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Thomas R Talbot

Publications and source records attributed to Thomas R Talbot.

31 records · Page 2Linked to original sources
PubMed2005

Improving timely surgical antibiotic prophylaxis redosing administration using computerized record prompts.

BACKGROUND: Timely prophylactic antibiotic administration aids in preventing postoperative superficial surgical site infections. However, during lengthy surgical procedures, redosing of prophylactic antibiotics may be unintentionally omitted. We assessed the utility of a computerized reminder as part of the anesthesia charting system to increase the rate of timely intraoperative prophylactic antibiotic redosing. METHODS: A retrospective observational analysis was performed on consecutive patients undergoing non-cardiac surgical procedures at a university-affiliated hospital prior to and after the institution of a computerized reminder system. The reminder system presented the clinician with a series of on-screen dialog boxes prior to the redose time for the specific prophylactic antibiotic administered preoperatively. Antibiotic redosing was defined as appropriate if it occurred within 30 min prior to or after the due time, calculated as twice the half-life of the specific antibiotic. Patients were excluded if the case duration was less than twice the half-life of the administered prophylactic antibiotic, or if no prophylactic antibiotic was given. RESULTS: A total of 287 cases were included in the study (148 pre-intervention, 139 post-intervention). Patient age, case length, and American Society of Anesthesiologists (ASA) score stratification did not differ between the groups. Use of the reminder system resulted in an increase in the appropriate redosing of antibiotics from 20% prior to institution of the reminder to 58% after institution (p < 0.001). CONCLUSIONS: A computerized reminder system is an effective tool to assist in appropriate intraoperative redosing of prophylactic antibiotics during lengthy surgical procedures.

Adult↗
PubMed2005

Creating and validating a pneumococcal vaccination registry.

Healthy People 2010 set a goal of 90% vaccination rate for pneumococcal vaccine in elderly patients. We developed a keyword search, using pharmacy orders for Pneumovax as a gold standard, to determine patient eligibility for a computerized pneumococcal vaccination registry. The keyword search captured 98% of vaccinations in the validation dataset. A total of 4,768 patients matched at least one keyword in the search and were added to the immunization registry. Through our search, we found a 63% vaccination rate in the primary care patient population older than 65, leaving 37% of the high risk population still needing vaccinations.

Aged↗
PubMed2004

Vaccination success rate and reaction profile with diluted and undiluted smallpox vaccine: a randomized controlled trial.

CONTEXT: Additional smallpox vaccine doses are needed to augment current US national stockpile. Aventis Pasteur smallpox vaccine (APSV), initially manufactured in the 1950s from the New York Board of Health vaccinia strain in a frozen preparation, appears as effective as lyophilized vaccine but the effectiveness of diluted doses of APSV is unclear. OBJECTIVE: To compare the vaccination success rate and the reaction profile of various APSV dilutions. DESIGN, SETTING, AND PARTICIPANTS: A double-blind, randomized controlled trial of 340 healthy vaccinia-naive adults aged 18 to 32 years from 3 academic medical centers who were vaccinated with 1 of 3 strengths of APSV dilutions (undiluted, 1:5, and 1:10) between October 9, 2002, and February 24, 2003. Volunteers were followed up every 3 to 5 days until the vaccination site healed for bandage changes, vaccine response assessment, and adverse event evaluation, followed by 1- and 2-month clinic evaluations and 6-month telephone interview. MAIN OUTCOME MEASURES: Successful vaccination, defined by presence of a vesicle or pustule at the inoculation site 6 to 11 days postvaccination, and local and systemic reactions to vaccination. RESULTS: A total of 340 volunteers were vaccinated (vaccine dose: undiluted, n = 113; 1:5 dilution, n = 114; and 1:10 dilution, n = 113). Following vaccination, 99.4% (95% confidence interval [CI], 97.9%-99.9%) of all volunteers had successful vaccinations. Success rates did not differ between the dilution groups (undiluted, 100.0%; 95% CI, 96.8%-100.0%; 1:5 dilution, 98.2%; 95% CI, 93.8%-99.8%; 1:10 dilution, 100.0% 95% CI, 96.8%-100.0%; P =.33). Overall, 99.7% of volunteers reported at least 1 local symptom at the vaccination site, and 61.8% had axillary lymphadenopathy, 15.0% developed satellite lesions, and 7.6% developed a rash away from the vaccination site. Fever developed in 21.5%. No differences were noted in local or systemic reactions between the 3 dilution groups (P>.05 for each comparison). A total of 25% of volunteers missed scheduled duties due to vaccine-related symptoms. CONCLUSIONS: Even at diluted doses, APSV is an effective smallpox vaccine, allowing for expansion of the current stockpile. However, reactogenicity was not reduced with dilution of the vaccine and, as with other smallpox vaccines, may impair daily activities.

