Nosocomial Infections in a Turkish University Hospital: A 2‐Year Survey •

Nosocomial Infections in a Turkish University Hospital: A 2‐Year Survey • Author(s): A. N. Yalcin; H. Turgut; B. Cetin; H. Erbay; S. SerinSource: Infection Control and Hospital Epidemiology, Vol. 24, No. 4 (April 2003), pp. 235-236Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiologyof AmericaStable URL: http://www.jstor.org/stable/10.1086/503477 .

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Vol. 24 No. 4 INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY 233

Apparent Transmission ofTwo Species of Gram-Negative Rods inCatheterized Residents ona 50-Bed Nursing HomeUnit

To the Editor:Infection control reporting in

nursing homes usually lists clinicalsyndromes (eg, respiratory tract or uri-nary tract infection), room number,and date. Unfortunately, such listingsdo not provide much evidence of trans-mission unless they occur as part of anexplosive outbreak. The various infec-tion syndromes may be caused by dif-ferent organisms and a common strainmay produce more than one syndrome(eg, methicillin-resistant Staphylococcusaureus may cause pneumonia, woundinfection, or urinary tract infection).1

Infection control surveillance atthe Wisconsin Veterans Homeincludes a review of a computerizeddatabase with bacterial isolates foreach nursing unit stacked by species,looking for clustering of organisms(ie, identical species and antibioticsensitivities) in space and time.2 InDecember 2001, we noted that twochronically catheterized residentswith acute urinary symptoms on thesame 50-bed nursing unit shared twourinary organisms (Klebsiella pneu-moniae and Pseudomonas aeruginosa)within 5 weeks of one another(November 8 and December 14,2001). The isolates showed no unusu-al sensitivity patterns. Both individu-als were totally dependent on staff fortheir activities of daily living. They didnot socialize directly. Pulsed-field gelelectrophoresis (PFGE) was subse-quently performed and revealedindistinguishable PFGE patterns forthe two species in the two residents.These PFGE results suggest the pos-sibility of transmission. During theprevious 6 months, eight additionalPFGE analyses had been performedon eight other P. aeruginosa isolatesat the home: seven were completelyunrelated (ie, all varied by > sevenbands) and one varied by three bandsfrom the two reported. The third iso-

late had been collected on October16, 2001, from the urine of an acutelysymptomatic, catheterized individualwho resided in a different building.We found no direct epidemiologic linkbetween the two individuals withindistinguishable Pseudomonas iso-lates from the same floor and thethird individual from a different build-ing with an isolate that varied by onlythree bands. The three individualscould have shared inter-building care-givers. All three isolates were clus-tered in time (November 8 toDecember 14, 2001).

Similar to others, we havedemonstrated clustering of gram-neg-ative organisms in nursing homesusing PFGE.3,4 The other studiesincluded extensive longitudinal orcross-sectional sampling as part ofresearch protocols. In our study, wedetected a cluster of transmission bysimply reviewing culture reports,identifying two chronically catheter-ized residents on the same nursingunit who shared two organisms, andfurther supported the transmissionhypothesis with PFGE. The sharingof two organisms might strengthenthe possibility. Such investigationsare within the scope of many facilitiesand serve as a powerful personalreminder to staff that organisms maybe transmitted in their facility andthat lapses in technique have conse-quences. The Foley catheter shouldalways be approached as a potentialreservoir of resistant organisms. It iscritical for staff who are caring forthose with Foley catheters to main-tain excellent hygiene practices asthey go from resident to resident inthe hope of slowing down the docu-mented phenomenon of clusteringand transmission of organisms innursing home residents who arechronically catheterized.

REFERENCES1. Drinka PJ, Faulks JT, Gauerke C, Goodman B,

Stemper M, Reed K. Adverse events associat-ed with methicillin-resistant Staphylococcusaureus in a nursing home. Arch Intern Med2001;161:2371-2377.

2. Drinka PJ, Gauerke C, Faulks JT. The iden-tification and investigation of clustered bac-terial isolates on nursing units. InfectControl Hosp Epidemiol 2001;22:476-477.

3. Wingard E, Shlaes JH, Mortimer EA,Shlaes DM. Colonization and cross-colo-

nization of nursing home patients withtrimethoprim-resistant gram-negative bacil-li. Clin Infect Dis 1993;16:75-81.

4. Trick WE, Jarvis WR, Weinstein RA, et al.Colonization of skilled-care facility residentswith antimicrobial-resistant pathogens. J AmGeriatr Soc 2001;49:270-276.

