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Biomedical subjects

K Crossley

Publications and source records attributed to K Crossley.

13 recordsLinked to original sources
PubMed1992

State regulations governing infection control issues in long-term care.

OBJECTIVE: To examine states' regulations governing infections and infection control in long-term-care institutions. DESIGN: Collection and examination of relevant documents from all of the states, the District of Columbia, the Joint Commission on Accreditation of Health Care Organizations, and Medicare/Medicaid. MAIN OUTCOME MEASURES: Rules governing (1) admissions of patients with infections, (2) tuberculin testing of residents, (3) employee health, (4) use of immunizations, (5) human immunodeficiency virus (HIV)-infected patients, and (6) infection control were compared. RESULTS: There were wide variations in states' policies in each of these areas and many were inconsistent with current scientific knowledge. CONCLUSION: Uniform federal standards for long-term care would probably provide a better and more economical way to ensure quality of care in these institutions.

Facility Regulation and Control↗
PubMed1991

Methicillin-resistant Staphylococcus aureus in Minnesota nursing homes.

OBJECTIVE: To assess the experience of Minnesota nursing homes with methicillin-resistant Staphylococcus aureus (MRSA) and the policies and procedures used for its control. DESIGN: A 12-question survey, with primarily categorical responses, was mailed to the Directors of Nursing of all Minnesota long-term-care facilities. A follow-up mailing was sent to non-responders 5 weeks later. The mailing included a cover letter, a description of the study and its purposes, and a stamped return envelope. Four weeks after the second mailing, all non-responding institutions were contacted by telephone and invited to participated by mail or by completing the survey by telephone. SETTING: All long-term-care facilities in Minnesota licensed for skilled and intermediate care. PARTICIPANTS: The survey was directed to the Directors of Nursing of the long-term-care facilities with the request that, if another individual was better able to complete it, the survey be forwarded to them. RESULTS: Completed responses were obtained from 88% (395/445) of all long-term-care facilities in Minnesota. Forty-eight institutions (12%) had residents colonized or infected with MRSA. Only four (8%) of these facilities stated that MRSA was a problem; however, 33 (69%) of facilities with MRSA had sought outside help or consultation from a variety of sources for its control. Few facilities (7%) had cultured residents specifically for MRSA. Policies regarding the admission of colonized or infected persons were reported by 14% and 21% of facilities, respectively, and over 40% of these policies stated that persons with MRSA would not be accepted. Policies regarding the care of MRSA-colonized or -infected persons were not uniform. Both metropolitan and non-metropolitan facilities had residents with MRSA. CONCLUSIONS: Our results suggest that MRSA in long-term-care facilities may be a widespread and underrecognized problem. There is a need to develop uniform policies for the control of MRSA in nursing homes. These policies should consider the sources and objectives of long-term-care facilities.

Cross Infection↗
PubMed1979

Tetanus and diphtheria immunity in urban Minnesota adults.

Tetanus and diphtheria antitoxin levels were measured in 183 urban adults, using a hemagglutination technique. Protective levels (greater than 0.01 unit/mL) of tetanus antitoxin were present in more than 85% of sera from all subjects under 40 years of age and from men between 40 and 59 years old. A minority of women (36%) between 40 and 59 years of age, and of men (41%) and women (29%) over 60 years of age, were protected. Less than one quarter of the study group had protective levels (greater than 0.01 unit/mL) of diphtheria antitoxin. The results of the study suggest that a minority of middle-aged women and older adults have been appropriately immunized against diphtheria and tetanus.

Adolescent↗
PubMed1979

Comparative study of cefaclor and amoxicillin in treatment of urinary tract infection.

