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Biomedical subjects

R A Weinstein

Publications and source records attributed to R A Weinstein.

At least 145 records · Page 8Linked to original sources
PubMed1978

An outbreak of pneumocystis pneumonia in children with acute lymphocytic leukemia.

Between Jan 1 and Oct 31, 1975, a cluster of ten cases of pneumocystis pneumonia occurred in children with acute lymphocytic leukemia (ALL) at the James Whitcomb Riley Hospital for Children in Indianapolis. The risk of infection appeared to be related to the intensity of chemotherapy. Furthermore, illness developed in nine of the ten patients between 30 and 100 days after initiation of therapy, suggesting a period of heightened susceptibility to infection. An indirect immunofluorescent test was used to detect antipneumocystis antibodies in serum samples collected from patients with pneumocystis pneumonia and their contacts. Members of the Riley Hospital staff who had close contact with infected children had a higher prevalence of elevated antibody titers (7/12) than other staff members (2/22; P = .004) or parents of infected patients (0/8; P = .01). This suggests that transmission of pneumocystis may occur within the hospital environment.

Adolescent↗
PubMed1978

The role of the microbiology laboratory in surveillance and control of nosocomial infections.

The microbiology laboratory's rapid and consistent identification of nosocomial pathogens is a keystone in the surveillance and control of hospital-acquired infections. In addition, the laboratory serves as a source of expert consultation for clinicians and infection control personnel and as an "early warning center" for infection problems. In making its contributions to infection control most effective, the laboratory must recognize its capabilities and limitations, must insure that the materials and methods it uses and the specimens it processes meet high standards, must provide retrievable records, and must have a good working knowledge of microbiologic technics used to evaluate both endemic and epidemic infections. Moreover, because laboratory workers come into contact daily with potentially infectious specimens and isolates, the laboratory's contributions to infection control should also include the prevention and surveillance of laboratory-acquired infections.

Cross Infection↗
PubMed1977

Pseudoepidemics in hospital.

20 (11%) of 181 nosocomial epidemics investigated by the Center for Disease Control during 1956-75 were actually false outbreaks. In each pseudoepidemic, on-site investigation showed that errors in specimen processing (11), surveillance artefacts (6), or clinical misdiagnosis (3) had resulted in real clusters of false infections or artefactual clusters of real infections. Specimen-processing errors included contamination during collection or transport, cross-contamination in the laboratory, and incorrect identification of organisms. Prevention of pseudoepidemics depends on quality control aimed at avoiding such errors and on close cooperation between laboratory workers and clinicians, to ensure systematic review of incongruous laboratory results.

Bacterial Infections↗
PubMed1976

Pressure monitoring devices. Overlooked source of nosocomial infection.

Contaminated pressure monitoring devices recently have been implicated as a source of epidemic organisms in three outbreaks of nosocomial bacteremia, one outbreak of candidemia, and one outbreak of hepatitis. Measures necessary to prevent monitoring-related infections have not always been appreciated or taken. As a minimum, pressure monitoring devices should be sterilized between use with different patients; strict aseptic technique should be employed when setting up and using monitoring systems; and each patient's monitoring tubing, fluid, and monitoring devices should be changed at regular intervals.

Blood Pressure Determination↗
PubMed1976

Sternal osteomyelitis and mediastinitis after open-heart operation: pathogenesis and prevention.

Sternal osteomyelitis and mediastinitis caused by Pseudomonas cepacia developed in a patient undergoing coronary artery bypass two weeks after the operation. P. cepacia bacteremia from a contaminated pressure transducer had preceded and probably caused the chest infection. While other authors have suggested that postoperative sternal osteomyelitis and mediastinitis result from local wound contamination, this case suggests the importance of bacteremia as a cause of such gram-negative infections. Since patients undergoing open-heart operation are exposed to many sources of bacteremia, prevention of severe postoperative chest infections may depend in large part on careful preoperative evaluation of each patienc antibiotic regimens, and, as shown in this patient, on very thorough periodic review of equipment sterilization and intravascular monitoring practices.

Cardiac Surgical Procedures↗
PubMed1976

Pressure transducers as a source of bacteremia after open heart surgery. Report of an outbreak and guidelines for prevention.

