Skip to main content
PMC home page
Clinical Microbiology Reviews logoLink to Clinical Microbiology Reviews
. 1993 Oct;6(4):428–442. doi: 10.1128/cmr.6.4.428

An overview of nosocomial infections, including the role of the microbiology laboratory.

T G Emori 1, R P Gaynes 1
PMCID: PMC358296  PMID: 8269394

Abstract

An estimated 2 million patients develop nosocomial infections in the United States annually. The increasing number of antimicrobial agent-resistant pathogens and high-risk patients in hospitals are challenges to progress in preventing and controlling these infections. While Escherichia coli and Staphylococcus aureus remain the most common pathogens isolated overall from nosocomial infections, coagulase-negative staphylococci (CoNS), organisms previously considered contaminants in most cultures, are now the predominant pathogens in bloodstream infections. The growing number of antimicrobial agent-resistant organisms is troublesome, particularly vancomycin-resistant CoNS and Enterococcus spp. and Pseudomonas aeruginosa resistant to imipenem. The active involvement and cooperation of the microbiology laboratory are important to the infection control program, particularly in surveillance and the use of laboratory services for epidemiologic purposes. Surveillance is used to identify possible infection problems, monitor infection trends, and assess the quality of care in the hospital. It requires high-quality laboratory data that are timely and easily accessible.

Full text

PDF
428

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Acar J. F. Therapy for lower respiratory tract infections with imipenem/cilastatin: a review of worldwide experience. Rev Infect Dis. 1985 Jul-Aug;7 (Suppl 3):S513–S517. doi: 10.1093/clinids/7.supplement_3.s513. [DOI] [PubMed] [Google Scholar]
  2. Banerjee S. N., Emori T. G., Culver D. H., Gaynes R. P., Jarvis W. R., Horan T., Edwards J. R., Tolson J., Henderson T., Martone W. J. Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989. National Nosocomial Infections Surveillance System. Am J Med. 1991 Sep 16;91(3B):86S–89S. doi: 10.1016/0002-9343(91)90349-3. [DOI] [PubMed] [Google Scholar]
  3. Beck-Sagué C., Dooley S. W., Hutton M. D., Otten J., Breeden A., Crawford J. T., Pitchenik A. E., Woodley C., Cauthen G., Jarvis W. R. Hospital outbreak of multidrug-resistant Mycobacterium tuberculosis infections. Factors in transmission to staff and HIV-infected patients. JAMA. 1992 Sep 9;268(10):1280–1286. doi: 10.1001/jama.1992.03490100078031. [DOI] [PubMed] [Google Scholar]
  4. Bjerke N. B., Fabrey L. J., Johnson C. B., Bennett G., Schollenberger D., Jacobsen D., Vinci C., Tsivitis M. C., McGill M. L., Bergmann E. Job analysis 1992: infection control practitioner. Am J Infect Control. 1993 Apr;21(2):51–57. doi: 10.1016/0196-6553(93)90224-r. [DOI] [PubMed] [Google Scholar]
  5. Boyce J. M., Causey W. A. Increasing occurrence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control. 1982 Sep-Oct;3(5):377–383. doi: 10.1017/s0195941700057337. [DOI] [PubMed] [Google Scholar]
  6. Britt M. R., Schleupner C. J., Matsumiya S. Severity of underlying disease as a predictor of nosocomial infection. Utility in the control of nosocomial infection. JAMA. 1978 Mar 13;239(11):1047–1051. [PubMed] [Google Scholar]
  7. Büscher K. H., Cullmann W., Dick W., Opferkuch W. Imipenem resistance in Pseudomonas aeruginosa resulting from diminished expression of an outer membrane protein. Antimicrob Agents Chemother. 1987 May;31(5):703–708. doi: 10.1128/aac.31.5.703. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Casewell M. W., Dalton M. T., Webster M., Phillips I. Gentamicin-resistant Klebsiella aerogenes in a urological ward. Lancet. 1977 Aug 27;2(8035):444–446. doi: 10.1016/s0140-6736(77)90621-3. [DOI] [PubMed] [Google Scholar]
