Virginia Roth

Transfusion‐transmitted bacterial infectionin the United States, 1998 through 2000

BACKGROUND: Bacterial contamination of blood components can result in transfusion‐transmitted infection, but the risk is not established.

Development of Cervical Fat Pads Following Therapy with Human Immunodeficiency Virus Type 1 Protease Inhibitors

Eight patients with infection due to human immunodeficiency virus type 1 developed fat pads at the bases of their necks a median of 22 weeks (range, 4-61 weeks) after initiation of protease inhibitor therapy. This finding was seen in association with the use of each of the available protease inhibitors. The patients had no other cushingoid features or histories of corticosteroid use, and all had normal 24-hour urine cortisol levels. The computed tomography scans of five patients showed large, nonencapsulated accumulations of subcutaneous adipose tissue. Histological examination of tissue from one patient confirmed a nonlipomatous subcutaneous fat deposition. Although the pathogenesis of this unique clinical finding is unclear, the temporal relationship between the use of protease inhibitors and the development of cervical fat pads is suggestive of a complication of therapy.

The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital

Background: The effect of hospital-acquired infection with Clostridium difficile on length of stay in hospital is not yet fully understood. We determined the independent impact of hospital-acquired infection with C. difficile on length of stay in hospital. Methods: We conducted a retrospective observational cohort study of admissions to hospital between July 1, 2002, and Mar. 31, 2009, at a single academic hospital. We measured the association between infection with hospital-acquired C. difficile and time to discharge from hospital using Kaplan–Meier methods and a Cox multivariable proportional hazards regression model. We controlled for baseline risk of death and accounted for C. difficile as a time-varying effect. Results: Hospital-acquired infection with C. difficile was identified in 1393 of 136 877 admissions to hospital (overall risk 1.02%, 95% confidence interval [CI] 0.97%–1.06%). The crude median length of stay in hospital was greater for patients with hospital-acquired C. difficile (34 d) than for those without C. difficile (8 d). Survival analysis showed that hospital-acquired infection with C. difficile increased the median length of stay in hospital by six days. In adjusted analyses, hospital-acquired C. difficile was significantly associated with time to discharge, modified by baseline risk of death and time to acquisition of C. difficile. The hazard ratio for discharge by day 7 among patients with hospital-acquired C. difficile was 0.55 (95% CI 0.39–0.70) for patients in the lowest decile of baseline risk of death and 0.45 (95% CI 0.32–0.58) for those in the highest decile; for discharge by day 28, the corresponding hazard ratios were 0.74 (95% CI 0.60–0.87) and 0.61 (95% CI 0.53–0.68). Interpretation: Hospital-acquired infection with C. difficile significantly prolonged length of stay in hospital independent of baseline risk of death.

Real-time polymerase chain reaction detection of methicillin-resistant Staphylococcus aureus: impact on nosocomial transmission and costs.

OBJECTIVES To assess the impact of real-time polymerase chain reaction (PCR) detection of methicillin-resistant Staphylococcus aureus (MRSA) on nosocomial transmission and costs. DESIGN Monthly MRSA detection rates were measured from April 1, 2000, through December 31, 2005. Time series analysis was used to identify changes in MRSA detection rates, and decision analysis was used to compare the costs of detection by PCR and by culture.Setting. A 1,200-bed, tertiary care hospital in Canada. PATIENTS Admitted patients at high risk for MRSA colonization. MRSA detection using culture-based screening was compared with a commercial PCR assay. RESULTS The mean monthly incidence of nosocomial MRSA colonization or infection was 0.37 cases per 1,000 patient-days. The time-series model indicated an insignificant decrease of 0.14 cases per 1,000 patient-days per month (95% confidence interval, -0.18 to 0.46) after the introduction of PCR detection (P=.39). The mean interval from a reported positive result until contact precautions were initiated decreased from 3.8 to 1.6 days (P<.001). However, the cost of MRSA control increased from Can

The Effect of Hospital-Acquired Clostridium difficile Infection on In-Hospital Mortality

605,034 to Can

Ocular tuberculosis: diagnostic and treatment challenges

771,609. Of 290 PCR-positive patients, 120 (41.4%) were placed under contact precautions unnecessarily because of low specificity of the PCR assay used in the study; these patients contributed 37% of the increased cost. The modeling study predicted that the cost per patient would be higher with detection by PCR (Can

Cloxacillin versus vancomycin for presumed late-onset sepsis in the Neonatal Intensive Care Unit and the impact upon outcome of coagulase negative staphylococcal bacteremia: a retrospective cohort study

96) than by culture (Can

Cluster of cases of severe acute respiratory syndrome among Toronto healthcare workers after implementation of infection control precautions: a case series.

67). CONCLUSION Detection of MRSA by the PCR assay evaluated in this study was more costly than detection by culture for reducing MRSA transmission in our hospital. The cost benefit of screening by PCR varies according to incidences of MRSA colonization and infection, the predictive values of the assay used, and rates of compliance with infection control measures.

Evaluation of a reporting system for bacterial contamination of blood components in the United States.

BACKGROUND The effects of hospital-acquired Clostridium difficile infection (CDI) on patient outcomes are incompletely understood. We conducted this study to determine the independent impact of hospital-acquired CDI on in-hospital mortality after adjusting for the time-varying nature of CDI and baseline mortality risk at hospital admission. METHODS This retrospective observational study used data from the Ottawa Hospital (Ottawa, Ontario, Canada) data warehouse. Inpatient admissions with a start date after July 1, 2002, and a discharge date before March 31, 2009, were included. Stratified analyses and a Cox multivariate proportional hazards regression model were used to determine if hospital-acquired CDI was associated with time to in-hospital death. RESULTS A total of 136 877 admissions were included. Hospital-acquired CDI was identified in 1393 admissions (overall risk per admission, 1.02%; 95% confidence interval [CI], 0.97%-1.06%). The risk of hospital-acquired CDI significantly increased as the baseline mortality risk increased: from 0.2% to 2.6% in the lowest to highest deciles of baseline risk. Hospital-acquired CDI significantly increased the absolute risk of in-hospital death across all deciles of baseline risk (pooled absolute increase, 11%; 95% CI, 9%-13%). Cox regression analysis revealed an average 3-fold increase in the hazard of death associated with hospital-acquired CDI (95% CI, 2.4-3.7); this hazard ratio decreased with increasing baseline mortality risk. CONCLUSIONS Hospital-acquired CDI was independently associated with an increased risk of in-hospital death. Across all baseline risk strata, for every 10 patients acquiring the infection, 1 person died.

Impact of the 2009 influenza A (H1N1) pandemic on Canadian health care workers: A survey on vaccination, illness, absenteeism, and personal protective equipment

Ocular tuberculosis (TB) is a challenging clinical entity, pre-senting hurdles in diagnosis and management for bothophthalmologists and infectious disease specialists. Earlydiagnosis and prompt treatment may be sight-saving inpatients with ocular TB. However, diagnostic obstacles pre-sent the greatest limitations in understanding and treatingocular TB in 2008.