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Nosocomial Infection Caused by Antibiotic-Resistant Organisms in the Intensive-Care Unit

Published online by Cambridge University Press:  02 January 2015

John P. Flaherty  and
Robert A. Weinstein
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Abstract

Resistance to antimicrobial agents is an evolving process, driven by the selective pressure of heavy antibiotic use in individuals living in close proximity to others. The intensive care unit (ICU), crowded with debilitated patients who are receiving broad-spectrum antibiotics and being cared for by busy physicians, nurses, and technicians, serves as an ideal environment for the emergence of antibiotic resistance. Problem pathogens presently include multiply resistant gram-negative bacilli, methicillin-resistant Staphylococcus aureus, and the recently emerged vancomycin-resistant enterococci. The prevention of antimicrobial resistance in ICUs should focus on recognition via routine unit-based sur veillance, improved compliance with handwashing and barrier precautions, and antibiotic-use policies tailored to individual units within hospitals.

Type
Review
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 4 , April 1996 , pp. 236 - 248
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996 

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References

1. Holmberg, SD, Solomon, SL, Blake, PA. Health and economic impacts of antimicrobial resistance. Rev Infect Dis 1987;9:1065–1078.10.1093/clinids/9.6.1065CrossRefGoogle ScholarPubMed
2. Kreger, BE, Craven, DE, McCabe, WR. Gram-negative bacteremia, IV: re-evaluation of clinical features and treatment in 612 patients. Am J Med 1980;68:344–355.10.1016/0002-9343(80)90102-3CrossRefGoogle ScholarPubMed
3. Bisbe, J, Gatell, JM, Puig, J, et al. Pseudomonas aeruginosa bacteremia: univariate and multivariate analyses of factors influencing the prognosis in 133 episodes. Rev Infect Dis 1988;10:629–635.10.1093/clinids/10.3.629CrossRefGoogle ScholarPubMed
4. Saito, H, Elting, L, Bodey, GP, Berkey, P. Serratia bacteremia: review of 188 cases. Rev Infect Dis 1989;11:912–920.10.1093/clinids/11.6.912CrossRefGoogle Scholar
5. Celis, R, Torres, A, Gatell, JM, et al. Nosocomial pneumonia. A multivariate analysis of risk and prognosis. Chest 1988;93:318–324.10.1378/chest.93.2.318CrossRefGoogle ScholarPubMed
6. Torres, A, Aznar, R, Gatell, JM, et al. Incidence, risk and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990;142:523–528.10.1164/ajrccm/142.3.523CrossRefGoogle ScholarPubMed
7. Phelps, CE. Bug/drug resistance: sometimes less is more. Med Care 1989;27:194–203.10.1097/00005650-198902000-00009CrossRefGoogle ScholarPubMed
8. Jacoby, GA, Archer, GL. New mechanisms of bacterial resistance to antimicrobial agents. N Engl J Med 1991;324:601–612.Google ScholarPubMed
9. Greenwood, D. In vitro veritas? Antimicrobial susceptibility tests and their clinical relevance. J Infect Dis 1981;144:380–385.10.1093/infdis/144.4.380CrossRefGoogle ScholarPubMed
10. Rahal, JJ. Therapy of patients with resistant bacterial infections. Bull N Y Acad Med 1987;63:318–329.Google ScholarPubMed
11. Gutmann, L, Kitzis, MD, Billot-Klein, D, et al. Plasmid-mediated beta-lactamase (TEM-7) involved in resistance to ceftazidime and aztreonam. Rev Infect Dis 1988;10:860–866.10.1093/clinids/10.4.860CrossRefGoogle ScholarPubMed
12. Quinn, JP, Miyashiro, D, Sahm, D, et al. Novel plasmid-mediated beta-lactamase (TEM-10) conferring selective resistance to ceftazidime and aztreonam in clinical isolates of Klebsiella pneumoniae. Antimicrob Agents Chemother 1989;33:1451–1456.CrossRefGoogle ScholarPubMed
13. Gaynes, RP, Culver, DH. Resistance to imipenem among selected gram-negative bacilli in the United States. Infect Control Hosp Epidemiol 1995;13:10–14.10.1086/646417CrossRefGoogle Scholar
14. Chambers, HF. Methicillin-resistant staphylococci. Clin Microbiol Rev 1988;1:173–186.10.1128/CMR.1.2.173CrossRefGoogle ScholarPubMed
15. Frongillo, RF, Donati, L, Federico, G, et al. Clinical comparative study on the activity of cefamandole in the treatment of serious staphylococcal infections caused by methicillin-susceptible and methicillin-resistant strains. Antimicrob Agents Chemother 1986;29:789–796.CrossRefGoogle ScholarPubMed
