Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 7 de 7
Filtrar
1.
Clin Infect Dis ; 2024 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-38315890

RESUMO

BACKGROUND: Carbapenemase-producing, carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA) are extensively drug resistant bacteria. We investigated the source of a multistate CP-CRPA outbreak. METHODS: Cases were defined as a U.S. patient's first isolation of P. aeruginosa sequence type 1203 with the carbapenemase gene blaVIM-80 and cephalosporinase gene blaGES-9 from any specimen source collected and reported to CDC between January 1, 2022-May 15, 2023. We conducted a 1:1 matched case-control study at the post-acute care facility with the most cases, assessed exposures associated with case status for all case-patients, and tested products for bacterial contamination. RESULTS: We identified 81 case-patients from 18 states, 27 of whom were identified through surveillance cultures. Four (7%) of 54 case-patients with clinical cultures died within 30 days of culture collection, and four (22%) of 18 with eye infections underwent enucleation. In the case-control study, case-patients had increased odds of receiving artificial tears compared to controls (crude matched OR: 5.0, 95% CI: 1.1, 22.8). Overall, artificial tears use was reported by 61 (87%) of 70 case-patients with information; 43 (77%) of 56 case-patients with brand information reported use of Brand A, an imported, preservative-free, over-the-counter (OTC) product. Bacteria isolated from opened and unopened bottles of Brand A were genetically related to patient isolates. FDA inspection of the manufacturing plant identified likely sources of contamination. CONCLUSIONS: A manufactured medical product serving as the vehicle for carbapenemase-producing organisms is unprecedented in the U.S. The clinical impacts from this outbreak underscore the need for improved requirements for U.S. OTC product importers.

2.
J Infect Dis ; 225(3): 367-373, 2022 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-34031692

RESUMO

BACKGROUND: The prevalence of current or past coronavirus disease 2019 in skilled nursing facility (SNF) residents is unknown because of asymptomatic infection and constrained testing capacity early in the pandemic. We conducted a seroprevalence survey to determine a more comprehensive prevalence of past coronavirus disease 2019 in Los Angeles County SNF residents and staff members. METHODS: We recruited participants from 24 facilities; participants were requested to submit a nasopharyngeal swab sample for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) polymerase chain reaction (PCR) testing and a serum sample for detection of SARS-CoV-2 antibodies. All participants were cross-referenced with our surveillance database to identify persons with prior positive SARS-CoV-2 results. RESULTS: From 18 August to 24 September 2020, we enrolled 3305 participants (1340 residents and 1965 staff members). Among 856 residents providing serum samples, 362 (42%) had current or past SARS-CoV-2 infection. Of the 346 serology-positive residents, 199 (58%) did not have a documented prior positive SARS-CoV-2 PCR result. Among 1806 staff members providing serum, 454 (25%) had current or past SARS-CoV-2 infection. Of the 447 serology-positive staff members, 353 (79%) did not have a documented prior positive SARS-CoV-2 PCR result. CONCLUSIONS: Past testing practices and policies missed a substantial number of SARS-CoV-2 infections in SNF residents and staff members.


Assuntos
COVID-19/epidemiologia , SARS-CoV-2 , Pessoal de Saúde , Humanos , Los Angeles/epidemiologia , SARS-CoV-2/isolamento & purificação , Estudos Soroepidemiológicos , Instituições de Cuidados Especializados de Enfermagem
3.
Emerg Infect Dis ; 27(9): 2475-2479, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34424168

RESUMO

Reports of organisms harboring multiple carbapenemase genes have increased since 2010. During October 2012-April 2019, the Centers for Disease Control and Prevention documented 151 of these isolates from 100 patients in the United States. Possible risk factors included recent history of international travel, international inpatient healthcare, and solid organ or bone marrow transplantation.


