Clinical infectious diseases : an official publication of the Infectious Diseases Society of America
-
Ventilator-associated pneumonia (VAP), the most common hospital-acquired infection in intensive care units, increases mortality and health care costs. We describe the long-term impact of a multifaceted program for decreasing VAP rates that markedly improved compliance with 8 targeted preventive measures. ⋯ Our preventive program produced sustained VAP rate decreases in the long term. However, VAP rates remained substantial despite high compliance with preventive measures, suggesting that eliminating VAP in the intensive care unit may be an unrealistic goal.
-
To describe the distribution and temporal trends of the quality and strength of evidence supporting recommendations in the Infectious Diseases Society of America (IDSA) clinical practice guidelines. ⋯ The IDSA guideline recommendations are primarily based on low-quality evidence derived from nonrandomized studies or expert opinion. These findings highlight the limitations of current clinical infectious diseases research that can provide high-quality evidence. There is an urgent need to support high-quality research to strengthen the evidence available for the formulation of guidelines.
-
Randomized Controlled Trial
Influenza virus contamination of common household surfaces during the 2009 influenza A (H1N1) pandemic in Bangkok, Thailand: implications for contact transmission.
Rational infection control guidance requires an improved understanding of influenza transmission. We studied households with an influenza-infected child to measure the prevalence of influenza contamination, the effect of hand washing, and associations with humidity and temperature. ⋯ We documented influenza virus RNA contamination on household surfaces and on the fingertips of ill children. Homes with younger children were more likely than homes of older children to have contaminated surfaces. Lower absolute humidity favors surface contamination in households with multiple infections. Increased hand washing can reduce influenza contamination in the home.
-
Review
The unique issues of outpatient parenteral antimicrobial therapy in children and adolescents.
The decision to discharge a hospitalized child or adolescent to receive outpatient parenteral antimicrobial therapy (OPAT) is based on criteria very different from those concerning adults. Clinical studies of pediatric OPAT are sparse, as are pharmacokinetic data for antimicrobial agents in children. ⋯ The psychological disadvantage of hospitalization in children, compared with adults, is great, and both populations are equally vulnerable to nosocomial infection, increasingly augmented by multidrug-resistant organisms. Although the relatively few clinical studies involving OPAT in children attest to its efficacy and safety, well-designed prospective trials and comprehensive cost-benefit analyses are still needed.