  9. Chambers H. F. Treatment of infection and colonization caused by methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol. 1991 Jan;12(1):29–35. doi: 10.1086/646235. [DOI] [PubMed] [Google Scholar]
  10. Chow J. W., Fine M. J., Shlaes D. M., Quinn J. P., Hooper D. C., Johnson M. P., Ramphal R., Wagener M. M., Miyashiro D. K., Yu V. L. Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann Intern Med. 1991 Oct 15;115(8):585–590. doi: 10.7326/0003-4819-115-8-585. [DOI] [PubMed] [Google Scholar]
  11. Craven D. E., Steger K. A., Barber T. W. Preventing nosocomial pneumonia: state of the art and perspectives for the 1990s. Am J Med. 1991 Sep 16;91(3B):44S–53S. doi: 10.1016/0002-9343(91)90343-v. [DOI] [PubMed] [Google Scholar]
  12. Cross A. S., Roup B. Role of respiratory assistance devices in endemic nosocomial pneumonia. Am J Med. 1981 Mar;70(3):681–685. doi: 10.1016/0002-9343(81)90596-9. [DOI] [PubMed] [Google Scholar]
  13. Culver D. H., Horan T. C., Gaynes R. P., Martone W. J., Jarvis W. R., Emori T. G., Banerjee S. N., Edwards J. R., Tolson J. S., Henderson T. S. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med. 1991 Sep 16;91(3B):152S–157S. doi: 10.1016/0002-9343(91)90361-z. [DOI] [PubMed] [Google Scholar]
  14. Decker M. D. Continuous quality improvement. Infect Control Hosp Epidemiol. 1992 Mar;13(3):165–169. doi: 10.1086/646501. [DOI] [PubMed] [Google Scholar]
  15. Donabedian A. The quality of medical care. Science. 1978 May 26;200(4344):856–864. doi: 10.1126/science.417400. [DOI] [PubMed] [Google Scholar]
  16. Dooley S. W., Villarino M. E., Lawrence M., Salinas L., Amil S., Rullan J. V., Jarvis W. R., Bloch A. B., Cauthen G. M. Nosocomial transmission of tuberculosis in a hospital unit for HIV-infected patients. JAMA. 1992 May 20;267(19):2632–2634. [PubMed] [Google Scholar]
  17. Duncan I. B., Rennie R. P., Duncan N. H. A long-term study of gentamicin-resistant Pseudomonas aeruginosa in a general hospital. J Antimicrob Chemother. 1981 Feb;7(2):147–155. doi: 10.1093/jac/7.2.147. [DOI] [PubMed] [Google Scholar]
  18. Edlin B. R., Tokars J. I., Grieco M. H., Crawford J. T., Williams J., Sordillo E. M., Ong K. R., Kilburn J. O., Dooley S. W., Castro K. G. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. N Engl J Med. 1992 Jun 4;326(23):1514–1521. doi: 10.1056/NEJM199206043262302. [DOI] [PubMed] [Google Scholar]
  19. Eickhoff T. C. Epidemiology of Legionnaires' disease. Ann Intern Med. 1979 Apr;90(4):499–502. doi: 10.7326/0003-4819-90-4-499. [DOI] [PubMed] [Google Scholar]
  20. Eickhoff T. C. Hospital infection control begins with good surveillance. Hospitals. 1967 Mar 16;41(6):118–120. [PubMed] [Google Scholar]
  21. Eickhoff T. C. The social evolution of the Infectious Diseases Society of America. J Infect Dis. 1985 Mar;151(3):383–387. doi: 10.1093/infdis/151.3.383. [DOI] [PubMed] [Google Scholar]
  22. Emori T. G., Culver D. H., Horan T. C., Jarvis W. R., White J. W., Olson D. R., Banerjee S., Edwards J. R., Martone W. J., Gaynes R. P. National nosocomial infections surveillance system (NNIS): description of surveillance methods. Am J Infect Control. 1991 Feb;19(1):19–35. doi: 10.1016/0196-6553(91)90157-8. [DOI] [PubMed] [Google Scholar]
  23. Emori T. G., Haley R. W., Garner J. S. Techniques and uses of nosocomial infection surveillance in U.S. hospitals, 1976-1977. Am J Med. 1981 Apr;70(4):933–940. doi: 10.1016/0002-9343(81)90559-3. [DOI] [PubMed] [Google Scholar]
  24. Emori T. G., Haley R. W., Stanley R. C. The infection control nurse in US hospitals, 1976-1977. Characteristics of the position and its occupant. Am J Epidemiol. 1980 May;111(5):592–607. doi: 10.1093/oxfordjournals.aje.a112936. [DOI] [PubMed] [Google Scholar]
