N B Cushion

University of Texas Southwestern Medical Center, Dallas, TX, United States

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Publications (3)13.88 Total impact

  • J D Siegel, N B Cushion
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    ABSTRACT: To determine the effect of single-dose penicillin given at birth on the rate of early-onset group B streptococcal (GBS) invasive disease in an inner-city population. Laboratory-based surveillance of GBS disease from 1972-1994 at Parkland Memorial Hospital and Children's Medical Center in Dallas, Texas, was reviewed retrospectively. All infants born at Parkland Memorial Hospital from January 1, 1972 to December 31, 1994, or a total of 259,049 live births, were included. Early-onset (within 3 days) GBS disease rates were compared for each of five observation groups to determine the efficacy of a single dose of aqueous penicillin G 50,000 U for infants weighing 2,000 g or more and 25,000 U for those weighing less than 2,000 g) administered intramuscularly within 1 hour of delivery for prevention of GBS disease. The rates of early-onset GBS disease were compared in five observation groups: A) pre-study, January 1, 1972 to December 3, 1977--no GBS prophylaxis; B) prospective, controlled intervention study, December 4, 1977 to May 31, 1981, including infants who received a single dose of penicillin at birth (group B1) and those who did not (group B2); C) universal penicillin prophylaxis, June 1, 1981 to October 31, 1986; and D) no routine penicillin prophylaxis, November 1, 1986 to December 31, 1994. The incidence of early-onset GBS disease in the penicillin groups (B1, C) was significantly lower than that in the untreated groups (A, B2, D): 0.25 and 0.63 per 1,000 versus 1.59, 1.19, and 1.95 per 1,000, respectively (P < or = .03). The incidence of late-onset GBS disease was unaffected by penicillin prophylaxis, and there was no increase in the incidence of disease caused by penicillin-resistant pathogens or associated mortality in penicillin-treated infants; 2.2 and 2.1 per 1,000 versus 1.6 and 3.3 per 1,000 for disease; 1.0 and 0.5 per 1,000 versus 0.4 and 0.3 per 1,000 for deaths. Universal administration of single-dose penicillin at birth is a safe and effective intervention for the prevention of early-onset GBS disease.
    Obstetrics and Gynecology 05/1996; 87(5 Pt 1):692-8. · 4.37 Impact Factor
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    ABSTRACT: To control infections with endemic methicillin-resistant Staphylococcus aureus (MRSA) in a neonatal intensive care unit (NICU), triple dye was applied to the umbilical cords of infants in the intermediate-care but not the intensive-care area. The rate of MRSA infection, adjusted for time and intensity of care, decreased in the intermediate-care area (rate ratio, 0.35; 95% confidence interval [CI], 0.14-0.87; P < .01) but not in the intensive-care area (rate ratio, 0.92; 95% CI, 0.41-2.24; P = .48). After 22 months, the rate increased in both areas (Mantel-Haenszel rate ratio, 1.7; 95% CI, 1.0-2.8; P < .05) after overcrowding and understaffing increased. After temporary reduction of overcrowding and understaffing, extension of triple dye use to the intensive-care area and dedication of an infection control nurse to the NICU, MRSA colonization and infection rates decreased to near zero in both areas (infection rate ratios, 0.09 and 0.11, respectively; P < .005). The endemic MRSA strain, identified by pulsed-field gel electrophoresis, was eradicated.
    The Journal of Infectious Diseases 03/1995; 171(3):614-24. · 5.78 Impact Factor
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    ABSTRACT: We assessed the clinical significance of a reactive urine latex agglutination (LA) test in neonates without bacteriologically confirmed group B streptococcal (GBS) infection. In a retrospective review of a 3 1/2-month period, during which 367 urine specimens from newborn infants evaluated for suspected sepsis were tested by LA, 25 infants (6.9%) with sterile blood cultures but positive urine LA test results were compared with a control group of 112 infants with both blood cultures and urine LA test results negative for GBS. When the data were studied with stepwise discriminant analysis, the only variables significantly associated with a positive urine LA test result were immature to total neutrophil ratios greater than or equal to 0.16 at 0 and 12 hours. The influence of mucosal GBS colonization on urine LA test results was then investigated prospectively in 98 healthy infants (83 born to mothers colonized with GBS and 15 born to mothers with negative GBS cultures). Eight (8.2%) of the infants studied, or 8 of 52 (15.4%) infants colonized with GBS, had a positive urine LA test result. GBS was isolated from urine cultures of all infants with a positive urine LA test result. A positive urine LA test result was associated with positive GBS rectal and vaginal cultures and with increased density of colonization at those sites. We conclude that contamination of bag specimens of urine with GBS from perineal and rectal colonization may produce a positive urine LA test result in an infant with no systemic sign of infection.
    Journal of Pediatrics 05/1990; 116(4):601-6. · 3.74 Impact Factor