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Richard P Wenzel

Publications and source records attributed to Richard P Wenzel.

31 records · Page 2Linked to original sources
PubMed2004

Preoperative risk factors for nasal carriage of Staphylococcus aureus.

BACKGROUND: Staphylococcus aureus nasal carriage is a risk factor for surgical-site infections (SSIs) caused by S. aureus, and eradication of carriage reduces postoperative nosocomial infections caused by it. No study has compared large groups of preoperative carriers and non-carriers to identify factors that are linked to S. aureus nasal carriage. METHODS: While conducting a clinical trial evaluating whether mupirocin prevented S. aureus SSIs, we prospectively collected data on 70 patient characteristics that might be associated with S. aureus carriage. We performed stepwise logistic regression analysis. RESULTS: Of the 4,030 patients, 891 (22%) carried S. aureus. Independent risk factors for S. aureus nasal carriage were obesity (odds ratio [OR], 1.29; 95% confidence interval [CI95], 1.11-1.50), male gender (OR, 1.29; CI95, 1.11-1.51), and a history of a cerebrovascular accident (OR, 1.53; CI95, 1.03-2.25) for all patients. Factors associated with nasal carriage varied somewhat by surgical specialty. In all groups, preoperative use of antimicrobial agents was independently associated with a lower risk of carrying S. aureus in the nares. Previously identified risk factors were not significantly associated with S. aureus nasal carriage in this large group of surgical patients. CONCLUSION: Male gender, obesity, and a history of a cerebrovascular accident were identified as risk factors for S. aureus nasal carriage. It remains to be seen whether preoperative weight loss would reduce the rate of nasal carriage. In addition, the value of screening this patient population for S. aureus nasal carriage merits further investigation.

Adult↗
PubMed2003

Current trends in the epidemiology of nosocomial bloodstream infections in patients with hematological malignancies and solid neoplasms in hospitals in the United States.

A total of 2340 patients with underlying malignancy were identified among 22,631 episodes of nosocomial bloodstream infections (BSIs) in a prospectively collected database for 49 hospitals in the United States (Surveillance and Control of Pathogens of Epidemiologic Importance [SCOPE] Project). Data were obtained for the period of March 1995 through February 2001. Gram-positive organisms accounted for 62% of all BSIs in 1995 and for 76% in 2000 (P<.001), and gram-negative organisms accounted for 22% and 14% of all BSIs for these years, respectively. Neutropenia was observed in 30% of patients, so neutropenic and nonneutropenic patients were compared. In both, the predominant pathogens were coagulase-negative staphylococci (32% of isolates recovered from neutropenic patients and 30% of isolates recovered from nonneutropenic patients). The source of BSI was not determined for 57% of patients. The crude mortality rate was 36% for neutropenic patients and 31% for nonneutropenic patients.

Adolescent↗
PubMed2003

High altitude headache: efficacy of acetaminophen vs. ibuprofen in a randomized, controlled trial.

Ibuprofen has been shown to be more effective than placebo in the treatment of high altitude headache (HAH), but nonsteroidal anti-inflammatory agents have been linked to increased incidence of gastrointestinal (GI) side effects and high-altitude pulmonary edema (HAPE). We postulated that acetaminophen, which does not share ibuprofen's theorized causal link to GI side effects or HAPE, could provide effective HAH therapy. We conducted a prospective, randomized, double-blind, clinical trial of ibuprofen vs. acetaminophen in the Solu Khumbu, Nepal: Mt. Everest Base Camp, Pheriche, Dingboche (4240 m to 5315 m). Seventy-four consecutive patients (ages 13 to 61 years) were randomized, were assessed with the Lake Louise Acute Mountain Sickness (AMS) criteria, and received a physical examination (which included vital signs, oxygen saturation as measured by pulse oximetry (SpO(2)), and assessment of clinical Lake Louise AMS criteria). Patients then received either 400 mg of ibuprofen (IBU) or 1000 mg of acetaminophen (ACET), and were asked to rate their cephalgia using a 10-cm visual analog scale (VAS). Thirty-nine patients received IBU, and 35 received ACET. Baseline Lake Louise AMS scores were identical in the two groups (mean = 5.9). No differences in mean VAS scores between IBU and ACET groups were noted at time 0 (presentation), 30, 60, or 120 min. No cases of HAPE or high altitude cerebral edema were noted during the study period. In this study population, acetaminophen was as effective as ibuprofen in relieving the pain of HAH.

