Clinical and molecular epidemiology of community-onset, extended-spectrum beta-lactamase-producing Escherichia coli infections in Thailand: a case-case-control study.

Background: Extended-spectrum beta-lactamase (ESBL)-producing organisms, first identified in Germany in 1983, are now widely recognized as clinically relevant causes of infections in community.

Methods: Our objective was to evaluate the clinical and molecular epidemiology of community-onset, extended-spectrum beta-lactamase (CO-ESBL)-producing Escherichia coli infections. We used a case-case-control study undertaken in a 450-bed, tertiary care hospital.

Clostridium difficile: emergence of hypervirulence and fluoroquinolone resistance.

Clostridium difficile is a well-known cause of sporadic and healthcare-associated diarrhea. Multihospital outbreaks due to a single strain and outbreaks associated with antibiotic selective pressure, especially clindamycin, have been well documented. Severe cases and fatalities from C.

Risk factors for and outcomes of healthcare-associated infection due to extended-spectrum beta-lactamase-producing Escherichia coli or Klebsiella pneumoniae in Thailand.

A matched case-control study was performed to evaluate the risk factors for and outcomes of healthcare-associated infection due to extended-spectrum beta-lactamase-producing Escherichia coli or extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in Thailand. By multivariable analysis, prior exposure to third-generation cephalosporins and transfer from another hospital were risk factors associated with infection. Receipt of inadequate antimicrobial therapy was a predictor of mortality.

Pseudo-outbreak of Acinetobacter lwoffii infection in a tertiary care center in Thailand.

We describe a pseudo-outbreak of Acinetobacter lwoffii infection that was recognized early. The pseudo-outbreak involved 16 patients and occurred 3.5 months after the GNS-506 Vitek automated system was introduced in the microbiology laboratory.

The emergence of a novel ceftazidime-resistant CTX-M extended-spectrum beta-lactamase, CTX-M-55, in both community-onset and hospital-acquired infections in Thailand.

We report a novel CTX-M type of extended-spectrum beta-lactamase (ESBL), designated CTX-M-55, among 7 patients who had infection with ESBL-producing Escherichia coli or Klebsiella pneumoniae at a university hospital in Thailand. The CTX-M-55 ESBL showed reduced susceptibility to ceftazidime. This investigation provides the relevant clinical and molecular epidemiology for the gene encoding for CTX-M-55 in the isolates from these patients.

Non-neoformans cryptococcal infections: a systematic review.

Non-neoformans cryptococci have been generally regarded as saprophytes and rarely reported as human pathogens. However, the incidence of infection due to these organisms has increased over the past 40 years, with Cryptococcus laurentii and Cryptococcus albidus, together, responsible for 80% of reported cases. Conditions associated with impaired cell-mediated immunity are important risks for non-neoformans cryptococcal infections and prior azole prophylaxis has been associated with antifungal resistance.

Risk factors and outcomes of influenza A (H3N2) pneumonia in an area where avian influenza (H5N1) is endemic.

We conducted a cohort study to identify the risks and outcomes of influenza A (H3N2) pneumonia. Of the 145 patients studied, 10 (7%) had influenza A pneumonia. Logistic regression identified multiple comorbidities (P<.

Outbreak of varicella-zoster virus infection among Thai healthcare workers.

Objective: To evaluate the correlation between self-report of a prior history of chickenpox and results of varicella-zoster virus (VZV) immunoglobulin (Ig) G serologic test results in an outbreak of VZV infection among Thai healthcare workers (HCWs) and to conduct a cost-benefit analysis of establishing routine VZV immunization as part of an occupational health program on the basis of the outbreak data.

Methods: All exposed patients received prophylaxis and the HCWs in our 3 intensive care units (ICUs) were prospectively evaluated. HCWs were assessed for disease history and serologic evidence of VZV IgG.

Possible role of pseudoephedrine and other over-the-counter cold medications in the deaths of very young children.

The Philadelphia Medical Examiners Office has reported a series of 15 deaths between February 1999 and June 2005 of infants and toddlers 16 months and younger in which drugs commonly found in over-the-counter (OTC) cold medications were present. A total of 10 different drugs were detected: pseudoephedrine, dextromethorphan, acetaminophen, brompheniramine, carbinoxamine, chlorpheniramine, ethanol, doxylamine and the anticonvulsants, phenobarbital, and phenytoin. The drugs were confirmed and quantified by gas chromatography (GC)-mass spectrometry, with the exception of ethanol, which was analyzed by headspace GC and of phenobarbital and phenytoin that were quantified by GC with a nitrogen phosphorus detector.

Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial.

Background: It is not known whether rigorous intraoperative glycemic control reduces death and morbidity in cardiac surgery patients.

Objective: To compare outcomes of intensive insulin therapy during cardiac surgery with those of conventional intraoperative glucose management.

Design: A randomized, open-label, controlled trial with blinded end point assessment.

Avian influenza H5N1 screening of intensive care unit patients with community-acquired pneumonia.

From February 1, 2005, to January 31, 2006, we screened 115 adults for avian influenza (H5N1) and influenza A if admitted to an intensive care unit with pneumonia. Using reverse transcription-PCR, viral culture, and serologic testing for anti-H5 antibody, we identified 8 (7%) patients with influenza A (H3N2); none had H5N1. Estimated costs for H5N1 screening were $7,375.

Clostridium difficile in the intensive care unit: epidemiology, costs, and colonization pressure.

Objective: To evaluate the epidemiology, outcomes, and importance of Clostridium difficile colonization pressure (CCP) as a risk factor for C. difficile-associated disease (CDAD) acquisition in intensive care unit (ICU) patients.

Design: Secondary analysis of data from a 30-month retrospective cohort study.

Evaluation of cryptococcus laurentii meningitis in a patient with HIV infection: a case report and review of the literature.

Cryptococcus neoformans is the most common cryptococci causing infection in humans. Non-neoformans cryptococci have generally been regarded as saprophytes and rarely reported as human pathogens. We report a probable case of Cryptococcus laurentii meningitis in a HIV-infected patient and reviewed the literature on risk factors and treatment of this infection in humans.

Vancomycin-resistant enterococcal bloodstream infections on a hematopoietic stem cell transplant unit: are the sick getting sicker?

Patients with hematologic malignancies and hematopoietic stem cell transplant (HSCT) recipients are at high risk for bacterial bloodstream infections (BSI) owing to resistant organisms. Data describing the outcomes of vancomycin-resistant enterococcal (VRE) BSI in this patient population are limited. We performed a retrospective cohort study of all cases of VRE BSI that occurred between February 1996 and December 2002 on the Leukemia/HSCT unit at Barnes-Jewish Hospital.

Surveillance for vancomycin-resistant enterococci: type, rates, costs, and implications.

Objective: To evaluate 2 active surveillance strategies for detection of enteric vancomycin-resistant enterococci (VRE) in an intensive care unit (ICU).

Design: Thirty-month prospective observational study.

Setting: ICU at a university-affiliated referral center.

The CASE adherence index: A novel method for measuring adherence to antiretroviral therapy.

The Center for Adherence Support Evaluation (CASE) Adherence Index, a simple composite measure of self-reported antiretroviral therapy (ART) adherence, was compared to a standard three-day self-reported adherence measure among participants in a longitudinal, prospective cross-site evaluation of 12 adherence programs throughout the United States. The CASE Adherence Index, consisting of three unique adherence questions developed for the cross-site study, along with a three-day adherence self-report were administered by interviews every three months over a one-year period. Data from the three cross-site adherence questions (individually and in combination) were compared to three -day self-report data and HIV RNA and CD4 outcomes in cross-sectional analyses.

Development of Stage of Readiness and decisional balance instruments: tools to enhance clinical decision-making for adherence to antiretroviral therapy.

This study presents the development of Stage of Readiness (SOR) and decisional balance instruments based on the Transtheoretical Model of Behavior Change (TTM) to improve adherence to antiretroviral therapy (ART). These instruments were tested on HIV positive women who enrolled in an adherence support study at a women's HIV clinic at a mid-western medical school. The decisional balance instrument was analyzed and 8 of 11 items were retained.

Computed tomography characteristics of Burkholderia pseudomallei liver abscess.

We report 3 cases of Burkholderia pseudomallei liver abscesses that have a characteristic "honeycomb" appearance on computed tomography scans. Such a finding should prompt physicians to include B. pseudomallei infection in the differential diagnoses of liver abscesses and consider initiation of empirical therapy for melioidosis in high-risk patients from areas of endemicity.