Nosocomial infections in medical intensive care units in the United States

Abstract

The distribution of sites of infection in medical ICUs differed from that previously reported in NNIS ICU surveillance studies, largely as a result of anticipated low rates of surgical site infections. Primary bloodstream infections, pneumonia, and urinary tract infections associated with invasive devices made up the great majority of nosocomial infections. Coagulase-negative staphylococci were more frequently associated with primary bloodstream infections than reported from NNIS ICUs of all types in the 1980s, and enterococci were a more frequent isolate from bloodstream infections than S. aureus. Fungal urinary tract infections, often asymptomatic and associated with catheter use, were considerably more frequent than previously reported. Invasive device-associated infections were associated with specific pathogens. Although device-associated site-specific infection rates are currently our most useful rates for performing comparisons between ICUs, the considerable variation in these rates between ICUs indicates the need for further risk adjustment.

Antimicrobial Properties of Nanostructured Hydrogel Webs Containing Silver

“…About half of these infections are related to medical devices that are implanted in patients for different lengths of duration. 1 It is well documented that the microbes causing device-related infections are attached to surfaces and grow into biofilms, which are highly hydrated structures comprised of a polysaccharide matrix secreted by the bound microbes. 2 Biofilm cells are up to 1000 times more tolerant to antimicrobial agents (hereafter, antimicrobials) and disinfectants than their free-swimming counterparts.…”

Primary Renal Candidiasis

“…There is very little in the literature about the sonographic features of primary renal candidiasis in adult patients. 1,2,6 All sonographic studies in our series showed renal pelvic and calyceal wall thickening. A pattern of layered wall thickening consisting of an inner echogenic rim representing the damaged mucosa, a middle hypoechoic layer probably caused by submucosal edema and infiltration, and a thick hyperechoic outer layer of muscularis may be seen.…”

“…Although rare, it is increasing in incidence. 1,2 The risk for developing primary renal candidiasis (primary Candida pyelonephritis) is increased after urinary tract surgery or when host defenses are compromised because of diabetes, prior antibiotics, malignancy, or immunosuppressive therapy. 1,3,4 Inconsistencies remain in the diagnosis of primary renal candidiasis because patients usually have variable clinical presentations or have no systemic signs and symptoms of infection, unlike patients with renal candidiasis secondary to disseminated infection.…”

“…Evidence of papillary necrosis, calyceal filling defects due to debris from sloughed papilla, large filling defects in the renal pelvis due to fungal ball formation, and caliectasis and hydropelvis are seen on excretory intravenous pyelography and retrograde and antegrade pyelography. 2,3,6 Papillary necrosis is most often seen with analgesic use, diabetes mellitus, and sickle cell disease. However, associated wall thickening seen on sonography and the presence of candiduria favors candidiasis.…”

“…1,4,8,9 Multiple debris extractions and irrigations are frequently needed after Candida has invaded into the interstitium. [1][2][3][4][5][6][7][8] A filling defect in the renal pelvis should be differentiated from a blood clot, nonopaque renal calculus, transitional cell neoplasm, or ureteritis cystica, especially in adult patients. 4,6 In our series, all adult patients had retrograde pyelography and tissue biopsies.…”