16. Boyce, JM, Papa, E, Dickenson, R, Medeiros, AA. Failure of routine susceptibility tests to detect imipenem resistance among strains of methicillin-resistant Staphylococcus aureus . Antimicrob Agents Chemother 1991;35:1495–1497.10.1128/AAC.35.7.1495CrossRefGoogle ScholarPubMed
17. Tenover, FC, Tokars, J, Swenson, J, Paul, S, Spitalny, K, Jarvis, W. Ability of clinical laboratories to detect antimicrobial agentresistant enterococci. J Clin Microbiol 1993;31:1695–1699.CrossRefGoogle ScholarPubMed
18. Zabransky, RJ, Dinuzzo, AR, Huber, MB, Woods, GL. Detection of vancomycin resistance in enterococci by the Vitek AMS System. Diagn Microbiol Infect Dis 1994;20:113–116.10.1016/0732-8893(94)90102-3CrossRefGoogle ScholarPubMed
19. Weinstein, RA. Endemic emergence of cephalosporin-resistant Enterobacter: relation to prior therapy. Infect Control 1986;7(suppl):120–123.Google ScholarPubMed
20. Follath, F, Costa, E, Thommen, A, et al. Clinical consequences of development of resistance to third-generation cephalosporins. Eur J Clin Microbiol Infect Dis 1987;6:446–450.Google ScholarPubMed
21. Johnson, MP, Ramphal, R. Beta-lactam–resistant Enterobacter bacteremia in febrile neutropenic patients receiving monotherapy. J Infect Dis 1990;162:981–983.CrossRefGoogle ScholarPubMed
22. Chow, JW, Fine, MJ, Shlaes, DM, et al. Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann Intern Med 1991;115:585–590.CrossRefGoogle ScholarPubMed
23. Snydman, DR. Clinical implications of multi-drug resistance in the intensive care unit. Scand J Infect Dis 1991;78(suppl):54–63.Google ScholarPubMed
24. Fontanals, D, Pineda, V, Pons, I, Rojo, C. Penicillin-resistant beta-lactamase producing Neisseria meningitidis in Spain. Eur J Clin Microbiol Infect Dis 1989;8:90.10.1007/BF01964130CrossRefGoogle ScholarPubMed
25. Botha, P. Penicillin-resistant Neisseria meningitidis in Southern Africa. Lancet 1988;1:54.10.1016/S0140-6736(88)91029-XCrossRefGoogle ScholarPubMed
26. Munoz, R, Coffey, TJ, Daniels, M, et al. Intercontinental spread of a multiresistant clone of serotype 23F Streptococcus pneumoniae . J Infect Dis 1991;164:302–306.CrossRefGoogle ScholarPubMed
27. McDougal, LK, Facklam, R, Reeves, M, et al. Analysis of multiply antimicrobial-resistant isolates of Streptococcus pneumoniae from the United States. Antimicrob Agents Chemother 1992;36:2176–2184.10.1128/AAC.36.10.2176CrossRefGoogle ScholarPubMed
28. Barry, AL, Pfaller, MA, Fuchs, PC, Packer, RR. In vitro activities of 12 orally administered antimicrobial agents against four species of bacterial respiratory pathogens from US medical centers in 1992 and 1993. Antimicrob Agents Chemother 1994;38:2419–2425.10.1128/AAC.38.10.2419CrossRefGoogle Scholar
29. Phillippon, A, Labia, R, Jacoby, G. Extended-spectrum beta-lactamases. Antimicrob Agents Chemother 1989;33:1131–1136.CrossRefGoogle Scholar
30. Jacoby, GA, Medeiros, AA. More extended-spectrum beta-lactamases. Antimicrob Agents Chemother 1991;35:1697–1704.10.1128/AAC.35.9.1697CrossRefGoogle ScholarPubMed
31. Lester, SC, del Pilar Pla, M, Wang, F, et al. The carriage of Escherichia coli resistant to antimicrobial agents by healthy children in Boston, in Caracas, Venezuela, and in Qin Pu, China. N Engl J Med 1990;23:285–289.10.1056/NEJM199008023230501CrossRefGoogle Scholar
32. Gaynes, RP, Weinstein, RA, Chamberlin, W, Kabins, SA. Antibiotic-resistant flora in nursing home patients admitted to the hospital. Arch Intern Med 1985;145:1804–1807.10.1001/archinte.1985.00360100064009CrossRefGoogle ScholarPubMed
33. Hsu, CCS, Macaluso, CP, Special, L, Hubble, RH. High rate of methicillin resistance of Staphylococcus aureus isolated from hospitalized nursing home patients. Arch Intern Med 1988;148:569–570.CrossRefGoogle ScholarPubMed
34. Saravolatz, LD, Markowitz, N, Arking, L, et al. Methicillin-resistant Staphylococcus aureus: epidemiologic observations during a community-acquired outbreak. Ann Intern Med 1982;96:11–16.CrossRefGoogle ScholarPubMed
35. Ellner, PD, Fink, DJ, Neu, HC, Parry, MF. Epidemiologic factors affecting antimicrobial resistance of common bacterial isolates. J Clin Microbiol 1987;25:1668–1674.CrossRefGoogle ScholarPubMed
36. Cohen, J. Variations in sensitivities to antibiotics: nosocomial versus community-acquired infections caused by same organism. NY State J Med 1976;76:391–393.Google ScholarPubMed
37. Schaberg, DR, Culver, DH, Gaynes, RP. Major trends in the microbial etiology of nosocomial infection. Am J Med 1991;91(suppl 3B):72S–75S.10.1016/0002-9343(91)90346-YCrossRefGoogle ScholarPubMed
