Showing papers by "Donald A. Goldmann published in 1991"
TL;DR: In this paper, a case-control study among 882 infants treated in two neonatal intensive care units during 1982 was conducted to investigate potential risk factors for this nosocomial infection.
176 citations
TL;DR: In this paper, active and passive immunization against capsular polysaccharide adhesin (PS/A) was investigated in a rabbit model to prevent Staphylococcus epidermidis endocarditis.
Abstract: BACKGROUNDStaphylococcus epidermidis is the principal pathogen in prosthetic valve endocarditis. The capsular polysaccharide adhesin (PS/A) has been shown to mediate attachment of bacteria to medical devices. In this study, we investigated the efficacy of active and passive immunization against PS/A in preventing S. epidermidis endocarditis in a rabbit model.METHODS AND RESULTSAortic valve vegetations were produced by inserting a Teflon catheter into the left ventricle through the right carotid artery. Bacteremia and endocarditis were then established by implanting in the left jugular vein a catheter that was attached to an osmotic pump and contaminated with S. epidermidis strain RP62A. During a 3-week study period, of 64 blood cultures taken every second or third day from six nonimmune rabbits, 54 (84%) yielded strain RP62A. In rabbits actively immunized with PS/A, eight of 60 blood cultures (13%) were positive (odds ratio 5.0, 95% CI, 2.0-12.3, p = 0.005). At death, all six nonimmune rabbits had infecte...
81 citations
TL;DR: The results indicate that the beta-lactamase genes and gentamicin resistance genes in these strains are integrated into the bacterial chromosome and the cotransmissibility of the resistance determinants raises the possibility of their incorporation into a multiresistance transposable genetic element.
Abstract: We have analyzed four distinct strains of multiply resistant, beta-lactamase-producing enterococci isolated during an outbreak of colonization with these strains on an infant-toddler surgical ward at The Children's Hospital in Boston, Mass. All four strains were resistant to erythromycin, penicillin, and tetracycline and to high levels of gentamicin and streptomycin. One strain was also resistant to chloramphenicol. Plasmid profiles revealed four different plasmid patterns, with the number of identified plasmids ranging from zero to three. The gene coding for beta-lactamase production could be transferred at low frequency (less than 10(-8)) to an enterococcal recipient from one strain in conjunction with all of the other resistance determinants. Probes derived from the staphylococcal beta-lactamase gene and gentamicin resistance gene failed to hybridize with any of the detectable plasmids, but both genes were present on restriction fragments of genomic DNA in all strains. Our results indicate that the beta-lactamase genes and gentamicin resistance genes in these strains are integrated into the bacterial chromosome. The cotransmissibility of the resistance determinants raises the possibility of their incorporation into a multiresistance transposable genetic element.
70 citations
TL;DR: Catheters coated in vitro bound fewer organisms than uncoated catheters and host proteins do not enhance adherence of coagulase-negative staphylococci to biomaterials.
Abstract: We studied the effects of in vitro and in vivo coating of catheters with human blood proteins on binding of coagulase-negative staphylococci. Coating resulted in no enhancement of binding. Catheters coated in vitro bound fewer organisms than uncoated catheters. Host proteins do not enhance adherence of coagulase-negative staphylococci to biomaterials.
67 citations
TL;DR: It is not clear whether gloves are superior to handwashing (if performed obsessionally) in this respect, and there is little evidence that gowns confer additional benefit, but barrier precautions can substantially reduce the risk of some infections, such as respiratory syncytial virus disease.
56 citations
TL;DR: It is concluded that it may be difficult to implement and sustain improvements in clinical practice in the absence of an infection control infrastructure and a strong commitment by hospital clinicians and administrators.
36 citations
TL;DR: Routine monitoring of antibiotic resistance at Children's Hospital, Boston, detected a dramatic increase in the prevalence of imipenem-resistant strains of Pseudomonas aeruginosa, which was due, in part, to the loss of imIPenem potency in customized MIC microdilution trays supplied by Sensititre Ltd.
Abstract: Routine monitoring of antibiotic resistance at Children9s Hospital, Boston, detected a dramatic increase in the prevalence of imipenem-resistant strains of Pseudomonas aeruginosa. Further studies documented that false resistance to imipenem was due, in part, to the loss of imipenem potency in customized MIC microdilution trays supplied by Sensititre Ltd. (West Sussex, United Kingdom). Recognition of the problem was delayed by use of the quality control standard recommended by the manufacturer, which were higher and broader than those suggested by the National Committee for Clinical Laboratory Standards.
24 citations
TL;DR: Hospital epidemiologists should collaborate more closely with clinical and bench investigators in a number of areas, including microbial pathogenesis, immunology, and biotechnology, to help them trace the spread of nosocomial pathogens.
15 citations
Journal Article•
2 citations