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T R Townsend

Publications and source records attributed to T R Townsend.

32 records · Page 2Linked to original sources
PubMed1981

Nosocomial bloodstream infections in a newborn intensive care unit: a case-matched control study of morbidity, mortality and risk.

Routine surveillance of 1252 newborns admitted over a four-year period to a newborn intensive care unit (ICU) identified 49 (4%) with nosocomial bloodstream infections. Forty-nine control subjects without such infections were selected, matching for birth weight, gestational age, and at least three diagnoses per patient. Overall, 27% of cases and 6% of controls died (p = 0.01) and significant differences persisted when cases with multiple bloodstream infections were removed from analysis. Although small numbers of case-control pairs remained for analysis, significant differences disappeared when cases with multiple bloodstream infections plus case-control pairs discordant for presence/absence of nosocomial infections at other sites were eliminated from comparison. On the average, all cases and controls were hospitalized for 70 +/- 14 days and 50 +/- 8 days, respectively, but when cases with multiple bloodstream infections or the multiple bloodstream infections-discordant pair group were removed from analysis, the significant difference in hospitalization disappeared. A strong association between nosocomial infections at sites other than the bloodstream and bloodstream infections was demonstrated and may suggest a means of reducing the incidence of bloodstream infections in a high risk population.

Bacterial Infections↗
PubMed1981

Are surveillance of resistant enteric bacilli and antimicrobial usage among neonates in a newborn intensive care unit useful?

From March 1976 through December 1978, the prevalence of ampicillin- and gentamicin-resistant enteric bacilli was monitored in fecal cultures of neonates in an intensive care unit. Substantial fluctuations in colonization rates were observed which did not correlate with the occurrence of sepsis due to these organisms nor with variations in antibiotic use. This experience suggests that the availability of these surveillance data did not result in more effective control of neonatal sepsis due to enteric bacilli.

Ampicillin↗
PubMed1979

Use of antimicrobial drugs in general hospitals: patterns of prophylaxis.

The patterns of prophylactic use of antimicrobial drugs were reviewed in 5288 charts drawn by a random method from 20 randomly selected short-stay general hospitals in Pennsylvania. About 10 per cent of hospitalized patients received antimicrobial drugs for prophylaxis in operations or nonsurgical procedures, and prophylaxis accounted for about 30 per cent of all antimicrobial drugs administered in hospitals. The drugs used most often for prophylaxis were cephalosporins, followed by benzyl penicillins, ampicillin and tetracyclines, in that order. Despite indications that prophylaxis, when useful at all, is effective only when given concurrently with and for 24 to 48 hours after operation, it was usually continued throughout hospitalization. Almost 80 per cent of prophylactic antimicrobial drugs were administered at least 48 hours after an operation or procedure -- suggesting that limiting prophylaxis to the first 24 to 48 hours, as currently recommended, would substantially reduce expenditures for antimicrobial drugs in hospitals.

Ampicillin↗
PubMed1979

Use of antimicrobial drugs in general hospitals. I. Description of population and definition of methods.

The patterns of use of antimicrobial drugs in a random sample of general hosptials in Pennsylvania were studied. The sample was tested for validity, and all deaths and discharges were analyzed for 10 random days drawn across the year spanning July 1973 to June 1974. Methods were developed for abstracting the hospital records and for determining the reproducibility of the findings of the physician and nonphysician chart reviewers. More than 99% of the requested charts were available. In the 5,288 charts reviewed, most of the required data were readily available. The study population was 84% white and 58% female; most patients were in hospitals that had more than 300 beds and that were located in towns with populations of greater than 10,000. In 41% of the 2,070 antimicrobial courses administered to almost 30% of the patients, an explicit clinical statement of why the drug was being given could be found in the chart. The information for review was found in clinical charts, but in half of the charts, the information required was not on face sheets and discharge summaries.

Anti-Bacterial Agents↗
PubMed1979

Use of antimicrobial drugs in general hospitals. II. Analysis of patterns of use.

The hospital charts were surveyed of 5,288 patients in 20 hospitals that were randomly selected from the 194 general hospitals in Pennsylvania. Antimicrobial drugs were administered to 28% of the patients, with little variation in pattern according to hospital size. Surgical services accounted for 61% of the patients who received antimicrobial drugs, and the proportion of patients receiving such drugs varied from 84% on thoracic and cardiovascular surgical services to 13% on obstetrical services. General medicine accounted for 29% of the patients who received antimicrobial drugs and pediatrics for 9%. Eight percent of the hospital population accounted for 50% of all antimicrobial drugs used. Ampicillin was the most frequently used drug, being given in 22% of all courses, with cephalosporins (18%), benzylpenicillins (14%), and tetracycline (13%) next in order. Approximately 30% of the antimicrobial courses were used for prophylaxis.

Anti-Bacterial Agents↗
PubMed1979

Development of a statewide program for surveillance and reporting of hospital-acquired infections.

In 1974, a statewide program was begun to improve surveillance of nosocomial infection in Virginia hospitals. Infection control practitioners were trained at the University of Virginia Hospital, Charlottesville, and were encouraged to submit monthly surveillance reports for analysis. In the first three years of the project, 141 students from 65 hospitals within the state attended a two-week basic course, with eight to 10 students per class. Of the 98 Virginia hospitals that sent students, 75 (73%) submitted monthly reports. The consistency of reporting (number of monthly reports received divided by the number of possible reporting months) was 83%. The sensitivity of reported data was estimated in comparative daily prospective surveys to be 69% for participating hospitals, and the specificity was 99%. The crude infection rate for the first 1.1 million patients at risk was 3.3%.

