Clostridium difficile-associated diarrhea (CDAD) is common among hospital-acquired bacterial diarrhea, its mortality and morbidity show an increasing trend in recent years. Improper antimicrobial drug use is one of the key reasons. Adequate hand hygiene of healthcare workers, thorough disinfection of hospital environment, and appropriate isolation of patients are effective measures to prevent the outbreak of hospital-aquired CDAD.
Clostridium difficile ; physiology ; Cross Infection ; microbiology ; mortality ; prevention & control ; Diarrhea ; microbiology ; mortality ; prevention & control ; Enterocolitis, Pseudomembranous ; microbiology ; mortality ; prevention & control ; Humans ; Infection Control

PURPOSE: Despite advances in infection control practices, Surgical Site Infections (SSIs) remain a substantial cause of morbidity and mortality among hospitalized patients. This study was undertaken to determine prospectively the incidence of postoperative wound infections in surgical patients and to identify the risk factors associated with the development of wound infections. METHODS: Prospective data on 761 surgical operation patients in the department of surgery at Ewha Womans University Mokdong Hospital were collected over a 7 month-period from May 1, to December 31, 2001. The Centers for Disease Control and Prevention (CDC)'s definitions of surgical wound infections were used. RESULTS: A total of 761 patients were observed over 30 days. The overall incidence of wound infection was 2%. SSIs were significantly associated with the degree of wound contamination (P=0.0004). The infection rate increased as the degree of wound contamination increased from clean (1.4%) through clean-contaminated (1.8%) and contaminated (1.8%), to dirty- infected wound (12.7%). The infection rate was related with the American Society of Anesthesiologists (ASA) preoperative assessment score (P=0.00153). There were no SSIs from laparoscopic surgery. The duration of operation was not associated with an increase in wound infections. Enterococcus faecium and Staphylococcus aureus were the most frequently isolated organisms. Three out of the five (60%) cases of E. faecium were vancomycin-resistant enterococci (VRE) and all of three cases of S. aureus were methicillin- resistant Staphylococcus aureus (MRSA). CONCLUSION: This study confirms that the degree of wound contamination is a significant preoperative risk factor for SSI. Many antibiotic-resistant bacteria such as MRSA and VRE were isolated. Accordingly, infection control practitioners need to consider this risk factor in the design of effective infection control strategies. There should be another safe and feasible option available for the treatment of selective patients.
Bacteria ; Centers for Disease Control and Prevention (U.S.) ; Cross Infection ; Enterococcus faecium ; Female ; Humans ; Incidence ; Infection Control ; Infection Control Practitioners ; Laparoscopy ; Methicillin-Resistant Staphylococcus aureus ; Mortality ; Prospective Studies* ; Risk Factors ; Staphylococcus aureus ; Surgical Wound Infection* ; Wound Infection ; Wounds and Injuries

During the second half of the 19th century many operations were developed after anesthesia was introduced but advances were limited for many years because of the high rate of infection and the high mortality rate that followed infections. After the introduction of the principle of antisepsis, postoperative infectious morbidity decreased substantially. With the introduction of antibiotic therapy in the middle of the 20th century, a new adjunctive method to treat and prevent surgical infections was discovered. However, not only have postoperative wound and hospital required infections continued, but widespread antibiotic therapy has often made prevention and control of surgical infections more difficult. Based on National Nosocomial Infection Surveillance (NNIS) system reports, SSIs (Surgical Site Infections) are the third most common nosocomial infection, accounting for 14% to 16% of all nosocomial infections among hospitalized patients. It is also a significant source of postoperative morbidity, resulting in increased hospital length of stay and increased cost. Determination of risk factors for the development of SSI has been a major focus of surgical research. To reduce the rate of SSIs we have to eliminate risk factors of SSIs and keep a continuous surveillance with feedback of information to surgeons and other relevant staff. A successful SSI surveillance program includes standardized definition of infection, effective surveillance method, and stratification of the SSIs rates according to risk factors. Because SSIs may be the most preventable of nosocomial infections, health care facilities should make special efforts to reduce the risk of development of these surgical complications. The evaluation of infection control programs and the development of more effective infection control strategies should be established and surgeons should be more concern about SSI control.
Anesthesia ; Antisepsis ; Cross Infection ; Delivery of Health Care ; Humans ; Infection Control ; Length of Stay ; Mortality ; Risk Factors ; Wounds and Injuries

