Routine Screening for Methicillin-ResistantStaphylococcus AureusAmong Patients Newly Admitted to an Acute Rehabilitation Unit

Background:Following an outbreak of methicillin-resistantStaphylococcus aureus(MRSA) infection in our acute rehabilitation unit in 1987, all patients except in-house transfers (because of their low prevalence of MRSA colonization) underwent MRSA screening cultures on admission.Objectives:To better characterize the current profile of patients with positive MRSA screening cultures at the time of admission to our acute rehabilitation unit, and to determine the relative yield of nares, perianal, and wound screening cultures in this population.Methods:Prospective chart review with ongoing active surveillance for infections associated with the acute rehabilitation unit.Results:The rate of MRSA isolation from one or more body sites increased significantly from 5% (1987–1988) to 12% (1999–2000) (P= .0009) for newly admitted patients and from 0% to 7% (P< .0001) for in-house transfers. A negative nares culture was highly predictive (98%) of a negative perianal culture. Prior history of MRSA infection or colonization and transfer from outside sources were independently associated with positive MRSA screening cultures.Conclusion:The rate of MRSA isolation from screening cultures of newly admitted patients, including in-house transfers, has increased significantly during the past decade in our acute rehabilitation unit. When paired with nares cultures, perianal cultures were of limited value in this patient population.

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Diabetic Foot Infections

10.1093/med/9780199976805.003.0043 ◽

2016 ◽

Author(s):

Clare Kelleher

Keyword(s):

Diabetic Foot ◽

Prior History ◽

Diabetic Foot Infections ◽

Definitive Therapy ◽

Empiric Antibiotic ◽

History Of ◽

Mrsa Infection ◽

Systemic Manifestations ◽

Purulent Drainage ◽

Incision Drainage

Diabetic foot infections (DFI) are diagnosed by two or more classic findings of inflammation (redness, swelling, warmth, and tenderness) or purulent drainage within an existing diabetic foot wound. Wounds without clinical evidence of soft tissue or bone infection often do not require antibiotic therapy. When infection is present, empiric antibiotic regimens must be based on the available clinical and local epidemiologic data, but definitive therapy should be based on cultures of infected tissues or clinical response. Consideration of methicillin-resistant Staphylococcus aureus (MRSA) coverage should be given when local prevalence is high, in patients with a prior history of MRSA infection, or when the systemic manifestations are severe. Surgical intervention and vascular assessment play key roles in the management of many DFI; deep DFI require incision, drainage, and debridement. Redistribution of pressure off of the wound is a tenet in the management of DFI.

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Identifying the Risk Factors for Hospital-Acquired Methicillin-Resistant Staphylococcus aureus (MRSA) Infection among Patients Colonized with MRSA on Admission

Infection Control and Hospital Epidemiology ◽

10.1086/668420 ◽

2012 ◽

Vol 33 (12) ◽

pp. 1219-1225 ◽

Cited By ~ 24

Author(s):

Yuriko Fukuta ◽

Candace A. Cunningham ◽

Patricia L. Harris ◽

Marilyn M. Wagener ◽

Robert R. Muder

Keyword(s):

