Search

Prospective surveillance of nosocomial infection was conducted at seven skilled proprietary nursing facilities in Orange County, Calif., USA. The average incidence of facility-acquired infection was 5.2 infections/1,000 patient days. The most common source of infection was urinary tract (47%), followed by respiratory tract (26%) and skin (14%). The four most common pathogens isolated were Proteus spp. (20%), Escherichia coli (17%), Staphylococcus aureus (13%) and Pseudomonas spp. (11%). Trimethoprim-sulfamethoxazole (20%) was the most frequently used antibiotic among all prescriptions, followed by ampicillin (16%) and ciprofloxacin (14%). Among all residents surveyed, 33% received at least one course of antibiotics during the study. Of special significance was the fact that 4 (22%) of the 18 strains of Pseudomonas were gentamicin resistant as were 12 of 80 (15%) of the strains of Enterobacteriaceae. Furthermore, 9 of 29 (31%) strains of Pseudomonas tested were found resistant to norfloxacin as were 15 of 129 (12%) strains of enterobacteriaceae. Susceptibility patterns of the isolated pathogens were similar to those of the acute care hospital. This study indicates that infection continues to be a major problem in the skilled nursing facility and that antibiotic-resistant pathogens will be a challenge for the future.

A review of 231 penetrating keratoplasties performed for corneal disease due to herpes simplex keratitis shows that clear grafts may be obtained in 75% and satisfactory visual results in about 70% during a long-term follow-up. Over a three-year follow-up period, recurrence of the herpetic disease in the graft was observed in 12%. Over a longer period of follow-up, up to 15 years, the rate of recurrence increased to 47%. About half of the corneas with recurrence achieved clear grafts with treatment. Recurrence did not appear to be less frequent in those cases which circumscribed scars as compared with those in which there was diffuse scarring. The state of activity of the disease preoperatively could not be demonstrated to influence greatly the results of the keratoplasty.