Paul J. Drinka, MDWisconsin Veterans Home

King, WisconsinMary E. Stemper, MT (ASCP), MS

Marshfield Clinics LaboratoryMarshfield, Wisconsin

Cathy Gauerke, MT (ASCP)Wisconsin Veterans Home

King, WisconsinJanice Miller, MT

Kurt D. Reed, MDMarshfield Clinics Laboratory

Marshfield, Wisconsin

Molecular Epidemiologyof Methicillin-ResistantStaphylococcus aureus in aVeterans AdministrationMedical Center

To the Editor:The work of Herwaldt et al.

entitled “Molecular Epidemiology ofMethicillin-Resistant Staphylococcusaureus in a Veterans AdministrationMedical Center”1 prompted us toreview our clinical experience withindividuals who had pulsed-field gelelectrophoresis (PFGE) typing of 2isolates separated in time. Herwaldtet al. reported that of 10 patientswho had 2 isolates more than 3months apart (mean, 56 weeks), 5patients had more than 1 strain. Anisolate was considered to be differ-ent if the dice coefficient was lessthan 85%.1

We previously reported a 6-yearexperience performing PFGE on 71initial methicillin-resistant S. aureus(MRSA) isolates in a 721-bed nurs-ing facility.2 At this time, our datahave extended to 8 years with 113initial isolates. During the 8-yearinvestigation, we encountered 8 res-idents with initial MRSA isolateswho had been treated with antibi-otics because of infection, or “decol-

Letters to the Editor



234 INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY April 2003

onized” because extra secretion pre-cautions were an impediment totheir freedom in activities of dailyliving. Individuals were selected fora second PFGE determination when8 to 24 months had passed withoutan MRSA isolate. We were interest-ed in the genetic relationshipbetween the 2 isolates and won-dered whether the delayed isolaterepresented relapse or reinfection.The table presents the initial sitesinfected or colonized, the durationof apparent remission, the numberand site of negative culturesobtained during “remission,” andthe genetic relationship between theinitial and the delayed isolates. Werecommend 3 negative cultures ofpreviously colonized sites. Theauthors did not individually treatthese residents. In 3 cases, the setsof isolates varied by 2 bands; in 2cases, by 3 bands; in 1 case, by 4bands; and in 2 cases, by 5 bands. Inour database, a dif ference of 3bands corresponds to a dice coeffi-cient of 84.2% to 85.7%.

It is unclear what criteria shouldbe used to differentiate probablerelapse from reinfection. The relative-ly long durations between the sets ofisolates could allow time for “geneticdrift” with one or two mutations.None of these individuals had movedfrom their original nursing unit dur-ing the period of observation. Wehave previously reported statisticallysignificant clustering of identicalPFGE isolates on nursing units intime and space.2 This makes reinfec-tion with a genetically related strain apossibility. Our data, however, make

us suspicious that residents of nurs-ing homes may harbor a strain forprolonged periods despite apparenteradication.

REFERENCES1. Herwaldt LA, Pottinger JM, Coffman S,

Tjaden J. Molecular epidemiology of methi-cillin-resistant Staphylococcus aureus in aVeterans Administration Medical Center.Infect Control Hosp Epidemiol 2002;23:502-505.

2. Drinka PJ, Faulks JT, Gauerke C, Goodman B,Stemper M, Reed K. Adverse events associat-ed with methicillin-resistant Staphylococcusaureus in a nursing home. Arch Intern Med2001;161:2371-2377.

Paul J. Drinka, MDWisconsin Veterans Home

King, WisconsinMary E. Stemper, MT (ASCP), MS


Cathy Gauerke, MT (ASCP)Peggy Krause, RN, CCRC

Lori Nest, RNCWisconsin Veterans Home

King, WisconsinKurt D. Reed, MD


The authors decline to reply.

A Gown Is a Gown Is aGown: Or Is It?

To the Editor:The results of the study by

Srinivasan et al.1 published in the

August 2002 issue of Infection Controland Hospital Epidemiology on theeffectiveness of cover gowns in reduc-ing the nosocomial transmission ofvancomycin-resistant enterococci(VRE) in an intensive care unit war-rant comment.

In an earlier study listed in thereferences,2 the researchers conclud-ed that the use of cover gowns had noinfluence on the rate of transmission.This is particularly noteworthybecause the two studies were compa-rable in length (4 to 5 months), andthe same cover gown was used inboth. The results of the two studiesshould have been similar, despite thebehavioral component of healthcareworker compliance with gown useand hand hygiene. However, theresults were contradictory.

