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1.
Am J Med ; 109(4): 342-3, 2000 Sep.
Article in English | MEDLINE | ID: mdl-11203146
2.
Clin Perform Qual Health Care ; 6(4): 179-82, 1998.
Article in English | MEDLINE | ID: mdl-10351285

ABSTRACT

OBJECTIVE: To determine whether handwashing surveillance could be conducted by measurements of soap and towel consumption. DESIGN AND PARTICIPANTS: In the medical intensive-care unit (MICU) of the Omaha Veterans' Affairs Medical Center, 10 4-hour day-time observation periods encompassing 409 handwashing episodes were scheduled in a 51-day period. In the surgical intensive-care unit (SICU), 7 4-hour periods encompassing 350 episodes were scheduled in a 49-day period. An observer measured paper towel height, towel weight, and soap weight at each sink. The observer also counted handwashing episodes and bed occupancy. Using handwashing episodes as a dependent variable, stepwise linear regression was performed with changes in towel height, towel weight, and soap weight as independent variables. RESULTS: Mean handwashing episodes per hour per occupied bed were 2.39 +/- 0.80 (standard deviation) in the MICU and 2.83 +/- 0.72 in the SICU. Correlation r with handwashing episodes for MICU changes was 0.891 for towel height, 0.950 for towel weight, and 0.882 for soap weight. Corresponding correlations for the SICU were 0.881, 0.918, and 0.904. For both units, stepwise regression retained changes in the weight of towels and soap as independent variables (P < .0001), with R2 0.965 (MICU) and 0.981 (SICU). CONCLUSION: Because soap and towel consumption measurements are closely related to handwashing frequency and because these measurements are easy to obtain, they offer a means of handwashing surveillance that can be sustained indefinitely. This can facilitate feedback-based interventions to improve handwashing frequency.


Subject(s)
Hand Disinfection , Intensive Care Units/standards , Medical Staff, Hospital/statistics & numerical data , Nursing Staff, Hospital/statistics & numerical data , Adult , Data Collection , Hospitals, Veterans , Humans , Infection Control/methods , Middle Aged , Nebraska , Paper , Regression Analysis , Soaps , Workforce
5.
Antimicrob Agents Chemother ; 35(12): 2558-61, 1991 Dec.
Article in English | MEDLINE | ID: mdl-1810189

ABSTRACT

Thirty-two adults hospitalized with skin and skin structure infections received intravenous ofloxacin followed by oral ofloxacin. The standard treatment was 400 mg every 12 h. One patient with renal failure received 400 mg every 24 h. Serum ofloxacin levels were measured (1.5 h postdose and 1 h predose) during intravenous (32 patients) and oral (30 patients) therapy. Levels were assayed by high-pressure liquid chromatography (HPLC) and microbiological assay (MBA). Mean levels +/- standard deviation (in micrograms per milliliter) when measured by MBA after intravenous dosing were (postdose versus predose) 6.23 +/- 2.49 versus 2.42 +/- 1.56, and those after oral dosing were 6.17 +/- 3.25 versus 3.49 +/- 2.77. When measured by HPLC, mean levels +/- standard deviation after intravenous dosing were 5.81 +/- 2.08 versus 2.14 +/- 1.26 and those after oral dosing were 5.63 +/- 2.92 versus 3.41 +/- 2.98. There were no significant differences between levels achieved with oral or intravenous dosing when measured by either MBA or HPLC. Levels in serum did not correlate with side effects. The MICs for 50 and 90% of the 40 aerobic pathogens isolated from 21 patients were 0.5 and 2.0 micrograms/ml, respectively. Cure or improvement was achieved in 30 patients. Intravenous and oral administration of ofloxacin yielded similar levels in serum which were safe and effective in the therapy of skin infections in adult patients.


Subject(s)
Ofloxacin/therapeutic use , Skin Diseases/drug therapy , Administration, Oral , Adult , Aged , Aged, 80 and over , Bacteriological Techniques , Chromatography, High Pressure Liquid , Female , Humans , Injections, Intravenous , Male , Microbial Sensitivity Tests , Middle Aged , Ofloxacin/administration & dosage , Ofloxacin/blood , Skin Diseases/blood , Staphylococcus aureus/drug effects , Streptococcus/drug effects
6.
Am J Med ; 91(3): 261-6, 1991 Sep.
Article in English | MEDLINE | ID: mdl-1892146

