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Biomedical subjects

L J Strausbaugh

Publications and source records attributed to L J Strausbaugh.

At least 19 recordsLinked to original sources
PubMed2001

National shortages of antimicrobial agents: results of 2 surveys from the Infectious Diseases Society of America Emerging Infections Network.

In November 1999 and August 2000, the Infectious Diseases Society of America Emerging Infections Network (EIN) surveyed its members about shortages of antimicrobial agents in their hospitals and medical centers. Almost 90% of the members had encountered shortages of 1 or more agents in 1999. Of 496 respondents, 382 (77%) reported diminished supplies of penicillin G. Other agents in short supply included meropenem (38%), ticarcillin with or without clavulanate (24%), cefazolin (20%), gentamicin (50%), and nafcillin-oxacillin (13%). In 2000, 291 (60%) of 485 respondents reported shortages of penicillin G, but significantly fewer members had experienced a lack of other agents. In both surveys, members indicated that shortages had affected numerous therapeutic indications. In 1999, members estimated that shortages had affected thousands of patients. In 2000, they estimated that fewer patients were affected. The results of these 2 EIN surveys raise questions about the forces that govern the availability of these valuable therapeutic resources.

Anti-Infective Agents↗
PubMed2001

Treating cardiovascular disease with antimicrobial agents: a survey of knowledge, attitudes, and practices among physicians in the United States.

To assess physicians' knowledge, attitudes, and prescribing behaviors with regard to the association between Chlamydia pneumoniae and cardiovascular disease, we surveyed 750 physicians in Alaska, 1172 in West Virginia, and 569 infectious disease (ID) specialists in a nationwide network during February-May 1999. Eighty-five percent knew of the association between C. pneumoniae and atherosclerosis, but this awareness was more common among ID specialists and cardiologists than among generalists (96% vs. 77%; P<.001). Knowledge scores were significantly higher among ID specialists and cardiologists (P<.001) and among physicians who saw relatively more patients who had myocardial infarction and/or were at risk of atherosclerotic disease. Four percent of physicians had treated or recommended treating cardiovascular diseases with antimicrobial agents; this percentage was significantly higher among cardiologists, physicians who empirically treat patients with peptic ulcers with antimicrobial agents, and physicians with a relatively high knowledge score.

Adult↗
PubMed2001

The Emerging Infections Network electronic mail conference and web page.

In February 1997, the Emerging Infections Network (EIN) established an electronic mail conference to facilitate discussions about emerging infectious diseases and related topics among its members and public health officials. Later that year, the EIN opened its section of the Infectious Diseases Society of America's home page. The EIN Web page was developed to give its members an alternative route for responding to EIN surveys and to facilitate rapid dispersal of EIN reports. The unrestricted portion of the site allows visitors access to information about the EIN and to published EIN reports on specific topics. For the most part, these are brief summaries or abstracts. In the restricted, password-protected portion of the EIN site, members can access the detailed, original reports from EIN queries and the comprehensive listings of member observations. Search functions in both portions of the EIN site enhance the retrieval of reports and observations on specific topics.

Communicable Diseases, Emerging↗
PubMed2000

The burden of infection in long-term care.

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.

Bacterial Infections↗
PubMed1999

Vancomycin in Oregon: who's using it and why.

