TMZ at this dose and schedule results in CD4(+) lymphopenia in a majority of patients that can result in OIs. Pneumocystis pneumonia prophylaxis should be considered for patients who develop sustained lymphopenia on TMZ.

The implementation of safety-engineered devices reduced percutaneous injury rates across occupations, activities, times of injury, and devices. Moreover, intervention impact was observed when stratified by risk for blood-borne pathogen transmission.

Background-Clostridium difficile-associated diarrhea (CDAD) is an important infection in hospital settings. Its impact on outpatient care has not been well defined. Objective-To examine risk factors of ambulatory cancer patients with CDAD.Design-Case-control study.Setting-Memorial Sloan Kettering Cancer Center, a tertiary-care hospital.Methods-Cases of CDAD among oncology outpatients from January 1999 through December 2000 were identified via positive C. difficile toxin assay results on stool specimen sent from clinics or the emergency department. A 1:3 matched case-control study examined exposures associated with CDAD.Results-Forty-eight episodes of CDAD were identified in cancer outpatients. The median age was 51 years; 44% were female. Forty-one (85%) had received antibiotics within 60 days of diagnosis, completing courses a median of 16.5 days prior to diagnosis. Case-patients received longer courses of first-generation cephalosporins (4.8 vs 3.2 days, P = .03) and fluoroquinolones (23.6 vs 8 days; P < .01) than did control-patients. Those receiving clindamycin were 3.9-fold more likely to develop CDAD (P < .01). For each additional day of clindamycin or thirdgeneration cephalosporin exposure, patients were 1.29-and 1.26-fold more likely to develop CDAD (P < .01 and .04, respectively). The 38 CDAD patients hospitalized during the risk period (79.2%) spent more time as inpatients than control-patients (19.3 vs 9.7 days, P < .001).Conclusions-Antibiotic use, especially with cephalosporins and clindamycin, and prolonged hospitalization contributed to development of CDAD. Outpatient CDAD appears to be most strongly to be related to inpatient exposures; reasons for delayed development of symptoms are unknown.Address reprint requests to

JSTOR is a not-for-profit service that helps scholars, researchers, and students discover, use, and build upon a wide range of content in a trusted digital archive. We use information technology and tools to increase productivity and facilitate new forms of scholarship. For more information about JSTOR, please contact support@jstor.org. The University of Chicago Press and BACKGROUND:Clostridium difficile-associated diarrhea (CDAD) causes substantial healthcare-associated morbidity. Unlike other common healthcare-associated pathogens, little comparative information is available about CDAD rates in hospitalized patients.OBJECTIVES: To determine CDAD rates per 10,000 patientdays and per 1,000 hospital admissions at 7 geographically diverse tertiary-care centers from 2000 to 2003, and to survey participating centers on methods of CDAD surveillance and case definition.METHODS: Each center provided specific information for the study period, including case numbers, patient-days, and hospital characteristics. Case definitions and laborator y diagnoses of healthcare-associated CDAD were determined by each institution. Within institutions, case definitions remained consistent during the study period.RESULTS: Overall, mean annual case rates of CDAD were

Safety-engineered device implementation decreased rates of PIs formally reported and self-reported on the survey. However, this intervention, with concomitant intensive education, had varying effects on reporting behavior by occupation and a minimal effect on overall reporting rates.