Management of pediatric multidrug-resistant tuberculosis and latent tuberculosis infections in New York City from 1995 to 2003.

Background: Few studies have assessed the management and outcomes of multidrug-resistant tuberculosis (MDR-TB) in the pediatric population. Treatment of children with second-line TB drugs is complicated by potential toxicities of these agents.

Methods: We performed a retrospective study of children <15 years of age treated for MDR-TB or MDR-latent TB infection (LTBI) from 1995 to 2003.

Barriers to adherence to cystic fibrosis infection control guidelines.

Background: In 2003, the American Cystic Fibrosis (CF) Foundation published revised, evidence-based guidelines for infection control. We sought to assess potential barriers to adherence to these guidelines experienced by health care professionals (HCPs) caring for CF patients.

Methods: From April 2004 to December 2005, a knowledge, attitude, and practice survey was administered to HCPs at randomly selected CF centers in the United States to explore potential barriers to adherence to selected guidelines: (1) obtaining quarterly cultures from CF patients, (2) discouraging socialization among CF patients during hospitalization, (3) educating patients and families about hand hygiene, (4) educating patients and families to clean and disinfect home nebulizers, and (5) cleaning the clinic exam rooms between CF patients.

Epidemiology of enterococci in a neonatal intensive care unit.

We performed an epidemiological investigation of a 62-bed neonatal intensive care unit in response to 2 infants with clinical cultures positive for vancomycin-resistant enterococci (VRE). Surveillance cultures detected 11 infants colonized with VRE. Surveillance triggered by even a single clinical culture positive for VRE may be justified in the neonatal intensive care unit, because a single culture result may represent a large hidden reservoir of VRE-colonized infants.

Bloodstream infections in patients given treatment with intravenous prostanoids.

Objective: In September 2006, the Centers for Disease Control and Prevention was notified of cases of gram-negative bloodstream infection (BSI) occurring among outpatients who received an intravenous formulation of the prostanoid treprostinil. An investigation was conducted to determine rates of prostanoid-associated BSI in this patient population and possible risk factors for infection.

Methods: We performed a retrospective cohort study of patients who had received intravenous formulations of at least 1 of the 2 approved prostanoids (epoprostenol and treprostinil) from January 1, 2004, through late 2006.

Underuse of effective measures to prevent and manage pediatric tuberculosis in the United States.

Objective: To characterize problems with prevention and management of pediatric tuberculosis (TB) and latent TB infection (LTBI).

Design: A multisite, cross-sectional study using data from medical records and public health logs to categorize and define use of routine prevention practices in managing pediatric TB and LTBI.

Setting: Four areas of the United States.

Survey of infection control policies for patients with cystic fibrosis in the United States.

Written infection control policies used at cystic fibrosis (CF) care sites in the United States were compared with recently published guidelines. Most policies recommended contact precautions for hospitalized patients infected with Burkholderia cepacia complex (73%), multidrug-resistant organisms (63%), and methicillin-resistant Staphylococcus aureus (64%). Socializing among CF patients was discouraged in 80% of inpatient policies and 55% of outpatient policies.

Epidemiology of nontuberculous mycobacteria in patients without HIV infection, New York City.

We reviewed medical records of patients without known HIV and with positive cultures for nontuberculous mycobacteria (NTM) isolated during 2000-2003 from 1 large hospital in New York, New York. Overall, 505 patients had positive NTM cultures; 119 (24%) met the criteria for NTM disease. The difference between demographic characteristics of case-patients in our study (66% female, 61% white, and 59% > 60 years of age) and those of the base population as determined by regional census data was statistically significant.

Hospital-acquired infections in the NICU: epidemiology for the new millennium.

Nosocomial infections are an important cause of morbidity and mortality in the preterm neonate. Extrinsic and intrinsic risk factors make the preterm neonate particularly susceptible to infection. This review focuses on two major pathogens that cause nosocomial infection, Candida and methicillin-resistant Staphylococcus aureus.

The gastrointestinal tract serves as the reservoir for Gram-negative pathogens in very low birth weight infants.

We report a pilot study testing the hypothesis that Gram-negative bacilli colonizing the gastrointestinal tracts of infants with birth weights <1500 g are the source of subsequent bloodstream infections. Ninety-five percent (18 of 19) of paired bloodstream infection or antecedent rectal cultures were genotypically concordant. The gastrointestinal tract is the reservoir for most cases of Gram-negative sepsis in this population.

Update on the epidemiology and management of Staphylococcus aureus, including methicillin-resistant Staphylococcus aureus, in patients with cystic fibrosis.

Purpose Of Review: Staphylococcus aureus is one of the first and most common pathogens to be isolated from the respiratory tract of patients with cystic fibrosis. The prevalence of respiratory tract colonization/infection with both methicillin-susceptible and methicillin-resistant S. aureus has increased over the past decade.

Clinical utility of synergy testing for multidrug-resistant Pseudomonas aeruginosa isolated from patients with cystic fibrosis: 'the motion for'.

Patients with cystic fibrosis are at risk of developing infections with multidrug-resistant (MDR) pathogens, particularly Pseudomonas aeruginosa. Thus, there has been widespread interest in using antimicrobial agents in combination to expand the antimicrobial spectrum, prevent the emergence of resistance, reduce toxicity and provide synergistic activity. There are multiple methodologies for synergy testing, but checkerboard dilution assays and multiple combination bactericidal testing have been used most often for cystic fibrosis isolates.

A review of antimicrobial control strategies in hospitalized and ambulatory pediatric populations.

