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  • 1
    Electronic Resource
    Electronic Resource
    Nosocomial Infections in a Neurosurgery Intensive Care Unit (1999)
    Springer
    Acta neurochirurgica 141 (1999), S. 1303-1308 
    Details
    ISSN: 0942-0940
    Keywords: Keywords: Intensive care unit; neurosurgery; nosocomial infection; surveillance.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary ¶ In order to identify overall and site-specific nosocomial infection (NI) rates in patients receiving neurosurgical intensive care therapy, a prospective study was started in February 1997 in the eight-bed neurosurgical ICU of the University Hospital of Freiburg, Germany. Case records were reviewed twice a week, all microbiology reports were reviewed and ward staff was consulted. NI were defined according to the CDC-criteria and were categorised into specific infection sites. Within 20 months, 545 patients with a total of 5,117 patient days were investigated (mean length of stay: 9.4 days). 113 NI were identified in 90 patients (72 pts. with one, 13 with two and 5 with three infections, respectively). A moderate to high overall incidence (20.7/100 pts.) and a moderate incidence density (22.1/1,000 patient days) of NI in the neurosurgical ICU could be documented; these figures are well within the range of published data. Site specific incidence rates and incidence densities were: 1 bloodstream infection per 100 patients (0.9 central line-associated BSIs per 1,000 central line-days), 9 pneumonias per 100 patients (15.1 ventilator-associated pneumonias per 1,000 ventilator-days), 7.3 urinary tract infections per 100 patients (8.5 urinary catheter-associated UTIs per 1,000 urinary catheter-days). Additionally, 1.1 cases of meningitis, 0.7 brain abscesses/ventriculitis, and 1.7 other infections (surgical site infection, bronchitis, catheter related local infection, diarrhoea) were documented per 100 patients, respectively. 14.6% of isolated pathogens were E. coli, 10.2% enterococci, 9.6% S. aureus, 6.4% CNS, 6.4% Klebsiella spp., 5% Enterobacter spp. and 5% Pseudomonas spp.. In 11 cases of NI no pathogen could be isolated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s007010050434
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  • 2
    Electronic Resource
    Electronic Resource
    Shunt nephritis associated withPropionibacterium acnes (1994)
    Springer
    Infection 22 (1994), S. 99-101 
    Details
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bei einem 22jährigen Patienten, der im September 1989 einen ventrikuloatrialen Shunt und einen Ventrikelkatheter zur Therapie einer zerebralen Zyste implantiert erhielt, wurde eine membranoproliferative Glomerulonephritits in Assoziation mit einer Shuntinfektion durchPropionibacterium acnes diagnostiziert. Obgleich Infektionen von zentralnervösen Shunts nichts Ungewöhnliches darstellen, ist die Entwicklung einer Glomerulonephritis eine Seltenheit. Vermutlich ist die Shuntnephritis die Folge einer Immunkomplexantwort und der Ablagerung von Immunkomplexen in der Niere. Nach der nur unvollständigen Entfernung des Shunts aufgrund technischer Probleme und zusätzlicher Gabe von 3 × 2 g Cefotaxim für 14 Tage verbesserte sich die Nierenfunktion, jedoch trat keine komplette Remission ein.
