The teaching and guideline intervention improved the quality and reduced the quantity of antimicrobial use in LTC patients.

Outbreaks can be prevented with strict biosecurity and microbiological monitoring.

Infection caused by vancomycin-resistant enterococci (VRE) is associated with high morbidity and mortality rates; it poses a serious threat, in particular, to immunosuppressed patients. It generates high costs and challenges infection-control programs. Here, we look at the insights that mathematical models offer into the epidemiology of VRE colonization and infection, the potential benefits of various infection-control interventions, and the possibility of designing a tailored approach to controlling VRE. Models show that epidemics of VRE infection in diverse institutions may differ in the relative contributions of cross-transmission and the influx of new cases, as well as in the various mechanisms of local transmission. They also highlight the phenomenon of decreasing returns associated with many interventions and, hence, the need to identify the most important routes of transmission, to break the weakest links in the chain of transmission, and to contain the influx of cases of VRE infection. These observations also provide insights into the management of infection with other antibiotic-resistant nosocomial pathogens.

i Using Exserohilum rostratum-specific and panfungal real-time PCR, we studied 24 blood samples and 2 synovial fluid specimens from 20 patients with persistent or worsening pain following injections of contaminated methylprednisolone. Seven blood specimens from 6 patients were significantly positive for fungal DNA by panfungal PCR, with multiple fungal species identified.