18 results
Reductions in inpatient fluoroquinolone use and postdischarge Clostridioides difficile infection (CDI) from a systemwide antimicrobial stewardship intervention
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- K. Ashley Jones, Udodirim N. Onwubiko, Julianne Kubes, Benjamin Albrecht, Kristen Paciullo, Jessica Howard-Anderson, Sujit Suchindran, Ronald Trible, Jesse T. Jacob, Sarah H. Yi, Dana Goodenough, Scott K. Fridkin, Mary Elizabeth Sexton, Zanthia Wiley
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- Journal:
- Antimicrobial Stewardship & Healthcare Epidemiology / Volume 1 / Issue 1 / 2021
- Published online by Cambridge University Press:
- 22 October 2021, e32
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Objective:
To determine the impact of an inpatient stewardship intervention targeting fluoroquinolone use on inpatient and postdischarge Clostridioides difficile infection (CDI).
Design:We used an interrupted time series study design to evaluate the rate of hospital-onset CDI (HO-CDI), postdischarge CDI (PD-CDI) within 12 weeks, and inpatient fluoroquinolone use from 2 years prior to 1 year after a stewardship intervention.
Setting:An academic healthcare system with 4 hospitals.
Patients:All inpatients hospitalized between January 2017 and September 2020, excluding those discharged from locations caring for oncology, bone marrow transplant, or solid-organ transplant patients.
Intervention:Introduction of electronic order sets designed to reduce inpatient fluoroquinolone prescribing.
Results:Among 163,117 admissions, there were 683 cases of HO-CDI and 1,104 cases of PD-CDI. In the context of a 2% month-to-month decline starting in the preintervention period (P < .01), we observed a reduction in fluoroquinolone days of therapy per 1,000 patient days of 21% after the intervention (level change, P < .05). HO-CDI rates were stable throughout the study period. In contrast, we also detected a change in the trend of PD-CDI rates from a stable monthly rate in the preintervention period to a monthly decrease of 2.5% in the postintervention period (P < .01).
Conclusions:Our systemwide intervention reduced inpatient fluoroquinolone use immediately, but not HO-CDI. However, a downward trend in PD-CDI occurred. Relying on outcome measures limited to the inpatient setting may not reflect the full impact of inpatient stewardship efforts.
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. 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- Edited by Robert Audi, University of Notre Dame, Indiana
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- 05 August 2015
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135 - Enterococcus
- from Part XVIII - Specific organisms: bacteria
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- By Ronald N. Jones, Tufts University School of Medicine
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- Clinical Infectious Disease