    Notes: Summary Membranoproliferative glomerulonephritis was observed in a 22-year-old male patient in whom a ventriculoatrial shunt and a ventricular catheter were implanted after he was diagnosed in September 1989 with a cerebral cyst.Propionibacterium acnes infection of a central nervous system shunt was diagnosed. The venticuloatrial shunt was removed (the catheter had become embedded in tissue and was left in place) and the patient was treated with cefotaxime (3×2 g) for 14 days. Renal function improved, but recovery was not complete.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01739014
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  • 3
    Electronic Resource
    Electronic Resource
    Synergismus von Netilmicin und anderen Aminoglykosiden mit Cefotaxim gegen nosokomiale, nicht fermentierende Erreger (1980)
    Springer
    Infection 8 (1980), S. S433 
    Details
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Using the checkerboard agar dilution method, the combined effect of cefotaxime with netilmicin and other aminoglycosides on 57 non-fermenting, gram-negative bacteria (Pseudomonas aeruginosa, Pseudomonas cepacia, Pseudomonas maltophilia, Pseudomonas fluorescensputida, Acinetobacter anitratus, Acinetobacter lwoffi) was tested. These bacteria had been isolated from patients with nosocomial infections. An average of 39% of the non-fermenting bacteria were inhibited by the additive effect of cefotaxime-aminoglycoside combinations. 14% on the average by the synergistic effect. The additive and synergistic effect was greatest againstP. aeruginosa, P. maltophilia andP. fluorescens-putida strains and weakest againstAcinetobacter species. No synergism was found withP. cepacia strains. The additive and/or synergistic combinations reduced the minimal inhibitory concentrations of cefotaxime, netilmicin and other aminoglycosides to therapeutically attainable serum concentrations for nearly all strains.
    Notes: Zusammenfassung Mit der Checkerboard-Agar-Dilutionsmethode wurde die Kombinationswirkung von Cefotaxim mit Netilmicin und anderen Aminoglykosiden gegen 57 nicht fermentierende gramnegative Bakterien (Pseudomonas aeruginosa, Pseudomonas cepacia, Pseudomonas maltophilia, Pseudomonas fluorescensputida, Acinetobacter anitratus, Acinetobacter lwoffi) überprüft, die von Patienten mit im Krankenhaus erworbenen Infektionen isoliert worden waren. Durchschnittlich 39% der Nonfermenter wurden durch Cefotaxim-Aminoglykosid-Kombinationen additiv, 14% synergistisch gehemmt. Die additive und synergistische Wirkung war am besten beiP. aeruginosa, P. maltophilia undP. fluorescens-putida Stämmen, am niedrigsten gegenAcinetobacter Spezies; gegenP. cepacia Stämme trat kein Synergismus auf. Die additiven und/oder synergistischen Kombinationen senkten die minimalen Hemmkonzentrationen von Cefotaxim, Netilmicin und anderen Aminoglykosiden bei fast allen Stämmen auf therapeutisch erreichbare Serumkonzentrationen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01639413
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  • 4
    Electronic Resource
    Electronic Resource
    Antibiotic usage in community-acquired pneumonia: Results of a survey in 288 departments of internal medicine in German hospitals (1991)
    Springer
    Infection 19 (1991), S. 301-304 
    Details
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Im Rahmen einer 1989 durchgeführten Umfrage in 800 internistischen Abteilungen von Krankenhäusern aller Größenordnungen im gesamten Bundesgebiet und West-Berlin wurden Informationen über die Praxis der Antibiotikatherapie bei der nicht krankenhauserworbenen Pneumonie gesammelt. 288 Fragebögen (36,0%) konnten ausgewertet werden. Während bei Pneumonie mit nicht lebensbedrohlichem Krankheitsbild die Therapie in der Regel meist richtig war, obwohl Makrolide als Mittel der Wahl nur selten (11%) angegeben wurden, traf dies bei lebensbedrohlichem Zustand der Patienten nicht zu. Hier wurden in 50% auch neuere Betalactam-Antibiotika und in 43% Betalactam-Antibiotika in Kombination mit Aminoglykosiden genannt. Die atypischen Erreger werden somit bei den meisten Therapieregimen nicht eingeschlossen.