38. Wakefield, DS, Pfaller, M, Massanari, RM, Hammons, GT. Variation in methicillin-resistant Staphylococcus aureus occurrence by geographic location and hospital characteristics. Infect Control 1987;8:151–157.CrossRefGoogle ScholarPubMed
39. Johanson, WG, Pierce, AK, Sanford, JP, Thomas, GD. Nosocomial respiratory infections with gram-negative bacilli. Ann Intern Med 1972;77:701–706.10.7326/0003-4819-77-5-701CrossRefGoogle ScholarPubMed
40. Shah, PM, Asanger, R, Kahan, FM. Incidence of multi-resistance in gram-negative aerobes from intensive care units of 10 German hospitals. Scand J Infect Dis 1991;78(suppl):22–34.Google ScholarPubMed
41. Verbist, L. Incidence of multi-resistance in gram-negative bacterial isolates from intensive care units in Belgium: a surveillance study. Scand J Infect Dis 1991;78(suppl):45–53.Google ScholarPubMed
42. Muder, RR, Brennen, C, Goetz, AM, Wagener, MM, Rihs, JD. Association with prior fluoroquinolone therapy of widespread ciprofloxacin resistance among gram-negative isolates in a Veterans Affairs medical center. Antimicrob Agents Chemother 1991;35:256–258.CrossRefGoogle Scholar
43. Richard, P, Delangle, M, Merrien, D, et al. Fluoroquinolone use and fluoroquinolone resistance: is there an association? Clin Infect Dis 1994;19:54–59.10.1093/clinids/19.1.54CrossRefGoogle ScholarPubMed
44. Coronado, VG, Edwards, JR, Culver, DH, Gaynes, RP, NNIS System. Ciprofloxacin resistance among nosocomial Pseudomonas aeruginosa and Staphylococcus aureus in the United States. Infect Control Hosp Epidemiol 1995;16:71–75.10.2307/30140945CrossRefGoogle ScholarPubMed
45. Centers for Disease Control and Prevention. Nosocomial enterococci resistant to vancomycin—United States, 1989-1993. MMWR 1993;42:597–599.Google Scholar
46. Levine, JF, Maslow, MJ, Leibowitz, RE, et al. Amikacin-resistant gram-negative bacilli: correlation of occurrence with amikacin use. J Infect Dis 1985;151:295–300.CrossRefGoogle ScholarPubMed
47. Saavedra, S, Vera, D, Ramirez-Ronda, CH. Susceptibility of aerobic gram-negative bacilli to aminoglycosides: effects of 45 months of amikacin as first-line aminoglycoside therapy. Am J Med 1986;80(suppl 6B):65–70.CrossRefGoogle ScholarPubMed
48. Cross, AS, Opal, S, Kopecko, DJ. Progressive increase in antibiotic resistance of gram-negative bacterial isolates. Arch Intern Med 1983;143:2075–2080.CrossRefGoogle ScholarPubMed
49. Greene, WH, Moody, M, Schimpff, S, et al. Pseudomonas aeruginosa resistant to carbenicillin and gentamicin: epidemiologic and clinical aspects in a cancer center. Ann Intern Med 1973;79:684–689.CrossRefGoogle Scholar
50. Olson, B, Weinstein, RA, Nathan, C, et al. Occult aminoglycoside resistance in Pseudomonas aeruginosa: epidemiology and implications for therapy and control. J Infect Dis 1985;152:769–774.10.1093/infdis/152.4.769CrossRefGoogle ScholarPubMed
51. Gaman, W, Cates, C, Snelling, CFT, et al. Emergence of gentamicinand carbenicillin-resistant Pseudomonas aeruginosa in a hospital environment. Antimicrob Agents Chemother 1976;9:474–480.CrossRefGoogle Scholar
52. Jarlier, V, Nicolas, MH, Fournier, G, Philippon, A. Extended broad-spectrum beta-lactamases conferring transferable resistance to newer beta-lactam agents in Enterobacteriaceae: hospital prevalence and susceptibility patterns. Rev Infect Dis 1988;10:867–878.CrossRefGoogle ScholarPubMed
53. Sirot, J, Chanal, C, Petit, A, et al. Klebsiella pneumoniae and other Enterobacteriaceae producing novel plasmid-mediated beta-lactamases markedly active against third-generation cephalosporins: epidemiologic studies. Rev Infect Dis 1988;10:850–859.CrossRefGoogle ScholarPubMed
54. Meyer, KS, Urban, C, Eegan, JA, Berger, BJ, Rahal, JJ. Nosocomial outbreak of Klebsiella infection resistant to lategeneration cephalosporins. Ann Intern Med 1993;119:353–358.CrossRefGoogle ScholarPubMed
55. Muder, RR, Brennen, C, Goetz, AM, et al. Association with prior fluoroquinolone therapy of widespread ciprofloxacin resistance among gram-negative isolates in a Veterans Affairs medical center. Antimicrob Agents Chemother 1991;35:256–258.CrossRefGoogle Scholar
56. Go, ES, Urban, C, Burns, J, et al. Clinical and molecular epidemiology of Acinetobacter infections sensitive only to polymyxin B and sulbactam. Lancet 1994;344:1329–1332.CrossRefGoogle ScholarPubMed
57. Karanfil, LV, Murphy, M, Josephson, A, et al. A cluster of vancomycin-resistant Enterococcus faecium in an intensive care unit. Infect Control Hosp Epidemiol 1992;13:195–200.10.1086/646509CrossRefGoogle Scholar