Cross Infection↗
PubMed1979

Use of antimicrobial drugs in general hospitals: IV. Infants and children.

The use of antimicrobial drugs was studied among 933 randomly selected infants and children who were hospitalized in 20 short-stay general hospitals in Pennsylvania. Twenty-two percent of pediatric patients received antimicrobial drugs: 5% of neonates and 57% of patients aged 12 to 18 months. Sixty-eight percent of the 265 antimicrobial courses administered to these children consisted of a penicillin or a penicillin analogue. Ampicillin was the single drug most frequently administered and was given in 32% of all courses. In contrast to the findings in older children, penicillin or penicillin analogues and aminoglycosides were the only antimicrobial drug groups administered to neonataes. Seventy-nine percent of courses were initiated for proved or suspected infections and 17% were initiated to prevent infections associated with surgical or nonsurgical invasive procedures. Cultures were associated with the initiation of 84% of courses among neonates and 39% of courses among children 6 to 9 years of age. This study provides the initial information, from data derived from randomly selected general hospitals, to permit a statement of norms of practice with respect to use of antimicrobial drugs in pediatric populations.

Adolescent↗
PubMed1977

Morbidity/mortality and economics of hospital-acquired blood stream infections: a controlled study.

A controlled study of mortality, length of hospital stay, and cost of hospitalization in 40 patients with hospital-acquired blood stream infections and 40 similarly ill patients without blood stream infections was done. Patients with septicemia were identified by ongoing routine surveillance, while controls were selected from computer surveys of similarly aged patients matched for primary diagnosis of operation or both. Bacteremic cases for which no matched controls could be obtained and 109 additional cases of blood stream infection occurring after the study period were also characterized to determine any gross bias in the process of case selection. Mortality in bacteremic patients was 38% compared to 10% in controls; median hospital stay was 33 days for bacteremic patients and cost was $6,692, compared to 14 days' hospitalization and $2,322 cost for controls. Mortality among the unmatched cases as well as the 109 additional cases was 34%. The excess morbidity, mortality, and hospitalization costs offer a better estimate of the direct effects of the hospital-acquired blood stream infection.

Adult↗
PubMedDate not supplied

Prophylactic antibiotic therapy with cefamandole and tobramycin for patients undergoing renal transplantation.

The incidence of infections among patients undergoing renal transplantation has been reported as high as 83% during the first post-transplant year. In an effort to reduce the occurrence of such infections, we evaluated the role of perioperative prophylactic antibiotics in these patients. Thirty-seven patients undergoing transplantation were assigned randomly to treatment groups (N = 20, cefamandole, 1 gm IM every 6 hrs for 8 doses/tobramycin 1 mg/kg IM for 1 dose, starting 2 hrs prior to surgery) and control groups (N = 17, no antibiotics). A uniform infection surveillance system was used. Eighty-one percent (30/37) of patients became infected; 70% (14/20) of treated patients and 94% (16/17) of controls (p = 0.14). Since antibiotic prophylaxis might be expected to exert the greatest influence in the immediate postoperative period, we examined patient outcome data for both the first seven posttransplant days and for the entire hospitalization. Of the 38% (14/37) of patients who developed infections during the first posttransplant week, a statistically greater proportion came from the control group than from the treated group (10/17 vs. 4/20, p = 0.04). These data suggest that this regimen is effective in reducing the occurrence of infections during the first week following renal transplantation.

Adult↗
PubMedDate not supplied

An efficacy evaluation of a synergized glutaraldehyde-phenate solution in disinfecting respiratory therapy equipment contaminated during patient use.

Reusable, corrugated, expiratory limb ventilator tubing that had been in use for 24 hours, were randomly allocated to one of three groups: no treatment (N = 36); detergent wash (N = 83); or a detergent wash followed by a 10 minute immersion in a 1:16 dilution of synergized glutaraldehyde-phenate solution which was reused for 30 days. (Between 10 and 22 tubes were tested in each five day interval during this 30-day period.) Tubes were quantitatively and qualitatively cultured. There were significant differences in both the percent of contaminated tubes (no treatment = 92%, detergent wash = 72%, glutaraldehyde-phenate = 0 to 20%) and numbers of microorganisms per tube (no treatment = 3.2 x 10(6), detergent wash = 1.3 x 10(4), glutaraldehyde-phenate = 0 to 182) between groups. There was no apparent decrease in glutaraldehyde-phenate's efficacy throughout the 30-day reuse period, and in the final five days of the reuse period it was completely effective.

Aldehydes↗
PubMedDate not supplied

Comparison of broth and filtration methods for culturing of intravenous fluids.

Ninety-six specimens of intravenous fluid solutions (D5/025 NS) were inoculated with S. aureus, E. coli, P. aeruginosa, K. pneumoniae, E. agglomerans, or C. albicans in concentrations of .1, 1, 10, or 10(2) organisms/ml. They were cultured in tubes containing 5 ml of double enriched broth and after passage through a .45 mu pore membrane filter. After 24 hours of incubation, broth cultures were 68% as sensitive as the filter cultures (p less than .001). At the lowest concentration (.1 organism/ml) broth cultures wer only 45% as sensitive as the membrane filter technique after 24 hours of growth (p less than .001). Membrane filters provide a rapid method to accurately detect and quantitate the presence of microbial contamination even at very low levels of concentration. The simplicity and accuracy of the filtration method offers the clinician a valuable adjunct in managing suspected cases of intravenous fluid related sepsis.

Bacteria↗