The Journal of hospital infection
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Nasal mupirocin has an important role to play in the prevention of Staphylococcus aureus infection by eliminating nasal carriage of this organism. Indeed, in many countries nasal mupirocin is one of the mainstays for controlling outbreaks of methicillin-resistant S. aureus. Eradication of nasal S. aureus with mupirocin has been shown to be effective in preventing postoperative infections in patients undergoing cardiothoracic surgery and in preventing exit-site infections in patients undergoing haemodialysis. ⋯ Low-level resistance does not represent a significant clinical problem but high-level resistance resulting from indiscriminate use may give grounds for concern. Further review of these issues is required. As with any antibiotic, mupirocin should be used judiciously, as part of an integrated programme of infection control.
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In this study, we evaluated whether ultrasound instruments are important in the spread of nosocomial staphylococcal infections. Following genomic typing by pulsed-field gel electrophoresis, it was apparent that ultrasound procedures transferred colonizing staphylococci from a patient's skin to the ultrasound instruments. ⋯ Furthermore, S. aureus was more resistant to the ultrasonic medium than Pseudomonas aeruginosa, also a significant cause of hospital-acquired infections. To prevent staphylococcal transmission by ultrasound equipment, we recommend disinfection of the probe and removal of the medium after each examination.
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Antibiotics are the most prescribed drugs in hospitals in France and approximately one-third of prescriptions are for antimicrobial prophylaxis. Although the principles of prophylaxis have been defined over the years, there is still widespread misuse of antimicrobials for that purpose. The aim of this survey was to determine whether prescription of prophylactic antibiotics by French anaesthetists complies with the French Guidelines on Surgical Antibiotic Prophylaxis. ⋯ This survey indicates discrepancies between the French Guidelines on Surgical Antibiotic Prophylaxis and the current practice of French anaesthetists. Major concerns are the use of antibiotics such as 3GCs or fluoroquinolones and prescription for periods exceeding 48 h. In conclusion, compliance with guidelines for prophylactic antimicrobial administration should be more strict in surgical patients.
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We prospectively studied the incidence of hospital-acquired pneumonia in 1886 consecutive admissions to an 1800 bed hospital in Bombay; 991 of them to general medical wards and 895 to a 17-bed medical intensive care unit (ICU). The average bed occupancy in the general wards was 56 patients in a ward with 40 beds. Staffing in the general ward was two nurses for 56 patients, and in the ICU three nurses for 17 beds. ⋯ Costs of additional stay and antibiotics accounted for 18.6% of the ICU budget. The incidence of nosocomial pneumonia was lower than expected, despite occupancy exceeding bed capacity, low nurse:patient ratios, and extensive reuse of disposable respiratory therapy equipment. Nevertheless, nosocomial pneumonia imposes a significant financial burden on the already scarce resources available for intensive care in developing countries like India.