PubMed Health⌕ Search

Biomedical subjects

R P Wenzel

Publications and source records attributed to R P Wenzel.

At least 271 records · Page 15Linked to original sources
PubMed1977

Protective efficacy of an inactivated Mycoplasma pneumoniae vaccine.

The protective efficacy of a formalin-inactivated Mycoplasma pneumoniae vaccine was evaluated in a double-blind fashion in 7,861 Marine Corps recruits at Parris Island, South Carolina. Vaccine, administered in a 1-ml dose by a jet-injection device, was glass-grown and contained 264 microgram of protein nitrogen/ml. Phosphate-buffered saline with formalin was injected as a control. Systemic reactions to injection were similar in both groups, but the percentage of vaccinees with erythema (51%) and induration (52%) at 24 hr was significantly greater than the percentage of controls (2%) with these reaction (P less than 0.001). Twenty-one (0.5%) of 3,930 vaccinees and 43 (1.1%) of the 3.931 placebo recipients were hospitalized with pneumonia (chi2=7.61; P less than 0.01). Ten of 21 vaccinees and seven of 43 controls with pneumonia had a positive pharyngeal culture for M. pneumoniae (chi2=1.69; P =0.20), and fourfold rises in titer of serum antibody were noted in five of 14 vaccinees and in 15 of 28 placebo recipients with pneumonia (chi2=7.90; P less 0.0005). Therefore, vaccine efficacy for M. pneumoniae-specific pneumonia was 42% as determined by cultures and 67% by serologic tests. The vaccine showed no protective efficacy for M. pneumoniae-specific bronchitis or for M. pneumoniae pharyngeal carriage in recrutis in training.

Antibodies, Bacterial↗
PubMed1977

Postoperative wound infection: a controlled study of the increased duration of hospital stay and direct cost of hospitalization.

The increased hospital stay and direct cost of hospitalization that resulted from a postoperative wound infection (presence of pus at the incision site) after each of 6 common operations were evaluated. With the aid of the hospital computer, matched controls were obtained with respect to patient age, sex, exact operation performed, clinical service performing operation, pathologic finding, and underlying disease process which might alter the patient's predisposition toward infection. Several of the operations (appendectomy. cholecystectomy, total abdominal hysterectomy, and coronary artery bypass graft) were subtyped in order to obtain equivalence between controls and infected patients. In general, an infection doubles the postoperative stay and significantly increases the hospital expense.

Adolescent↗
PubMed1977

Morbidity/mortality and economics of hospital-acquired blood stream infections: a controlled study.

A controlled study of mortality, length of hospital stay, and cost of hospitalization in 40 patients with hospital-acquired blood stream infections and 40 similarly ill patients without blood stream infections was done. Patients with septicemia were identified by ongoing routine surveillance, while controls were selected from computer surveys of similarly aged patients matched for primary diagnosis of operation or both. Bacteremic cases for which no matched controls could be obtained and 109 additional cases of blood stream infection occurring after the study period were also characterized to determine any gross bias in the process of case selection. Mortality in bacteremic patients was 38% compared to 10% in controls; median hospital stay was 33 days for bacteremic patients and cost was $6,692, compared to 14 days' hospitalization and $2,322 cost for controls. Mortality among the unmatched cases as well as the 109 additional cases was 34%. The excess morbidity, mortality, and hospitalization costs offer a better estimate of the direct effects of the hospital-acquired blood stream infection.

Adult↗
PubMed1977

Absence of clinical pneumonia following bronchoscopy with contaminated and clean bronchofiberscopes.

Two hundred forty-nine fiberoptic bronchoscopy procedures were surveyed for the presence of bronchoscopy-related pneumonia. The first 103 procedures were performed during a period when the fiberscope was presemably contaminated with Pseudomonas aeruginosa. Chart review of these 103 procedures and prospective epidemiologic surveillance of the remaining 146 procedures revealed no cases of bronchoscopy-related pneumonia.

Bronchi↗
PubMed1977

Hospital-acquired viral respiratory illness on a pediatric ward.

All 171 patients admitted to four study rooms containing cribs were under surveillance during the winter and spring for development of nosocomial respiratory and infection. One sixth of the 90 children at risk acquired respiratory illness while in the hospital. Viruses were isolated from two thirds of the patients with nosocomial infections: rhinovirus, respiratory syncytial virus, parainfluenza, and influenza A and B. Serial viral cultures of the children under surveillance suggested that nine of 11 virus-positive nosocomial infections were not acquired from a roommate. Furthermore, the risk to a patient of becoming infected with a virus being shed by a roommate was only 3%. The need for isolation of all children with respiratory illness in a single room with a separate air exhaust system is not suggested by these data.

Child, Preschool↗
PubMed1977

Postoperative wound infection rates.

Postoperative wound infections following 5,260 selected procedures at a University Hospital were studied. These data were collected during a three year period using a single surveillance system. These data were compared with those of earlier reports. Accurate postoperative wound infection rates can be obtained as part of a total hospital surveillance program. Operative procedures should be subdivided, so that postoperative wound infection rates among different institutions can be reasonably compared. The major importance of prospective surveillance lies in the actual control of infections.

Female↗
PubMed1976

Toxigenic bacterial diarrhea: nursery outbreak involving multiple bacterial strains.

