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ICE volume 38 issue 2 Cover and Back matter ICE第38卷第2期封面和封底
Pub Date : 2017-01-18 DOI: 10.1017/ice.2016.340
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引用次数: 0
ICE volume 38 issue 2 Cover and Front matter ICE第38卷第2期封面和封面问题
Pub Date : 2017-01-18 DOI: 10.1017/ice.2016.339
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引用次数: 0
An Evaluation of Food as a Potential Source for Clostridium difficile Acquisition in Hospitalized Patients – CORRIGENDUM 食物作为住院病人难辨梭菌获得的潜在来源的评估-勘误表
Pub Date : 2017-01-18 DOI: 10.1017/ice.2017.2
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引用次数: 0
A Practical Tool for Surveillance of Surgical-Site Infections: A 5-Year Experience in Orthopedic Surgeries 手术部位感染监测的实用工具:5年骨科手术经验
Pub Date : 2017-01-10 DOI: 10.1017/ice.2016.322
S. Benenson, A. Moses, Matan J. Cohen, M. Brezis, N. Minster, C. Schwartz, L. Kandel, M. Liebergall, Y. Mattan
Continuous surveillance of surgical-site infection (SSI) is labor intensive. We developed a semiautomatic surveillance system partly assisted by surgeons. Most patients who developed postdischarge SSI were readmitted, which allowed us to limit postdischarge surveillance to this group. This procedure significantly reduced workload while maintaining high sensitivity and specificity for SSI diagnosis. Infect Control Hosp Epidemiol 2017;38:610–613
持续监测手术部位感染(SSI)是劳动密集型的。我们开发了一种半自动监控系统,部分由外科医生协助。大多数发生出院后SSI的患者再次入院,这使我们能够将出院后监测限制在该组。该程序显著减少了工作量,同时保持了SSI诊断的高灵敏度和特异性。中华流行病学杂志,2017;38 (4):591 - 591
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引用次数: 5
Detection of Piperacillin-Tazobactam-Resistant/Pan-β-Lactam-Susceptible Escherichia coli with Current Automated Susceptibility Test Systems 现有自动药敏试验系统检测哌拉西林-他唑巴坦耐药/Pan-β-内酰胺敏感大肠杆菌
Pub Date : 2017-01-10 DOI: 10.1017/ice.2016.325
M. Monogue, Linda K Tanner, S. Brecher, J. Aslanzadeh, D. Nicolau
infection in patients with indwelling urinary catheters: a prospective study of 761 patients. Arch Intern Med 2000;160: 673–677. 9. Humphries RM, Dien Bard J. Point-counterpoint: reflex cultures reduce laboratory workload and improve antimicrobial stewardship in patients suspected of having urinary tract infections. J Clin Microbiol 2016;54:254–258. 10. Fakih MG, Krein SL, Edson B, Watson SR, Battles JB, Saint S. Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm. Am J Infect Control 2014;42:S223–S229.
