Ruth L. Berkelman

Pseudobacteremia Attributed to Contamination of Povidone-Iodine with Pseudomonas cepacia

Pseudomonas cepacia was recovered from the blood cultures of 52 patients in four hospitals in New York over 6 months from April through October 1980. Epidemiologic investigation in one hospital indicated that the positive results of blood culture represented pseudobacteremias and implicated a 10% povidone-iodine solution used as an antiseptic and disinfectant (Pharmadine; Sherwood Pharmaceutical Company, Mahwah, New Jersey) as the source of contamination. Physicians who drew blood cultures positive for P. cepacia were more likely to have left povidone-iodine on the skin before venipuncture (p = 0.026) and were more likely to have applied povidone-iodine to the blood culture bottle tops and to have left it there while inoculating the blood culture media (p = 0.007) than those who drew cultures negative for P. cepacia. Direct inoculation of Pharmadine into brain-heart infusion broth yielded P. cepacia; however, 2 weeks after the first cultures, the same Pharmadine bottles were culture negative. The iodine concentrations of the contaminated Pharmadine solutions were similar to those of 10% povidone-iodine solutions distributed by other manufacturers.

Beta-Adrenergic Antagonists and Fatal Anaphylactic Reactions to Oral Penicillin

Excerpt To the editor: Although penicillin is one of the commoner causes of anaphylactic reactions, fatal reactions to oral penicillin are rare, with only a few reports in the medical literature (1...

Alternative HIV testing methods among populations at high risk for HIV infection.

OBJECTIVEnThe purpose of this study was to determine the levels of awareness and use of alternative HIV tests (home collection kit, oral mucosal transudate collection kit, and rapid tests) among people at high risk for HIV infection.nnnMETHODSnData were collected as part of an anonymous, cross-sectional interview study--the HIV Testing Survey (HITS)--conducted in seven states from September 2000 to February 2001. Three high-risk populations were recruited: men who have sex with men, injection drug users, and high-risk heterosexuals. Respondents were asked about their awareness and use of alternative HIV tests.nnnRESULTSnThe overall awareness and use of the alternative tests was limited: 54% of respondents were aware of the home collection kit, 42% were aware of the oral mucosal transudate collection kit test, and 13% were aware of rapid tests. Among those aware of alternative tests, self-reported use of the tests was also low. The most common reasons given for not using alternative HIV tests were: preference for the standard test; concern that the results could be less accurate; and that alternative tests were not offered.nnnCONCLUSIONSnThe low levels of awareness and use of alternative HIV tests suggest that the potential for promoting testing among individuals at high risk for HIV by encouraging use of alternative HIV tests has not been fully realized. Alternative tests should be made more broadly available and should be accompanied by education about these tests for physicians and people at risk. Educational efforts should be evaluated to determine if promoting alternative HIV tests increases the numbers of people at risk for HIV who are tested.

Emerging Infectious Diseases in the United States: Improved Surveillance, a Requisite for Prevention

Emerging infectious diseases such as prolonged diarrheal illness due to water-borne Cryptosporidium, hemorrhagic colitis and renal failure from food-borne E. coli O157:H7, and rodent-borne hantavirus pulmonary syndrome as well as reemerging infections such as tuberculosis, pertussis, and cholera vividly illustrate that we remain highly vulnerable to the microorganisms with which we share our environment. Prompt detection of new and resurgent infectious disease threats depends on careful monitoring by modern surveillance systems. This article focuses on five important elements of improved surveillance for emerging infections: 1) strengthening the national notifiable disease system, 2) establishing sentinel surveillance networks, 3) establishing population-based emerging infections programs, 4) developing a system for enhanced global surveillance, and 5) applying new tools and novel approaches to surveillance.

Recommendations for the Care of Automated Peritoneal Dialysis Machines: Can the Risk of Peritonitis Be Reduced?

Automated peritoneal dialysis systems have helped make intermittent peritoneal dialysis an alternative to hemodialysis for long-term management of patients with end-stage renal disease. However, if not cleaned and maintained properly, these machines provide a reservoir for pathogens. The microbiologic barriers in these machines are not impenetrable, but sterile dialysate fluid can be produced if the machines are adequately cleaned and disinfected. Potential shortcomings of the microbiologic barriers are discussed, and guidelines to prevent contamination of the internal parts of a machine are suggested.