Secondary Infections In Patients Research Articles

Nosocomial infections and Secondary Infections in Sepsis

Hospital-acquired infection remains an important cause of morbidity and mortality. Many of the measures used in the diagnosis and therapy of septic shock may predispose the patient to such infections. Selected aspects of secondary infection in patients with septic shock syndrome are reviewed.

Nosocomial infections in a respiratory intensive care unit.

A total of 250 consecutive admissions to an open-plan respiratory ICU were analyzed prospectively to identify the incidence of secondary hospital-acquired infections and possible predisposing factors. Despite preventative measures and a restricted antibiotic policy, 23.6% of patients developed secondary infections. Patients admitted after multiple trauma were the only diagnostic category of patients who showed a significantly increased incidence of secondary infections. The length of hospitalization and number of patients who had intubations or tracheostomies was higher in the group with secondary infection; the causal relationship was difficult to establish. Patients who were not intubated or tracheostomized did not develop secondary infection. Prior administration of antibiotics did not appear to influence the incidence of secondary infection. There was a significant increase in secondary infections in patients with a higher therapeutic intervention scoring system score. The predominant pathogens cultured were highly resistant Gram-negative organisms, particularly Acinetobacter sp. and Pseudomonas sp. Staphylococcus aureus was the most common Gram-positive pathogen. The ICU course was probably prolonged by the complication of nosocomial infection, which may have contributed to the deaths.

Clinical and bacteriological evaluation of Branhamella catarrhalis in respiratory infections.

The clinical significance of Branhamella catarrhalis in respiratory infections is evaluated. 175 strains were isolated, mainly from the sputum, in 71 patients with respiratory infections. B. catarrhalis was most frequently isolated in mixed infections with Haemophilus influenzae (38.3%), H. influenzae plus Streptococcus pneumoniae (10.3%) or S. pneumoniae (9.7%). The rate of isolation of B. catarrhalis alone was as low as 5.1% and from mixed infections with Pseudomonas aeruginosa, Escherichia coli, and Enterobacter and/or Klebsiella species it was 36.6%. More than 10(7) cfu/ml of B. catarrhalis were isolated from 71.4% of cases. In 29 cases the organism was determined to be causative according to our criteria, most often in secondary infections in patients with complicated pneumoconiosis, chronic bronchitis and bronchiectasis. 29 of 47 strains (61.7%) produced beta-lactamase of the penicillinase type. Against these strains, penicillin antibiotics and first and second generation cephalosporin antibiotics (except cefroxadine) showed weak activity compared with their activity against non-beta-lactamase-producing strains. The third generation cephalosporins showed a uniform spectrum of activity against both groups of organisms.

Indolent Bacterial Corneal Ulcers

We studied a total of 45 consecutive patients with indolent bacterial corneal ulcers. All patients underwent complete eye examination and corneal scrapings were submitted for study on smears and cultures. The most frequently encountered causative agent was Staphylococcus epidermidis. This was followed by Moraxella sp., Staphylococcus aureus, Serratia marcescens, Alpha-hemolytic streptococcus, and Nocardia sp. Six of the 45 patients had known herpes simplex keratitis with culture-proven secondary bacterial corneal ulcers. Certain bacteria which cause indolent corneal ulcers should be considered in the differential diagnosis of herpetic geographic corneal ulcers. Furthermore, bacteria may cause secondary infection in patients with herpetic keratitis.