Adult↗
PubMed2004

Reduction in high rates of antibiotic-nonsusceptible invasive pneumococcal disease in tennessee after introduction of the pneumococcal conjugate vaccine.

BACKGROUND: Invasive pneumococcal disease (IPD) is a burgeoning problem, with rates of antibiotic-nonsusceptible IPD, in particular, increasing during the past decade. One measure to combat IPD is vaccination with the recently introduced 7-valent pneumococcal conjugate vaccine (PCV). METHODS: To evaluate the effects of the introduction of PCV in 2000 on the epidemiology of antibiotic-nonsusceptible IPD, a database of IPD cases from January 1995 through December 2002 identified through active surveillance in 5 Tennessee counties was examined. For each case, clinical data were collected, and antibiotic susceptibility testing and serotyping were performed on available isolates. RESULTS: Among children younger than 2 years, IPD rates peaked at 235 cases per 100,000 in 1999 before decreasing, after PCV licensure, to 46 cases per 100,000 in 2002 (P<.001). The proportion of penicillin-nonsusceptible IPD isolates from this age group declined from 59.8% in 1999 to 30.4% in 2002 (P<.01). After 2001, similar decreases in IPD rates and in the proportion of antibiotic-nonsusceptible isolates recovered were seen among persons aged 2 years and older (P<.01). Rates of IPD due to PCV-associated serotypes declined after PCV introduction in all age groups (P<.001), whereas the rate of IPD due to nonvaccine serotypes increased among persons aged 2 years and older. CONCLUSIONS: In the 2 years since licensure, widespread PCV vaccination of children has resulted in dramatic declines in the proportion of antibiotic-nonsusceptible isolates in Tennessee. PCV vaccination of children also appears to be a highly effective method for reducing the burden of IPD in adults.

Anti-Bacterial Agents↗
PubMed2004

Perioperative blood transfusion is predictive of poststernotomy surgical site infection: marker for morbidity or true immunosuppressant?

To analyze risk factors for the development of adult poststernotomy surgical site infections (SSIs), we performed a retrospective case-control study at a tertiary care hospital. Case patients with poststernotomy SSI between June 1999 and January 2001 were matched to control subjects without poststernotomy SSI according to date of procedure and age. Data were collected on known SSI risk factors. Of 711 procedures, we identified 38 cases with SSI and 114 matched controls. Univariate analysis revealed that receipt of transfused blood (odds ratio [OR], 3.19; 95% confidence interval [CI], 1.54-6.62), diabetes (OR, 2.90; 95% CI, 1.27-6.59), length of stay before hospitalization (OR, 1.19 per day; 95% CI, 1.02-1.37 per day), and American Society of Anesthesia score (OR, 2.19; 95% CI, 1.04-4.64) were significantly associated with SSI. Multivariate analysis revealed that transfusion (OR, 3.21; 95% CI, 1.41-7.31) and diabetes (OR, 3.65; 95% CI, 1.42-9.36) were predictors for SSI. The exact role of blood transfusion in the pathogenesis of SSI, whether as a direct immunosuppressant or a surrogate marker for morbidity, remains unresolved.

