To determine the prevalence of infections and antibiotic use at a community hospital in 1990 and to compare the results with those from previous surveys in 1971, 1979, and 1984.

Point prevalence survey.

Community teaching hospital.

All hospitalized patients, excluding those on the nursery, psychiatry, and short-stay wards.

Medical records were reviewed and a pertinent physical examination was performed on each patient.

Overall, 46 (20.1%) of 229 patients had infection in 1990. Community-acquired and hospital-acquired infections were present in 26 (11.4%) and 24 (10.5%) of the patients, respectively. The most common site of community-acquired infection was the deep abdomen in 8 (25.8%) of 32 sites, while hospital-acquired infection most frequently involved the lower respiratory tract in 8 (25.0%) of 32 sites. Antimicrobial agents were being administered to 88 (38.4%) of the patients. Cephalosporins (particularly newer, broad-spectrum agents) were the most frequently used antibiotics, comprising 53 (45.3%) of the 117 total antimicrobial prescriptions. seven (18.4%) of the 38 antibiotics used for surgical prophylaxis were given for more than 48 hours. Trend analysis revealed no significant changes in the proportions of patients with community-acquired, hospital-acquired, or total infection over the last 20 years (p=.18, p=.12, and p=.O7, respectively). While the overall use of antibiotics increased p<.ool), the administration of prophylactic perioperative antibiotics for greater than 48 hours decreased p=.009).

Despite major shifts in factors associated with an increased risk of infection, the overall prevalences of hospital-acquired and community-acquired infections remained remarkably constant during the last 20 years. Although total antibiotic use increased, the duration of surgical prophylaxis decreased and the pattern of use of therapeutic antibiotics also changed with increased use of broad-spectrum agents

In this study, we measured microbial growth and endotoxin production in the intravenous anesthetic propofol using 10 different microbial strains; 6 isolated from outbreak cases and 4 from laboratory stock cultures.

In each trial, endotoxin-free glass tubes containing 10 ml propofol were inoculated with 10°-103 CFU/ml of the test organism and incubated at 30°C for 72 hours.

In May and June 1990, the Centers for Disease Control received reports of 5 outbreaks in 5 states of postsurgical patient infections and/or pyrogenic reactions. Epidemiologic and laboratory investigations implicated extrinsic contamination of an intravenous anesthetic, propofol, as the probable source of these outbreaks.

After 24 hours, 9 of the 10 cultures increased in viable counts by 3 to 6 logs. At least 1 ng/ml of endotoxin was produced within 24 hours by Escherichia coli, Enterobacter cloacae, and Acinetobacter calcoaceticus subspecies anitratus.

Propofol can support rapid microbial growth and endotoxin production. To avoid infectious complications, scrupulous aseptic technique should be used when preparing or administering this anesthetic.

To evaluate the impact of patient migration on human immunodeficiency virus (HIV)-related healthcare use in a rural setting.

Data were collected on all patients seeking medical care related to HIV infection at The University of Iowa HIV/acquired immunodeficiency syndrome (AIDS) clinic. Information was collected related to patient care, stage of illness, prior and current residence, and clinic and hospital use.

An outpatient clinic in a university hospital offering primary and consultative medical care for persons with HIV infection.

All patients scheduled into clinic reported a previous positive HIV serologic test.

Forty-five percent (81 of 181) of patients reported moving to Iowa, yet no more than 11% (n = 20) moved out of the state during the same period of observation. Of patients meeting the centers for Disease control criteria for AIDS, 24% were diagnosed prior to moving to Iowa (18 of 74). Twenty-seven percent of AIDS-related inpatient days of hospitalization and 19% of AIDS-related outpatient clinic visits were used by persons diagnosed in another state. Lifetime charges totalled for eight patients ranged from $24,873 to $232,556, with a mean of $109,934.

A substantial portion of HIV related healthcare in our rural area was used by individuals who had migrated to or back to Iowa. Further understanding of the reasons for and the extent of HIV patient migration to rural areas is needed.

To assess the incidence and spectrum of complications associated with central venous catheter (CVC) placement in the critically ill infant.

A prospective study of all babies hospitalized in a neonatal intensive care unit (NICU) from January 1989 to December 1989. Potential risk factors associated with infection were evaluated by a case-control comparison.

Conducted at a university-affiliated, tertiary care community hospital.

Neonates requiring intensive care and a central venous catheter. Controls consisted of noninfected babies.

Of 263 critically ill neonates, only 13 (4.9%) required a CVC insertion. Seventeen CVCs were placed in these 13 neonates for a total duration of 600 days (median, 32 days/cannula). Fifteen (88%) of these cannulas had one or more complications during its catheter life including dislodgement or leakage (53%), occlusion or thrombosis (47%), infections (29%), or minor bleeding (12%). Five babies (29%) developed 6 episodes of bloodstream infection including 3 sporadic cases due to Staphylococcus epidermidis and a cluster of fungemia due to Malassezia furfur associated with lipid emulsion therapy Infants with a CVC-associated infection were a younger gestational age (24 weeks versus 32 weeks, p=.04) and weighed less at birth (580 g versus 1285 g, p =.02). The overall rate of bloodstream infection was one episode per 100 days of catheter use.

CVCs may be lifesaving to a critically ill neonate, but complications occur frequently Use must be restricted to infants in whom alternate delivery routes of intravenous therapy or support are otherwise unavailable.