Risk Factors ◽

Staphylococcus Aureus ◽

Univariate Analysis ◽

Significant Risk ◽

Prior History ◽

Methicillin Resistant ◽

Control Subjects ◽

History Of ◽

Mrsa Infection ◽

Hospital Acquired

Background.Methicillin-resistant Staphylococcus aureus (MRSA) is a major pathogen in hospital-acquired infections. MRSA-colonized inpatients who may benefit from undergoing decolonization have not been identified.Objective.To identify risk factors for MRSA infection among patients who are colonized with MRSA at hospital admission.Design.A case-control study.Setting.A 146-bed Veterans Affairs hospital.Participants.Case patients were those patients admitted from January 2003 to August 2011 who were found to be colonized with MRSA on admission and then developed MRSA infection. Control subjects were those patients admitted during the same period who were found to be colonized with MRSA on admission but who did not develop MRSA infection.Methods.A retrospective review.Results.A total of 75 case patients and 150 control subjects were identified. A stay in the intensive care unit (ICU) was the significant risk factor in univariate analysis (P<.001). Prior history of MRSA (P = .03), transfer from a nursing home (P = .002), experiencing respiratory failure (P<.001), and receipt of transfusion (P = .001) remained significant variables in multivariate analysis. Prior history of MRSA colonization or infection (P = .02), difficulty swallowing (P = .04), presence of an open wound (P = .002), and placement of a central line (P = .02) were identified as risk factors for developing MRSA infection for patients in the ICU. Duration of hospitalization, readmission rate, and mortality rate were significantly higher in case patients than in control subjects (P< .001, .001, and <.001, respectively).Conclusions.MRSA-colonized patients admitted to the ICU or admitted from nursing homes have a high risk of developing MRSA infection. These patients may benefit from undergoing decolonization.

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Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19 patients—a case series

Egyptian Journal of Radiology and Nuclear Medicine ◽

10.1186/s43055-020-00401-0 ◽

2021 ◽

Vol 52 (1) ◽

Author(s):

Akshat Agrawal ◽

Kamal Kumar Sen ◽

Gitanjali Satapathy ◽

Humsheer Singh Sethi ◽

Ajay Sharawat ◽

...

Keyword(s):

Subcutaneous Emphysema ◽

Case Series ◽

Prior History ◽

Invasive Ventilation ◽

Computed Tomography Scan ◽

Case Presentation ◽

Spontaneous Pneumomediastinum ◽

History Of ◽

Time Of Admission ◽

Tomography Scan

Abstract Background Spontaneous pneumomediastinum, pneumothorax and spontaneous subcutaneous emphysema are rare entities. A rising trend in the setting of COVID-19 even in patients who are not put on invasive ventilation can suggest an alternative aetiology. Case presentation We describe four cases which presented with suspected symptoms of COVID-19 and were diagnosed with pneumomediastinum, pneumothorax, and subcutaneous emphysema which would have been missed if not for computed tomography scan performed at the time of admission. Three of these cases had no prior history of any iatrogenic intervention, and the fourth person developing pneumothorax and subcutaneous emphysema after intubation. Conclusions Pneumomediastinum, pneumothorax and subcutaneous emphysema can be noted as a complication of COVID-19 itself as well as the complication of management of COVID-19.

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Challenges of Applying the SHEA/HICPAC Metrics for Multidrug-Resistant Organisms to a Real-World Setting

Infection Control and Hospital Epidemiology ◽

10.1086/658939 ◽

2011 ◽

Vol 32 (4) ◽

pp. 323-332 ◽

Cited By ~ 5

Author(s):

E. Yoko Furuya ◽

Elaine Larson ◽

Timothy Landers ◽

Haomiao Jia ◽

Barbara Ross ◽

...

Keyword(s):

At Risk ◽

Real World ◽

Multidrug Resistant ◽

Prior History ◽

Real World Setting ◽

Significant Difference ◽

Multidrug Resistant Organisms ◽

History Of ◽

Mrsa Infection ◽

Not At Risk

Objective.To test in a real-world setting the recommendations for measuring infection with multidrug-resistant organisms (MDRO) from the Society for Healthcare Epidemiology of America (SHEA) and the Centers for Disease Control and Prevention's Healthcare Infection Control Practices Advisory Committee (HICPAC).Methods.Using data from 3 hospital settings within a healthcare network, we applied the SHEA/HICPAC recommendations to measure methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization. Data were obtained from the hospitals' electronic surveillance system and were supplemented by manual medical record review as necessary. Additionally, we tested (1) different definitions for nosocomial incidence, (2) the effect of excluding patients not at risk from the denominator for hospital-onset incidence, and (3) the appropriate time period to use when including or excluding patients with a prior history of MRSA infection or colonization from nosocomial rates. Negative binomial regression models were used to test for differences between rate definitions. A rating scale was created for each metric, assessing the extent to which manual or electronic data elements were required.Results.There was no statistically significant difference between using 72 hours or 3 calendar days as the cutoff to define hospital-onset incidence. Excluding patients not at risk from the denominator when calculating hospital-onset incidence led to statistically significant increases in rates. When excluding patients with a prior history of MRSA infection or colonization from nosocomial incidence rates, rates were similar regardless of whether we looked at 1, 2, or 3 years' worth of prior data.Conclusions.The SHEA/HICPAC MDRO metrics are useful but can be challenging to implement. We include in our description of the data sources and processes required to calculate these metrics information that may simplify the process for institutions.