    Notes: Summary In 1989 a survey was conducted in 800 medical departments of university hospitals and large to small teaching and non-teaching hospitals in the Federal Republic of Germany and West Berlin to gather information on the usage of antibiotics for the treatment of community-acquired pneumonia. A total of 288 (36%) questionnaires could be evaluated. In cases of non-life-threatening pneumonia, the therapy specified was mostly correct, although macrolides as the treatment of choice were stated only rarely (11%). However, patients with life-threatening pneumonia were most often (50%) treated with new β-lactam antibiotics or β-lactam antibiotics in combination with aminoglycosides (43%). Thus, atypical pathogens causing pneumonia were not covered by most therapeutic regimens.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01645351
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  • 5
    Electronic Resource
    Electronic Resource
    In vitro activity of sulbactam plus ampicillin against hospital isolates of coagulase-negative staphylococci and acinetobacter species (1989)
    Springer
    Infection 17 (1989), S. 272-274 
    Details
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Bei klinischen Isolaten von 54 koagulase-negativen schleimbildenden und nicht-schleimbildenden Staphylokokken und 52 Acinetobacter-Spezies wurde im Agardilutionstest das Resistenzverhalten gegenüber Sulbactam, Ampicillin und der 1:1-Kombination aus beiden Substanzen untersucht. Die koagulase-negativen Staphylokokken erwiesen sich als sulbactam-resistent, jedoch gleichsam ampicillin- wie sulbactam/ampicillin-empfindlich (MHK- bzw. MBK-Modalwert Ampicillin: 0,03 bzw. 4 mg/l; Sulbactam/Ampicillin: jeweils 1 mg/l; geometrischer MHK- bzw. MBK-Mittelwert Ampicillin: 0,38 bzw. 0,56 mg/l, Sulbactam/Ampicillin: 0,26 bzw. 0,38 mg/l). In der Empfindlichkeit schleimbildender oder nicht-schleimbildender Stämme bestand gegen Ampicillin im Vergleich zur Kombination kein Unterschied; eine Ausnahme hiervon machte nur die höhere Ampicillin-MBK (Modalwert: 4 mg/l) gegen die schleimbildenen Stämme. Ampicillin sowie Sulbactam/Ampicillin zeigten größere Wirksamkeit gegen nichtschleimbildende als gegen schleimbildende Stämme mit MHK- bzw. MBK-Modalwerten von 0,03 vs 1 mg/l. Acinetobacter-Spezies waren sulbactam-empfindlich (MHK- bzw. MBK-Modalwert 1 mg/l; geometrischer MHK- bzw. MBK-Mittelwert 1,51 bzw. 2,98 mg/l), jedoch ampicillin-resistent. Die Kombination Sulbactam/Ampicillin dagegen zeigte eine sehr gute Wirksamkeit gegen die Keime aus der Acinetobacter-Gruppe (MHK-bzw. MBK-Modalwert 0,5 bzw. 2 mg/l; geometrischer MHK- bzw. MBK-Mittelwert 0,74 bzw. 2,08 mg/l).
    Notes: Summary The antimicrobial susceptibility of 54 recent clinical isolates of coagulase-negative slime- and non-slime-producing staphylococci and 52Acinetobacter spp. to sulbactam, ampicillin and the combination of both drugs with a 1:1 ratio was studied by means of an agar dilution test. The coagulase-negative staphylococci showed resistance against sulbactam alone, whereas ampicillin as a single agent was nearly as active as sulbactam plus ampicillin (mode of MIC and MBC 0.03 and 4 mg/l vs. 1 mg/l; geometric mean of MIC and MBC 0.38 and 0.56 vs. 0.26 and 0.38 mg/l, respectively). Among slime-producing or non-slime-producing strains, there was no difference in the susceptibility against ampicillin alone compared to the sulbactam/ampicillin combination, with the exception of the higher MBC (mode: 4 mg/l) for slime-producing strains. Both ampicillin and the sulbactam/ampicillin combination were more active against non-slime-producing than slime-producing strains with modes of MIC and MBC of 0.03 vs. 1 or 4 mg/l.Acinetobacter spp. were susceptible to sulbactam alone (mode of MIC and MBC 1 mg/l; geometric mean of MIC and MBC 1.51 and 2.98, respectively), but resistant to ampicillin. However, the sulbactam/ampicillin combination was highly active againstAcinetobacter spp. (mode of MIC and MBC 0.5 and 2 mg/l; geometric mean of MIC and MBC 0.74 and 2.08 mg/l, respectively).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01639539
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  • 6
    Electronic Resource
    Electronic Resource
    MIC and serum bactericidal activity of clindamycin against methicillin-resistant and -sensitive Staphylococci (1993)
    Springer
    Infection 21 (1993), S. 407-409 
    Details
