To investigate possible transmission of multidrug-resistant tuberculosis (MDR-TB) in a dental setting.

A retrospective, descriptive study of dental workers (DWs), patients, and practice characteristics.

Two dental workers (DW1 and DW2) with acquired immunodeficiency syndrome and MDR-TB.

A hospital-based (Hospital X) human immunodeficiency virus (HIV) dental clinic in New York City.

To identify dental patients with tuberculosis (TB), patients treated in the dental clinic at Hospital X during 1990 were cross-matched with those listed in the New York City Department of Health Tuberculosis Registry Mycobacterium tuberculosis isolates from both DWs and from dental patients with TB were tested for antimicrobial susceptibility and typed by restriction fragment length polymorphism (RFLP) analysis. Infection control practices were reviewed.

M tuberculosis isolates infecting DW1 and DW2 were resistant to isoniazid and rifampin and had identical RFLP patterns. DW1 and DW2 worked in close proximity to each other in a small HIV dental clinic in Hospital X during 1990. Of 472 patients treated in the dental clinic in 1990, 41 (8.7%) had culture-proven M tuberculosis infection. Of these 41, 5 had isolates with resistance patterns similar to both DWs; however, for four available isolates, the RFLP patterns were different from the patterns of the DWs. Sixteen of the 41 patients received dental treatment while potentially infectious. Dental patients were not routinely questioned about TB by dental staff, nor were all dental staff screened routinely for TB. No supplemental environmental measures for TB were employed in the dental clinic in 1990.

Our investigation suggests that MDR-TB transmission may have occurred between two DWs in an HIV dental clinic. Opportunities for transmission of TB among dental staff and patients were identified. TB surveillance programs for DWs and appropriate infection control strategies, including worker education, are needed to monitor and minimize exposure to TB in dental settings providing care to patients at risk for TB.

To describe the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) at a university hospital during a 14-month period.

Prospective laboratory-based surveillance for MRSA with descriptive epidemiology based on medical chart review and characterization of strains by DNA typing, using pulsed-field gel electrophoresis (PFGE).

An 850-bed tertiary care university hospital.

Patients with clinical isolates of MRSA.

Determination whether MRSA isolates were community- or hospital-related.

Among 87 patients with MRSA, 36 (41%) had community-acquired infections. Community acquisition was associated with recent hospitalization, previous antibiotic therapy, nursing home residence, and intravenous drug use. Greater than 3 months had elapsed from the time of discharge for 13 (62%) of the 21 patients with community-acquired isolates hospitalized within the last year. Eight patients (22%) with community-acquired MRSA had no discernible risk factors. PFGE allowed differentiation of 35 distinct whole-cell DNA patterns; heterogeneity was seen among both nosocomial and community-acquired isolates, with few instances of cross-transmission.

Our data suggest an increase in community acquisition of MRSA. PFGE demonstrated heterogeneity of MRSA isolates from both the community and the hospital setting.

1) To compare policies and procedures for distribution of influenza and pneumococcal vaccines to long-term care facilities for the elderly in Canada, 2) to determine vaccination rates of residents and staff, and 3) to describe vaccination and tuberculin skin testing programs in these facilities.

A cross-sectional survey consisting of telephone interviews and a mailed questionnaire was conducted in the spring of 1991. Telephone interviews were conducted with provincial/territorial epidemiologists. The questionnaire was sent to all (N = 1,520) Canadian long-term care facilities for the elderly with ≥ 25 beds.

There were 1,270 responding facilities (84%). The mean overall influenza vaccination rate for residents was 78.5%. The mean vaccination rate was higher in those provinces in which the vaccine was paid for by the government (79% versus 71%; P= 0.002). Only 19% of facilities reported staff vaccination rates >25%; rates again were higher in those provinces in which vaccine for staff was provided by the government. Pneumococcal vaccine was offered to residents in 12% of the facilities. The proportions of facilities with >10% and >75% of residents vaccinated were significantly higher in the provinces where the pneumococcal vaccine was recommended and paid for as compared with those where it was not (P<0.001 for both). Tuberculin skin testing programs for residents existed in 360 long-term care facilities (28%) across the country.

In 1990, the number of residents living in Canadian long-term care facilities who were vaccinated against influenza and Streptococcus pneumoniae was suboptimal. Staff influenza vaccination rates were very low across the country. Most facilities did not have a baseline tuberculin skin test status for their residents. Vaccination rates are higher in jurisdictions in which governments provide the vaccine without charge.

To investigate an outbreak in neonates of Enterobacter cloacae infection resistant to third-generation cephalosporins.

A retrospective study of an outbreak in the neonatal intensive care unit (NICU) and review of E cloacae isolates in pediatric wards and other intensive care units from June 1992 through March 1993.

An academic tertiary care hospital.

Six patients admitted to the NICU were colonized or infected with E cloacae resistant to third-generation cephalosporins. In the period preceding the outbreak, four E cloacae isolates were available from four patients in the pediatric surgical ward. Nine isolates from four patients in two other intensive care units (ICUs) also were collected during the outbreak. Isolates were biotyped by the API 50CH system and genotyped by polymerase chain reaction (PCR) fingerprinting.

Typing by interrepeat PCR showed that 21 isolates, which were obtained from five neonates, were identical. One neonate was colonized with a different strain. Some neonates were colonized with a single type of E cloacae for a relatively long period of time. Isolates of patients who were cared for in the pediatric surgical ward and the two other intensive care units (ICUs) showed different genotypes. One patient in an ICU was colonized with an E cloacae strain genetically identical to the outbreak strain. No predominant biotype could be established.

E cloacae can colonize neonates for a long period of time and although colonization with E cloacae initially may arise endogenously, we were able to show further transmission by cross-contamination in a neonatal intensive care unit.