Adult↗
PubMed2004

Adverse events after smallpox immunizations are associated with alterations in systemic cytokine levels.

The immunization of healthy adults with vaccinia virus (VV) induces a protective response against smallpox in most individuals but is also reactogenic in a significant number of vaccinees. The immunological mechanisms underlying the protective response or adverse events in humans are not well defined. Although cytokines contribute to antiviral immunity and, in some cases, cause systemic adverse effects, their role in the human response to VV is unknown. We investigated the effect of smallpox immunization on systemic cytokine concentrations in a cohort of VV-naive individuals. We found that smallpox immunization induces an interferon (IFN)- gamma -dominant response in the systemic compartment 1 week after immunization, with concentrations returning to baseline during convalescence. The level of IFN- gamma induced was not affected by the dilution of vaccine used. We also found that particular adverse events correlated with systemic cytokine patterns, which suggests a role for these molecules in the pathogenesis of adverse events.

Adolescent↗
PubMed2004

Risk of vaccinia transfer to the hands of vaccinated persons after smallpox immunization.

Transmission of vaccinia virus after smallpox vaccination is a concern. We conducted a prospective examination of the protection afforded by vaccination-site bandages in recently vaccinated individuals. After smallpox vaccination, inoculation sites were covered with 2 occlusive dressings. Site assessment and bandage changes occurred every 3-5 days until the site was healed. At each visit, specimens from the vaccination site, outer dressing surface, and contralateral hand were obtained for vaccinia culture. For 148 vaccinated subjects, vaccinia was detected from vaccination lesions of every subject on several occasions. Only 6 (0.65%) of 918 dressing (95% CI, 0.24%-1.4%) and 2 (0.22%) of 926 hand (95% CI, 0.03%-0.78%) specimens tested positive for vaccinia. The mean number of bandage changes was 9.6 (95% CI, 9.17-10.0). Vaccinia autoinoculation did not occur. The rate of vaccinia recovery outside occlusive bandages covering smallpox vaccination sites was remarkably low, suggesting excellent protection against inadvertent transmission.

Adult↗
PubMed2004

Elimination of racial differences in invasive pneumococcal disease in young children after introduction of the conjugate pneumococcal vaccine.

BACKGROUND: Racial differences in the epidemiology of invasive pneumococcal disease (IPD) have been widely recognized, but the impact of conjugate pneumococcal vaccine (PCV) introduction in 2000 on these differences has not been extensively studied. METHODS: IPD episodes in 5 Tennessee counties from January 1995 through December 2002 were collected prospectively using the Centers for Disease Control and Prevention's Active Bacterial Core Surveillance system (ABCs). Trained nurses collected clinical data, and antibiotic susceptibility testing was performed on available isolates. RESULTS: Before vaccine licensure, IPD rates were highest in children younger than 2 years and in blacks. The disparity in IPD rates between blacks and whites younger than 2 years of age substantially diminished after PCV introduction. In 1999, the IPD rate in black children younger than 2 years was 340.2 per 100,000, representing 176.5 more events per 100,000 than in white children (P < 0.001). In 2002, this rate had decreased 83% to 57.4 per 100,000, similar to the rate in white children (39.6 per 100,000; P = 0.31). Before vaccine licensure, a higher percentage of isolates from whites were antibiotic-nonsusceptible. In 2002, the proportion of antibiotic-nonsusceptible pneumococcal isolates was similar in whites and blacks of all ages for the first time during the study period (P > 0.05 for separate comparisons of penicillin, cephalosporin and erythromycin nonsusceptibility). These changes occurred despite a lower PCV vaccination coverage in Tennessee in blacks than in whites (31.2% versus 47.6%). CONCLUSIONS: With conjugate pneumococcal vaccine introduction in Tennessee, racial differences in the incidence rates of IPD have largely been eliminated, particularly in young children.

Adolescent↗
PubMed2003

Focal and generalized folliculitis following smallpox vaccination among vaccinia-naive recipients.