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. 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Douglas Meeks, Monica Jyotsna Melanchthon, Ilie Melniciuc-Puica, Everett Mendoza, Raymond A. Mentzer, William W. Menzies, Ina Merdjanova, Franziska Metzger, Constant J. Mews, Marvin Meyer, Carol Meyers, Vasile Mihoc, Gunner Bjerg Mikkelsen, Maria Inêz de Castro Millen, Clyde Lee Miller, Bonnie J. Miller-McLemore, Alexander Mirkovic, Paul Misner, Nozomu Miyahira, R. W. L. Moberly, Gerald Moede, Aloo Osotsi Mojola, Sunanda Mongia, Rebeca Montemayor, James Moore, Roger E. Moore, Craig E. Morrison O.Carm, Jeffry H. Morrison, Keith Morrison, Wilson J. Moses, Tefetso Henry Mothibe, Mokgethi Motlhabi, Fulata Moyo, Henry Mugabe, Jesse Ndwiga Kanyua Mugambi, Peggy Mulambya-Kabonde, Robert Bruce Mullin, Pamela Mullins Reaves, Saskia Murk Jansen, Heleen L. Murre-Van den Berg, Augustine Musopole, Isaac M. T. Mwase, Philomena Mwaura, Cecilia Nahnfeldt, Anne Nasimiyu Wasike, Carmiña Navia Velasco, Thulani Ndlazi, Alexander Negrov, James B. Nelson, David G. Newcombe, Carol Newsom, Helen J. Nicholson, George W. E. Nickelsburg, Tatyana Nikolskaya, Damayanthi M. A. Niles, Bertil Nilsson, Nyambura Njoroge, Fidelis Nkomazana, Mary Beth Norton, Christian Nottmeier, Sonene Nyawo, Anthère Nzabatsinda, Edward T. Oakes, Gerald O'Collins, Daniel O'Connell, David W. Odell-Scott, Mercy Amba Oduyoye, Kathleen O'Grady, Oyeronke Olajubu, Thomas O'Loughlin, Dennis T. Olson, J. Steven O'Malley, Cephas N. Omenyo, Muriel Orevillo-Montenegro, César Augusto Ornellas Ramos, Agbonkhianmeghe E. Orobator, Kenan B. Osborne, Carolyn Osiek, Javier Otaola Montagne, Douglas F. Ottati, Anna May Say Pa, Irina Paert, Jerry G. Pankhurst, Aristotle Papanikolaou, Samuele F. Pardini, Stefano Parenti, Peter Paris, Sung Bae Park, Cristián G. Parker, Raquel Pastor, Joseph Pathrapankal, Daniel Patte, W. Brown Patterson, Clive Pearson, Keith F. Pecklers, Nancy Cardoso Pereira, David Horace Perkins, Pheme Perkins, Edward N. Peters, Rebecca Todd Peters, Bishop Yeznik Petrossian, Raymond Pfister, Peter C. Phan, Isabel Apawo Phiri, William S. F. Pickering, Derrick G. Pitard, William Elvis Plata, Zlatko Plese, John Plummer, James Newton Poling, Ronald Popivchak, Andrew Porter, Ute Possekel, James M. Powell, Enos Das Pradhan, Devadasan Premnath, Jaime Adrían Prieto Valladares, Anne Primavesi, Randall Prior, María Alicia Puente Lutteroth, Eduardo Guzmão Quadros, Albert Rabil, Laurent William Ramambason, Apolonio M. Ranche, Vololona Randriamanantena Andriamitandrina, Lawrence R. Rast, Paul L. Redditt, Adele Reinhartz, Rolf Rendtorff, Pål Repstad, James N. Rhodes, John K. Riches, Joerg Rieger, Sharon H. Ringe, Sandra Rios, Tyler Roberts, David M. Robinson, James M. Robinson, Joanne Maguire Robinson, Richard A. H. Robinson, Roy R. Robson, Jack B. Rogers, Maria Roginska, Sidney Rooy, Rev. Garnett Roper, Maria José Fontelas Rosado-Nunes, Andrew C. Ross, Stefan Rossbach, François Rossier, John D. Roth, John K. Roth, Phillip Rothwell, Richard E. Rubenstein, Rosemary Radford Ruether, Markku Ruotsila, John E. Rybolt, Risto Saarinen, John Saillant, Juan Sanchez, Wagner Lopes Sanchez, Hugo N. Santos, Gerhard Sauter, Gloria L. Schaab, Sandra M. Schneiders, Quentin J. Schultze, Fernando F. Segovia, Turid Karlsen Seim, Carsten Selch Jensen, Alan P. F. Sell, Frank C. Senn, Kent Davis Sensenig, Damían Setton, Bal Krishna Sharma, Carolyn J. Sharp, Thomas Sheehan, N. Gerald Shenk, Christian Sheppard, Charles Sherlock, Tabona Shoko, Walter B. Shurden, Marguerite Shuster, B. Mark Sietsema, Batara Sihombing, Neil Silberman, Clodomiro Siller, Samuel Silva-Gotay, Heikki Silvet, John K. Simmons, Hagith Sivan, James C. Skedros, Abraham Smith, Ashley A. Smith, Ted A. Smith, Daud Soesilo, Pia Søltoft, Choan-Seng (C. S.) Song, Kathryn Spink, Bryan Spinks, Eric O. Springsted, Nicolas