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Clostridium perfringens wound infection associated with elastic bandages
Volume 9 Number 1 February, 1981
in epidemic situations, high-risk patients in an intensive care unit receiving multiple antibiotics should be cohorted away from patients receiving no antibiotics or a single antibiotic. Clostridiumperfringenswound infection associated with elastic bandages Richard D. Pearson, William M. Valenti, and Roy T. Steigbigel: JAMA 244: 1128-1130, Sept. 1980. Reprint requests: Roy T. Steigbigel, M.D., University of Rochester Medical Center, Box MED, 601 Elmwood Ave., Rochester, NY 14642.
The authors describe five cases of clostridial wound infection that occurred in diabetic patients who had undergone elective lower extremity amputations for peripheral vascular insufficiency. Nonsterile elastic bandages that had been used as outer wraps of sterile gauze dressings in four of the five patients were found to be contaminated with Clostridium perfringens and other clostridial species. A plaster splint that had been used in the fifth patient 'was also contaminated. The authors suggest that diabetic vascular disease with concomitant local tissue ischemia and lowered oxidization-reduction potential provided a suitable milieu for the development of anaerobic infection. It is noteworthy that clostridial species were recovered from samples of tightly rolled, ethylene oxide-exposed bandages as well as "nonsterile" elastic bandages taken from the operating room area. This report is reminiscent of recent reports of Rhizopus wound infections associated with contaminated elasticized adhesive tape dressings. The authors reemphasize the possibility that nonsterile bandages may be sources for nosocomial wound infections. They point out the importance of maintaining a dry barrier over the wound and separating the wound from these types of bandages. Postoperative wound infection rates: Results of prospective statewide surveillance Bruce F. Farber and Richard P. Wenzel: Am J Surg 140: 343-346, Sept. 1980. Reprint requests: Richard P. Wenzel, M.D., Box 473, University of Virginia Medical Center, Charlottesville, VA 22908.
The results of a prospective statewide study of postoperative wound infection rates after 19
Reviews: Literature
21
selected surgical operations are reported. Rates are based on 44,689 operations performed at 38 hospitals from January 1, 1977, through May 31, 1979. Rates of infection after a number of selected surgeries are reported. For instance, the following rates of postoperative wound infections were described: appendectomy (nonruptured), 3%; cholecystectomy, 3%; colon resection, 12%; cesarean section, 6%; and uncomplicated herniorrhaphy, 1%. This study is interesting because of the numbers of cases, the type of cases, and the type of hospitals surveyed. Ieps will find the table documenting procedures, infection numbers, and rates in various hospitals by type of hospital and size of hospital of interest. Many will be comparing their own surgical wound rates to this table. Nosocomial bacteriuria: A prospective study of case clustering and antimicrobial resistance Dennis R. Schaberg, Robert W. Haley, Anita K. Highsmith, Robert L. Anderson, and John E. McGowan, Jr.: Ann Intern Med 93:420-424, Sept. 1980. Reprint requests: SENIC Project 5066-1, Bacterial Diseases Division, Bureau of Epidemiology, Center for Disease Control, Atlanta, GA 30333.
In this study, the authors attempted to investigate the role of cross-infection in the transmission of nonepidemic nosocomial bacteriuria. They were able to confirm clustering of cases by epidemiologic evidence and laboratory testing in 30 of 194 episodes (15.5%) of nosocomial bacteriuria. They found that in 90% of clustered and 76% of nonclustered cases there had been previous urinary catheterizations. Bacterial species such as Pseudomonas aeruginosa, Serratia marcescens, and Citrobacter freundii were isolated more often from cases involved in clusters, while Escherichia coli predominated in noncluster cases. Finally, pathogens isolated from cluster cases were more likely to be resistant to gentamicin (70%) than isolates from noncluster cases (14%). The therapeutic implications of this observation were discussed. This study characterizes the incidence, epidemiologic characteristics, and bacteriology of nosocomial bacteriuria spread by cross-
in epidemic situations, high-risk patients in an intensive care unit receiving multiple antibiotics should be cohorted away from patients receiving no antibiotics or a single antibiotic. Clostridiumperfringenswound infection associated with elastic bandages Richard D. Pearson, William M. Valenti, and Roy T. Steigbigel: JAMA 244: 1128-1130, Sept. 1980. Reprint requests: Roy T. Steigbigel, M.D., University of Rochester Medical Center, Box MED, 601 Elmwood Ave., Rochester, NY 14642.
