Journal Article Evidence for Clonal Spread of a Single Strain of β-Lactamase-Producing Enterococcus (Streptococcus) faecalis to Six Hospitals in Five States Get access Barbara E. Murray, Barbara E. Murray Center for Infectious Diseases and Department of Biochemistry, University of Texas Medical School at Houston; Yale University School of Medicine, New Haven, Connecticut; New England Deaconess Hospital, Boston, Massachusetts; Hunter Holmes McGuire Medical Center, Richmond, Virginia; Hospital Nacional de Pediatria, Buenos Aires, Argentina; Hotel Dieu, Beirut, Lebanon; William Beaumont Hospital, Royal Oak, Michigan; Hopital Saint-Joseph, Paris, France; Medical Center of Delaware, Wilmington; University of North Florida, Jacksonville Reprints or correspondence: Dr. Barbara E. Murray, Center for Infectious Diseases, University of Texas Medical School at Houston, 6431 Fannin, 1.728 JFB, Houston, TX 77030. Search for other works by this author on: Oxford Academic PubMed Google Scholar Kavindra V. Singh, Kavindra V. Singh Center for Infectious Diseases and Department of Biochemistry, University of Texas Medical School at Houston; Yale University School of Medicine, New Haven, Connecticut; New England Deaconess Hospital, Boston, Massachusetts; Hunter Holmes McGuire Medical Center, Richmond, Virginia; Hospital Nacional de Pediatria, Buenos Aires, Argentina; Hotel Dieu, Beirut, Lebanon; William Beaumont Hospital, Royal Oak, Michigan; Hopital Saint-Joseph, Paris, France; Medical Center of Delaware, Wilmington; University of North Florida, Jacksonville Search for other works by this author on: Oxford Academic PubMed Google Scholar Sheldon M. Markowitz, Sheldon M. Markowitz Center for Infectious Diseases and Department of Biochemistry, University of Texas Medical School at Houston; Yale University School of Medicine, New Haven, Connecticut; New England Deaconess Hospital, Boston, Massachusetts; Hunter Holmes McGuire Medical Center, Richmond, Virginia; Hospital Nacional de Pediatria, Buenos Aires, Argentina; Hotel Dieu, Beirut, Lebanon; William Beaumont Hospital, Royal Oak, Michigan; Hopital Saint-Joseph, Paris, France; Medical Center of Delaware, Wilmington; University of North Florida, Jacksonville Search for other works by this author on: Oxford Academic PubMed Google Scholar Horacio A. Lopardo, Horacio A. Lopardo Center for Infectious Diseases and Department of Biochemistry, University of Texas Medical School at Houston; Yale University School of Medicine, New Haven, Connecticut; New England Deaconess Hospital, Boston, Massachusetts; Hunter Holmes McGuire Medical Center, Richmond, Virginia; Hospital Nacional de Pediatria, Buenos Aires, Argentina; Hotel Dieu, Beirut, Lebanon; William Beaumont Hospital, Royal Oak, Michigan; Hopital Saint-Joseph, Paris, France; Medical Center of Delaware, Wilmington; University of North Florida, Jacksonville Search for other works by this author on: Oxford Academic PubMed Google Scholar Jan Evans Patterson, Jan Evans Patterson Center for Infectious Diseases and Department of Biochemistry, University of Texas Medical School at Houston; Yale University School of Medicine, New Haven, Connecticut; New England Deaconess Hospital, Boston, Massachusetts; Hunter Holmes McGuire Medical Center, Richmond, Virginia; Hospital Nacional de Pediatria, Buenos Aires, Argentina; Hotel Dieu, Beirut, Lebanon; William Beaumont Hospital, Royal Oak, Michigan; Hopital Saint-Joseph, Paris, France; Medical Center of Delaware, Wilmington; University of North Florida, Jacksonville Search for other works by this author on: Oxford Academic PubMed Google Scholar Mark J. Zervos, Mark J. Zervos Center for Infectious Diseases and Department of Biochemistry, University of Texas Medical School at Houston; Yale University School of Medicine, New Haven, Connecticut; New England Deaconess Hospital, Boston, Massachusetts; Hunter Holmes McGuire Medical Center, Richmond, Virginia; Hospital