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P Drinka

Publications and source records attributed to P Drinka.

At least 19 recordsLinked to original sources
PubMed2001

Adverse events associated with methicillin-resistant Staphylococcus aureus in a nursing home.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) generates concern in nursing homes. Restrictive isolation precautions may be applied for indefinite periods. Adverse events driving these concerns include transmission and infection. METHODS: The 721-bed Wisconsin Veterans Home in King performs approximately 645 cultures annually. The site, severity, and number of MRSA infections were determined for 69 months. Pulsed-field gel electrophoresis was performed on all initial isolates, followed by a statistical cluster analysis looking for evidence of transmission. RESULTS: Sixty-seven MRSA infections were identified (1.6 per 100 residents per year); many were polymicrobial, and it was difficult to determine the proportionate role of MRSA in morbidity or mortality. There was an episode of rapidly fatal MRSA septicemia in which empiric antibiotic therapy was ineffective. Twenty-one genetic strains were encountered. Statistical analysis identified 13 clusters of genetically identical strains clustered in time and space (P<.05). CONCLUSIONS: Infections with MRSA were identified at relatively low rates; however, the etiology of many serious nursing home infections is not determined, especially pneumonia. Statistical analysis revealed clustering and evidence of transmission. Nursing home practitioners should consider MRSA when applying empiric treatment to serious infections. We recommend a program including (1) judicious use of antibiotics, including topical agents, to reduce selection of resistant organisms; (2) obtaining and tracking cultures of infectious secretions to diagnose MRSA infections and focus antibiotic therapy; (3) universal standard secretion precautions because any resident could be a carrier; and (4) a detailed assessment and care plan for the carrier that maximizes containment of secretions and independence in activities. However, basic hygiene cannot be maintained in communal areas by some residents without restriction of activities of daily living.

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PubMed2001

Granzyme B: a marker of risk for influenza in institutionalized older adults.

Risk for influenza increases with age while cellular immune responses decline. This was a prospective study to determine the relationship between cytokine and granzyme B levels in peripheral blood mononuclear cells stimulated with live influenza virus, and subsequent influenza illness. Granzyme B levels were lower in the group who later developed symptomatic laboratory-confirmed influenza (n=10) compared to the group who did not (n=90) (ANOVA, P=0.024). In contrast, none of the cytokine levels were related to the development of influenza. Thus, granzyme B is a potential marker of influenza risk in older adults.

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PubMed1998

Immune response to influenza vaccination in institutionalized elderly: effect on different T-cell subsets.

Humoral and cellular immunological responses to influenza vaccination were measured in volunteers in a long-term care facility. All participants were vaccinated with the commercially available 1994-95 trivalent influenza vaccine and blood samples were collected before and 6 and 12 weeks after vaccination. Cytokine and granzyme B in peripheral blood mononuclear cell (PBMC) cultures after virus stimulation, and serum antibody titres were measured for each of these time points. In general, the measures of the immunological response to vaccination were low and variably significant. The major finding was the difference with respect to post-vaccination measures for the two strains of influenza A contained in the vaccine. Geometric mean antibody titres were significantly higher for A/Texas/36/91 at all time points in the study when compared to A/Shangdong/09/93. There was a corresponding rise for interleukin-10 (IL-10) to the A/Texas/36/91 strain while no increase in IL-10 was observed in A/Shangdong/09/93-stimulated cultures after vaccination. In contrast, granzyme B rose after vaccination only in cultures stimulated with A/Shangdong/09/93. Interferon-gamma levels were also significantly higher in these PBMC cultures. There was a poor interleukin-2 (IL-2) response to both strains of influenza A. These data suggest that different strains or subtypes of influenza A may preferentially enhance T-helper type 1 versus type 2 responses through vaccination in institutionalized seniors.

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PubMed1998

Efficacy of zanamivir for chemoprophylaxis of nursing home influenza outbreaks.