Acetaminophen↗
PubMed2003

Nosocomial bloodstream infections in pediatric patients in United States hospitals: epidemiology, clinical features and susceptibilities.

BACKGROUND: We identified the predominant pathogens and antimicrobial susceptibilities of nosocomial bloodstream isolates in pediatric patients in the US Prospective surveillance for nosocomial bloodstream infections at 49 hospitals during a 6-year period [Surveillance and Control of Pathogens of Epidemiologic Importance (SCOPE)] detected 22 609 bloodstream infections, of which 3432 occurred in patients < or =16 years of age. RESULTS: Gram-positive organisms accounted for 65% of cases, Gram-negative organisms accounted for 24% of cases and 11% were caused by fungi. The overall crude mortality was 14% (475 of 3432) but notably higher for infections caused by Candida spp. and Pseudomonas aeruginosa, 20 and 29%, respectively. The most common organisms were coagulase-negative staphylococci (43%), enterococci, Staphylococcus aureus and Candida spp. (each, 9%). The mean interval between admission and infection averaged 21 days for coagulase-negative staphylococci, 25 days for S. aureus and Candida spp., 32 days for Klebsiella spp. and 34 days for Enterococcus spp. The proportion of methicillin-resistant S. aureus increased from 10% in 1995 to 29% in 2001. Vancomycin-resistance was seen in 1% of Enterococcus faecalis and in 11% of Enterococcus faecium isolates. CONCLUSION: Nosocomial BSI occurred predominantly in very young and/or critically ill children. Gram-positive pathogens predominated across all ages, and increasing antimicrobial resistance was observed in pediatric patients.

Age Distribution↗
PubMed2003

In vitro susceptibilities of gram-negative bacteria isolated from hospitalized patients in four European countries, Canada, and the United States in 2000-2001 to expanded-spectrum cephalosporins and comparator antimicrobials: implications for therapy.

Access to current antimicrobial agent surveillance data is an important prerequisite for the optimal management of patients with hospital-acquired infections. The present study used data collected in 2000 to 2001 from 670 laboratories in Europe (France, Germany, Italy, and Spain), Canada, and the United States to report on the in vitro activities of ceftriaxone, cefotaxime, and comparative agents against >125,000 isolates of gram-negative bacteria from hospitalized patients. All but two isolates of Enterobacteriaceae (one isolate of Proteus mirabilis from France and one isolate of Morganella morganii from Canada) were susceptible to imipenem. The susceptibility of Escherichia coli to ceftriaxone or cefotaxime was > or = 97% in each country, and for P. mirabilis, susceptibility was 99% in each country except Italy. In contrast, susceptibility of E. coli to ciprofloxacin varied from 80.5% (Spain) to 94.0% (France); levofloxacin susceptibility ranged from 75.2% (Spain) to 91.6% (United States). Among Klebsiella pneumoniae and Klebsiella oxytoca isolates, ceftriaxone and cefotaxime susceptibilities ranged from 86.6 to 98.7% and 83.5 to 99.7%, respectively, depending upon the country. Considerable geographic variation in the susceptibilities (generally 85 to 95% susceptible) of Serratia marcescens and M. morganii to ceftriaxone and cefotaxime were observed. For S. marcescens, susceptibility to piperacillin-tazobactam varied from 81.5% (France) to 94.1% (Italy) and susceptibility to ciprofloxacin ranged from 66.2% (Germany) to 90.7% (Spain). Enterobacter cloacae and Enterobacter aerogenes were less susceptible to ceftriaxone and cefotaxime than were the other species of Enterobacteriaceae studied. The present study demonstrated that established parenteral expanded-spectrum cephalosporin antimicrobial agents retain significant in vitro activity against many clinically important gram-negative pathogens.

Anti-Bacterial Agents↗
PubMed2002

Treating sepsis.

Explore the source record for details and available documents.

APACHE↗
PubMed2002

Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections.