Antimicrobial resistance is a growing crisis in healthcare. Various antimicrobial stewardship strategies have been used to control antibiotic use in efforts to reduce antibiotic resistance. We conducted a systematic review of antimicrobial stewardship programs in pediatric settings.

Antimicrobial resistance patterns of colonizing flora on nurses' hands in the neonatal intensive care unit.

Background: The Centers for Disease Control and Prevention recommends the use of an alcohol-based handrub for health care worker hand hygiene. The purpose of this study was to examine effects of hand hygiene product and skin condition on the antimicrobial resistance patterns of colonizing hand flora among nurses.

Methods: Colonizing hand flora of 119 nurses working in 2 neonatal intensive care units was compared during a 22-month crossover study using alcohol handrub or antiseptic soap.

Clinical response to azithromycin in cystic fibrosis correlates with in vitro effects on Pseudomonas aeruginosa phenotypes.

A 6-month clinical trial of azithromycin (AZM) in American cystic fibrosis (CF) patients with chronic Pseudomonas aeruginosa infection showed clinical improvement without significant reduction in bacterial density. Sub-inhibitory AZM has been hypothesized to affect P. aeruginosa virulence, partly contributing to the mechanism of action of AZM.

Predictors and outcomes for pregnant women with vaginal-rectal carriage of community-associated methicillin-resistant Staphylococcus aureus.

The purpose of this study was to determine the predictors and outcomes of pregnant women with vaginal-rectal carriage of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). We performed an unmatched 1:4 case-control study with two control groups (13 CA-MRSA cases, 52 methicillin-sensitive S. aureus (MSSA) controls, and 52 S.

Risk factors for late-onset health care-associated bloodstream infections in patients in neonatal intensive care units.

Background: There are few data comparing risk factors for catheter-related (CR) versus non-CR bloodstream infection (BSI) or for BSI caused by gram-positive versus gram-negative organisms. The aims of this study were to compare risk factors for CR versus non-CR BSI and to compare risk factors for BSI associated with gram-negative versus gram-positive organisms among infants hospitalized in two neonatal intensive care units (NICUs).

Methods: Data were collected prospectively over a 2-year period to assess risk factors among 2,935 neonates from two NICUs.

Prevalence and clinical relevance of Staphylococcus warneri in the neonatal intensive care unit.

Objective: To describe the prevalence of Staphylococcus warneri on the hands of nurses and the clinical relevance of this organism among neonates in the neonatal intensive care unit (NICU).

Design: Prospective cohort study that examined the microbial flora on the hands of nurses and clinical isolates recovered from neonates during a 23-month period (March 1, 2001, through January 31, 2003).

Setting: Two high-risk NICUs in New York City.

Antimicrobial susceptibility and synergy studies of Burkholderia cepacia complex isolated from patients with cystic fibrosis.

Susceptibility (18 antimicrobial agents including high-dose tobramycin) and checkerboard synergy (23 combinations) studies were performed for 2,621 strains of Burkholderia cepacia complex isolated from 1,257 cystic fibrosis patients. Minocycline, meropenem, and ceftazidime were the most active, inhibiting 38%, 26%, and 23% of strains, respectively. Synergy was rarely noted (range, 1% to 15% of strains per antibiotic combination).

A low incidence of nontuberculous mycobacterial infections in pediatric hematopoietic stem cell transplantation recipients.

Hematopoietic stem cell transplantation (HSCT) is being used to treat a wide spectrum of clinical disorders but opportunistic infection remains an important factor determining outcomes for these patients. Nontuberculous mycobacterial (NTM) infections are being reported more frequently in HSCT recipients and the incidence of NTM infections in adult recipients is reported to be 0.4%-4.

Rational treatment of pulmonary infections in patients with cystic fibrosis.

The life expectancy of patients with cystic fibrosis has increased markedly during the past two decades due in large part to improved clinical care, including the use of more effective antimicrobial agents for Pseudomonas. However, the chronic lung disease of CF remains the principal cause of mortality. A growing understanding of the complex interactions between infection and inflammation has led to new approaches for treatment, including chronic use of aerosolized antibiotics, particularly tobramycin, in patients known to be colonized/infected with P.

Effectiveness of barrier precautions and surveillance cultures to control transmission of multidrug-resistant organisms: a systematic review of the literature.

Background: Despite the priority placed on preventing transmission of multidrug-resistant organisms (MDROs) in health care facilities, there is a lack of consensus among recommended infection control guidelines. We focused on control measures that have a great potential to affect patient care, patient services, and hospital cost/resources: barrier precautions/patient isolation and surveillance cultures.

Methods: We conducted a systematic review of the literature and published English-language guidelines pertaining to the use of barrier precautions/patient isolation and surveillance cultures to prevent the transmission of MDROs.

Prevalence of methicillin-sensitive and methicillin-resistant Staphylococcus aureus in pregnant women.

Objective: To estimate the extent of Staphylococcus aureus vaginal-rectal colonization among pregnant women as severe S aureus infections have emerged in pregnant and postpartum women and infants.

Methods: We conducted a prospective surveillance study for methicillin-sensitive S aureus and methicillin-resistant S aureus on all routine de-identified vaginal-rectal prenatal group B streptococcus (GBS) screening cultures submitted to the microbiology laboratory of a tertiary-care facility from January to July 2005. Standard microbiologic techniques and molecular analyses were used to detect community-associated methicillin-resistant S aureus strains.

Impact of staffing on bloodstream infections in the neonatal intensive care unit.

Objective: To examine the association between registered nurse staffing and healthcare-associated bloodstream infections in infants in the neonatal intensive care unit (NICU).

Design: Prospective cohort study.

Setting: Two level III-IV NICUs in New York, NY, from March 1, 2001, through January 31, 2003.