CONTEXT: With the reintroduction of smallpox vaccination, detailed contemporary descriptions of adverse reactions to the vaccine are needed to adequately inform the public and clinicians. During a multicenter, randomized controlled trial investigating the efficacy of various dilutions of smallpox vaccine, we observed the appearance of a papulovesicular eruption (focal and generalized) in study volunteers. OBJECTIVE: To characterize the papulovesicular eruptions by clinical, virologic, and histopathological characteristics. DESIGN, SETTING, AND PARTICIPANTS: Prospective case series of papulovesicular eruptions following smallpox vaccination in healthy, vaccinia-naive adult participants compared with noncases conducted from October 2002 to March 2003. Variables potentially related to these eruptions were collected retrospectively through chart review. Eruptions were described based on viral culture, clinical examination, and histopathological evaluation (1 biopsy specimen from 1 case). MAIN OUTCOME MEASURE: Cases of papulovesicular eruptions following vaccination. RESULTS: During the trial, of 148 volunteers (56% women; mean age 23.6 years), 4 participants (2.7%) developed generalized eruptions and 11 (7.4%) noted focal eruptions. Viral cultures of sample lesions were negative for vaccinia. The result of a skin biopsy sample from 1 case of generalized rash revealed suppurative folliculitis without evidence of viral infection. All lesions resolved without scarring. In the cohort, cases and noncases did not show significant differences in terms of sex, in the use of nonsteroidal anti-inflammatory drugs or oral or depo contraceptives, in medication allergies, in the incidence of fever or lymphadenopathy after vaccination, or in the dilution of vaccine received. CONCLUSIONS: Folliculitis is a common and benign eruption observed in vaccinia-naive adult volunteers following smallpox vaccination. This eruption may be seen in volunteers receiving the vaccine in the newly instituted vaccination programs and may be met with heightened anxiety, potentially being confused with generalized vaccinia. This description of folliculitis using clinical, virologic, and histopathological findings should allay these concerns and provide additional insight into this eruption.

Adult↗
PubMed2003

Ehrlichia chaffeensis infections among HIV-infected patients in a human monocytic ehrlichiosis-endemic area.

Manifestations of human monocytic ehrlichiosis (HME), a tick-borne infection caused by Ehrlichia chaffeensis, range from asymptomatic disease to fulminant infection and may be particularly severe in persons infected with HIV. We conducted a serologic study to determine the epidemiology of HME in HIV-positive patients residing in an HME-endemic area. We reviewed charts from a cohort of 133 HIV-positive patients who were seen during the 1999 tick season with symptoms compatible with HME (n=36) or who were asymptomatic (n=7). When available, paired plasma samples obtained before and after the tick season were tested by using an indirect immunofluorescence assay (IFA) to detect antibodies reactive to E. chaffeensis. Two symptomatic incident cases were identified by IFA, resulting in a seroincidence of 6.67% among symptomatic HIV-positive participants with paired samples available for testing and 1.64% overall. The baseline seroprevalence of HME was 0%. In contrast to infection in immunocompetent patients, E. chaffeensis infection in HIV-positive persons typically causes symptomatic disease.

Adult↗
PubMed2002

Scedosporium apiospermum pneumonia and sternal wound infection in a heart transplant recipient.

BACKGROUND: The most common fungi that cause invasive infection in transplant recipients are the spp, spp, and the endemic fungi such as and. Recently, however, other fungal pathogens have emerged as important causes of invasive disease in these immunocompromised individuals, including the dematiaceous fungi, such as and the spp, species of and, and the hyalohyphomycoses, such as (Pseudallescheria boydii) (1). METHODS: We present a single patient case report and literature review. RESULTS: We illustrate the first reported case of a postoperative sternal wound infection and pneumonia caused by in a heart transplant recipient and review the significant clinical, microbiologic, and therapeutic aspects of infection with this important opportunistic pathogen. CONCLUSIONS: Postsurgical wound infection should be added to the growing list of infections in the transplant population caused by.

Aged↗