To establish the prevalence of urinary tract infection in patients undergoing various forms of bladder management.

A nationwide descriptive point-prevalence survey with logistic regression analysis of the data relating infection to bladder management.

Fifteen hospitals, 21 nursing homes, and 13 home care districts throughout Denmark.

Information was collected on 3,665 patients. On the day of the study, 349 patients had indwelling catheters and 1,150 were using external urine drainage systems (condoms or diapers) for bladder management.

The prevalence of urinary tract infections in catheterized patients and those using external drainage systems was 13.2% and 8.1%, respectively. The prevalence of hospital-acquired urinary tract infection (4.2%) had not changed from that reported in 1978. The proportion of these infections related to the indwelling catheter, however, had reduced from 66% to 30%. Logistic regression analysis confirmed that, when corrected for the patient-related confounders (female gender, age >60 years, incontinence, immobility, and stay in hospital for longer than 15 days), condoms (odds ratio [OR], 5.94; 95% confidence interval [CI95], 2.8 to 12.5), indwelling catheters (OR, 3.3; CI95, 2.3 to 4.8), and diapers (OR, 1.5; CI95, 1.1 to 2.1) were significantly (P<.001, P<.001, and P=.008, respectively) related to infection.

Prevalence surveys have revealed that over the period 1978 to 1991, during which efforts have been made to restrict the use of indwelling catheters and to encourage the care of catheterized patients according to guidelines recommended by the Danish National Centre for Hospital Hygiene, the percentage of hospital-acquired urinary tract infections associated with indwelling catheters has been halved. External urine drainage systems, however, have emerged as significant risk factors for urinary tract infection.

To study the loss of antimicrobial susceptibility in repeat (same patient, same bacterial species, and same site) aerobic gram-negative bacilli (AGNB) isolated from individual patients during their stay in the intensive-care unit (ICU).

A 792-bed, tertiary-care community hospital with a total of 107 adult, pediatric, and neonatal ICU beds. METHOD: An obser vational prospective study performed November 1992 through mid-July 1993.

Of 594 consecutive AGNB from 287 ICU patients, 117 isolates (20%) from 55 patients (19%) were repeat isolates, with the majority obtained from respiratory secretions (83%). Pseudomonas aeruginosa and Enterobacter species accounted for 61% of the isolates. Forty-two (36%) of the repeat isolates from 24 patients (44%) had >4-fold increase in minimum inhibitory concentration to at least one antibiotic and no longer were considered fully susceptible based on National Committee on Clinical Laboratory Standards criteria. Loss of antimicrobial susceptibility often developed within several (median 8) days and was associated only infrequently with simultaneous transition from colonization to infection in the individual patient. Use of certain β-lactam antibiotics was associated with increasing resistance to several other antibiotics in the same class. Concurrent use of β-lactams and aminoglycosides did not prevent loss of antimicrobial susceptibility to the former in repeat isolates.

We conclude that loss of antimicrobial susceptibility in repeat AGNB isolated from ICU patients is common, usually is not associated with transition from colonization to infection, and often is associated with prior use of antibiotics. Minimizing antibiotic use in ICU patients should help reduce the risk of antimicrobial resistance in repeat AGNB isolates.

To describe the epidemiology and the inter ventions used to control two methicillin-resistant Staphylococcus aureus (MRSA) epidemics involving 46 infants with two fatalities in a neonatal intensive care unit (NICU).

A 50-bed, level III NICU in a university hospital.

After traditional interventions failed to stop the first epidemic, an intensive microbiologic surveillance (IMS) program was developed. Cultures were obtained on all infants each week, and those colonized with MRSA were isolated. When an infant was found to be colonized with MRSA, cultures immediately were obtained on all surrounding infants. This was continued until no MRSA-colonized infants were found in the area. During the first epidemic, mupirocin was used in an attempt to eradicate the organism from the unit.

All infants, colonized and noncolonized, and parents of and personnel working with colonized infants were treated simultaneously with 5 days of mupirocin. This failed to eradicate MRSA in colonized infants. The spread of MRSA ceased in the unit, but a second epidemic occurred 4 months later. This time, IMS alone was successful in quickly containing the epidemic, and MRSA disappeared from the unit after all colonized infants were discharged. Plasmid analysis demonstrated that the same strain was responsible for both outbreaks.

IMS and isolation are effective in containing the spread of MRSA in an NICU. The use of mupirocin failed to eradicate the organism.

To assess risk factors associated with Clostridium difficile diarrhea in hospitalized adult patients, and to test the hypothesis that sucralfate ingestion is associated with nondetection of C difficile cytotoxin in stool specimens.

A retrospective case-control study of hospitalized adult patients who had stool specimens assayed for C difficile cytotoxin. For each patient who had positive C difficile cytotoxin, a patient who had negative C difficile cytotoxin was used as a control. The study period was January to December 1993.

A community teaching hospital affiliated with a medical school in northeastern Ohio.

There were 91 case patients and 91 control patients. Cephalosporin exposure was identified as a risk factor in patients with C difficile diarrhea. The number of patients who had sucralfate ingestion was comparable in both groups of patients.

Administration of cephalosporins was identified as a risk factor in patients with C difficile diar-rhea. We were not able to confirm a recent report of the association between ingestion of sucralfate and nondetection of C difficile cytotoxin in stool specimens. Our findings suggest that sucralfate ingestion is not associated with nondetection of C difficile cytotoxin in stool specimens. Assay of C difficile cytotoxin in stool specimens remains a valid method of diagnosing C difficile diarrhea, even in patients who ingest sucralfate.