Hospital-acquired infections (HAI) are often seen as preventable incidents that result from unsafe practices or poor hospital hygiene. This however ignores the fact that transmissibility is not only a property of the causative organisms but also of the hosts who can translocate bacteria when moving between hospitals. In an epidemiological sense, hospitals become connected through the patients they share. We here postulate that the degree of hospital connectedness crucially influences the rates of infections caused by hospital-acquired bacteria. To test this hypothesis, we mapped the movement of patients based on the UK-NHS Hospital Episode Statistics and observed that the proportion of patients admitted to a hospital after a recent episode in another hospital correlates with the hospital-specific incidence rate of MRSA bacteraemia as recorded by mandatory reporting. We observed a positive correlation between hospital connectedness and MRSA bacteraemia incidence rate that is significant for all financial years since 2001 except for 2008–09. All years combined, this correlation is positive and significantly different from zero (partial correlation coefficient r = 0.33 (0.28 to 0.38)). When comparing the referral pattern for English hospitals with referral patterns observed in the Netherlands, we predict that English hospitals more likely see a swifter and more sustained spread of HAIs. Our results indicate that hospitals cannot be viewed as individual units but rather should be viewed as connected elements of larger modular networks. Our findings stress the importance of cooperative effects that will have a bearing on the planning of health care systems, patient management and hospital infection control.

SummaryThis paper reports our experience in monitoring gentamicin therapy during the treatment of 68 episodes of serious Gramnegative sepsis in 65 hospital patients. Most of the patients had major underlying disease. Of those who were adequately treated (peak serum concentrations of 5 ,ug/ml or more in 72 hours for septicaemia, urinary tract infection, and wound infection; and 8 ,ug/ml or more at some time during the course of treatment for pneumonia) B4% (46 out of 55) were cured. These serum concentrations could be achieved only by starting with a regimen of 5 mg/kg/day in three divided doses in ali adult patients, subsequent dosage being determined by the results of rapid serum assay. The incidence of nephrotoxicity and symptomatic ototoxicity was no greater than in previous series. The main reason for assaying serum gentamicin is to ensure that an adequate dosage is achieved as soon as possible. In patients with impaired renal function or receiving prolonged high dosage assays also serve to guard against an excessive accumulation of gentamicin and an increased risk of toxicity.

quence of impaired uterine or ovarian development during the mother's own fetal life.34One observational study cannot form the basis for changing dietary recommendations to pregnant women. The differing relations of nutrient intakes in early and late pregnancy to placental and fetal growth need replication in other studies. Our findings, however, do parallel those of experimental studies in sheep in which high nutrient intakes in early pregnancy have been shown to suppress placental and fetal growth.We thank the mothers who gave us their time; the staff on the antenatal clinic, labour ward, and postnatal ward for their considerable assistance in the study; Mr T Wheeler and Professor E J Thomas for their guidance and for allowing us to include their patients; and Mr D Howe for advice and for performing ultrasound scans. The fieldwork was carried out by S Crofts, V Davill, J Hammond, L Greenaway, S Mitcham, and S White.

The epidemiology of notified cases of campylobacter gastroenteritis in adults in Nottingham Health District was investigated using a case-control study with a postal questionnaire to ascertain data on risk factors. Over a 14-month period 531 cases (a 73% response rate of all laboratory confirmed cases) and 512 controls replied. Conditional logistic regression analysis was used to determine independent associations with infection. These included foreign travel (odds ratio (OR) 3.4; 95% confidence intervals (CI) 2.0-5.7), diabetes mellitus (OR 4.1, CI 1.1-17), medication with omeprazole (OR 3.5, CI 1.1-12) and H2 and H2 antagonists (OR 3.7, CI 1.3-15), contact with puppies (OR 11.3, CI 1.2-105), eating chicken (OR 1.4, CI 1.1-1.8) and drinking milk from bottles with tops damaged by a bird (OR 3.3, CI 1.0-11). Preparing main meals (OR 0.9, CI 0.8-1.0) and drinking delivered milk (OR 0.6, CI 0.4-0.9) were associated with a reduced risk of campylobacter infection. Foreign travel was reported in 25% of cases and another 15% had significant associations with other risk factors. The majority of cases, 60%, remained unexplained, indicating the need for further evolution of sporadic cases.

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