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Introduction: An extensive gathering of data should contribute to evaluate the risk and to reduce prejudices., Material and Method: Within 6 weeks 57 different criteria according to accident, person and circumstances from 3,512 skiers and snowboarders were gathered and collected in a database. For analysis additional data about frequency of transportation and weather and piste conditions were available., Results: Injury risk for piste sports is 0.7%. The risk is especially influenced by bad weather conditions. Young people represent a risk group. The carving technique has led to a reduction of injury risk, but caused a shift of the injury pattern. Protectors reduce the risk up to 50%., Discussion: Skiing and snowboarding are among the safest sports because of improved material and pistes. The new injury pattern with the carving technique is due to higher speeds in curves resulting in higher centrifugal forces; 18% of skiing accidents are collisions and 14% of all skiers do not know the FIS rules of conduct., Conclusion: There was no increase in injury risk at the pistes in recent years. The use of protectors has a positive effect and should be supported in the future too.

From October 1993 till October 1994, 115 oxacillin resistant Staphylococus aureus strains were isolated in the laboratory of a teaching hospital. This was 2.4% of all of the Staphylococcus aureus strains. The bacteria were isolated from 30 patients, 7 medical personnel and in the environment of the infected patients. Most of the isolates were cultured from blood cultures, wound swabs and drains. If the referring hospitals has been informed about the MRSA status of the patients, several transmissions could have been prevented. In 10 infected patients, the MRSA strains were isolated from the nose, throat and hands. The isolates were also found on the hands of several personnel and in the patients environment, suggesting that the strains had been widely spread. The MRSA strains predominated in the medical and surgical intensive care units and in 2 general surgical wards. They were only found sporadically in other departments (Ophthalmology, Gynaecology, Paediatrics and Urology). MRSA-strains were more resistant to imipenem, ofloxacin, gentamicin, trimethoprim-sulfamethoxazole, tetracycline, erythromycin and clindamycin as oxacillin-sensitive Straphylococcus aureus strains. Genotyping (Restriction-Fragment-Length-Polymorphism) revealed six different strain patterns. The same RFLP types were mainly found on different wards. We conclude that various clones of MRSA may have emerged independently within one hospital and that their spread between wards was remarkably limited. Subsequent intensive hygiene measures have been successful in reducing the number of new isolates.

A multiresistant E. cloacae strain spread during a six month period in a paediatric oncology ward amongst nine children, who had different tumors and malformations. Three children who had shared a room were especially affected. E. cloacae was isolated 122 times from the children with tumors and five times from their environment. Specimens from which the bacteria were isolated, included blood cultures, catheter tips, wound swabs, drains, skin and mucous membranes from most parts of the body. The majority of the E. cloacae strains were resistant to ampicillin, mezlocillin, piperacillin, azlocillin, doxycycline and cephalosporins of the second and third generation and sensitive to imipenem, aminoglycosides and quinolones. The antimicrobial resistance patterns of the E. cloacae strains from the paediatric oncology ward were compared to those isolated from other wards in the hospital. E. cloacae isolates from the intensive care unit had a reduced sensitivity to beta-lactam antibiotics, whereas the isolates from the other wards were, with the exception of ampicillin, sensitive to beta-lactam antibiotics. The analysis of the E. cloacae strains from the paediatric oncology ward revealed the same antimicrobial resistance pattern, bacteriocin type, RFLP-type and an identical enzyme and whole cell profile. Isolates from other wards showed considerably deviating patterns. The systematic registration and isolation of patients, colonized or infected with multiresistant E. cloacae strains, together with infection control methods, lead to a significant reduction in infections.

Resistant strains of Klebsiella pneumoniae were found in increasing frequency as a cause of nosocomial infection in an intensive care unit between July and October 1990. The isolated strains had an almost identical biochemical profile, showed a similar pattern of antibiotic resistance, and produced type SHV2-broad-spectrum betalactamase. Thus, it was assumed that the isolates were copies of identical strains, causing an outbreak of nosocomial infections. The bacteria were resistant to third-generation cephalosporins, such as cefotiam, cefotaxime and ceftriaxone, and also to aminoglycosides and acylaminopenicillins. Approximately half of the strains were resistant to ceftazidim and aztreonam. The bacteria were sensitive in vitro to ciprofloxacin, imipenem, latamoxef and cefotetan. During three months, 10% (11) of all patients became infected; four of these patients (36%) died from septicemia. After conventional hygiene programs had failed to stop the outbreak, the intensive care unit was closed and disinfected, a measure, which effectively interrupted the infection.

The upper respiratory tracts of 20 children attending a crèche were studied for bacteria up to the 128th day of crèche attendance. To this end nose and throat swabs as well as double blood withdrawals were to determine antibodies against various respiratory viruses. The germ spectrum thus obtained was correlated with the acute pathological processes occurring during the period of investigation. In addition to the normal flora, the nasopharynx of infection-stable children was, with one exception, only populated with gram-positive pathopotent bacteria during the first four months of crèche attendance. In infection-labile children, however, gram-negative pathopotent bacteria, blastomycetes of the Candida group as well as Mycoplasma, virus and mixed infections were discovered apart from gram-positive bacteria. This broad germ spectrum should be taken into wider consideration in the chemotherapy of respiratory infections.