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung In dieser Studie wurde dieIn-vivo-Aktivität von Clindamycin gegen 50 Oxacillin-sensible (MSSA) und 50 Oxacillin-resistenteStaphylococcus aureus(MRSA-)Stämme mit dem Serumbakterizidie-Test/(SBA) untersucht. Sechs Probanden wurde einmalig 600 mg Clindamycin intravenös infundiert. Weiterhin wurde die minimale Hemmkonzentration (MHK) von Clindamycin gegen 50 Oxacillin-sensible und -resistenteS. aureus und 50 Oxacillin-resistenteStaphylococcus epidermidis-Stämme, von welchen die Hälfte Schleim produzierten, bestimmt. Clindamycin hatte eine gleich hohe Serumbakterizidie gegen Oxacillin-sensible und-resistenteS. aureus-Stämme (durchschnittlicher reziproker SBA Titer von MSSAvs MRSA 1h nach Applikation: 13,0vs 13,45), obwohl die MHK-Werte gegen die Oxacillin-sensiblenS. aureus deutlich geringer waren (MHK 90 von MSSAvs MRSA: 0,06vs 32 mg/l). Die MHK-Werte gegen die Oxacillin-resistentenS. epidermidis-Stämme waren ebenfalls niedrig, ein Unterschied zwischen Schleim-, beziehungsweise nicht schleimproduzierenden Stämmen bestand nicht.
    Notes: Summary Six volunteers were given 600 mg clindamycin intravenously to investigate the serum bactericidal activity (SBA) against 50 methicillin susceptible (MSSA) and 50 methicillin resistantStaphylococcus aureus (MRSA) strains. Minimal inhibitory concentrations (MIC) against MSSA, MRSA and 50 methicillin resistant strains ofStaphylococcus epidermidis (MRSE), of which 50% were slime-producing, were determined. SBA of clindamycin against MSSA and MRSA was equally high (mean reciprocal SBA titer against MSSAvs MRSA 1h after application was 13.0vs 13.45), although MICs against MRSA were markedly higher than against MSSA (MIC 90 of MRSAvs MSSA: 0.06vs〉32 mg/l). There was no difference in MICs between slime- and non-slime-producing MRSE.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01728926
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  • 7
    Electronic Resource
    Electronic Resource
    Letter to the Editor (1981)
    Springer
    Infection 9 (1981), S. 302-302 
    Details
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01640997
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  • 8
    Electronic Resource
    Electronic Resource
    Zentrale Venenkatheter: State of the Art (1999)
    Springer
    Intensivmedizin und Notfallmedizin 36 (1999), S. 332-334 
    Details
    ISSN: 1435-1420
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003900050247
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  • 9
    Electronic Resource
    Electronic Resource
    Prävention nosokomialer Harnweginfektionen Empfehlungen des Nationalen Referenzzentrums für Krankenhaushygiene (1999)
    Springer
    Intensivmedizin und Notfallmedizin 36 (1999), S. 15-26 
    Details
    ISSN: 1435-1420
    Keywords: Key words Nosocomial urinary tract infection ; prevention of catheter-associated urinary tract infections ; evidence-based guidelines ; Schlüsselwörter Nosokomiale Harnweginfektionen ; Prävention Katheterassoziierter Harnweginfektionen ; evidenzbasierte Leitlinien
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Harnweginfektionen sind mit einem Anteil von ca. 40% die häufigsten nosokomialen Infektionen und in den meisten Fällen mit transurethralen Kathetern assoziiert. Die Empfehlungen der Centers for Disease Control and Prevention (CDC, Atlanta, USA) als international wichtigste, evidenz-basierte Leitlinien zur Prävention Katheterassoziierter Harnweginfektionen wurden im Jahre 1981 veröffentlicht und seitdem nicht aktualisiert. Evidenzbasierte nationale Empfehlungen sind in Deutschland bislang nicht verfügbar. Wir haben deshalb eine systematische Literaturrecherche nach randomisierten, kontrollierten Interventionsstudien zur Prävention Katheterassoziierter Harnweginfektionen durchgeführt (Medline, Cochrane Library, Durchsicht wichtiger Standardwerke). Insgesamt wurden 50 randomisierte, kontrollierte Interventionsstudien identifiziert, welche die Einschlußkriterien erfüllten. Wesentliche neue Erkenntnisse ergaben sich in den letzten Jahren zu Alternativen von transurethralen Kathetern und zu neuen Kathetermaterialien. Von den CDC-Empfehlungen ausgehend, deren wichtigste Prinzipien immer noch Gültigkeit besitzen, wurden vom Nationalen Referenzzentrum für Krankenhaushygiene* aktualisierte Leitlinien zur Prävention Katheter-assoziierter Harnweginfektionen entwickelt.
