Etiology of bloody diarrhea among patients presenting to United States emergency departments: prevalence of Escherichia coli O157:H7 and other enteropathogens.

Escherichia coli O157:H7 and other Shiga toxin-producing E. coli (STEC) infections have been associated with bloody diarrhea. The prevalence of enteropathogens among patients with bloody diarrhea was determined by a prospective study at 11 US emergency departments. Eligible patients had bloody stools, > or =3 loose stool samples per 24-h period, and an illness lasting <7 days. Among 873 patients with 877 episodes of bloody diarrhea, stool samples for culture were obtained in 549 episodes (62.6%). Stool cultures were more frequently ordered for patients with fever, >10 stools/day, and visibly bloody stools than for patients without these findings. Enteropathogens were identified in 168 episodes (30.6%): Shigella (15.3%), Campylobacter (6.2%), Salmonella (5.8%), STEC (2.6%), and other (1.6%). Enteropathogens were isolated during 12.5% of episodes that physicians thought were due to a noninfectious cause. The prevalence of STEC infection varied by site from 0% to 6.2%. Hospital admissions resulted from 195 episodes (23.4%). These data support recommendations that stool samples be cultured for patients with acute bloody diarrhea.

Adolescent↗
PubMed2001

New directions in antiinfective therapy for community-acquired pneumonia in the emergency department.

The emergency department is becoming an increasingly important setting for the management of community-acquired pneumonia (CAP). This trend reflects the shortened hospital stays and decreased mortality among elderly hospitalized patients resulting from rapid administration of antimicrobials. In addition, decisions about the site of care (inpatient vs outpatient) and antimicrobial therapy frequently are made in the emergency department. Recent research and subsequent clinical guidelines may help with these decisions. For example, recently issued guidelines, such as those of the Infectious Diseases Society of America and the American Thoracic Society, suggest that selection of antimicrobials for CAP (which is typically empiric) should be based on the potential pathogens and likelihood of antimicrobial resistance. Macrolides and tetracyclines are recommended in younger patients with mild-to-moderate disease. Patients with more severe disease and those at risk for drug-resistant pathogens should be treated with broad-spectrum therapy, such as a newer fluoroquinolone or a cephalosporin plus a macrolide. When hospitalization is required, early switch from intravenous to oral therapy, followed by early discharge, can be a highly successful strategy. Antimicrobials that are available in both intravenous and oral formulations, such as the newer fluoroquinolones (e.g., levofloxacin and gatifloxacin), can simplify switch therapy For outpatients, an initial long-acting parenteral dose of azithromycin, ceftriaxone, or levofloxacin followed by oral therapy is an effective protocol. In addition, use of a prediction rule to identify low-risk patients with CAP may help guide decisions about the need for hospital admission.

Aged↗
PubMed2000

Emergency department management of blood and body fluid exposures.

Exposure to blood and body fluids that may be contaminated with infectious agents is a common occupational hazard for health care workers. Health care workers in the emergency department or out-of-hospital setting are at especially high risk for exposure to blood or body fluids. Nonemergency health care workers are frequently referred to hospital EDs for immediate treatment of occupation exposures. A series of recommendations by the Centers for Disease Control and Prevention evolved over the past decade, and changes are expected to continue. This state-of the-art article reviews current recommendations for management of persons exposed to blood or body fluids and discusses the scientific basis for recommendations regarding hepatitis B virus, hepatitis C virus, and HIV.

Algorithms↗
PubMed2000

Pharmacologic management of HIV/STD exposure.

Emergency physicians must be familiar with management of occupational exposures to HIV-infected bodily fluids. Victims of sexual assault also may be exposed to HIV and other sexually transmitted diseases. The Centers for Disease Control and Prevention guidelines for the management of occupational exposures include recommendations for administration of combination antiretroviral therapy to reduce the risk for HIV transmission. Antiretroviral therapy also may be indicated for certain types of sexual exposure to HIV. Drugs that are used to treat sexually transmitted diseases also may be given to prevent infection after possible exposures. This article reviews current recommendations for prophylaxis against HIV and other sexually transmitted diseases and the scientific basis for these recommendations.

Animals↗
PubMed1999

Bacteriologic analysis of infected dog and cat bites. Emergency Medicine Animal Bite Infection Study Group.

