Hepatitis E virus infection as a direct cause of neuralgic amyotrophy.

INTRODUCTION: We describe a patient who developed neuralgic amyotrophy (NA) related to hepatitis E virus (HEV) infection. METHODS: The patient underwent neurological and electrodiagnostic examinations, high-resolution analysis of serological changes, and HEV load profile, and was treated with intravenous immunoglobulin. RESULTS: There was evidence of bilateral, asymmetric acute inflammatory cervical polyradiculopathy and possible brachial plexopathy. Positive serum anti-HEV IgM was followed by seroconversion to anti-HEV IgG positivity. A calculated anti-HEV antibody index was compatible with intrathecal synthesis, and HEV genotype 3 RNA was found in serum and cerebrospinal fluid (CSF). Liver function tests returned to normal within 6 weeks. CONCLUSIONS: Bilateral involvement of cervical nerve roots and/or plexus, elevated liver function tests, and abnormal CSF are typical features of HEV-associated NA. The pathogenesis involves possible immune-mediated mechanisms. However, our findings support the hypothesis that HEV-related NA is associated with direct infection. Muscle Nerve 54: 325-327, 2016.

[Antimicrobial stewardship in primary care setting]. / Antimicrobial stewardship en pratique communautaire.

Antibiotic overuse in primary care setting is a major contributor to the development of resistant bacteria. Antibiotic consumption is low in Switzerland compared to neighbour countries, but improvement is possible and has to be pursued. Antibiotic stewardship helps physician to better recognize patients who need antibiotic (guidelines implementation, electronic decision support and laboratory testing) and educate patients about the uselessness of antibiotics in a given situation (delayed prescription and shared decision making). Clinical studies demonstrated the efficacy of these interventions in reducing antibiotic consumption, mainly in acute respiratory infections, without affecting patients' clinical outcome.

Improvement of antibiotic prescription in outpatient care: a cluster-randomized intervention study using a sentinel surveillance network of physicians.

OBJECTIVES: To assess the effectiveness of implementing guidelines, coupled with individual feedback, on antibiotic prescribing behaviour of primary care physicians in Switzerland. METHODS: One hundred and forty general practices from a representative Swiss sentinel network of primary care physicians participated in this cluster-randomized prospective intervention study. The intervention consisted of providing guidelines on treatment of respiratory tract infections (RTIs) and uncomplicated lower urinary tract infections (UTIs), coupled with sustained, regular feedback on individual antibiotic prescription behaviour during 2 years. The main aims were: (i) to increase the percentage of prescriptions of penicillins for all RTIs treated with antibiotics; (ii) to increase the percentage of trimethoprim/sulfamethoxazole prescriptions for all uncomplicated lower UTIs treated with antibiotics; (iii) to decrease the percentage of quinolone prescriptions for all cases of exacerbated COPD (eCOPD) treated with antibiotics; and (iv) to decrease the proportion of sinusitis and other upper RTIs treated with antibiotics. The study was registered at ClinicalTrials.gov (NCT01358916). RESULTS: While the percentage of antibiotics prescribed for sinusitis or other upper RTIs and the percentage of quinolones prescribed for eCOPD did not differ between the intervention group and the control group, there was a significant increase in the percentage of prescriptions of penicillins for all RTIs treated with antibiotics [57% versus 49%, OR=1.42 (95% CI 1.08-1.89), P=0.01] and in the percentage of trimethoprim/sulfamethoxazole prescriptions for all uncomplicated lower UTIs treated with antibiotics [35% versus 19%, OR=2.16 (95% CI 1.19-3.91), P=0.01] in the intervention group. CONCLUSIONS: In our setting, implementing guidelines, coupled with sustained individual feedback, was not able to reduce the proportion of sinusitis and other upper RTIs treated with antibiotics, but increased the use of recommended antibiotics for RTIs and UTIs, as defined by the guidelines.

Bacteremia caused by Comamonas kerstersii in a patient with diverticulosis.

We report for the first time a case of bacteremia caused by Comamonas kerstersii in a 65-year-old patient with sign of diverticulosis. In addition, we review the isolation of Comamonas sp. and related organisms in our hospital over 25 years.

Physicochemical and biological ageing processes of (micro)plastics in the environment: a multi-tiered study on polyethylene.

