[Current detection rates of multiresistant gram negative bacteria (3MRGN, 4MRGN) in patients with chronic leg ulcers]. / Aktuelle Nachweisraten multiresistenter Gram-negativer Bakterien (3MRGN, 4MRGN) bei Patienten mit chronischem Ulcus cruris.

BACKGROUND: Due to the increasing problem of antibiotic resistance in gram-negative pathogens, the Commission for Hospital Hygiene and Infection Prevention (KRINKO) decided to establish a new clinically oriented definition of multi-resistance. Gram-negative pathogens with a multidrug-resistance (MRGN) are divided into those with resistance to three (3MRGN) or four (4MRGN) antibiotic groups. PATIENTS AND METHODS: In this multicenter study which was done in ten dermatological wound clinics, the bacteriological swabs from up to 100 patients with chronic leg ulcers per center were analyzed according to the current classification KRINKO and evaluated. RESULTS: Overall, the results of 970 patients (553 women, 417 men) could be evaluated. We found 681 gram-positive and 1155 gram-negative bacteria. Pseudomonas aeruginosa was with a detection-rate of 31.1% the most frequent gram-negative pathogen, followed by Proteus mirabilis with 13.7% and various enterobacteria with 28.6%. According to the current KRINKO classification,eight patients with 4MRGN and 34 patients with 3MRGN could be identified. CONCLUSIONS: Our results demonstrate the current spectrum of bacteria in patients with chronic leg ulcers with a variety of gram-negative pathogens, some of which are classified as multi-drug resistant. As a clinical consequence some of the patients require individualized preventive measures and therapy.

[Managing EHEC in hospital routine]. / Krankenhaushygiene: Umgang mit einem EHEC-Ausbruch.

BACKGROUND: During May and June 2011 an outbreak of enterohemorrhagic Escherichia coli (EHEC) occurred in Germany. More than 4000 patients were infected of which 800 developed hemolytic uremic syndrome (HUS) as a severe complication. Reports in the press led to great concern in the general population. Many people with diarrhea reported to hospitals in order to exclude EHEC infections. METHODS: We describe the management of patients with suspected infectious diarrhea at the university hospital of Essen. A hospital with a significant number of immunocompromised patients. RESULTS: One important measure to handle the surge of contagious patients was to establish a multidisciplinary coordination team under leadership and guidance of the Department of Nephrology and the Department of Hospital Hygiene. Suspected infectious patients were separated in a modified emergency room. A new ward for infectious diseases was established to isolate in-patients. CONCLUSION: In our hospital the management of EHEC outbreak enabled us to treat these additional infectious patients without hampering the treatment of the other patients. As a result we plan the implementation of a coordination team for future epidemics.

Fungal colonization and invasive fungal infections following allogeneic BMT using metronidazole, ciprofloxacin and fluconazole or ciprofloxacin and fluconazole as intestinal decontamination.

Invasive fungal infections (IFI) are increasingly diagnosed in patients undergoing allogeneic BMT. We have previously shown that the addition of metronidazole to ciprofloxacin for gastrointestinal bacterial decontamination significantly reduces the incidence of grades II-IV aGVHD by reduction of the anaerobic intestinal bacterial flora. Here, we found that the combined use of ciprofloxacin, metronidazole and fluconazole as antifungal prophylaxis increased intestinal yeast colonization when compared to ciprofloxacin and fluconazole alone (P < 0.01). Based on the EORTC criteria, a total of 18 out of 134 study patients developed IFI: seven of 68 (10%) patients who received metronidazole compared to 11 of the 66 (17%) patients decontaminated without metronidazole developed IFI (log-rank P = 0.36). Lethal IFI occurred in two of seven patients receiving metronidazole and in four of 11 patients without anaerobic decontamination. In conclusion, bacterial intestinal decontamination using metronidazole as an antibiotic with activity against most anaerobic intestinal bacteria significantly increases the intestinal yeast burden without influencing the incidence of IFI in patients undergoing allogeneic BMT.

Susceptibility of Helicobacter pylori to simethicone and other non-antibiotic drugs.

The antifoaming agent simethicone (Lefax), the protease inhibitor gabexate mesilate (FOY), the antimycotic ketoconazole, and the hydroxyl scavangers dimethylsulphoxide (DMSO) and allopurinol were investigated for growth inhibition of Helicobacter pylori and representative strains of other bacterial species. H. pylori were selectively inhibited by 64-128 mg/L of simethicone, 64-128 mg/L gabexate mesilate, and 16-64 mg/L ketoconazole. Dimethylsulphoxide and allopurinol showed no antibacterial effect at concentrations used therapeutically. It is concluded that gabexate mesilate, ketoconazole and, particularly, simethicone are candidates for treatment of H. pylori infection.

Aspergillus antigenuria compared to antigenemia in bone marrow transplant recipients.

The detection of galactomannan antigen in urine was investigated in 26 bone marrow transplant recipients using an Aspergillus latex agglutination test (Pastorex). After modification of the method, which was originally devised for serum testing, the detection limit in native urine was approximately 20 ng/ml. Antigen was found in 79 (36.4%) of 217 serial urine samples, compared to 40 (11.8%) of 340 serum samples. As a rule, antigenuria preceded antigenemia and was more persistent. The sensitivity, specificity, positive predictive value and negative predictive value of antigenuria for autopsy-proven aspergillosis and clinically suspected Aspergillus infection were 57%, 53%, 31% and 77%, respectively, while those of antigenemia were 43%, 53%, 25% and 71%. It is concluded that urine testing is more reliable than serum testing for the detection of Aspergillus galactomannan. The detection of antigen, however, whether in serum or in urine, allows no clear distinction between Aspergillus infection and exposure to non-infectious Aspergillus antigens.

Characterisation of a Helicobacter pylori phage (HP1).

The infection of two Helicobacter pylori strains with a phage-containing supernate of the lysogenic H. pylori strain IMMi 290/89 resulted in a lytic cycle and propagation of phage HP1. In negatively-stained preparations, the empty phage heads measured 55-60 nm in diameter and mature heads measured 50 nm. The flexible, striated phage tail was c. 170 nm in length and 9.5 nm in diameter. The phage showed a mean density of 1.40 g/cm3 in sucrose-density gradients and contained double-stranded DNA c. 22,000 bp in length.

Flocculation of venereal disease research laboratory reagent by Helicobacter pylori.

Helicobacter pylori strains flocculated with Venereal Disease Research Laboratory (VDRL) reagent in a glass slide test. Other pathogenic bacterial and fungal strains were nonreactive. The specific VDRL reaction property of Helicobacter pylori indicates an affinity of the cells for lipoidal substances, and can be used as a diagnostic aid for species identification.