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17 results

  • Sequential introduction of a multistep testing algorithm and nucleic acid amplification testing leading to an increase in Clostridioides difficile detection and a trend toward increased strain diversity

  • Andrew M. Skinner, Brian Yu, Adam Cheknis, Susan M. Pacheco, Dale N. Gerding, Stuart Johnson
  • Journal:
    Infection Control & Hospital Epidemiology / Volume 41 / Issue 10 / October 2020
    Published online by Cambridge University Press:
    24 June 2020, pp. 1148-1153
    Print publication:
    October 2020
  • Background:

    Most clinical microbiology laboratories have replaced toxin immunoassay (EIA) alone with multistep testing (MST) protocols or nucleic acid amplification testing (NAAT) alone for the detection of C. difficile.

    Objective:

    Study the effect of changing testing strategies on C. difficile detection and strain diversity.

    Design:

    Retrospective study.

    Setting:

    A Veterans’ Affairs hospital.

    Methods:

    Initially, toxin EIA testing was replaced by an MST approach utilizing a glutamate dehydrogenase (GDH) and toxin EIA followed by tcdB NAAT for discordant results. After 18 months, MST was replaced by a NAAT-only strategy. Available patient stool specimens were cultured for C. difficile. Restriction endonuclease analysis (REA) strain typing and quantitative in vitro toxin testing were performed on recovered isolates.

    Results:

    Before MST (toxin EIA), 79 of 708 specimens (11%) were positive, and after MST (MST-A), 121 of 517 specimens (23%) were positive (P < .0001). Prior to NAAT-only testing (MST-B), 80 of the 490 specimens (16%) were positive by MST, and after NAAT-only testing was implemented, 67 of the 368 specimens (18%) were positive (P = nonsignificant). After replacing toxin EIA testing, REA strain group diversity increased (8, 13, 13, and 10 REA groups in the toxin EIA, MST-A, MST-B, and NAAT-only periods, respectively) and in vitro toxin concentration decreased. The average log10 toxin concentration of the isolates were 2.08, 1.88, 1.20 and 1.55 ng/mL for the same periods, respectively.

    Conclusions:

    MST and NAAT had similar detection rates for C. difficile. Compared to toxin testing alone, they detected increased diversity of C. difficile strains, many of which were low toxin producing.

  • The Impact of Recurrent Clostridium difficile Infection on Patients’ Prevention Behaviors

  • Frances M. Weaver, William E. Trick, Charlesnika T. Evans, Michael Y. Lin, William Adams, Mai T. Pho, Susan C. Bleasdale, Kathleen M. Mullane, Stuart Johnson, Monica K. Sikka, Lance R. Peterson, Anthony E. Solomonides, Dale N. Gerding
  • Journal:
    Infection Control & Hospital Epidemiology / Volume 38 / Issue 11 / November 2017
    Published online by Cambridge University Press:
    26 September 2017, pp. 1351-1357
    Print publication:
    November 2017
  • OBJECTIVE

    To determine the impact of recurrent Clostridium difficile infection (RCDI) on patient behaviors following illness.

    METHODS

    Using a computer algorithm, we searched the electronic medical records of 7 Chicago-area hospitals to identify patients with RCDI (2 episodes of CDI within 15 to 56 days of each other). RCDI was validated by medical record review. Patients were asked to complete a telephone survey. The survey included questions regarding general health, social isolation, symptom severity, emotional distress, and prevention behaviors.

    RESULTS

    In total, 119 patients completed the survey (32%). On average, respondents were 57.4 years old (standard deviation, 16.8); 57% were white, and ~50% reported hospitalization for CDI. At the time of their most recent illness, patients rated their diarrhea as high severity (58.5%) and their exhaustion as extreme (30.7%). Respondents indicated that they were very worried about getting sick again (41.5%) and about infecting others (31%). Almost 50% said that they have washed their hands more frequently (47%) and have increased their use of soap and water (45%) since their illness. Some of these patients (22%–32%) reported eating out less, avoiding certain medications and public areas, and increasing probiotic use. Most behavioral changes were unrelated to disease severity.

    CONCLUSION

    Having had RCDI appears to increase prevention-related behaviors in some patients. While some behaviors are appropriate (eg, handwashing), others are not supported by evidence of decreased risk and may negatively impact patient quality of life. Providers should discuss appropriate prevention behaviors with their patients and should clarify that other behaviors (eg, eating out less) will not affect their risk of future illness.

    Infect Control Hosp Epidemiol. 2017;38:1351–1357

  • Dairy Productivity and Technical Change: An Analysis of Confinement and Management Intensive Grazing Dairies in Maryland for 1995–2009

  • Kota Minegishi, Dale M. Johnson
  • Journal:
    Agricultural and Resource Economics Review / Volume 46 / Issue 3 / December 2017
    Published online by Cambridge University Press:
    04 August 2017, pp. 555-578
    • Article
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  • U.S. dairy production has been consolidating into large-scale confinement operations. Large numbers of small- to medium-scale dairies have disappeared in the last two decades, and many more are disappearing. This article analyzes small- to medium-scale dairy operations in Maryland during 1995–2009 for changes in technology and efficiency through a novel two-stage DEA approach to examine productivity changes. Conventional confinement dairy operations and management-intensive grazing dairies are analyzed separately. The results show that both dairy systems have become more productive on the technological frontiers, yet the rate of technical change for graziers was less than half the rate for confinement.