留置导尿患者感染:一项761例患者的前瞻性研究实习医学2000;160:673-677。9. Humphries RM, Dien Bard J.点对点:反射培养减少实验室工作量并改善尿路感染患者的抗菌药物管理。中华微生物学杂志(英文版);2016;44(4):544 - 544。10. Fakih MG, Krein SL, Edson B, Watson SR, Battles JB, Saint S.动员卫生保健工作者预防导尿管相关性尿路感染并避免患者伤害。[J] .中国传染病防治杂志,2014;32(2):444 - 444。
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引用次数: 7
Active Surveillance for Influenza Reduces but Does Not Eliminate Hospital Exposure to Patients With Influenza 积极监测流感减少但不能消除医院接触流感患者
Pub Date : 2017-01-10 DOI: 10.1017/ice.2016.321
B. Coleman, Wil Ng, Vinaya Mahesh, Maja McGuire, K. Hassan, K. Green, S. Mcneil, A. McGeer, K. Katz
OBJECTIVE To describe the frequency, characteristics, and exposure associated with influenza in hospitalized patients in a Toronto hospital DESIGN/METHOD Prospective data collected for consenting patients with laboratory-confirmed influenza and a retrospective review of infection control charts for roommates of cases over 3 influenza seasons RESULTS Of the 661 patients with influenza (age range: 1 week–103 years), 557 were placed on additional precautions upon admission. Of 104 with symptoms detected after admission, 57 cases were community onset and 47 were nosocomial (10 nosocomial were part of outbreaks). A total of 78 cases were detected after admission exposing 143 roommates. Among roommates tested for influenza after exposure, no roommates of community-onset cases and 2 of 16 roommates of nosocomial cases were diagnosed with influenza. Of 637 influenza-infected patients, 25% and 57% met influenza-like illness definitions from the Public Health Agency of Canada (PHAC) and Centers for Disease Control and Prevention (CDC), respectively, and 70.3% met the Provincial Infectious Diseases Advisory Committee (PIDAC) febrile respiratory illness definition. Among the 56 patients with community-onset influenza detected after admission, only 13%, 23%, and 34%, met PHAC, CDC, and PIDAC classifications, respectively. CONCLUSIONS In a setting with extensive screening and testing for influenza, 1 in 6 patients with influenza was not diagnosed until patients and healthcare workers had been exposed for >24 hours. Only 30% of patients with community-onset influenza detected after admission met the Ontario definition intended to identify cases, hampering efforts to prevent patient and healthcare worker exposures and reinforcing the need for prevention through vaccination. Infect Control Hosp Epidemiol 2017;38:387–392
设计/方法收集实验室确诊流感患者的前瞻性数据,并对3个流感季节患者室友的感染控制图进行回顾性分析。结果661例流感患者(年龄范围:1周- 103岁)中,557例在入院时采取了额外的预防措施。入院后发现症状的104例中,57例为社区发病,47例为院内发病(10例为院内发病)。入学后共发现78例,暴露143名室友。在接触后进行流感检测的室友中,没有社区发病病例的室友被诊断为流感,16名医院病例的室友中有2名被诊断为流感。在637例流感感染患者中,分别有25%和57%符合加拿大公共卫生署(PHAC)和疾病控制与预防中心(CDC)的流感样疾病定义,70.3%符合省传染病咨询委员会(PIDAC)的发热性呼吸道疾病定义。入院后检出56例社区发病流感患者中,分别只有13%、23%和34%符合PHAC、CDC和PIDAC分类。结论:在流感广泛筛查和检测的环境中,6名流感患者中有1名在患者和卫生保健工作者接触超过24小时后才被诊断出来。入院后发现的社区发病流感患者中,只有30%符合安大略省旨在确定病例的定义,这阻碍了预防患者和卫生保健工作者接触的努力,并加强了通过接种疫苗进行预防的必要性。中华流行病学杂志,2017;38 (8):387 - 392
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引用次数: 6
