Infections nosocomial

Lower respiratory tract infections IV 400 mg ql2h for 7-14 days. PO 500mgql2hfor 7-14 days (750 mgql2h for 7-14 days for severe or complicated infections). Nosocomial pneumonia IV 400 mg q8h for 10-14 days. 

The hepatitis C virus can be transmitted parenterally or sporadically. Risk groups with a high prevalence rate are haemophiliac patients (70-90%), i.v. drug addicts (50-90%), posttransfusion patients (60-80%), dialysis patients (5-30%) and liver transplant recipients. In 40-50% of patients with a positive anti-HCV test, the transmission route is still unknown. These cases are designated community-acquired or sporadic hepatitis C. The cause is rooted in poor hygienic conditions and close physical contact. Ill, 211, 334) Fundamentally, the possibility of infection depends on the virus titre in the source person - it is considerably lower than with HBV infection. Nosocomial infection between patients has also been observed. (281, 329, 390)... 

Cefuroxime (35) is effective against community-acquired pneumonia in which ampicillin-resistant Haemophilus influence is the probable etiologic agent. Cefoxitin (23) is used to treat mixed aerobic—anaerobic infections including pelvic infections, intra-abdorninal infections, and nosocomial aspiration pneumonia. Cefonicid (31), because of its long half-life has been used in a once-a-day regimen to treat a variety of mild to moderate infections including community-acquired pneumonias, urinary tract infections, and infections of the skin and soft tissue (132,215). 

A new profession, that of infection control practitioner, has been developed to deal with hospital infection problems and at least one practitioner for every 250 hospital beds has been recommended (10). In the mid-1970s, the cost of nosocomial infections was said to be in excess of 1 biUion dollars (11), and has continued to rise with health care costs. 

Susceptibility of viruses to antimicrobial agents can depend on whether the viruses possess a lipid envelope. Non-lipid viruses are frequently more resistant to disinfectants and it is also likely that such viruses cannot be readily categorized with respect to their sensitivities to antimicrobial agents. These viruses are responsible for many nosocomial infections, e.g. rotaviruses, picornaviruses and adenoviruses (see Chapter 3), and it may be necessary to select an antiseptic or disinfectant to suit specific circumstances. Certain viruses, such as Ebola and Marburg which cause haemorrhagic fevers, are highly infectious and their safe destruction by disinfectants is of paramount importance. 

Examples of preservatives are phenylmercuric nitrate or acetate (0.002% w/v), chlorhexidine acetate (0.01 % w/v), thiomersal (0.01 % w/v) and benzalkorrium chloride (0.01 % w/v). Chlorocresol is too toxic to the comeal epithehum, but 8-hydroxyquinoline and thiomersal may be used in specific instances. The principal considerahon in relation to antimicrobial properties is the activity of the bactericide against Pseudomonas aeruginosa, a major source of serious nosocomial eye infections. Although benzal-konium chloride is probably the most active of the recommended preservatives, it cannot always be used because of its incompatibility with many compounds commonly used to treat eye diseases, nor should it be used to preserve eye-drops containing anaesthetics. Since benzalkonium chloride reacts with natural mbber, silicone or butyl rabber teats should be substituted. Since silicone mbber is permeable to water vapour, products should not be stored for more than 3 months after manufacture. As with all mbber components, the mbber teat should be pre-equilibrated with the preservative prior to... 

The sole objective of all hygiene and manufacturing controls is to ensure the quality of the pharmaceuhcal product for the safety and protection of the pahent. The manufacture of non-sterile pharmaceutical products requires that certain criteria of cleanliness, personal hygiene, produchon methods and storage must be met. Many such products are for oral and topical use and the question may fairly be posed as to the point of what are now quite stringent conditions. Nevertheless, some carefully controlled hospital studies have indeed shown that both types of medicine may be associated with nosocomial (hospital-acquired) infections and this risk can be minimized by the application of GMP principles. 

Flansen, S., Stamm-Balderjahn, S., Zuschneid, I., Behnke, M., Ruden, FI., Vonberg, R. P., and Gastmeier, P. (2007). Closure of medical departments during nosocomial outbreaks data from a systematic analysis of the literature. J. Hasp. Infect. 65, 348-353. 

Sommer, C., Mueller, W., and Resch, B. (2009). Two nosocomial norovirus outbreaks in the neonatal intensive and intermediate care unit. Eur. J. Clin. Microbiol. Infect. Dis. 28, 1133-1136. 

Patients with a history of recent antimicrobial use may have altered normal flora or harbor resistant organisms. If a patient develops a new infection while on therapy, fails therapy, or has received antimicrobials recently, it is prudent to prescribe a different class of antimicrobial because resistance is likely. Previous hospitalization or health care utilization (e.g., residing in a nursing home, hemodialysis, and outpatient antimicrobial therapy) are risk factors for the acquisition of nosocomial pathogens, which are often resistant organisms. 

Only active against gram-negative bacteria, including P. aeruginosa. Generally useful for nosocomial infections when aminoglycosides are to be avoided and in penicillin-susceptible patients. 

Enterococcus species are normal inhabitants of the gastrointestinal tract, but should empiric treatment of intra-abdominal infections have activity against Enterococcus species Empiric treatment that covered Enterococcus species in intraabdominal infections was equivalent to empiric treatment that lacked enterococcal coverage. Routine coverage for Enterococcus is not necessary for patients with community-acquired intra-abdominal infections. However, in patients with nosocomial or high-severity infections, enterococcal coverage may be warranted.39... 

Candida species are the most common opportunistic fungal pathogens encountered in hospitals, ranking as the third to fourth most common cause of nosocomial bloodstream infections in United States Hospitals.18 The incidence of nosocomial candidiasis has increased steadily since the early 1980s, with the widespread use of central venous catheters, broad-spectrum antimicrobials, and other advancements in the supportive care... 

MRSA methiciUin-resistant Staphylococcus aureus MSSA methiciUin-sensitive Staphylococcus aureus NNIS National Nosocomial Infections Surveillance System... 

Nosocomial infection An infection acquired within the health care system. Generally, symptoms of infection must occur after at least 48 hours of care to be considered nosocomial. 

Rapid sub-typing of bacteria is needed for protection of public health and in civil-, criminal-, or terror-related forensics. Distinction of microbiological sub-types can signal important differences that affect the health risk from microbial infection and treatment strategies for disease. It can also be used to monitor the emergence of mutant strains.1 In cases of nosocomial (hospital-incurred) infections and outbreaks, sub-typing capability could be used as an alternative for identifying the route by which infection spreads. Many studies... 

Cartmill,T. D. Orr, K. Freeman, R. Sisson, P. R. Lightfoot,N. F. Nosocomial infection with Clostridium difficile investigated by pyrolysis mass spectrometry. J. Med. Microbiol. 1992,37, 352-356. 

Sisson, P. R. Freeman, R. Gould, F. K. Lightfoot, N. F. Strain differentiation of nosocomial isolates of Pseudomonas aeruginosa by pyrolysis mass spectrometry. /. Hosp. Infect. 1991,19,137-140. 

National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2003, issued August 2003. Am. J. Infect. 

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