We performed a prospective study of infections following bone marrow transplantation in 50 patients treated for aplastic anemia or hematologic malignancy. Early, continuous prophylaxis with trimethoprim/sulfamethoxazole and oral nystatin, and empiric intravenous antimicrobial therapy during febrile granulocytopenic episodes were standard treatment for all patients. The use of trimethoprim/sulfamethoxazole did not appear to adversely affect donor marrow engraftment. Serious gram-negative bacillary and systemic Candida infections were uncommon. Although gram-positive bacterial infections were frequent, they were rarely associated with mortality. Aspergillosis emerged as the single most important infection, contributing to the death of nine patients. Cytomegalovirus diseases developed in 13 patients, seven of whom died. Patient age and chronic myelogenous leukemia were risk factors for the development of fatal infections. This study demonstrates that although certain serious infections can be controlled, there is a critical need for effective measures to prevent and treat aspergillosis and cytomegalovirus disease in these seriously compromised hosts.

The purpose of this study was to determine the source of organisms responsible for biliary infection associated with T-tube placement. Two groups of patients who had had T-tubes placed following common bile duct exploration were studied. In one group of 34 patients, bacterial cultures were taken daily from the drainage bag and the lumen of the T-tube. In the second group of patients, paired daily bacterial cultures were taken from the T-tube lumen and the skin tract surrounding the T-tube. Results of the first group showed the drainage bag to be the initial site of infection in seven cases, with “descending” infection from the patient's skin occurring in 27 cases, 14 in whom the organism was initially present in the bile while in the other 13 the organism appeared later. In the second group, of 32 isolates only five were found extraluminally before they appeared within the lumen, these five being all Staphylococcus epidermidis. Thus the majority of bile infections occurring after T-tube placement were found to originate from the patient's own biliary tree or skin.

We reviewed the records of the microbiology laboratory of the Veterans Administration Medical Center, Bronx, New York in order to determine the prevalence, epidemiology and complete antibiotic susceptibility profile of amikacin-resistant aerobic and facultative gram-negative bacilli isolated from clinical specimens submitted for culture between January 1,1980 and May 1,1981. Of more than 5000 gram-negative rods isolated during this 16-month period, 2.8% were determined to be resistant to amikacin by the disc diffusion method. Eighty-eight of the amikacin-resistant organisms were unique isolates derived from cultures on 74 patients located throughout the hospital. Urine (51%) and sputum (27%) were the predominant sources of specimens yielding resistant strains. These organisms represented seven different genera of Enterobacteriaceae (58%) or Pseudomonas aeruginosa (31%) and other glucose non-fermenting species (11%). Resistance to amikacin was usually associated with resistance to gentamicin, tobramycin and most of the other antimicrobials tested. Twenty percent of isolates were susceptible to only a single antimicrobial, and another 5% were resistant to every agent routinely tested. Although geographic clustering of a small number of amikacin-resistant organisms occurred twice (a strain of Proteus mirabilis on the spinal cord injury service and a strain of P. aeruginosa on one medical ward), the vast majority of isolations were consistent with a pattern of endemic resistance.

During a 30-month period in our 570-bed private community hospital, employees reported 218 injuries from needles and other sharp objects. Five of these injuries were from needles used on patients known to be hepatitis B surface antigens (HBsAg) positive. Four were from blades or scalpels used on HBsAg positive patients. A nother needle injury resulted in serious Staphylococcus aureus infection. Thirty-three percent of the injuries were from improperly disposed objects, generally in trash baskets in patient rooms. Housekeeping employees were the “innocent victims” of more than one-half of the injuries from such improperly disposed objects. A survey of reporting practices revealed housekeepers reported all their injuries. Underreporting was identified as a problem with laboratory personnel and nurses who tended to make their own judgment concerning the extent of the injury. An effective innovation resulting from our survey was the use of plastic irrigation bottles as an inexpensive and readily available container for disposal of sharps.

To a new student in this field, with a background in the economics of health care financing and insurance, there appear to be many challenging issues regarding: a) the efficacy of particular infection control measures; b) the calculation of economic benefit from particular measures; c) the determinants of the actual levels of expenditure on infection control and the measures actually adopted; and d) the rationale and pitfalls of regulatory standards such as those recommended by the Centers for Disease Control or adopted by the Joint Commission on Accreditation of Hospitals.