Pollution by plastic and microplastic impacts the environment globally. Knowledge on the ageing mechanisms of plastics in natural settings is needed to understand their environmental fate and their reactivity in the ecosystems. Accordingly, the study of ageing processes is gaining focus in the context of the environmental sciences. However, laboratory-based experimental research has typically assessed individual ageing processes, limiting environmental applicability. In this study, we propose a multi-tiered approach to study the environmental ageing of polyethylene plastic fragments focusing on the combined assessment of physical and biological processes in sequence. The ageing protocol included ultraviolet irradiation in air and in a range of water solutions, followed by a biofouling test. Changes in surface characteristics were assessed by Fourier transform infrared spectroscopy, scanning electron microscopy, and water contact angle. UV radiation both in air and water caused a significant increase in the density of oxidized groups (i.e., hydroxyl and carbonyl) on the plastic surface, whereby water solution chemistry influenced the process both by modulating surface oxidation and morphology. Biofouling, too, was a strong determinant of surface alterations, regardless of the prior irradiation treatments. All biofouled samples present (i) specific infrared bands of new surface functional groups (e.g., amides and polysaccharides), (ii) a further increase in hydroxyl and carbonyl groups, (iii) the diffuse presence of algal biofilm on the plastic surface, and (iv) a significant decrease in surface hydrophobicity. This suggests that biological-driven alterations are not affected by the level of physicochemical ageing and may represent, in real settings, the main driver of alteration of both weathered and pristine plastics. This work highlights the potentially pivotal role of biofouling as the main process of plastic ageing, providing useful technical insights for future experimental works. These results also confirm that a multi-tiered laboratory approach permits a realistic simulation of plastic environmental ageing in controlled conditions.

Point prevalence study of antibiotic appropriateness and possibility of early discharge from hospital among patients treated with antibiotics in a Swiss University Hospital.

BACKGROUND: The growing threat of multidrug resistant organisms have led to increasingly promote prudent and rational use of antimicrobials as well as early hospital discharge plan. Antibiotic stewardship programs (ASP) have been developed as multifaceted approaches to improve use of current antibiotics and are now widely applied through different strategies. Proactive interventions are still limited in Switzerland and data on antimicrobial appropriateness and early discharge strategies are lacking. We aimed to describe the opportunities of antibiotics prescriptions optimization at Lausanne University Hospital, Switzerland and evaluate the suitability for early discharge among patients receiving antibiotics. The need for outpatient medical structures was also assessed. METHODS: We conducted a point prevalence survey of antibiotic prescriptions in adult medical and surgical units with exclusion of intermediate and intensive care units. All hospitalized patients receiving a systemic antibiotic on the day of evaluation were included. An infectious diseases specialist evaluated antimicrobial appropriateness and assessed suitability for discharge according to medical and nursing observations. The need of flexible additional outpatient facility for a close medical follow-up was evaluated concomitantly. RESULTS: A total of 564 patients' files were reviewed. 182 (32%) patients received one or more systemic antibiotic: 62 (34%) as a prophylaxis and 120 (66%) as a treatment with or without concomitant prophylaxis. 37/62 (60%) patients receiving prophylaxis had no indication to continue the antibacterial. Regarding the patients treated with antibiotics, 69/120 (58%) presented at least one opportunity for treatment optimization, mainly interruption of treatment. A previous ID consultation was recorded for 55/120 (46%) patients, of whom 21 (38%) could have benefited from antimicrobial therapy optimization on the day of the point assessment. 9.2% patients were eligible for discharge of whom 64% could leave the hospital with a close outpatient follow-up for infectious issues. CONCLUSIONS: This point prevalence study offers precious indicators for tailoring future antibiotic stewardship interventions that can be combined with early discharge. Any centre considering implementing ASP should conduct this type of analysis with a pragmatic approach to gain insight into local practices and needed resources.

Overall burden of healthcare-associated infections among surgical patients. Results of a national study.

