Publications (2)11.17 Total impact
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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.
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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.
University of Texas Southwestern Medical Center
Dallas, Texas, United States
- Department of Pediatrics