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R P Wenzel

Publications and source records attributed to R P Wenzel.

At least 217 records · Page 12Linked to original sources
PubMed1987

The relationship between surgeon experience and endometritis after cesarean section.

We studied 294 primary cesarean section and repeat cesarean section deliveries with premature rupture of membranes which occurred over a two year period to determine if an association existed between postoperative endometritis and the level of physician training. The results of preliminary analysis revealed that a relationship existed between the level of physician training and the presence of endometritis (p less than 0.01). Endometritis rates for patients under the care of attending physicians, chief residents and residents serving as the primary surgeon were six, 13 and 24 per cent, respectively. Stepwise discriminant function analysis allowed us to account for the contribution of independent risk factors for endometritis. When surgeon experience was evaluated with other risk factors, the presence of a resident serving as the lead surgeon and the age of the patient were the only significant predictors of endometritis (p = 0.046 and 0.007, respectively). The clinical and biologic relevance of the actual age difference between infected and noninfected patients (22 years for infected patients versus 25 years for noninfected patients) is not readily apparent. However, in this study, the identification of a resident acting as a lead surgeon has been shown to be a new independent risk factor for predicting endometritis. This study demonstrates the need for the evaluation of training programs for residents who serve as the principal surgeon for patients who underwent cesarean section.

Adult↗
PubMed1986

Microbiologic studies of coagulase-negative staphylococci isolated from patients with nosocomial bacteraemias.

We studied 50 strains of coagulase-negative staphylococci (CNS) isolated from 50 patients with hospital-acquired bacteraemia, identified by prospective surveillance at the University of Virginia Hospital between March 1981 and September 1982. Using the Staph-Ident System for speciation, we found that 37 strains (74%) were Staphylococcus epidermidis, 7 (14%) Staph. hominis, 3 (6%) Staph. haemolyticus and 3 (6%) Staph. warneri. 33 (66%) of the strains produced slime and a higher proportion of the Staph. epidermidis group (75%) than the non-epidermidis group (46%), did so. Minimal inhibitory concentrations (MIC) were determined by a microdilution technique with 20 different antibiotics. There was no difference in geometric mean MICs between slime producers and non-slime producers within either the epidermidis or non-epidermidis group. The most potent antibiotics against Staph. epidermidis (MIC90 mg l-1) were rifampin (0.05), netilmicin (0.05), amikacin (2.9), thienamycin (0.75), teichomycin (0.85), vancomycin (1.0) and nafcillin (0.39). On the other hand strains were resistant to tobramycin (15), moxalactam (50), fosfomycin (greater than 64), and clindamycin (greater than 64). Overall, eight (16%) of the CNS strains were resistant to methicillin, three of which were Staph. haemolyticus. The non-epidermidis strains were more resistant than the Staph. epidermidis strains to most beta-lactam antibiotics. Differences in antibiograms indicate that speciation of CNS may prove useful for clinical and epidemiologic purposes.

Anti-Bacterial Agents↗
PubMed1986

The efficacy of several new handwashing agents for removing non-transient bacterial flora from hands.

Forty subjects participated in a study of four handwashing agents evaluated for their efficacy in removing non-transient bacteria: 70% isopropanol, 0.05% stabilized iodine, 4% chlorhexidine gluconate, and 1% para-chloro-meta-xylenol. Each subject performed a non-medicated handwash to remove transient flora. Afterwards, three consecutive experimental handwashes were performed using a 10-second contact time, and a fourth handwash employed a 1-minute contact time. Quantitative post-handwash cultures were obtained using the sterile bag technique incorporating an effective agent neutralizer. Significant mean log10 reductions were documented for chlorhexidine gluconate, but only after the third (P = .05) and fourth (p = .004) handwash; however, the total log10 reduction was less than 1.0 for any single agent. Subsequently, three evaporative handwash agents, including 70% isopropanol, 0.5% chlorhexidine in 70% isopropanol, and a 60% isopropanol formulation containing evaporative retardants, were tested in 14 subjects. Contact time was prolonged to the point of evaporation prior to culturing. Four consecutive post-handwash cultures were obtained after performing a baseline pre-handwash culture. When compared with the other two evaporative agents, the 60% isopropanol formulation demonstrated significant mean log10 reductions for each handwash (p less than or equal to .03), with a total log10 reduction of 2.9 over all four handwashes (p = .0001). The brief contact time incorporated in our handwashing technique reflects clinical usage patterns. The marked bacterial reduction demonstrated by the 60% isopropanol formulation warrants further study.

1-Propanol↗
PubMed1986

Nosocomial bloodstream infections: secular trends in a statewide surveillance program in Virginia.

