To evaluate the use of focused surveillance in following resistance patterns within an intensive care unit (ICU).

Antibiograms of 167 gram-negative isolates from ICU patients were compared to the hospitalwide antibiograms. ICU isolates were examined for the newer forms of beta-lactamase resistance. An outbreak of multiresistant Pseudomonas aeruginosa during the survey illustrated the usefulness of focused surveillance in early intervention and containment.

A 700-bed adult tertiary care hospital with a 16-bed medical and surgical ICU.

Hospitalwide and ICU antibiograms of the Enterobacteriaceae were similar. However, resistance of P aeruginosa in the ICU was underestimated by hospitalwide rates. Susceptibility of ICU isolates to ceftazidime, ciprofloxacin, and piperacillin was 54%, 54%, and 42%, compared with 81%, 77%, and 85%, respectively, in the hospital at large. Thirty-five percent of isolates exhibited one of the newer forms of beta-lactamase-mediated resistance, with 17% of isolates exhibiting Class I cephalosporinase production.

Targeted survey of high antibiotic-use hospital units should be used to study bacterial epidemiology, rather than relying on general hospital data to evaluate patterns of antimicrobial resistance. Monitoring of potential problem areas leads to prompt identification of changes in resistance and allows early intervention.

To evaluate an outbreak of fever and hypotension after cardiac surgical procedures and the role of polygeline, a plasma expander.

Unmatched case-control study.

A six-bed cardiac surgery intensive care unit (SICU) of the Hospital Clinic of Barcelona (Spain), a 940-bed public teaching hospital.

Eight cases and 25 control patients admitted to the SICU over a 4-week epidemic period.

Development of hypotension (systolic blood pressure ≤ 90 mm Hg or a drop of 40 mm Hg from baseline systolic blood pressure) and fever (axillary temperature >38.5°C) within 24 hours of a cardiac surgical procedure.

The single risk factor significantly different between cases and controls was the total volume of polygeline used throughout the surgical procedure for extracorporeal circulation: a median of 1,250 mL (mean, 1,312.5 ± 842.5 mL) in cases versus 500 mL (mean, 566.0 ± 159.9 mL) in controls (P = .0029). By multiple logistic regression analysis, polygeline use was the single risk factor significantly related to the outcome (odds ratio, 8.75; CI95, 1.36 to 56.2; P= .01). Neither blood cultures from patients nor cultures of the polygeline used yielded growth of any microorganism. Stopping use of the implicated polygeline lot controlled the outbreak.

Use of polygeline was associated with an outbreak of fever and hypotension in a SICU. Information from the manufacturer indicated the likelihood of contamination of the product with Bacillus stearothermophilus components. The manufacturer has since changed the production and control processes, and no further adverse events have been seen.

To evaluate the impact of a coordinated approach for the isolation, diagnosis, and treatment of patients with tuberculosis.

Retrospective cohort study.

Bronx-Lebanon Hospital Center, an inner-city hospital in the South Bronx, New York City.

Patients with smear-positive, culture-confirmed pulmonary tuberculosis.

Institution of a coordinated tuberculosis team.

Admissions of 46 patients before and 39 patients after the formation of a tuberculosis team were reviewed. Before institution of the tuberculosis team, 35% of patients were isolated within 24 hours of presentation, 41% never were isolated, and the mean number of days patients were not isolated was 19. After implementation of the tuberculosis team, 59% of patients were isolated within 24 hours, only 5% were never isolated, and the mean number of days patients were not isolated was 3.5. These differences were statistically significant. There also was a corresponding decrease in length of hospitalization. In addition, there were noticeable improvements in patient and staff morale and attitudes.

The tuberculosis team likely has decreased the risk of nosocomial tuberculosis transmission by increasing the proportion of infectious tuberculosis patients admitted into AFB isolation and by reducing (by 780) the number of days out of isolation while smear positive. There also were concomitant financial savings.

To determine the prevalence of tuberculin reactivity among all new employees at a hospital in New York City.

Prospective measurement of purified protein derivative (PPD) status in consecutive new employees at a hospital in New York City from 1991 to 1993. All employees are tested as part of a pre-employment physical, assuring complete compliance. Aplisol (Parke-Davis, Morris Plains, NJ) was used in 1991 and 1992, and Tubersol (Connaught, Swiftwater, PA) in 1993. Tests were applied and interpreted by trained employee health personnel.

Of 313 consecutive new employees, comprising all job categories, 40% were PPD positive at time of initial hire, including 20% of US-born and 70% of foreign-born employees. Of 114 persons who had received BCG vaccination, 67% were PPD positive. By multivariate regression analysis, age, BCG vaccination history, and foreign country of birth were independent predictors of a reactive PPD test.

The high prevalence of tuberculin reactivity may reflect high rates of Mycobacterium tuberculosis infection and disease in the community, complicating interpretation of the efficacy of Centers for Disease Control and Prevention (CDC) guidelines to prevent the spread of tuberculosis in healthcare facilities.