We analyzed data from the National Nosocomial Infections Surveillance (NNIS) System from 1986-2003 to determine the epidemiology of gram-negative bacilli in intensive care units (ICUs) for the most frequent types of hospital-acquired infection: pneumonia, surgical site infection (SSI), urinary tract infection (UTI), and bloodstream infection (BSI). We analyzed >410,000 bacterial isolates associated with hospital-acquired infections in ICUs during 1986-2003. In 2003, gram-negative bacilli were associated with 23.8% of BSIs, 65.2% of pneumonia episodes, 33.8% of SSIs, and 71.1% of UTIs. The percentage of BSIs associated with gram-negative bacilli decreased from 33.2% in 1986 to 23.8% in 2003. The percentage of SSIs associated with gram-negative bacilli decreased from 56.5% in 1986 to 33.8% in 2003. The percentages pneumonia episodes and UTIs associated with gram-negative bacilli remained constant during the study period. The proportion of ICU pneumonia episodes associated with Acinetobacter species increased from 4% in 1986 to 7.0% in 2003 (P<.001, by the Cochran-Armitage chi2 test for trend). Significant increases in resistance rates were uniformly seen for selected antimicrobial-pathogen combinations. Gram-negative bacilli are commonly associated with hospital-acquired infections in ICUs. The proportion of Acinetobacter species associated with ICU pneumonia increased from 4% in 1986 to 7.0% in 2003.

Overview of Nosocomial Infections Caused by Gram-Negative Bacilli

SUMMARY Health care-associated infections (HAIs) have become more common as medical care has grown more complex and patients have become more complicated. HAIs are associated with significant morbidity, mortality, and cost. Growing rates of HAIs alongside evidence suggesting that active surveillance and infection control practices can prevent HAIs led to the development of hospital epidemiology and infection control programs. The role for infection control programs has grown and continues to grow as rates of antimicrobial resistance rise and HAIs lead to increasing risks to patients and expanding health care costs. In this review, we summarize the history of the development of hospital epidemiology and infection control, common HAIs and the pathogens causing them, and the structure and role of a hospital epidemiology and infection control program.

Hospital Epidemiology and Infection Control in Acute-Care Settings

Origin of infection in acute nonlymphocytic leukemia. Significance of hospital acquisition of potential pathogens.

National Surveillance of Nosocomial Blood Stream Infection Due to Candida albicans: Frequency of Occurrence and Antifungal Susceptibility in the SCOPE Program

Norfloxacin prevents bacterial infection in cirrhotics with gastrointestinal hemorrhage.

THE major infectious disease problems in most hospitals today are those that occur in the hospital — so-called nosocomial infections. In this discussion I shall define briefly the scope of the problem, explore some of the causes of the unacceptably high prevalence of hospital-acquired infections, evaluate some of the current preventive measures, and speculate on developments that may improve prevention and therapy. I shall focus on bacterial infections, although in certain classes of patients other organisms at times may be etiologic. The Problem Prevalence In 1959, Rogers1 presented data from an autopsy study confirming that the types of infection causing . . .

Hospital-acquired infections.

THE clinical use of digitalis is accompanied by a distressingly high prevalence of toxic manifestations, the most serious of which are arrhythmias and disturbances of conduction.1 , 2 Many factors contribute to the development of digitalis toxicity (Table 1). Perhaps the most important is the accumulation of excessive amounts of digitalis in the body and in the myocardium in particular. Although excessive digitalis accumulation occasionally reflects excessive dosage, it is more commonly due to diminished excretion. Largely as a result of the studies of Doherty3 4 5 6 7 and of Marcus8 9 10 and their collaborators, much has recently been learned about the factors that lead to . . .

Digoxin: immunologic approaches to measurement and reversal of toxicity.

RAPID advances in our understanding of anti-body specificity and in the sensitivity of immunologic methods have provided powerful tools for the study of basic mechanisms in normal and abnormal phys...

Immunologic Studies of Gastrin

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Hospital-acquired infections.

Digoxin: immunologic approaches to measurement and reversal of toxicity.

Immunologic Studies of Gastrin