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Clin Microbiol Rev. 1993 October; 6(4): 428–442.
PMCID: PMC358296

An overview of nosocomial infections, including the role of the microbiology laboratory.


An estimated 2 million patients develop nosocomial infections in the United States annually. The increasing number of antimicrobial agent-resistant pathogens and high-risk patients in hospitals are challenges to progress in preventing and controlling these infections. While Escherichia coli and Staphylococcus aureus remain the most common pathogens isolated overall from nosocomial infections, coagulase-negative staphylococci (CoNS), organisms previously considered contaminants in most cultures, are now the predominant pathogens in bloodstream infections. The growing number of antimicrobial agent-resistant organisms is troublesome, particularly vancomycin-resistant CoNS and Enterococcus spp. and Pseudomonas aeruginosa resistant to imipenem. The active involvement and cooperation of the microbiology laboratory are important to the infection control program, particularly in surveillance and the use of laboratory services for epidemiologic purposes. Surveillance is used to identify possible infection problems, monitor infection trends, and assess the quality of care in the hospital. It requires high-quality laboratory data that are timely and easily accessible.

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  • Acar JF. Therapy for lower respiratory tract infections with imipenem/cilastatin: a review of worldwide experience. Rev Infect Dis. 1985 Jul-Aug;7 (Suppl 3):S513–S517. [PubMed]
  • Banerjee SN, Emori TG, Culver DH, Gaynes RP, Jarvis WR, Horan T, Edwards JR, Tolson J, Henderson T, Martone WJ. Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989. National Nosocomial Infections Surveillance System. Am J Med. 1991 Sep 16;91(3B):86S–89S. [PubMed]
  • Beck-Sagué C, Dooley SW, Hutton MD, Otten J, Breeden A, Crawford JT, Pitchenik AE, Woodley C, Cauthen G, Jarvis WR. Hospital outbreak of multidrug-resistant Mycobacterium tuberculosis infections. Factors in transmission to staff and HIV-infected patients. JAMA. 1992 Sep 9;268(10):1280–1286. [PubMed]
  • Bjerke NB, Fabrey LJ, Johnson CB, Bennett G, Schollenberger D, Jacobsen D, Vinci C, Tsivitis MC, McGill ML, Bergmann E, et al. Job analysis 1992: infection control practitioner. Am J Infect Control. 1993 Apr;21(2):51–57. [PubMed]
  • Boyce JM, Causey WA. Increasing occurrence of methicillin-resistant Staphylococcus aureus in the United States. Infect Control. 1982 Sep-Oct;3(5):377–383. [PubMed]
  • Britt MR, Schleupner CJ, Matsumiya S. Severity of underlying disease as a predictor of nosocomial infection. Utility in the control of nosocomial infection. JAMA. 1978 Mar 13;239(11):1047–1051. [PubMed]
  • Büscher KH, Cullmann W, Dick W, Opferkuch W. Imipenem resistance in Pseudomonas aeruginosa resulting from diminished expression of an outer membrane protein. Antimicrob Agents Chemother. 1987 May;31(5):703–708. [PMC free article] [PubMed]
  • Casewell MW, Dalton MT, Webster M, Phillips I. Gentamicin-resistant Klebsiella aerogenes in a urological ward. Lancet. 1977 Aug 27;2(8035):444–446. [PubMed]
  • Chambers HF. Treatment of infection and colonization caused by methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol. 1991 Jan;12(1):29–35. [PubMed]
  • Chow JW, Fine MJ, Shlaes DM, Quinn JP, Hooper DC, Johnson MP, Ramphal R, Wagener MM, Miyashiro DK, Yu VL. Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann Intern Med. 1991 Oct 15;115(8):585–590. [PubMed]
  • Craven DE, Steger KA, Barber TW. Preventing nosocomial pneumonia: state of the art and perspectives for the 1990s. Am J Med. 1991 Sep 16;91(3B):44S–53S. [PubMed]
