PubMed Health⌕ Search

Biomedical subjects

F D Daschner

Publications and source records attributed to F D Daschner.

At least 19 recordsLinked to original sources
PubMed1992

Prolongation of hospital stay and extra costs due to ventilator-associated pneumonia in an intensive care unit.

A prospective cohort study was performed to determine the prolongation of stay and the extra costs incurred due to the occurrence of ventilator-associated pneumonia in intensive care unit patients. Over a 16-month period a sample of 270 consecutive adult patients from a large university anesthesiological intensive care unit requiring ventilation therapy for more than 24 hours was analyzed. A matching procedure using multiple control patients without pneumonia per infected patient (= case) was employed. Of 78 cases 21 (26.9%) died and were excluded from the matching procedure as well as 23 (29.5%) for whom suitable controls could not be found. The maximum number of controls per case was five. The mean added stay was calculated to be 10.13 days and the extra costs attributable to the prolongation of stay were 14,253 German Marks (US$8,800) per patient, demonstrating considerable added stay and costs due to ventilator-associated pneumonia acquired during intensive care. However, it should be taken into account that the calculations for excess stay and costs are based on a subset of rather ill patients and thus cannot generally apply to all ventilated patients and that cases were excluded which could not be matched.

Adult↗
PubMed1992

Added hospital stay due to wound infections following cardiac surgery.

To determine the prolongation of hospital stay due to postoperative wound infections following cardiac surgery, a prospective cohort study was performed by matching multiple control patients without infection to each infected patient (= case). Out of 22 cases, no patient died. No case had to be excluded from the matching process because of a lack of suitable control patients. The maximum number of controls per case was 10. The mean added stay was 12.2 days constituting a considerable prolongation of stay due to wound infection in cardiac surgery.

Adult↗
PubMed1991

Incidence of pneumonia in mechanically ventilated patients treated with sucralfate or cimetidine as prophylaxis for stress bleeding: bacterial colonization of the stomach.

Retrograde colonization of the oropharynx from the stomach by microaspiration of gastric fluid is a recently recognized phenomenon associated with increased gastric pH that may result in pneumonia during ventilation therapy. In a prospective study we investigated 104 mechanically ventilated patients in the intensive care unit who were receiving sucralfate (n = 49) or cimetidine (n = 55) for stress ulcer prophylaxis. The incidence of pneumonia was 45.5% (25 patients) in the cimetidine group and 26.5% (13 patients) in the sucralfate group (95% confidence interval 0.98 to 6.97; odds ratio 2.61; p = 0.0549). Mortality rates were 18.4% (9 patients) in the sucralfate group versus 25.5% (14 patients) in the cimetidine group (p = 0.48). The mean pH values of gastric aspirates were significantly lower in patients treated with sucralfate than in patients receiving cimetidine (p = 0.044). The number of colony-forming units of Enterobacteriaceae in gastric aspirates was also significantly lower in the sucralfate group (p = 0.0037).

Adult↗
PubMed1991

Potential inroads to reducing hospital-acquired staphylococcal infection and its cost.

Staphylococci are still the most common agents implicated in hospital-acquired infections. In addition to Staphylococcus aureus, coagulase-negative staphylococci have attracted widespread interest, since they have emerged as the most frequent pathogen in foreign-body related infections. The emergence of methicillin-resistant S. aureus has resulted in increasing use of potentially toxic and extremely expensive antibiotics. To prevent hospital-acquired staphylococcal infections only control measures proven to be effective should be implemented and the cost of infection control procedures should always be considered. Handwashing as the simplest, cheapest, and still the most effective measure should constantly be stressed. In this article, effective procedures for the prevention of hospital-acquired staphylococcal infections are summarized, with special emphasis on cost-saving measures.

Cost Control↗
PubMed1991

Penetration into tissues of various drugs active against gram-positive bacteria.

Gram-positive bacteria are the most important pathogens causing hospital- and community-acquired infections. We therefore reviewed the penetration of various antibiotics active against Gram-positive bacteria including methicillin-resistant Staphylococcus aureus into tissues, where staphylococcal infections are common. Rifampicin reaches heart valve concentrations of 65% of the simultaneous serum levels. At 8 h after administration blood and tissues concentrations of rifampicin exceeded the MIC90 values for S. aureus as well as for S. epidermidis. After a 2-g intravenous bolus injection of flucloxacillin heart valve concentrations exceeded MIC values for staphylococci for more than 8 h whereas subcutaneous and muscle concentrations declined within the same time to undetectable levels. The MIC90 values of vancomycin for S. epidermidis and Enterococcus faecalis are 2.0 and 4.0 mg/l respectively and for S. aureus 1.0 mg/l. This concentration is reached in subcutaneous tissue, heart valves and muscle for at least 4-6 h after administration of 15 mg/kg, however the corresponding value for Enterococcus faecalis in heart valve is maintained only for 3-4 h. After two and three dose regimens of teicoplanin serum and bone levels were significantly higher than fat levels, exceeding the MIC90 values for S. aureus, S. epidermidis and E. faecalis. The ratio of tissue concentration of teicoplanin to serum concentrations was 11% for fat and 65% for bone.

Anti-Bacterial Agents↗
PubMed1990

An epidemiological study assessing the relative importance of airborne and direct contact transmission of microorganisms in a medical intensive care unit.