Over a 7-year period (1978-1984) the authors studied the rates of nosocomial bloodstream infections in acute-care hospitals participating in a statewide surveillance network in Virginia. A total of 4,617 hospital-acquired bloodstream infections were documented among 1,807,989 patients at risk for an overall rate of 25.5 cases per 10,000 patient admissions/discharges (annual range = 22.1 to 30.7). Compliance of reporting for Virginia hospitals averaged 58% (1 to 5 monthly reports in a study year), and 39% (greater than or equal to 6 monthly reports annually). Significant changes in bloodstream infection rates (cases per 10,000 patient admissions/discharges) due to specific pathogens included the following: coagulase-negative staphylococci increased from a rate of 1.3 to 4.5 (P = .0003), and those due to all gram-positive cocci increased from a rate of 7.5 to 11.4 (P = .03). Candida species increased from a rate of 0.1 to 1.5 (P = .005). The data show a continuing rise of nosocomial Candida BSI and clearly document the re-emergence of gram-positive cocci as major nosocomial bloodstream pathogens.

Candidiasis↗
PubMed1986

Associated mortality and clinical characteristics of nosocomial Pseudomonas maltophilia in a university hospital.

We studied the spectrum of clinical disease in 99 patients with nosocomial Pseudomonas maltophilia isolates at the University of Virginia Hospital from 1981 through 1984. The annual rate of isolation increased from 7.1 to 14.1 per 10,000 patient discharges. A crude mortality rate of 43% was documented in all patients from whom the organism was cultured, and the data include 12 patients with nosocomial bacteremia (four deaths). Risk factors associated with death for patients having a P. maltophilia isolate included the following: requirement for care in any intensive care unit during hospitalization (P = 0.0001), patient age over 40 years (P = 0.002), and a pulmonary source for the P. maltophilia isolate (P = 0.003). All P. maltophilia isolates were susceptible to trimethoprim-sulfamethoxazole, 60% of the isolates were resistant to all aminoglycosides (amikacin, tobramycin, and gentamicin), and more than 75% of the isolates were resistant to all beta-lactam antibiotics. The antibiotic susceptibility pattern allows for a niche exploitable in the hospital microbial environment by an organism with a marked associated mortality.

Adolescent↗
PubMed1986

Acute febrile cerebrovasculitis: a syndrome of unknown, perhaps rickettsial, cause.

In late 1983, five patients living near Charlottesville, Virginia, were treated for an unusual syndrome of fever, headache, altered mentation, multifocal neurologic signs, and cerebrospinal fluid pleocytosis. Clinical signs of brainstem disease developed in four patients. All five had had recent exposure to forests or wood and contact with flea-infested dogs. Two patients died; one survivor has had recurrent seizures. Brain biopsy samples in two patients and autopsy findings in another showed cerebral vasculitis and perivasculitis involving mostly venules and capillaries. In the autopsy, the severest vascular lesions involved the brainstem and thalami, where they were accompanied by acute fibrinoid necrosis, but discrete vascular lesions of lesser intensity were randomly distributed in the white matter and cortex. Serologic studies on paired specimens in four patients showed significant cross-reacting antibody responses to rickettsial (typhus-group) antigens in the indirect hemagglutination, latex agglutination, and IgM microimmunofluorescence tests, but no agent was visualized or isolated. The cause of this serious inflammatory disorder is unknown.

Acute Disease↗
PubMed1986

Nosocomial urinary tract infections due to enterococcus. Ten years' experience at a university hospital.

From 1975 through 1984, 473 cases of enterococcal nosocomial urinary tract infection (UTI) were identified by prospective hospital-wide surveillance at the University of Virginia Hospital, Charlottesville. The rate of infection increased progressively from 12.3 to 32.2 cases per 10 000 patient discharges, and the proportion of nosocomial UTIs due to this organism increased from 6% to 16%. During the study period, crude mortality was 15%. Patients with the diagnosis of neurogenic bladder accounted for 26% of cases and had a crude mortality of 7.3%; all other cases (74%) had a crude mortality of 18.1%. Risk factors associated with fatal outcome in cases having a nosocomial enterococcal UTI included age of more than 50 years, concurrent acute respiratory failure, hospitalization on the internal medicine service, and concurrent gastrointestinal hemorrhage. Enterococcus is the second most frequent cause of nosocomial UTI in our hospital. The emergence of this pathogen may reflect, in part, its selective advantage imparted by resistance to cephalosporin antibiotics.

Cross Infection↗
PubMed1985

Nosocomial infections, diagnosis-related groups, and study on the efficacy of nosocomial infection control. Economic implications for hospitals under the prospective payment system.

It is obvious that escalating costs of medical care must be curbed. Fortunately, since the major proportion of health care costs relate to inpatient management, the diagnosis-related group "experiment" forces the medical community to examine carefully the costs of the specific components of health care delivery. One such item is the cost of nosocomial infections. With respect to the potential importance of hospital-acquired infections and reimbursement under the diagnosis-related group system, several points should be underscored. Nosocomial infections represent a direct economic liability of $5 to $10 billion annually in the United States. Under the new diagnosis-related group reimbursement system, it is probable that very little of the costs related to excess stay resulting from infections will be reimbursed to hospitals. For the first time, there are data indicating that as much as one third of hospital-acquired infections can be prevented by implementing effective infection control programs. The currently available information suggests that under the existing diagnosis-related group reimbursement system, hospitals with effective infection control programs can significantly improve their economic position.

Adult↗