Long-term epidemiological survey of Candida species: comparison of isolates found in an intensive care unit and in conventional wards.

The aim of this study was to compare the distribution of Candida species in patients hospitalized in an intensive care unit (ICU) and in conventional wards. A retrospective analysis was performed covering an 18-year period in a 700-bed teaching hospital. Various body sites were investigated in all patients admitted during the study and isolates were identified by microscopic and macroscopic morphology, and by commercially available kits. The susceptibility of strains to amphotericin B and flucytosine was assessed by the ATB-fungus system, itraconazole and fluconazole by Etest. No difference was observed between the distribution of Candida species in ICU and in conventional wards. Candida albicans represented about 70% of isolates and Candida glabrata was the second most common species involved in infection or colonization. The small number of C. glabrata resistant to fluconazole suggested this antifungal agent as suitable empirical treatment for non-immunocompromized patients in whom a fungal infection was suspected.

Prevention of nosocomial urinary tract infection in ICU patients: comparison of effectiveness of two urinary drainage systems.

STUDY OBJECTIVES: To determine whether the rate of acquisition of bacteriuria differs between the use of a complex closed drainage system (CCDS) with a preattached catheter, antireflux valve, drip chamber, and povidone-iodine releasing cartridge, and a two-chamber open drainage system (TCOS) in ICU patients. DESIGN: Prospective, nonrandomized, controlled trial. SETTING: Medical/surgical/trauma ICU in a university hospital. PATIENTS: Two hundred twenty-four ICU patients requiring an indwelling urinary catheter. INTERVENTION: We compared the rate of acquisition of bacteriuria in two groups of consecutive patients (n = 113 and n = 111, respectively) who underwent bladder catheterization with a TCOS during the first 6 months and with a CCDS during the next 6 months. Urinary catheters were managed by a team of trained nurses following the same written protocol. No prophylactic antibiotics were administered, either during management of catheter placements or catheter withdrawal, but 75% of patients received one or more antimicrobial medications for treatment of infected sites other than the urinary tract. Urine samples were obtained weekly for the duration of catheterization and within 24 h after catheter removal, and each time symptoms of urinary infection were suspected. Only patients who required an indwelling catheter for > 48 h were evaluated. MEASUREMENTS AND RESULTS: There was no statistical difference in the rate of bacteriuria between the two groups. Bacteriuria occurred in 11.5% and 13.5% of patients, and was diagnosed on day 14 +/- 8 and 13 +/- 9 of catheterization (mean +/- SD) for the TCOS and the CCDS, respectively. A CCDS cost $3 (US dollars) more than the TCOS. CONCLUSIONS: To our knowledge, this is the first study to compare the effectiveness of a TCOS and a CCDS in ICU patients. No differences were noted between the two systems (alpha = 0.05). The higher cost of a CCDS is not justified for ICU patients.

[Catheter-related nosocomial urinary infections in intensive care: physiopathology, epidemiology and prevention]. / Infections urinaires nosocomiales sur sonde en réanimation: physiopathologie, épidémiologie et prophylaxie.

OBJECTIVES: Nosocomial urinary tract infections associated with bladders catheters are common and poorly understood. Data on the prevention of urinary tract infections are numerous and heterogenous. This update article aimed at analysing mechanisms, epidemiology and prevention of these infections. DATA SOURCES: We searched in the Medline database for articles in English or French, without limiting date of publication, using the following key words separely or in combination: urinary tract infection, nosocomial, catheter, infection urinaire, sonde urinaire. STUDY SELECTION: We considered all categories of articles. DATA EXTRACTION: Data on prevention of nosocomial urinary tract infections were analysed in depth. DATA SYNTHESIS: The data on pathogenesis of nosocomial urinary tract infections are still controversial. Various means for preventing urinary tract infections have been recommended: addition of antibacterial agents to urinary drainage system, inclusion of antimicrobial components into the catheter itself, antibiotic prophylaxis or closed sterile drainage system. Their efficiency in intensive therapy unit has not yet been fully assessed. The therapy of these infections is still under debate and requires additional prospective studies to establish the optimal management. CONCLUSION: Catheter-associated urinary tract infections reflect the general hygiene policy, starting with nurse practice patterns at catheter insertion, and ending with antibio-therapy prescriptions by medical staff.

Prevalence surveys of nosocomial infections using a random sampling method in Marseille hospitals.

In 1992, we conducted two prevalence surveys on hospital-acquired infections (HAIs) in a group of eight university affiliated hospitals with a total of 4462 acute care beds. Most of the intensive care units (ICUs) already had a prospective surveillance scheme. The need for HAI rates that could be estimated easily and economically led us to develop a prevalence survey by using a stratified sampling method. The units were distributed into four groups: ICU; clean surgery; other surgery; and medical. In each group a sample of units was randomly selected using different sampling fractions. The first survey was conducted in May and involved 1220 patients. The second survey in November included 1389 patients. The HAI rates in May and November were 8.6% (95% CI 7.4-9.8%) and 7.1% (95% CI 6-8.2%), respectively. This study allowed us to direct resources towards high risk units and clean surgical procedures. Based on the results, prospective surveillance was implemented in units of the clean surgery group.

[Modification of curarization after acute administration of 2 antiepileptic drugs]. / Modifications de la curarisation après administration aiguë de deux antiépileptiques.

In rats anaesthetised with sodium pentobarbital the previous administration of a single dose of an anti-epileptic agent (carbamazepine or sodium valproate) significantly increases the curarising action of two short-action curare-like agents--pancuronium bromide and fazadinium bromide. It seems that this potentialisation of curare action might be the result of either a pharmacokinetic interference (competion for plasma protisen receptor sites), or due to a summation of depressor actions at the neuromuscular level, especially through changes in the levels of GABA and/or cAMP.