Despite vaccination, influenza remains a common of morbidity in nursing homes. Chemoprophylaxis of residents with currently available antivirals is not always effective and new agents effective against both influenza A and B are needed. In a randomized, unblinded pilot study, we compared 14 day chemoprophylaxis with zanamivir, an antiviral which inhibits influenza neuraminidase, to standard of care during sequential influenza A and influenza B outbreaks in a 735 bed nursing home. Influenza A outbreaks were declared on 6/14 epidemic units. Sixty-five volunteers on four epidemic units were randomized to zanamivir and on two epidemic units, 23 volunteers were randomized to rimantadine. During the 14 days of prophylaxis, only four new febrile respiratory illnesses were detected. One volunteer receiving rimantadine prophylaxis developed laboratory-confirmed influenza. Influenza B outbreaks were declared on 3/14 epidemic units. Thirty-five volunteers on two epidemic units were randomized to zanamivir and 18 volunteers on one epidemic unit were randomized to no drug. During the 14 days of prophylaxis, only one new febrile respiratory illness was detected. One volunteer randomized to receive no drug developed laboratory-confirmed influenza. Zanamivir appears comparably effective to standard of care in preventing influenza-like illness and laboratory-confirmed influenza in nursing homes, but requires further testing.

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PubMed1998

Assessment of markers of the cell-mediated immune response after influenza virus infection in frail older adults.

The purpose of this study was to determine whether measures of the cell-mediated immune response to influenza virus could be used as markers of influenza virus infection. We studied 23 subjects who developed upper respiratory, lower respiratory, or systemic symptoms during a small outbreak of influenza in a nursing home population. Influenza virus culture from nasopharyngeal swabs yielded influenza virus isolates from 7 of the 23 subjects. Only three of the subjects had a fourfold rise in antibody titer to the influenza virus antigen positivity after the infection. Granzyme B and cytokine levels were measured in peripheral blood mononuclear cells (PBMC) obtained from all subjects and stimulated with live influenza virus. Elevated granzyme B levels in virus-stimulated PBMC in combination with lower respiratory tract or systemic symptoms in study subjects was a significant predictor of culture-confirmed influenza virus infection compared to those from whom influenza virus could not be identified. Cytokine levels did not distinguish between the two groups in a similar type of analysis. Granzyme B in combination with the clinical profile of symptoms may be a useful retrospective marker for influenza virus infection.

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PubMed1995

A rhinovirus outbreak among residents of a long-term care facility.

OBJECTIVE: To describe the epidemiology of and clinical findings associated with a rhinovirus outbreak that occurred among institutionalized elderly persons. DESIGN: Retrospective review of medical records and nursing surveillance reports. SETTING: A 685-bed, long-term care facility for veterans and their spouses. PATIENTS: 33 persons from whom rhinovirus was cultured. MEASUREMENTS: Throat and nasopharyngeal virus culture; review of medical records to determine underlying diseases, signs and symptoms of respiratory illness, illness duration, and interventions during illness; and review of nursing surveillance reports to determine room locations of ill persons. RESULTS: Between 14 August and 2 September 1993, the number of respiratory illnesses increased. Throat and nasopharyngeal virus cultures were taken from 67 ill residents; 33 cultures yielded rhinovirus, and no other respiratory virus was isolated. Geographic clustering of persons infected with rhinovirus was observed. Of those persons with rhinovirus infections, 100% had upper respiratory symptoms, 34% had gastrointestinal symptoms, 71% had systemic symptoms, 66% had lower respiratory symptoms (including productive cough), and 52% had new abnormalities on lung auscultation. The 17 persons with rhinovirus infection who had chronic obstructive pulmonary disease had more severe illnesses: Five (29%) required glucocorticoid or bronchodilator therapy for illness-associated bronchospasm; 2 required transfer out of the facility; 1 developed a radiographically documented infiltrate; and 1 died of respiratory failure. CONCLUSIONS: Rhinovirus may cause epidemic, clinically important respiratory illness in nursing homes residents. A large proportion of residents may become ill, and infection may be severe in persons with underlying lung disease.

