Rhinofacial Conidiobolus coronatus infection presenting with nasal enlargement.

Rhinofacial Conidiobolus coronatus infection is a rare form of zygomycosis in humans living in the northern hemispheres. Most human cases are observed in the periequatorial areas of Africa, Asia, or South America. Only limited information regarding optimal treatment is available. We report a case of rhinofacial C. coronatus infection in an emigrated Sudanese patient. The infection was successfully treated with terbinafin and itraconazole for 12 months. Diagnosis was confirmed by microbiological culture from a tissue biopsy. Antimicrobial susceptibility testing of this organism was not predictive of optimal therapy.

[Central issues of prevention of nosocomial infections--status in 2004]. / Schwerpunkte der Prävention nosokomialer Infektionen--Stand 2004.

Despite significant progress in our understanding of their pathogenesis, nosocomial infections remain a major problem in hospitals. They may originate from the endogenous flora of the patient as a result of translocation of microorganisms from a physiologically colonized area to an area, where they act as pathogens. Transmission of microorganisms between patients results in exogenous infections. Healthcare workers may serve as transient carriers and vectors or even as reservoir of these infectious agents. Both, exogenous as well as endogenous nosocomial infections are preventable. Based on knowledge of the mode of transmission, the pathogenesis of and risk factors for infection, it is possible to design appropriate preventive strategies, which must be targeted to the type of infection to be prevented and should also be adapted to the local circumstances in a given hospital. Regardless of the type of infection to be prevented, hand disinfection is a standard measure and remains the most important preventive activity. The approach to the prevention of nosocomial infections has to be interdisciplinary and should involve all areas that are affected by any of the proposed measures. Hospital epidemiology plays a central role in coordinating preventive activities and often sets the priorities for prevention based on the available information. Given the growing complexity and the emergence of new nosocomial threats such as SARS, hospital administrators are well advised to invest sufficiently into their department of hospital hygiene and epidemiology in order to be ready for all the problems that will need to be tackled in the future.

[Requirements for infection control during surgery]. / Spitalhygienische Anforderungen bei chirurgischen Eingriffen.

Infections of the surgical site following surgery may compromise the outcome of surgery and may under certain circumstances even endanger the life of the patient. Therefore, hospital epidemiology plays an important role in various surgical fields of medicine by developing guidelines and recommendations for the prevention of surgical site infections. In addition, surveillance of patients regarding the development of surgical site infections should be another important component of infection control activities in all hospitals. In order to develop appropriate guidelines and to perform surveillance in surgery, it is important to utilize uniform definitions of surgical site infections and to know the pathogenesis and risk factors of surgical site infections. Knowledge in this field has increased dramatically over the course of the last several decades and has resulted in the creation of guidelines for prevention, their implementation, and revision. The current review will summarize the state-of-the-art of the requirements for infection control. The recommendations will be grouped according to their respective timing during the course of a surgical procedure, which includes a pre- as well as a postoperative phase in addition to the intraoperative phase. Despite the significant progress that has been achieved in this field, some issues remain unresolved. Among these, the practical implementations of nasal decolonization regarding S. aureus prior to surgery and improvement of glucose control during surgery in patients with diabetes are mentioned as examples for unfinished work, which awaits further research.

[Prevention of nosocomial infections in the medical office]. / Hygiene in der Arztpraxis.

Nosocomial infections are usually considered to be a problem of hospitals. However, outpatient care is also not without risks to the patient or to the healthcare workers. Cases of iatrogenic infections following invasive acts such as intramuscular injections in medical offices have occurred repeatedly and have resulted in malpractice charges against the physicians involved. This illustrates a need for physicians in private practice to establish a concept for the prevention of nosocomial infections in their office. This concept should include patients as well as healthcare workers and must be adapted to the particular setting of the practice. After implementation of such a concept, it will be possible to provide care to all patients--the routine patient, the routine patient undergoing an invasive procedure, the patient who is colonized with a resistant microorganism, as well as the patient who presents himself with an infectious disease--under conditions that minimize the risk of nosocomial infection to the patient as well as to the healthcare workers. The essential elements of such a concept include written guidelines for disinfection, sterilization and personnel protection. Depending on the type of practice, additional guidelines, i.e. guidelines for reprocessing of endoscopes in a gastroenterology practice, will be needed.

[Perioperative antibiotic prophylaxis at the Clinic of Reconstructive Surgery of the Zurich University Hospital]. / Zur Umsetzung einer perioperativen Antibiotikaprophylaxe an der Klinik für Wiederherstellungschirurgie des Universitätsspitals Zürich.

With the goal of ensuring maximal safety, surgeons tend to apply antibiotic prophylaxis generously to patients undergoing selective operative procedures. However, the indiscriminate or inappropriate use of prophylactic antibiotics i) leads to the selection of resistant microbial organisms and ii) results in an increase in general medical treatment costs. Given this controversy, the clinic of reconstructive surgery implemented in 1999 a set of guidelines for the proper use of antibiotics. Antibiotic prophylaxis was defined as a pre- or perioperative application of antibiotics as a single to maximum triple-shot dose. It was recommended only for operations involving special risk factors or the implantation of alloplastic material. The recommended medication of choice was the widely-accepted standard first-generation cephalosporin product Cefazolin. We have carried out a quality control trial to analyse prospectively our own experience with the implementation of these guidelines and to compare results with a retrospective group of patients. A total of 792 patients (441 in the retrospective group, 351 in the prospective group) were enrolled in the study. About one third of all patients received an antibiotic prophylaxis. Of these, about 3/4 received the antibiotic prophylaxis without having one of the above-mentioned indications. We observed that 35% of all prophylaxis were given for breast surgery, followed by surgery for scar revisions and lipodystrophy. The most commonly used antibiotic was Cefuroxim rather than Cefazolin. There was no significant reduction in the general application of antibiotic prophylaxis yet apparent in the prospective group. However, there was a clear increase in the use of Cefazolin from 0.2% to 13.2%. We conclude that guidelines can be created to reduce the incidence of uninformed and inappropriate decisions, but their implementation requires time, motivation, and thorough and repeated information campaigns.

[Significance of antibiotic resistance in treatment of soft tissue infections]. / Bedeutung der Antibiotikaresistenz bei der Behandlung von Weichteilinfektionen.

Soft tissue infections are common. The clinical spectrum includes infections of skin, subcutaneous tissue, and of deeper structures such as fascia and muscles. The pathogenesis of these infections is quite variable. Introduction of microorganisms through skin breaks or through trauma of other soft tissue is usually at the origin of such infections. Staphylococci, especially S. aureus, as well as streptococci, mainly group A streptococci cause most soft tissue infections. In immunocompromised patients or in particuluar circumstances gram-negative bacteria may also be found to cause such infections. Occasionally, infections are polymicrobial. Given the predominance of gram-positive cocci, betalactam antibiotics with good antistaphylococcal activity are the drugs of choice for empiric treatment. Penicillins or cephalosporins that are stable against penicillinase should be chosen, since many staphylococci produce penicillinase. Over the course of the last 40 years staphylococci first became resistant against penicillin, and later developed resistance against methicillin. Methicillin-resistant S. aureus (MRSA) is now a significant problem worldwide. There continue to be major differences in the prevalence of MRSA between geographic regions. In areas with a high prevalence of methicillin resistance among S. aureus, empiric treatment of life-threatening soft tissue infections should include treatment with a glycopeptide (i.e. vancomycin or teicoplanin). New antibiotics such as oxazolidinones (i.e. linezolid) or quinupristin/dalfopristin are interesting alternatives to the glycopeptides in the treatment of soft tissue infections.