Standaert, Brian Stanley, Glen H. Stassen, Karel Steenbrink, Stephen J. Stein, Andrea Sterk, Gregory E. Sterling, Columba Stewart, Jacques Stewart, Robert B. Stewart, Cynthia Stokes Brown, Ken Stone, Anne Stott, Elizabeth Stuart, Monya Stubbs, Marjorie Hewitt Suchocki, David Kwang-sun Suh, Scott W. Sunquist, Keith Suter, Douglas Sweeney, Charles H. Talbert, Shawqi N. Talia, Elsa Tamez, Joseph B. Tamney, Jonathan Y. Tan, Yak-Hwee Tan, Kathryn Tanner, Feiya Tao, Elizabeth S. Tapia, Aquiline Tarimo, Claire Taylor, Mark Lewis Taylor, Bishop Abba Samuel Wolde Tekestebirhan, Eugene TeSelle, M. Thomas Thangaraj, David R. Thomas, Andrew Thornley, Scott Thumma, Marcelo Timotheo da Costa, George E. “Tink” Tinker, Ola Tjørhom, Karen Jo Torjesen, Iain R. Torrance, Fernando Torres-Londoño, Archbishop Demetrios [Trakatellis], Marit Trelstad, Christine Trevett, Phyllis Trible, Johannes Tromp, Paul Turner, Robert G. Tuttle, Archbishop Desmond Tutu, Peter Tyler, Anders Tyrberg, Justin Ukpong, Javier Ulloa, Camillus Umoh, Kristi Upson-Saia, Martina Urban, Monica Uribe, Elochukwu Eugene Uzukwu, Richard Vaggione, Gabriel Vahanian, Paul Valliere, T. J. Van Bavel, Steven Vanderputten, Peter Van der Veer, Huub Van de Sandt, Louis Van Tongeren, Luke A. Veronis, Noel Villalba, Ramón Vinke, Tim Vivian, David Voas, Elena Volkova, Katharina von Kellenbach, Elina Vuola, Timothy Wadkins, Elaine M. Wainwright, Randi Jones Walker, Dewey D. Wallace, Jerry Walls, Michael J. Walsh, Philip Walters, Janet Walton, Jonathan L. Walton, Wang Xiaochao, Patricia A. Ward, David Harrington Watt, Herold D. Weiss, Laurence L. Welborn, Sharon D. Welch, Timothy Wengert, Traci C. West, Merold Westphal, David Wetherell, Barbara Wheeler, Carolinne White, Jean-Paul Wiest, Frans Wijsen, Terry L. Wilder, Felix Wilfred, Rebecca Wilkin, Daniel H. Williams, D. Newell Williams, Michael A. Williams, Vincent L. Wimbush, Gabriele Winkler, Anders Winroth, Lauri Emílio Wirth, James A. Wiseman, Ebba Witt-Brattström, Teofil Wojciechowski, John Wolffe, Kenman L. Wong, Wong Wai Ching, Linda Woodhead, Wendy M. Wright, Rose Wu, Keith E. Yandell, Gale A. Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
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- 05 August 2012
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- 20 September 2010, pp xi-xliv
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Contributors
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- By Deborah Abeles, Adrian Alvarez, Euler Ázaro, Paulo Batista, Donald P. Bernstein, Jay B. Brodsky, Kathleen Carey, Venita Chandra, Jenny Choi, Maria L. Collazo-Clavell, Jeremy Collins, Eric J. DeMaria, Galina Dimirova, Sanjeev Dutta, João Ettinger, Ronald Harter, Matthew M. Hutter, Jerry Ingrande, Daniel B. Jones, Stephanie B. Jones, Helen Karakelides, Fawzi S. Khayat, Hendrikus J. M. Lemmens, Yigal Leykin, Amy Lightner, Masha Livhits, Melinda A. Maggard, Tracy Martinez, John M. Morton, Patrick J. Neligan, Ninh T. Nguyen, Alfons Pomp, Silvia E. Perez-Protto, Steve E. Raper, Roman Schumann, Scott A. Shikora, Ashish Sinha, Brian R. Smith, Juraj Sprung, Pedro P. Tanaka, Brandon Tari, David O. Warner, Toby N. Weingarten, Joseph G. Werner, Gavitt A. Woodard, Basil M. Yurcisin, David Zvara
- Edited by Adrian Alvarez, Jay B. Brodsky, Stanford University School of Medicine, California, Hendrikus J. M. Lemmens, Stanford University School of Medicine, California, John M. Morton, Stanford University School of Medicine, California
