R. VANFURTH Infection is an inseparable part of communal life, and infections are more common and more severe in hospital communi ties because the sick are more easily infected than the healthy. However, even though progress in the medical sciences has meant that many more patients suftering from relatively severe diseases can be helped at present, the use of more sophisticated and complex treatment leads to impairment of the defence mechanisms in more patients than was the case ten to twenty years ago, and these patients are also more prone to develop an infection. Two questions are particularly relevant in this context. 1) Under what conditions do hospital infections occur? Defects of host defence mechanisms are of great importance in this respect. Such defects can be due to the disease or to the treatment given to the patient. 2) Which of the host defence mechanisms can be affected by a stay in the hospital? Among the factors involved in the host defence against infections (Table I), a number are especially important in this respect. For instance, venepuncture, indwelling catheters, and surgery all cause a breach in the surface structures. Anaesthesia causes temporary impairment of mechanical factors. Vascularization may be defective -- especial ly in the aged and patients with diabetes mellitus -- and this may complicate the healing of wounds in the skin and mucous membranes after surgery.
Table of Contents1. Introduction.- 2. Evaluation of antimicrobial resistance.- 3. Plasmid typing as an epidemiological tool.- Discussion.- 4. Clinical implications of acquired antimicrobial resistance.- 5. Antibiotic resistance in various municipalities in The Netherlands.- Discussion.- 6. Antibiotic prescribing in a general hospital.- 7. Insights into antibacterial pharmacotherapy and measures leading to control of drug use.- Discussion.- 8. Antimicrobial resistance in hospital: New trends and control.- 9. Computer monitoring of drug resistance in the hospital.- Discussion.- 10. Occurrence of infections and antibiotic prophylaxis in non-surgical patients.- 11. Implications and consequences of antimicrobial therapy for the development and transfer of resistance.- Discussion.- 12. Don’t touch the blade: Control of surgical sepsis.- 13. Comments on the occurrence and prophylaxis of surgical infections.- Discussion.- 14. Nosocomial infections in compromised hosts.- 15. Antibiotic strategy in myelocompromised patients.- Discussion.- 16. Bacterial infection in the critically-ill neonate.- 17. Nosocomial infections in the neonatal intensive care unit.- Discussion.- 18. Infection in the renal transplant patient.- 19. Factors contributing to an increased infection rate after kidney transplantation.- Discussion.- 20. Cost-benefit aspects of surveillance of hospital infections.- 21. Comments on issues in studying the cost-benefit of hospital infection surveillance and control programs.- Discussion.- 22. Future trends in nosocomial infections: Understanding selectivity and specificity in microbial opportunism.