Nosocomial infections in general surgery: surveillance report from a German university clinic

At the general surgery clinics, University of Giessen, we developed our own system for surveillance of nosocomial infections according to the guidelines of the Centers of Disease Control. Atlanta, USA, and according to the results of the SENIC Project. We wanted to receive information about the overall infection rate, the procedure specific infection rate, site specific infection rate, distribution of nosocomial infections by pathogen and resistance pattern of antibiotics at the general surgery clinics. The overall infection rate of operations, classified as clean, clean--contaminated, and contaminated and dirty, was 13%. The surgical wound infection rate of 3% after clean operations was mainly caused by an elevated infection rate of 13% after clean operations of a prolonged duration and hyperthermic perfusion of the extremities in patients with melanoma. There is also a difference in nosocomial infection rates at the general surgery ward (11%) and at the intensive care unit (29%). At the intensive care unit candida and coagulase negative staphylococci are mainly isolated whereas Escherichia coli, Staphylococcus aureus and Enterococcus faecalis dominated the general surgery ward. Different operations show different distributions of isolates; operations on the pancreas are prone to have infections with coagulase negative staphylococci, candida and Pseudomonas aeruginosa. The antibiotic susceptibility tests for the most commonly used antibiotics revealed no resistance problems for E. coli, E. faecalis, and Staphylococcus aureus, common pathogens at the general surgery ward, but did for coagulase-negative staphylococci where we can consider only a few antibiotics like amikacin in obvious infections at the intensive care unit.