  • Cross AS, Roup B. Role of respiratory assistance devices in endemic nosocomial pneumonia. Am J Med. 1981 Mar;70(3):681–685. [PubMed]
  • Culver DH, Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG, Banerjee SN, Edwards JR, Tolson JS, Henderson TS, et al. Surgical wound infection rates by wound class, operative procedure, and patient risk index. National Nosocomial Infections Surveillance System. Am J Med. 1991 Sep 16;91(3B):152S–157S. [PubMed]
  • Decker MD. Continuous quality improvement. Infect Control Hosp Epidemiol. 1992 Mar;13(3):165–169. [PubMed]
  • Donabedian A. The quality of medical care. Science. 1978 May 26;200(4344):856–864. [PubMed]
  • Dooley SW, Villarino ME, Lawrence M, Salinas L, Amil S, Rullan JV, Jarvis WR, Bloch AB, Cauthen GM. Nosocomial transmission of tuberculosis in a hospital unit for HIV-infected patients. JAMA. 1992 May 20;267(19):2632–2634. [PubMed]
  • Duncan IB, Rennie RP, Duncan NH. A long-term study of gentamicin-resistant Pseudomonas aeruginosa in a general hospital. J Antimicrob Chemother. 1981 Feb;7(2):147–155. [PubMed]
  • Edlin BR, Tokars JI, Grieco MH, Crawford JT, Williams J, Sordillo EM, Ong KR, Kilburn JO, Dooley SW, Castro KG, et al. An outbreak of multidrug-resistant tuberculosis among hospitalized patients with the acquired immunodeficiency syndrome. N Engl J Med. 1992 Jun 4;326(23):1514–1521. [PubMed]
  • Eickhoff TC. Hospital infection control begins with good surveillance. Hospitals. 1967 Mar 16;41(6):118–120. [PubMed]
  • Eickhoff TC. Epidemiology of Legionnaires' disease. Ann Intern Med. 1979 Apr;90(4):499–502. [PubMed]
  • Eickhoff TC. The social evolution of the Infectious Diseases Society of America. J Infect Dis. 1985 Mar;151(3):383–387. [PubMed]
  • Emori TG, Culver DH, Horan TC, Jarvis WR, White JW, Olson DR, Banerjee S, Edwards JR, Martone WJ, Gaynes RP, et al. National nosocomial infections surveillance system (NNIS): description of surveillance methods. Am J Infect Control. 1991 Feb;19(1):19–35. [PubMed]
  • Emori TG, Haley RW, Garner JS. Techniques and uses of nosocomial infection surveillance in U.S. hospitals, 1976-1977. Am J Med. 1981 Apr;70(4):933–940. [PubMed]
  • Emori TG, Haley RW, Stanley RC. The infection control nurse in US hospitals, 1976-1977. Characteristics of the position and its occupant. Am J Epidemiol. 1980 May;111(5):592–607. [PubMed]
  • Fidalgo S, Vázquez F, Mendoza MC, Pérez F, Méndez FJ. Bacteremia due to Staphylococcus epidermidis: microbiologic, epidemiologic, clinical, and prognostic features. Rev Infect Dis. 1990 May-Jun;12(3):520–528. [PubMed]
  • Finland M. And the walls come tumbling down. More antibiotic resistance, and now the pneumococcus. N Engl J Med. 1978 Oct 5;299(14):770–771. [PubMed]
  • Freeman J, McGowan JE., Jr Day-specific incidence of nosocomial infection estimated from a prevalence survey. Am J Epidemiol. 1981 Dec;114(6):888–901. [PubMed]
  • Freeman J, McGowan JE., Jr Methodologic issues in hospital epidemiology. III. Investigating the modifying effects of time and severity of underlying illness on estimates of cost of nosocomial infection. Rev Infect Dis. 1984 May-Jun;6(3):285–300. [PubMed]
  • French GL, Cheng AF, Wong SL, Donnan S. Repeated prevalence surveys for monitoring effectiveness of hospital infection control. Lancet. 1989 Oct 28;2(8670):1021–1023. [PubMed]
  • Garibaldi RA, Britt MR, Coleman ML, Reading JC, Pace NL. Risk factors for postoperative pneumonia. Am J Med. 1981 Mar;70(3):677–680. [PubMed]
  • Garibaldi RA, Cushing D, Lerer T. Risk factors for postoperative infection. Am J Med. 1991 Sep 16;91(3B):158S–163S. [PubMed]
  • Gaynes RP, Culver DH. Resistance to imipenem among selected gram-negative bacilli in the United States. Infect Control Hosp Epidemiol. 1992 Jan;13(1):10–14. [PubMed]
