To identify the risk factors associated with an unexpected outbreak of malaria that occurred among seven patients in a general teaching hospital in Taipei in October 1995.

A three-stage case-control study was conducted to identify risk factors.

We identified all 7 patients who were diagnosed as malaria cases and 69 controls from those undergoing computed tomography (CT) examination.

Malaria was diagnosed by demonstrating the presence of Plasmodium falciparum on either thick or thin blood smears. Clinical characteristics and exposure information were collected from medical records and patient interviews.

The index case was infected by malaria when he visited Nigeria in early September and was diagnosed when he was hospitalized in hospital A in October. Among 10 patients examined with the Imatron scanner after the index case, all 6 who were injected with contrast medium were infected, but none of 4 examined without contrast medium were infected (P=.005).

This nosocomial outbreak of malaria was most likely due to transmission via a contaminated catheter and contrast medium used for CT scanning. Use of disposable catheters may avoid such nosocomial outbreaks in the future.

To determine the risk factors for colonization or infection with methicillin-resistant Staphylococcus aureus in human immunodeficiency virus (HIV)-infected patients.

Retrospective matched-pair case-control study.

Continuity clinic and inpatient HIV service of a university medical center.

Patients with HIV infection from the general population of eastern and coastal Texas and from the Texas Department of Criminal Justice.

Patient charts and the AIDS Care and Clinical Research Program Database were reviewed for the following: age, race, number of admissions, total hospital days, presence of a central venous catheter, serum albumin, total white blood cell count and absolute neutrophil count, invasive or surgical procedures, any cultures positive for S aureus, and a history of opportunistic illnesses, diabetes, or dermatologie diagnoses. Data also were collected on the administration of antibiotics, antiretroviral therapy, steroids, cancer chemotherapy, and subcutaneous medications.

In the univariate analysis, the presence of a central venous catheter, an underlying dermatologie disease, lower serum albumin, prior steroid therapy, and prior antibiotic therapy, particularly antistaphylococcal therapy or multiple courses of antibiotics, were associated with increased risk for colonization or infection with methicillin-resistant S aureus. Multivariate analysis yielded a model that included presence of a central venous catheter, underlying dermatologie disease, broad-spectrum antibiotic exposure, and number of hospital days as independent risk factors for colonization or infection with methicillin-resistant S aureus.

In our HIV-infected patient population, prior hospitalization, exposure to broad-spectrum antibiotics, presence of a central venous catheter, and dermatologie disease were risk factors for acquisition of methicillin-resistant S aureus

To investigate relationships between the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and the use of different classes of antimicrobials in Belgian hospitals.

Using Pearson correlation coefficients, the number of new nosocomial MRSA-colonized or -infected patients in the second half of 1994 and the first half of 1995 reported by the national MRSA surveillance program was compared with use of various antimicrobial classes as reported by the National Institute for Sickness and Disability Insurance. Relationships between different classes of antimicrobials were evaluated in a correlation matrix. MRSA incidence, antimicrobial use, and potential confounding factors were included in a multiple linear regression analysis.

50 hospitals in Belgium.

The use of a number of different classes of antimicrobials was interrelated. In the multivariate analysis, the incidence of nosocomial MRSA increased with increasing use of ceftazidime and cefsulodin (P=.0003), amoxicillin with clavulanic acid (P=.02), and quinolones (P=.005). No association was found between MRSA incidence and total antimicrobial use.

The relationships between antimicrobial use and MRSA are complex. Interventions aimed at promoting more rational prescribing patterns should be supported by adequate experimental and epidemiological evidence. Advice for preventing and controlling MRSA has focused mainly on hygienic measures and precautions to avoid cross-transmission; the role of relieving antimicrobial pressure needs to be clarified.

To determine the prevalence and risk factors for nosocomial infections (NIs) in four Swiss university hospitals.

A 1-week period-prevalence survey conducted in May 1996 in medical, surgical, and intensive-care wards of four Swiss university hospitals (900-1,500 beds). Centers for Disease Control and Prevention definitions were used, except that asymptomatic bacteriuria was not categorized as NI. Study variables included patient demographics, primary diagnosis, comorbidities, exposure to medical and surgical risk factors, and use of antimicrobials. Risk factors for NIs were determined using logistic regression with adjustment for length of hospital stay, study center, device use, and patients' comorbidities.