Cefaclor or amoxicillin was given to 51 randomly assigned patients with urinary tract infections. Inclusion in the study required two pretreatment urine cultures yielding the same organism (susceptible to both antibiotics) in concentrations greater than or equal to 10(5)/ml. Both drugs were administered as 250 mg. orally every eight hours for ten days. Cefaclor was given to 27 patients and amoxicillin to 24. Most patients in both groups had negative urine cultures at five to nine days and four to six weeks following therapy. One patient in each group was unsuccessfully treated. Relapse or reinfection occurred with similar frequency in both treatment groups. Both antibiotics were well tolerated. minimal inhibiting concentrations (MICS) of cefaclor, amoxicillin, cephradine, and cephalexin were determined by an agar dilution technique for the 44 available pretreatment isolates (41 Escherichia coli and 3 Proteus mirabilis). Mean MICs (micrograms./ml., +/- SD) were 2.2 +/- 1.4 for cefaclor, 4.4 +/- 2.0 with amoxicillin, 8.1 +/- 4.2 for cephradine, and 5.7 +/- 3.0 with cephalexin. Cefaclor is highly active in vitro against those gram-negative bacteria which are commonly isolated from urine. Cefaclor is as effective as amoxicillin when administered three times daily for the treatment of urinary tract infection.

Amoxicillin↗
PubMed1979

An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. I. Clinical studies.

In a 22-month period, strains of Staphylococcus aureus resistant to methicillin and multiple aminoglycosides, (designated MARS) were recovered from 108 inpatients with nosocomial infections at a hospital in the midwestern United States. Sixty-six of these patients were staying in a burn unit, and 42 were on other hospital wards. Among the patients with burns, MARS were recovered from the burn wounds of 64%; 32% of the patients with burns had MARS bacteremia. The patients without burns were age-matched with patients with nosocomial infections caused by antibiotic-susceptible strains of S. aureus. Patients from whom MARS were isolated had a longer mean hospital stay (79.6 days vs. 36.9 days; P less than 0.01), developed infection later (26.5 days vs. 13.5 days after admission; P less than 0.01), and had received antibiotic therapy before infection more often (81% vs. 38% of patients; P less than 0.01) than patients in the comparative population. Types of infection and incidences of death and bacteremia were similar in the two groups. Antibiotic-resistant strains of S. aureus may cause serious infections and significant mortality.

Aminoglycosides↗
PubMed1979

An outbreak of infections caused by strains of Staphylococcus aureus resistant to methicillin and aminoglycosides. II. Epidemiologic studies.

Studies to determine the epidemiologic behavior of strains of Staphylococcus aureus resistant to methicillin and aminoglycosides (MARS) were conducted over a period of two and one-half years, during which MARS were isolated from 201 patients at a hospital in the midwestern United States. Most cases of infection or colonization with MARS (156 of 201) occurred in patients with burns. In the burn unit, MARS were recovered from the air, from the hair and hands of personnel, and from inanimate objects. Nasal (72%) and rectal (66%) colonization were common among burned patients with infected or colonized burn wounds but occurred in only six of 74 burn unit personnel. When compared with two control periods, the prophylactic use of antistaphylococcal agents in patients with burns increased markedly at the time the outbreak began. Of the 45 patients without burns from whom MARS were isolated, 42 (93%) were surgical patients. MARS were not demonstrated in the air or environment of patients with infected surgical wounds. None of 334 non-burn unit hospital personnel were found to be carriers of MARS. Four phage types (83A, 6/75/85, 29/52/80, and 92) were recovered during the outbreak. A determinant of antibiotic resistance was probably transmitted among strains of S. aureus.

Aminoglycosides↗
PubMed1979

Staphylococcus aureus bacteriuria.

One hundred twenty-seven episodes of Staphylococcus aureus bacteriuria were reviewed retrospectively in two hospitals to establish the rate of occurrence, clinical importance, and associated predisposing factors. Staphylococcus aureus was an infrequent urinary isolate, and accounted for only about 1% of all positive urine cultures. Although almost all cases in a Veterans Hospital occurred in elderly men, episodes in a community hospital were observed in women and children as well. Patients usually had pyuria (71%) but only 39% had urinary symptoms of fever. Among predisposing factors, serious underlying diseases were uncommon, but urinary tract manipulations or abnormalities were present in nearly two thirds of patients. Fifty-five percent of cases were nosocomial, and 73% of these were associated with urinary catheterization or other invasive urinary tract procedures. Most patients (61%) were not treated for their bacteriuria, and there was a secondary bacteremia rate of 5.5% in the Veterans Hospital. Although infrequently encountered, the presence of S aureus in urine should be treated with at least as much concern as more frequently encountered bacteria.