Nacional de Pediatria, Buenos Aires, Argentina; Hotel Dieu, Beirut, Lebanon; William Beaumont Hospital, Royal Oak, Michigan; Hopital Saint-Joseph, Paris, France; Medical Center of Delaware, Wilmington; University of North Florida, Jacksonville Search for other works by this author on: Oxford Academic PubMed Google Scholar Etelvina Rubeglio, Etelvina Rubeglio Center for Infectious Diseases and Department of Biochemistry, University of Texas Medical School at Houston; Yale University School of Medicine, New Haven, Connecticut; New England Deaconess Hospital, Boston, Massachusetts; Hunter Holmes McGuire Medical Center, Richmond, Virginia; Hospital Nacional de Pediatria, Buenos Aires, Argentina; Hotel Dieu, Beirut, Lebanon; William Beaumont Hospital, Royal Oak, Michigan; Hopital Saint-Joseph, Paris, France; Medical Center of Delaware, Wilmington; University of North Florida, Jacksonville Search for other works by this author on: Oxford Academic PubMed Google Scholar George M. Eliopoulos, George M. Eliopoulos Center for Infectious Diseases and Department of Biochemistry, University of Texas Medical School at Houston; Yale University School of Medicine, New Haven, Connecticut; New England Deaconess Hospital, Boston, Massachusetts; Hunter Holmes McGuire Medical Center, Richmond, Virginia; Hospital Nacional de Pediatria, Buenos Aires, Argentina; Hotel Dieu, Beirut, Lebanon; William Beaumont Hospital, Royal Oak, Michigan; Hopital Saint-Joseph, Paris, France; Medical Center of Delaware, Wilmington; University of North Florida, Jacksonville Search for other works by this author on: Oxford Academic PubMed Google Scholar Louis B. Rice, Louis B. Rice Center for Infectious Diseases and Department of Biochemistry, University of Texas Medical School at Houston; Yale University School of Medicine, New Haven, Connecticut; New England Deaconess Hospital, Boston, Massachusetts; Hunter Holmes McGuire Medical Center, Richmond, Virginia; Hospital Nacional de Pediatria, Buenos Aires, Argentina; Hotel Dieu, Beirut, Lebanon; William Beaumont Hospital, Royal Oak, Michigan; Hopital Saint-Joseph, Paris, France; Medical Center of Delaware, Wilmington; University of North Florida, Jacksonville Search for other works by this author on: Oxford Academic PubMed Google Scholar Fred W. Goldstein, Fred W. Goldstein Center for Infectious Diseases and Department of Biochemistry, University of Texas Medical School at Houston; Yale University School of Medicine, New Haven, Connecticut; New England Deaconess Hospital, Boston, Massachusetts; Hunter Holmes McGuire Medical Center, Richmond, Virginia; Hospital Nacional de Pediatria, Buenos Aires, Argentina; Hotel Dieu, Beirut, Lebanon; William Beaumont Hospital, Royal Oak, Michigan; Hopital Saint-Joseph, Paris, France; Medical Center of Delaware, Wilmington; University of North Florida, Jacksonville Search for other works by this author on: Oxford Academic PubMed Google Scholar ... Show more Stephen G. Jenkins, Stephen G. Jenkins Center for Infectious Diseases and Department of Biochemistry, University of Texas Medical School at Houston; Yale University School of Medicine, New Haven, Connecticut; New England Deaconess Hospital, Boston, Massachusetts; Hunter Holmes McGuire Medical Center, Richmond, Virginia; Hospital Nacional de Pediatria, Buenos Aires, Argentina; Hotel Dieu, Beirut, Lebanon; William Beaumont Hospital, Royal Oak, Michigan; Hopital Saint-Joseph, Paris, France; Medical Center of Delaware, Wilmington; University of North Florida, Jacksonville Search for other works by this author on: Oxford Academic PubMed Google Scholar Gregory M. Caputo, Gregory M. Caputo Center for Infectious Diseases and Department of Biochemistry, University of Texas Medical School at Houston; Yale University School of Medicine, New Haven, Connecticut; New England Deaconess Hospital, Boston, Massachusetts; Hunter Holmes McGuire Medical Center, Richmond, Virginia; Hospital