  • Gaynes RP, Martone WJ, Culver DH, Emori TG, Horan TC, Banerjee SN, Edwards JR, Jarvis WR, Tolson JS, Henderson TS, et al. Comparison of rates of nosocomial infections in neonatal intensive care units in the United States. National Nosocomial Infections Surveillance System. Am J Med. 1991 Sep 16;91(3B):192S–196S. [PubMed]
  • Goldmann DA. Nosocomial infection control in the United States of America. J Hosp Infect. 1986 Sep;8(2):116–128. [PubMed]
  • Goldmann DA. New microbiological techniques for hospital epidemiology. Eur J Clin Microbiol. 1987 Jun;6(3):344–347. [PubMed]
  • Green J, Wintfeld N, Sharkey P, Passman LJ. The importance of severity of illness in assessing hospital mortality. JAMA. 1990 Jan 12;263(2):241–246. [PubMed]
  • Griffith SJ, Nathan C, Selander RK, Chamberlin W, Gordon S, Kabins S, Weinstein RA. The epidemiology of Pseudomonas aeruginosa in oncology patients in a general hospital. J Infect Dis. 1989 Dec;160(6):1030–1036. [PubMed]
  • Gross PA. Striving for benchmark infection rates: progress in control for patient mix. Am J Med. 1991 Sep 16;91(3B):16S–20S. [PubMed]
  • Gross PA, Beaugard A, Van Antwerpen C. Surveillance for nosocomial infections: can the sources of data be reduced? Infect Control. 1980 Jul-Aug;1(4):233–236. [PubMed]
  • Haley CE, Cohen ML, Halter J, Meyer RD. Nosocomial Legionnaires' disease: a continuing common-source epidemic at Wadsworth Medical Center. Ann Intern Med. 1979 Apr;90(4):583–586. [PubMed]
  • Haley RW. The "hospital epidemiologist" in U.S. hospitals, 1976-1977: a description of the head of the infection surveillance and control program. Report from the SENIC project. Infect Control. 1980 Jan-Feb;1(1):21–32. [PubMed]
  • Haley RW. Surveillance by objective: a new priority-directed approach to the control of nosocomial infections. The National Foundation for Infectious Diseases lecture. Am J Infect Control. 1985 Apr;13(2):78–89. [PubMed]
  • Haley RW, Culver DH, Morgan WM, White JW, Emori TG, Hooton TM. Increased recognition of infectious diseases in US hospitals through increased use of diagnostic tests, 1970-1976. Am J Epidemiol. 1985 Feb;121(2):168–181. [PubMed]
  • Haley RW, Culver DH, Morgan WM, White JW, Emori TG, Hooton TM. Identifying patients at high risk of surgical wound infection. A simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol. 1985 Feb;121(2):206–215. [PubMed]
  • Haley RW, Culver DH, White JW, Morgan WM, Emori TG. The nationwide nosocomial infection rate. A new need for vital statistics. Am J Epidemiol. 1985 Feb;121(2):159–167. [PubMed]
  • Haley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP, Hooton TM. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol. 1985 Feb;121(2):182–205. [PubMed]
  • Haley RW, Hooton TM, Culver DH, Stanley RC, Emori TG, Hardison CD, Quade D, Shachtman RH, Schaberg DR, Shah BV, et al. Nosocomial infections in U.S. hospitals, 1975-1976: estimated frequency by selected characteristics of patients. Am J Med. 1981 Apr;70(4):947–959. [PubMed]
  • Haley RW, Schaberg DR, Crossley KB, Von Allmen SD, McGowan JE., Jr Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison. Am J Med. 1981 Jan;70(1):51–58. [PubMed]
  • Haley RW, White JW, Culver DH, Hughes JM. The financial incentive for hospitals to prevent nosocomial infections under the prospective payment system. An empirical determination from a nationally representative sample. JAMA. 1987 Mar 27;257(12):1611–1614. [PubMed]
  • Holmberg SD, Solomon SL, Blake PA. Health and economic impacts of antimicrobial resistance. Rev Infect Dis. 1987 Nov-Dec;9(6):1065–1078. [PubMed]
  • Holtz TH, Wenzel RP. Postdischarge surveillance for nosocomial wound infection: a brief review and commentary. Am J Infect Control. 1992 Aug;20(4):206–213. [PubMed]