  25. Fidalgo S., Vázquez F., Mendoza M. C., Pérez F., Méndez F. J. Bacteremia due to Staphylococcus epidermidis: microbiologic, epidemiologic, clinical, and prognostic features. Rev Infect Dis. 1990 May-Jun;12(3):520–528. doi: 10.1093/clinids/12.3.520. [DOI] [PubMed] [Google Scholar]
  26. Finland M. And the walls come tumbling down. More antibiotic resistance, and now the pneumococcus. N Engl J Med. 1978 Oct 5;299(14):770–771. doi: 10.1056/NEJM197810052991408. [DOI] [PubMed] [Google Scholar]
  27. Freeman J., McGowan J. E., Jr Day-specific incidence of nosocomial infection estimated from a prevalence survey. Am J Epidemiol. 1981 Dec;114(6):888–901. doi: 10.1093/oxfordjournals.aje.a113259. [DOI] [PubMed] [Google Scholar]
  28. Freeman J., McGowan J. E., Jr Methodologic issues in hospital epidemiology. III. Investigating the modifying effects of time and severity of underlying illness on estimates of cost of nosocomial infection. Rev Infect Dis. 1984 May-Jun;6(3):285–300. doi: 10.1093/clinids/6.3.285. [DOI] [PubMed] [Google Scholar]
  29. French G. L., Cheng A. F., Wong S. L., Donnan S. Repeated prevalence surveys for monitoring effectiveness of hospital infection control. Lancet. 1989 Oct 28;2(8670):1021–1023. doi: 10.1016/s0140-6736(89)91026-x. [DOI] [PubMed] [Google Scholar]
  30. Garibaldi R. A., Britt M. R., Coleman M. L., Reading J. C., Pace N. L. Risk factors for postoperative pneumonia. Am J Med. 1981 Mar;70(3):677–680. doi: 10.1016/0002-9343(81)90595-7. [DOI] [PubMed] [Google Scholar]
  31. Garibaldi R. A., Cushing D., Lerer T. Risk factors for postoperative infection. Am J Med. 1991 Sep 16;91(3B):158S–163S. doi: 10.1016/0002-9343(91)90362-2. [DOI] [PubMed] [Google Scholar]
  32. Gaynes R. P., Culver D. H. Resistance to imipenem among selected gram-negative bacilli in the United States. Infect Control Hosp Epidemiol. 1992 Jan;13(1):10–14. doi: 10.1086/646417. [DOI] [PubMed] [Google Scholar]
  33. Gaynes R. P., Martone W. J., Culver D. H., Emori T. G., Horan T. C., Banerjee S. N., Edwards J. R., Jarvis W. R., Tolson J. S., Henderson T. S. Comparison of rates of nosocomial infections in neonatal intensive care units in the United States. National Nosocomial Infections Surveillance System. Am J Med. 1991 Sep 16;91(3B):192S–196S. doi: 10.1016/0002-9343(91)90368-8. [DOI] [PubMed] [Google Scholar]
  34. Goldmann D. A. New microbiological techniques for hospital epidemiology. Eur J Clin Microbiol. 1987 Jun;6(3):344–347. doi: 10.1007/BF02017637. [DOI] [PubMed] [Google Scholar]
  35. Goldmann D. A. Nosocomial infection control in the United States of America. J Hosp Infect. 1986 Sep;8(2):116–128. doi: 10.1016/0195-6701(86)90038-1. [DOI] [PubMed] [Google Scholar]
  36. Green J., Wintfeld N., Sharkey P., Passman L. J. The importance of severity of illness in assessing hospital mortality. JAMA. 1990 Jan 12;263(2):241–246. [PubMed] [Google Scholar]
  37. Griffith S. J., Nathan C., Selander R. K., Chamberlin W., Gordon S., Kabins S., Weinstein R. A. The epidemiology of Pseudomonas aeruginosa in oncology patients in a general hospital. J Infect Dis. 1989 Dec;160(6):1030–1036. doi: 10.1093/infdis/160.6.1030. [DOI] [PubMed] [Google Scholar]
  38. Gross P. A., Beaugard A., Van Antwerpen C. Surveillance for nosocomial infections: can the sources of data be reduced? Infect Control. 1980 Jul-Aug;1(4):233–236. doi: 10.1017/s0195941700053078. [DOI] [PubMed] [Google Scholar]
  39. Gross P. A. Striving for benchmark infection rates: progress in control for patient mix. Am J Med. 1991 Sep 16;91(3B):16S–20S. doi: 10.1016/0002-9343(91)90338-x. [DOI] [PubMed] [Google Scholar]
  40. Haley C. E., Cohen M. L., Halter J., Meyer R. D. Nosocomial Legionnaires' disease: a continuing common-source epidemic at Wadsworth Medical Center. Ann Intern Med. 1979 Apr;90(4):583–586. doi: 10.7326/0003-4819-90-4-583. [DOI] [PubMed] [Google Scholar]