OBJECTIVE: To assess the overall burden of healthcare-associated infections (HAIs) in patients exposed and nonexposed to surgery. BACKGROUND: Targeted HAI surveillance is common in healthcare institutions, but may underestimate the overall burden of disease. METHODS: Prevalence study among patients hospitalized in 50 acute care hospitals participating in the Swiss Nosocomial Infection Prevalence surveillance program. RESULTS: Of 8273 patients, 3377 (40.8%) had recent surgery. Overall, HAI was present in 358 (10.6%) patients exposed to surgery, but only in 206 (4.2%) of 4896 nonexposed (P < 0.001). Prevalence of surgical site infection (SSI) was 5.4%. Healthcare-associated infections prevalence excluding SSI was 6.5% in patients with surgery and 4.7% in those without (P < 0.0001). Patients exposed to surgery carried less intrinsic risk factors for infection (age >60 years, 55.6% vs 63.0%; American Society of Anesthesiologists score >3,5.9% vs 9.3%; McCabe for rapidly fatal disease, 3.9% vs 6.6%; Charlson comorbidity index >2, 12.3% vs 20.9%, respectively; all P < 0.001) than those nonexposed, but more extrinsic risk factors (urinary catheters, 39.6%vs 14.1%; central venous catheters, 17.8% vs 7.1%; mechanical ventilation, 4.7% vs 1.3%; intensive care stay, 18.3% vs 8.8%, respectively; all P<0.001). Exposure to surgery independently predicted an increased risk of HAI (odds ratio 2.43; 95% CI 2.0­3.0). CONCLUSIONS: Despite a lower intrinsic risk, patients exposed to surgery carried more than twice the overall HAI burden than those nonexposed; almost half was accountable to SSI. Extending infection control efforts beyond SSI prevention in these patients might be rewarding, especially because of the extrinsic nature of risk factors.

High proportion of wrongly identified methicillin-resistant Staphylococcus aureus carriers by use of a rapid commercial PCR assay due to presence of staphylococcal cassette chromosome element lacking the mecA gene.

During a 9-month period, 217 patients were newly diagnosed as methicillin-resistant Staphylococcus aureus (MRSA) carriers by using a commercial rapid PCR-based test (GeneXpert). However, no MRSA was recovered by culturing the second swab in 61 of these patients. Further analyses showed that 28 (12.9%) of the patients harbored S. aureus isolates with a staphylococcal cassette chromosome element lacking the mecA gene and were thus incorrectly determined to be MRSA carriers.

Adult native septic arthritis: a review of 10 years of experience and lessons for empirical antibiotic therapy.

OBJECTIVES: To review the epidemiology of native septic arthritis to establish local guidelines for empirical antibiotic therapy as part of an antibiotic stewardship programme. METHODS: We conducted a 10 year retrospective study based on positive synovial fluid cultures and discharge diagnosis of septic arthritis in adult patients. Microbiology results and medical records were reviewed. RESULTS: Between 1999 and 2008, we identified 233 episodes of septic arthritis. The predominant causative pathogens were methicillin-susceptible Staphylococcus aureus (MSSA) and streptococci (respectively, 44.6% and 14.2% of cases). Only 11 cases (4.7%) of methicillin-resistant S. aureus (MRSA) arthritis were diagnosed, among which 5 (45.5%) occurred in known carriers. For large-joint infections, amoxicillin/clavulanate or cefuroxime would have been appropriate in 84.5% of cases. MRSA and Mycobacterium tuberculosis would have been the most frequent pathogens that would not have been covered. In contrast, amoxicillin/clavulanate would have been appropriate for only 75.3% of small-joint infections (82.6% if diabetics are excluded). MRSA and Pseudomonas aeruginosa would have been the main pathogens not covered. Piperacillin/tazobactam would have been appropriate in 93.8% of cases (P < 0.01 versus amoxicillin/clavulanate). This statistically significant advantage is lost after exclusion of diabetics (P = 0.19). CONCLUSIONS: Amoxicillin/clavulanate or cefuroxime would be adequate for empirical coverage of large-joint septic arthritis in our area. A broad-spectrum antibiotic would be significantly superior for small-joint infections in diabetics. Systematic coverage of MRSA is not justified, but should be considered for known carriers. These recommendations are applicable to our local setting. They might also apply to hospitals sharing the same epidemiology.

Measures to prevent surgical site infections: what surgeons (should) do.