  • Horan TC, Gaynes RP, Martone WJ, Jarvis WR, Emori TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Am J Infect Control. 1992 Oct;20(5):271–274. [PubMed]
  • Horan TC, White JW, Jarvis WR, Emori TG, Culver DH, Munn VP, Thornsberry C, Olson DR, Hughes JM. Nosocomial infection surveillance, 1984. MMWR CDC Surveill Summ. 1986;35(1):17SS–29SS. [PubMed]
  • Houang ET, Greenwood D. Aminoglycoside cross-resistance patterns of gentamicin-resistant bacteria. J Clin Pathol. 1977 Aug;30(8):738–744. [PMC free article] [PubMed]
  • Hughes JM, Culver DH, White JW, Jarvis WR, Morgan WM, Munn VP, Mosser JL, Emori TG. Nosocomial infection surveillance, 1980-1982. MMWR CDC Surveill Summ. 1983;32(4):1SS–16SS. [PubMed]
  • Hunter PR. Reproducibility and indices of discriminatory power of microbial typing methods. J Clin Microbiol. 1990 Sep;28(9):1903–1905. [PMC free article] [PubMed]
  • Jarvis WR, Edwards JR, Culver DH, Hughes JM, Horan T, Emori TG, Banerjee S, Tolson J, Henderson T, Gaynes RP, et al. Nosocomial infection rates in adult and pediatric intensive care units in the United States. National Nosocomial Infections Surveillance System. Am J Med. 1991 Sep 16;91(3B):185S–191S. [PubMed]
  • Jencks SF, Daley J, Draper D, Thomas N, Lenhart G, Walker J. Interpreting hospital mortality data. The role of clinical risk adjustment. JAMA. 1988 Dec 23;260(24):3611–3616. [PubMed]
  • Kahn KL, Keeler EB, Sherwood MJ, Rogers WH, Draper D, Bentow SS, Reinisch EJ, Rubenstein LV, Kosecoff J, Brook RH. Comparing outcomes of care before and after implementation of the DRG-based prospective payment system. JAMA. 1990 Oct 17;264(15):1984–1988. [PubMed]
  • Kazlauskas KL, Nadzam DM. The agenda for change: development of the Joint Commission infection control indicators. Infect Control Hosp Epidemiol. 1992 Jun;13(6):331–335. [PubMed]
  • Keeler EB, Kahn KL, Draper D, Sherwood MJ, Rubenstein LV, Reinisch EJ, Kosecoff J, Brook RH. Changes in sickness at admission following the introduction of the prospective payment system. JAMA. 1990 Oct 17;264(15):1962–1968. [PubMed]
  • Keys TF, Washington JA., 2nd Gentamicin-resistant Pseudomonas aeruginosa: Mayo Clinic Experience, 1970-1976. Mayo Clin Proc. 1977 Dec;52(12):797–801. [PubMed]
  • Kosecoff J, Kahn KL, Rogers WH, Reinisch EJ, Sherwood MJ, Rubenstein LV, Draper D, Roth CP, Chew C, Brook RH. Prospective payment system and impairment at discharge. The 'quicker-and-sicker' story revisited. JAMA. 1990 Oct 17;264(15):1980–1983. [PubMed]
  • Kunin CM. Evaluation of antibiotic usage: a comprehensive look at alternative approaches. Rev Infect Dis. 1981 Jul-Aug;3(4):745–753. [PubMed]
  • Kunin CM, McCormack RC. Prevention of catheter-induced urinary-tract infections by sterile closed drainage. N Engl J Med. 1966 May 26;274(21):1155–1161. [PubMed]
  • Leclercq R, Derlot E, Duval J, Courvalin P. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N Engl J Med. 1988 Jul 21;319(3):157–161. [PubMed]
  • Ludlam HA, Noble WC, Marples RR, Phillips I. The evaluation of a typing scheme for coagulase-negative staphylococci suitable for epidemiological studies. J Med Microbiol. 1989 Nov;30(3):161–165. [PubMed]
  • Maki DG. Nosocomial bacteremia. An epidemiologic overview. Am J Med. 1981 Mar;70(3):719–732. [PubMed]
  • Maki DG, Goldman DA, Rhame FS. Infection control in intravenous therapy. Ann Intern Med. 1973 Dec;79(6):867–887. [PubMed]
  • Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med. 1977 Jun 9;296(23):1305–1309. [PubMed]
  • Mallison GF, Haley RW. Microbiologic sampling of the inanimate environment in U.S. hospitals, 1976-1977. Am J Med. 1981 Apr;70(4):941–946. [PubMed]
  • Massanari RM, Wilkerson K, Streed SA, Hierholzer WJ., Jr Reliability of reporting nosocomial infections in the discharge abstract and implications for receipt of revenues under prospective reimbursement. Am J Public Health. 1987 May;77(5):561–564. [PubMed]
