Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-03T03:59:16.814Z Has data issue: false hasContentIssue false
  • English
  • Français

Nosocomial Bloodstream Infection at a Veterans Hospital; 1979 to 1987

Published online by Cambridge University Press:  21 June 2016

Joseph M. Mylotte ,
Donald White ,
Carolyn McDermott  and
Carolyn Hodan
Joseph M. Mylotte*
Affiliation:
Medical Services, Veterans Administration Medical Center, Buffalo, New York Department of Medicine, Infectious Diseases Division and Department of Microbiology, State University of New York at Buffalo, Buffalo, New York
Donald White
Affiliation:
Department of Statistics, State University of New York at Buffalo, Buffalo, New York
Carolyn McDermott
Affiliation:
Nursing Services (Infection Control), Veterans Administration Medical Center, Buffalo, New York
Carolyn Hodan
Affiliation:
Nursing Services (Infection Control), Veterans Administration Medical Center, Buffalo, New York
*
Infectious Diseases (111F), VA Medical Center, 3495 Bailey Ave., Buffalo, NY 14215
Get access Rights & Permissions [Opens in a new window]

Abstract

Studies of nosocomial bloodstream infection (NBI) have come primarily from university, municipal or community hospitals with little specific information from veterans hospitals. The objective of this study was to define trends in NBI at a tertiary care veterans hospital. Patients with NBI were identified by retrospective review of microbiology records and of infection control surveillance records from 1979 to 1987 at the Buffalo Veterans Administration Medical Center (VAMC). Between 1979 and 1985 there was no significant upward or downward trend. Beginning in early 1986 a significant increase in NBI was noted. This increase was because of changes in incidence of gram-positive NBI (primarily Streptococcus aureus and enterococcus) while there was no change in incidence of gram-negative NBI. The most common sources of NBI were similar to previous studies and included urinary tract infection, pneumonia, surgical wound infections and intravenous catheter related infections. The frequency of various organisms causing NBI was likewise similar to other studies except for pneumonia in which Streptococcus pneumoniae most commonly was isolated. The yearly incidence of gentamicin resistance among gram-negative NBI isolates demonstrated no significant trend. In conclusion, there was a significant increase in incidence of NBI at the Buffalo VAMC between 1979 and 1987 that occurred primarily in the last two years studied. The importance of gram-positive organisms as a cause of NBI at the Buffalo VAMC has been clearly documented as a recent phenomenon.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 10 , Issue 10 , October 1989 , pp. 455 - 464
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1989