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- Morbid Obesity
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- 04 May 2010
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- 11 March 2010, pp -
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- By Phillip L. Ackerman, Neil Anderson, Jens B. Asendorpf, R. Michael Bagby, Michael Harris Bond, Gregory J. Boyle, Andrea L. Briggs, Giles St J. Burch, Turhan Canli, David Canter, Gianvittorio Caprara, Charles S. Carver, Douglas F. Cellar, Gordon Claridge, Susan Cloninger, Elisabeth D. Conradt, Philip J. Corr, Sharon Dawe, Ian J. Deary, Boele De Raad, Edward L. Deci, Colin G. DeYoung, M. Brent Donnellan, Juris G. Draguns, Marko Elovainio, Aurelio José Figueredo, David C. Funder, Paul Gladden, Rapson Gomez, Samuel D. Gosling, Jeremy R. Gray, Robert D. Hare, B. Austin Harley, Edward Helmes, Robert Hogan, Lauri A. Jensen-Campbell, Daniel Nelson Jones, Mika Kivimäki, Jennifer M. Knack, James T. Lamiell, Natalie J. Loxton, Geoff MacDonald, Gerald Matthews, Robert R. McCrae, Mario Mikulincer, Stephanie N. Mullins-Sweatt, Marcus R. Munafò, Vickie Nam, Craig S. Newmann, Rainer Reisenzein, Madeline Rex-Lear, Richard W. Robins, Michael D. Robinson, Mary K. Rothbart, Richard M. Ryan, Gerard Saucier, Michael F. Scheier, Constantine Sedikides, Phillip R. Shaver, Brad E. Sheese, Yuichi Shoda, Ronald E. Smith, Alice F. Stuhlmacher, Rhonda Swickert, Avril Thorne, David D. Vachon, Geneva Vásquez, Michele Vecchione, Seth A. Wagerman, Fiona Warren, Hannelore Weber, Thomas A. Widiger, Pedro Sofio Abril Wolf, Donna Youngs, Moshe Zeidner
- Edited by Philip J. Corr, University of East Anglia, Gerald Matthews, University of Cincinnati
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- The Cambridge Handbook of Personality Psychology
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- 05 June 2012
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- 16 July 2009, pp xv-xvii
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133 - Enterococcus
- from Part XVIII - Specific Organisms – Bacteria
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- By Ronald N. Jones, JMI Laboratories
- Edited by David Schlossberg
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- Clinical Infectious Disease
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- 05 March 2013
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- 12 May 2008, pp 953-960
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Summary
Since the early 1970s, the enterococci have steadily emerged as major hospital-acquired (nosocomial) pathogens. In statistics from the National Nosocomial Infectious Surveillance System (NNISS), they are the second most common gram-positive cause of nosocomial bloodstream infection and the third most common cause of nosocomial wound infections. In fact, enterococci rank first among gram-positive cocci in producing urinary tract infections (17.4%, see Table 133.1). The significant increases in occurence of this genus since the early to mid-1970s is related to patterns of general antimicrobial use in the hospital and in particular to widespread use of extended-spectrum cephalosporins, β-lactamase inhibitor/penicillin combinations, fluoroquinolones, carbapenems, and aminoglycosides and the emergence of resistances in the genus.