BACKGROUND: Patients with nasal carriage of Staphylococcus aureus have an increased risk of surgical-site infections caused by that organism. Treatment with mupirocin ointment can reduce the rate of nasal carriage and may prevent postoperative S. aureus infections. METHODS: We conducted a randomized, double-blind, placebo-controlled trial to determine whether intranasal treatment with mupirocin reduces the rate of S. aureus infections at surgical sites and prevents other nosocomial infections. RESULTS: Of 4030 enrolled patients who underwent general, gynecologic, neurologic, or cardiothoracic surgery, 3864 were included in the intention-to-treat analysis. Overall, 2.3 percent of mupirocin recipients and 2.4 percent of placebo recipients had S. aureus infections at surgical sites. Of the 891 patients (23.1 percent of the 3864 who completed the study) who had S. aureus in their anterior nares, 444 received mupirocin and 447 received placebo. Among the patients with nasal carriage of S. aureus, 4.0 percent of those who received mupirocin had nosocomial S. aureus infections, as compared with 7.7 percent of those who received placebo (odds ratio for infection, 0.49; 95 percent confidence interval, 0.25 to 0.92; P=0.02). CONCLUSIONS: Prophylactic intranasal application of mupirocin did not significantly reduce the rate of S. aureus surgical-site infections overall, but it did significantly decrease the rate of all nosocomial S. aureus infections among the patients who were S. aureus carriers.

Administration, Intranasal↗
PubMed2002

Vancomycin susceptibility of oxacillin-resistant Staphylococcus aureus isolates causing nosocomial bloodstream infections.

Nosocomial oxacillin-resistant Staphylococcus aureus (ORSA) bloodstream isolates were tested to determine the prevalence of vancomycin heteroresistance. We screened 619 ORSA nosocomial bloodstream isolates from 36 hospitals between 1997 and 2000. Only one isolate exhibiting heterotypic resistance was detected. Thus, vancomycin heteroresistance in clinical bloodstream isolates remains rare in the United States.

Anti-Bacterial Agents↗
PubMed2002

Recognizing the real threat of biological terror.

Weapons of mass destruction can be used to harm and terrorize populations. Such weapons include those with chemical, nuclear or biological properties. Obviously computer viruses can add additional barriers to a quick response. The most effective, least costly and greatest threats are biologicals. Biological terror is not new, and biological weapons have been used for centuries. However, as a result of modern technology, the risks are greater now and the outcomes more terrible. Today they include live pathogens, various toxins, and theoretically "bioregulators"--biochemicals affecting cell signaling. Altered cell signaling could be used to induce apoptosis-cell death, or a heightened outpouring of cytokines mimicking overwhelming sepsis, or even an intracellular, biochemical "strike" causing cellular paralysis. Biological weaponeers now have the frightening ability to alter the genetic makeup of pathogens, rendering them resistant not only to available antibiotic therapy but also to currently effective vaccines. In dark corners of some fringe groups, bioweaponeers are searching for the capability of designing pathogens that target specific races, by virtue of discriminating ligands (1). The resulting morbidity and mortality from use of any biological weapons will be accompanied by chaos, governmental and social instability, panic, an extraordinary utilization of available resources, and an ongoing epidemic of sleepless nights (2,3). Herein I will review some of the issues and some of the currently available biological weapons. The major goal is to highlight the clinical presentations of patients with infections that could be used as biological weapons.

Animals↗
PubMedDate not supplied

Bacteremias: a leading cause of death.

Bloodstream infections (BSIs), recognized to be a major cause of morbidity and mortality globally, are increasing in incidence. The reported rates of crude and attributable mortality vary, possibly due to heterogeneity in patient populations and methodology. Few studies, however, have focused on pathogen-specific attributable mortality. These studies include S. aureus, coagulase-negative staphylococci and enterococcus. Other studies of attributable mortality have been conducted in select populations such as nosocomial and community-acquired cohorts, intensive care units, neutropenic patients, and HIV-positive patients. Regrettably, despite advances in treatment and intensive care facilities, mortality remains high.

Bacteremia↗
PubMedDate not supplied

Lessons from severe acute respiratory syndrome (SARS): implications for infection control.

Severe acute respiratory syndrome (SARS), the first global epidemic in the 21st century, affected over 8500 people in approximately 30 countries . With a crude mortality of 9%, its cause was quickly identified as a novel coronavirus that jumped species from animals to man. The SARS coronavirus epidemic, which began in the Fall of 2002, was related to the exotic food industry in southern China, initially involving disproportionate numbers of animal handlers, chefs, and caterers. Subsequently, person-to-person transmission spawned the outbreak. What distinguished this illness clinically was the fact that approximately half of the victims were health care workers , infected while caring for recognized or unrecognized patients with SARS. There are many curiosities and uncertainties surrounding the epidemic of SARS with lessons that may be useful to the community of infectious diseases physicians, especially when looking ahead to the next epidemic. Herein we relate our perspectives on useful lessons derived from a review of the SARS epidemic.

China↗