OBJECTIVE: To determine the proportion of vancomycin orders that are appropriate according to national guidelines and to identify targets for educational messages. DESIGN: Population-based study of vancomycin use in Oregon during a 3-week period. Survey of pharmacists, prospective flagging of vancomycin orders, and data abstraction from patient charts using standardized forms. SETTING: Nonpsychiatric hospitals in Oregon. RESULTS: Four (6%) of the 66 Oregon hospitals had pharmacy restrictions on initial vancomycin orders. Sixty-four (97%) of the hospitals participated in the study of indications for use; 293 vancomycin orders were reported; 3.8 courses were initiated per 1,000 patient-days. Indications for use were determined for 266 (91%); of these, 159 (60%) were deemed appropriate. Of uses for prophylaxis, empirical treatment of suspected gram-positive infection, and treatment of documented gram-positive infection, 57%, 56%, and 65%, respectively, were appropriate. Of hospitals with <250, 251-475, and >475 licensed beds, 65%, 58%, and 57% of vancomycin orders were appropriate. No single medical specialty accounted for >16% of inappropriate vancomycin use. CONCLUSIONS: Vancomycin was used inappropriately by physicians of many different specialties, in hospitals of all sizes, and in sundry clinical situations. The problem of inappropriate vancomycin use does not lend itself to solution by educational strategies targeted at specific subgroups; restrictions by hospital pharmacies may be required.

Anti-Bacterial Agents↗
PubMed1997

Haemophilus influenzae infections in adults: a pathogen in search of respect.

Despite the success of Haemophilus influenzae type b vaccines in preventing bacterial disease in children, H influenzae remains a common pathogen in adult patients in the United States and Europe. At least half of invasive H influenzae infections are caused by nontypable strains. The spectrum of diseases includes sinusitis, pneumonia, otitis media, epiglotitis, and meningitis. An etiologic diagnosis is most reliably established by positive cultures from a normally sterile site. Although resistance to ampicillin and amoxicillin has steadily increased in clinical H influenzae isolates during the past two decades, a variety of other antimicrobial agents are available for the treatment of infections caused by this bacterium.

Adult↗
PubMed1997

Emerging infectious diseases: a challenge to all.

Emerging infections are defined as diseases of infectious origin with an incidence that has increased within the past two decades or threatens to increase in the near future. Some of these diseases are associated with newly discovered infectious agents; others are well-known conditions rapidly increasing in incidence. Five emerging infections are reviewed in this article: ehrlichiosis, a tick-borne infection caused by obligate intraleukocytic bacteria; infections caused by vancomycin-resistant enterococci, which have become a serious nosocomial problem; hantavirus pulmonary syndrome, a Sin Nombre virus infection associated with the adult respiratory distress syndrome and a high case fatality rate; infection with Escherichia coli strain O157:H7, which typically produces hemorrhagic colitis that may lead to the hemolyticuremic syndrome, and streptococcal toxic shock syndrome, a devastating illness often associated with necrotizing fasciitis and multiple organ failure.

Anti-Bacterial Agents↗
PubMed1996

Antimicrobial resistance in long-term-care facilities.

During the last quarter century, numerous reports have indicated that antimicrobial resistance commonly is encountered in long-term-care facilities (LTCFs). Gram-negative uropathogens resistant to penicillin, cephalosporin, aminoglycoside, or fluoroquinolone antibiotics and methicillin-resistant Staphylococcus aureus have received the greatest attention, but other reports have described the occurrence of multiply-resistant strains of Haemophilus influenzae and vancomycin-resistant enterococci (VRE) in this setting. Antimicrobial-resistant bacteria may enter LTCFs with colonized patients transferred from the hospital, or they may arise in the facility as a result of mutation or gene transfer. Once present, resistant strains tend to persist and become endemic. Rapid dissemination also has been documented in some facilities. Person-to-person transmission via the hands of healthcare workers appears to be the most important means of spread. The LTCF patients most commonly affected are those with serious underlying disease, poor functional status, wounds such as pressure sores, invasive devices such as urinary catheters, and prior antimicrobial therapy. The presence of antimicrobial-resistant pathogens in LTCFs has serious consequences not only for residents but also for LTCFs and hospitals. Experience with control strategies for antimicrobial-resistant pathogens in LTCFs is limited; however, strategies used in hospitals often are inapplicable. Six recommendations for controlling antimicrobial resistance in LTCFs are offered, and four priorities for future research are identified.

Cross Infection↗
PubMed1996

Infections and antibiotic resistance in nursing homes.

