Multiple Nosocomial Infections: A Risk of Modern Intensive Care

Many components of modern medical care greatly predispose subjects to nosocomial infection. These include cancer chemotherapy, organ transplanta tion, immunosuppression, and intensive supportive care, particularly in con junction with mechanical ventilatory support, invasive monitoring devices and prolonged central or peripheral intravenous therapy. The hazard of noso comial infection associated with residence in a modern intensive care unit is dramatized by the case history of a near-drowning victim whose hospital course was complicated by an unusually large number and variety of noso comial bacterial infections. Sixteen different bacterial organisms were iso lated from cultures of blood, purulent thoracostomy tube drainage, or purulent tracheal secretions during the patient's prolonged hospital course. Factors which predisposed this patient to nosocomial infections included prolonged positive pressure mechanical ventilation, long-term broad spectrum anti biotics, indwelling arterial and central venous lines, violation of anatomic barriers by foreign bodies such as multiple thoracostomy tubes, and resi dence in an intensive care unit. This patient's case demonstrates that effec tive means to prevent nosocomial colonization and infection are urgently needed.