Soon after our hospital instituted the BACTEC mycobacterial isolation system, the proportion of cultures positive for nontuberculous mycobacteria increased dramatically. After eliminating other possible sources of contamination, the BACTEC probe's sterilization time and temperature were increased, and the incidence of positive mycobacterial cultures returned to its former rate.

After controlling an epidemic of vanB-type vancomycin-resistant Enterococcus faecium (VRE), we contained a subsequent vanA E faecium outbreak by using prospective laboratory-based surveillance, placing patients with VRE in private rooms, requiring the use of both gowns and gloves by all personnel entering the patients' rooms, and conducting prevalence surveys of patients on affected wards.

Currently, collection of bacterial susceptibility data is very incomplete; national or international susceptibility data simply do not exist. The large volume of scientific publications on this subject contributes to the perception that bacterial resistance to antimicrobials is extensive and growing. However, only a very few papers address the epidemiology of bacterial resistance. Those papers that do report quantitatively on this topic are from hospitals that are systematically different from hospitals that do not publish. No one can deny the existence and the importance of drug resistance, but the sensational reports from the media are grossly untrue. Multidrug-resistant bacteria affect an extremely small proportion of patients. Most antibiotics still are highly effective and cure the majority of infections. It is proposed that medical microbiology laboratories report their susceptibility data on eight common species that constitute 68.5% of all isolates. Such reports could be analyzed and published yearly.

Public hospitals face challenging infection control problems that differ from those in other hospitals. This article reviews some of the unique aspects of infection control in public hospitals, including governance, physical plant, patient mix, communicable diseases, and employee issues, and suggests management strategies.

We are pleased to bring to our readership the contents of a symposium on nosocomial colonization held on January 14-16, 1994, in Clearwater, Florida, under the aegis of the University of South Florida College of Medicine and the National Foundation for Infectious Diseases.

The symposium was developed with the following goals: (1) to provide an up-to-date over view of the factors important in microbial colonization of human nonsterile surfaces or tissues, especially skin, nose, oropharynx, and gastrointestinal tract; (2) to provide an understanding of the impact of colonization upon the development of nosocomial infections; and (3) to provide an appreciation of how to control or manage colonization to prevent nosocomial infections.

Bacteria have developed a wide variety of molecular mechanisms that permit firm adherence to a biologic surface. This review summarizes basic principles involved in this process, as exemplified by adherence of the group A streptococcus to oral epithelium, staphylococci to indwelling prostheses, and Escherichia coli to uroepithelium and enterocytes.

Arbitrary primed polymerase chain reaction (AP PCR) assays are suited for the discrimination of isolates of all clinically relevant bacterial species. In a hospital setting, this type of DNA amplification test can be used for the timely detection of ongoing nosocomial outbreaks. For rapid screening of isolates of many medically important bacterial species, including Acinetobacter baumannii, Staphylococcus aureus, Serratia marcescens, Xanthomonas maltophilia and others, a single AP PCR assay can be used as a primary typing screen for genetic relatedness. In combination with epidemiological data, AP PCR testing is particularly useful for identifying true outbreaks caused by a single strain.