In another study on the influenceof cover gowns on VRE,3 theresearchers found that gown useproved to be “protective in reducingVRE acquisition in an MICU with highVRE colonization pressure.” However,during the 18-month period of thisstudy, personnel wore reusable gownsthat were made of a fluid-resistantmaterial (L. Mundy, MD, personalcommunication, October 3, 2002).

Although the specifics of thatfluid-resistant capability are notknown, that is not the case with thedisposable polyethylene gowns usedin the other two studies. The materialwas described as water resistant afterit displayed its level of resistance whensubjected to the challenge presentedby the American Association of TextileColorists and Chemists HydrostaticHead Test 127. Expressed in terms ofthe height of a column of water, thematerial was found to resist penetra-tion until the water reached 11.5 cm.2(The maximum height that the testcan accommodate is 55 cm, which isthe equivalent of 0.8 pound of pressureper square inch.)

The Hospital Infection ControlPractices Advisory Committee quali-fies its recommendation about the useof a “clean, non-sterile gown”4 in themanner that the Occupational Safetyand Health Administration hasdescribed as the “task and degree ofexposure anticipated.”5 Thus, theselection of a cover gown is not a mat-ter of whether it is reusable or dispos-able, but rather one that should bepredicated on its protective capabilityfor the anticipated level of exposure.6

TABLE RELAPSE OF METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS

Initial RemissionPositive Negative Cultures Duration Band

Case No. Sites* During Remission (mo) Difference

1 Urine None 8 22 Urine, nose 5 urine, 1 nasal 8 23 Conjunctiva, nose 3 conjunctiva, 3 nasal 20 24 Urine 2 urine 20 35 Urine, wound 2 urine, 3 wound 9 36 Nose, sputum 3 nose, 3 sputum 9 47 Urine, nose 4 urine, 3 nose 11 58 Urine, nose 4 urine, 1 nasal 24 5

* Nasal cultures were performed in all cases.



Vol. 24 No. 4 LETTERS TO THE EDITOR 235

REFERENCES1. Srinivasan A, Song X, Ross T, et al. A

prospective study to determine whethercover gowns in addition to gloves decreasenosocomial transmission of vancomycin-resistant enterococci in an intensive careunit. Infect Control Hosp Epidemiol2002;23:424-428.

2. Slaughter S, Hayden MK, Nathan C, et al. Acomparison of the effect of universal use ofgloves and gowns with that of glove usealone on acquisition of vancomycin-resistantenterococci in a medical intensive care unit.Ann Intern Med 1996;125:448-456.

3. Puzniak LA, Leet T, Mayfield J, et al. Togown or not to gown: the effect on acquisi-tion of vancomycin-resistant enterococci.Clin Infect Dis 2002;35:18-25.

4. Hospital Infection Control Practices AdvisoryCommittee (HICPAC). Recommendations forpreventing the spread of vancomycin resis-tance. MMWR 1995;44(RR12):1-13.

5. U.S. Department of Labor, Occupational Safetyand Health Administration. Occupational expo-sure to bloodborne pathogens: final rule.Federal Register 1991;56:64004-64182.

6. Belkin NL. Gowns: selection on a proce-dure-driven basis. Infect Control HospEpidemiol 1994;15:713-716.

Nathan L. Belkin, PhDClearwater, Florida

The authors decline to reply.

Nosocomial Infections ina Turkish UniversityHospital: A 2-Year Survey

To the Editor:Nosocomial infections repre-

sent an important problem world-wide as a major cause of morbidity,mortality, and economic conse-quences.1,2 Epidemiologic and etio-logic characteristics of nosocomialinfections have varied among coun-tries and even among different hos-pitals in the same country. In thisstudy, we determined the epidemio-logic and etiologic characteristics ofnosocomial infections in a Turkishuniversity hospital for 2 years.

The study was conducted inPamukkale University Hospital fromJanuary 2000 to December 2001.Criteria for defining nosocomial infec-tions were those published by theCenters for Disease Control andPrevention.3 All data, including admis-sion date, services, risk factors, infec-tion sites, isolated microorganismsand their susceptibility patterns, andtreatment, were recorded using SPSSsoftware (SPSS, Inc., Chicago, IL).

A total of 666 nosocomial infec-tions were detected in 480 (4.35%) of11,025 patients hospitalized during2000 and 2001 (6.04 infections per100 patients). The relative frequencyof nosocomial infection was highestin the Anesthesiology Intensive CareUnit (26%), followed by the NeonatalIntensive Care Unit and theNeurosurgery Unit (Table 1).

