ABSTRACT
We sought to determine the ability of surveillance cultures and isolation of vancomycin-resistant Enterococcus (VRE)-colonized patients to control nosocomial VRE infection and colonization during a 5-year period (November 1994 through October 1999). During this period, VRE colonization was limited to 0.82% of admissions. The incidence of VRE infection was 0.12 cases per 1000 patient-days (attack rate, 0.07%). Colonized patients were first identified by surveillance (95%) or routine clinical cultures (5%); 14% of colonized patients had a positive clinical culture a median of 15 days after a positive surveillance culture. Ten percent of colonized patients were identified by surveillance at the time of transfer from another health care facility. Identification of these colonized patients was associated with reduction from a peak incidence rate of 2.07% to a rate of 1.25% and stabilization at this lower level. The use of surveillance cultures to identify and isolate patients with asymptomatic colonization can provide sustained control of the spread of VRE within a health care facility.
Subject(s)
Cross Infection/epidemiology , Endemic Diseases , Enterococcus/drug effects , Gram-Positive Bacterial Infections/epidemiology , Vancomycin Resistance/physiology , Vancomycin/pharmacology , Anti-Bacterial Agents/pharmacology , Cross Infection/microbiology , Hospitals, University , Humans , Infection ControlABSTRACT
OBJECTIVE: To determine the frequency with which methicillin-resistant Staphylococcus aureus (MRSA) is spread from colonized or infected patients to their household and community contacts. DESIGN: Retrospective cohort study. SETTING: University hospital. PARTICIPANTS: Household and community contacts of MRSA-colonized or -infected patients for whom MRSA screening cultures were performed. RESULTS: MRSA was isolated from 25 (14.5%) of 172 individuals. Among the contacts of index patients who had at least one MRSA-colonized contact, those with close contact to the index patient were 7.5 times more likely to be colonized (53% vs 7%; 95% confidence interval, 1.1 to 50.3; P = .002). An analysis of antimicrobial susceptibility and DNA fingerprint patterns suggested person-to-person spread. CONCLUSIONS: MRSA colonization occurs frequently among household and community contacts of patients with nosocomially acquired MRSA, suggesting that transmission of nosocomially acquired MRSA outside of the healthcare setting may be a substantial source of MRSA colonization and infection in the community.
Subject(s)
Carrier State/transmission , Cross Infection/transmission , Methicillin Resistance , Staphylococcal Infections/transmission , Staphylococcus aureus/isolation & purification , Adolescent , Adult , Aged , Aged, 80 and over , Carrier State/epidemiology , Child , Child, Preschool , Cross Infection/epidemiology , Family Characteristics , Female , Hospitals, University , Humans , Infant , Male , Middle Aged , Population Surveillance , Retrospective Studies , Staphylococcal Infections/epidemiologyABSTRACT
Our goal was to investigate whether the neurokinin-1 receptor (NK1R)-expressing cells of the rostral ventrolateral medulla (RVLM) regulate respiration and arterial pressure (AP). We examined the consequences of their ablation on the cardiorespiratory responses [phrenic nerve discharge (PND) and AP] caused by injecting dl-homocysteic acid (DLH) into the ventral respiratory group (VRG). In intact rats, DLH produced tachypnea only when injected into the pre-Bötzinger complex (pre-BötC). Injections into pre-BötC and rostral VRG (rVRG) caused hypotension, whereas injections into the Bötzinger region elevated AP. Selective unilateral ablation of RVLM NK1R-immunoreactive cells (97% loss within the pre-BötC and rVRG without loss of catecholaminergic neurons) was done by injecting saporin (SAP) conjugated with a selective NK1R agonist [Sar9, Met(O2)11]-substance P (SSP). Free SAP produced no lesion. Resting AP was normal in SAP- and SSP-SAP-treated rats, but the PND rate was slightly elevated in SSP-SAP-treated rats. The response of SAP-treated rats to DLH injection into VRG was normal and identical on each side, but tachypnea could not be elicited in the pre-BötC of SSP-SAP-treated rats on the toxin-injected side, and DLH caused a long-lasting apnea on the untreated side. The hypotension produced by DLH injection into pre-BötC and rVRG of SSP-SAP-treated rats was reduced on the lesioned side only. In conclusion, NK1R-expressing cells of the rostral ventrolateral medulla control both respiratory rhythm and blood pressure. However, there is no evidence yet that these two functions are regulated by the same NK1R-expressing neurons.