Assuntos
Proteínas de Bactérias , beta-Lactamases , Proteínas de Bactérias/genética , Bactérias Gram-Negativas , Humanos , Estados Unidos/epidemiologia , beta-Lactamases/genética
4.
Clin Infect Dis ; 66(7): 1061-1067, 2018 03 19.
Artigo em Inglês | MEDLINE | ID: mdl-29099915

RESUMO

Background: The Clinical and Laboratory Standards Institute (CLSI) revised the carbapenem breakpoints for Enterobacteriaceae in 2010. The number of hospitals that adopted revised breakpoints and the clinical impact of delayed adoption has not been explored. Methods: We performed a cross-sectional, voluntary survey of microbiology laboratories from California acute care hospitals and long-term acute care hospitals (LTAC) to determine use of revised CLSI breakpoints. Carbapenem-resistant Enterobacteriaceae (CRE) clinical isolates from a single tertiary-care hospital from 2013 to 2017 were examined. All isolates with an elevated minimum inhibitory concentration (MIC; ≥2 µg/mL) to imipenem or meropenem were tested for the presence of carbapenemase genes by polymerase chain reaction (PCR). Results: We received responses from 128 laboratories that serve 264/393 (67%) of hospitals and LTACs. Current CLSI carbapenem breakpoints for Enterobacteriaceae were used by 92/128 (72%) laboratories. Among laboratories that used current breakpoints, time to implementation varied from 0 to 68 months (mean, 41 months; median, 55 months). Application of historical breakpoints to isolates with a carbapenemase gene detected by PCR resulted in susceptibility rates of 8.9%, 18.6%, and 18.6% to ertapenem, imipenem, and meropenem, respectively. By current breakpoints, <1% of these isolates were susceptible to ertapenem or imipenem and 2.6% to meropenem. Conclusion: Clinicians and epidemiologists should be aware that use of outdated MIC breakpoints for Enterobacteriaceae remains common and can result in reports of false susceptibility to carbapenems and missed identification of carbapenemase producers. This misclassification could have consequences for patient care and infection control efforts to address carbapenemase-producing Enterobacteriaceae.


Assuntos
Antibacterianos/farmacologia , Enterobacteriáceas Resistentes a Carbapenêmicos/isolamento & purificação , Carbapenêmicos/farmacologia , Infecções por Enterobacteriaceae/diagnóstico , Testes de Sensibilidade Microbiana/normas , Proteínas de Bactérias/genética , California , Enterobacteriáceas Resistentes a Carbapenêmicos/genética , Estudos Transversais , Humanos , Reação em Cadeia da Polimerase , Inquéritos e Questionários , Centros de Atenção Terciária/estatística & dados numéricos , beta-Lactamases/genética
5.
Clin Orthop Relat Res ; 473(10): 3197-203, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26100255

RESUMO

BACKGROUND: Cementing the metaphyseal stem during hip resurfacing surgery improves the initial fixation of the femoral component. However, there may be long-term detrimental effects such as stress shielding or an increased risk of thermal necrosis associated with this technique. QUESTIONS/PURPOSES: We compared (1) long-term survivorship free from radiographic femoral failure, (2) validated pain scores, and (3) radiographic evidence of component fixation between hips resurfaced with a cemented metaphyseal stem and hips resurfaced with the metaphyseal stem left uncemented. METHODS: We retrospectively selected all the patients who had undergone bilateral hip resurfacing with an uncemented metaphyseal stem on one side, a cemented metaphyseal stem on the other side, and had both surgeries performed between July 1998 and February 2005. Forty-three patients matched these inclusion criteria. During that period, the indications for cementing the stem evolved in the practice of the senior author (HCA), passing through four phases; initially, only hips with large femoral defects had a cemented stem, then all stems were cemented, then all stems were left uncemented. Finally, stems were cemented for patients receiving small femoral components (< 48 mm) or having large femoral defects (or both). Of the 43 cemented stems, two, 13, 0, and 28 came from each of those four periods. All 43 patients had complete followup at a minimum of 9 years (mean, 143 ± 21 months for the uncemented stems; and 135 ± 22 months for the cemented stems; p = 0.088). Survivorship analyses were performed with Kaplan-Meier and Cox proportional hazards ratios using radiographic failure of the femoral component as the endpoint. Pain was assessed with University of California Los Angeles (UCLA) pain scores, and radiographic femoral failure was defined as complete radiolucency around the metaphyseal stem or gross migration of the femoral component. RESULTS: There were four failures of the femoral component in the press-fit stem group while the cemented stem group had no femoral failures (p = 0.0471). With the numbers available, we found no differences between the two groups regarding pain relief or radiographic appearance other than in patients whose components developed loosening. CONCLUSIONS: Cementing the metaphyseal stem improves long-term implant survival and does not alter long-term pain relief or the radiographic appearance of the proximal femur as had been a concern based on the results of finite element studies. We believe that patients with small component sizes and large femoral head defects have more to gain from the use of this technique which adds surface area for fixation, and there is no clinical downside to cementing the stem in patients with large component sizes. LEVEL OF EVIDENCE: Level III, therapeutic study.