58. Handwerger, S, Raucher, B, Altarac, D, et al. Nosocomial outbreak due to Enterococcus faecium highly resistant to vancomycin, penicillin, and gentamicin. Clin Infect Dis 1993;16:750–755.CrossRefGoogle ScholarPubMed
59. Montecalvo, MA, Horowitz, H, Gedris, C, et al. Outbreak of vancomycin-, ampicillin-, and aminoglycoside-resistant Enterococcus faecium bacteremia in an adult oncology unit. Antimicrob Agents Chemother 1994;38:1363–1367.CrossRefGoogle Scholar
60. Livornese, LL, Dias, S, Samel, C, et al. Hospital-acquired infection with vancomycin-resistant Enterococcus faecium transmitted by electronic thermometers. Ann Intern Med 1992;117:112–116.CrossRefGoogle ScholarPubMed
61. Boyce, JM, Opal, SM, Potter-Bynoe, G, et al. Emergence and nosocomial transmission of ampicillin-resistant enterococci. Antimicrob Agents Chemother 1992;36:1032–1039.10.1128/AAC.36.5.1032CrossRefGoogle ScholarPubMed
62. Weinstein, RA, Nathan, C, Gruensfelder, R, Kabons, S. Endemic aminoglycoside resistance in gram-negative bacilli: epidemiology and mechanisms. J Infect Dis 1980;141:338–345.10.1093/infdis/141.3.338CrossRefGoogle ScholarPubMed
63. Schaberg, DR, Alford, RH, Anderson, R, et al. An outbreak of nosocomial infection due to multiply resistant Serratia marcescens: evidence of interhospital spread. J Infect Dis 1976;134:181–188.CrossRefGoogle ScholarPubMed
64. Knittle, MA, Eitzman, DV, Baer, H. Role of hand contamination of personnel in the epidemiology of gram-negative nosocomial infections. J Pediatr 1975;86:433–437.10.1016/S0022-3476(75)80980-2CrossRefGoogle ScholarPubMed
65. Buxton, AE, Anderson, RL, Werdegar, D, et al. Nosocomial respiratory tract infection and colonization with Acinetobacter calcoaceticus: epidemiologic characteristics. Am J Med 1978;65:507–513.10.1016/0002-9343(78)90777-5CrossRefGoogle ScholarPubMed
66. Haley, RW, Hightower, AW, Khabbaz, RF, et al. The emergence of methicillin-resistant Staphylococcus aureus infections in United States hospitals. Ann Intern Med 1982;97:297–308.10.7326/0003-4819-97-3-297CrossRefGoogle ScholarPubMed
67. Cookson, B, Peters, B, Webster, M, et al. Staff carriage of epidemic methicillin-resistant Staphylococcus aureus . J Clin Microbiol 1989;27:2471–2476.CrossRefGoogle ScholarPubMed
68. Opal, SM, Mayer, KH, Stenberg, MJ, et al. Frequent acquisition of multiple strains of methicillin-resistant Staphylococcus aureus by healthcare workers in an endemic hospital environment. Infect Control Hosp Epidemiol 1990;11:479–485.CrossRefGoogle Scholar
69. Reboli, AC, John, JF, Platt, CG, et al. Methicillin-resistant Staphylococcus aureus outbreak at a Veterans' Affairs medical center: importance of carriage of the organism by hospital personnel. Infect Control Hosp Epidemiol 1990;11:291–296.CrossRefGoogle Scholar
70. Boyce, JM, White, RL, Causey, WA, et al. Burn units as a source of methicillin-resistant Staphylococcus aureus infections. JAMA 1983;249:2803–2807.CrossRefGoogle ScholarPubMed
71. Rhinehart, E, Smith, NE, Wennersten, C, et al. Rapid dissemination of beta-lactamase–producing aminoglycoside-resistant Enterococcus faecalis among patients and staff on an infant-toddler surgical ward. N Engl J Med 1990;323:1814–1818.CrossRefGoogle Scholar
72. Henderson, DK, Baptiste, R, Parrillo, J, Gill, VJ. Indolent epidemic of Pseudomonas cepacia bacteremia and pseudobacteremia in an intensive care unit traced to a contaminated blood gas analyzer. Am J Med 1988;84:75–81.10.1016/0002-9343(88)90011-3CrossRefGoogle Scholar
73. Beck-Sague, CM, Jarvis, WR, Brook, JH, et al. Epidemic bacteremia due to Acinetobacter baumannii in five intensive care units. Am J Epidemiol 1990;132:723–733.CrossRefGoogle ScholarPubMed
74. Hartstein, AI, Rashad, AL, Liebler, JM, et al. Multiple intensive care unit outbreak of Acinetobacter calcoaceticus subspecies anitratus respiratory infection and colonization associated with contaminated, reusable ventilator circuits and resuscitation bags. Am J Med 1988;85:624–631.CrossRefGoogle ScholarPubMed
75. Peacock, JE, Sorrell, L, Sottile, FD, Price, LE, Rutala, WA. Nosocomial respiratory tract colonization and infection with aminoglycoside-resistant Acinetobacter calcoaceticus var anitratus: epidemiologic characteristics and clinical significance. Infect Control Hosp Epidemiol 1988;9:302–308.CrossRefGoogle ScholarPubMed
