Burden of meticillin-resistant Staphylococcus aureus colonization and infection in London acute hospitals: retrospective on a voluntary surveillance programme.

Although meticillin-resistant Staphylococcus aureus (MRSA) is recognized as an important cause of hospital and community healthcare-associated morbidity, and colonization as a precursor to infection, few studies have attempted to assess the burden of both colonization and infection across acute healthcare providers within a defined health economy. This study describes the prevalence and incidence of MRSA colonization and infection in acute London hospital Trusts participating in a voluntary surveillance programme in 2000-2001. Hospital infection control staff completed a weekly return including details on incident and prevalent colonizations, bacteraemias and other significant infections due to MRSA. Incidence and prevalence rates were calculated for hospitals with sufficient participation across both years. Colonizations accounted for 79% of incident MRSA cases reported; 4% were bacteraemias, and 17% other significant infections. There was no change in incidence of colonization of hospital patients between 2000 and 2001. By contrast, there was an unexplained 49% increase in prevalence of colonizations over this period. For any given month, prevalent colonizations outnumbered incident colonizations at least twofold. This MRSA surveillance programme was unusual for prospective ascertainment of incident and prevalent cases of both colonization and infection within an English regional health economy. Consistent with other studies, the incidence and prevalence of colonization substantially exceeded infection. Given the small contribution of bacteraemias to the overall MRSA burden, and the surveillance, screening and control interventions of recent years, it may be appropriate to review the present reliance on bacteraemia surveillance.

Impact of infection by verotoxigenic Escherichia coli O157:H7 on the use of surgical services in a children's hospital.

OBJECTIVES: To determine the impact of Escherichia coli O157:H7 infection in children on the need for surgical assessment in a pediatric surgical practice and whether clinical and bacteriologic variables might contribute to that need. DESIGN: Examination of a case series. SETTING: A tertiary-care pediatric hospital. PATIENTS: Between 1990 and 1994, E. coli O157:H7 gastrointestinal infections were documented among 85 children, 29 of whom suffered from hemolytic-uremic syndrome. INTERVENTION: Surgical consultation for presumed or proven complications of the infection. MAIN OUTCOME MEASURES: The frequency of and reasons for surgical consultation, clinical and bacteriologic variables between patients who did or did not require surgical assessment. RESULTS: Of the 85 children, 17 (20%) were assessed by the surgical service. The majority of these children were inpatients. Two required abdominal surgery. Female gender, older age and progression to hemolytic-uremic syndrome were factors associated in univariate analyses with a likelihood of need for surgical assessment; variation in bacterial genotype was not. CONCLUSION: There is the potential for verotoxigenic E. coli O157:H7 infection to have a considerable impact on the utilization of pediatric surgical services.

Endemic giardiasis and municipal water supply.

To test the hypothesis that endemic giardiasis may be transmitted by unfiltered municipal water supplies, the incidence of laboratory-confirmed giardiasis was studied in a natural experiment due to the arrangement of the public water supply of Dunedin, New Zealand. The incidence rate ratio was 3.3 (90% CI = 1.1, 10.1) for the population receiving unfiltered (microstrained) water relative to that using sand filtered water. In a parallel case-control study of incident cases, the odds ratio for giardiasis and unfiltered (microstrained) water supply was 1.8 (90% CI = 0.5, 6.9).

Adolescent and adult lymphoblastic leukaemia: prognostic factors and response to treatment.

Thirty consecutive patients with acute lymphoblastic leukaemia (ALL) who received treatment at Christchurch Hospital between 1972 and 1982 were reviewed. Complete remission (CR) was achieved in 80 per cent with a median survival of 65 weeks. Eleven of 30 patients had one or more of the following features--B cell ALL, a mediastinal mass, the Philadelphia chromosome (Ph1) and age 60 years or older at diagnosis. Although CR was obtained in 8 of these patients none survived three years. The remaining 19 patients were regarded as 'good risk' and treated by moderate intensity chemotherapy schedules. CR was obtained in 16 of these patients (84 per cent) and the estimated 5 year survival was 62 per cent with 6 patients remaining in remission from 5 to 9 years from diagnosis. These results demonstrate the value of objective and reproducible clinical and laboratory findings in defining a subset of ALL patients which may not require high intensity chemotherapy schedules.