BACKGROUND: The present study was designed to evaluate surgeons' strategies and adherence to preventive measures against surgical site infections (SSIs). MATERIALS AND METHODS: All surgeons participating in a prospective Swiss multicentric surveillance program for SSIs received a questionnaire developed from the 2008 National (United Kingdom) Institute for Health and Clinical Excellence (NICE) clinical guidelines on prevention and treatment of SSIs. We focused on perioperative management and surgical technique in hernia surgery, cholecystectomy, appendectomy, and colon surgery (COL). RESULTS: Forty-five of 50 surgeons contacted (90%) responded. Smoking cessation and nutritional screening are regularly propagated by 1/3 and 1/2 of surgeons, respectively. Thirty-eight percent practice bowel preparation before COL. Preoperative hair removal is routinely (90%) performed in the operating room with electric clippers. About 50% administer antibiotic prophylaxis within 30 min before incision. Intra-abdominal drains are common after COL (43%). Two thirds of respondents apply nonocclusive wound dressings that are manipulated after hand disinfection (87%). Dressings are usually changed on postoperative day (POD) 2 (75%), and wounds remain undressed on POD 2-3 or 4-5 (36% each). CONCLUSIONS: Surgeons' strategies to prevent SSIs still differ widely. The adherence to the current NICE guidelines is low for many procedures regardless of the available level of evidence. Further research should provide convincing data in order to justify standardization of perioperative management.

Diversity of staphylococcal cassette chromosome mec elements in predominant methicillin-resistant Staphylococcus aureus clones in a small geographic area.

Recent population genetic studies suggest that staphylococcal cassette chromosome mec (SCCmec) was acquired much more frequently than previously thought. In the present study, we aimed to investigate the diversity of SCCmec elements in a local methicillin-resistant Staphylococcus aureus (MRSA) population. Each MRSA isolate (one per patient) recovered in the Vaud canton of Switzerland from January 2005 to December 2008 was analyzed by the double-locus sequence typing (DLST) method and SCCmec typing. DLST analysis indicated that 1,884/2,036 isolates (92.5%) belong to four predominant clones. As expected from the local spread of a clone, most isolates within clones harbored an identical SCCmec type. However, three to seven SCCmec types have been recovered in every predominant DLST clone, suggesting that some of these elements might have been acquired locally. This pattern could also be explained by distinct importations of related isolates into the study region. The addition of a third highly variable locus to further increase the discriminatory power of typing as well as epidemiological data suggested that most ambiguous situations were explained by the second hypothesis. In conclusion, our study showed that even if the acquisition of new SCCmec elements at a local level likely occurs, it does not explain all the diversity observed in the study region.

[Importance and prevention of nosocomial infections in the outpatient setting]. / Infections nosocomiales en médecine ambulatoire: importance et prévention.

The concept of nosocomial infections (or healthcare-related infections) applies to the outpatients clinics. However, data are scarce and imprecise in this setting compared with hospitals. The choice of preventive measures is therefore difficult. A lower risk in the outpatient facilities does not justify the complete implementation of hospital precautions. The latter can nevertheless be adapted since infection may be acquired during an ambulatory consultation through the same mechanisms as in hospitals. We propose a preventive strategy derived from standard precautions to be applied in every case, transmission-based precautions that are more rarely needed, and asepsis in case of invasive procedure.

Promotion of the influenza vaccination to hospital staff during pre-employment health check: a prospective, randomised, controlled trial.

BACKGROUND: Vaccination is the most effective prevention of seasonal influenza. Despite its recommendation and active promotion, vaccination coverage remains low among healthcare staff. The goal of the study was to test if a pre-employment health check is a good opportunity to promote future vaccination against influenza among healthcare workers newly hired by a university hospital. METHODS: All new hospital employees active at the bedside who underwent a pre-employment health check between the end of 2016's influenza epidemic and the start of the next influenza vaccination campaign were randomly allocated to a control group or an intervention group. The intervention consisted of a semi-structured dialog and the release of an information leaflet about influenza and influenza vaccination during the check-up, and the shipment of a postcard reminder 2 weeks before the next vaccination campaign. Vaccination rates during the campaign were compared among the two groups. RESULTS: Three hundred fifty-seven employees were included. Vaccination rates were similar in both groups: 79/172 (46%) in the control and 92/185 (50%) in the intervention group. A significantly higher rate of vaccination was noted among physicians (70/117, 60%) than among other employees (101/240, 42%, p = 0.001). In a pre-defined exploratory analysis among physicians, the vaccination rate was higher in the intervention group (36/51, 71%) than in the control group (34/65, 52%, p = 0.046). CONCLUSIONS: Promotion of the influenza vaccine during pre-employment health check did not improve the vaccination rate of newly hired hospital healthcare workers overall during the next influenza vaccination campaign. Results suggest a favourable impact on the vaccination rate of physicians. Thus, there may be an interest in using communication strategies tailored to the different categories of healthcare workers to promote the influenza vaccine during pre-employment health check. TRIAL REGISTRATION: ClinicalTrials, NCT02758145 . Registered 26 April 2016.