Puerperal sepsis is one of the leading causes of maternal morbidity and mortality worldwide. Postpartum pelvic infections can cause various complications, including wound infections and necrotizing fasciitis. Several microorganisms are known to cause such infections; however, no study has reported on Staphylococcus caprae, a coagulase-negative staphylococcus that is isolated frequently from animals and infrequently from human specimens, as a causative agent. Here, we report a rare case of septic shock complicated by necrotizing fasciitis after a cesarean section. This is the first report of a human isolate of S. caprae in association with puerperal sepsis and necrotizing fasciitis.
Animals ; Cesarean Section ; Escherichia coli ; Escherichia ; Fasciitis, Necrotizing ; Female ; Goats ; Humans ; Mortality ; Pelvic Infection ; Postpartum Period ; Pregnancy ; Puerperal Infection ; Sepsis ; Shock, Septic ; Staphylococcus ; Wound Infection

BACKGROUND: Lymphocytopenia is a common finding in critically ill patients while lymphocyte depletion in critically ill patients is presumed to have little clinical significance. However, a total lymphocyte count has been reported to provide prognostic information in surgical patients. The aim of this study was to evaluate the association of a total lymphocyte count (TLC) with a prognostic criterion in critically ill patients. METHODS: The patients were divided into three groups according to their TLC on admission to intensive care unit (ICU) (Group 1: TLC > 1.0 x 10(9)/L, Group 2: 0.7 x 10(9)/L < TLC < 1.0 x 10(9)/L, and Group 3: TLC <0.7 x 10(9)/L). Outcomes examined were patients' in-hospital mortality, length of hospital stay and incidence of infection. RESULTS: Patients with a TLC less than 0.7 x 10(9)/L (Group 3) had an infection twice (32% VS 15%) as often as those with a TLC more than 0.7 109/L (Group 1 2). But, in the hospital stay and mortality, there was no significant difference among the groups. CONCLUSIONS: TLC is very useful indicator in critically ill patients with a high risk of hospital infection on ICU admission.
Critical Illness* ; Cross Infection* ; Hospital Mortality ; Humans ; Incidence ; Intensive Care Units ; Length of Stay ; Lymphocyte Count* ; Lymphocyte Depletion ; Lymphopenia ; Mortality

Infective endocarditis related to pacemaker implantation is a rare complication. However, it is a potentially lethal complication with a mortality rate of 30 to 35%. Infective endocarditis associated with pacemaker implantation usually involves the right heart and tricuspid valve. Conservative treatment without complete removal of the entire pacing system is prone to fail (i.e. result in infection relapse or development of sepsis). Therefore, the total extraction of the entire pacemaker system should be considered as standard therapy for most patients with pacemaker-related endocarditis and for many patients with local infectious symptoms at the site of pacemaker implantation to achieve complete recovery. We report a case of a 42-year-old man with documented pacemaker related left-sided endocarditis that was associated with multiple embolic events. Also, we review the literature regarding pacemaker-related endocarditis and local wound infection, in particular with respect to the modalities of treatment.
Adult ; Aortic Valve* ; Endocarditis* ; Endocarditis, Bacterial ; Heart ; Humans ; Mortality ; Recurrence ; Tricuspid Valve ; Wound Infection

