Volume 9 Number 1

February, 1981

in epidemic situations, high-risk patients in anintensive care unit receiving multiple antibio­tics should be cohorted away from patients re­ceiving no antibiotics or a single antibiotic.

Clostridiumperfringenswound infectionassociated with elastic bandagesRichard D. Pearson, William M. Valenti, and Roy T. Steig­bigel: JAMA 244: 1128-1130, Sept. 1980. Reprint requests:Roy T. Steigbigel, M.D., University of Rochester Medical Cen­ter, Box MED, 601 Elmwood Ave., Rochester, NY 14642.

The authors describe five cases of clostridialwound infection that occurred in diabetic pa­tients who had undergone elective lower ex­tremity amputations for peripheral vascularinsufficiency. Nonsterile elastic bandages thathad been used as outer wraps of sterile gauzedressings in four of the five patients were foundto be contaminated with Clostridium per­fringens and other clostridial species. A plastersplint that had been used in the fifth patient'was also contaminated. The authors suggestthat diabetic vascular disease with concomi­tant local tissue ischemia and lowered oxidiza­tion-reduction potential provided a suitablemilieu for the development of anaerobic infec­tion. It is noteworthy that clostridial specieswere recovered from samples of tightly rolled,ethylene oxide-exposed bandages as well as"nonsterile" elastic bandages taken from theoperating room area.

This report is reminiscent of recent reportsof Rhizopus wound infections associated withcontaminated elasticized adhesive tape dress­ings. The authors reemphasize the possibilitythat nonsterile bandages may be sources fornosocomial wound infections. They point outthe importance of maintaining a dry barrierover the wound and separating the wound fromthese types of bandages.

Postoperative wound infection rates: Resultsof prospective statewide surveillanceBruce F. Farber and Richard P. Wenzel: Am J Surg140:343-346, Sept. 1980. Reprint requests: Richard P. Wenzel,M.D., Box 473, University of Virginia Medical Center, Char­lottesville, VA 22908.

The results of a prospective statewide studyof postoperative wound infection rates after 19

Reviews: Literature 21

selected surgical operations are reported. Ratesare based on 44,689 operations performed at 38hospitals from January 1, 1977, through May31, 1979. Rates of infection after a number ofselected surgeries are reported. For instance,the following rates of postoperative wound in­fections were described: appendectomy (non­ruptured), 3%; cholecystectomy, 3%; colon re­section, 12%; cesarean section, 6%; anduncomplicated herniorrhaphy, 1%.

This study is interesting because of the num­bers of cases, the type of cases, and the type ofhospitals surveyed. Ieps will find the tabledocumenting procedures, infection numbers,and rates in various hospitals by type of hospi­tal and size of hospital of interest. Many will becomparing their own surgical wound rates tothis table.

Nosocomial bacteriuria: A prospective studyof case clustering and antimicrobialresistanceDennis R. Schaberg, Robert W. Haley, Anita K. Highsmith,Robert L. Anderson, and John E. McGowan, Jr.: Ann InternMed 93:420-424, Sept. 1980. Reprint requests: SENIC Project5066-1, Bacterial Diseases Division, Bureau of Epidemiology,Center for Disease Control, Atlanta, GA 30333.

In this study, the authors attempted to in­vestigate the role of cross-infection in thetransmission of nonepidemic nosocomial bac­teriuria. They were able to confirm clusteringof cases by epidemiologic evidence and labora­tory testing in 30 of 194 episodes (15.5%) ofnosocomial bacteriuria. They found that in 90%of clustered and 76% of nonclustered casesthere had been previous urinary catheteriza­tions. Bacterial species such as Pseudomonasaeruginosa, Serratia marcescens, and Citrobacterfreundii were isolated more often from cases in­volved in clusters, while Escherichia coli pre­dominated in noncluster cases. Finally, patho­gens isolated from cluster cases were morelikely to be resistant to gentamicin (70%) thanisolates from noncluster cases (14%). The ther­apeutic implications of this observation werediscussed.

This study characterizes the incidence, epi­demiologic characteristics, and bacteriology ofnosocomial bacteriuria spread by cross-