76. Panlilo, AL, Beck-Sague, CM, Siegel, JD, et al. Infections and pseudoinfections due to povidone-iodine solution contaminated with Pseudomonas cepacia . Clin Infect Dis 1992;14:1078–1083.CrossRefGoogle Scholar
77. Selden, R, Lee, S, Wang, WLL, et al. Nosocomial Klebsiella infections: intestinal colonization as a reservoir. Ann Intern Med 1971;74:657–664.10.7326/0003-4819-74-5-657CrossRefGoogle ScholarPubMed
78. Olson, B, Weinstein, RA, Nathan, C, et al. Epidemiology of endemic Pseudomonas aeruginosa: why infection control efforts have failed. J Infect Dis 1984;150:808–816.10.1093/infdis/150.6.808CrossRefGoogle ScholarPubMed
79. Flynn, DM, Weinstein, RA, Nathan, C, et al. Patients' endogenous flora as the source of ‘nosocomial’ Enterobacter in cardiac surgery. J Infect Dis 1987;156:363–368.CrossRefGoogle Scholar
80. Chetchotisakd, P, Phelps, CL, Harstein, AI. Assessment of bacterial cross-transmission as a cause of infections in patients in intensive care units. Clin Infect Dis 1994;18:929–937.CrossRefGoogle ScholarPubMed
81. Appelbaum, PC, Spangler, SK, Jacobs, MR. Beta-lactamase production and susceptibilities to amoxicillin, amoxicillin-clavulanate, ticarcillin, ticarcillin-clavulanate, cefoxitin, imipenem, and metronidazole of 320 non-Bacteroides fragilis Bacteroides isolates and 129 fusobacteria from 28 US centers. Antimicrob Agents Chemother 1990;34:1546–1550.CrossRefGoogle Scholar
82. Schwalbe, RS, Stapleton, JT, Gilligan, PH. Emergence of vancomycin resistance in coagulase-negative staphylococci. N Engl J Med 1987;316:927–931.CrossRefGoogle ScholarPubMed
83. Veach, LA, Pfaller, MA, Barrett, M, et al. Vancomycin resistance in Staphylococcus haemolyticus causing colonization and bloodstream infection. J Clin Microbiol 1990;28:2064–2068.CrossRefGoogle ScholarPubMed
84. Quinn, JP, Studemeister, AE, DiVincenzo, CA, Lerner, SA. Resistance to imipenem in Pseudomonas aeruginosa: clinical experience and biochemical mechanisms. Rev Infect Dis 1988;10:892–898.CrossRefGoogle ScholarPubMed
85. Livingston, D, Gill, MJ, Wise, R. Mechanisms of resistance to the carbapenems. J Antimicrob Chemother 1995;35:1–5.10.1093/jac/35.1.1CrossRefGoogle Scholar
86. Lee, EH, Nicolas, MH, Kitzis, MD, Pialoux, G, Collatz, E, Gutmann, L. Association of two resistance mechanisms in a clinical isolate of Enterobacter cloacae with high-level resistance to imipenem. Antimicrob Agents Chemother 1991;35:1093–1098.CrossRefGoogle Scholar
87. Watanabe, M, Iyobe, S, Inoue, M, Mitsuhashi, S. Transferable imipenem resistance in Pseudomonas aeruginosa . Antimicrob Agents Chemother 1991;35:147–151.CrossRefGoogle ScholarPubMed
88. Seifert, H, Baginski, R, Schulze, A, Pulverer, G. Antimicrobial susceptibility of Acinetobacter species. Antimicrob Agents Chemother 1993;37:750–753.CrossRefGoogle ScholarPubMed
89. Urban, C, Go, E, Mariano, N, et al. Effect of sulbactam on infections caused by imipenem-resistant Acinetobacter calcoaceticus biotype anitratus. J Infect Dis 1993;167:448–451.CrossRefGoogle ScholarPubMed
90. Villarino, ME, Stevens, LE, Schable, B, et al. Risk factors for epidemic Xanthomonas maltophilia infection/colonization in intensive care unit patients. Infect Control Hosp Epidemiol 1992;13:201–206.CrossRefGoogle ScholarPubMed
91. Vativarian, S, Anaissie, E, Bodey, G, Sprigg, H, Rolston, K. A changing pattern of susceptibility of Xanthomonas maltophilia to antimicrobial agents: implications for therapy. Antimicrob Agents Chemother 1994;38:624–627.CrossRefGoogle Scholar
92. Spika, JS, Facklam, RR, Plikaytis, BD, et al. Antimicrobial resistance of Streptococcus pneumoniae in the United States, 1979-1987. J Infect Dis 1991;163:1273–1278.CrossRefGoogle ScholarPubMed
93. Weingarten, RD, Markiewicz, Z, Gilbert, DN, et al. Meningitis due to penicillin- resistant Streptococcus pneumoniae in adults. Rev Infect Dis 1990;12:118–124.CrossRefGoogle ScholarPubMed
94. John, CC. Treatment failure with use of a third-generation cephalosporin for penicillin-resistant pneumococcal meningitis: case report and review. Clin Infect Dis 1994;18:188–193.CrossRefGoogle ScholarPubMed
95. Jackson, LA, Tenover, FC, Baker, C, et al. Prevalence of Neisseria meningitidis relatively resistant to penicillin in the United States, 1991. J Infect Dis 1994;169:438–441.CrossRefGoogle ScholarPubMed
96. Uriz, S, Pineda, V, Grau, M, et al. Neisseria meningitidis with reduced sensitivity to penicillin: observations in 10 children. Scand J Infect Dis 1991;23:171–174.CrossRefGoogle ScholarPubMed
