The Journal of hospital infection
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An analysis of hospital-acquired bacteraemia among ICU patients was carried out over a two-year period in order to determine the incidence, associated mortality rate and susceptibility pattern of causative pathogens. There was a high incidence of bacteraemia, occurring in 127 (18.4%) of 692 patients. Mortality attributable to nosocomial bacteraemia was 52% of the total 79 deaths from all causes. ⋯ Whilst Gram-negative organisms were relatively susceptible to imipenem (85%), ciprofloxacin (88%) and amikacin (87%), they had unacceptably low levels of susceptibility to cefuroxime (59.3%), cefotaxime (71%), ceftazidime (60.9%), and piperacillin (51.1%). This study shows that hospital-acquired bacteraemia in ICU patients carries a poor prognosis. Information regarding the infective agents and their susceptibility in the ICU setting is valuable for the selection of empirical therapy before culture and susceptibility results are known.
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Comparative Study
Nosocomial outbreak of gentamicin-resistant Klebsiella pneumoniae in a neonatal intensive care unit controlled by a change in antibiotic policy.
Between August and November 1997, a nosocomial outbreak caused by gentamicin-resistant Klebsiella pneumoniae occurred in the Neonatal Intensive Care Unit (NICU) of our hospital. Thirteen neonates became colonized and three of them became infected. Comparison of the isolates by amplified fragment length polymorphism (AFLP) revealed clonal similarity for isolates of eight neonates (homology > 90%). ⋯ Length of stay on the NICU was significantly longer for cases, but mean time until colonization (6.3 days) was shorter than the total stay for controls (9.5 days). No single member of the medical or nursing staff was significantly more involved with cases than with controls. The outbreak was stopped by replacing gentamicin by amikacin as the antibiotic of first choice whenever the use of an aminoglycoside antibiotic was indicated.
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The relationship between surface contamination (cfus/m2/h) with particles carrying aerobic bacteria and corresponding air contamination rates (cfus/m3) was evaluated in operating rooms (OR) equipped with ultra clean vertical or horizontal laminar airflow (LAF). For the evaluation we collected data during strictly standardized sham operations using non-woven disposable or cotton clothing. Air contamination in the wound and instrument areas (Casella slit sampler) was related to the surface contamination rate (settle plates) in the same areas and in addition, on the patient chest. ⋯ The wide variation of SAR values and the inconsistent relationship between surface and air counts indicates that measurement of OR air contamination represents an unhelpful method for assessment of surgical site contamination in LAF units. We propose instead that colony counts on sedimentation plates is a clinically more relevant indicator of bacterial OR contamination in LAF units. In addition to the current bacteriological standard for ultra clean OR air of (< 10 cfus/m3) we suggest a corresponding standard for the surface contamination rate of < 350 cfus/m2/h.