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Chicago Ridge, IL, United States

Climo M.W.,Hunter Holmes ire Veterans Affairs Medical Center | Climo M.W.,Virginia Commonwealth University | Yokoe D.S.,Harvard University | Warren D.K.,University of Washington | And 9 more authors.
New England Journal of Medicine | Year: 2013

BACKGROUND: Results of previous single-center, observational studies suggest that daily bathing of patients with chlorhexidine may prevent hospital-acquired bloodstream infections and the acquisition of multidrug-resistant organisms (MDROs). METHODS: We conducted a multicenter, cluster-randomized, nonblinded crossover trial to evaluate the effect of daily bathing with chlorhexidine-impregnated washcloths on the acquisition of MDROs and the incidence of hospital-acquired bloodstream infections. Nine intensive care and bone marrow transplantation units in six hospitals were randomly assigned to bathe patients either with no-rinse 2% chlorhexidine - impregnated washcloths or with nonantimicrobial washcloths for a 6-month period, exchanged for the alternate product during the subsequent 6 months. The incidence rates of acquisition of MDROs and the rates of hospital-acquired bloodstream infections were compared between the two periods by means of Poisson regression analysis. RESULTS: A total of 7727 patients were enrolled during the study. The overall rate of MDRO acquisition was 5.10 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P = 0.03), the equivalent of a 23% lower rate with chlorhexidine bathing. The overall rate of hospital-acquired bloodstream infections was 4.78 cases per 1000 patient-days with chlorhexidine bathing versus 6.60 cases per 1000 patient-days with nonantimicrobial washcloths (P = 0.007), a 28% lower rate with chlorhexidine-impregnated washcloths. No serious skin reactions were noted during either study period. CONCLUSIONS: Daily bathing with chlorhexidine-impregnated washcloths significantly reduced the risks of acquisition of MDROs and development of hospital-acquired blood-stream infections. Copyright © 2013 Massachusetts Medical Society. Source

Lin M.Y.,Rush University Medical Center | Lolans K.,Rush University Medical Center | Blom D.W.,Rush University Medical Center | Lyles R.D.,Cook County Health and Hospitals System | And 6 more authors.
Infection Control and Hospital Epidemiology | Year: 2014

We evaluated the effectiveness of daily chlorhexidine gluconate (CHG) bathing in decreasing skin carriage of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae (KPC) among longterm acute care hospital patients. CHG bathing reduced KPC skin colonization, particularly when CHG skin concentrations greater than or equal to 128 μg/mL were achieved. © 2014 by The Society for Healthcare Epidemiology of America. All rights reserved. Source

Murphy A.B.,Northwestern University | Nyame Y.,Cleveland Clinic | Martin I.K.,University of Pennsylvania | Catalona W.J.,Northwestern University | And 6 more authors.
Clinical Cancer Research | Year: 2014

Purpose: The association between vitamin D and prostate biopsy outcomes has not been evaluated. We examine serum vitamin D levels with prostate biopsy results in men with an abnormal prostate-specific antigen and/or digital rectal examination. Experimental Design: Serum 25-hydroxyvitamin D (25-OH D) was obtained from 667 men, ages 40 to 79 years, prospectively enrolled from Chicago urology clinics undergoing first prostate biopsy. Logistic regression was used to evaluate the associations between 25-OH D status and incident prostate cancer, Gleason score, and tumor stage. Results: Among European American (EA) men, there was an association of 25-OH D <12 ng/mL with higher Gleason score≥4+4 [OR, 3.66;95%confidence interval (CI), 1.41-9.50; P=0.008] and tumor stage [stage≥cT2b vs. ≤cT2a, OR, 2.42 (1.14-5.10); P=0.008]. In African American (AA) men, we find increased odds of prostate cancer diagnosis on biopsy with 25-OHD< 20 ng/mL [OR, 2.43 (1.20-4.94); P=0.01]. AA men demonstrated an association between 25-OH D < 12 ng/mL and Gleason ≥ 4+4 [OR, 4.89 (1.59-15.07); P=0.006]. There was an association with tumor stage≥cT2b vs.≤cT2a [OR, 4.22 (1.52-11.74); P= 0.003]. Conclusions: In AA men, vitamin D deficiency was associated with increased odds of prostate cancer diagnosis on biopsy. In both EA and AAmen, severe deficiency was positively associated with higher Gleason grade and tumor stage. © 2014 AACR. Source

Patrianakos T.D.,Cook County Health and Hospitals System
Journal of Cataract and Refractive Surgery | Year: 2014

This review examines the anatomic and physiologic rationale for accessing the suprachoroidal space in the management of glaucoma. The potential benefits and limitations of past and present attempts to tap into the intraocular pressure-lowering effects of the suprachoroidal space are highlighted. Financial Disclosure The author has no financial or proprietary interest in any material or method mentioned. © 2014 ASCRS and ESCRS. Source

Attar B.M.,Cook County Health and Hospitals System | Attar B.M.,Rush University Medical Center | Van Thiel D.,Advanced Liver and Gastrointestinal Disease Center
Gastroenterology Research and Practice | Year: 2015

Background. The prevalence of occult hepatitis C infection (OCI) in the population of HCV-RNA negative but anti-HCV positive individuals is presently unknown. OCI may be responsible for clinically overt recurrent disease following an apparent sustained viral response (SVR) weeks to years later. Purpose. To review the available current literature regarding OCI, prevalence, pathogenic mechanisms, clinical characteristics, and future directions. Data Sources. Searching MEDLINE, article references, and national and international meeting abstracts for the diagnosis of OCI (1990-2014). Data Synthesis. The long-term followup of individuals with an OCI suggests that the infection can be transient with the loss of detectable HCV-RNA in PPBMCs after 12-18 months or alternatively exist intermittently and potentially long term. The ultimate outcome of HCV infection is decided by interplay between host immune responses, antiviral therapies, and the various well-identified viral evasion mechanisms as well as the presence of HCV infection within extrahepatic tissues. Conclusion. The currently widely held assumption of a HCV-cure in individuals having had "SVR" after 8-12 weeks of a course of DAA therapy as recently defined may not be entirely valid. Careful longitudinal followup utilizing highly sensitive assays and unique approaches to viral isolation are needed. © 2015 Bashar M. Attar and David Van Thiel. Source

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