Surgical wound infections offer a major challenge to hospital infection control programs. Surgical procedures and host factors are independent variables which markedly influence the risk of infection. Frequently used categories of surgical procedures (clean, contaminated, and infected) are inadequate to identify the special risks and problems of individual procedures. In 1976, in conjunction with the practicing surgeons of a large, referral hospital, the Infections Control Committee instituted surveillance of selected clean surgical procedures and deep-versus-superficial wound infections. Major problems associated with the cleaning of sternal saws and the timing of the administration of prophylactic antibiotics have been detected by these methods. Conventional surveillance undoubtedly would have overlooked these problems. Effective surveillance and control of surgical wound infections requires a willingness to modify surveillance activities to meet the local needs, and a determination to include the operating surgeons in the planning of surveillance activities.

Hospital Bed Capacity, 500 and over↗

PubMedDate not supplied

Localized brucellosis: popliteal artery aneurysm, mediastinitis, dementia, and pneumonia.

Four patients with unusual manifestations of brucellosis presented to two tertiary-care teaching hospitals over a 15-year period. These cases posed difficult diagnostic problems. Each patient presented with signs and symptoms suggestive of a localized disease process: ischemic limb, mediastinal mass, dementia, and pneumonia. Two were afebrile, and two were acutely ill with high fever. Three patients had normal agglutination titers on admission, although in one patient the titer rose to 1:5,120 during therapy. During this same 15-year period only 10 cases of acute uncomplicated brucellosis were diagnosed at the two hospitals. The rarity of focal manifestations of brucellosis and general inexperience with brucellosis led to delays in diagnosis of 5-14 days. In view of the protean clinical presentations of localized brucellosis, careful inquiries about possible exposure to livestock and repeated serologic tests for brucellosis are important in the management of any diagnostically difficult clinical problem.

Adult↗

PubMedDate not supplied

Life-threatening pharyngitis caused by herpes simplex virus, type 2.

A 21-year-old man who had pharyngitis needed hospitalization for observation of airway patency and for parenteral fluid therapy. Infection with herpes simplex virus, type 2 (HSV-2), was diagnosed on the basis of the finding of significantly increased IgM indirect hemagglutination antibody titers. The pharyngitis appeared to have been contracted by heterosexual orogenital contact (cunnilingus). The results of this case study indicate that HSV-2 infection should be considered in the differential diagnosis in cases of severe pharyngitis in sexually active patients.

Adult↗

PubMedDate not supplied

Perioperative antimicrobial prophylaxis in middle Tennessee, 1989-1990.

The patterns of use of perioperative antimicrobial prophylaxis were assessed in a randomly selected sample of short-stay hospitals in middle Tennessee. Overall, 438 procedures (48%) were associated with antimicrobial prophylaxis. Prophylaxis was more common in hospitals with more than 400 beds than in smaller hospitals. Moreover, prophylactic antibiotics were given more often for procedures with a proven indication for prophylaxis than for those without a proven indication (60% vs. 41%, P less than .05); this relationship remained constant regardless of hospital size (common odds ratio, 2.09). However, prophylaxis for procedures with a proven indication was more likely to be given in teaching hospitals than in nonteaching hospitals (odds ratios, 5.41 vs. 1.94). The duration of prophylaxis was less than 2 days for 89% of procedures. A wide variety of agents were used. This study suggests that while improvements have been made over the past decade in decisions about the duration of prophylaxis, considerable variation remains in the selection of the procedures in which such treatment is administered and of the antimicrobial agents used.

Anti-Infective Agents↗