  • 11 - Emerging technologies

    • By Dale Van Stempvoort, National Water Research Institute, PO Box 5050, Burlington ON, Canada L7R 4A6, Kevin Biggar, BGC Engineering, Inc., 207, 5140–82 Avenue, Edmonton, Alberta, Canada T6B OE6, Dennis M. Filler, Dept. of Civil and Environmental Engineering, University of Alaska Fairbanks, PO Box 755900, Fairbanks AK 99775, USA, Ronald A. Johnson, Dept. of Mechanical Engineering, Institute of Northern Engineering Energy Research Center, University of Alaska Fairbanks, PO Box 755910, Fairbanks AK 99775–5910, USA, Ian Snape, Environmental Protection and Change Program, Australian Antarctic Division, Channel Highway, Kingston, Tasmania 7050, Australia, Kate Mumford, Particulate Fluids Processing Centre (ARC Special Research Centre), Department of Chemical and Biomolecular Engineering, University of Melbourne, Victoria 3010, Australia, William Schnabel, Golder Associates, 1346 West Arrowhead Road, Duluth MN 55811, USA, Steve Bainbridge, Contaminated Sites Program, Division of Spill Prevention and Response, Department of Environmental Conservation, 610 University Avenue, Fairbanks AK 99709–3643, USA
  • Edited by Dennis M. Filler, University of Alaska, Fairbanks, Ian Snape, David L. Barnes, University of Alaska, Fairbanks
  • Book:
    Bioremediation of Petroleum Hydrocarbons in Cold Regions
    Published online:
    22 August 2009
    Print publication:
    21 February 2008, pp 212-230

  • Summary

    Introduction

    In this book, current scientific knowledge and practical experiences with bioremediation of petroleum-contaminated soils in cold regions are reviewed and compiled. We now more fully understand the inter-relationships between cold temperatures, soil and water properties, and biological processes. This aids decision making about practical remediation treatment for petroleum-contaminated sites in cold regions. Landfarming and enhanced bioremediation schemes have emerged as viable soil treatment methods that offer a number of advantages over other methods. Nevertheless, work still needs to be done to optimize these methods, and with regards to evaluating phytoremediation and rhizosphere enhancement potentials for cold soils.

    Two emerging technologies have been identified that could offer significant cost savings; low-cost heating and controlled-release nutrient systems are described briefly here (see also Chapter 8). In addition, natural attenuation has received little rigorous evaluation for use in cold soils. The main limitation for natural attenuation in cold regions is the low rate of degradation, coupled with off-site migration that can be relatively rapid in soils or gravel pads that have a poor adsorption capacity. Permeable reactive barriers are one groundwater treatment technology that could buy time for slower in situ techniques such as natural attenuation to take place. An outline of emerging permeable-reactive barrier technology is presented here, although full-scale trials are not yet complete. It is possible that such in situ techniques, when coupled with aeration, sparging and biostimulation could offer methods for groundwater treatment in cold regions.

  • Predominance of a Single Restriction Endonuclease Analysis Group with Intrahospital Subgroup Diversity Among Clostridium difficile Isolates at Two Chicago Hospitals

  • Endale T. Mekonen, Dale N. Gerding, Susan P. Sambol, Jean M. Pottinger, Joseph J. Pulvirenti, Dayle Marsh, Frank E. Kocka, Stuart Johnson
  • Journal:
    Infection Control & Hospital Epidemiology / Volume 23 / Issue 11 / November 2002
    Published online by Cambridge University Press:
    02 January 2015, pp. 648-652
    Print publication:
    November 2002
  • Objective:

    To determine the epidemiology and relatedness of Clostridium difficile isolates in two geographically separated hospitals in a large metropolitan area, each with unique patients and personnel.

    Design:

    Observational descriptive molecular epidemiology of clinical C. difficile isolates.

    Setting:

    Two tertiary-care hospitals in Chicago.

    Methods:

    Consecutive C. difficile isolates from the clinical laboratory of a Veterans Affairs hospital during a 13-month period were typed by restriction endonuclease analysis (REA). During an overlapping 3-month period, stool specimens that tested positive for C. difficile toxin from patients at a nearby county hospital were cultured and the recovered isolates typed by the same method.

    Results:

    Nineteen (68%) of 28 nosocomial isolates at the smaller, Veterans Affairs hospital belonged to REA group K. Within this group of closely related strains, 9 distinct REA types were recognized. Twenty-one (72%) of 29 nosocomial isolates at the larger, county hospital also belonged to group K. However, the predominant REA types within group K differed markedly at each institution.

    Conclusions:

    These findings demonstrate a high degree of similarity among nosocomial C. difficile strains from different hospitals in the same city and suggest the possibility of an extended outbreak of a prototype group K strain with subsequent genetic drift at the two different institutions.