The most frequent types of noso-comial infections were urinary tractinfections (n = 167 [25.1%]), pneumo-nia (n = 155 [23.3%]), bacteremia (n =117 [17.6%]), and surgical-site infec-tions (n = 95 [14.3%]). One hundredthirty-two other infections accountedfor an additional 19.8%.

A total of 801 microorganismswere isolated from 480 patients. Themost frequently isolated microorgan-isms were Staphylococcus aureus(18.7% [with 65% of these beingmethicillin-resistant S. aureus]),Pseudomonas aeruginosa (16%), coag-ulase-negative staphylococci (13.1%),and Acinetobacter baumannii (10.1%)(Table 2).

The observed attack rate of 6infections per 100 patients in thisstudy was consistent with the rates of3.5% and 11.6% reported from multi-ple other countries.4-9

In this study, the highest infec-tion rates involved intensive care unitpatients for whom the most commonnosocomial infection was pneumo-nia, followed by urinary tract infec-tions. In other services, urinary tractand surgical-site infections were

TABLE 1NOSOCOMIAL INFECTION RATES BY CLINICS

No. of No. ofClinic Patients Nosocomial Infections %%

Anesthesiology Intensive 434 113 26Care Unit

Neonatal Intensive 240 46 19.2Care Unit

Neurosurgery 466 58 12.4Pediatrics 671 63 9.4Dermatology 48 4 8.3Internal medicine 940 50 5.3General surgery 793 38 4.8Orthopedic surgery 657 31 4.7Cardiovascular surgery 134 4 3Neurology 137 4 2.9Urology 816 19 2.3Plastic surgery 305 7 2.3Chest diseases 152 2 1.3Pediatric surgery 270 3 1.1Obstetrics and gynecology 2920 29 1Otorhinolaryngology 869 6 0.7Others 1,173 3 0.3

TABLE 2DISTRIBUTION OF ISOLATED

MICROORGANISMS

Microorganism No. %%

Staphylococcus 150 (98 MR) 18.7 aureus

Pseudomonas 128 16aeruginosa

Coagulase-negative 105 (69 MR) 13.1staphylococci

Acinetobacter 81 10.1baumannii

Klebsiella 77 9.6pneumoniae

Enterobacter cloacae 73 9.1Escherichia coli 68 8.5Candida species 63 7.9Others 56 7Total 801 100

MR = methicillin resistant.



236 INFECTION CONTROL AND HOSPITAL EPIDEMIOLOGY April 2003

more frequent. The relative frequen-cy distribution of etiologic agents forthis Turkish hospital was similar towhat has been observed in multipleother countries.

A Korean study reported that themost commonly isolated microorgan-isms were S. aureus (17.2%), P. aerugi-nosa (13.8%), and Escherichia coli(12.3%).4 A prevalence study done inSwitzerland found that the leadingpathogens were S. aureus (13%), E. coli(12%), and P. aeruginosa (11%).8 Ofnote, S. aureus was the most frequentcause of nosocomial infections in ourhospital and 65.3% were resistant tomethicillin, suggesting the need forimproved control measures.

REFERENCES1. Spencer RC. Prevalence studies in nosoco-

mial infections. Eur J Clin Microbiol InfectDis 1992;11:95-98.

2. Yalcin AN, Hayran M, Unal S. Economic analy-sis of nosocomial infections in a Turkish uni-versity hospital. J Chemother 1997;9:411-414.

3. Garner JS, Jarvis WR, Emori TG, Horan TC,Hughes JM. CDC definitions for nosocomi-al infections, 1988. Am J Infect Control1988;16:128-140.

4. Kim JM, Park ES, Jeong JS, et al. Multicentersurveillance study for nosocomial infections inmajor hospitals in Korea: Nosocomial InfectionSurveillance Committee of the Korean Societyfor Nosocomial Infection Control. Am J InfectControl 2000;28:454-458.

5. Scheel O, Stormark M. National prevalencesurvey on hospital infections in Norway. JHosp Infect 1999;41:331-335.

6. Gikas A, Pediaditis I, Roumbelaki M,Troulakis G, Romanos J, Tselentis Y.Repeated multi-centre prevalence surveysof hospital-acquired infection in Greek hos-pitals. J Hosp Infect 1999;41:11-18.

7. The French Prevalence Survey StudyGroup. Prevalence of nosocomial infectionsin France: results of the nationwide surveyin 1996. J Hosp Infect 2000;46:186-193.

