In October 1990, Enterococcus faecium that was highly resistant to glycopeptides, penicillins, and aminoglycosides was isolated from the peritoneal dialysis fluid from a patient in an intensive care unit. Over the following 6 months, multiresistant E. faecium organisms were isolated from cultures of blood, urine, or surgical wound specimens from eight additional patients. Surveillance cultures of groin and/or rectal swabs were positive for eight of 37 patients and four of 62 employees at risk. Restriction endonuclease digestion of chromosomal DNA from outbreak isolates was consistent with dissemination of a single strain throughout the intensive care unit. Strict infection control interventions contained the outbreak after several weeks. Review of patient charts suggested that renal insufficiency, length of hospital stay, duration of antibiotic treatment, and prior treatment with vancomycin were risks for infection due to multiresistant E. faecium. The emergence of multiple-drug-resistant enterococci presents serious infection control and therapeutic dilemmas.

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Purged stools from 389 patients were evaluated microscopically for the presence of Blastocystis hominis. A total of five or more B. hominis cells per 40x field were observed in 43 patients (11%), and B. hominis was the only intestinal parasite present in 23 (6%) of these patients. Of the 23 patients, 19 had symptoms which included abdominal discomfort (15 patients), anorexia (10 patients), diarrhea (9 patients), and flatus (9 patients). The remaining four patients were asymptomatic. The proportion of eosinophils in the peripheral blood ranged from 4 to 12% in 11 (58%) of the symptomatic patients. Absolute eosinophil counts were greater than 250/uIl in 8 patients and greater than 400/,ul in 5 patients. Eosinophilia was not observed in the remaining symptomatic or asymptomatic patients. This study supports the emerging concept of the role of B. hominis as an intestinal parasite causative of human disease.