ABSTRACT

PURPOSE: This multicenter study was designed to compare an exclusively oral regimen with "usual care" in patients hospitalized with acute bacterial pneumonia. PATIENTS AND METHODS: One hundred forty-seven patients were enrolled. All patients presented with a clinical picture consistent with pneumonia: (1) clinical symptoms of a lower respiratory tract infection, such as chest pain, cough, and production of purulent sputum; (2) roentgenographic infiltrate compatible with acute infection; and (3) Gram's stain of purulent sputum or other appropriate bronchopulmonary specimen containing gram-negative organisms, staphylococci, or pneumococci. All patients required hospitalization. The design was a parallel-group, open-label study with randomization in blocks of four. Ofloxacin, a new fluoroquinolone antimicrobial agent, was administered orally or by nasogastric tube, 400 mg every 12 hours. This was compared with the individual investigator's best selection of therapy that was administered parenterally, at least initially. RESULTS: One hundred thirty-three patients were evaluable after exclusions for deviation from protocol, early death due to unrelated causes, incorrect diagnosis, or early adverse drug reactions. All 69 patients treated with ofloxacin and 61 of 64 control patients had favorable clinical and microbiologic responses. There were no statistically significant differences between the groups in terms of demographics, therapeutic outcome, and duration of therapy. There were few side effects overall and rates were similar for the two groups. CONCLUSIONS: An exclusively oral regimen, in this case ofloxacin, may be substituted for parenteral therapy in selected patients with pneumonia. This might significantly reduce costs and risks to the patient.


Subject(s)
Bacterial Infections/drug therapy , Ofloxacin/administration & dosage , Pneumonia/drug therapy , Administration, Oral , Adult , Aged , Aged, 80 and over , Bacterial Infections/blood , Female , Humans , Male , Middle Aged , Ofloxacin/adverse effects , Ofloxacin/blood , Pneumonia/blood , Pneumonia/microbiology , Research Design , Sputum/microbiology
7.
Eur J Clin Microbiol Infect Dis ; 9(11): 827-30, 1990 Nov.
Article in English | MEDLINE | ID: mdl-2086219

ABSTRACT

This report describes a patient with nosocomial meningitis from whom four distinct isolates of Enterobacter aerogenes were recovered over a complicated course of chemotherapy. The initial isolate was susceptible to expanded spectrum beta-lactams despite constitutive production of high levels of beta-lactamase. Resistant isolates recovered during antibiotic therapy had lost a 42,000 outer membrane protein. These data suggest that b-lactam susceptibility in the original isolate was due to "hyperpermeability" mediated by the 42,000 Dalton protein.


Subject(s)
Anti-Bacterial Agents/pharmacology , Enterobacter/drug effects , Enterobacteriaceae Infections/microbiology , Meningitis/microbiology , beta-Lactamases/biosynthesis , Bacterial Outer Membrane Proteins/analysis , Drug Resistance, Microbial/physiology , Enterobacter/enzymology , Enterobacter/isolation & purification , Humans , Male , Middle Aged , beta-Lactams
8.
Ther Drug Monit ; 12(5): 419-26, 1990 Sep.
Article in English | MEDLINE | ID: mdl-2127324

ABSTRACT

In a prospective, randomized study, 75 adults receiving aminoglycosides were followed by a clinical pharmacokinetic service and 70 followed as controls. The two groups were similar in age, gender, height, and APACHE II score. A cost-to-charge ratio was used to derive direct costs of hospitalization and calculate cost-benefit. Excluded from this comparison were patients with incomplete acceptance of pharmacokinetic service recommendations and patients followed by other clinical pharmacists. Pharmacokinetic service patients had shorter hospitalizations (322.67 +/- 270.28 h; controls 442.89 +/- 536.81, p = 0.087) and febrile periods (50.05 +/- 79.38 h; controls 92.23 +/- 122.50, p less than 0.05). More pharmacokinetic service patients had adequate peak levels. Pharmacokinetic service direct costs were lower ($7,102.56 +/- 9,898.19; controls $13,758.64 +/- 22,874.31, p less than 0.05). Calculated direct cost of the service was $85.00/patient. Annual savings for 500 patients is $2,220,540.00.


