Because the severe acute respiratory syndrome (SARS) outbreak in Taiwan in 2003 was worsened by hospital infections, we analyzed 229 questionnaires (84.8% of 270 sent) completed by surveyed healthcare workers who cared for patients with SARS in 3 types of hospitals, to identify surveillance problems. Atypical clinical presentation was the most often reported problem, regardless of hospital type, which strongly indicates that more timely syndromic surveillance was needed.

Studies have produced conflicting findings on outcomes for patients with antimicrobial-resistant infection. This study evaluated whether infection with an antimicrobial-resistant organism affects outcome in critically ill patients with acute kidney injury treated with renal replacement therapy and whose clinical course is complicated with a nosocomial bloodstream infection. We found that infection with an antimicrobial-resistant organism did not adversely affect clinical outcome in this specific cohort, which already has a high mortality rate.

We investigated whether insertion of urinary catheters that had been coated with Escherichia coli HU2117 could establish bladder colonization with this nonvirulent organism. Ten of 12 subjects were successfully colonized for 14 days or more. The rate of symptomatic UTI during colonization was 0.15 per 100 patient-days.

We report a severe outbreak of Clostridium difficile infection. According to a chart review, half of the patients who received treatment for bacterial pneumonia before they developed C. difficile infection may not have had pneumonia. Excessive use of the hospital's new pneumonia care plan during the influenza season may have contributed to the intensity of this outbreak.

We conducted a cohort study to identify the risks and outcomes of influenza A (H3N2) pneumonia. Of the 145 patients studied, 10 (7%) had influenza A pneumonia. Logistic regression identified multiple comorbidities (P<.001) and diarrhea at the initial presentation (P = .001) as associated risks. Infection with influenza A (P = .01) and receipt of inadequate antimicrobial therapy (P = .005) were predictors of mortality.

We compared real-time polymerase chain reaction (RT-PCR) with in vitro culture for detecting methicillin-resistant Staphylococcus aureus in samples from environmental surfaces. The sensitivity of RT-PCR, compared with culture, was 92.5%, and the specificity was 51.4%. Because of poor specificity, the RT-PCR kit tested is not suitable for the detection of MRSA on hospital surfaces.

A comparison of needlestick injury surveillance data from Japan and the United States revealed a higher proportion of foot injuries to Japanese healthcare workers (HCWs), compared with US HCWs. This study investigates the underlying factors that contribute to this difference and proposes evidence-based prevention strategies to address the risk, including the use of safety-engineered needle devices, point-of-use disposal containers for sharp instruments and devices, and closed-toe footwear.

We assessed methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization in hospitalized prisoners. Of 434 admission surveillance cultures, 58 (13%) were positive for MRSA. The sensitivity of admission surveillance cultures of samples from the anterior nares was 72% and increased to 84% when the calculation included cultures of wound samples. Hospitalized prisoners are at high risk for MRSA infection and colonization, and surveillance should include cultures of nares and wound samples.

Our objective was to assess the incidence of and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition among patients in acute care wards. For 5 months, patients were screened for MRSA colonization at admission and at discharge. At admission, 6.6% of patients had cultures positive for MRSA, and 3.1% of patients who had tested negative for MRSA on admission had cultures positive for MRSA at discharge. Only the presence of chronic skin breaks at admission was independently associated with MRSA acquisition.

We examined the possible unintended consequences of a 72-hour automatic order to discontinue vancomycin therapy in an antimicrobial stewardship program (ASP). Of 120 patients, 11 had vancomycin therapy discontinued at 72 hours without a call to the ASP, and 7 experienced a treatment interruption of 6-36 hours. All discontinuation of therapy was considered appropriate, and the 7 treatment interruptions did not have clear clinical consequences. Only one-third of patients had ASP stickers that warned of impending discontinuation of vancomycin therapy placed appropriately in the medical record.

Less than 20% of infectious diseases consultants work in hospitals that routinely employ decolonization therapy for individuals with staphylococcal carriage undergoing elective surgical procedures or for infection control efforts to limit nosocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA). However, infectious diseases consultants frequently encounter patients with recurrent MRSA furunculosis and attempt to decolonize them.

Compliance with isolation precautions recommended by the Centers for Disease Control and Prevention (CDC) was evaluated in 3 hospital-wide observational surveys. The compliance rate, by type of isolation, was as follows: droplet transmission, 100% (4 observations); airborne transmission, 61.5% (13 observations); contact isolation, 73.3% (165 observations); and protective isolation, 73.6% (72 observations). As with hand hygiene, there is suboptimal compliance with recommended isolation precautions.

The incidence of community-associated, healthcare-associated, and hospital-acquired sterile-site infections due to methicillin-re-sistant Staphylococcus aureus (MRSA) isolates and the susceptibility of the isolates to non-β-lactam antibiotics were evaluated for 549 hospitalized patients during a 3-year period. The incidence of community-associated MRSA infection increased significantly. The annual percentage of MRSA isolates from cases of healthcare-associated and hospital-acquired infection that were susceptible to 3 or more non-β-lactam antibiotics increased significantly.

In patients undergoing hemodialysis, catheter-related bacteremia results in expensive hospitalizations. In our study, the mean cost was $23,451 per hospitalization. When itemized, housing (“bed-related”) costs accounted for 66% of the total; laboratory costs accounted for 4%, radiologic costs accounted for 9%, and procedure-related costs accounted for 21%. Hypoalbuminemia and bacteremia due to methicillin-resistant Staphylococcus aureus (MRSA) are associated with higher healthcare costs; bacteremia due to MRSA is also associated with poor survival rates.

Fecal carriage of extended-spectrum β-lactamase (ESBL)-producing organisms was assessed in 272 inpatients, 162 outpatients, and 426 asymptomatic healthy individuals. Of 860 stool samples cultured, 152 (17.7%) yielded ESBL-producing organisms. Isolates were recovered from 71 (26.1%) of the inpatients, 25 (15.4%) of the outpatients, and 56 (13.1%) of the healthy individuals. These findings suggest that the community could be a reservoir of ESBL-producing organisms.

Using sequence typing methods, we found that healthcare workers on our orthopedic surgery unit were persistent carriers of a limited number of sequence types of Staphylococcus aureus for a limited time. Multilocus sequence typing characterized 3 clonal complexes that accounted for more than 80% of the clonal complexes identified.

We report the descriptive and molecular epidemiology of vancomycin-resistant enterococci (VRE) infection and colonization and cocolonization with methicillin-resistant Staphylococcus aureus (MRSA) in children. Interunit and intraunit spread of VRE was detected, and 8 cases of VRE-MRSA cocolonization were identified. Seven of these cases were identified only via active surveillance, because clinical evidence of VRE colonization was absent.

There are few Australian data on the incidence of catheter-associated bloodstream infection (BSI) among patients in hematology-oncology units. We found an increase in catheter-associated BSI rates coincident with the introduction of a mechanical valve connector (2.6 infections vs 5.8 infections per 1,000 catheter-days; incidence rate ratio, 2.2; P = .031).