97. Centers for Disease Control. Nosocomial transmission of multidrug-resistant tuberculosis to healthcare workers and HIVinfected patients in an urban hospital—Florida. MMWR 1990;39:718.Google Scholar
98. Centers for Disease Control. Outbreak of multidrug-resistant tuberculosis at a hospital—New York City, 1991. MMWR 1993;42:427–434.Google Scholar
99. Edlin, BR, Tokars, JI, Grieco, MH, et al. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. N Engl J Med 1992;326:1514–1521.CrossRefGoogle ScholarPubMed
100. Pearson, ML, Jereb, JA, Frieden, TR, et al. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis . Ann Intern Med 1992;117:191–196.10.7326/0003-4819-117-3-191CrossRefGoogle ScholarPubMed
101. Beck-Sague, C, Dooley, SW, Hutton, MD, et al. Hospital outbreak of multidrug-resistant Mycobacterium tuberculosis infections. JAMA 1992;268:1280–1286.10.1001/jama.1992.03490100078031CrossRefGoogle ScholarPubMed
102. Iseman, MD. Treatment of multidrug-resistant tuberculosis. N Engl J Med 1993;329:784–791.Google ScholarPubMed
103. Vasquez, JA, Sanchez, V, Dmuchowski, C, Dembry, LM, Sobel, JD, Zervos, MJ. Nosocomial acquisition of Candida albicans: an epidemiologic study. J Infect Dis 1993;168:195–201.CrossRefGoogle Scholar
104. Burnie, JP, Odds, FC, Lee, W, Webster, C, Williams, JD. Outbreak of systemic Candida albicans in intensive care unit caused by cross infection. Br Med J 1985;290:746–748.CrossRefGoogle ScholarPubMed
105. Finkelstein, R, Reinhertz, G, Hashman, N, Merzbach, D. Outbreak of Candida tropicalis fungemia in a neonatal intensive care unit. Infect Control Hosp Epidemiol 1993;14:587–590.CrossRefGoogle Scholar
106. Wingard, JR, Merz, WG, Rinaldi, MG, Johnson, TR, Karp, JE, Saral, R. Increases in Candida krusei infection among patients with bone marrow transplantation and neutropenia treated prophylactically with fluconazole. N Engl J Med 1991;325:1274–1277.CrossRefGoogle ScholarPubMed
107. Rex, JH, Rinaldi, MG, Pfaller, MA. Resistance of Candida species to fluconazole. Antimicrob Agents Chemother 1995;39:1–8.CrossRefGoogle ScholarPubMed
108. Fan-Havard, P, Capano, D, Smith, SM, Mangia, A, Eng, RHK. Development of resistance in Candida isolates from patients receiving prolonged antifungal therapy. Antimicrob Agents Chemother 1991;35:2302–2305.CrossRefGoogle ScholarPubMed
109. Boken, DJ, Swindells, S, Rinaldi, MG. Fluconazole-resistant Candida albicans . Clin Infect Dis 1993;17:1018–1021.CrossRefGoogle ScholarPubMed
110. Rex, JH, Bennett, JE, Sugar, AM, et al. A randomized trial comparing fluconazole with amphotericin B for the treatment of candidemia in patients without neutropenia. N Engl J Med 1994;331:1325–1330.CrossRefGoogle ScholarPubMed
111. Englund, JA, Zimmerman, ME, Swierkosz, EM, et al. Herpes simplex virus resistant to acyclovir: a study in a tertiary care center. Ann Intern Med 1990;112:416–422.10.7326/0003-4819-76-3-112-6-416CrossRefGoogle ScholarPubMed
112. Brice, A, Chou, S, Biron, KK, et al. Progressive disease due to ganciclovir-resistant cytomegalovirus in immunocompromised patients. N Engl J Med 1989;320:289–293.Google Scholar
113. Safrin, S, Kemmerly, S, Smith, T, et al. Foscarnet-resistant herpes simplex virus infection in patients with AIDS. J Infect Dis 1994;169:193–196.CrossRefGoogle ScholarPubMed
114. Perl, TM, Haugen, TH, Pfaller, MA, et al. Transmission of herpes simplex virus type 1 infection in an intensive care unit. Ann Intern Med 1992;117:584–586.10.7326/0003-4819-117-7-584CrossRefGoogle Scholar
115. Wenzel, RP, Nettleman, MD, Jones, RN, Pfaller, MA. Methicillinresistant Staphylococcus aureus: implications for the 1990s and effective control measures. Am J Med 1991;91(suppl 3B):221S–227S.CrossRefGoogle ScholarPubMed
116. Albert, RK, Condie, F. Handwashing patterns in medical intensivecare units. N Engl J Med 1981;304:1465–1466.CrossRefGoogle ScholarPubMed
117. Preston, GA, Larson, EL, Stamm, WE. The effect of private isolation rooms on patient care practices, colonization, and infection in an intensive care unit. Am J Med 1981;70:641–645.CrossRefGoogle Scholar
118. Simmons, B, Bryant, J, Neiman, K, Spencer, L, Arheart, K. The role of handwashing in prevention of endemic intensive care unit infections. Infect Control Hosp Epidemiol 1990;11:589–594.CrossRefGoogle ScholarPubMed
119. Mayer, JA, Dubbert, PM, Miller, M, et al. Increasing handwashing in an intensive care unit. Infect Control 1986;7:259–262.CrossRefGoogle Scholar