Subject(s)
Amikacin/blood , Bacterial Infections/blood , Gentamicins/blood , Monitoring, Physiologic/economics , Tobramycin/blood , Aminoglycosides/blood , Bacterial Infections/drug therapy , Cost-Benefit Analysis , Female , Gram-Negative Bacteria , Humans , Length of Stay/economics , Male , Prospective Studies
9.
Antimicrob Agents Chemother ; 32(9): 1327-30, 1988 Sep.
Article in English | MEDLINE | ID: mdl-3195995

ABSTRACT

In a prospective, randomized, double-blind study, the effect of ciprofloxacin (250 mg orally, twice daily) was compared with that of trimethoprim-sulfamethoxazole (160 mg of trimethoprim and 800 mg of sulfamethoxazole orally, twice daily) on 45 patients with complicated urinary tract infections. Pretherapy isolates were all members of the family Enterobacteriaceae. Isolates were eradicated from 18 (82%) of 22 patients treated with ciprofloxacin and 12 (52%) of 23 patients treated with trimethoprim-sulfamethoxazole during and 5 to 9 days after therapy (P = 0.035). Both groups had similar relapse and reinfection rates at 4 to 6 weeks posttherapy. Adverse effects were mild and reversible, occurring in 1 of 22 in the ciprofloxacin group and 6 of 23 in the trimethoprim-sulfamethoxazole group. Disk diffusion susceptibility tests correlated better with broth macrodilution for ciprofloxacin than for trimethoprim-sulfamethoxazole. Ciprofloxacin is a safe, effective alternative to trimethoprim-sulfamethoxazole for the treatment of complicated urinary tract infections.


Subject(s)
Ciprofloxacin/therapeutic use , Sulfamethoxazole/therapeutic use , Trimethoprim/therapeutic use , Urinary Tract Infections/drug therapy , Double-Blind Method , Drug Therapy, Combination , Humans , Microbial Sensitivity Tests , Random Allocation , Sulfamethoxazole/administration & dosage , Trimethoprim/administration & dosage
10.
Am J Infect Control ; 16(4): 141-6, 1988 Aug.
Article in English | MEDLINE | ID: mdl-3263821

ABSTRACT

Retrospective review of 197 patients with methicillin-resistant Staphylococcus aureus (MRSA) identified 47 in whom a regimen for eradication of MRSA colonization could be evaluated. The patients were elderly (mean age, 67.7 years), with 53% transferred from another institution and 53% treated in an intensive care unit. A mean of 47.1 days of hospitalization with an average of 4.9 antibiotics preceded the first MRSA culture. The usual regimen (mean, 6.0 days) was oral trimethoprim-sulfamethoxazole, 160/800 mg twice daily, oral rifampin, 600 mg once daily, and bacitracin ointment three times a day. Eradication succeeded in 40 patients, 9 relapsed, and MRSA persisted in 7. Twenty-four of 25 nares sites were cleared but only 16 of 22 other sites. MRSA infection eventually developed in 36%. No adverse reactions to the eradication regimen were noted. Although this treatment for MRSA carriage was safe and effective, decreased efficacy outside the nares and relapse limited its value.


Subject(s)
Bacitracin/therapeutic use , Cross Infection/prevention & control , Rifampin/therapeutic use , Staphylococcal Infections/drug therapy , Staphylococcus aureus/drug effects , Sulfamethoxazole/therapeutic use , Trimethoprim/therapeutic use , Aged , Carrier State/drug therapy , Drug Combinations/therapeutic use , Drug Therapy, Combination/therapeutic use , Hospital Bed Capacity, 300 to 499 , Humans , Methicillin/pharmacology , Middle Aged , Nebraska , Penicillin Resistance , Retrospective Studies , Staphylococcus aureus/isolation & purification , Trimethoprim, Sulfamethoxazole Drug Combination
12.
Infect Control ; 8(5): 191-4, 1987 May.
Article in English | MEDLINE | ID: mdl-3647939

ABSTRACT

To determine the frequency of isolation of methicillin-resistant Staphylococcus aureus (MRSA) at Veterans Administration Medical Centers, 163 hospitals were surveyed; 137 responded. Between 1975 and 1984, the number of Veterans Administration Medical Centers with known MRSA increased from 3 to 111. This increase was geographically widespread and occurred in hospitals of all sizes. In Veterans Administration Medical Centers, isolation policies for MRSA-infected patients were (% of hospitals using): strict (19%), contact (52%), site-related (28%), no isolation (1%). For patients colonized with MRSA policies were: strict (15%), contact (44%), site-related (35%), and no isolation (6%). Only 41% of Veterans Administration Medical Centers reported discharging known MRSA-colonized patients to nursing homes. Most attempts to eradicate MRSA carriage used trimethoprim-sulfamethoxazole plus rifampin with or without bacitracin ointment; success rates were low. MRSA incidence is increasing at Veterans Administration Medical Centers across the United States. Improved regimens to eliminate MRSA carriage are needed.


