ABSTRACT
We have reviewed all 3577 nosocomial infections occurring at our institution over a 49-month period and found coagulase-negative staphylococci (CNS) associated with 297. Seventy-eight of 193 CNS tested for antibiotic sensitivity were multiple-drug resistant (MR-CNS). There were 19 well-documented serious postoperative CNS infections including nine ventricular, seven bloodstream and three peritoneal infections. Each was associated with an indwelling device and 11 of the infections involved MR-CNS. Antibiotic therapy with or without removal of the device resulted in cure of all patients. Air samples taken during various surgical procedures frequently were positive for CNS but rarely revealed MR-CNS. Our results cause concern regarding current antibiotic prophylaxis regimens.
Subject(s)
Cross Infection/epidemiology , Postoperative Complications/etiology , Staphylococcal Infections/epidemiology , Air Microbiology , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Coagulase/metabolism , Cross Infection/microbiology , Drug Resistance, Microbial , Female , Humans , Male , Operating Rooms , Postoperative Complications/epidemiology , Premedication , Staphylococcal Infections/microbiology , Staphylococcus/drug effects , Staphylococcus/enzymology , Staphylococcus/isolation & purificationABSTRACT
During 1981, 39 nosocomial infections occurred in 27 of 223 patients undergoing cardiac surgery in the North Carolina Memorial Hospital. The peak attack rate (23.7%) occurred in August and September compared to 10.1% in January through July. A case-control study demonstrated that the only risk factor common to poor and stable health groups compared to controls was duration of stay in the cardiothoracic intensive care unit (CTICU). Microbiologic studies of the environment, personnel and patients showed that colonization or infection of patients occurred 1 to 6 days after admission to the CTICU and that nosocomial pathogens were found: 1) in and around the unit's soiled utility sink, 2) in pooled handwashing cultures of unit personnel, and 3) on contaminated clean hands and air near the soiled utility sink, plus nearby bedside air only while the water in the sink was running. Environmental and personnel hand contamination by soiled utility sink aerosols likely contributed to these infections. Infection control measures, including discontinued use of the soiled utility sink, resulted in a significantly lower infection rate (5.6%).
Subject(s)
Cardiac Surgical Procedures , Coronary Care Units , Cross Infection/epidemiology , Disease Outbreaks/epidemiology , Sanitary Engineering , Surgical Wound Infection/epidemiology , Air Microbiology , Disease Reservoirs , Hand Disinfection , Hospital Bed Capacity, 500 and over , Humans , Middle Aged , North Carolina , RiskABSTRACT
The subacute development of an almost isolated bilateral gaze paralysis in a patient with mycosis fungoides allowed a unique opportunity for in vivo clinicoanatomical correlation when enhanced computerized tomography (CT) scan revealed two extremely small lesions of the pontine tegmentum. The larger lesion involved the region occupied by the medial longitudinal fasciculus and the paramedian pontine reticular formation (PPRF) bilaterally, and was alone sufficient to account for the eye movement disorder.
