An international survey of the prevalence of hospital-acquired infection.

The prevalence of hospital-acquired infection was measured in 47 hospitals in 14 countries in four continents. The aim was to establish the evidence that hospital infection is a common and serious problem throughout the world. Using a standard protocol, 28,861 patients were observed by local teams of doctors and nurses in their own hospitals. The prevalence rates in individual hospitals varied from 3% to 21% (median 8.4%). The highest rates were seen on intensive care (13.3%), surgical (13.1%) and orthopaedic wards (11.2%). Children under the age of 1 year (infection prevalence 13.5%) and adults over 64 years (prevalence 12.0%) suffered more infection than others. In children the commonest infections were of the lower respiratory tract, of the skin and gastroenteritis. In the elderly, urinary-tract infections predominated. The prevalence of postoperative wound infection in individual hospitals ranged from 5.2% to 34.4%, with even greater variation when the wounds were analysed as clean, clean-contaminated and contaminated. The micro-organisms isolated from infected patients were similar to previous surveys: Escherichia coli and Staphylococcus aureus each caused a sixth of the infections with positive microbiological results. When examined, 30% of patients were on antimicrobial drugs. Penicillin, ampicillin/amoxycillin and gentamicin were the commonest antibiotics used.

Multicentre evaluation of a direct coagglutination test for group A streptococci.

A coagglutination test for detection of group A streptococci in throat samples was evaluated in a multicentre study and found to be about 95% sensitive when applied to swabs taken from symptomatic patients which yielded more than 100 colonies per plate on culture. The sensitivity of the test dropped significantly when it was applied to swabs giving fewer than 100 colonies on culture. The specificity of the test was high regardless of colony count on conventional media.

An extensive community outbreak of enteropathogenic Escherichia coli O86: B7 gastroenteritis.

During the last 20 years numerous reports of hospital-associated epidemics of enteropathogenic Escherichia coli (EEC) gastroenteritis have appeared in the medical literature. Some of the reports suggest that EEC gastroenteritis can also be a community problem. However, community epidemics of EEC gastroenteritis comparable to those of other communicable diseases like cholera or typhoid are rare.An extensive epidemic of acute gastroenteritis occurred among children in Surat, Gujarat State, India, between 29 October and 3 December 1965. A total of 418 patients was hospitalized during this period: 344 of them were under 2 years of age. Faecal specimens from 81 children admitted between 25 November and 30 November were subjected to microbiological examination. Of these samples, 34 yielded pure cultures of E. coli O(86):B(7) and 1 yielded a pure culture of O(126):B(16). The cases occurred throughout the town including a rural ward. The morbidity rate for the total population was 0.16% and the age-specific morbidity rate for the 0-2-years age-group, was 0.98%; the highest morbidity rate (2.4%) was in the 6-11-months age-group in the urban wards. No definite mode of transmission of the disease could be established.