The clinical and prognostic importance of positive blood cultures in adults.

Background: Bloodstream infections are a major cause of morbidity and mortality in adults. Bloodstream infections should be reassessed periodically because of increased antibiotic resistance, more patients receiving immunomodulatory therapy, improved antiretroviral therapy, and acquisition of infection in health care settings other than hospitals.

Methods: We conducted retrospective assessment by infectious disease physicians of hospitalized adults with positive blood cultures at 3 academic medical centers.

Postoperative joint infections due to Propionibacterium species: a case-control study.

We compared 40 patients with Propionibacterium acnes postoperative joint infection to a cohort of uninfected patients. Infection manifested a median of 210 days after surgery. Most patients with joint prostheses underwent hardware removal.

First reported United States case of Legionella pneumophila serogroup 1 pneumonia in a patient receiving anti-tumor necrosis factor-alpha therapy.

Legionellosis has been reported to be an extremely rare disease in Hawai'i. The authors report a case of a 67-year-old woman with a history of rheumatoid arthritis treated with long-term adalimumab who developed severe right-sided community-acquired pneumonia and a parapneumonic effusion. Legionella pneumophila serogroup 1 was confirmed as the microbiologic cause based on a positive urine Legionella antigen as well as direct fluorescent antibody and Legionella culture of bronchoalveolar lavage.

Assessment of Clostridium difficile-associated disease surveillance definitions, North Carolina, 2005.

Objective: To determine the timing of community-onset Clostridium difficile-associated disease (CDAD) relative to the patient's last healthcare facility discharge, the association of postdischarge cases with healthcare facility-onset cases, and the influence of postdischarge cases on overall rates and interhospital comparison of rates of CDAD.

Design: Retrospective cohort study for the period January 1, 2005, through December 31, 2005.

Setting: Catchment areas of 6 acute care hospitals in North Carolina.

Methicillin-resistant Staphylococcus aureus outbreak in an intensive care nursery: potential for interinstitutional spread.

Background: After surveillance surveys documented the absence of methicillin-resistant Staphylococcus aureus (MRSA) in our intensive care nursery, an outbreak of MRSA infection occurred there during a 7-month period in 2005.

Methods: Control measures included reinforcement of hand hygiene and contact precautions procedures. Active surveillance cultures were obtained on all neonates, including interinstitutional transfers.

Controlled clinical comparison of BacT/ALERT standard aerobic and standard anaerobic blood culture bottles inoculated directly or after transport in sodium polyanethol sulfonate tubes.

To assess relative performances in the BacT/ALERT blood culture system, we compared results from the direct inoculation of standard media and inoculation after the transport of blood samples in Vacutainer tubes with sodium polyanethol sulfonate. No significant differences in yields or times to detection were found for 387 clinically important isolates from 4,306 blood culture sets.

Use of sentinel laboratories by clinicians to evaluate potential bioterrorism and emerging infections.

With the persistent threat of emerging infectious diseases and bioterrorism, it has become increasingly important that clinicians be able to identify the diseases that might signal the occurrence of these unusual events. Essential to a thoughtful diagnostic approach is understanding when to initiate a public health investigation and how to appropriately use commonly performed microbiology procedures in the sentinel laboratory to evaluate potential pathogens. Although diagnostic test development is evolving rapidly, recognizing many of these pathogens continues to challenge the capabilities of most sentinel laboratories.