Decrease in Antibacterial Use and Facility-Level Variability After the Introduction of Guidelines and Implementation of Physician-Pharmacist-Nurse Quality Circles in Swiss Long-term Care Facilities.

OBJECTIVES: The objective of this study is to describe antibacterial use in long-term care facilities and to investigate the determinants of use. DESIGN: This study is a quality improvement study conducted from January 2011 to December 2016. SETTING: Long-term care facilities in the canton of Vaud, Western Switzerland, were investigated. PARTICIPANTS: Twenty-three long-term care facilities were included in this study. INTERVENTION: The intervention included the publication of local guidelines on empirical antibacterial therapy and the implementation of physician-pharmacist-nurse quality circles. MEASURES: The main outcome was antibacterial use, expressed as defined daily doses (DDD) per 1000 beds per day. Statistical analyses were performed through a 1-level mixed model for repeated measurements. RESULTS: Antibacterial use decreased from 45.6 to 35.5 DDD per 1000 beds per day (-22%, P < .01) over the 6-year study period, which was mostly explained by reduced fluoroquinolone use (-59%, P < .001). A decrease in range of use among LTCFs was observed during the study period, and 27% of antibacterial use was related to the WATCH group (antibiotics with higher toxicity concerns and/or resistance potential) according to the AWaRe categorization of the WHO, decreasing from 17.3 DDD per 1000 beds per day to 9.5 (-45%) over the study period. The use of antibacterials from the RESERVE group ("last-resort" treatment options) was very low. CONCLUSION AND IMPLICATIONS: A reduction in facility-level antibacterial use and in variability across LTCFs was observed over the study period. The dissemination of empirical antibacterial prescription guidelines and the implementation of physician-pharmacist-nurse quality circles in all LTCFs of the canton of Vaud likely contributed to this reduction. Antibacterials from the WATCH group still represented 27% of the total use, providing targets for future antibiotic stewardship activities.

Comparison of automated strategies for surveillance of nosocomial bacteremia.

OBJECTIVE: Surveillance of nosocomial bloodstream infection (BSI) is recommended, but time-consuming. We explored strategies for automated surveillance. METHODS: Cohort study. We prospectively processed microbiological and administrative patient data with computerized algorithms to identify contaminated blood cultures, community-acquired BSI, and hospital-acquired BSI and used algorithms to classify the latter on the basis of whether it was a catheter-associated infection. We compared the automatic classification with an assessment (71% prospective) of clinical data. SETTING: An 850-bed university hospital. PARTICIPANTS: All adult patients admitted to general surgery, internal medicine, a medical intensive care unit, or a surgical intensive care unit over 3 years. RESULTS: The results of the automated surveillance were 95% concordant with those of classical surveillance based on the assessment of clinical data in distinguishing contamination, community-acquired BSI, and hospital-acquired BSI in a random sample of 100 cases of bacteremia. The two methods were 74% concordant in classifying 351 consecutive episodes of nosocomial BSI with respect to whether the BSI was catheter-associated. Prolonged episodes of BSI, mostly fungemia, that were counted multiple times and incorrect classification of BSI clinically imputable to catheter infection accounted for 81% of the misclassifications in automated surveillance. By counting episodes of fungemia only once per hospital stay and by considering all cases of coagulase-negative staphylococcal BSI to be catheter-related, we improved concordance with clinical assessment to 82%. With these adjustments, automated surveillance for detection of catheter-related BSI had a sensitivity of 78% and a specificity of 93%; for detection of other types of nosocomial BSI, the sensitivity was 98% and the specificity was 69%. CONCLUSION: Automated strategies are convenient alternatives to manual surveillance of nosocomial BSI.

Importation of Acinetobacter baumannii into a burn unit: a recurrent outbreak of infection associated with widespread environmental contamination.

A burn patient was infected with Acinetobacter baumannii on transfer to the hospital after a terrorist attack. Two patients experienced cross-infection. Environmental swab samples were negative for A. baumannii. Six months later, the bacteria reemerged in 6 patients. Environmental swab samples obtained at this time were inoculated into a minimal mineral broth, and culture results showed widespread contamination. No case of infection occurred after closure of the unit for disinfection.

