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dc.contributor.authorHess, Aaron Stansbury
dc.date.accessioned2013-01-28T17:22:24Z
dc.date.available2013-01-28T17:22:24Z
dc.date.issued2012
dc.identifier.urihttp://hdl.handle.net/10713/2324
dc.descriptionUniversity of Maryland in Baltimore. Epidemiology and Preventive Medicine. Ph.D. 2012en_US
dc.description.abstractBackground: Antibiotic-resistant infections are a common complication of hospital care in the United States and associated with increases in cost, length of stay, and mortality. Methods proposed to anticipate and prevent these infections include improved hospital cleaning and the use of prior culture data. Objectives: To test enhanced hospital cleaning as a potential method to reduce patient-to-patient transmission of antibiotic-resistant infections among intensive-care patients, and to evaluate the relationship between prior colonization with antibiotic-resistant bacteria and the subsequent risk of antibiotic-resistant infections among cancer patients. Methods: We tested the effect of enhanced room cleaning on the contamination of healthcare workers' gowns and gloves with antibiotic-resistant bacteria by conducting a cluster-randomized, controlled trial in four intensive care units. The relationship between prior colonization with antibiotic-resistant bacteria and the subsequent risk of antibiotic-resistant infections among cancer patients was assessed with a matched case-control study of cancer patients with suspected infection who subsequently developed an antibiotic-resistant Gram-negative bacteremia. Results: The trial enrolled 142 hospital rooms and sampled 4,444 patient-healthcare worker interactions. Improved room cleaning was associated with a reduction in gown and glove contamination with both methicillin-resistant S. aureus (relative risk: 0.89, 95% confidence interval: 0.50 - 1.53) and multidrug-resistant A. baumannii (relative risk: 0.77, 95% confidence interval: 0.28 - 2.11). In the case-control study of cancer patients with suspected infection, antibiotic-resistant Gram-negative colonization was associated with subsequent antibiotic-resistant Gram-negative bacteremia after exposure to broad-spectrum antibiotics in the previous month (odds ratio: 8.1, 95% confidence interval: 3.6 - 18.0). Conclusion: Improved room cleaning may reduce the risk of patient-to-patient transmission of antibiotic-resistant bacteria in the intensive care setting. Prior colonization with antibiotic-resistant Gram-negative bacteria is a risk factor for subsequent bacteremia among cancer patients, and might be used to guide antibiotic therapy.en_US
dc.language.isoen_USen_US
dc.rights.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/
dc.subjectantibiotic resistanceen_US
dc.subjecthospital cleaningen_US
dc.subjecthospital infectionen_US
dc.subjectMDR Acinetobacteren_US
dc.subjectMRSAen_US
dc.subject.lcshCancer--Patientsen_US
dc.subject.meshAcinetobacter baumanniien_US
dc.subject.meshCross Infection--prevention & controlen_US
dc.subject.meshDrug Resistance, Bacterialen_US
dc.subject.meshHousekeeping, Hospital--standardsen_US
dc.subject.meshInfection Controlen_US
dc.subject.meshIntensive Care Unitsen_US
dc.subject.meshMethicillin-Resistant Staphylococcus aureusen_US
dc.titleAnticipation and Prevention of Antimicrobial-Resistant Bacterial Infection in Severely Ill Hospitalized Patientsen_US
dc.typedissertationen_US
dc.contributor.advisorHarris, Anthony D.
dc.identifier.ispublishedNo
refterms.dateFOA2019-02-21T01:57:11Z


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