  41. Haley R. W., Culver D. H., Morgan W. M., White J. W., Emori T. G., Hooton T. M. Identifying patients at high risk of surgical wound infection. A simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol. 1985 Feb;121(2):206–215. doi: 10.1093/oxfordjournals.aje.a113991. [DOI] [PubMed] [Google Scholar]
  42. Haley R. W., Culver D. H., Morgan W. M., White J. W., Emori T. G., Hooton T. M. Increased recognition of infectious diseases in US hospitals through increased use of diagnostic tests, 1970-1976. Am J Epidemiol. 1985 Feb;121(2):168–181. doi: 10.1093/oxfordjournals.aje.a113989. [DOI] [PubMed] [Google Scholar]
  43. Haley R. W., Culver D. H., White J. W., Morgan W. M., Emori T. G., Munn V. P., Hooton T. M. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol. 1985 Feb;121(2):182–205. doi: 10.1093/oxfordjournals.aje.a113990. [DOI] [PubMed] [Google Scholar]
  44. Haley R. W., Culver D. H., White J. W., Morgan W. M., Emori T. G. The nationwide nosocomial infection rate. A new need for vital statistics. Am J Epidemiol. 1985 Feb;121(2):159–167. doi: 10.1093/oxfordjournals.aje.a113988. [DOI] [PubMed] [Google Scholar]
  45. Haley R. W., Hooton T. M., Culver D. H., Stanley R. C., Emori T. G., Hardison C. D., Quade D., Shachtman R. H., Schaberg D. R., Shah B. V. Nosocomial infections in U.S. hospitals, 1975-1976: estimated frequency by selected characteristics of patients. Am J Med. 1981 Apr;70(4):947–959. doi: 10.1016/0002-9343(81)90561-1. [DOI] [PubMed] [Google Scholar]
  46. Haley R. W., Schaberg D. R., Crossley K. B., Von Allmen S. D., McGowan J. E., Jr Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison. Am J Med. 1981 Jan;70(1):51–58. doi: 10.1016/0002-9343(81)90411-3. [DOI] [PubMed] [Google Scholar]
  47. Haley R. W. Surveillance by objective: a new priority-directed approach to the control of nosocomial infections. The National Foundation for Infectious Diseases lecture. Am J Infect Control. 1985 Apr;13(2):78–89. doi: 10.1016/0196-6553(85)90085-9. [DOI] [PubMed] [Google Scholar]
  48. Haley R. W. The "hospital epidemiologist" in U.S. hospitals, 1976-1977: a description of the head of the infection surveillance and control program. Report from the SENIC project. Infect Control. 1980 Jan-Feb;1(1):21–32. doi: 10.1017/s019594170005236x. [DOI] [PubMed] [Google Scholar]
  49. Haley R. W., White J. W., Culver D. H., Hughes J. M. The financial incentive for hospitals to prevent nosocomial infections under the prospective payment system. An empirical determination from a nationally representative sample. JAMA. 1987 Mar 27;257(12):1611–1614. [PubMed] [Google Scholar]
  50. Holmberg S. D., Solomon S. L., Blake P. A. Health and economic impacts of antimicrobial resistance. Rev Infect Dis. 1987 Nov-Dec;9(6):1065–1078. doi: 10.1093/clinids/9.6.1065. [DOI] [PubMed] [Google Scholar]
  51. Holtz T. H., Wenzel R. P. Postdischarge surveillance for nosocomial wound infection: a brief review and commentary. Am J Infect Control. 1992 Aug;20(4):206–213. doi: 10.1016/s0196-6553(05)80148-8. [DOI] [PubMed] [Google Scholar]
  52. Horan T. C., Gaynes R. P., Martone W. J., Jarvis W. R., Emori T. G. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control. 1992 Oct;20(5):271–274. doi: 10.1016/s0196-6553(05)80201-9. [DOI] [PubMed] [Google Scholar]
  53. Horan T. C., White J. W., Jarvis W. R., Emori T. G., Culver D. H., Munn V. P., Thornsberry C., Olson D. R., Hughes J. M. Nosocomial infection surveillance, 1984. MMWR CDC Surveill Summ. 1986;35(1):17SS–29SS. [PubMed] [Google Scholar]