During four weeks in 1974, eight (26 percent) of 31 intensive care unit patients who had undergone open-heart surgery developed symptomatic Pseudomonas cepacia bacteremia in the intensive care unit one to three days after the open-heart surgery. An investigation demonstrated that operating room pressure transducers were being contaminated during cleaning with a detergent that contained P cepacia at the rate of 10(4) organisms per milliliter and that the organisms were transmitted to patients after open-heart surgery as a result of one to three days of contact with transducer-monitoring lines used in the operating room and brought to the intensive care unit with the patient. Pressure-transducer contamination, a frequently unappreciated but preventable cause of nosocomial bacteremia, can be minimized by sterilizing transducers between use on different patients by paying strict attention to aseptic technique when setting up, calibrating, and using monitoring systems; and by changing transducers, tubing, and monitoring fluid for each monitored patient at regular intervals.

Antisepsis↗
PubMed1975

Factitious meningitis. Diagnostic error due to nonviable bacteria in commercial lumbar puncture trays.

A cluster of five false-positive cerebrospinal fluid (CSF) Gram stains led to an investigation of possible causes of specimen or smear contamination. Specimen tubes supplied in commercial lumbar puncture trays from the lot being used in the involved hospital were shown to contain nonviable bacteria, When filled with a test solution and processed in a manner similar to that used for processing CSF specimens, 10 of 12 tubes evaluated yielded Gram stains containing either Gram-negative rods, diplococci, or coccobacilli. Before this problem was recognized, the patient from whom the first false-positive smear was obtained was treated for bacterial meningitis. It is important to realize that microbial contamination of commercial CSF specimen tubes can result in findings simulating those of early bacterial meningitis.

Bacteriological Techniques↗
PubMed1975

Early detection of false-positive acid-fast smears. An epidemiological approach.

An unusual series of positive acid-fast smears, including positive stains of a commercial saline solution, has been studied. Short of waiting 2--6 weeks for culture results, a laboratory investigation of these findings appeared hopeless: repeat staining failed to confirm the origin smear results, and a review of laboratory techniques and supplies failed to pinpoint any source of specimen or smear contamination. An alternative epidemiological approach was adopted. A review of the laboratory records indicated that, during the time the unusual series occurred, there had been a distinct change in the distribution of positive smears by type of specimen submitted and by ward of origin. The change in distribution indicated that the unusual series was probably part of a larger episode of false-positive acid-fast smears caused by random specimen or smear contamination in the hospital laboratory. Culture results eventually confirmed this and showed that the period of random laboratory contamination had ended just before the present investigation (thus explaining the failure of the initial approach). This experience suggests that ongoing analysis of specimen and ward distribution of positive acid-fast smear results will enable hospitals to detect episodes of false-positive smears earlier, thus reducing erroneous diagnoses and permitting prompt evaluation of sources of specimen and smear contamination.

Bacteriological Techniques↗
PubMed1975

Isolation of herpes simplex virus from the cerebrospinal fluid in viral meningitis.

Two cases of meningitis are reported in which the etiologic diagnosis was established by isolation of herpes simplex virus from the cerebrospinal fluid. Both patients were afebrile and had bradycardia when the cultures were obtained, and one patient had been thought to have leukemic meningitis. This experience added to that of others in the literature indicates the value of culture for herpes simplex virus in the cerebrospinal fluid.

Adult↗
PubMedDate not supplied

Control of aminoglycoside resistance by barrier precautions.

The efficacy of antibiotic resistance (barrier) precautions for control of aminoglycoside resistance was evaluated from 1978 to 1981. Despite increasing aminoglycoside use and a 13-fold increase in aminoglycoside-resistant isolates on a newly opened oncology unit, the hospital-wide frequency of aminoglycoside resistant Enterobacteriaceae remained low, supporting the continued value of barrier precautions which were initiated in our hospital in 1974. This control enabled us to focus on exceptions to the effectiveness of barrier precautions. These were traced to environmental reservoirs, very chronic and heavily infected patients, asymptomatic carriers of Serratia, and oncology patients receiving oral non-absorbable aminoglycosides. In addition, resistance in Pseudomonas aeruginosa paralleled aminoglycoside use and, as in our prior experience, continued to rise. With increasing adoption of barrier precautions by others such exceptions should be anticipated.

Aminoglycosides↗
PubMedDate not supplied

The comparative in vitro activity of clinafloxacin and other antimicrobials against vancomycin-susceptible and vancomycin-resistant enterococci.

The susceptibilities of 50 unique vancomycin-susceptible (n = 15) and vancomycin-resistant (n = 35) enterococci to 6 antimicrobials were compared. Teicoplanin was consistently the most active agent for all strains. Ampicillin and imipenem were active primarily for vancomycin-sensitive Enterococcus faecalis. Clinafloxacin and ciprofloxacin showed poorer activity compared to prior studies, suggesting that the emergence of quinolone resistance is now occurring in enterococci.

Ampicillin↗