To quantify surgical-infection rate, to assess adherence with the antibiotic prophylaxis protocol, and to identify independent factors associated with surgical-wound infection (SWI).

We carried out a prospective study of a cohort of 2,237 general surgery patients with postsurgery stays of more than 48 hours. Odds ratios (OR) were estimated using unconditional multiple logistic regression.

A 1,300-bed, university-affiliated, tertiarycare hospital in Madrid, Spain.

254 patients developed SWI. The rate of adherence to the antibiotic prophylaxis protocol was 63.5%. Eight factors were independently associated with risk of SWI: age (OR=1.2 for every 10 years of age); wound classification (clean-contaminated, OR=6.4; contaminated, OR=3.7; dirty or infected, OR=9.3); antimicrobial prophylaxis (OR=0.5); stay prior to surgery (OR=1.1 for every 3 days); duration of operation (OR=1.5 for every 60 minutes); malignant neoplasm (OR=1.7); emergency procedure (OR=1.99); intensive-care unit stay prior to surgery (OR=2.6); and antimicrobial prophylaxis administered 2 or more hours before operation (OR=5.3).

In general, antimicrobial prophylaxis protects against SWI (OR=0.5); however, administration 2 hours or more before the operation increases the risk of SWI by a factor of 5.3. Therefore, measures should be taken to ensure the correct timing of antimicrobial prophylaxis.

To determine risk factors for patients whose cultures grew Stenotrophomonas maltophilia.

Retrospective case-control study of 60 patients with cultures positive for S maltophilia, matched by specimen site to 120 controls whose cultures grew other gram-negative aerobic bacteria.

University medical center.

S maltophilia was identified from the following sites: respiratory (36), wound (13), urinary (6), blood (4), and cerebral spinal fluid (1). By univariate analysis, cases had a higher risk of exposure than controls for ampicillin (P<.001), gentamicin (P<.001), vancomycin (P=.001), metronidazole (P=.003), piperacillin (P=.007), cefotaxime (P=.014), ceftazidime (P=.017), ciprofloxacin (P=.030), tobramycin (P=.040), and chronic respiratory disease (P=.024). Length of time foreign objects were in place prior to positive culture differed significantly between cases and controls only for endotracheal tubes in patients with respiratory isolates (median number of days: 12.5 for cases, 5 for controls; P=.007). For patients with urinary tract infections, having a urinary catheter increased the odds of infection 10 times over controls. Exposures found by multivariate analysis to be significantly more prevalent in cases than controls included ampicillin, cefotaxime, erythromycin, gentamicin, metronidazole, piperacillin, tobramycin, chronic respiratory disease, and female gender. Odds ratios were >1 indicating higher risk for cases, except for erythromycin, which had an odds ratio <1.

The primary risk factor associated with isolation of S maltophilia was antibiotic use. For patients with pulmonary infections, chronic respiratory disease and length of time an endotracheal tube was in place also contributed to the risk. This suggests that judicious use of antibiotics may prevent some cases of S maltophilia infection.

Investigate the nosocomial transmission of Trichophyton tonsurans tinea corporis.

Descriptive study of a nosocomial epidemic of tinea corporis.

A free-standing inpatient rehabilitation facility.

Patients and healthcare workers present on an inpatient rehabilitation ward at the time of transmission of tinea corporis.

T tonsurans tinea corporis was transmitted from one patient to four healthcare workers despite early diagnosis and treatment. Infection rates for healthcare workers having major, moderate, and minor contact with the index case were 30%, 17%, and 0%, respectively (overall rate, 25%).

This study identifies rehabilitation inpatients as another population in which nosocomial transmission of T tonsurans tinea corporis can occur. The high attack rate and transmission, despite early diagnosis and treatment, emphasizes the need for isolation precautions.

To characterize and enumerate central venous catheter (CVC)-related complications among children with chronic illnesses, and to reduce the complication rate through changes in CVC management and education.

A prospective obser vational study followed by an educational program and a nonrandomized inter ventional trial.

The Children's Hospital of Philadelphia, a tertiary, pediatric facility.

268 children with Broviac, Hickman, or Infusaport catheters in place during 58,290 catheter days.

