RESUMEN
BACKGROUND: Surveillance is an effective strategy for reducing surgical site infections (SSIs); however, current identification methods are resource-intensive. Therefore, we sought to validate an electronic SSI triaging tool for detection of probable infections and identify operational barriers and challenges. METHODS: A retrospective cohort study was conducted among all Veterans Affairs Surgical Quality Improvement Program (VASQIP)-reviewed surgeries at 2 Veterans Affairs medical centers from October 1, 2011-September 30, 2014. During the postoperative period, clinical and administrative variables associated with SSI (relevant microbiology order, antibiotic order, radiology order, and administrative codes) were extracted from the electronic medical record and used to score the probability (high, intermediate, and low) that an SSI occurred. VASQIP manual chart review was used as the gold standard of comparison. RESULTS: VASQIP manual review identified 118 SSIs out of 3,700 surgeries (3.2%). There were 2,041, 1,428, and 231 surgeries that met criteria for low, intermediate, and high probability for SSI. The tool's area under the curve was 0.86 (95% confidence interval, 0.82-0.89). The sensitivity among low-probability surgeries was 92.4%, and the specificity among high-probability surgeries was 95.1%. CONCLUSIONS: The electronic SSI tool has the potential to be used for triaging VASQIP surveillance toward the high-probability surgeries and to avoid manual review of surgeries with low probability of SSI.
Asunto(s)
Procedimientos Quirúrgicos Operativos/efectos adversos , Infección de la Herida Quirúrgica/epidemiología , Estudios de Cohortes , Interpretación Estadística de Datos , Registros Electrónicos de Salud , Hospitales de Veteranos/estadística & datos numéricos , Humanos , Pautas de la Práctica en Medicina , Garantía de la Calidad de Atención de Salud , Mejoramiento de la Calidad , Estudios Retrospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/etiología , Triaje , Estados Unidos , United States Department of Veterans Affairs , Estudios de Validación como AsuntoAsunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/prevención & control , Neumonía por Pneumocystis/prevención & control , Pirimetamina/uso terapéutico , Sulfadoxina/uso terapéutico , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Administración por Inhalación , Adolescente , Adulto , Quimioterapia Combinada , Humanos , Masculino , Pentamidina/administración & dosificación , Pentamidina/efectos adversos , Neumonía por Pneumocystis/tratamiento farmacológico , Pirimetamina/efectos adversos , Sulfadoxina/efectos adversos , Sulfadoxina/sangre , Zidovudina/efectos adversos , Zidovudina/uso terapéuticoRESUMEN
OBJECTIVE: Mycobacterium genavense is a newly described pathogen that causes disseminated infection in AIDS. It is difficult to detect and identify due to its slow growth and fastidious nature. There is little information available about therapy for this new pathogen. We describe clinical and laboratory features and response to therapy in four patients with advanced AIDS complicated by disseminated M. genavense infection from Denver, Colorado, USA. DESIGN AND METHODS: Retrospective analysis of four cases identified in an AIDS clinic affiliated with a municipal hospital in Denver, Colorado. Clinical samples were inoculated onto BACTEC 12B, Lowenstein-Jensen, and Middlebrook 7H11 media. RESULTS: The clinical features mimicked those of disseminated M. avium complex infection, with invasion of liver, spleen and lymph nodes with acid-fast bacilli (AFB). Acid-fast smears of blood and lymph nodes were positive; there was a modest increase in the growth index in BACTEC broth and tiny colonies appeared on Middlebrook agar. Patients were treated with combinations of antimycobacterial agents. Blood smears and cultures reverted to negative in treated patients. The best clinical response was associated with clarithromycin therapy. CONCLUSIONS: Disseminated disease due to M. genavense should be suspected among patients with the clinical presentation of disseminated M. avium complex infection and low growth index on BACTEC cultures for AFB. The diagnosis of M. genavense may be facilitated by performing acid-fast stains of samples from BACTEC bottles in such individuals. Clarithromycin therapy is associated with clinical improvement and clearance of bacteremia.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones por Mycobacterium/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Adulto , Humanos , Masculino , Persona de Mediana Edad , Infecciones por Mycobacterium/complicaciones , Infecciones por Mycobacterium/microbiología , Estudios RetrospectivosRESUMEN
A strain of enteroinvasive Escherichia coli was isolated from the blood of a patient with advanced human immunodeficiency virus disease on repeated occasions, associated with severe diarrheal illness. The isolate was killed in vitro by control sera but not by sera collected from the patient before or after his bacterial illnesses.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Bacteriemia/complicaciones , Infecciones por Escherichia coli/complicaciones , Adulto , Bacteriemia/microbiología , Diarrea/complicaciones , Diarrea/microbiología , Sistema Digestivo/microbiología , Escherichia coli/aislamiento & purificación , Escherichia coli/patogenicidad , Infecciones por Escherichia coli/microbiología , Humanos , MasculinoRESUMEN
A method was developed for detection of Listeria monocytogenes by polymerase chain reaction amplification followed by agarose gel electrophoresis or dot blot analysis with a 32P-labeled internal probe. The technique identified 95 of 95 L. monocytogenes strains, 0 of 12 Listeria strains of other species, and 0 of 12 non-Listeria strains.