We performed a prospective study of bloodstream infection to determine factors independently associated with mortality. Between February 1999 and July 2000, 929 consecutive episodes of bloodstream infection at two tertiary care centers were studied. An ICD-9-based Charlson Index was used to adjust for underlying illness. Crude mortality was 24% (14% for community-onset versus 34% for nosocomial bloodstream infections). Mortality attributed to the bloodstream infection was 17% overall (10% for community-onset versus 23% for nosocomial bloodstream infections). Multivariate logistic regression revealed the independent associations with in-hospital mortality to be as follows: nosocomial acquisition (odds ratio [OR] 2.6, P < 0.0001), hypotension (OR 2.6, P < 0.0001), absence of a febrile response (P ‫؍‬ 0.003), tachypnea (OR 1.9, P ‫؍‬ 0.001), leukopenia or leukocytosis (total white blood cell count of <4,500 or >20,000, P ‫؍‬ 0.003), presence of a central venous catheter (OR 2.0, P ‫؍‬ 0.0002), and presence of anaerobic organism (OR 2.5, P ‫؍‬ 0.04). Even after adjustments were made for underlying illness and length of stay, nosocomial status of bloodstream infection was strongly associated with increased total hospital charges (P < 0.0001). Although accounting for about half of all bloodstream infections, nosocomial bloodstream infections account for most of the mortality and costs associated with bloodstream infection.Bloodstream infections cause substantial morbidity and mortality (7,18,24). Increasing rates of antimicrobial resistance (1, 6-8, 21), changing patterns of antimicrobial usage (8), and the wide application of new medical technologies (e.g., indwelling catheters and other devices) may change the epidemiology and outcome of bloodstream infection. It is therefore important to continually review and update the epidemiology and outcome of bloodstream infection, including an examination of the variables most strongly associated with mortality. Understanding these variables will help to prioritize resources and plan strategies for decreasing the mortality associated with bloodstream infection.We sought to determine the current epidemiology and outcome of bloodstream infection by prospectively evaluating consecutive patients at two large tertiary-care hospitals. Using multivariate models and controlling for underlying illness, we sought to determine which variables were most strongly and independently associated with mortality among patients with bloodstream infection. We were particularly interested in the relative contributions of nosocomial bloodstream infection to the overall mortality and costs associated with bloodstream infection.

We analyzed antimicrobial use in 509 episodes of clinically significant bloodstream infection to assess the impact that microbiology laboratory reporting had on antimicrobial management. Most therapy interventions occurred at the time of phlebotomy and after notification of Gram stain results by telephone. Release of antimicrobial susceptibility data had the least impact on antimicrobial management. The clinical microbiology laboratory plays a significant role in the management of patients with BSI. Culturing a pathogenic microorganism from blood is a highly specific indicator of BSI, and performance of antimicrobial susceptibility testing (AST) may assist in the appropriate use of antimicrobial therapy for patients with BSI (2, 4, 6). Furthermore, early and rapid administration of antimicrobial therapy to patients with BSI has been shown to reduce mortality (8-13).The purpose of this study was to evaluate the association between positive blood culture reporting by the clinical microbiology laboratory and the antimicrobial management of patients with BSI. Findings from consecutive episodes of BSI at the University of Iowa Hospitals and Clinics over a 13-month period are summarized.All patients at the University of Iowa Hospitals and Clinics from July 1999 through July 2000 with a positive signal from the BacT/Alert continuous monitoring blood culture system (bioMérieux, Marcy l'Etoile, France) were screened for inclusion in this study. An episode of BSI was considered to have begun at the time the initial positive blood culture was obtained. Referral blood cultures from outside facilities and autopsy blood cultures, as well as patients with false-positive signals (no organisms observed on Gram stain or cultivated from bottle subculture) and patients not admitted to the hospital, were excluded from the study.Of the 509 episodes of bacteremia characterized in this study, 59% were judged to be hospital acquired; the remaining 41% were judged to be community acquired. The following percentages of bacteremic episodes occurred in the patients studied: Յ1 year of age, 8%; 1 to 15 years of age, 11%; 16 to 39 years of age, 18%; 40 to 59 years of age, 32%; 60 to 79 years of age, 28%; 80 to 101 years of age, 4%. Thirty percent of patients were hospitalized in intensive-care units at the time of the septic episode; the remaining patients were in general-care areas. The six most common causes of bacteremia in this study were Staphylococcus aureus (20% of episodes), Escherichia coli (14%), coagulase-negative staphylococci (13%), enterococci (12%), Pseudomonas aeruginosa (6%), and Klebsiella pneumoniae (5%).Each positive blood culture was critically assessed and categorized as clinically significant or not clinically significant, taking into account clinical signs and symptoms, white blood cell count, number of blood samples culture positive out of the total number drawn, results of other cultures, pathology findings, imaging results, and clinical course. All indeterminate cases were reviewed by an infectious disease physician...