Paramyxovirus Outbreak in a Long-Term Care Facility: The Challenges of Implementing Infection Control Practices in a Congregate Setting 长期护理机构中的副粘病毒爆发:在聚集环境中实施感染控制措施的挑战
Pub Date : 2017-01-09 DOI: 10.1017/ice.2016.316
S. S. Spires, H. Talbot, Carolyn A. Pope, T. Talbot
OBJECTIVE We report an outbreak of respiratory syncytial virus (RSV) and human metapneumovirus (HMPV) infections in a dementia care ward containing 2 separately locked units (A and B) to heighten awareness of these pathogens in the older adult population and highlight some of the infection prevention challenges faced during a noninfluenza respiratory viral outbreak in a congregate setting. METHODS Cases were defined by the presence of new signs or symptoms that included (1) a single oral temperature ≥ 37.8°C (100.0°F) and (2) the presence of at least 2 of the following symptoms: cough, dyspnea, rhinorrhea, hoarseness, congestion, fatigue, and malaise. Attempted infection-control measures included cohorting patients and staff, empiric isolation precautions, and cessation of group activities. Available nasopharyngeal swab specimens were sent to the Tennessee Department of Health for identification by rT-PCR testing. RESULTS We identified 30 of the 41 (73%) residents as cases over this 16-day outbreak. Due to high numbers of sick personnel, we were unable to cohort staff to 1 unit. Unit B developed its first case 8 days after infection control measures were implemented. Of the 14 cases with available specimens, 6 patients tested positive for RSV-B, 7 for HMPV and 1 patient test positive for influenza A. Overall, 15 cases (50%) required transfer to acute care facilities; 10 of these patients (34%) had chest x-ray confirmed pulmonary infiltrates; and 5 residents (17%) died. CONCLUSIONS This case report highlights the importance of RSV and HMPV in causing substantial disease in the older adult population and highlights the challenges in preventing transmission of these viruses. Infect Control Hosp Epidemiol 2017;38:399–404
目的:我们报告了一起呼吸道合胞病毒(RSV)和人超肺病毒(HMPV)感染在一个痴呆护理病房的爆发,该病房包含两个单独锁定的病房(a和B),以提高老年人对这些病原体的认识,并强调在聚集环境中非流感呼吸道病毒爆发期间面临的一些感染预防挑战。方法病例的定义是出现新的体征或症状,包括:(1)单口温度≥37.8°C(100.0°F),(2)至少出现以下症状中的2种:咳嗽、呼吸困难、鼻漏、声音嘶哑、充血、疲劳和不适。尝试的感染控制措施包括将患者和工作人员聚集在一起,采取经验性隔离预防措施,以及停止集体活动。可获得的鼻咽拭子标本送至田纳西州卫生部,通过rT-PCR检测进行鉴定。结果在这次为期16天的暴发中,我们确定了41名居民中的30名(73%)为病例。由于患病人员人数众多,我们无法将工作人员集中到一个单位。B单位在实施感染控制措施8天后出现了第一例病例。在可获得标本的14例病例中,6例RSV-B检测呈阳性,7例HMPV检测呈阳性,1例甲型流感检测呈阳性。总体而言,15例(50%)需要转至急性护理机构;其中10例(34%)胸片证实肺部浸润;死亡5人(17%)。结论:本病例报告强调了RSV和HMPV在老年人群中引起实质性疾病的重要性,并强调了预防这些病毒传播的挑战。中华流行病学杂志,2017;38 (4):391 - 391
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引用次数: 10
A Randomized Trial to Determine the Impact of an Educational Patient Hand-Hygiene Intervention on Contamination of Hospitalized Patient’s Hands with Healthcare-Associated Pathogens 一项随机试验,旨在确定患者手卫生教育干预对住院患者手部沾染卫生保健相关病原体的影响
Pub Date : 2017-01-05 DOI: 10.1017/ice.2016.323
V. Sunkesula, S. Kundrapu, Shanina C. Knighton, J. Cadnum, C. Donskey