8. Pittet D, Harbarth S, Ruef C, et al. Prevalenceand risk factors for nosocomial infections infour university hospitals in Switzerland. InfectControl Hosp Epidemiol 1999;20:37-42.

9. Gastmeier P, Kampf G, Wischnewski N, etal. Prevalence of nosocomial infections inrepresentative German hospitals. J HospInfect 1998;38:37-49.

Ata Nevzat Yalcin, MDHuseyin Turgut, MD

Banu Cetin, MDDepartment of Infectious Diseases and

Clinical MicrobiologyHakan Erbay, MDSimay Serin, MD

Department of Anesthesiologyand Reanimation

Pamukkale UniversityMedicine Faculty

Denizli, Turkey

Nasal Carriage ofMethicillin-ResistantStaphylococcus aureusAmong HealthcareWorkers of an IranianHospital

To the Editor:Staphylococcus aureus causes

important infections in hospitalizedpatients that can have severe conse-quences despite antibiotic therapy.1Its main ecological niche is the nose,but the prevalence of nasal carriagehas varied according to the popula-tion studied. Approximately one-thirdof the general population carry S.aureus, but healthcare workers(HCWs) may be an especially impor-tant reservoir, even if transiently colo-nized. Several studies have reportedrates of nasal carriage ranging from17% to 56% in HCWs.2

Methicillin-resistant strains of S.aureus (MRSA) were identified imme-diately after the introduction of methi-cillin into clinical practice. The firstMRSA outbreaks occurred inEuropean hospitals in the early 1960s.Since then MRSA has spread world-wide, causing problems with therapyand higher mortality rates.1

Colonized patients have been the pri-mary reservoir for spread, although itcan also occur from colonized HCWs.The aim of this study was to deter-mine the frequency of nasal carriageof MRSA among HCWs in ImamKhomeini Hospital of Urmia, WestAzarbayjan, Iran.

This is a general, 300-bed, uni-versity-affiliated teaching hospitalwith more than 400 employees,including service and technical staff.For this study, 230 consenting staffmembers (115 men and 115 women)

had cultures using moistened cottonswabs rotated five times in both ante-rior nares.3 Samples were carriedwithin 2 hours to the microbiologylaboratory and processed as previous-ly described.4 The agar screen testwas used to detect MRSA by inoculat-ing 104 colony-forming units ontoMueller–Hinton agar supplementedwith 4% NaCl and containing 6 mg ofoxacillin per milliliter according to theNational Committee for ClinicalLaboratory Standards guideline.5 Nochange in the method of identifyingMRSA occurred during the study.Antibiotyping was performed byusing the disk-diffusion methodaccording to the National Committeefor Clinical Laboratory Standardsguideline.6

This study revealed that 92(40%) of the participants had nasalcolonization with S. aureus and 32(35%) of these were MRSA (ie, 13.9%of all study participants). Of 92 HCWscarrying S. aureus, 53 (57.6%) weremale and 39 (42.4%) were female. Themean age was 31.3 years (standarddeviation ± 6.3 years). Carriage ratesfor S. aureus and MRSA differed forvarious professional groups (Table).Paramedical staff had more carriageof MRSA than did other groups.There was not an association betweengender, age, or years of healthcareservice and nasal carriage. Resistancerates to other antibiotics were as fol-lows: penicillin, 67.4%; cotrimoxazole,42.3%; gentamicin, 25%; clindamycin,18.3%; ciproflaxin, 14.18%; ery-thromycin, 8.7%; and vancomycin,0%.7 A previous study in this hospitalhad shown that 53.6% of clinical S.aureus isolates from patients wereMRSA.7 The antibiograms of isolatesin this study were compared withthose from patients in the prior studyand rates of resistance to all antibi-otics tested were significantly higher

TABLEFREQUENCY OF STAPHYLOCOCCUS AUREUS CARRIAGE AND METHICILLIN-RESISTANT S.AUREUS (MRSA) AMONG HEALTHCARE WORKERS

Healthcare No. With Carriage Frequency ofWorker No. of S. aureus MRSA

Physician 28 12 (42.8%) 1 (3.5%)Nurse 54 22 (40.7%) 7 (12.9%)Paramedical staff 108 43 (39.8%) 22 (20.3%)Staff not involved in 40 15 (37.5%) 5 (12.5%)

patient care



Vol. 24 No. 4 LETTERS TO THE EDITOR 237

for patients than for HCWs (P < .001to .05).

