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During a 3 1/2-year period (January 1978 through June 1981), 245 patients in a university hospital became colonized or infected with methicillin-resistant Staphylococcus aureus. During the first 18 months, the incidence of colonization and infection was only 0.05%. After a focal outbreak of methicillin-resistant S aureus in the burn unit, acquisition of the organism by patients on other wards increased significantly. Nonburn patients acquired the organism more often during time periods when newly admitted burn patients acquired methicillin-resistant S aureus. After the burn unit was closed, acquisition of the organism among nonburn patients on adult surgical and medical services decreased significantly. A questionnaire survey of other institutions disclosed that large outbreaks of this infection occurred more frequently in hospitals with burn units. These studies suggest that the occurrence of methicillin-resistant S aureus infections in burn units may lead to increased transmission of the organism to nonburn patients and that control of the infection in such units may reduce spread of the organism to patients without burns.

Cultures of blood drawn through indwelling intravascular venous and arterial cannulas were compared with those of blood drawn simultaneously by percutaneous venipuncture. In 92% of 174 comparisons, the results were identical. Cultures of blood drawn through indwelling intravascular catheters are as reliable as those of percutaneously obtained samples. In addition, the speed, ease, and lack of trauma in obtaining blood for cultures in critically ill patients further recommends this technique.

This study was designed to determine if lidocaine inhibited growth of Blastomyces dermatitidis and thereby reduced recovery of the fungus from bronchoscopy specimens. Case records of 36 patients with pulmonary blastomycosis showed that when the fungus was present at microscopy, whether the specimen was sputum or bronchial washings, culture of the bronchoscopic specimen was more frequently negative than the culture of the sputum specimen (p less than .05). In addition, lidocaine was shown to inhibit growth of B dermatitidis in vitro, with the inhibition depending on the concentration of the drug and the duration of exposure (p less than .01). High concentrations of lidocaine for topical anesthesia appear to adversely affect the recovery of B dermatitidis from bronchoscopic specimens.

Primary human skin fibroblasts are an accessible source of phenotypically and karyotypically normal human cells, but are difficult to transfect with exogenous DNA. Here we demonstrate that both transient expression and stable transformation can be carried out by the method of electroporation. Highly efficient transient chloramphenicol acetyltransferase expression was shown after transfection with plasmid pRSVCAT. Stable transformation of human skin fibroblasts to G418 resistance was obtained after electroporation with neo-containing plasmids at an efficiency of approximately 1.4 x 10(-5)/micrograms DNA. The ability to easily transfect these cells with exogenous DNA may have important applications in the study of human genetic diseases and cancer.

Electron microscopic examination of yeasts of Blastomyces dermatitidis, exposed in vitro to concentrations of lidocaine that occur when the drug is used for topical anesthesia, showed that lidocaine rapidly damaged intracellular structures. The extent of damage was dependent on the concentration of drug and length of exposure. The observed ultrastructural changes were very similar to those reported for other drugs that directly damage membranes. This relationship suggests that the antifungal effect of lidocaine is the result of direct membrane damage.

A patient with multiple subcutaneous abscesses was found to have disseminated actinomycosis. No predisposing cause was identified. No defects in immunity were found. His disease responded promptly to penicillin therapy.

We investigated an increase in the number of patient specimens yielding Mycobacterium terrae in 1986, isolation of M. terrae was associated with specimens obtained from inpatients at our new hospital, but not with specimens referred from other hospitals [37(+)/144 inpatient specimens versus 2(+)/26 referred specimens, p less than 0.05]. By October 31, 1987, we had identified 163 positive specimens from 131 patients. All M. terrae were isolated from specimens obtained from non-sterile sites, i.e., respiratory, gastrointestinal, or urine. No clinical disease related to M. terrae occurred. Review of procedures and cultures of solutions used in the Microbiology Laboratory suggested the source of M. terrae was not in the Microbiology Laboratory. An analysis of case location showed an association with hospital tier (p less than 0.05), a pattern matching the design of the potable water system of the hospital. M. terrae was cultured from multiple outlets of this system. There appeared to be multiple modes of transmission of M. terrae from this reservoir. Control measures included avoidance of water sources during specimen collection and hyperchlorination of the potable water system. These measures appeared to result in the disappearance of M. terrae from subsequent clinical specimens. We believe this to be the first report defining the epidemiologic aspects of M. terrae contaminating clinical specimens.

Several types of commercially available respiratory filter/sorbent combinations were tested in a coke oven environment. The percent penetration of benzene soluble particulate and benzo(a)pyrene through these filters was determined and was generally found to be less than ten percent. Degradation of filtering efficiency was noted with some types of filters. The use of a sorbent cartridge in conjunction with a covering filter did not significantly change penetration of the contaminants which were measured.

The records of 108 patients treated for bacterial endocarditis were reviewed. Six were diagnosed at autopsy and had not been treated for endocarditis. Of the 102 treated patients, 32 died during the first 30 days and 32 more were dead by 365 days. Although some reports indicate a much greater survival rate, our findings are more in keeping with those reports giving a rather poor long-term outlook for patients with endocarditis.

Diet-induced ultrastructural changes that occur in the atrial wall prior to thrombus formation are atrial subendothelial edema, endothelial vacuoles, damaged basement membrane and villous projections from endothelial (luminal surface) cells. Upon the return to a normal diet for 1-4 weeks, atrial edema is completely reversible, while the other ultrastructural alterations show minor or no signs of being repaired.

The serum half-life of tobramycin was found to be the same as that of gentamicin in patients with similar renal function. The values ranged from 2 hr in normal volunteers to 53.4 hr in anephric patients. Both drugs were readily removed from the serum by the Kiil artificial kidney, with a 70% reduction in serum concentrations during a 12-hr dialysis period.