Adolescent↗
PubMed1978

Staphylococcus aureus endocarditis. Combined therapy with vancomycin and rifampin.

Two children with persistent bacteremia and endocarditis due to Staphylococcus aureus failed to respond to vancomycin therapy, even though serum levels greatly exceeded the inhibitory concentrations. The Staphylococcus from one patient was resistant to methicillin; the other patient had a penicillin hypersensitivity. There was a wide disparity between the minimum inhibitory and the minimum bactericidal concentrations of vancomycin. Striking clinical and laboratory evidence of improvement was demonstrated with the addition of rifampin therapy.

Blood↗
PubMed1978

The association between Staphylococcus aureus bacteremia and bacteriuria.

The relationship between Staphylococcus aureus bacteremia and bacteriuria was studied over a five year period in three hospitals. In a Veterans Administration Hospital, 59 patients with Staph, aureus bacteremia had a urine culture within 48 hours of a positive blood culture. In 16 of 59 (27 per cent), greater than 10(5) Staph. aureus was recovered from the urine in pure culture. Six of these patients had apparent primary staphylococcal urinary tract infection. Clinical and laboratory parameters in the patients with staphylococcal bacteremia and bacteriuria were compared with those in 31 patients with staphylococcal bacteremia and sterile urine cultures. The two groups differed only in the more frequent occurrence of pyuria and proteinuria in the bacteriuric patients. In two other hospitals, staphylococcal bacteriuria occurred in 7 per cent of patients with Staph. aureus bacteremia and in 13 per cent of cases of staphylococcal endocarditis. Review of autopsy records for 33 patients who died within one month of their bacteremia failed to show a correlation between bacteriuria and the presence of renal abscess. Staphylococcal bacteriuria is a frequent and unexplained concomitant of Staph. aureus bactremia.

Abscess↗
PubMed1976

Therapy of Staphylococcus aureus bacteremia associated with a removable focus of infection.

We did a retrospective study of Staphylococcus aureus bacteremia--from removable foci of infection--treated with short course antimicrobial therapy. Patients with S. aureus endocarditis were excluded from our study. The majority of patients had sepsis from intravascular devices. After removal of the focus of bacteremia, antibiotics were administered for a mean period of 15.2 days. There were no relapses, and no patient developed endocarditis. A 10- to 21-day antibiotic regimen can be curative in S. aureus bacteremia associated with a removable focus of infection.

Adolescent↗
PubMed1975

Parenteral clindamycin phosphate: pharmacology with normal and abnormal liver function and effect on nasal staphylococci.

Parenteral clindamycin was evaluated in 41 patients with a variety of infections. The four major findings were as follows. (i) Five hours after the intravenous administration of 600 mg of clindamycin, the mean serum concentration in patients with "moderate to severe" hepatic dysfunction was 24.3 mug/ml, and in those with normal liver function it was 8.3 mug/ml (P < 0.02). This suggests that the dose of clindamycin might be modified in patients with liver disease. (ii) There was a positive association between the 5-h serum clindamycin level and the degree of elevation of the serum glutamic oxaloacetic transaminase. (iii) No significant side effects were observed. Of 24 patients with preexisting hepatic dysfunction, 5 showed deterioration and 5 showed improvement of liver function during therapy. (iv) Whereas all pre-treatment isolates of Staphylococcus epidermidis from the anterior nares were susceptible to clindamycin, 6 of 9 post-treatment isolates were resistant, most probably due to selection of resistant organisms.

Adolescent↗