A one-day point prevalence of infection analysis was undertaken in 1417 intensive care units (ICUs) (10,038 patients) in 17 western European countries. The prevalence of ICU-acquired infection was 20.6% (2064 patients), representing almost half the cases of infection. Pneumonia was the most commonly reported infection (46.9%), followed by infection of the lower respiratory tract (17.8%), urinary tract (17.6%), and blood (13.0%). Staphylococcus aureus was the most frequently isolated organism (30.1%), followed by Pseudomonas aeruginosa (28.7%), coagulase-negative staphylococci (19.1%), yeasts (17.1%), and enterococci (11.7%). As a group, the Enterobacteriaceae were the most commonly isolated organisms (34.4%). The study also revealed that resistance to antimicrobial agents is common among Staphylococcus aureus, Pseudomonas aeruginosa, and coagulase-negative staphylococci.
Patients admitted to ICUs are at the greatest risk of acquiring nosocomial infections, partly because of their serious underlying disease, but also by exposure to life-saving invasive procedures. Nosocomial infections increase patient morbidity, increase the length of hospital stay and hospital costs, and may increase mortality rates. When serious infections are suspected, treatment must be commenced immediately to increase the likelihood of a satisfactory outcome for the patient. Empirical knowledge, to select appropriate antibiotics, must be used so that the most likely infecting organisms are treated. In the past this has meant that antibiotics with activity against Gram-negative pathogens were most likely to be selected. However, infections where Gram-positive pathogens are responsible (e.g. Staphylococcus aureus, Staphylococcus epidermidis and enterococci) are increasingly being found. The European Prevalence of Infection in Intensive Care Study (EPIC), the largest point-prevalence study of infection in ICUs in Western Europe was carried out on 28 April 1992. Data on 10,038 patients in 1417 adult ICU departments from 17 countries was collected and analysed. Of the ICU patients surveyed, 21% had at least one infection acquired in an ICU. The most common infections acquired in an ICU were pneumonia (47%), other infections of the lower respiratory tract (18%), infections of the urinary tract (18%) and infections of the blood-stream (12%). The bacterial isolates were equally divided between Gram-negative and Gram-positive species. The commonly reported bacteria were Enterobacteriaceae (34%), S. aureus (30%), Pseudomonas aeruginosa (29%), coagulase-negative staphylococci (19%) and enterococci (12%).
A total of 538 patients from 45 different general practice centres across the UK was admitted to an open study and randomized to one of the following treatment groups: nitrofurantoin modified release (MR) 100 mg bd, trimethoprim 200 mg bd or co-trimoxazole 960 mg bd. Each patient received seven days of medication. Clinical cure, defined as relief from symptoms at visit 2, occurred in 87.2% of the patients treated with nitrofurantoin MR, 84.5% of the co-trimoxazole group and 86.5% of the trimethoprim group. The bacteriological cure rate for nitrofurantoin MR was comparable to co-trimoxazole at 82.3% and 83.2%, respectively, with trimethoprim the lowest at 76.8%. Whilst the cure rate for Escherichia coli infection was similar, 81.5% cured with nitrofurantoin MR, 82.5% with co-trimoxazole and 78.4% by trimethoprim, for non-E. coli pathogens nitrofurantoin MR was equivalent to co-trimoxazole with 86.7% cure but higher than trimethoprim at 72.0%. In-vitro sensitivity to all pathogens isolated at baseline was very high for nitrofurantoin at 96.1%, significantly higher than either co-trimoxazole or trimethoprim at 87.5% (P < 0.01). The test drugs were equally well tolerated with 28 patients (15.7%) reporting adverse events with nitrofurantoin MR, 28 (15.5%) with co-trimoxazole and 28 (15.6%) with trimethoprim. However, nitrofurantoin MR showed fewer patients with drug-related adverse events (5.6%) as judged by the investigator, compared to co-trimoxazole (8.8%) or trimethoprim (7.3%). (ABSTRACT TRUNCATED AT 250 WORDS)
The emergence of a clonal group of gonococci showing decreased susceptibility to cefixime in England and Wales highlights the need for continued surveillance.
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