PURPOSE: Neonates in neonatal intensive care units(NICU) have a high risk of acquiring nosocomial infection because of their impaired host defence mechanism and invasive procedures. Nosocomial infection result in considerable morbidity and mortality among neonates. This study was carried out to survey both the epidemiology of nosocomial infection in our NICU and the annual trends of pathogens. METHODS: We retrospectively reviewed culture proven nosocomial infection which occurred in our NICU from January 1995 to December 1999. The data included clinical characteristics, site of infection, pathogens, and mortality. RESULTS: Nosocomial infection rates was 9.0 per 100 NICU admissions during the five-year period. Major sites of infection were bloodstream(32.3%), skin(18.4%), endotracheal tube(17.2%), and catheter(10.6%). The most common pathogen was S. aureus(29.9%). and the others were coagulase-negative staphylococci(CONS)(14.8%), Enterobacter(12.4%), and Candida(9.0%). During the five-year period, nosocomial infection rates increased from 9.5 to 11.6 per 100 admissions with the increase of CONS, Candida, Klebsiella, and Acinetobacter baumannii. The infection rate of S. aureus decreased. Multiple episodes of nosocomial infection occurred in 26.1% of all nosocomial infections. Overall bloodstream infection rates were 3.6 per 100 NICU admissions during five years. CONS(29.1%) and S. aureus(27.1%) were the two most common pathogens. Increasing rates of bloodstream infection by CONS, Candida, Klebsiella, and Acinetobacter baumannii were observed. Bloodstream infection related mortality was 11.9%. CONCLUSION: The predominant pathogens of nosocomial infection in NICU were S. aureus and CONS. Bloodstream infection, the most frequent nosocomial infection, should be a major focus of surveillance and prevention efforts in NICU.
Acinetobacter baumannii ; Candida ; Cross Infection* ; Epidemiology ; Humans ; Infant, Newborn ; Intensive Care, Neonatal* ; Klebsiella ; Mortality ; Retrospective Studies

Infected median sternotomy wounds represents one of major complication of cardiothoracic surgery. Although the incidence is less than 1%, its associated morbidity, mortality, and "cost" remain unacceptably high. For the treatment of this recalcitrant wound infections, most patient underwent radical debridement with sternectomy and reconstructed by muscle flaps. The most common combination of flaps being the omentum and bilateral pectoralis major musculocutaneous flaps. In our case, 2 patients who had extensive mediastinal infection at sternotomy wound underwent omental transposition flap pedicled on the right gastroepiploic artery and pectoralis major muscle flap. Omentum has rich lymphatics and high vascularity enough to revascularize the ischemic tissues. Using the greater omentum for infected median sternotomy wound combined with other muscle flap is an useful method for reconstruction of large defects invading lower 1/3 of sternum or retrosternal dead space.
Debridement ; Gastroepiploic Artery ; Humans ; Incidence ; Mortality ; Myocutaneous Flap ; Omentum ; Sternotomy ; Sternum ; Wound Infection ; Wounds and Injuries

BACKGROUND: The hospital-acquired pneumonia is the most common nosocomial infection. Recently, the Acinetobacter baummannii infections are rapidly increasing, especially the frequency of Multi-drug resistant A. baumannii. Therefore we assessed clinical features and prognosis of patients in the ICU with Multi-drug resistant A. baumannii from the sputum culture using the Clinical Pulmonary Infection Score(CPIS). METHODS: The medical records of 43 patients with Multi-drug resistant A. baumannii from sputum culture who were suspected had clinically pneumonia and admitted to the ICU from January 2000 to July 2002 were retrospectively analyzed. RESULT: 19 patients were CPIS greater than 6 and 24 patients were CPIS less than or equal to 6. Mean age for the former was 71+/-11 years old, and the latter was 61+/-19 years old. The mean APACHE II score on admission and on sputum study was not different between two groups(17.4+/-5.7 vs 18.5+/-6.1, p=0.553, 20+/-6 vs 17+/-8, p=0.078). But the mortality rate was 73.7% for the former, and 16.7% for the latter(p<0.001). CONCLUSION: In ICU patients who had clinically suspected pneumonia with sputum culture positive for Multi-drug resistant A. baumannii, the mortality was significantly higher if CPIS was greater than 6.
Acinetobacter baumannii* ; Acinetobacter* ; APACHE ; Cross Infection ; Humans ; Medical Records ; Mortality ; Pneumonia ; Prognosis ; Retrospective Studies ; Sputum*

No abstract available.
Female ; Humans ; Infection/*therapy ; Male ; Pancreatitis, Acute Necrotizing/epidemiology/mortality/*therapy ; Survival Rate