FTER BEING INITIALLY REported among injecting drug users in Detroit in 1981 1 and then associated with the deaths of 4 children in Minnesota and North Dakota in 1997, 2 community-associated methicillin-resistant Staphylococcus aureus (MRSA) has become the most frequent cause of skin and soft tissue infections presenting to emergency departments in the United States. 3 Although community outbreaks of MRSA in diverse populations, including American Indian and Alaska Natives, 4 sports See also p 1803 and Patient Page.

Objective. The purpose of this study was to provide a national estimate of the number of healthcare-associated infections (HAI) and deaths in United States hospitals. Methods. No single source of nationally representative data on HAIs is currently available. The authors used a multi-step approach and three data sources. The main source of data was the National Nosocomial Infections Surveillance (NNIS) system, data from 1990–2002, conducted by the Centers for Disease Control and Prevention. Data from the National Hospital Discharge Survey (for 2002) and the American Hospital Association Survey (for 2000) were used to supplement NNIS data. The percentage of patients with an HAI whose death was determined to be caused or associated with the HAI from NNIS data was used to estimate the number of deaths. Results. In 2002, the estimated number of HAIs in U.S. hospitals, adjusted to include federal facilities, was approximately 1.7 million: 33,269 HAIs among newborns in high-risk nurseries, 19,059 among newborns in well-baby nurseries, 417,946 among adults and children in ICUs, and 1,266,851 among adults and children outside of ICUs. The estimated deaths associated with HAIs in U.S. hospitals were 98,987: of these, 35,967 were for pneumonia, 30,665 for bloodstream infections, 13,088 for urinary tract infections, 8,205 for surgical site infections, and 11,062 for infections of other sites. Conclusion. HAIs in hospitals are a significant cause of morbidity and mortality in the United States. The method described for estimating the number of HAIs makes the best use of existing data at the national level.

Background Knowledge of the number of persons with chronic hepatitis C virus (HCV) infection in the United States is critical for public health and policy planning. Objective To estimate the prevalence of chronic HCV infection between 2003 and 2010 and to identify factors associated with this condition. Design Nationally representative household survey. Setting U.S. noninstitutionalized civilian population. Participants 30 074 NHANES (National Health and Nutrition Examination Survey) participants between 2003 and 2010. Measurements Interviews to ascertain demographic characteristics and possible risks and exposures for HCV infection. Serum samples from participants aged 6 years or older were tested for antibody to HCV; if results were positive or indeterminate, the samples were tested for HCV RNA, which indicates current chronic infection. Results Based on 273 participants who tested positive for HCV RNA, the estimated prevalence of HCV infection was 1.0% (95% CI, 0.8% to 1.2%), corresponding to 2.7 million chronically infected persons (CI, 2.2 to 3.2 million persons) in the U.S. noninstitutionalized civilian population. Infected persons were more likely to be aged 40 to 59 years, male, and non-Hispanic black and to have less education and lower family income. Factors significantly associated with chronic HCV infection were illicit drug use (including injection drugs) and receipt of a blood transfusion before 1992; 49% of persons with HCV infection did not report either risk factor. Limitation Incarcerated and homeless persons were not surveyed. Conclusion This analysis estimated that approximately 2.7 million U.S. residents in the population sampled by NHANES have chronic HCV infection, about 500 000 fewer than estimated in a similar analysis between 1999 and 2002. These data underscore the urgency of identifying the millions of persons who remain infected and linking them to appropriate care and treatment. Primary Funding Source None.

Centers for Disease Control and Prevention.

The proportion of Staphylococcus aureus isolates that were methicillin resistant (MRSA) increased from 35.9% in 1992 to 64.4% in 2003 for hospitals in the National Nosocomial Infections Surveillance system. During the same period, there was a decrease in resistance rates for several non- beta -lactam drugs among the MRSA isolates.

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The impact of hepatitis C virus (HCV) infection on health and medical care in the United States is a major problem for infectious disease physicians. Although the incidence of HCV infection has declined markedly in the past 2 decades, chronic infection in 3 million or more residents now accounts for more disease and death in the United States than does human immunodeficiency virus (HIV)/AIDS. Current trends in the epidemiology of HCV infection include an apparent increase in young, often suburban heroin injection drug users who initiate use with oral prescription opioid drugs; infections in nonhospital healthcare (clinic) settings; and sexual transmission among HIVinfected persons. Infectious disease physicians will increasingly have the responsibility of diagnosing and treating HCV patients. An understanding of how these patients were infected is important for determining whom to screen and treat.The first descriptions of the epidemiology of hepatitis C virus (HCV) infection date well before both the actual identification of the virus in 1989 [1] and the US Food and Drug Administration's approval of tests to detect antibody to hepatitis C virus in 1992. "Non-A, non-B hepatitis" was identified as a cause of chronic liver disease among transfusion recipients in studies during the 1970s in the United States [2] and abroad [3]. Since then, hepatitis C in this country has gone from an unknown and untreatable infection, mainly identified when transmitted through receipt of blood or hemodialysis, to an identifiable and curable-but underappreciated-infection today. In this article, we review trends in incidence, prevalence, mortality, and mode of transmission of HCV infection in the United States. INCIDENCE OF ACUTE, SYMPTOMATIC HCV INFECTIONThe lack of a simple test to determine the meaning of a positive HCV-antibody test remains one of the greatest obstacles to HCV infection epidemiology, diagnosis, and determination of which patients need treatment. A positive HCV-antibody test can imply either chronic HCV (about 80%) or resolved HCV (about 20%), or some small fraction of new, acute HCV

Thirty-two outpatient hemodialysis providers in the UnitedStates voluntarily reported 3699 adverse events to the Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) during 2006. These providers were previously enrolled in the Dialysis Surveillance Network. The pooled mean rates of hospitalization among patients with arteriovenous fistulas, grafts, permanent and temporary cen tral venous catheters were 7.7, 9.2, 15.7, and 34.7 per 100 patient-months, respectively. For bloodstream infection the pooled mean rates were 0.5, 0.9, 4.2, and 27.1 per 100 patient-months in these groups. Among the 599 isolates reported, 461 (77%) represented access-associated blood stream infections in patients with central lines, and 138 (23%) were in patients with fistulas or grafts. The microorganisms most frequently identified were common skin contaminants (e.g., coagulase-negative staphylococci). In 2007, enrollment in NHSN opened to all providers of outpatient hemodialysis. Specific information is available at http://www.cdc.gov/ ncidod/dhqp/nhsn_FAQenrollment.html.