We found that

Copper in various forms has been known to have bactericidal activity. Challenges to its application include preventing mobilization of the copper, to both extend activity and avoid toxicity, and bioincompatibility of many candidate substrates for copper immobilization. Using a simple ionic liquid, butylmethylimmidazolium chloride as the solvent, we developed a facile and green method to synthesize biocompatible composites containing copper oxide nanoparticles (CuONPs) from cellulose (CEL) and chitosan (CS) or CEL and keratin (KER). Spectroscopy and imaging results indicate that CEL, CS, and KER remained chemically intact and were homogeneously distributed in the composites with CuONPs with size of 22 ± 1 nm. Electron paramagnetic resonance (EPR) suggests that some 25% of the EPR-detectable Cu(II) is present as a monomeric species, chemically anchored to the substrate by two or more nitrogen atoms, and, further, adopts a unique spatially oriented conformation when incorporated into the [CEL + CS] composite but not in the [CEL + KER] composite. The remaining 75% of EPR-detectable Cu(II) exhibited extensive spin-spin interactions, consistent with Cu(II) aggregates and Cu(II) on the surface of CuONPs. At higher levels of added copper (>59 nmol/mg), the additional copper was EPR-silent, suggesting an additional phase in larger CuONPs, in which S > 0 spin states are either thermally inaccessible or very fast-relaxing. These data suggest that Cu(II) initially binds substrate via nitrogen atoms, from which CuONPs develop through aggregation of copper. The composites exhibited excellent antimicrobial activity against a wide range of bacteria and fungi, including methicillin-resistant Staphylococcus aureus; vancomycin-resistant Enterococcus; and highly resistant Escherichia coli, Streptococcus agalactiae, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and Candida albicans. Expectedly, the antibacterial activity was found to be correlated with the CuONPs content in the composites. More importantly, at CuONP concentration of 35 nmol/mg or lower, bactericidal activity of the composite was complemented by its biocompatibility with human fibroblasts.

Following analysis of primary cervix, vagina, and first-void female urine specimens for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis via commercial transcription-mediated amplification (TMA), residual material was subjected to Mycoplasma genitalium research-use-only TMA. Representation within a 2,478-specimen retrospective study set was established by comparison to a 6-month audit of clinical C. trachomatis TMA (12,999 specimens) on the basis of the C. trachomatis detection rate, specimen source distribution, clinic location, and age. M. genitalium was detected in 282 (11.4%) patients. This rate was higher than those seen with T. vaginalis (9.0%; P ‫؍‬ 0.005), C. trachomatis (6.2%), and N. gonorrhoeae (1.4%). Positive M. genitalium results were confirmed by repeat testing or alternative-target TMA at a rate of 98.7%. The mean age of the M. genitalium-infected females (24.7 years) was lower than that of the T. vaginalis-infected females (mean, 30.1 years; P < 0.0001) and higher than that of the C. trachomatis-infected females (mean, 23.8 years; P ‫؍‬ 0.003). Of 566 patient encounters positive for at least one sexually transmitted infection (STI), 35.9% exhibited sole detection of M. genitalium (P < 0.0004 versus sole detection of other STI agents) and 26.1% were solely positive for T. vaginalis (P < 0.0002 versus C. trachomatis). The M. genitalium and T. vaginalis detection rates among 755 patients at urban emergency departments were 14.6% and 13.0%, respectively (P ‫؍‬ 0.37). A 10.0% M. genitalium detection rate from other facilities exceeded that of T. vaginalis (7.2%; P ‫؍‬ 0.004). Incorporation of M. genitalium TMA into comprehensive testing programs would detect M. genitalium in a significant proportion of females, particularly those in outpatient obstetrics and gynecology (OB/GYN) settings. T he sexually transmitted infection (STI) agentMycoplasma genitalium has historically had a role of pathogenicity in male nongonococcal urethritis (1). Recent evidence has implicated the bacterium in clinically significant disease in females (2, 3). Additional studies suggest that M. genitalium infection promotes HIV acquisition (4-6) and virus shedding (7,8). Moreover, in a recent meta-analysis, Lis et al. (9) reported significant associations between M. genitalium infection and cervicitis, pelvic inflammatory disease, preterm birth, and spontaneous abortion.Until recently, a lack of reliable testing options has curtailed laboratory diagnosis of M. genitalium infection. Culture and serologic modalities have been limited by sensitivity and/or cross-reactivity with other mycoplasmas (1) and are becoming supplanted by molecular diagnostics, largely on a research basis. PCR-based assays have correlated M. genitalium DNA burden with clinical condition (10, 11) and treatment efficacy (12) in males. Quantitative molecular analysis has sought to study progression of genital disease in females (13). In the realm of laboratory diagnosis, initial studies of target capture-based transcription-mediated amp...