Subject(s)
Cross Infection/epidemiology , Hospitals, Veterans , Methicillin/pharmacology , Staphylococcal Infections/epidemiology , Staphylococcus aureus/drug effects , Cross Infection/prevention & control , Humans , Patient Isolation , Penicillin Resistance , Staphylococcal Infections/prevention & control , Staphylococcus aureus/isolation & purification , Surveys and Questionnaires , United States
13.
Am J Med ; 82(4A): 295-300, 1987 Apr 27.
Article in English | MEDLINE | ID: mdl-3555051

ABSTRACT

The effectiveness and safety of ciprofloxacin, a new quinolone antibiotic, were prospectively evaluated in the treatment of patients with complicated urinary tract infections caused by gram-negative organisms resistant to trimethoprim/sulfamethoxazole. Twenty-five elderly (mean age, 70.4 years) patients (24 men and one woman) were enrolled. Initial pathogens included Pseudomonas aeruginosa (15 isolates), Escherichia coli (five isolates), Enterobacter aerogenes (one isolate), Citrobacter freundii (one isolate), Serratia species (two isolates), Proteus vulgaris (one isolate), and enterococcus (one isolate). Patients received 500 mg of ciprofloxacin orally twice daily for one week (mean, 6.98 days). Results of urine cultures obtained during therapy were negative in all cases, and at one week post-therapy, 21 of 25 (84 percent) infections were cured. Four patients experienced a relapse with P. aeruginosa. Repeat urine culture specimens were obtained at four to six weeks from 14 patients who had cures at one week post-therapy, and seven continued to have cures. Three patients had late relapses with P. aeruginosa, E. coli, or Serratia marcescens, and four were reinfected with new strains. Five patients who received concomitant oral antacids had lower mean peak and trough serum ciprofloxacin levels than did patients not receiving antacids (p less than 0.05, Wilcoxon rank sum test). Mild adverse effects were seen in seven patients: eosinophilia (one patient), eosinophilia and reduced white blood cell count (one patient), crystalluria (one patient), granular casts (one patient), elevation of serum creatinine and blood urea nitrogen levels (one patient), and nausea (two patients), but none warranted discontinuation of ciprofloxacin therapy. P. aeruginosa isolates from two patients who experienced a relapse showed increases in minimal inhibitory concentrations from 0.13 to 0.5 and 2.0 micrograms/ml, respectively, to ciprofloxacin and other antibiotics. Orally administered ciprofloxacin was a safe and effective therapy for complicated urinary tract infections in elderly patients.


Subject(s)
Bacterial Infections/drug therapy , Ciprofloxacin/administration & dosage , Urinary Tract Infections/drug therapy , Administration, Oral , Aged , Aged, 80 and over , Bacterial Infections/complications , Ciprofloxacin/adverse effects , Clinical Trials as Topic , Drug Resistance, Microbial , Drug Tolerance , Female , Gram-Negative Bacteria , Humans , Male , Middle Aged , Urinary Tract Infections/complications
14.
J Antimicrob Chemother ; 18(5): 621-7, 1986 Nov.
Article in English | MEDLINE | ID: mdl-3804884

ABSTRACT

Patients with pneumonia or bronchitis were randomized to receive ceftriaxone or cefamandole. A total of 30 of 38 patients were evaluable, 16 in the ceftriaxone group (average age 66.3 years) and 14 in the cefamandole group (average age 69.4 years). All but one had underlying diseases. Patients usually received 1 g of ceftriaxone intravenously every 12 h (mean duration 8.7 days) or 1.5 g of cefamandole intravenously every 6 h (mean duration 8.2 days). Adverse experiences attributable to the drugs were confined to one episode of discomfort at the infusion site in each group. Bacteriological results with ceftriaxone were 83% cured, 11% superinfected after eradication of pretherapy isolate, and 6% failed. Bacteriological results with cefamandole were 76% cured, 24% failed. Clinical results with ceftriaxone were 38% cured, 56% improved, 6% failed. Clinical results with cefamandole were 57% cured, 21% improved, 21% failed. Emergence of a resistant Serratia marcescens was seen in a ceftriaxone-treated patient. Disc diffusion susceptibility testing identified six of the seven pretherapy nonfastidious Gram-negative isolates as susceptible; however, two of the six could not be eradicated with the assigned drug and another two were eradicated with ensuing super-infection with susceptible isolates of Pseudomonas aeruginosa. In contrast, MBCs were an accurate guide to clinical outcome with nonfastidious Gram-negative bacilli.