The authors describe five cases of clostridial wound infection that occurred in diabetic patients who had undergone elective lower extremity amputations for peripheral vascular insufficiency. Nonsterile elastic bandages that had been used as outer wraps of sterile gauze dressings in four of the five patients were found to be contaminated with Clostridium perfringens and other clostridial species. A plaster splint that had been used in the fifth patient 'was also contaminated. The authors suggest that diabetic vascular disease with concomitant local tissue ischemia and lowered oxidization-reduction potential provided a suitable milieu for the development of anaerobic infection. It is noteworthy that clostridial species were recovered from samples of tightly rolled, ethylene oxide-exposed bandages as well as "nonsterile" elastic bandages taken from the operating room area. This report is reminiscent of recent reports of Rhizopus wound infections associated with contaminated elasticized adhesive tape dressings. The authors reemphasize the possibility that nonsterile bandages may be sources for nosocomial wound infections. They point out the importance of maintaining a dry barrier over the wound and separating the wound from these types of bandages. Postoperative wound infection rates: Results of prospective statewide surveillance Bruce F. Farber and Richard P. Wenzel: Am J Surg 140: 343-346, Sept. 1980. Reprint requests: Richard P. Wenzel, M.D., Box 473, University of Virginia Medical Center, Charlottesville, VA 22908.
The results of a prospective statewide study of postoperative wound infection rates after 19
Reviews: Literature
21
selected surgical operations are reported. Rates are based on 44,689 operations performed at 38 hospitals from January 1, 1977, through May 31, 1979. Rates of infection after a number of selected surgeries are reported. For instance, the following rates of postoperative wound infections were described: appendectomy (nonruptured), 3%; cholecystectomy, 3%; colon resection, 12%; cesarean section, 6%; and uncomplicated herniorrhaphy, 1%. This study is interesting because of the numbers of cases, the type of cases, and the type of hospitals surveyed. Ieps will find the table documenting procedures, infection numbers, and rates in various hospitals by type of hospital and size of hospital of interest. Many will be comparing their own surgical wound rates to this table. Nosocomial bacteriuria: A prospective study of case clustering and antimicrobial resistance Dennis R. Schaberg, Robert W. Haley, Anita K. Highsmith, Robert L. Anderson, and John E. McGowan, Jr.: Ann Intern Med 93:420-424, Sept. 1980. Reprint requests: SENIC Project 5066-1, Bacterial Diseases Division, Bureau of Epidemiology, Center for Disease Control, Atlanta, GA 30333.
In this study, the authors attempted to investigate the role of cross-infection in the transmission of nonepidemic nosocomial bacteriuria. They were able to confirm clustering of cases by epidemiologic evidence and laboratory testing in 30 of 194 episodes (15.5%) of nosocomial bacteriuria. They found that in 90% of clustered and 76% of nonclustered cases there had been previous urinary catheterizations. Bacterial species such as Pseudomonas aeruginosa, Serratia marcescens, and Citrobacter freundii were isolated more often from cases involved in clusters, while Escherichia coli predominated in noncluster cases. Finally, pathogens isolated from cluster cases were more likely to be resistant to gentamicin (70%) than isolates from noncluster cases (14%). The therapeutic implications of this observation were discussed. This study characterizes the incidence, epidemiologic characteristics, and bacteriology of nosocomial bacteriuria spread by cross-