[Role of primary care physicians in the influenza pandemic]. / Pandémie de grippe: quel rôle pour les médecins de premier recours?

A new pandemic influenza will most probably occur in the future. As the avian flu caused by Influenza A H5N 1 has a clear potential to cause a pandemic, it stimulates ongoing efforts towards a preparedness plan. The involvement of primary care physicians is pivotal in the response to pandemic because of the expected burden and because of these physicians' key role in outpatients management. The aims of this article is to describe what the primary care physicians' contribution would be in case of pandemic and to show two possible organisation models: one involving the practitioners in a dedicated healthcare network specifically set up for pandemic influenza, the other taking advantage of the existing practices.

Influence of Enhanced Recovery Pathway on Surgical Site Infection after Colonic Surgery.

BACKGROUND: The present study aimed to evaluate a potential effect of ERAS on surgical site infections (SSI). METHODS: Colonic surgical patients operated between May 2011 and September 2015 constituted the cohort for this retrospective analysis. Over 100 items related to demographics, surgical details, compliance, and outcome were retrieved from a prospectively maintained database. SSI were traced by an independent National surveillance program. Risk factors for SSI were identified by univariate and multinomial logistic regression. RESULTS: Fifty-four out of 397 patients (14%) developed SSI. Independent risk factors for SSI were emergency surgery (OR 1.56; 95% CI 1.09-1.78, p = 0.026), previous abdominal surgery (OR 1.7; 95% CI 1.32-1.87, p = 0.004), smoking (OR 1.71; 95% CI 1.22-1.89, p = 0.014), and oral bowel preparation (OR 1.86; 95% CI 1.34-1.97, p = 0.013), while minimally invasive surgery (OR 0.3; 95% CI 0.16-0.56, p < 0.001) protected against SSI. Compliance to ERAS items of >70% was not retained as a protective factor for SSI after multivariate analysis (OR 0.94; 95% CI 0.46-1.92, p = 0.86). CONCLUSIONS: Smoking, open and emergency surgery, and bowel preparation were risk factors for SSI. ERAS pathway had no independent impact while minimally invasive approach did. This study was registered under ResearchRegistry.com (UIN researchregistry2614).

Exogenous sources of pseudomonas aeruginosa in intensive care unit patients: implementation of infection control measures and follow-up with molecular typing.

BACKGROUND: In 1998, a study in the intensive care unit (ICU) of our institution suggested possible transmission of Pseudomonas aeruginosa from faucet to patient and from patient to patient. Infection-control measures were implemented to reduce the degree of P. aeruginosa colonization in faucets, to reduce the use of faucet water in certain patient care procedures, and to reduce the rate of transmission from patient to patient. OBJECTIVE: To evaluate the effect of the control measures instituted in 1999 to prevent P. aeruginosa infection and colonization in ICU patients. DESIGN: Prospective, molecular, epidemiological investigation. SETTING: A 870-bed, university-affiliated, tertiary care teaching hospital. METHODS: The investigation was performed in a manner identical to the 1998 investigation. ICU patients with a clinical specimen positive for P. aeruginosa were identified prospectively. Swab specimens from the inner part of the ICU faucets were obtained for the culture on 9 occasions between September 1997 and December 2000. All patients and environmental isolates were typed by pulsed-field gel electrophoresis (PFGE). RESULTS: Compared with the 1998 study, in 2000 we found that the annual incidence of ICU patients colonized or infected with P. aeruginosa had decreased by half (26.6 patients per 1,000 admissions in 2000 vs 59.0 patients per 1,000 admissions in 1998), although the populations of patients were comparable. This decrease was the result of the decreased incidence of cases in which an isolate had a PFGE pattern identical to that of an isolate from a faucet (7.0 cases per 1,000 admissions in 2000, vs 23.6 per 1,000 admissions in 1998) or from another patient (6.5 cases per 1,000 admissions in 2000 vs 16.5 cases per 1,000 admissions in 1998), whereas the incidence of cases in which the isolate had a unique PFGE pattern remained nearly unchanged (13.1 cases per 1,000 admissions in 2000 vs 15.6 cases per 1,000 admissions in 1998). CONCLUSIONS: These results suggest that infection control measures were effective in decreasing the rate of P. aeruginosa colonization and infection in ICU patients, confirming that P. aeruginosa strains were of exogenous origin in a substantial proportion of patients during the preintervention period.