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Maki, DG: Nosocomial bacteremia: An epidemiologic overview. Am J Med 1981;70:719–732.10.1016/0002-9343(81)90603-3Google Scholar
2. McGowan, JE: Changing etiology of nosocomial bacteremia and fungemia and other hospital-acquired infections. Rev Infect Dis 1985;7(suppl 3):357–370.10.1093/clinids/7.Supplement_3.S357Google Scholar
3. McGowan, JE: Septicemia: Changing patterns of causative organisms underlying conditions, in Shanson, DC (ed): Septicemia and Endocarditis: Clinical and Microbiological Aspects. Oxford, England, Oxford University Press, 1989, pp 2–48.Google Scholar
4. Weinstein, MP, Reller, LB, Murphy, JR, et al: The clinical significance of positive blood cultures: A comprehensive analysis of 500 episodes of bacteremia and fungemia in adults. I. Laboratory and epidemiologic observations. Rev Infect Dis 1983:5:35–53.10.1093/clinids/5.1.35CrossRefGoogle ScholarPubMed
5. Bryan, CS, Reynolds, KL, Brenner, ER: Analysis of 1,186 episodes of gram-negative bacteremia in non-university hospitals: The effects of antimicrobial therapy. Rev Infect Dis 1983;5:629–638.10.1093/clinids/5.4.629Google Scholar
6. Bryan, CS, Hornung, CA, Reynolds, KL, et al: Endemic bacteremia in Columbia, South Carolina. Am J Epidemiol 1986;123:113–127.10.1093/oxfordjournals.aje.a114205Google Scholar
7. Chang, JI, Mylotte, JM: Pneumococcal bacteremia-Update from an adult hospital with a high rate of nosocomial cases. J Am Geriatr Soc 1987;35:747–754.10.1111/j.1532-5415.1987.tb06353.xGoogle Scholar
8. Mylotte, JM; Gentamicin resistance among gram-negative bacillary blood isolates in a hospital with long-term use of gentamicin. Arch Intern Med 1987;147:1642–1644.10.1001/archinte.1987.00370090118020Google Scholar
9. Mylotte, JM, McDermott, C, Spooner, JA: Prospective study of 114 consecutive episodes of Staphylococcus aureus bacteremia. Rev Infect Dis 1987;9:891–907.10.1093/clinids/9.5.891CrossRefGoogle ScholarPubMed
10. Bauer, AW, Kirby, WMM, Sherris, JC, et al: Antibiotic susceptibility testing by a standardized angle disk method. Am J Clin Pathol 1966;70:493–496.10.1093/ajcp/45.4_ts.493Google Scholar
11. USDHEW, Public Health Service: Outline for Surveillance and Control of Nosocomial Infections. Atlanta, Centers for Disease Control Bureau of Epidemiology. 1972.Google Scholar
12. Duncan, AJ: Quality Control and Industrial Statistics, ed 5. Homewood, Illinois, Richard D. Irwin Inc. 1986, pp 461–475.Google Scholar
13. Centers for Disease Control: Nosocomial Infection Surveillance, 1984 CDC Surveillance Summaries 1986. Atlanta, Centers for Disease Control,(supp 155)17SS–29SS.Google Scholar
14. McGowan, JE, Barnes, MW, Finland, M: Bacteremia at Boston City Hospital: Occurrence and mortalily during 12 selected years (1935-1972), with special reference to hospital-acquired cases. J Infect Dis 1975;132:316–335.10.1093/infdis/132.3.316Google Scholar
15. Holzman, KS, Florman, AL, Toharsky, B: The clinical usefulness of an ongoing bacteremia surveillance program. Am J Med Sci 1977;274:13–19.10.1097/00000441-197707000-00002Google Scholar
16. Maki, DG: Infections due to infusion therapy, in Bennett, JV, Brachman, PS (eds): Hospital Infections. Boston, Little, Brown & Co, 1986, pp 561–580.Google Scholar
17. Weinstein, RA: Other procedure-related infections, in Bennett, JV, Brachman, PS (eds): Hospital Infections. Boston, Little, Brown&Co, 1986, pp 619–637.Google Scholar
18. Mylotte, JM, McDermott, C: Recurrent gram-negative bacteremia. Am J Med 1988;85:159–163.10.1016/S0002-9343(88)80335-8Google Scholar
19. Horan, T, Culver, D, Jarvis, W, et al: Pathogens causing nosocomial infections-preliminary data from the National Nosocomial Infections Surveillance system. Antimicrobic Newsletter 1988;5:65–67.10.1016/0738-1751(88)90027-5Google Scholar
20. Mylotte, JM, McDermott, C: Staphylococcus aureus bacteremia caused by infected intravenous catheters. Am J Infect Control 1987;15:1–6.10.1016/0196-6553(87)90069-1Google Scholar
21. Ponce de Leon, S, Wenzel, RP: Hospital-acquired bloodstream infections with Staphylococcus epidermidis: Review of 100 cases. Am J Med 1984;77:639–644.10.1016/0002-9343(84)90354-1Google Scholar
22. Martin, MA, Pfaller, MA, Wenzel, RP: Coagulase-negative staphylococcal bacteremia. Mortalily and hospital stay. Ann Intern Med 1989;110:9–16.10.7326/0003-4819-110-1-9Google Scholar
23. Hoffmann, SA, Moellering, RC. The enterococcus: “Putting the bug in our ears .” Ann Intern Med 1987;106:757–761.10.7326/0003-4819-106-5-757Google Scholar
24. Zervos, MJ, Kauffman, CA, Therasse, PM, et al: Epidemiology of nosocomial infection caused by gentamicin resistant Streptococcus faecalis . Ann Intern Med 1987;106:687–691.10.7326/0003-4819-106-5-687Google Scholar
25. Maki, DG, Agger, WA: Enterococcal bacteremia: Clinical features, the risk of endocarditis, and management. Medicine 1988;67:248–269.10.1097/00005792-198807000-00005Google Scholar
26. Whiteside, M, Moore, J, Ratzan, D: An investigation of enterococcal bacteremia. Am J Infect Control 1983;14:125–129.10.1016/0196-6553(83)90028-7Google Scholar
27. Schlaes, D: Enterococcal bacteremia: A disease of the compromised host. Infect Surg 1986;5(suppl): 10–12.Google Scholar
28. Malone, DA, Wagner, RA, Myers, JP, et al: Enterococcal bacteremia in two large communily teaching hospitals. Am J Mrd 1986;81:601–606.10.1016/0002-9343(86)90544-9Google Scholar
29. Gullberg, RM, Homann, SR, Phair, JP: Enterococcal bacteremia: Analysis of 75 episodes. Rev Infect Dis 1989;11:74–85.10.1093/clinids/11.1.74Google Scholar
30. Mylotte, JM, Beam, TR: Comparison of community-acquired and nosocomial pneumococcal bacteremia. Am Rev Respir Dis 1981;123:265–268.Google Scholar
31. Alvarez, S, Guarderas, J, Shell, CG, et al: Nosocomial pneumococcal bacteremia. Arch Intern Med 1986;146:1509–1513.10.1001/archinte.1986.00360200059010Google Scholar
32. Fanciullo, GJ, Baltch, AL, Smith, RP, et al: Serotyping of 1,458 pneumococcal isolates with analysis of bacteremia in 84 patients. South Med J 1986;79:1370–1375.10.1097/00007611-198611000-00013Google Scholar
33. Allen, JR, Hightower, AW, Martin, SM, et al: Secular trends in nosocomial infections: 1970-1979. Am J Med 1981;70:389–392.10.1016/0002-9343(81)90777-4Google Scholar