120. Doebbeling, BN, Stanley, GL, Sheetz, CT, et al. Comparative efficacy of alternative handwashing agents in reducing nosocomial infections in intensive care units. N Engl J Med 1992;327:88–93.CrossRefGoogle ScholarPubMed
121. Conly, JM, Hill, S, Ross, J, Lertzman, J, Louie, TJ. Handwashing practices in an intensive care unit: the effects of an educational program and its relationship to infection rates. Am J Infect Control 1989;17:330–339.10.1016/0196-6553(89)90002-3CrossRefGoogle Scholar
122. Gaynes, RP, Weinstein, RA, Smith, J, et al. Control of aminoglycoside resistance by barrier precautions. Infect Control 1983;4:221–224.CrossRefGoogle ScholarPubMed
123. Weinstein, RA, Kabins, SA. Strategies for prevention and control of multiple drug-resistant nosocomial infection. Am J Med 1981;70:449–459.CrossRefGoogle ScholarPubMed
124. Klein, BS, Perloff, WH, Maki, DG. Reduction of nosocomial infection during pediatric intensive care by protective isolation. N Engl J Med 1989;320:1714–1721.CrossRefGoogle ScholarPubMed
125. Maki, DG, McCormick, RD, Zilz, MA, et al. An MRSA outbreak in an SICU during universal precautions: new epidemiology for nosocomial MRSA; downside for universal precautions. In: Program and Abstracts of the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy; Atlanta, GA; 1990. Abstract 473.Google Scholar
126. Patterson, JE, Vecchio, J, Pantelick, EL, et al. Association of contaminated gloves with transmission of Acinetobacter calcoaceticus var anitratus in an intensive care unit. Am J Med 1991;91:479–483.CrossRefGoogle Scholar
127. McGowan, JE. Antimicrobial resistance in hospital organisms and its relation to antibiotic use. Rev Infect Dis 1983;5:1033–1048.CrossRefGoogle ScholarPubMed
128. Marr, JJ, Moffet, HL, Kunin, CM. Guidelines for improving the use of antimicrobial agents in hospitals: a statement by the Infectious Diseases Society of America. J Infect Dis 1988;157:869–876.10.1093/infdis/157.5.869CrossRefGoogle ScholarPubMed
129. Price, DJE, Sleigh, JD. Control of infection due to Klebsiella aerogenes in a neurosurgical unit by withdrawal of all antibiotics. Lancet 1970;2:1213–1215.CrossRefGoogle Scholar
130. Shulman, JA, Terry, PM, Hough, CE. Colonization with gentamicin-resistant Pseudomonas aeruginosa, pyocin type 5, in a burn unit. J Infect Dis 1971;124(suppl):18S–23S.CrossRefGoogle Scholar
131. Lowbury, EJL, Babb, JR, Roe, E. Clearance from a hospital of gram-negative bacilli that transfer carbenicillin-resistance to Pseudomonas aeruginosa . Lancet 1972;2:941–945.CrossRefGoogle ScholarPubMed
132. McGowan, JE. Do intensive hospital antibiotic control programs prevent the spread of antibiotic resistance? Infect Control Hosp Epidemiol 1994;15:478–483.CrossRefGoogle ScholarPubMed
133. Hospital Infection Control Practices Advisory Committee. Recommendations for preventing the spread of vancomycin resistance. Infect Control Hosp Epidemiol 1995;16:105–113.CrossRefGoogle Scholar
134. Fink, MP, Snydman, DR, Niederman, MS, et al. Treatment of severe pneumonia in hospitalized patients: results of a multicenter, randomized, double-blind trial comparing intravenous ciprofloxacin with imipenem-cilastatin. Antimicrob Agents Chemother 1994;38:547–557.CrossRefGoogle ScholarPubMed
135. Flaherty, JP, Weinstein, RA. Infection control and pneumonia prophylaxis strategies in the intensive care unit. Semin Respir Infect 1990;5:191–203.Google ScholarPubMed
136. Stoutenbeek, CP, van Saene, HKF, Miranda, DR, Zandstra, DF. The effect of selective decontamination of the digestive tract on colonization and infection rate in multiple trauma patients. Intensive Care Med 1984;10:185–192.CrossRefGoogle ScholarPubMed
137. Unertl, K, Ruckdeschel, G, Selbmann, HK, et al. Prevention of colonization and respiratory infections in long-term ventilated patients by local antimicrobial prophylaxis. Intensive Care Med 1987;13:106–113.10.1007/BF00254795CrossRefGoogle ScholarPubMed
138. Kerver, AJH, Rommes, JH, Mevissen-Verhage, EAE, et al. Prevention of colonization and infection in critically ill patients: a prospective randomized study. Crit Care Med 1988;16:1087–1093.CrossRefGoogle ScholarPubMed
139. Ledingham, IM, Alcock, SR, Eastaway, AT, et al. Triple regimen of selective decontamination of the digestive tract, systemic cefotaxime, and microbiological surveillance for prevention of acquired infection in intensive care. Lancet 1988;1:785–790.10.1016/S0140-6736(88)91656-XCrossRefGoogle ScholarPubMed