Infections occur frequently in nursing home residents. The most common infections are pneumonia, urinary tract infection, and skin and soft tissue infection. Aging-associated physiologic and pathologic changes, functional disability, institutionalization, and invasive devices all contribute to the high occurrence of infection. Antimicrobial agent use in nursing homes is intense and usually empiric. All of these factors contribute to the increasing frequency of antimicrobial agent-resistant organisms in nursing homes. Programs that will limit the emergence and impact of antimicrobial resistance and infections in nursing homes need to be developed.

Aged↗
PubMed1996

Comparison of three methods for recovery of yeasts from hands of health-care workers.

This study compared three methods for the detection of yeasts on the hands of 30 nurses: (i) direct finger impressions on inhibitory mold agar plates, (ii) bag washes in brain heart infusion broth, and (iii) bag washes in brain heart infusion broth supplemented with gentamicin and vancomycin. The antimicrobial agent-supplemented bag wash method identified the greatest number of yeast carriers and yielded the most yeast isolates, especially non-C. albicans Candida spp.

Candida↗
PubMed1996

Vancomycin-resistant enterococci. The 'superbug' scourge that's coming your way.

Strains of vancomycin-resistant enterococci (VRE) have emerged and spread widely throughout the United States during the last few years. Multiply-resistant strains of Enterococcus faecium are especially troublesome because they are often resistant to all commercially available antimicrobial agents. At present, VRE infections occur most often in hospitalized patients with severe underlying disease who have undergone invasive procedures and received prolonged courses of broad-spectrum antimicrobial therapy. Because therapeutic options are limited, prevention of spread from patients with known cases to other vulnerable patients is essential.

Anti-Bacterial Agents↗
PubMed1995

Infections caused by Staphylococcus aureus in a Veterans' Affairs nursing home care unit: a 5-year experience.

OBJECTIVES: To describe the frequency and patterns of infection caused by methicillin-susceptible Staphylococcus aureus (MSSA) and methicillin-resistant S aureus (MRSA) infections in a single nursing home population and to determine the effect of MRSA's entry into the facility on subsequent experience with both MSSA and MRSA infections. DESIGN: Observational and descriptive. Surveillance data on nursing home-acquired infections were reviewed to identify all patients with MSSA and MRSA infections occurring during the 5-year period from 1987 to 1991. The medical records of these patients were reviewed retrospectively to collect additional information about the patients and their infections. SETTING AND PATIENTS: A 120-bed Veterans' Affairs nursing home care unit (NHCU) whose residents predominantly were elderly men with severe underlying diseases and functional impairments. RESULTS: During the 5-year study period, 40 MSSA and 28 MRSA infections were acquired by NHCU residents. Twelve to 19 S aureus infections occurred each year. S aureus accounted for 13% to 17% of all NHCU-acquired infections during the years of study, occurring with a frequency of 0.29 to 0.47 infections per 1,000 resident-care days. MRSA infections, first detected in 1988, accounted for an increasing percentage of S aureus infections in subsequent years, but this increase had little effect on the facility's overall infection rates, the composite S aureus infection rates, or the types of infections observed. MSSA and MRSA infections acquired in the NHCU were comparable. Both affected patients with severe underlying diseases and functional impairments. Pneumonia, urinary tract infections, skin and soft tissue infections, and conjunctivitis were the types of infections observed most frequently, accounting for 28%, 25%, 22%, and 15% of all S aureus infections, respectively. Four bacteremic infections occurred in the MSSA group, and five in the MRSA group (P = .47). Four of the MSSA and three of the MRSA infections resulted in death (P = 1.0). Nine of the MSSA and 12 of the MRSA infections resulted in the patient's transfer to the associated acute care hospital for additional care (P = .13). CONCLUSIONS: In the NHCU setting, MSSA and MRSA infections were similar in terms of the types of residents affected, the sites involved, and the frequency of adverse outcomes. The entry of MRSA into the facility appeared to have no effect on the subsequent experience with NHCU-acquired infections caused by S aureus.

Aged↗