Nacional de Pediatria, Buenos Aires, Argentina; Hotel Dieu, Beirut, Lebanon; William Beaumont Hospital, Royal Oak, Michigan; Hopital Saint-Joseph, Paris, France; Medical Center of Delaware, Wilmington; University of North Florida, Jacksonville Search for other works by this author on: Oxford Academic PubMed Google Scholar R. Nasnas, R. Nasnas Center for Infectious Diseases and Department of Biochemistry, University of Texas Medical School at Houston; Yale University School of Medicine, New Haven, Connecticut; New England Deaconess Hospital, Boston, Massachusetts; Hunter Holmes McGuire Medical Center, Richmond, Virginia; Hospital Nacional de Pediatria, Buenos Aires, Argentina; Hotel Dieu, Beirut, Lebanon; William Beaumont Hospital, Royal Oak, Michigan; Hopital Saint-Joseph, Paris, France; Medical Center of Delaware, Wilmington; University of North Florida, Jacksonville Search for other works by this author on: Oxford Academic PubMed Google Scholar Lynn S. Moore, Lynn S. Moore Center for Infectious Diseases and Department of Biochemistry, University of Texas Medical School at Houston; Yale University School of Medicine, New Haven, Connecticut; New England Deaconess Hospital, Boston, Massachusetts; Hunter Holmes McGuire Medical Center, Richmond, Virginia; Hospital Nacional de Pediatria, Buenos Aires, Argentina; Hotel Dieu, Beirut, Lebanon; William Beaumont Hospital, Royal Oak, Michigan; Hopital Saint-Joseph, Paris, France; Medical Center of Delaware, Wilmington; University of North Florida, Jacksonville Search for other works by this author on: Oxford Academic PubMed Google Scholar Edward S. Wong, Edward S. Wong Center for Infectious Diseases and Department of Biochemistry, University of Texas Medical School at Houston; Yale University School of Medicine, New Haven, Connecticut; New England Deaconess Hospital, Boston, Massachusetts; Hunter Holmes McGuire Medical Center, Richmond, Virginia; Hospital Nacional de Pediatria, Buenos Aires, Argentina; Hotel Dieu, Beirut, Lebanon; William Beaumont Hospital, Royal Oak, Michigan; Hopital Saint-Joseph, Paris, France; Medical Center of Delaware, Wilmington; University of North Florida, Jacksonville Search for other works by this author on: Oxford Academic PubMed Google Scholar George Weinstock George Weinstock Center for Infectious Diseases and Department of Biochemistry, University of Texas Medical School at Houston; Yale University School of Medicine, New Haven, Connecticut; New England Deaconess Hospital, Boston, Massachusetts; Hunter Holmes McGuire Medical Center, Richmond, Virginia; Hospital Nacional de Pediatria, Buenos Aires, Argentina; Hotel Dieu, Beirut, Lebanon; William Beaumont Hospital, Royal Oak, Michigan; Hopital Saint-Joseph, Paris, France; Medical Center of Delaware, Wilmington; University of North Florida, Jacksonville Search for other works by this author on: Oxford Academic PubMed Google Scholar The Journal of Infectious Diseases, Volume 163, Issue 4, April 1991, Pages 780–785, https://doi.org/10.1093/infdis/163.4.780 Published: 01 April 1991 Article history Received: 23 July 1990 Revision received: 03 October 1990 Published: 01 April 1991
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The symptoms, signs, and laboratory findings for 69 women who seen at a sexually transmitted diseases (STD) clinic and who had acute urinary tract infection (UTI) were compared with those for women who had vaginitis, gonorrhea, or chlamydial infection. Escherichia coli and Staphylococcus saprophyticus were the two most common causes of acute cystitis in this population and accounted for 62 (90%) of 69 infections. Forty-three percent of the women had positive tests for antibody-coated bacteria (ACB), an observation implying renal infection although symptoms of upper tract infection were infrequent. Frequency, urgency, dysuria, and suprapubic tenderness were significantly associated with cystitis, whereas vaginal