A prospective epidemiological survey was carried out over a period of seven weeks in a medical intensive care unit. Bacteria from patients, staff and air were monitored and the transmission of isolated microorganisms was followed. Handwashing samples revealed pathogenic bacteria in 30.8% of physicians (average number of colony forming units: 71,300 per hand) and 16.6% of nurses (39,800 cfu per hand). Air cultures yielded pathogens in 15% of sampling periods and nine of 53 patients were found to be colonized with Gram-negative bacteria, Staphylococcus aureus or Candida spp. The spectrum of bacteria recovered from patients and air was generally different, whereas strains recovered from patients and their attendants' hands were indistinguishable on multiple occasions. The results of this study confirm that direct contact is the principal pathway of microbial transmission, whereas little evidence for a significant role of airborne transmission is shown. The call for more extensive air-filtering and ventilation systems in medical intensive care units is not supported by the results shown in this communication.

Air Microbiology↗
PubMed1989

Influence of architectural design on nosocomial infections in intensive care units--a prospective 2-year analysis.

Nosocomial infection rates in an old intensive care ward constructed in 1924 were compared with those in a new one constructed in 1986. The nosocomial infection rate in the old unit was 34.2% and that in the new unit 31.9%, with an average of 33%. The most frequent infections were: pneumonia, urinary tract infection, septicaemia and wound infection. After transfer of the intensive care unit (ICU) the incidence and profile of nosocomial infections remained the same. These findings suggest that the influence of architectural design has little impact on the incidence of nosocomial infections.

Cohort Studies↗
PubMed1989

Nosocomial pneumonia in the intubated patient: role of gastric colonization.

A high rate of nosocomial pneumonia exists among intubated patients receiving mechanical ventilation. Retrograde colonization of the oropharynx and trachea with bacteria from the stomach is not widely appreciated in the pathogenesis of pneumonia. Gastric colonization is affected by age, malnutrition, antibiotics, disease of the gastrointestinal tract, and changes in pH. The widespread use of antacids and/or histamine type 2 blockers as prophylaxis against stress bleeding in the ventilated patient may also increase gastric pH and the risk of colonization in the upper gastrointestinal tract. Migration of bacteria between the stomach, oropharynx and trachea in the intubated patient may be a dynamic system involving large numbers of bacteria. The high fatality rate of mechanically ventilated patients with pneumonia, which persists despite treatment of these patients with appropriate antimicrobial therapy, underscores the need for effective measures of prevention. Preventive measures include the appropriate use of antibiotics, proper decontamination of respiratory therapy equipment, the cautious use of drugs that alter the natural gastric acid barrier, or, possibly, the selective use of antibiotics to prevent or reduce gastric, oropharyngeal and tracheal colonization.

Cross Infection↗
PubMed1989

Nasal carriage of Staphylococcus aureus treated with topical mupirocin (pseudomonic acid) in a children's hospital.

2% mupirocin ointment applied intra-nasally for 5 days was assessed for elimination of nasal carriage of Staphylococcus aureus in 31 staff members in a children's hospital. Three volunteers failed to complete the trial because of side effects, i.e. buccal reddening and swelling, and unpleasant taste. During treatment staphylococcal nasal carriage was not found in any case; of the 24 post-treatment nasal swabs taken 4 days after treatment 22 were still negative. Re-colonization with S. aureus of different phage types occurred in the remaining two cases.

Administration, Intranasal↗
PubMed1988

Infection risk of cardiac catheterization and arterial angiography with single and multiple use disposable catheters.

In a prospective study from November 1986 to June 1987, a cohort of 414 patients underwent cardiac catheterization or angiography with either multiple use or single use disposable catheters: 161 patients were studied with 426 single use catheters, 152 patients with 384 multiple use catheters which were resterilized once or twice, and 101 patients with 325 multiple use catheters reprocessed several times. Postcatheterization temperature did not exceed 38.2 degrees C in any patient, but was greater than 37.4 degrees C in 4-6% of the patients studied. No significant differences between the three groups with respect to fever could be observed. Infectious complications associated with cardiac catheterization or angiography did not occur in any case. Of 414 patients, 38 (9.2%) developed hematoma at the puncture site. It is concluded that careful cleaning, disinfection, and resterilization of intravascular catheters with ethylene oxide does not increase the risk of infection. With the rising pressure for containment of health care costs, it is likely that the practice of reprocessing and reuse of expensive intravascular catheters will expand further.

Angiography↗
PubMed1988

How cost-effective is the present use of antiseptics?

There are no studies about cost-effectiveness of hand hygiene in the literature. Instead of doing studies about cost-effectiveness, investigations on how to convince doctors and nurses that hand hygiene is absolutely necessary, should be performed. Disinfection by physical methods is more cost-effective than disinfection by chemicals.

Anti-Infective Agents, Local↗
PubMed1988

The role of the infection control doctor.

The ideal infection control doctor would be a combination of an infectious disease specialist, microbiologist, epidemiologist, social worker, psychologist, teacher, researcher, antibiotic therapy specialist, policeman, priest, supervisor for housekeeping, architect, partner for the infection control nurse, and who should combine the qualities of Mary Poppins, Sherlock Holmes, Francis von Assisi and Margaret Thatcher. A new role is that of a specialist in environmental pollution by detergents, disinfectants and certain disposables.

Cross Infection↗
PubMed1988

Concentrations of flucloxacillin in heart valves and subcutaneous and muscle tissues of patients undergoing open-heart surgery.

Thirty-seven patients were given a single, 2-g intravenous bolus injection of flucloxacillin prior to open-heart surgery. Within 12 h, flucloxacillin concentrations in serum and heart valves declined from 125.2 to 4.4 micrograms/ml and from 16.5 to 3.7 micrograms/g, respectively. Concentrations in subcutaneous tissue and muscle were almost identical, declining from 14.7 or 14.2 micrograms/g to undetectable levels after 8 to 10 h.

Cardiac Surgical Procedures↗