This study revealed a prevalenceof 40% for nasal carriage of S. aureusamong HCWs, of which more thanone-third were MRSA. Other studiesin Iran and Saudi Arabia have shown asimilar prevalence of S. aureus car-riage among HCWs,8,9,10 but theprevalence in other developing coun-tries has varied markedly by country.In a study performed in Madras,India, 18.23% of 724 HCWs carried S.aureus in the nose, including 12.15%with MRSA.11 Some of the differencesin observed prevalence among coun-tries may be due to differences in thequality of sampling and of culturemethods. The high prevalence ofMRSA in hospitals in this country islikely due to the lack of routine use ofmeasures for controlling spread andunrestricted antibiotic use.

Although MRSA remains largelya nosocomially acquired pathogen,screening high-risk patients forMRSA and placing colonized patientsin isolation have been recommendedfor effective control of MRSA.12 Therising prevalence of MRSA amongHCWs may lead to still greater spreadamong patients, however.

The prevalence of MRSA car-riage among HCWs is high and most

patients still may acquire MRSA inhealthcare facilities. For control ofinfections, screening of HCWs anderadication of colonization may thusneed to be considered.13

REFERENCES1. Cohen FL, Tartasky D. Microbial resis-

tance to drug therapy: a review. Am J InfectControl 1997;25:51-64.

2. Kluytmans J, van Belkum A, Verbrugh H.Nasal carriage of Staphylococcus aureus:epidemiology, underlying mechanisms, andassociated risks. Clin Microbiol Rev1997;10:505-520.

3. Troillet N, Carmeli Y, Samore MH, et al.Carriage of methicillin-resistant Staphylo-coccus aureus at hospital admission. InfectControl Hosp Epidemiol 1998;19:181-185.

4. Lally RT, Ederer MN, Woolfrey BF.Evaluation of mannitol salt agar withoxacillin as a screening medium for methi-cillin-resistant Staphylococcus aureus. J ClinMicrobiol 1985;22:501-504.

5. National Committee for Clinical LaboratoryStandards. Methods for AntimicrobialSusceptibility Tests for Bacteria That GrowAerobically, 5th ed. Wayne, PA: NationalCommittee for Clinical LaboratoryStandards; 1997. Approved standard M7-A5.

6. National Committee for Clinical LaboratoryStandards. Performance Standard forAntimicrobial Disk Susceptibility Tests, 7thed. Wayne, PA: National Committee forClinical Laboratory Standards; 2000.Approved standard M2-A7.

7. Rahbar M, Babazadeh H, Zargahmi N. Highmethicillin resistance of Staphylococcus aureusand coagulase-negative staphylococci inImmam Khomeini Hospital of Urmia, Iran.Infect Control Hosp Epidemiol 2001;22:196-197.

8. Hashemi S, Aghi H. Nasal carrier rate ofStaphylococcus aureus in medical and non-medical staff and their antibiotic sensitivity.Scientific Journal of Hamadan University ofMedical Science & Health Service 1998;5:10-15.

9. Rashidian M, Taherpoor A, Goodarzi S.Nasal carrier rate and antibiotic resistanceof Staphylococcus aureus isolates fromBeasat hospital staffs of Sanandaj. ScientificJournal of Kyrdistan University 2001;6:1-8.

10. Alghaithy AA, Bilal NE, Gedebou M, WeilyAH. Nasal carriage and antibiotic resistanceof Staphylococcus aureus isolates from hos-pital and non-hospital personnel in Abha,Saudi Arabia. Trans R Soc Trop Med Hyg2000;94:504-507.

11. Verghese S, Padmaja P, Sudha P, Vanitha V,Mathew T. Nasal carriage of methicillin-resistant Staphylococcus aureus in a cardio-vascular tertiary care center and its detect-ing by Lipovitellin salt mannitol agar. IndianJ Pathol Microbiol 1999;42:441-446.

12. Boyce JM. Understanding and controllingmethicillin-resistant Staphylococcus aureusinfections. Infect Control Hosp Epidemiol2002;23:485-487.

13. Kotilainen P, Routamaa M, Peltonen R, et al.Eradication of methicillin-resistant Staph-ylococcus aureus from a health center wardand associated nursing home. Arch InternMed 2001;161:859-863.

Mohammed Rahbar, PhDMohammed Karamiyar, MD

Rassol Gra-Agaji, MScDepartment of MicrobiologyReference Laboratory of Iran

Tehran, Iran



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Nosocomial Infections in a Turkish University Hospital: A 2‐Year Survey •