  54. Houang E. T., Greenwood D. Aminoglycoside cross-resistance patterns of gentamicin-resistant bacteria. J Clin Pathol. 1977 Aug;30(8):738–744. doi: 10.1136/jcp.30.8.738. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Hughes J. M., Culver D. H., White J. W., Jarvis W. R., Morgan W. M., Munn V. P., Mosser J. L., Emori T. G. Nosocomial infection surveillance, 1980-1982. MMWR CDC Surveill Summ. 1983;32(4):1SS–16SS. [PubMed] [Google Scholar]
  56. Hunter P. R. Reproducibility and indices of discriminatory power of microbial typing methods. J Clin Microbiol. 1990 Sep;28(9):1903–1905. doi: 10.1128/jcm.28.9.1903-1905.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  57. Jarvis W. R., Edwards J. R., Culver D. H., Hughes J. M., Horan T., Emori T. G., Banerjee S., Tolson J., Henderson T., Gaynes R. P. Nosocomial infection rates in adult and pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Am J Med. 1991 Sep 16;91(3B):185S–191S. doi: 10.1016/0002-9343(91)90367-7. [DOI] [PubMed] [Google Scholar]
  58. Jencks S. F., Daley J., Draper D., Thomas N., Lenhart G., Walker J. Interpreting hospital mortality data. The role of clinical risk adjustment. JAMA. 1988 Dec 23;260(24):3611–3616. [PubMed] [Google Scholar]
  59. KISLAK J. W., EICKHOFF T. C., FINLAND M. HOSPITAL-ACQUIRED INFECTIONS AND ANTIBIOTIC USAGE IN THE BOSTON CITY HOSPITAL--JANUARY, 1964. N Engl J Med. 1964 Oct 15;271:834–835. doi: 10.1056/NEJM196410152711608. [DOI] [PubMed] [Google Scholar]
  60. Kahn K. L., Keeler E. B., Sherwood M. J., Rogers W. H., Draper D., Bentow S. S., Reinisch E. J., Rubenstein L. V., Kosecoff J., Brook R. H. Comparing outcomes of care before and after implementation of the DRG-based prospective payment system. JAMA. 1990 Oct 17;264(15):1984–1988. [PubMed] [Google Scholar]
  61. Kazlauskas K. L., Nadzam D. M. The agenda for change: development of the Joint Commission infection control indicators. Infect Control Hosp Epidemiol. 1992 Jun;13(6):331–335. doi: 10.1086/646540. [DOI] [PubMed] [Google Scholar]
  62. Keeler E. B., Kahn K. L., Draper D., Sherwood M. J., Rubenstein L. V., Reinisch E. J., Kosecoff J., Brook R. H. Changes in sickness at admission following the introduction of the prospective payment system. JAMA. 1990 Oct 17;264(15):1962–1968. [PubMed] [Google Scholar]
  63. Keys T. F., Washington J. A., 2nd Gentamicin-resistant Pseudomonas aeruginosa: Mayo Clinic Experience, 1970-1976. Mayo Clin Proc. 1977 Dec;52(12):797–801. [PubMed] [Google Scholar]
  64. Kosecoff J., Kahn K. L., Rogers W. H., Reinisch E. J., Sherwood M. J., Rubenstein L. V., Draper D., Roth C. P., Chew C., Brook R. H. Prospective payment system and impairment at discharge. The 'quicker-and-sicker' story revisited. JAMA. 1990 Oct 17;264(15):1980–1983. [PubMed] [Google Scholar]
  65. Kunin C. M. Evaluation of antibiotic usage: a comprehensive look at alternative approaches. Rev Infect Dis. 1981 Jul-Aug;3(4):745–753. doi: 10.1093/clinids/3.4.745. [DOI] [PubMed] [Google Scholar]
  66. Kunin C. M., McCormack R. C. Prevention of catheter-induced urinary-tract infections by sterile closed drainage. N Engl J Med. 1966 May 26;274(21):1155–1161. doi: 10.1056/NEJM196605262742101. [DOI] [PubMed] [Google Scholar]
  67. Leclercq R., Derlot E., Duval J., Courvalin P. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N Engl J Med. 1988 Jul 21;319(3):157–161. doi: 10.1056/NEJM198807213190307. [DOI] [PubMed] [Google Scholar]
  68. Ludlam H. A., Noble W. C., Marples R. R., Phillips I. The evaluation of a typing scheme for coagulase-negative staphylococci suitable for epidemiological studies. J Med Microbiol. 1989 Nov;30(3):161–165. doi: 10.1099/00222615-30-3-161. [DOI] [PubMed] [Google Scholar]
  69. Maki D. G., Goldman D. A., Rhame F. S. Infection control in intravenous therapy. Ann Intern Med. 1973 Dec;79(6):867–887. doi: 10.7326/0003-4819-79-6-867. [DOI] [PubMed] [Google Scholar]