  • McGowan JE., Jr Whence come nosocomial infections? N Engl J Med. 1982 Dec 16;307(25):1576–1577. [PubMed]
  • McGowan JE., Jr New laboratory techniques for hospital infection control. Am J Med. 1991 Sep 16;91(3B):245S–251S. [PubMed]
  • McGowan JE, Jr, Terry PM, Huang TS, Houk CL, Davies J. Nosocomial infections with gentamicin-resistant Staphylococcus aureus: plamid analysis as an epidemiologic tool. J Infect Dis. 1979 Dec;140(6):864–872. [PubMed]
  • Miller JM. Molecular technology for hospital epidemiology. Diagn Microbiol Infect Dis. 1993 Feb;16(2):153–157. [PubMed]
  • Nichols RL. Surgical wound infection. Am J Med. 1991 Sep 16;91(3B):54S–64S. [PubMed]
  • Nicolas MH, Jarlier V, Honore N, Philippon A, Cole ST. Molecular characterization of the gene encoding SHV-3 beta-lactamase responsible for transferable cefotaxime resistance in clinical isolates of Klebsiella pneumoniae. Antimicrob Agents Chemother. 1989 Dec;33(12):2096–2100. [PMC free article] [PubMed]
  • Noble WC, Virani Z, Cree RG. Co-transfer of vancomycin and other resistance genes from Enterococcus faecalis NCTC 12201 to Staphylococcus aureus. FEMS Microbiol Lett. 1992 Jun 1;72(2):195–198. [PubMed]
  • Olson B, Weinstein RA, Nathan C, Kabins SA. Broad-spectrum beta-lactam resistance in Enterobacter: emergence during treatment and mechanisms of resistance. J Antimicrob Chemother. 1983 Apr;11(4):299–310. [PubMed]
  • Olson MM, Lee JT., Jr Continuous, 10-year wound infection surveillance. Results, advantages, and unanswered questions. Arch Surg. 1990 Jun;125(6):794–803. [PubMed]
  • Panlilio AL, Culver DH, Gaynes RP, Banerjee S, Henderson TS, Tolson JS, Martone WJ. Methicillin-resistant Staphylococcus aureus in U.S. hospitals, 1975-1991. Infect Control Hosp Epidemiol. 1992 Oct;13(10):582–586. [PubMed]
  • Patterson CH. Perceptions and misconceptions regarding the Joint Commission's view of quality monitoring. Am J Infect Control. 1989 Oct;17(5):231–240. [PubMed]
  • Pearson ML, Jereb JA, Frieden TR, Crawford JT, Davis BJ, Dooley SW, Jarvis WR. Nosocomial transmission of multidrug-resistant Mycobacterium tuberculosis. A risk to patients and health care workers. Ann Intern Med. 1992 Aug 1;117(3):191–196. [PubMed]
  • Philippon A, Labia R, Jacoby G. Extended-spectrum beta-lactamases. Antimicrob Agents Chemother. 1989 Aug;33(8):1131–1136. [PMC free article] [PubMed]
  • Preheim LC, Rimland D, Bittner MJ. Methicillin-resistant Staphylococcus aureus in Veterans Administration Medical Centers. Infect Control. 1987 May;8(5):191–194. [PubMed]
  • Quinn JP, Dudek EJ, DiVincenzo CA, Lucks DA, Lerner SA. Emergence of resistance to imipenem during therapy for Pseudomonas aeruginosa infections. J Infect Dis. 1986 Aug;154(2):289–294. [PubMed]
  • Relman AS. Assessment and accountability: the third revolution in medical care. N Engl J Med. 1988 Nov 3;319(18):1220–1222. [PubMed]
  • Relman AS. Shattuck Lecture--the health care industry: where is it taking us? N Engl J Med. 1991 Sep 19;325(12):854–859. [PubMed]
  • Rennie RP, Duncan IB. Emergence of gentamicin-resistant Klebsiella in a general hospital. Antimicrob Agents Chemother. 1977 Feb;11(2):179–184. [PMC free article] [PubMed]
  • Rhame FS, Sudderth WD. Incidence and prevalence as used in the analysis of the occurrence of nosocomial infections. Am J Epidemiol. 1981 Jan;113(1):1–11. [PubMed]
  • Roper WL, Winkenwerder W, Hackbarth GM, Krakauer H. Effectiveness in health care. An initiative to evaluate and improve medical practice. N Engl J Med. 1988 Nov 3;319(18):1197–1202. [PubMed]
  • Sanders WE, Jr, Sanders CC. Inducible beta-lactamases: clinical and epidemiologic implications for use of newer cephalosporins. Rev Infect Dis. 1988 Jul-Aug;10(4):830–838. [PubMed]