We conducted a non-blinded randomized trial to determine the impact of a patient hand-hygiene intervention on contamination of hospitalized patients’ hands with healthcare-associated pathogens. Among patients with negative hand cultures on admission, recovery of pathogens from hands was significantly reduced in those receiving the intervention versus those receiving standard care. Infect Control Hosp Epidemiol 2017;38:595–597
我们进行了一项非盲法随机试验,以确定患者手卫生干预对住院患者手部沾染卫生保健相关病原体的影响。在入院时手部培养阴性的患者中,接受干预的患者与接受标准治疗的患者相比,手部病原体的恢复明显减少。中华流行病学杂志,2017;38:595-597
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引用次数: 24
Preferential Use of Nitrofurantoin Over Fluoroquinolones for Acute Uncomplicated Cystitis and Outpatient Escherichia coli Resistance in an Integrated Healthcare System 在一个综合医疗系统中,治疗急性无并发症膀胱炎和门诊大肠杆菌耐药性的硝基呋喃妥因优先于氟喹诺酮类药物
Pub Date : 2017-01-05 DOI: 10.1017/ice.2016.315
Rebecca L Pedela, Katherine C. Shihadeh, Bryan C. Knepper, M. Haas, W. Burman, T. Jenkins
OBJECTIVES To evaluate changes in outpatient fluoroquinolone (FQ) and nitrofurantoin (NFT) use and resistance among E. coli isolates after a change in institutional guidance to use NFT over FQs for acute uncomplicated cystitis. DESIGN Retrospective preintervention–postintervention study. SETTING Urban, integrated healthcare system. PATIENTS Adult outpatients treated for acute cystitis. METHODS We compared 2 time periods: January 2003–June 2007 when FQs were recommended as first-line therapy, and July 2007–December 2012, when NFT was recommended. The main outcomes were changes in FQ and NFT use and FQ- and NFT-resistant E. coli by time-series analysis. RESULTS Overall, 5,714 adults treated for acute cystitis and 11,367 outpatient E. coli isolates were included in the analysis. After the change in prescribing guidance, there was an immediate 26% (95% CI, 20%–32%) decrease in FQ use (P<.001), and a nonsignificant 6% (95% CI, −2% to 15%) increase in NFT use (P=.12); these changes were sustained over the postintervention period. Oral cephalosporin use also increased during the postintervention period. There was a significant decrease in FQ-resistant E. coli of −0.4% per quarter (95% CI, −0.6% to −0.1%; P=.004) between the pre- and postintervention periods; however, a change in the trend of NFT-resistant E. coli was not observed. CONCLUSIONS In an integrated healthcare system, a change in institutional guidance for acute uncomplicated cystitis was associated with a reduction in FQ use, which may have contributed to a stabilization in FQ-resistant E. coli. Increased nitrofurantoin use was not associated with a change in NFT resistance. Infect Control Hosp Epidemiol 2017;38:461–468
目的:评价在使用氟喹诺酮(FQ)而非氟喹诺酮(NFT)治疗急性无并发症膀胱炎的制度指导改变后,门诊大肠杆菌分离物氟喹诺酮(FQ)和呋喃妥英(NFT)的使用和耐药性的变化。设计:干预前-干预后回顾性研究。城市综合医疗体系。成人急性膀胱炎门诊患者。方法我们比较了两个时间段:2003年1月至2007年6月,FQs被推荐为一线治疗;2007年7月至2012年12月,NFT被推荐为一线治疗。时间序列分析的主要结果是FQ和NFT的使用以及FQ和NFT耐药大肠杆菌的变化。结果:总体而言,5,714名接受急性膀胱炎治疗的成年人和11,367名门诊大肠杆菌分离株被纳入分析。改变处方指南后,FQ的使用立即减少了26% (95% CI, 20%-32%) (P< 0.001), NFT的使用增加了6% (95% CI, - 2% - 15%) (P=.12);这些变化在干预后持续了一段时间。口服头孢菌素的使用在干预后也有所增加。耐fq的大肠杆菌每季度显著减少- 0.4% (95% CI, - 0.6%至- 0.1%;P= 0.004);然而,没有观察到耐nft的大肠杆菌的变化趋势。结论:在综合医疗保健系统中,对急性无并发症膀胱炎的制度指导的改变与FQ使用的减少有关,这可能有助于FQ耐药大肠杆菌的稳定。呋喃妥英使用量的增加与NFT耐药性的变化无关。中华流行病学杂志,2017;38 (4):461 - 468