BACKGROUND AND METHODS: To define better the bacteria responsible for infections of dog and cat bites, we conducted a prospective study at 18 emergency departments. To be eligible for enrollment, patients had to meet one of three major criteria for infection of a bite wound (fever, abscess, and lymphangitis) or four of five minor criteria (wound-associated erythema, tenderness at the wound site, swelling at the site, purulent drainage, and leukocytosis). Wound specimens were cultured for aerobic and anaerobic bacteria at a research microbiology laboratory and, in some cases, at local hospital laboratories. RESULTS: The infected wounds of 50 patients with dog bites and 57 patients with cat bites yielded a median of 5 bacterial isolates per culture (range, 0 to 16) at the reference laboratory. Significantly more isolates grew at the reference laboratory than at the local laboratories (median, 1; range, 0 to 5; P<0.001). Aerobes and anaerobes were isolated from 56 percent of the wounds, aerobes alone from 36 percent, and anaerobes alone from 1 percent; 7 percent of cultures had no growth. Pasteurella species were the most frequent isolates from both dog bites (50 percent) and cat bites (75 percent). Pasteurella canis was the most common isolate of dog bites, and Past. multocida subspecies multocida and septica were the most common isolates of cat bites. Other common aerobes included streptococci, staphylococci, moraxella, and neisseria. Common anaerobes included fusobacterium, bacteroides, porphyromonas, and prevotella. Isolates not previously identified as human pathogens included Reimerella anatipestifer from two cat bites and Bacteroides tectum, Prevotella heparinolytica, and several porphyromonas species from dog and cat bites. Erysipelothrix rhusiopathiae was isolated from two cat bites. Patients were most often treated with a combination of a beta-lactam antibiotic and a beta-lactamase inhibitor, which, on the basis of the microbiologic findings, was appropriate therapy. CONCLUSIONS: Infected dog and cat bites have a complex microbiologic mix that usually includes pasteurella species but may also include many other organisms not routinely identified by clinical microbiology laboratories and not previously recognized as bite-wound pathogens.

Adolescent↗
PubMed1998

EMERGEncy ID NET: an emergency department-based emerging infections sentinel network. The EMERGEncy ID NET Study Group.

Acute infectious disease presentations among many at-risk patient groups (eg, uninsured, homeless, and recent immigrants) are frequently seen in emergency departments. Therefore EDs may be useful sentinel sites for infectious disease surveillance. This article describes the background, development, and implementation of EMERGE ncy ID NET, an interdisciplinary, multicenter, ED-based network for research of emerging infectious diseases. EMERGE ncy ID NET was established in cooperation with the National Center for Infectious Diseases, Centers for Disease Control and Prevention (CDC) as part of the CDC's strategy to expand and complement existing disease detection and control activities. The network is based at 11 university-affiliated, urban hospital EDs with a combined annual patient visit census of more than 900,000. Data are collected during ED evaluation of patients with specific clinical syndromes, and are electronically stored, transferred, and analyzed at a central receiving site. Current projects include investigation of bloody diarrhea and the prevalence of Shiga toxin-producing Escherichia coli, animal exposures and rabies postexposure prophylaxis practices, seizures and prevalence of neurocysticercosis, nosocomial ED Mycobacterium tuberculosis transmission, and hospital isolation bed use for adults admitted for pneumonia or suspected tuberculosis. EMERGE ncy ID NET also was developed to be a mechanism for rapidly responding to new diseases or epidemics. Future plans include study of antimicrobial use, meningitis, and encephalitis, and consideration of other public health concerns such as injury and national and international network expansion.

Acute Disease↗
PubMed1995

Tuberculosis infection-control practices in United States emergency departments.

STUDY OBJECTIVE: To determine the frequency with which patients with suspected tuberculosis (TB) or TB risk factors present to US emergency departments and to describe current ED TB infection-control facilities and practices. DESIGN: Mailed survey of a sample of EDs in US acute care facilities. PARTICIPANTS: A random sample (n = 446) of subjects who responded to a 1992 survey of all US municipal, Veterans Affairs, and university-affiliated hospitals and a 20% random sample of all private hospitals with more than 100 beds conducted by the Centers for Disease Control and Prevention (CDC). RESULTS: We collected data on patient demographics and general ED characteristics, TB isolation facilities and policies, and employee tuberculin skin-testing policies and results. Of 446 facilities surveyed, 305 surveys (68.4%) were returned. The proportions of facilities reporting that patients suspected of having TB are seen daily, weekly, monthly, and less frequently were, respectively, 12.6%, 17.2%, 23.3%, and 46.9%. The proportion of EDs in which indigent patients are cared for on a daily basis was 89%; the homeless, 57.5%; the HIV-infected, 35.9%; i.v. drug users, 45.4%; and recent immigrants, 30%. Written criteria for isolation of patients with suspected TB at triage or in the ED were in place in 56% and 76% of facilities, respectively. TB isolation rooms fulfilling CDC guidelines were available in triage or waiting areas in 1.7% of facilities and in 19.6% of EDs. Air venting directly outside, high-efficiency particulate air filtration of recirculated air, and UV germicidal lights were used in 21%, 17%, and 8% of general patient care areas of EDs, respectively. At least one ED employee had shown tuberculin skin test conversion in 16.1% of EDs in 1991; this figure was 26.9% in 1992. CONCLUSION: Patients with TB or at risk for TB are often treated in US EDs, and the risk for transmission of TB in this setting appears to be increasing. Prolonged waiting times and lack of infection-control facilities in EDs may contribute to this problem. Consideration should be given to implementation of policies and facilities recommended by the CDC.

Centers for Disease Control and Prevention, U.S.↗