  70. Maki D. G. Nosocomial bacteremia. An epidemiologic overview. Am J Med. 1981 Mar;70(3):719–732. doi: 10.1016/0002-9343(81)90603-3. [DOI] [PubMed] [Google Scholar]
  71. Maki D. G., Weise C. E., Sarafin H. W. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med. 1977 Jun 9;296(23):1305–1309. doi: 10.1056/NEJM197706092962301. [DOI] [PubMed] [Google Scholar]
  72. Mallison G. F., Haley R. W. Microbiologic sampling of the inanimate environment in U.S. hospitals, 1976-1977. Am J Med. 1981 Apr;70(4):941–946. doi: 10.1016/0002-9343(81)90560-x. [DOI] [PubMed] [Google Scholar]
  73. Massanari R. M., Wilkerson K., Streed S. A., Hierholzer W. J., Jr Reliability of reporting nosocomial infections in the discharge abstract and implications for receipt of revenues under prospective reimbursement. Am J Public Health. 1987 May;77(5):561–564. doi: 10.2105/ajph.77.5.561. [DOI] [PMC free article] [PubMed] [Google Scholar]
  74. McGowan J. E., Jr New laboratory techniques for hospital infection control. Am J Med. 1991 Sep 16;91(3B):245S–251S. doi: 10.1016/0002-9343(91)90376-9. [DOI] [PubMed] [Google Scholar]
  75. McGowan J. E., Jr, Terry P. M., Huang T. S., Houk C. L., Davies J. Nosocomial infections with gentamicin-resistant Staphylococcus aureus: plamid analysis as an epidemiologic tool. J Infect Dis. 1979 Dec;140(6):864–872. doi: 10.1093/infdis/140.6.864. [DOI] [PubMed] [Google Scholar]
  76. McGowan J. E., Jr Whence come nosocomial infections? N Engl J Med. 1982 Dec 16;307(25):1576–1577. doi: 10.1056/NEJM198212163072510. [DOI] [PubMed] [Google Scholar]
  77. Miller J. M. Molecular technology for hospital epidemiology. Diagn Microbiol Infect Dis. 1993 Feb;16(2):153–157. doi: 10.1016/0732-8893(93)90014-x. [DOI] [PubMed] [Google Scholar]
  78. Nichols R. L. Surgical wound infection. Am J Med. 1991 Sep 16;91(3B):54S–64S. doi: 10.1016/0002-9343(91)90344-w. [DOI] [PubMed] [Google Scholar]
  79. Nicolas M. H., Jarlier V., Honore N., Philippon A., Cole S. T. Molecular characterization of the gene encoding SHV-3 beta-lactamase responsible for transferable cefotaxime resistance in clinical isolates of Klebsiella pneumoniae. Antimicrob Agents Chemother. 1989 Dec;33(12):2096–2100. doi: 10.1128/aac.33.12.2096. [DOI] [PMC free article] [PubMed] [Google Scholar]
  80. Noble W. C., Virani Z., Cree R. G. Co-transfer of vancomycin and other resistance genes from Enterococcus faecalis NCTC 12201 to Staphylococcus aureus. FEMS Microbiol Lett. 1992 Jun 1;72(2):195–198. doi: 10.1016/0378-1097(92)90528-v. [DOI] [PubMed] [Google Scholar]
  81. Olson B., Weinstein R. A., Nathan C., Kabins S. A. Broad-spectrum beta-lactam resistance in Enterobacter: emergence during treatment and mechanisms of resistance. J Antimicrob Chemother. 1983 Apr;11(4):299–310. doi: 10.1093/jac/11.4.299. [DOI] [PubMed] [Google Scholar]
  82. Olson M. M., Lee J. T., Jr Continuous, 10-year wound infection surveillance. Results, advantages, and unanswered questions. Arch Surg. 1990 Jun;125(6):794–803. doi: 10.1001/archsurg.1990.01410180120020. [DOI] [PubMed] [Google Scholar]
  83. Panlilio A. L., Culver D. H., Gaynes R. P., Banerjee S., Henderson T. S., Tolson J. S., Martone W. J. Methicillin-resistant Staphylococcus aureus in U.S. hospitals, 1975-1991. Infect Control Hosp Epidemiol. 1992 Oct;13(10):582–586. doi: 10.1086/646432. [DOI] [PubMed] [Google Scholar]
  84. Patterson C. H. Perceptions and misconceptions regarding the Joint Commission's view of quality monitoring. Am J Infect Control. 1989 Oct;17(5):231–240. doi: 10.1016/0196-6553(89)90168-5. [DOI] [PubMed] [Google Scholar]
  85. Pearson M. L., Jereb J. A., Frieden T. R., Crawford J. T., Davis B. J., Dooley S. W., Jarvis W. R. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis. A risk to patients and health care workers. Ann Intern Med. 1992 Aug 1;117(3):191–196. doi: 10.7326/0003-4819-117-3-191. [DOI] [PubMed] [Google Scholar]