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引用次数: 13
Inpatient Urine Cultures Are Frequently Performed Without Urinalysis or Microscopy: Findings From a Large Academic Medical Center 住院病人尿培养经常在没有尿液分析或显微镜的情况下进行:来自一个大型学术医疗中心的发现
Pub Date : 2017-01-05 DOI: 10.1017/ice.2016.311
Abigail L. Carlson, S. Munigala, A. Russo, K. McMullen, Helen Wood, R. Jackups, D. Warren
OBJECTIVE To describe the frequency of urine cultures performed in inpatients without additional testing for pyuria DESIGN Retrospective cohort study SETTING A 1,250-bed academic tertiary referral center PATIENTS Hospitalized adults METHODS This study included urine cultures drawn on 4 medical and 2 surgical wards from 2009 to 2013 and in the medical and surgical intensive care units (ICUs) from 2012 to 2013. Patient and laboratory data were abstracted from the hospital’s medical informatics database. We identified catheter-associated urinary tract infections (CAUTIs) in the ICUs by routine infection prevention surveillance. Cultures without urinalysis or urine microscopy were defined as “isolated.” The primary outcome was the proportion of isolated urine cultures obtained. We used multivariable logistic regression to assess predictors of isolated cultures. RESULTS During the study period, 14,743 urine cultures were obtained (63.5 cultures per 1,000 patient days) during 11,820 patient admissions. Of these, 2,973 cultures (20.2%) were isolated cultures. Of the 61 CAUTIs identified, 31 (50.8%) were identified by an isolated culture. Predictors for having an isolated culture included male gender (adjusted odds ratio [aOR], 1.22; 95%; confidence interval [CI], 1.11–1.35], urinary catheterization (aOR, 2.15; 95% CI, 1.89–2.46), ICU admission (medical ICU aOR, 1.72; 95% CI, 1.47–2.00; surgical ICU aOR, 1.82; 95% CI, 1.51–2.19), and obtaining the urine culture ≥1 calendar day after admission (1–7 days aOR, 1.91; 95% CI. 1.71–2.12; >7 days after admission aOR, 2.81; 95% CI, 2.37–3.34). CONCLUSIONS Isolated urine cultures are common in hospitalized patients, particularly in patients with urinary catheters and those in ICUs. Interventions targeting inpatient culturing practices may improve the diagnosis of urinary tract infections. Infect Control Hosp Epidemiol 2017;38:455–460
回顾性队列研究设置了1250个床位的三级转诊中心住院成人患者。方法本研究包括2009年至2013年4个内科和2个外科病房以及2012年至2013年内科和外科重症监护病房(icu)的尿液培养。从医院的医学信息学数据库中提取患者和实验室数据。我们通过常规感染预防监测在icu中发现导管相关性尿路感染(CAUTIs)。未经尿液分析或尿液显微镜的培养物被定义为“分离的”。主要结果是获得分离尿液培养物的比例。我们使用多变量逻辑回归来评估分离培养物的预测因子。结果:在研究期间,在11,820例入院患者中,获得了14,743例尿液培养(每1,000患者日63.5例)。其中,2973个培养物(20.2%)为分离培养物。在鉴定的61例CAUTIs中,31例(50.8%)是通过分离培养鉴定的。孤立培养的预测因素包括男性(校正优势比[aOR], 1.22;95%;置信区间[CI], 1.11-1.35],导尿(aOR, 2.15;95% CI, 1.89-2.46), ICU入院(内科ICU aOR, 1.72;95% ci, 1.47-2.00;外科ICU aOR, 1.82;95% CI, 1.51-2.19),入院后≥1个日历日进行尿培养(1 - 7天aOR, 1.91;95%可信区间。1.71 - -2.12;>入院后7天aOR为2.81;95% ci, 2.37-3.34)。结论:分离尿培养在住院患者中很常见,特别是在有导尿管的患者和icu患者中。针对住院患者培养实践的干预措施可能提高尿路感染的诊断。中华流行病学杂志,2017;38 (4):455 - 456
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引用次数: 11
期刊
Infection Control &#x0026; Hospital Epidemiology
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