Cephalosporins are not active or bactericidal against enterococci, and they may therefore result in a selective advantage for this genus. Fluoroquinolones are also only modestly active against these species. Enterococcus faecalis produce most human enterococcal infections (70% to 80%), and Enterococcus faecium accounts for most (10% to 16%) of the remainder. Antimicrobial resistance is a particular problem among E. faecium isolates. Other species of interest are Enterococcus casseliflavus and Enterococcus gallinarum, not because of the frequency with which they are isolated, but because of the intrinsic low-level resistance to vancomycin (eg, the vanC genotype and resultant generally intermediate phenotype; minimum inhibitory concentrations [MICs], 4–8 μg/mL).
Surveillance in Taiwan Using Molecular Epidemiology for Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae
- Wen-Liang Yu, Patricia L. Winokur, Ronald N. Jones, Hélio S. Sader
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 25 / Issue 10 / October 2004
- Published online by Cambridge University Press:
- 02 January 2015, pp. 812-818
- Print publication:
- October 2004
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Objective:
To evaluate intrahospital and interhospital clonal dissemination of extended-spectrum beta-lactamase (ESBL)-producing strains of Klebsiella pneumoniae.
Setting:Eight tertiary-care university hospitals and 16 regional hospitals in Taiwan.
Methods:Two hundred eleven confirmed ESBL-producing isolates of K. pneumoniae were collected from January 1998 to June 2000. The isolates were characterized by various typing methods, including antibiogram (9 antimicrobial agents), computer-based ribotyping, pulsed-field gel electrophoresis (PFGE), and isoelectric focusing of beta-lactamase.
Results:Ribotyping identified 70 distinct ribogroups among 200 isolates evaluated. Forty-three of these ribogroups were unique. Eleven ribogroups, comprising 115 isolates, were detected in more than one hospital (interhospital dissemination), whereas 16 groups (42 isolates) were detected in more than one patient within a hospital (intrahospital dissemination). The combination of ribotyping and PFGE identified two large epidemic clones, which were called 691.5/PFGE-G and 595.7/PFGE-A. These epidemic clones were detected mainly in the hospitals located in the northern and central regions of Taiwan. However, variation of the profiles of antibiograms and isoelectric focusing was apparent within each clone. In addition, isolates with the same isoelectric focusing profile (isoelectric points 7.9, 8.2, and 8.4) and antibiogram (resistance to 9 compounds evaluated) were present among different molecular-typed clones.
Conclusions:Our results showed that clonal dissemination (both interhospital and intrahospital dissemination) is occurring in several regions of Taiwan. Rapid computer-based ribotyping associated with PFGE demonstrated multiple epidemic clones of ESBL-producing K. pneumoniae in Taiwan. The combination of phenotypic and molecular methods has proved useful to characterize these epidemic clones.
Molecular Typing and Antimicrobial Susceptibility of Vancomycin-Resistant Enterococcus faecium in Brazil
- Rosangela F. Cereda, Ana C. Gales, Suzane Silbert, Ronald N. Jones, Helio S. Sader
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 23 / Issue 1 / January 2002
- Published online by Cambridge University Press:
- 02 January 2015, pp. 19-22
- Print publication:
- January 2002
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Objectives:
To characterize vancomycin-resistant enterococci (VRE) isolates and to evaluate the mode of dissemination of this pathogen in Brazil.
Design:We collected 22 vancomycin-resistant Enterococcus faecium isolates from 6 medical centers in Sao Paulo, Brazil, and 1 isolate from a medical center in Curitiba, Brazil.
Participants:All Brazilian hospitals that had identified vancomycin-resistant E. faecium up to the beginning of this study (late 1999) contributed isolates to the study.
