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Biomedical subjects

L Stroud

Publications and source records attributed to L Stroud.

7 recordsLinked to original sources
PubMed1997

Nosocomial infections in HIV-infected patients: preliminary results from a multicenter surveillance system (1989-1995).

OBJECTIVE: To describe the characteristics of and trends in nosocomial infection among human immunodeficiency virus (HIV)-infected patients. DESIGN: Multicenter prospective cohort study. SETTING/PATIENTS: HIV-infected patients were enrolled at time of first inpatient admission at five Veterans' Administration Medical Centers (VAMCs). RESULTS: As of March 1995, 2,541 patients with 6,625 inpatient admissions had been monitored in the five VAMCs. A total of 530 nosocomial infections were detected using standard Centers for Disease Control and Prevention definitions. Overall distribution by infection site was 31% for primary bloodstream infections (BSIs), 28% for urinary tract infections, 15% for pneumonia, and 26% for all other sites. Of BSIs, 63% were central line-associated bloodstream infections (CLABs). The rate of CLABs per 1,000 central line days was 6.5 (range, 2.3-8.3) for all patients from participating hospitals, similar to the median CLAB rate of 6.0 for patients in medical intensive-care units (ICUs) of National Nosocomial Infections Surveillance (NNIS) System hospitals from January 1990 through September 1994. For ICU-specific CLABs, the rate from hospitals reporting at least one ICU CLAB was 12.7 (range, 12.1-13.1), comparable to the 90th percentile of NNIS hospital medical ICUs (13.1). Staphylococcus aureus, associated with 35% of BSIs, was the most common nosocomial BSI pathogen. Our data demonstrated the following: 13 (10%) of 134 patients with CD4 counts > or = 200 cells/mm3 had a CLAB, compared with 61 (6%) of 1,011 patients with CD4 counts < 200 cells/mm3, P = .08; the per-day risk of CLABs did not change with increased duration of catheterization (P = .4); and the per-day risk of a temporary (ie, short-term) CLAB was greater than that of a permanent CLAB (P < .001). CONCLUSIONS: The data suggest that HIV-infected patients were at higher risk of acquiring a BSI than were patients in the NNIS population; patients with CD4 counts > or = 200 cell/mm3 and temporary central lines were at increased risk for BSI, perhaps reflecting widespread prophylaxis with trimethoprim-sulfamethoxazole among patients with CD4 counts < 200 cells/mm3, and, in contrast to most studies, S aureus, not coagulase-negative Staphylococcus, was the most common BSI pathogen.

AIDS-Related Opportunistic Infections↗
PubMed1996

Risk factors for mortality associated with enterococcal bloodstream infections.

OBJECTIVE: To determine risk factors for mortality in patients with a nosocomial enterococcal primary bloodstream infection (EPBI) and to assess whether vancomycin resistance placed a patient at increased risk of death. DESIGN/SETTING: A retrospective cohort study was conducted in four National Nosocomial Infection Surveillance System hospitals. RESULTS: Of 145 patients identified with EPBIs, 74 (51%) died, and 26 (18%) had a vancomycin-resistant isolate. Upon comparing patients with EPBIs who survived to those who died, no associations were found between mortality and prior invasive device use, procedure history, type or number of prior nosocomial infections, length of hospitalization before infection, or receipt of vancomycin. Independent predictors of mortality were indices of severity of illness (APACHE II score and comorbidity weighted index), age, the use of third-generation cephalosporins or metronidazole during the week prior to infection, and female gender. CONCLUSIONS: Vancomycin resistance was not an independent predictor of death, and its role was difficult to establish, because cohort patients were among the most severely ill of all hospitalized patients. Enterococcal primary bloodstream infections appear to indicate severe, lifethreatening disease processes. The pathogenicity of enterococci and the role of vancomycin resistance as a cause of mortality in patients with EPBIs need to be assessed further.

Adolescent↗
PubMed1995

Postoperative infections traced to contamination of an intravenous anesthetic, propofol.

BACKGROUND: Between June 1990 and February 1993, the Centers for Disease Control and Prevention conducted investigations at seven hospitals because of unusual outbreaks of bloodstream infections, surgical-site infections, and acute febrile episodes after surgical procedures. METHODS: We conducted case-control or cohort studies, or both, to identify risk factors. A case patient was defined as any patient who had an organism-specific infection or acute febrile episode after a surgical procedure during the study period in that hospital. The investigations also included reviews of procedures, cultures, and microbiologic studies of infecting, contaminating, and colonizing strains. RESULTS: Sixty-two case patients were identified, 49 (79 percent) of whom underwent surgery during an epidemic period. Postoperative complications were more frequent during the epidemic period than before it. Only exposure to propofol, a lipid-based anesthetic agent, was significantly associated with the postoperative complications at all seven hospitals. In six of the outbreaks, an etiologic agent (Staphylococcus aureus, Candida albicans, Moraxella osloensis, Enterobacter agglomerans, or Serratia marcescens) was identified, and the same strains were isolated from the case patients. Although cultures of unopened containers of propofol were negative, at two hospitals cultures of propofol from syringes currently in use were positive. At one hospital, the recovered organism was identical to the organism isolated from the case patients. Interviews with and observation of anesthesiology personnel documented a wide variety of lapses in aseptic techniques. CONCLUSIONS: With the increasing use of lipid-based medications, which support rapid bacterial growth at room temperature, strict aseptic techniques are essential during the handling of these agents to prevent extrinsic contamination and dangerous infectious complications.

Adult↗
PubMedDate not supplied

Depression in children after recovery from severe burns.

This outcome study of children and adolescents with severe burns (ages 7 to 19 years) reports that unrecognized depression is common during their lifetimes. Thirty children who had severe burns (range, 5% to 95% body surface area) were assessed for depression at a mean of 9 years after burn injury. This article presents an analysis of depression items from the Diagnostic Interview for Children and Adolescents, which was used in face-to-face interviews to assess child psychiatric disorders with diagnostic criteria from the American Psychiatric Association's Diagnostic and Statistical Manual--Third Edition. At the time that the interviews took place, only one child had symptoms of major depression and only three children had symptoms of dysthymic disorder. However, eight children had a lifetime history of major depression; two of them had been abused by burning and two had been physically or sexually abused. Four had made suicide attempts: one suicide attempt was the cause of the burn injury and three attempts were made after burn injury. Thirteen children had had suicidal thoughts, and their parents were often unaware of this. Other types of affective disorders were prevalent. There was no statistically significant association between depression and burn size or disfigurement. Although burn-related factors were associated with some depressive episodes, other biologic and social risk factors were also very important. The authors conclude that referral for diagnostic services and psychotherapy, and for some, treatment with antidepressant medication, is often a necessary part of medical services for children with burns.

Adolescent↗
PubMedDate not supplied

Flexibility and anterior knee pain in adolescent elite figure skaters.

To investigate the relationship between thigh muscle flexibility and anterior knee pain in adolescent athletes, we examined 46 skaters. We taught them flexibility exercises and later retested 28 of them. Three fourths of the skaters who improved their quadriceps flexibility eliminated their pain. Two of the three skaters who lost flexibility developed pain. Analysis of all examinations showed that skaters with pain had tighter quadriceps muscles than those without pain. Poor hamstring flexibility was correlated with patellofemoral pain. This study shows that adolescent athletes may improve their flexibility after counseling and indicates a clear relationship between thigh muscle flexibility and anterior knee pain.

Adolescent↗