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Nosocomial infections, or infections acquired within the hospital, are a major source of illness. About 6 percent of all patients acquire a nosocomial infection, and 4 percent of those die either as a direct result of the infection or with the infection as a major contributing factor. Since the majority of nosocomial infections are the result of bacteria normally found in the digestive tract, it seems reasonable to investigate whether diarrhea might be a contributing factor to nosocomial infection. The cases of 78 patients (33 with diarrhea and 45 without) were reviewed to determine if diarrhea, along with other factors, might contribute to the development of infection. The results found that the presence of diarrhea contributes to the colonization of the urinary meatus and the subsequent development of a urinary tract infection. This likelihood is particularly great when the patient's urinary bladder is catheterized. The role of the urinary catheter in promotion of urinary tract infection has long been recognized, but the association of the catheter with the increased risk following diarrhea suggests that indwelling catheters probably should be removed following an episode of diarrhea. (Consumer Summary produced by Reliance Medical Information, Inc.)

AbstractObjective:To determine the frequency with which methicillin-resistant Staphylococcus aureus(MRSA) is spread from colonized or infected patients to their household and community contacts.Design:Retrospective cohort study.Setting:University hospital.Participants:Household and community contacts of MRSA-colonized or -infected patients for whom MRSA screening cultures were performed.Results:MRSA was isolated from 25 (14.5%) of 172 individuals. Among the contacts of index patients who had at least one MRSA-colonized contact, those with close contact to the index patient were 7.5 times more likely to be colonized (53% vs 7%; 95% confidence interval, 1.1 to 50.3; P= .002). An analysis of antimicrobial susceptibility and DNA fingerprint patterns suggested person-to-person spread.Conclusions:MRSA colonization occurs frequently among household and community contacts of patients with nosocomially acquired MRSA, suggesting that transmission of nosocomially acquired MRSA outside of the healthcare setting may be a substantial source of MRSA colonization and infection in the community.

AbstbactObjective:To determine risk factors for vancomycin-resistant Enterococcus(VRE) colonization during a hospital outbreak and to evaluate Centers for Disease Control and Prevention (CDC)-recommended control measures.Design:Epidemiological study involving prospective identification of colonization and a case-control study.Setting:A university hospital.Participants:Patients on eight wards involved in outbreak from late 1994 through early 1995.Methods:Cases were matched by ward and culture date with up to two controls. Risk factors were evaluated with four multivariate models using conditional logistic regression. The first evaluated proximity to other VRE patients and isolation status. The second evaluated proximity to unisolated VRE cases and three variables independently predictive after adjustment for proximity. The third evaluated seven significant univariate predictors in addition to proximity to unisolated VRE in backward, stepwise logistic regression. The fourth assessed proximity to VRE with all other variables collected, clustered in a principal components analysis. Pulsed-field gel electrophoresis was performed to assess clonality of two outbreak strains.Results:The incidence of transmission declined significantly after CDC guidelines were implemented. Proximity to unisolated VRE cases during the prior week was a significant predictor of acquisition in each of four multivariate models. Other significant risk factors in multivariate models included a history of major trauma and treatment with metronidazole. Pulsed-field gel electrophoresis confirmed the clonality of two outbreak strains.Conclusions:VRE was transmitted between patients during a hospital epidemic, with proximity to previously unisolated VRE patients being an important risk factor. Weekly surveillance cultures and contact isolation of colonized patients significantly reduced spread.

• Seventy-one patients with polymyositis-dermatomyositis (PM/DM) admitted to the Wellesley Hospital Rheumatic Disease Unit (RDU) in Toronto between 1965 and 1980 were followed up to 1981. The frequencies of malignant neoplasms occurring prior to or concurrent with initial RDU admission were compared, using case-control methods, with age- and sex-matched control groups with a diagnosis of any non— PM/DM rheumatic disease (rheumatic disease controls) or osteoarthritis, fibrositis, or fracture (noninflammatory musculoskeletal controls). In a cohort analysis, the incidence of malignant neoplasm subsequent to initial RDU admission in patients with PM/DM was compared with the expected incidence in the Canadian population. Fifteen of 71 patients with PM/DM had an antecedent or concurrent cancer compared with four of 71 rheumatic disease controls and one of 71 noninflammatory musculoskeletal controls. Cohort analysis showed no increase in the number of subsequent malignant neoplasms in patients with PM/DM compared with the age- and sex-matched Canadian population.(Arch Intern Med 1985;145:1835-1839)

• A survey evaluated the lifetime and current prevalence of mental disorders in 501 patients seeking assistance with alcohol and other drug problems at an addiction research and treatment facility. Information was gathered using the National Institute of Mental Health Diagnostic Interview Schedule (DIS) and computer diagnoses were generated according to DSM-III criteria. Four fifths (78%) of the sample had a DIS lifetime psychiatric disorder in addition to substance use, and two thirds (65%) had a current DIS mental disorder. Excluding the unreliably diagnosed generalized anxiety disorder, the most common lifetime disorders were antisocial personality disorder, phobias, psychosexual dysfunctions, major depression, and dysthymia. Patients who abused both alcohol and other drugs were the most psychiatrically impaired. Patients with DIS psychiatric disorders had more severe alcohol and other drug problems. Barbiturate/sedative/hypnotic, amphetamine, and alcohol abusers were the most likely to have a DIS mental disorder.