Postoperative Serratia marcescens wound infections traced to an out-of-hospital source.

From 25 August to 28 September 1994, 7 cardiovascular surgery (CVS) patients at a California hospital acquired postoperative Serratia marcescens infections, and 1 died. To identify the outbreak source, a cohort study was done of all 55 adults who underwent CVS at the hospital during the outbreak. Specimens from the hospital environment and from hands of selected staff were cultured. S. marcescens isolates were compared using restriction-endonuclease analysis and pulsed-field gel electrophoresis. Several risk factors for S. marcescens infection were identified, but hospital and hand cultures were negative. In October, a patient exposed to scrub nurse A (who wore artificial fingernails) and to another nurse-but not to other identified risk factors-became infected with the outbreak strain. Subsequent cultures from nurse A's home identified the strain in a jar of exfoliant cream. Removal of the cream ended the outbreak. S. marcescens does not normally colonize human skin, but artificial nails may have facilitated transmission via nurse A's hands.

Septic arthritis after arthroscopy: the contributing roles of intraarticular steroids and environmental factors.

During a 9-month period at a small surgical center, seven cases of postarthroscopic septic arthritis occurred after 352 arthroscopic procedures, for an infection rate of 2.0%. Electrocardiographic cables contaminated with Pseudomonas aeruginosa from an unsterile cleaning solution probably led to two shoulder infections. Five other infections (one definite Staphylococcus aureus and three definite and one possible coagulase-negative staphylococci) were attributed to inadequate arthroscope disinfection. In the initial phase of the outbreak, use of intraoperative intraarticular corticosteroids correlated with the occurrence of infection.

Septic arthritis following arthroscopy: clinical syndromes and analysis of risk factors.

During a 4-year study of 4,256 knee arthroscopies, eighteen patients became infected (infection rate 0.42%). Occurrence of infection was strongly associated with use of long-acting intraarticular intraoperative corticosteroids. Infection was more common among patients with longer surgery operating times, increased numbers of procedures during surgery, prior procedures, and performance of chondroplasty or soft tissue debridement. Subsequent to the study, the infection rate fell to 0.1%. Twenty-four infections were studied (our eighteen plus six other concurrent community cases); twelve were due to Staphylococcus aureus, eleven to coagulase-negative staphylococci, and one to Enterobacter cloacae. Seventy percent of the patients had onset of symptoms within 3 days of surgery. Most patients with coagulase-negative staphylococcal infections had fevers less than 38.3 degrees C (101 degrees F), negative Gram stains on synovial fluid, normal peripheral leukocyte counts, and somewhat indolent, mild clinical syndromes, while most patients with S. aureus infections had higher fevers, positive synovial Gram stains, peripheral leukocytosis, and more acute and severe clinical syndromes. Knee pain, swelling, and warmth always occurred, but erythema was noted in only 30% of patients. Treatment with 2 weeks of intravenous antibiotics was successful in all but one patient. Long-term results were excellent in sixteen of twenty-two patients.

Infection following breast reconstruction.

Of 33 patients who underwent 49 breast implantations for reconstructive surgery, 8 (24%) patients developed implant infections. All 8 of these patients were among a subgroup of 15 having immediate breast reconstructions with tissue expander implants after simple or modified radical mastectomy (a 53% infection rate). The infection rate increased substantially when bilateral procedures involving implants were performed as opposed to unilateral implants. Nine implants were removed (an overall implant loss rate of 18%). Patients who underwent other breast reconstruction techniques (i.e., including immediate reconstruction with permanent implants or delayed reconstruction with or without tissue expanders) did not develop infection unless they had had simultaneous immediate reconstruction with a tissue expander in the contralateral breast. The most frequently isolated organism was the coagulase-negative staphylococcus. The study concludes that neither the tissue expander nor immediate reconstruction is a risk factor, but the combination may lead to an unacceptable infection rate, especially in the face of bilateral breast procedures.

Postmortem coronary atherosclerosis findings in general aviation accident pilot fatalities: 1975-77.

The autopsies of 764 pilots involved in fatal general aviation accidents during the years 1975-77 were reviewed to appraise the age specific prevalence of coronary atherosclerosis among the autopsied group. Of the pilots killed in aircraft accidents and autopsied during 1975-77, 51% were found to have some degree of coronary atherosclerosis ranging from minimal to severe. However, only about 5% of the autopsied group were categorized as having severe coronary atherosclerosis. The rate per 1,000 of severe coronary atherosclerosis increased with age from 14.5 for ages less than 30, to 89.9 for ages 50 years and above; the rate nearly tripled from ages 30-39 to 40-49 (22.1 to 63.6). The prevalence of coronary atherosclerosis among this group of autopsied airmen is less than would have been expected based on the results of other recent studies.