Methods:The isolates were susceptibility tested using the broth microdilution method and the E-test. The presence of vancomycin resistance genes (vanA, vanB, vanC1, vanC2-3, and vanD) was evaluated by polymerase chain reaction; molecular typing was performed by pulsed-field gel electrophoresis (PFGE).
Results:The vanA gene was demonstrated in all vancomycin-resistant E. faecium, except for 1 isolate. None of the vancomycin resistance genes cited above was detected in the isolate from Curitiba, which was the first vancomycin-resistant E. faecium described in Brazil. All isolates were resistant to ampicillin and teicoplanin. The main clone remains susceptible to doxycycline and chloramphenicol, but intermediate to quinupristin-dalfopristin. PFGE analysis demonstrated 7 major PFGE patterns. A unique PFGE pattern with 4 subtypes was detected in 17 isolates from 4 different hospitals.
Conclusion:The results of our study indicate the occurrence of intra- and interhospital dissemination of VRE in Sao Paulo, Brazil.
A Cluster of Serious Escherichia coli Infections in a Neonatal Intensive-Care Unit
- Daniel J. Diekema, Joan Barr, Linda D. Boyken, Barry J. Buschelman, Ronald N. Jones, Michael A. Pfaller, Loreen A. Herwaldt
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 18 / Issue 11 / November 1997
- Published online by Cambridge University Press:
- 02 January 2015, pp. 774-776
- Print publication:
- November 1997
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A cluster of serious Escherichia coli infections was identified among patients in a neonatal intensive-care unit. Infection control staff identified the outbreak because they realized that E coli rarely caused infections in this unit. Pulsed-field gel electrophoresis confirmed that one strain of E coli was transmitted among patients.
Nosocomial Transmission of Serratia odorifera Biogroup 2: Case Report Demonstration by Macrorestriction Analysis of Chromosomal DNA Using Pulsed-Field Gel Electrophoresis
- Helio S. Sader, Trish M. Perl, Richard J. Hollis, Donna Divishek, Loreen A. Herwaldt, Ronald N. Jones
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 15 / Issue 6 / June 1994
- Published online by Cambridge University Press:
- 02 January 2015, pp. 390-393
- Print publication:
- June 1994
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Objectives:
To investigate a cluster of Serratia odorifera in a cardiothoracic surgery unit (CTSU) and to evaluate the applicability of three typing methods for this species.
Design:During a surveillance surgical wound study, S odorifera was isolated from two patients in the CTSU. The patients' hospital charts were reviewed for the details of surgery and for common personnel, procedures, or medications. Cultures were obtained of water, soap, and unit dose medications from the CTSU, the operating room, and the surgical intensive care unit. The isolates' antibiograms, biotypes (Vitek identification card and API 20E), and patterns of chromosomal DNA (chrDNA) by pulsed-field gel electrophoresis (PFGE) were examined. S odorifera isolates from our organism collection were used as controls.
Setting:A 900-bed university hospital with a 22-bed CISU.
Results:ChrDNA patterns of isolates from the two patients were identical, suggesting a possible nosocomial source. However, no source of organisms or mode of transmission was identified. Neither biotype nor antibiogram were useful for epidemiologically typing S odorifera, and PFGE was necessary to discriminate among isolates.
Conclusions:Although rarely isolated, S odorifera and other non- marcescens Serratia species may cause nosocomial outbreaks. PFGE of chrDNA seems to be a reliable method for epidemiologically typing this species.
Evaluation of Interhospital Spread of Methicillin-Resistant Staphylococcus aureus in Sao Paulo, Brazil, Using Pulsed-Field Gel Electrophoresis of Chromosomal DNA
- Helio S. Sader, Antonio C. Pignatari, Richard J. Hollis, Ronald N. Jones
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 15 / Issue 5 / May 1994
- Published online by Cambridge University Press:
- 02 January 2015, pp. 320-323
- Print publication:
- May 1994
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The widespread dissemination of a single clone of methicillin-resistant Staphylococcus aureus (MRSA) in several hospitals in Sao Paulo could make the intrahospital epidemiologic evaluation of MRSA outbreaks very difficult. The high index of PPD reactivity among our healthcare workers (HCWs) obligates us to develop programs suitable to the prevailing conditions of Latin American hospitals to control TB inside healthcare facilities.