Assuntos
Artroplastia de Quadril/métodos , Cimentos Ósseos , Prótese de Quadril , Feminino , Fêmur , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
6.
J Bone Joint Surg Am ; 97(11): 920-4, 2015 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-26041853

RESUMO

UNLABELLED: Liner cementation into a preexisting stable socket may reduce the morbidity of revision hip arthroplasty and preserve acetabular bone. However, the long-term outcomes of this technique remain unknown. The purpose of this report was to analyze the long-term results of a previously reported cohort of patients. Cementation of thirty-two liners (seventeen polyethylene and fifteen metal liners) into preexisting sockets was performed during revision hip arthroplasty, and the patients were followed for a minimum of two years. A retrospective chart review was performed to investigate the complications and survivorship. The mean duration of follow-up was 12.7 years (range, 2.1 to 19.1 years), with ten hips requiring rerevision at a mean of 6.4 years (range, 1.0 to 15.5 years). Nine patients experienced posterior dislocations, and two hips required rerevision for instability. Liner dissociation from the shell occurred in two patients. Survivorship analysis, with rerevision as the end point, demonstrated ten and fifteen-year survivorship of 77.3% and 68.8%, respectively. Dissociation of the cemented liner from the acetabular shell was an infrequent cause of failure despite long-term follow-up. Given the high rate of dislocations in this study, careful patient selection and surgical technique should be considered. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Artroplastia de Quadril/métodos , Cimentação/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Cimentos Ósseos/uso terapêutico , Cimentação/efeitos adversos , Feminino , Seguimentos , Luxação do Quadril/etiologia , Prótese de Quadril/efeitos adversos , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Polietileno/uso terapêutico , Falha de Prótese/efeitos adversos , Reoperação/métodos , Estudos Retrospectivos
7.
Am J Public Health ; 105(2): 302-3, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25521877

RESUMO

We asked persons who inject drugs questions about HCV, including past testing and diagnosis followed by HCV testing. Of 540 participants, 145 (27%) were anti-HCV positive, but of those who were positive, only 46 (32%) knew about their infection. Asking about previous HCV testing results yielded better results than did asking about prior HCV diagnosis. Factors associated with knowing about HCV infection included older age, HIV testing, and drug treatment. Comprehensive approaches to educating and screening this population for HCV need implementation.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Hepatite C/psicologia , Abuso de Substâncias por Via Intravenosa/psicologia , Sorodiagnóstico da AIDS/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , California/epidemiologia , Feminino , Hepatite C/epidemiologia , Hepatite C/etiologia , Humanos , Masculino , Fatores de Risco , Testes Sorológicos/psicologia , Testes Sorológicos/estatística & dados numéricos , Abuso de Substâncias por Via Intravenosa/complicações , Abuso de Substâncias por Via Intravenosa/terapia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...