  • Schaberg DR, Culver DH, Gaynes RP. Major trends in the microbial etiology of nosocomial infection. Am J Med. 1991 Sep 16;91(3B):72S–75S. [PubMed]
  • Scheckler WE. Continuous quality improvement in a hospital system: implications for hospital epidemiology. Infect Control Hosp Epidemiol. 1992 May;13(5):288–292. [PubMed]
  • Schwalbe RS, Stapleton JT, Gilligan PH. Emergence of vancomycin resistance in coagulase-negative staphylococci. N Engl J Med. 1987 Apr 9;316(15):927–931. [PubMed]
  • Shands JW, Jr, Wenzel RP, Wolff SM, Eickhoff TC, Fields BN, Jackson GG. From the Infectious Diseases Society of America. Hospital epidemiology and infection control: the changing role of the specialist in infectious diseases. J Infect Dis. 1981 Dec;144(6):609–613. [PubMed]
  • Shannon R, McArthur BJ, Weinstein S, Pugliese G, Jackson MM, Lynch P, Tsinzo M, Serkey J, McGuire N. A national task analysis of infection control practitioners, 1982. Part Two: Tasks, knowledge, and abilities for practice. Am J Infect Control. 1984 Jun;12(3):187–196. [PubMed]
  • Stamm WE. Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. Am J Med. 1991 Sep 16;91(3B):65S–71S. [PubMed]
  • Stamm WE, Weinstein RA, Dixon RE. Comparison of endemic and epidemic nosocomial infections. Am J Med. 1981 Feb;70(2):393–397. [PubMed]
  • Steere AC, Mallison GF. Handwashing practices for the prevention of nosocomial infections. Ann Intern Med. 1975 Nov;83(5):683–690. [PubMed]
  • Stillman RI, Wenzel RP, Donowitz LC. Emergence of coagulase negative staphylococci as major nosocomial bloodstream pathogens. Infect Control. 1987 Mar;8(3):108–112. [PubMed]
  • Sutherland S. Viral typing. J Hosp Infect. 1988 Feb;11 (Suppl A):315–319. [PubMed]
  • Trias J, Nikaido H. Outer membrane protein D2 catalyzes facilitated diffusion of carbapenems and penems through the outer membrane of Pseudomonas aeruginosa. Antimicrob Agents Chemother. 1990 Jan;34(1):52–57. [PMC free article] [PubMed]
  • Trias J, Dufresne J, Levesque RC, Nikaido H. Decreased outer membrane permeability in imipenem-resistant mutants of Pseudomonas aeruginosa. Antimicrob Agents Chemother. 1989 Aug;33(8):1202–1206. [PMC free article] [PubMed]
  • Wakefield DS, Pfaller M, Massanari RM, Hammons GT. Variation in methicillin-resistant Staphylococcus aureus occurrence by geographic location and hospital characteristics. Infect Control. 1987 Apr;8(4):151–157. [PubMed]
  • Weinstein RA. Epidemiology and control of nosocomial infections in adult intensive care units. Am J Med. 1991 Sep 16;91(3B):179S–184S. [PubMed]
  • Weinstein RA, Mallison GF. The role of the microbiology laboratory in surveillance and control of nosocomial infections. Am J Clin Pathol. 1978 Feb;69(2):130–136. [PubMed]
  • Weinstein RA, Nathan C, Gruensfelder R, Kabins SA. Endemic aminoglycoside resistance in gram-negative bacilli: epidemiology and mechanisms. J Infect Dis. 1980 Mar;141(3):338–345. [PubMed]
  • Wenzel RP, Nettleman MD, Jones RN, Pfaller MA. Methicillin-resistant Staphylococcus aureus: implications for the 1990s and effective control measures. Am J Med. 1991 Sep 16;91(3B):221S–227S. [PubMed]
  • Wenzel RP, Osterman CA, Donowitz LG, Hoyt JW, Sande MA, Martone WJ, Peacock JE, Jr, Levine JI, Miller GB., Jr Identification of procedure-related nosocomial infections in high-risk patients. Rev Infect Dis. 1981 Jul-Aug;3(4):701–707. [PubMed]
  • Wenzel RP, Osterman CA, Hunting KJ, Gwaltney JM., Jr Hospital-acquired infections. I. Surveillance in a university hospital. Am J Epidemiol. 1976 Mar;103(3):251–260. [PubMed]
  • Wenzel RP, Pfaller MA. Infection control: the premier quality assessment program in United States hospitals. Am J Med. 1991 Sep 16;91(3B):27S–31S. [PubMed]

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