An outbreak of watery diarrhea occurred in 14 of 15 infants in a special care unit over a four-day period. Using the CHO cell assay for enterotoxin, we found that 11 of these patients had toxigenic bacteria in their stools. These bacteria comprised nine different serotypes of three species of organisms: Escherichia coli, Klebsiella, and Citrobacter. None of the three serotypes of E. coli were classic enteropathogenic serotypes. Rectal swab specimens from all 15 infants were examined for the presence of viruses by electron microscopic and cell culture techniques as well as by studies in suckling mice. None had parvovirus- or reovirus-like agents and two had adenoviruses. No other viral agents were detected. Of 38 bacterial strains isolated from ten control infants without diarrhea, three Klebsiella strains from two individuals were found to be toxigenic. Analysis of a total of 136 enteric isolates showed that toxigenicity as measured by the CHO assay was strongly associated with strains isolated during acute diarrheal illness when compared with strains isolated in convalescence (p less than 10(-5)) or with strains from control infants without diarrhea (p less than 10(-5)). This study raises the possibility of an outbreak of disease caused by a transmissible plasmid responsible for a cholera-like enterotoxin production in several enteric bacterial strains.

Adenoviruses, Human↗
PubMed1976

Field trial of an inactivated Mycoplasma pneumoniae vaccine. I. Vaccine efficacy.

The efficacy of an inactivated Mycoplasma pneumoniae vaccine was evaluated in a double-blind study of 7,861 Marine Corps recruits at Parris Island, South Carolina. Vaccine was administered to half for the volunteers in a 1-ml dose by a jet-injection device, and phosphate-buffered saline was administered similarly to control subjects. Twenty-one vaccinees (5.3 per 1,000) and 43 recipients of placebo (10.9 per 1,000) were hospitalized with pneumonia; the incidence of illness among the two groups indicated a 51% overall protective efficacy for the vaccine (x2 = 7.49; P less than 0.01). The refined data for pneumonia due to M. pneumoniae showed 67% protective efficacy when serologic data were employed (x2 = 7.84; P = 0.005) and a 42% protective efficacy (x2 = 1.80; P greater than 0.10) when data from cultures for M. pneumoniae were employed. Vaccinees with pneumonia due to M. pneumoniae suffered no increased illness compared to controls, suggesting no hypersensitization with natural illness following the inactivated vaccine. Only when serologic data were analyzed did it appear that the M. pneumoniae vaccine protected against M. pneumoniae specific bronchitis (35% efficacy) but the difference was not statistically significant (x2 = 1.28; P greater than 0.20).

Bacterial Vaccines↗
PubMed1976

Hospital-acquired infections. I. Surveillance in a university hospital.

A new system of surveillance is described for detecting hospital-aquired infections. Surveillance begins on the ward where a weekly review of the nursing care plan (Kardex) is used to select high risk patients (approximately 65% of the total population) for a subsequent chart review. A nurse-epidemiologist required 16-25 hr per week to perform surveillance and 4 more hr to organize line listings of infected patients. The Kardex review was 82 to 94 percent accurate in detecting nosocomial infections when compared to prospective reviews of the charts of all hospitalized patients. The new surveillance method was more accurate than a system based on weekly chart reviews of all patients receiving systemic antibiotics and/or of all patients with fever (temperature less than or equal to 37.8 C orally). In addition, it was more accurate and offered advantages over a system in which surveillance depended primarily on the bacteriology laboratory. Over a 12-month period 1154 hospital-acquired infections were identified for a 7% annual infection rate. Data from ongoing surveillance are used to record accurate infection rates by service, to define the risk of various hospital procedures, and to monitor for common source outbreaks of infection.

Cross Infection↗
PubMed1976

Providencia stuartii, a hospital pathogen: potential factors for its emergence and transmission.

The emergence of Providencia stuartii as a hospital pathogen in a burn unit was demonstrated by routine infection surveillance. The organism was initially recognized in a burn wound and subsequently in urine or sputum. Compared to controls, those patients harboring P. stuartii were similar in age and percentage of body surface burned and were more likely to have been in one of the two burn unit rooms, (p less than 0.02). Infection with P. stuartii was independent of duration in the Intensive Care Unit or Burn Unit, and of number of visits to hydrotherapy or operating rooms (OR). Once patients were colonized with P. stuartii they had greater morbidity than non-colonized patients as evidenced by longer stays in the unit and increased visits to the OR for debridement. P. stuartii was isolated from air samples (5/14) more commonly than from the hands of personnel. In vitro tests suggested that extensive use of parenteral gentamicin and replacement of the antibacterial topical cream sulfamylon by silver sulfadiazine favored the emergence of P. stuartii over Pseudomonas aeruginosa as the predominant colonizing organism.

Adult↗
PubMed1976

Hospital-acquired infections. II. Infection rates by site, service and common procedures in a university hospital.

Over a three-year period, 3432 nosocomial infections occurred in a university hospital admitting 55,476 patients over a three-year period (6/100 admissions). A single system of surveillance was used, and overall monthly rates varied from 4-9/100 admissions with particularly high rates in the Newborn Intensive Care Unit (24/100). Annual rates greater than or equal to 10/100 admissions were found in major surgical services of Gneral Surgery, Neuro-Surgery, Thoracic Cardiovascular Surgery (TCV), Plastic Surgery and Urology; 1243 urinary tract infections (2.24/100 admissions/ accounted for 36% of the problem. The rate of urinary tract infections after catheterization was 13/100 procedures overall with unusually high rates for patients in Neuro-Surgery (37/100), Orthopedics (23/100), and Plastic Srugery (18/100). There were 524 nosocomial pneumonias (.94/100 admissions), and the rate was especially high (3.7/100) for patients admitted to the TCV service or for those placed on a respirator (3.4/100 patients). Identifying high risk areas and high risk procedures in a hospital is a practical starting point for infection control.

Anesthesia↗