  86. Philippon A., Labia R., Jacoby G. Extended-spectrum beta-lactamases. Antimicrob Agents Chemother. 1989 Aug;33(8):1131–1136. doi: 10.1128/aac.33.8.1131. [DOI] [PMC free article] [PubMed] [Google Scholar]
  87. Preheim L. C., Rimland D., Bittner M. J. Methicillin-resistant Staphylococcus aureus in Veterans Administration Medical Centers. Infect Control. 1987 May;8(5):191–194. doi: 10.1017/s0195941700065929. [DOI] [PubMed] [Google Scholar]
  88. Quinn J. P., Dudek E. J., DiVincenzo C. A., Lucks D. A., Lerner S. A. Emergence of resistance to imipenem during therapy for Pseudomonas aeruginosa infections. J Infect Dis. 1986 Aug;154(2):289–294. doi: 10.1093/infdis/154.2.289. [DOI] [PubMed] [Google Scholar]
  89. ROE B. B. TOTAL ANOMALOUS PULMONARY VENOUS DRAINAGE, TECHNICAL AND PHYSIOLOGICAL CONSIDERATIONS. Ann Surg. 1964 Jul;160:1–6. doi: 10.1097/00000658-196407000-00001. [DOI] [PMC free article] [PubMed] [Google Scholar]
  90. Relman A. S. Assessment and accountability: the third revolution in medical care. N Engl J Med. 1988 Nov 3;319(18):1220–1222. doi: 10.1056/NEJM198811033191810. [DOI] [PubMed] [Google Scholar]
  91. Relman A. S. Shattuck Lecture--the health care industry: where is it taking us? N Engl J Med. 1991 Sep 19;325(12):854–859. doi: 10.1056/NEJM199109193251205. [DOI] [PubMed] [Google Scholar]
  92. Rennie R. P., Duncan I. B. Emergence of gentamicin-resistant Klebsiella in a general hospital. Antimicrob Agents Chemother. 1977 Feb;11(2):179–184. doi: 10.1128/aac.11.2.179. [DOI] [PMC free article] [PubMed] [Google Scholar]
  93. Rhame F. S., Sudderth W. D. Incidence and prevalence as used in the analysis of the occurrence of nosocomial infections. Am J Epidemiol. 1981 Jan;113(1):1–11. doi: 10.1093/oxfordjournals.aje.a113058. [DOI] [PubMed] [Google Scholar]
  94. Roper W. L., Winkenwerder W., Hackbarth G. M., Krakauer H. Effectiveness in health care. An initiative to evaluate and improve medical practice. N Engl J Med. 1988 Nov 3;319(18):1197–1202. doi: 10.1056/NEJM198811033191805. [DOI] [PubMed] [Google Scholar]
  95. Sanders W. E., Jr, Sanders C. C. Inducible beta-lactamases: clinical and epidemiologic implications for use of newer cephalosporins. Rev Infect Dis. 1988 Jul-Aug;10(4):830–838. doi: 10.1093/clinids/10.4.830. [DOI] [PubMed] [Google Scholar]
  96. Schaberg D. R., Culver D. H., Gaynes R. P. Major trends in the microbial etiology of nosocomial infection. Am J Med. 1991 Sep 16;91(3B):72S–75S. doi: 10.1016/0002-9343(91)90346-y. [DOI] [PubMed] [Google Scholar]
  97. Scheckler W. E. Continuous quality improvement in a hospital system: implications for hospital epidemiology. Infect Control Hosp Epidemiol. 1992 May;13(5):288–292. doi: 10.1086/646528. [DOI] [PubMed] [Google Scholar]
  98. Schwalbe R. S., Stapleton J. T., Gilligan P. H. Emergence of vancomycin resistance in coagulase-negative staphylococci. N Engl J Med. 1987 Apr 9;316(15):927–931. doi: 10.1056/NEJM198704093161507. [DOI] [PubMed] [Google Scholar]
  99. Shands J. W., Jr, Wenzel R. P., Wolff S. M., Eickhoff T. C., Fields B. N., Jackson G. G. From the Infectious Diseases Society of America. Hospital epidemiology and infection control: the changing role of the specialist in infectious diseases. J Infect Dis. 1981 Dec;144(6):609–613. doi: 10.1093/infdis/144.6.609. [DOI] [PubMed] [Google Scholar]
  100. Shannon R., McArthur B. J., Weinstein S., Pugliese G., Jackson M. M., Lynch P., Tsinzo M., Serkey J., McGuire N. A national task analysis of infection control practitioners, 1982. Part Two: Tasks, knowledge, and abilities for practice. Am J Infect Control. 1984 Jun;12(3):187–196. doi: 10.1016/0196-6553(84)90096-8. [DOI] [PubMed] [Google Scholar]