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PubMed1994

Efficacy of an influenza hemagglutinin-diphtheria toxoid conjugate vaccine in elderly nursing home subjects during an influenza outbreak.

OBJECTIVE: To compare the efficacy of an influenza hemagglutinin-diphtheria toxoid conjugate vaccine with the commercially available influenza hemagglutinin-subunit vaccine in preventing influenza in older adults living in a nursing home. DESIGN: A prospective, randomized, double-blind vaccine trial with 5 months of follow-up after vaccination. SETTING: Fourteen Wisconsin nursing homes. PARTICIPANTS: Nursing home residents at least 65 years old who were able to give informed consent and were free of malignancy and not receiving immunosuppressive therapy. INTERVENTIONS: Participants received, by intramuscular injection, 0.5 mL of a trivalent influenza vaccine containing 15 micrograms each of A/Leningrad/360/86 (H3N2), A/Taiwan/1/86 (H1N1), and B/Ann Arbor/1/86 (HA) or 0.5 mL of an influenza vaccine containing the same antigens conjugated to diphtheria toxoid (HA-D). MEASUREMENTS: Blood was obtained pre- and 1 month post-vaccination to assess for any vaccine-induced antibody titer change. Clinical surveillance for respiratory illness was performed twice weekly for 5 months. A record was kept of all signs and symptoms of new respiratory illness, and a viral culture and acute and convalescent sera were obtained. RESULTS: 204 participants received HA and 204 received HA-D. Both groups had similar baseline antibody levels to all influenza antigens. HA-D recipients seroconverted more frequently based on serum neutralizing activity (P < 0.05), had a greater increase in geometric mean titer (GMT), and sustained the increase in antibody titer longer than HA recipients. Vaccine hemagglutinin recall was greater in a subset of HA-D recipients as measured by lymphocyte proliferative assays (P < 0.05). During an outbreak of influenza A (H3N2 A/Shanghai/11/87-like and A/Victoria/7/87-like), fewer HA-D (29/195) than HA (43/204) recipients had laboratory-confirmed infection (P = 0.053), and, of these, fewer HA-D-treated subjects had lower respiratory tract involvement (5/29 HA-D and 17/43 HA) (P = 0.022). CONCLUSIONS: HA-D was more immunogenic in institutionalized elderly recipients and produced greater protection from influenza infection. Superior protection may be due to HA-D's ability to stimulate and recruit antigen-presenting cells, thus enabling the recipient to achieve and maintain functional antibody titers.

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PubMed1994

Hyposomatomedinemia and hypogonadism in hemiplegic men who live in nursing homes.

The purpose of this study was to determine the prevalence of low serum insulin-like growth factor-I (IGF-I) and testosterone in men with poststroke hemiplegia. Serum concentrations of IGF-I, total testosterone, and free testosterone were compared in healthy young men, healthy old men, and old men with poststroke hemiplegia. A low IGF-I level, below the lower 2.5 percentile of the healthy young men, occurred in 85% of the healthy old men, and in 88% of the poststroke hemiplegic patients. When a low IGF-I was defined as a value below the lower 2.5 percentile of the healthy old men, the prevalence in the hemiplegic men was 5%. For total testosterone, a value below the lower 2.5 percentile in the healthy young men occurred in 78% of the healthy old men and in 79% of the stroke survivors. Low total testosterone, defined as a value below the lower 2.5 percentile of the healthy old men, occurred in 17% of the hemiplegic men. The results with free testosterone were similar. Compared with healthy young men, most healthy old men have low serum IGF-I and testosterone levels. Old hemiplegic men resemble healthy old men in their IGF-I levels, but they have more cases of severe hypogonadism (total tostosterone < 193ng/dL). Because correction of IGF-I and testosterone deficiencies in younger adults improves muscle strength, work capacity, and quality of life, treatment with human growth hormone and testosterone may be a useful adjunct to physical measures in the rehabilitation of selected hemiplegic stroke survivors.

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