176 NI were recorded in 156 of 1,349 screened patients (11.6%; interhospital range, 9.8%-13.5%). The most frequent NI was surgical-site infection (53; 30%), followed by urinary tract infection (39; 22%), lower respiratory tract infection (27; 15%), and bloodstream infection (23; 13%). Prevalence of NI was higher in critical-care units (25%) than in medical (9%) and surgical wards (12%). Overall, 65% of NIs were culture-proven; the leading pathogens were Enterobacteriaceae (44; 28%), Staphylococcus aureus (20; 13%), Pseudomonas aeruginosa (17; 11%), and Candida species (16; 10%). Independent risk factors for NI were central venous catheter (CVC) use (odds ratio [OR], 3.35; 95% confidence interval [CI95], 2.91-3.80), admission to intensive care (OR, 1.75; CI95, 1.30-2.21), emergency admission (OR, 1.57; CI95, 1.15-2.00), impaired functional status (Karnofsky index 1-4: OR, 2.56; CI95, 1.95-3.17), and McCabe classification of ultimately fatal (OR, 2.50; CI95, 2.04-2.96) or rapidly fatal (OR 2.25; CI95,1.52-2.98) underlying condition.

According to the results of this survey, NIs are frequent in Swiss university hospitals. This investigation confirms the importance of CVCs as a major risk factor for NI. Patient comorbidities must be taken into account to adjust for case mix in any study comparing interhospital or intrahospital infection rates.

To describe the epidemiology, diagnosis, risk factors, patient impact, and treatment strategies for recurrent Clostridium difficile-associated disease (CDAD).

Data were collected as part of a blinded, placebo-controlled clinical trial testing a new combination treatment for recurrent CDAD. Retrospective data regarding prior CDAD episodes were collected from interviews and medical-chart review. Prospective data on the current CDAD episode, risk factors, and recurrence rates were collected during a 2-month follow-up.

National referral study.

Patients with recurrent CDAD.

Treatment with a 10-day course of low-dose (500 mg/d) or high-dose (2 g/d) vancomycin or metronidazole (1 g/d).

Recurrent CDAD was found to have a lengthy course involving multiple episodes of diarrhea, abdominal cramping, nausea, and fever. CDAD may recur over several years despite frequent treatment with antibiotics. Recurrence rates were similar regardless of the choice or dose of antibiotic. Recurrent CDAD is not a trivial disease: patients may have multiple episodes (as many as 14), may require hospitalization, and the mean lifetime cost of direct medical care was $10,970 per patient. Fortunately, the disease does not become progressively more severe as the number of episodes increase. Two risk factors predictive for recurrent CDAD were found: increasing age and a decreased quality-of-life score at enrollment.

Recurrent CDAD is a persistent disease that may result in prolonged hospital stays, additional medical costs, and rare serious complications.

To examine the policies and practices in hospitals within the state of Victoria, Australia, with respect to vaccination of staff against hepatitis B infection.

A written self-administered questionnaire to be completed by the infection control officer (or designated officer for hepatitis B vaccination) within each hospital.

Public (teaching and nonteaching) and private hospitals, including metropolitan and rural institutions in Victoria.

A random sample of 30% of Victorian hospitals were asked to participate in the survey. Of 78 eligible institutions, 69 (88%) completed and returned questionnaires.

There was no consistent hepatitis B prevention policy in place across Victoria. Of the 69 responding hospitals, 63 (91%) offered hepatitis B vaccination to staff, and 58 (84%) of these also paid all costs of vaccination. Of the 63 hospitals offering vaccination to staff, 39 offered vaccination to all staff, 23 offered vaccination based on job title, and one offered vaccination based on anticipated exposure. In many institutions, postexposure protocols were recalled more readily than preexposure vaccination guidelines. Numerous respondents indicated a need for clear guidelines on policy and clarification on practical matters of management, such as acceptable immune levels, management of nonresponders to the primary series, and the need for, and timing of, booster doses of vaccine. Eleven (18%) of the 63 hospitals offering hepatitis B vaccination to staff undertook routine prevaccination screening, a practice not generally regarded as cost-effective in Australia. Fifty-five of these hospitals (91%) also undertook postvaccination screening.

It is evident from this study that a considerable number of potentially susceptible healthcare personnel in Victorian hospitals remain unprotected against hepatitis B infection. A more reliable and consistent approach to preexposure hepatitis B vaccination is recommended