Antibacterial Features of Lubraseptic Jelly
- Martha Bale, Ronald N. Jones
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 15 / Issue 4 / April 1994
- Published online by Cambridge University Press:
- 02 January 2015, pp. 225-226
- Print publication:
- April 1994
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Discussion
- Edited by Jaime De Melo, Université de Genève, Arvind Panagariya, The World Bank
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- New Dimensions in Regional Integration
- Published online:
- 04 May 2010
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- 29 July 1993, pp 79-89
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Summary
In the title of Paul Krugman's stimulating paper I would have been tempted to replace ‘versus’ connecting ‘regionalism’ and ‘multilateralism’ with an ‘and’. Herein, I think, hangs a tale. Those who view the emergence of regional efforts to establish free-trading areas, especially in Europe and North America, as a threat to the more than forty years of efforts of GATT to lower trade barriers on a multilateral basis are driven to compare the benefits of multilateralism with the potential or actual welfare-reducing possibilities of discriminatory regional arrangements. To my knowledge few economists would do an 180° turn on the comparison to argue that regional efforts raise welfare whereas multilateral reductions in trade impediments lower real incomes. ‘Regionalism and multilateralism’ reflects a different point of view: in today's world regionalism and multilateralism can coexist. Indeed, given the strong inclinations of certain regions to pursue closer economic associations among small groups of countries, there is an even more important role for GATT and international consultations to ensure that trading blocs join others in a multilateral effort to reduce obstacles to trade. Choosing between the two is not the option.
Krugman's Chapter 3 is based on a paper that is the third of a sequence inaugurated at a conference in Tel Aviv in 1989 (Krugman, 1991a). In that paper the Krugman touch is well illustrated by his analysis of the effect on world welfare of a systematic joining of countries into trading blocs, with each such bloc imposing an optimal tariff on imports. As the number of blocs decreases (with each getting larger), so does world welfare, with such welfare racing a minimum when there are three such blocs.
Oxacillin- and Quinolone-Resistant Staphylococcus Aureus in Sao Paulo, Brazil: A Multicenter Molecular Epidemiology Study
- Helio S. Sader, Antonio C. Pignatari, Richard J. Hollis, Ivani Leme, Ronald N. Jones
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 14 / Issue 5 / May 1993
- Published online by Cambridge University Press:
- 21 June 2016, pp. 260-264
- Print publication:
- May 1993
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Objective:
To investigate the possibility of interhospital spread of multiresistant Staphylococcus aureus in Sao Paulo, Brazil.
Design:We evaluated 13 nosocomial S aureus strains selected because of resistance to oxacillin and ciprofloxacin.
Setting:The strains were collected between March 1991 and September 1991 from four hospitals in Sao Paulo. Two were teaching hospitals, and two were private hospitals.
Patients:Each strain was isolated from a different patient. All patients were hospitalized when the strains were isolated.
Interventions:The strains were typed by restriction endonuclease analyses of plasmid DNA (REAP) using EcoRI, HindIII, RsaI, and Alu1 and by extended antibiogram profile (34 drugs).
Results:All strains had identical plasmid and antibiogram profile. They demonstrated the same plasmid pattern as previously described in one of the hospitals studied.
Conclusions:Our results suggest the dissemination of a unique oxacillin- and quinolone-resistant strain of S aureus in several hospitals of Sao Paulo, Brazil.
Antimicrobial Prophylaxis of Cesarean Section
- Ronald N. Jones
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 11 / Issue 5 / May 1990
- Published online by Cambridge University Press:
- 21 June 2016, pp. 233-234
- Print publication:
- May 1990
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