ABSTRACT
Postoperative wound infections following open heart cardiac surgery increased markedly after hospital relocation (7 of 77 v 4 of 320; p = .0007). Of the multiple identified risk factors, significant patient and procedural association included prolonged operative time of infected patients (384 minutes +/- 115 SD v 318 +/- 67, p = .025) and operation in a room used within the previous 48 hours for a contaminated case (4/7 infected v 10/67 not infected; p = .023). Several defects were discovered in the air handling system. After appropriate changes, the infection rate decreased in the next 12 months (1 of 109; p less than .02). Other concurrent surgical wound infection rates remained unchanged suggesting that defective air handling may have impacted only on the open heart cardiac surgery patients. Preceding contaminated surgery and prolonged operative time were associated with postoperative wound infections in cardiac surgery.
Subject(s)
Cardiac Surgical Procedures , Disease Outbreaks/epidemiology , Hospitals, Veterans , Operating Rooms , Surgical Wound Infection/epidemiology , Adult , Aged , Air Conditioning , Cross Infection/epidemiology , Georgia , Hospital Bed Capacity, 300 to 499 , Humans , Intraoperative Care , Middle Aged , Risk , Surgical Wound Infection/etiology , Time Factors , VentilationABSTRACT
A number of bacteria hydrolyze esculin enzymatically to esculetin. This characteristic is used by taxonomists and clinical microbiologists in the differentiation and identification of bacteria, especially to distinguish Lance-field group D streptococci from non-group D organisms and Listeria monocytogenes from morphologically similar Erysipelothrix rhusipoathiae and diphtheroids. Conventional methods used for esculin hydrolysis require 4--48 h for completion. We developed and evaluated a medium which gives positive results more rapidly. The 2,330 isolates used in this study consisted of 1,680 esculin positive and 650 esculin negative organisms. The sensitivity and specificity of this method were compared with the PathoTec esculin hydrolysis strip and the procedure of Vaughn and Levine (VL). Of the 1,680 esculin positive organisms, 97% gave positive reactions within 30 minutes with the rapid test whereas PathoTec required 3--4 h incubation for the same number of organisms to yield a positive reaction.
Subject(s)
Bacteria/metabolism , Bacteriological Techniques , Esculin/metabolism , Flavonoids/metabolism , Streptococcaceae/metabolism , Bacteria/classification , Corynebacterium diphtheriae/metabolism , Erysipelothrix/metabolism , Hydrolysis , Listeria monocytogenes/metabolism , Staphylococcus/metabolism , Streptococcaceae/classificationABSTRACT
An esculin hydrolysis test is described which distinguishes over 97% of bacteria that can convert esculin to esculetin in a buffered solution, from those that cannot, within an hour.