discharge and vulvar itching were associated with vaginitis. There was, however, considerable overlap in symptoms among the four groups of women, and their accurate differentiation required objective information based upon pelvic examination, examination of vaginal fluid, and urinalysis. In the absence of vaginitis on wet mount and mucopurulent cervicitis on examintation, pyuria, as determined by examination of centrifuged urine, had an 88% sensitivity, 76% specificity, 61% positive predictive value, and 93% negative predictive value for acute UTI. Because of the high pervalence of positive ACB tests and the possibility that infection with Chlamydia trachomatis and/or Neisseria gonorrhoeae may be mistaken for cystitis, we prefer a five-to seven-day course of antibiotics over single-dose therapy for treatment of patients with possible UTI in the setting of an STD clinic.
In Reply. —We believe our choice of patient-care months as the denominator for occupational exposures is neither inappropriate nor misleading. In our study, we were interested in the difference in the frequency of occupational exposures before and after implementation of UPs and, specifically, with regard to needlestick injuries, the percent reduction as a result of UPs (ie, the rate of injuries after implementation divided by the rate of injuries before implementation). For this calculation, it is clear that the choice of denominators is irrelevant since they cancel out. We contend that the risk of needlestick injuries is procedure-dependent and the number of patients cared for on the study wards is the most important determinant of the number of procedures performed. Since we observed no variations in the month-to-month patient census or any changes in ward practices during the study period, we attributed the reduction in the frequency of exposures to
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Abstract Objective: To prospectively examine the epidemiology of blood and body fluid exposures sustained by medicine housestaff, medical school students, registered nurses (RNs), licensed practical nurses (LPNs), and nurses' aides (NAs) on general medicine wards and to define problem areas that may be amenable to change. Design: Daily data collection during 9 months using a self-reporting questionnaire. Setting: General medical wards in 2 tertiary referral hospitals. Participants: Medicine housestaff/students and nursing personnel. Results: Physicians reported 644 exposures, of which 98 (15.2%), 296 (46.0%), and 250 (38.8%) were sustained by medicine residents, interns, and students, respectively. Blood contact occurred with 591 (91.8%) exposures. For physicians, 575 (89.3%) exposures occurred during venipuncture, intravenous catheter manipulation, and arterial punctures. Interns and students most commonly incurred exposures during venipunctures and intravenous manipulations; residents commonly were exposed during emergent intravenous catheter placements. Five-hundred-twenty-two (8 1%) exposures occurred between 7 A.M. and 7 P.M. During 524 (81.4%) exposures, physicians were not using barrier devices. Nurses reported 235 exposures, of which 140 (59.6%), 23 (9.8%), and 72 (30.6%) were sustained by RNs, LPNs, and NAs, respectively. RN exposures commonly occurred during intravenous manipulations and glucometer fingersticks. LPNs and NAs incurred a higher percentage of exposures during nonprocedural patient care. Blood contact and wound drainage accounted for 167 (71.1%) and 31 (13.2%) exposures, respectively. Conclusions: Exposures to blood and body fluids frequently are incurred by healthcare workers on general medical wards. Efforts to reduce these exposures should be directed not only at improving procedural skills of healthcare workers for venipunctures, intravenous catheter insertions, and glucometer fingersticks, but also in increasing barrier use during procedural and nonprocedural tasks.