  101. Stamm W. E. Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. Am J Med. 1991 Sep 16;91(3B):65S–71S. doi: 10.1016/0002-9343(91)90345-x. [DOI] [PubMed] [Google Scholar]
  102. Stamm W. E., Weinstein R. A., Dixon R. E. Comparison of endemic and epidemic nosocomial infections. Am J Med. 1981 Feb;70(2):393–397. doi: 10.1016/0002-9343(81)90778-6. [DOI] [PubMed] [Google Scholar]
  103. Steere A. C., Mallison G. F. Handwashing practices for the prevention of nosocomial infections. Ann Intern Med. 1975 Nov;83(5):683–690. doi: 10.7326/0003-4819-83-5-683. [DOI] [PubMed] [Google Scholar]
  104. Stillman R. I., Wenzel R. P., Donowitz L. C. Emergence of coagulase negative staphylococci as major nosocomial bloodstream pathogens. Infect Control. 1987 Mar;8(3):108–112. doi: 10.1017/s0195941700067278. [DOI] [PubMed] [Google Scholar]
  105. Sutherland S. Viral typing. J Hosp Infect. 1988 Feb;11 (Suppl A):315–319. doi: 10.1016/0195-6701(88)90205-8. [DOI] [PubMed] [Google Scholar]
  106. Trias J., Dufresne J., Levesque R. C., Nikaido H. Decreased outer membrane permeability in imipenem-resistant mutants of Pseudomonas aeruginosa. Antimicrob Agents Chemother. 1989 Aug;33(8):1202–1206. doi: 10.1128/aac.33.8.1202. [DOI] [PMC free article] [PubMed] [Google Scholar]
  107. Trias J., Nikaido H. Outer membrane protein D2 catalyzes facilitated diffusion of carbapenems and penems through the outer membrane of Pseudomonas aeruginosa. Antimicrob Agents Chemother. 1990 Jan;34(1):52–57. doi: 10.1128/aac.34.1.52. [DOI] [PMC free article] [PubMed] [Google Scholar]
  108. Wakefield D. S., Pfaller M., Massanari R. M., Hammons G. T. Variation in methicillin-resistant Staphylococcus aureus occurrence by geographic location and hospital characteristics. Infect Control. 1987 Apr;8(4):151–157. doi: 10.1017/s0195941700065814. [DOI] [PubMed] [Google Scholar]
  109. Weinstein R. A. Epidemiology and control of nosocomial infections in adult intensive care units. Am J Med. 1991 Sep 16;91(3B):179S–184S. doi: 10.1016/0002-9343(91)90366-6. [DOI] [PubMed] [Google Scholar]
  110. Weinstein R. A., Mallison G. F. The role of the microbiology laboratory in surveillance and control of nosocomial infections. Am J Clin Pathol. 1978 Feb;69(2):130–136. doi: 10.1093/ajcp/69.2.130. [DOI] [PubMed] [Google Scholar]
  111. Weinstein R. A., Nathan C., Gruensfelder R., Kabins S. A. Endemic aminoglycoside resistance in gram-negative bacilli: epidemiology and mechanisms. J Infect Dis. 1980 Mar;141(3):338–345. doi: 10.1093/infdis/141.3.338. [DOI] [PubMed] [Google Scholar]
  112. Wenzel R. P., Nettleman M. D., Jones R. N., Pfaller M. A. Methicillin-resistant Staphylococcus aureus: implications for the 1990s and effective control measures. Am J Med. 1991 Sep 16;91(3B):221S–227S. doi: 10.1016/0002-9343(91)90372-5. [DOI] [PubMed] [Google Scholar]
  113. Wenzel R. P., Osterman C. A., Donowitz L. G., Hoyt J. W., Sande M. A., Martone W. J., Peacock J. E., Jr, Levine J. I., Miller G. B., Jr Identification of procedure-related nosocomial infections in high-risk patients. Rev Infect Dis. 1981 Jul-Aug;3(4):701–707. doi: 10.1093/clinids/3.4.701. [DOI] [PubMed] [Google Scholar]
  114. Wenzel R. P., Osterman C. A., Hunting K. J., Gwaltney J. M., Jr Hospital-acquired infections. I. Surveillance in a university hospital. Am J Epidemiol. 1976 Mar;103(3):251–260. doi: 10.1093/oxfordjournals.aje.a112223. [DOI] [PubMed] [Google Scholar]
  115. Wenzel R. P., Pfaller M. A. Infection control: the premier quality assessment program in United States hospitals. Am J Med. 1991 Sep 16;91(3B):27S–31S. doi: 10.1016/0002-9343(91)90340-4. [DOI] [PubMed] [Google Scholar]

Articles from Clinical Microbiology Reviews are provided here courtesy of American Society for Microbiology (ASM)

RESOURCES