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Are Patients with Prior Clostridium difficile Infection (CDI) a Potential Source of Transmission during Hospital Admissions?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1004 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S402-S402

Author(s):

Melany Gonzalez-Orta ◽

Carlos Saldana ◽

Jennifer Cadnum ◽

Curtis J Donskey

Keyword(s):

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Hospital Admissions ◽

Prior History ◽

Positive Skin ◽

Potential Source ◽

History Of ◽

Time Of Admission

Abstract Background Many patients with Clostridium difficile infection (CDI) continue to shed spores asymptomatically after completion of CDI therapy. However, the duration of shedding and the potential for transmission during subsequent healthcare exposures is unknown. Methods During a 6-month period, we collected perirectal, groin, and skin (chest/abdomen and hands) cultures for toxigenic C. difficile from patients with a prior history of CDI who were admitted to the hospital. We calculated the frequencies of perirectal and skin shedding of C. difficile at the time of admission, stratified by the time since the prior CDI diagnosis. Results Of 28 patients with a prior history of CDI enrolled in the study, 10 (36%) had positive perirectal cultures for toxigenic C. difficile upon admission, and 6 of 10 (60%) had positive skin cultures. The figure shows the percentages of CDI cases with positive perirectal, groin, or skin cultures, stratified by the time since the prior CDI diagnosis. Conclusion Patients with prior CDI often shed spores asymptomatically during hospital admissions. Further studies are needed to determine whether these carriers contribute significantly to transmission. Disclosures All authors: No reported disclosures.

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Validating the Questionnaire to Verify Stroke-Free Status by Patient History and Physical Examination

Stroke ◽

10.1161/str.32.suppl_1.362-a ◽

2001 ◽

Vol 32 (suppl_1) ◽

pp. 362-362

Author(s):

William J Jones ◽

Linda S Williams ◽

Gayle Redmon ◽

James F Meschia

Keyword(s):

Physical Examination ◽

Predictive Value ◽

Prior History ◽

Face To Face ◽

General Internal ◽

History Of ◽

Low Prevalence ◽

Record Review ◽

High Degree ◽

Free Status

P127 Background and Purpose: The Questionnaire to Verify Stroke-Free Status (QVSFS) is an 8-item structured telephone interview designed to identify stroke-free individuals. Previously, the QVSFS was validated with medical record review to identify stroke status in a cohort with a low prevalence (7%) of stroke or TIA. The aim of this study was to evaluate the validity of the QVSFS using a face-to-face history and physical examination in a group with a higher prevalence of stroke. Methods: A research assistant administered the QVSFS to outpatients from VA stroke and general internal medicine clinics. Subjects were defined as QVSFS (-) if responses to all 8 questions were negative. Questions requiring clarification were noted. Neurologists, blinded to QVSFS scores, interviewed and recorded the NIH Stroke Scale in all subjects to determine stroke-free status, defined as no history or examination findings of previous TIA or stroke. Results: Ninety-one subjects were examined, mean age was 69 years, 98% were male. Twenty-five of the subjects were judged stroke-free by the examiners and 66 had a prior history of stroke (63) or TIA (3). The negative predictive value of the QVSFS was 0.93 with positive predictive value 0.86. No question required rephrasing in more than 3 subjects; only 12 subjects (13%) required rephrasing of at least one question. Years of education was not associated with need for question rephrasing. Conclusions: The QVSFS can effectively identify stroke-free individuals with a high degree of accuracy, even in a population including a large proportion of patients with prior stroke or TIA. Accuracy for identifying subjects with stroke is slightly lower but still high. The QVSFS is valid for interviewer administration but, because of the need for question clarification in some subjects, should be further evaluated before using self- or mail-completion.