Subject(s)
Bronchitis/drug therapy , Cefamandole/therapeutic use , Ceftriaxone/therapeutic use , Pneumonia/drug therapy , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Random Allocation , Sepsis/drug therapy
17.
Antimicrob Agents Chemother ; 28(2): 299-301, 1985 Aug.
Article in English | MEDLINE | ID: mdl-3914859

ABSTRACT

Sixty-seven patients with complicated urinary tract infections were randomized in double-blind fashion to ceftazidime or moxalactam (MOX). A total of 54 patients were evaluable, 27 in each group. Patients received 500 mg of antibiotic intravenously every 12 h, except for those with Pseudomonas aeruginosa randomized to MOX who received 2 g intravenously every 12 h. Toxic effects with ceftazidime were experienced by the following number of patients: pain with infusion, one; posttherapy diarrhea, one; liver function test elevations, two; and neutropenia, one. Toxic effects with MOX were experienced by the following number of patients: liver function test elevations, two; and prolonged prothrombin time, one. All resolved. At 1 week posttherapy, bacteriologic results were 74% cured, 11% relapsed, 15% reinfection with ceftazidime and 52% cured, 33% relapsed, and 19% reinfection with MOX. Ceftazidime was effective for infections caused by MOX-resistant P. aeruginosa. P. aeruginosa resistant to MOX and other beta-lactams was isolated from one patient after MOX therapy. Enterococcal reinfection was common in both groups.


Subject(s)
Ceftazidime/therapeutic use , Moxalactam/therapeutic use , Urinary Tract Infections/drug therapy , Adult , Aged , Ceftazidime/adverse effects , Double-Blind Method , Female , Humans , Male , Middle Aged , Moxalactam/adverse effects
18.
Arch Intern Med ; 145(4): 703-5, 1985 Apr.
Article in English | MEDLINE | ID: mdl-3885893

ABSTRACT

Three residents of The Open Door Mission of Omaha developed pulmonary infections due to Mycobacterium bovis. All were alcoholics with malnutrition. The disease was most likely due to reactivation of a primary infection acquired at least 30 years earlier in the index case. Both of the secondary patients had been treated more than ten years previously for infections due to Mycobacterium tuberculosis. Supervised short-course chemotherapy was effective in treating the disease caused by Mycobacterium bovis.


Subject(s)
Antitubercular Agents/therapeutic use , Tuberculosis, Pulmonary/drug therapy , Antitubercular Agents/administration & dosage , Disease Outbreaks , Drug Administration Schedule , Drug Therapy, Combination , Humans , Male , Middle Aged , Mycobacterium bovis/isolation & purification , Nebraska , Residential Facilities , Tuberculosis, Pulmonary/microbiology
19.
Antimicrob Agents Chemother ; 23(2): 261-6, 1983 Feb.
Article in English | MEDLINE | ID: mdl-6301365

ABSTRACT

We evaluated the efficacy and safety of ceftriaxone in 50 adults with serious infections, usually giving 1 g every 12 h. Of the 35 patients who could be evaluated for clinical efficacy, 15 had failed on previous therapy, 15 had nosocomial infections, and all but 1 had underlying diseases. One patient had three sites of infection. Favorable responses were seen in 34 of 37 infections, including 11 of 13 respiratory tract infections, all 7 urinary tract infections, all 12 skin and soft tissue infections, 1 of 2 bone and joint infections, a catheter-related septicemia, a liver abscess, and an otitis media and externa. Favorable bacteriological responses were seen for 48 of 58 organisms. This included 6 of 7 Staphylococcus aureus strains, 14 of 16 other aerobic gram-positive cocci, 18 of 20 Enterobacteriaceae, 6 of 9 Pseudomonas aeruginosa, and 1 of 2 anaerobes. Peak plasma ceftriaxone levels on day 1 were 152 micrograms/ml by bioassay and 78 micrograms/ml by high-pressure liquid chromatography. Four of the 31 initial isolates of aerobic gram-negative rods developed resistance to ceftriaxone on disk diffusion testing. Diarrhea occurred in 3 of 50 patients. All three had received a higher than usual dose. Drug administration was stopped twice, once for a thrombocytopenia and once for a thrombocytopenia with leukopenia. Neither problem could be attributed exclusively to ceftriaxone. Other adverse reactions were eosinophilia, abdominal pain, inguinal candidiasis, and nonsuppurative phlebitis. Even among debilitated adults, ceftriaxone was safe and effective in a twice daily regimen.


Subject(s)
Anti-Bacterial Agents/therapeutic use , Bacterial Infections/drug therapy , Cefotaxime/analogs & derivatives , Adolescent , Adult , Aged , Bacteria/isolation & purification , Bacterial Infections/microbiology , Cefotaxime/adverse effects , Cefotaxime/metabolism , Cefotaxime/therapeutic use , Ceftriaxone , Drug Resistance, Microbial , Female , Humans , Male , Middle Aged , Respiratory Tract Infections/drug therapy , Skin Diseases, Infectious/drug therapy , Urinary Tract Infections/drug therapy
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