Healthcare providers as sources of vaccine-preventable diseases.

Vaccine-preventable infectious diseases may be introduced into the healthcare setting and pose a serious risk to vulnerable populations including immunocompromised patients. Healthcare providers (HCPs) are exposed to these pathogens through their daily tasks and may serve as a reservoir for ongoing disease transmission in the healthcare setting. The primary method of protection from work-related infection risk is vaccination that protects not only an individual HCP from disease, but also subsequent patients in contact with that HCP.

Epidemiology of Candida kefyr in patients with hematologic malignancies.

Candida kefyr is an emerging pathogen among patients with hematologic malignancies (HM). We performed a retrospective study at Johns Hopkins Hospital to evaluate the epidemiology of C. kefyr colonization and infection in HM patients between 2004 and 2010.

An outbreak of human parainfluenza virus 3 infection in an outpatient hematopoietic stem cell transplantation clinic.

Background: Parainfluenza viruses cause respiratory tract infections in adults and children, with peak activity during the spring and summer months. Human parainfluenza virus type 3 (hPIV-3) can contribute to significant morbidity and mortality in patients undergoing hematopoietic stem cell transplantation (HSCT).

Methods: Automated surveillance software was used to identify an hPIV-3 outbreak in an HSCT clinic.

Electronic-eye faucets: Legionella species contamination in healthcare settings.

Objective: To compare heterotrophic plate counts (HPCs) and Legionella species growth from electronic and manual faucet water samples.

Design: Proportions of water samples with growth and colony-forming units were compared using Fisher's exact test and the Wilcoxon rank-sum test, respectively.

Setting: Two psychiatric units and 1 medical unit in a 1,000-bed university hospital.

Antimicrobial prescribing practices in response to different Clostridium difficile diagnostic methodologies.

We evaluated treatment decisions and antimicrobial use related to 2 testing algorithms for Clostridium difficile infection (CDI). Our findings suggest that a 2-step testing algorithm using rapid polymerase chain reaction confirmatory testing leads to decreased unnecessary anti-CDI antimicrobial use. In addition, a significant proportion of patients with confirmed CDI were not treated according to recommended guidelines.

Ventilator-associated tracheitis in children: does antibiotic duration matter?

Background: The optimal duration of antibiotic therapy for ventilator-associated tracheitis (VAT) has not been defined, which may result in unnecessarily prolonged courses of antibiotics. The primary objective of this study was to determine whether prolonged-course (≥7 days in duration) therapy for VAT was more protective against progression to hospital-acquired pneumonia (HAP) or ventilator-associated pneumonia (VAP), compared with short-course antibiotics (<7 days in duration). The secondary objective was to determine whether prolonged-course therapy was more likely to result in the acquisition of multidrug-resistant organisms (MDROs) compared with short-course therapy.

Hospital epidemiology and infection control in acute-care settings.

Health care-associated infections (HAIs) have become more common as medical care has grown more complex and patients have become more complicated. HAIs are associated with significant morbidity, mortality, and cost. Growing rates of HAIs alongside evidence suggesting that active surveillance and infection control practices can prevent HAIs led to the development of hospital epidemiology and infection control programs.

Seronegative HIV-1 infection: a review of the literature.

HIV-1-specific antibodies can be detected in HIV-1-positive patients within weeks of primary infection. Rare cases have been reported of patients who are persistently seronegative despite evidence of HIV-1 infection. We present a retrospective review of the clinical, virologic and immunologic characteristics of 25 persistently seronegative patients whose cases have been published to date and postulate a biologic mechanism for this phenomenon.

A case of seronegative HIV-1 infection.

Patients infected with human immunodeficiency virus type 1 (HIV-1) typically seroconvert within weeks of primary infection. In rare cases, patients do not develop antibodies against HIV-1 despite demonstrable infection. We describe here a human leukocyte antigen (HLA)-B*5802-positive individual who presented with acquired immune deficiency syndrome despite repeatedly negative HIV-1 antibody screening test results.

Immune reconstitution inflammatory syndrome: risk factors and treatment implications.

Background: Immune reconstitution inflammatory syndrome (IRIS), also called immune restoration disease, occurs in a subset of HIV-infected patients after the initiation of highly active antiretroviral therapy (HAART) and can be diagnostically challenging and difficult to treat. We sought to determine clinical risk factors for the development of IRIS.

Methods: Patients from the Johns Hopkins HIV Clinic who had IRIS were identified and matched with 4 controls without IRIS who had initiated HAART within 6 months of the case.