title: Postdischarge nosocomial infections in primary care.
abstract: OBJECTIVE
  To study both surgical and nonsurgical nosocomial infections (NIs) seen by primary-care physicians (general practitioners [GPs]) in France.
  
  
  METHODS
  Ongoing surveillance of postdischarge NIs by an organized group of GPs, from August 1997 to July 1999. Both the GP who personally examined the case spontaneously presenting with NI and the responsible hospital physician or surgeon were interviewed by telephone.
  
  
  METHODS
  305 general practices from all French regions.
  
  
  RESULTS
  2,199 (29%) of 7,540 patients referred for hospitalization reconsulted the GP within 30 days of discharge. In 21 (1%) of the 2,199 cases, an NI was diagnosed by the GP and confirmed as plausible by the responsible hospital physician. We diagnosed an NI in 8 (1.3%) of the post-surgical patients and in 13 (0.8%) of the non-surgical cases within the cohort. We saw eight urinary tract infections, seven surgical-site infections, three soft-tissue infections, two respiratory tract infections, and one primary bloodstream infection. In 19 patients (90%), clinical signs of NI appeared within 7 days of discharge. Assuming that all 5,431 patients who were missed for follow-up did not experience any NI, an attack rate of 0.3 per 100 admissions may be estimated for the whole group.
  
  
  CONCLUSIONS
  We diagnosed 1% of NIs following discharge from a hospital in a cohort of 2,199 patients, of which 1.3% were seen post-surgery and 0.8% following nonsurgical admissions. The percentage of postdischarge visits that were for an NI in nonsurgical patients warrants a major effort with feedback to the hospital physician to reduce infection rates.
authors.affiliation: Unit 444, WHO Collaborating Center for Electronic Disease Surveillance, National Institute for Health and Medical Research, Paris 6 University, France.
authors.forename: L
authors.initials: L
authors.lastname: Letrilliart
authors.forename: M
authors.initials: M
authors.lastname: Guiguet
authors.forename: T
authors.initials: T
authors.lastname: Hanslik
authors.forename: A
authors.initials: A
authors.lastname: Flahault
mesh_terms: D000359:Aftercare / Q000706:statistics & numerical data*; D003428:Cross Infection / Q000145:classification / Q000453:epidemiology*; D005194:Family Practice / Q000706:statistics & numerical data*; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D010351:Patient Discharge; D016012:Poisson Distribution; D011159:Population Surveillance; D011320:Primary Health Care / Q000706:statistics & numerical data; D012308:Risk Management; D013530:Surgical Wound Infection / Q000453:epidemiology; D013997:Time Factors