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At least 253 records · Page 14Linked to original sources
PubMed2004

An outbreak of methicillin-resistant Staphylococcus aureus infections related to central venous catheters for hemodialysis.

OBJECTIVES: To determine risk factors for hemodialysis catheter-related bloodstream infections (HCRBSIs) and investigate whether use of maximal sterile barrier precautions would prevent HCRBSIs. SETTING: Tertiary-care medical center hemodialysis unit. DESIGN: Open trial with historical comparison and case-control study of risk factors for HCRBSIs. METHODS: Prospective surveillance was used to compare HCRBSI rates for 1 year before and after implementation of maximal sterile barrier precautions. A case-control study compared 50 case-patients with HCRBSI with 51 randomly selected control-patients. RESULTS: The HCRBSI rate was 1.6% per 100 dialysis runs (CI95, 1.1%-2.3%) in the first year and 0.77% (CI95, 0.5%-1.1%) in the second year (P = .0106). The most frequent cause of HCRBSI was MRSA in the first year (15 of 32) and MSSA in the second year (13 of 18). Ten MRSA blood isolates in the first year were identical by PFGE. Diabetes mellitus was a risk factor for HCRBSI. Age, gender, site of hemodialysis central venous catheter (CVC), other underlying diseases, coma score, APACHE II score, serum albumin level, and cholesterol level were not associated with HCRBSI and did not change between the 2 years. Hospital stay was prolonged for case-patients (32.78 +/- 20.96 days) versus control-patients (22.75 +/- 17.33 days), but mortality did not differ. CONCLUSIONS: Use of maximal sterile barrier precautions during the insertion of CVCs reduced HCRBSIs in dialysis patients and seemed cost-effective. Diabetes mellitus was associated with HCRBSI. An outbreak of MRSA in the first year was likely caused by cross-infection via medical personnel.

Case-Control Studies↗
PubMed1998

Vancomycin-resistant Staphylococcus aureus: infection control considerations.

The lessons of the antibiotic era are crystal clear: in the footrace between humans and microbes, the organisms' genetic repertoire and efficient response to environmental changes will win the day. New antibiotics are essential, but their shelf life will be enhanced only if used wisely and sparingly. The antibiotic era is continually threatened by inappropriate decisions regarding use, inappropriate choices, and unnecessary durations of treatment. In concert with improved prescribing habits, efforts to identify and isolate resistant organisms introduced from outside institutions are essential. Last, continual energy is needed to influence the behavior of health care professionals and to maintain optimal infection control policies and procedures. We remain optimistic about the ability of infectious diseases physicians to respond appropriately to continued microbial challenges with research, education, and wise practice.

Anti-Bacterial Agents↗
PubMed1983

Vancomycin therapy of oxacillin-resistant Staphylococcus aureus infections.

Infections caused by oxacillin-resistant staphylococci were studied in 27 patients, who received vancomycin therapy as soon as the resistance of the pathogenic staphylococcal strain to oxacillin was documented. Therapy with vancomycin was usually started not later than 48 h after the onset of empiric therapy with oxacillin or cefamandole. In spite of high bactericidal activity in the serum of the patients receiving vancomycin, only 16 (59%) out of 27 patients responded to the treatment. Favourable clinical responses were usually associated with bacteriological cure, but super-infection by Gram-negative bacillary rods was a common complication in this series; it occurred in eight (30%) of the 27 patients studied. The overall death rate was 33% (9/27); death was associated in six patients with persisting staphylococcal infection and in three patients with Gram-negative bacillary superinfection of the bronchopulmonary tract, with or without persistent staphylococcal infection.

Adolescent↗