    Notes: Summary Urinary tract infections are the most frequent nosocomial infections, accounting for about 40% of all nosocomial infections. In most cases these infections are associated with indwelling urinary catheters. The guideline from the Centers for Disease Control and Prevention (Atlanta, USA) for the prevention of catheter-associated urinary tract infections, as the most important evidence-based guideline worldwide, was published in 1981 and has not been updated so far. Evidence-based national guidelines are not available in Germany. We have, therefore, performed a literature search for randomized, controlled studies on the prevention of catheter-associated urinary tract infections (Medline, Cochrane Library, reference text books) published since 1981. Fifty studies meeting our inclusion criteria were identified. Substantial new findings have been published on alternatives to urethral catheters and new catheter materials. Based upon the CDC guideline, whose principles are still valid, updated guidelines for the prevention of catheter-associated urinary tract infections have been developed by the National Reference Center for Hospital Hygiene.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003900050204
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  • 10
    Electronic Resource
    Electronic Resource
    Exogenous or endogenous reservoirs of nosocomialPseudomonas aeruginosa andStaphylococcus aureus infections in a surgical intensive care unit (1993)
    Springer
    Intensive care medicine 19 (1993), S. 161-165 
    Details
    ISSN: 1432-1238
    Keywords: Nosocomial infections ; Intensive care unit ; Staphylococcus aureus ; Pseudomonas aeruginosa
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective A 4 month prospective study was performed to assess the incidence and routes of endogenous or exogenous colonization and nosocomial infection caused byStaphylococcus aureus andPseudomonas aeruginosa in surgical critically ill patients. Design A total of 4634 specimens ware obtained. Patient's nasal, scalp, and rectal swabs as well as tracheal secretion (TS) were cultured every second day beginning on the day of admission. Nasal swabs and hand cultures of the personnel as well as cultures from gowns were also taken. all isolates ofS. aureus were phage typed and 116 of these isolates were also plasmid typed.P. aeruginosa isolates were sero-and pyocin typed. Resistance patterns were determined in all isolates. Setting The suty was carried out in the surgical intensive care unit (SICU) of an teaching hospital. Patients During the study period each patient (a total of 153 patients) admitted to the SICU entered the study. Results P. aeruginosa andS. aureus colonisation rate on admission were 5% and 36.5% respectively. Only 10 patients (6.5%) were colonized withP. aeruginosa during hospitalization, and only 7 patients (4.5%) acquiredS. aureus in the surgical intensive care unit (SICU). The most common primary colonisation site ofP. aeruginosa was the rectum, whereasS. aureus was predominantly found in nasal cultures. Horizontal transmission ofS. aureus occured in only 2 patients. Conclusion The study suggests that colonisation withP. aeruginosa andS. aureus occurs from endogenous rather than from exogenous sources and that the endogenous acquisition of both bacteria play a more important role in development of nosocomial infections than the exogenous route of transmission.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01720533
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