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Overall (N = 254) Medicine (Floors) (n = 96) Surgery (Floors) (n = 42) Medical ICU (n = 51) Surgical ICU (n = 31) Orders adherent to policy, n (%) 84 (33.1) 31 (32.3) 18 (42.9) 13 (25.5) 16 (51.6) Time from order entry to order verification, median minutes (range) All orders 11 (0 – 2142) 13 (1 – 2142) 9 (2 – 540) 13 (1 – 919) 31 (1 – 1769) Adherent orders 7 (1 – 213) 5 (1 – 148) 8.5 (2 – 52) 4 (1 – 74) 6.5 (1 – 213) Non-adherent orders 16 (0 – 2142) 22 (1 – 2142) 13 (2 – 540) 19 (1 – 919) 416 (5 – 1769) ID approval not obtained prior to order entry, n (%) 134 (52.8) 58 (60.4) 16 (38.1) 20 (39.2) 13 (41.9)

Two patients hyperinfected with Strongyloides stercoralis (an intestinal nematode) are described. Both were both in Puerto Rico and had left the island six to 15 years previously; both were receiving adrenal steroids (one for Hodgkin's disease and the other for Goodpasture's syndrome). One died shortly after diagnosis, but the other survived the hyperinfection syndrome and complicating bacterial sepsis and meningitis. In addition to our case reports, 103 previously described cases of presumed strongyloides hyperinfection are reviewed. Among 89 patients immunocompromised by therapy or disease, the mortality rate was 86%; bacterial sepsis often contributed to the fatal outcome. In most cases, infection was acquired in an endemic area, sometimes long before the hyperinfection syndrome occurred. The few patients who had never been to an endemic area had a history of prolonged contact with highly soiled material, an observation suggesting cross infection from a contaminated person. When administered in time, thiabendazole, the drug of choice for strongyloidiasis, was effective in 70% of cases. If intestinal infection with S. stercoralis is detected and treated before immunosuppressive therapy is initiated and if a high index of suspicion for the hyperinfection syndrome is maintained while immunosuppressive therapy is given, the mortality from this disease should decrease.

A case of purulent meningitis in an adult caused by Streptococcus MG-intermedius, also known as Streptococcus milleri, is described. The intriguing taxonomical history of this organism and its association with mycoplasma pneumoniae pulmonary infections is reviewed. The incidence of central nervous system infections due to this organism is also discussed.

Patients with acquired immune deficiency syndrome (AIDS) are known to have identifiable host defense deficiencies, especially deficiencies in cell-mediated immunity. They are at increased risk for developing infections of the bloodstream caused by Cryptococcus neoformans and Salmonella species. However, bacteremias caused by other enteric gram-negative rods and Pseudomonas aeruginosa are found less frequently in patients with AIDS than in patients without AIDS (P less than 0.001 and P less than 0.01, respectively). The findings of specific organisms in blood is consistent with the known types of host defense deficiencies in these patients.