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Ascertaining the Discernable Wishes of the Child in Post-Separation Contact Cases with a Prior History of Domestic Violence

PsycEXTRA Dataset ◽

10.1037/e516662013-106 ◽

2008 ◽

Author(s):

Stephanie Holt

Keyword(s):

Domestic Violence ◽

Prior History ◽

History Of

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High Risk of One-year Stroke Recurrence in Patients with Younger Age and Prior History of Ischemic Stroke

Current Neurovascular Research ◽

10.2174/1567202616666190618164528 ◽

2019 ◽

Vol 16 (3) ◽

pp. 250-257 ◽

Cited By ~ 1

Author(s):

Jiann-Der Lee ◽

Ya-Han Hu ◽

Meng Lee ◽

Yen-Chu Huang ◽

Ya-Wen Kuo ◽

...

Keyword(s):

Logistic Regression ◽

Ischemic Stroke ◽

Multivariate Logistic Regression Analysis ◽

Stroke Recurrence ◽

Prior History ◽

Multivariate Logistic Regression ◽

Cart Analysis ◽

Younger Age ◽

History Of ◽

One Year

Background and Purpose: Recurrent ischemic strokes increase the risk of disability and mortality. The role of conventional risk factors in recurrent strokes may change due to increased awareness of prevention strategies. The aim of this study was to explore the potential risk factors besides conventional ones which may help to affect the advances in future preventive concepts associated with one-year stroke recurrence (OSR). Methods: We analyzed 6,632 adult patients with ischemic stroke. Differences in clinical characteristics between patients with and without OSR were analyzed using multivariate logistic regression and classification and regression tree (CART) analyses. Results: Among the study population, 525 patients (7.9%) had OSR. Multivariate logistic regression analysis revealed that male sex (OR 1.243, 95% CI 1.025 – 1.506), age (OR 1.015, 95% CI 1.007 - 1.023), and a prior history of ischemic stroke (OR 1.331, 95% CI 1.096 – 1.615) were major factors associated with OSR. CART analysis further identified age and a prior history of ischemic stroke were important factors for OSR when classified the patients into three subgroups (with risks of OSR of 8.8%, 3.8%, and 12.5% for patients aged > 57.5 years, ≤ 57.5 years/with no prior history of ischemic stroke, and ≤ 57.5 years/with a prior history of ischemic stroke, respectively). Conclusions: Male sex, age, and a prior history of ischemic stroke could increase the risk of OSR by multivariate logistic regression analysis, and CART analysis further demonstrated that patients with a younger age (≤ 57.5 years) and a prior history of ischemic stroke had the highest risk of OSR.

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Dysbaric osteonecrosis associated with decompression sickness in a fishing diver

Undersea and Hyperbaric Medicine ◽

10.22462/04.06.2019.17 ◽

2019 ◽

pp. 217-220

Author(s):

Eduardo Briceño-Souza ◽

◽

Nina Méndez-Domínguez ◽

Ricardo j Cárdenas-Dajda ◽

Walter Chin ◽

...

Keyword(s):

Femoral Head ◽

Decompression Sickness ◽

Small Scale ◽

Prior History ◽

Radiological Findings ◽

Small Scale Fisheries ◽

Left Limb ◽

History Of ◽

Decompression Stress ◽

Probable Diagnosis

Diving as a method of fishing is used worldwide in small-scale fisheries. However, one of the main causes of morbidity and mortality among fishermen is decompression sickness (DCS). We report the case of a 46-year-old male fisherman diver who presented with chronic inguinal pain that radiated to the lower left limb. Living and working in a fishing port in Yucatan, he had a prior history of DCS. A diagnosis of avascular necrosis in the left femoral head secondary to DCS was made via analysis of clinical and radiological findings. The necrosis was surgically resolved by a total hip arthroplasty. Dysbaric osteonecrosis is a more probable diagnosis. In this region fishermen undergo significant decompression stress in their daily fishing efforts. Further studies regarding prevalence of dysbaric osteonecrosis among small-scale fisheries divers are needed. In a community where DCS is endemic and has become an epidemic, as of late, the perception of this health risk remains low. Furthermore, training and decompression technique are lacking among the fishing communities.

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