140. Ulrich, C, Harinck-de Weerd, JE, Bakker, NC, et al. Selective decontamination of the digestive tract with norfloxacin in the prevention of ICU-acquired infections: a prospective randomized study. Intensive Care Med 1989;15:424–431.CrossRefGoogle ScholarPubMed
141. Flaherty, J, Nathan, C, Kabins, SA, Weinstein, RA. Pilot trial of selective decontamination for prevention of bacterial infection in an intensive care unit. J Infect Dis 1990;162:1393–1397.CrossRefGoogle Scholar
142. Godard, J, Guillaume, C, Reverdy, ME, et al. Intestinal decontamination in a polyvalent ICU: a double-blind study. Intensive Care Med 1990;16:307–311.CrossRefGoogle Scholar
143. Pugin, J, Auckenthaler, R, Lew, DP, Suter, PM. Oropharyngeal decontamination decreases incidence of ventilator-associated pneumonia: a randomized, placebo-controlled, double-blind clinical trial. JAMA 1991;265:2704–2710.CrossRefGoogle ScholarPubMed
144. Blair, P, Rowlands, BJ, Lowry, K, et al. Selective decontamination of the digestive tract: a stratified, randomized, prospective study in a mixed intensive care unit. Surgery 1991;110:303–310.Google Scholar
145. Aerdts, SJA, van Dalen, R, Clasener, HAL, et al. Antibiotic prophylaxis of respiratory tract infection in mechanically ventilated patients: a prospective, blinded, randomized trial of the effect of a novel regimen. Chest 1991;100:783–791.CrossRefGoogle ScholarPubMed
146. Stoutenbeek, CP, van Saene, HKF, Zandstra, DF. The effect of oral non-absorbable antibiotics on the emergence of resistant bacteria in patients in an intensive care unit. J Antimicrob Chemother 1987;19:513–520.CrossRefGoogle Scholar
147. Gastinne, H, Wolff, M, Delatour, F, et al. A controlled trial in intensive care units of selective decontamination of the digestive tract with nonabsorbable antibiotics. N Engl J Med 1992;326:594–599.CrossRefGoogle ScholarPubMed
148. Cockerill, FR, Muller, SR, Anhalt, JP, et al. Prevention of infection in critically ill patients by selective decontamination of the digestive tract. Ann Intern Med 1992;117:545–553.CrossRefGoogle ScholarPubMed
149. Brun-Buisson, C, Legrand, P, Rauss, A, et al. Intestinal decontamination for control of nosocomial multiresistant gram-negative bacilli: study of an outbreak in an intensive care unit. Ann Intern Med 1989;110:873–881.CrossRefGoogle Scholar
150. Taylor, ME, Oppenheim, BA. Selective decontamination of the gastrointestinal tract as an infection control measure. J Hosp Infect 1991;17:271–278.CrossRefGoogle ScholarPubMed
151. Jarvis, WR, Edwards, JR, Culver, DH, et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. Am J Med 1991;91(3b):185S–191S.CrossRefGoogle ScholarPubMed
152. Johnson, JR, Roberts, PL, Olsen, RJ, et al. Prevention of catheter-associated urinary tract infection with a silver oxidecoated urinary catheter: clinical and microbiologic correlates. J Infect Dis 1990;162:1145–1150.CrossRefGoogle Scholar
153. Maki, DG, Cobb, L, Garman, JK, et al. An attachable silverimpregnated cuff for prevention of infection with central venous catheters: a prospective randomized multicenter trial. Am J Med 1988;85:307–314.CrossRefGoogle ScholarPubMed
154. Flowers, RH, Schwenzer, KJ, Kopel, RF, Fisch, MJ, Tucker, SI, Farr, BM. Efficacy of an attachable subcutaneous cuff for the prevention of intravascular catheter-related infection: a randomized, controlled trial. JAMA 1989;261:878–883.CrossRefGoogle ScholarPubMed
155. Valles, J, Artigas, A, Rello, J, et al. Continuous aspiration of subglottic secretions in preventing ventilator-associated pneumonia. Ann Intern Med 1995;122:179–186.CrossRefGoogle ScholarPubMed
156. Reagan, DR, Doebbeling, BN, Pfaller, MA, et al. Elimination of coincident Staphylococcus aureus nasal and hand carriage with intranasal application of mupirocin calcium ointment. Ann Intern Med 1991;114:101–106.CrossRefGoogle ScholarPubMed
157. Hill, RLR, Duckworth, GJ, Casewell, MW. Elimination of nasal carriage of methicillin-resistant Staphylococcus aureus with mupirocin during a hospital outbreak. J Antimicrob Chemother 1988;22:377–384.CrossRefGoogle ScholarPubMed
158. Roccaforte, JS, Bittner, MJ, Stumpf, CA, Preheim, LC. Attempts to eradicate methicillin-resistant Staphylococcus aureus colonization with the use of trimethoprim-sulfamethazole, rifampin, and bacitracin. Am J Infect Control 1988;16:141–146.CrossRefGoogle Scholar