Development and implementation of protocols for cleaning insertion site and hub, use of nonocclusive dressings, and manipulation of access; formal staff and parental education about protocols.

CVC-related infections fell from 4.58/1,000 catheter-days preinter vention to 3.83 postintervention (risk ratio [RR], 0.20; 95% confidence interval [CI95], 0.89-1.622; P=.25); exit-site infections fell from 0.58 to 0.11 (CI95, 1.22-45.64; P=.02); rates among infants on the surgical service fell from 15.46 to 6.67 (RR, 2.31; CI95, 1.10-4.30; P=.02).

Education and changes in management protocols reduced the incidence of exit-site infections among all patients and reduced the overall infectious complication rate among the infants receiving parenteral nutrition on the surgical ser vice. Other interventions are needed to decrease further the infectious complications in these children

To compare the epidemiology of vancomycin-resistant Enterococcus faecium (VRE) in a longterm–care unit and an acute-care hospital.

Point-prevalence surveys for VRE rectal colonization of patients were carried out over a 21-month period in patients in a long-term–care unit and an acutecare hospital (medical ward and intensive-care units). The environment and hands of healthcare workers also were sampled for VRE. Contour-clamped homogeneous electric field (CHEF) electrophoresis was used to evaluate possible transmission among roommates and the relatedness of patient strains to those in the environment and on the hands of healthcare workers.

A 200-bed Veterans Affairs Medical Center with an attached 90-bed long-term–care unit.

From December 1994 to January 1996, rectal VRE colonization of patients in the long-term–care unit increased significantly from 9% to 22%. In contrast, patients on the medical ward rarely were colonized after the first survey in December 1994, and only two intensivecare–unit patients were found to be colonized during the four surveys. The environment was contaminated persistently in the long-term–care unit. In the four surveys, carriage of VRE on hands of healthcare workers varied from 13% to 41%; 65% of healthcare workers with VRE found on their hands worked in the long-term–care unit.

Seven different strains were identified by CHEF typing. Although the initial survey found only vanA strains, subsequent surveys showed vanB strains also were present.

Residents of a long-term–care unit frequently were colonized with VRE, but infections were uncommon in this population. The environment of the long-term–care unit was contaminated with VRE, and VRE was found frequently on the hands of healthcare workers in this unit. Both vanA and vanB genotypes were found in this setting.

To describe the incidence and patterns of nosocomial fungal infection in a large teaching hospital in Taiwan.

Prospective, hospitalwide nosocomial surveillance data from 1981 through 1993 were analyzed to show the secular trend in nosocomial fungal infection rates and to identify the most common pathogens and sites of infection (other than skin) in this hospital.

The National Taiwan University Hospital is a medical school-affiliated hospital in the city of Taipei, Taiwan, with a 1,200-bed capacity before 1991 and 1,500 beds since 1992. It provides both primary and tertiary medical care.

The overall nosocomial fungal infection rate rose from 0.9 infections per 1,000 discharges in 1981 to 6.6 per 1,000 discharges in 1993, with the highest rate at the medical intensive-care unit (26.5/1,000 discharges in 1993). This increase in infection rate was found at four major anatomic sites of infection, particularly including the bloodstream (0.08-2.19/1,000 discharges) and the urinary tract (0.36-2.95/1,000 discharges). Of 256 pathogens causing nosocomial fungemia from 1981 through 1993, Candida albicans was the most commonly isolated (50.8%), followed by Candida tropicalis (17.6%), Candida parapsilosis (11.7%), and Candida glabrata (8.2%). As compared to isolates from 1981 through 1988, the proportion of C parapsilosis and C glabrata isolated between 1989 and 1993 increased more than sixfold and fourfold, respectively. The increasing importance of fungal infections was confirmed further by the increased use of amphotericin B and azoles in this hospital.

Candida species and other yeasts have become a prominent cause of nosocomial infections in this hospital. These fungal pathogens accounted for a higher proportion of nosocomial bloodstream and urinary infections than any single bacterial species. Therefore, it is important to conduct a prospective epidemiological study and to establish in vitro antifungal susceptibility testing to enhance efforts to control nosocomial fungal infections and to minimize the risk of emergence of antifungal resistance.