Combining VITEK® 2 with colistin agar dilution screening assist timely reporting of colistin susceptibility.

OBJECTIVES: The rise in carbapenem resistance among Gram-negative bacteria has renewed interest in colistin. Recently, the EUCAST-CLSI Polymyxin Breakpoints Working Group declared that broth microdilution (BMD) is the only valid method for colistin susceptibility testing. BMD is not easily incorporated into the routine work of clinical laboratories, and usually this test is incorporated serially, resulting in delayed susceptibility reporting. We tested a strategy of combining VITEK® 2 with a 2 µg/mL colistin agar dilution (VITEK® 2/AD) screening plate to improve performance and time to reporting of colistin susceptibility. METHODS: Colistin susceptibility for 364 clinical isolates was determined by VITEK® 2/AD and compared with the reference standard BMD according to the ISO 20776-1:2007 and CLSI guidelines. The EUCAST colistin susceptibility breakpoint of ≤2 µg/mL was used. Escherichia coli NCTC 13846 served as quality control strain. Agreement, very major error (VME) and major error rates were determined using ISO 20776-2:2007. RESULTS: The VME rate for VITEK® 2 alone was 30.6% (15/49, 95% CI 18.3-45.4%), and was reduced to 10.2% (5/49, 95% CI 3.4-22.2%) using the VITEK® 2/AD combined testing. The combined testing had categorical agreement with BMD of 97% (354/364, 95% CI 95.0-98.7%), and a major error (ME) rate of 1.6% (5/315, 95% CI 0.5-3.7%). Using the combined testing, even against challenging strains, 349 (95.8%, 95% CI 93.3-97.7%) colistin susceptibility results could be reported, and only 15 isolates required further analysis by BMD. DISCUSSION: Our method is simple to apply and allows rapid reporting of colistin susceptibility.

The negative impact of antibiotic resistance.

Antibacterial therapy is one of the most important medical developments of the twentieth century; however, the spread of resistance in healthcare settings and in the community threatens the enormous gains made by the availability of antibiotic therapy. Infections caused by resistant bacteria lead to up to two-fold higher rates of adverse outcomes compared with similar infections caused by susceptible strains. These adverse outcomes may be clinical or economic and reflect primarily the failure or delay of antibiotic treatment. The magnitude of these adverse outcomes will be more pronounced as disease severity, strain virulence, or host vulnerability increases. The negative impacts of antibacterial resistance can be measured at the patient level by increased morbidity and mortality, at the healthcare level by increased resource utilization, higher costs and reduced hospital activity and at the society level by antibiotic treatment guidelines favouring increasingly broad-spectrum empiric therapy. In this review we will discuss the negative impact of antibiotic resistance on patients, the healthcare system and society.

A case-control study to identify predictors of 14-day mortality following carbapenem-resistant Acinetobacter baumannii bacteraemia.

Carbapenem-resistant Acinetobacter baumannii (CRAB) is an increasingly common nosocomial pathogen. We sought to identify clinical and microbiological predictors of 14-day mortality among patients with CRAB bacteraemia. This case-control study included all adult patients in one Israeli hospital with CRAB on blood culture between July 2008 and June 2011. Cases were defined as patients who died within 14 days of bacteraemia onset and controls as patients who survived over 14 days. Sequence-typing of the blaOXA-51-like gene and REP-PCR identified CRAB clone groups. Logistic regression was performed to analyze predictors of 14-day all-cause mortality. To correct for differences in treatment onset, Cox regression was used to examine the effect of receiving an active antibiotic. Eighty-three cases and 89 controls were included. Six major CRAB clone groups were identified, with 14-day mortality ranging from 17 to 66%. Independent predictors of 14-day mortality were severity of illness (OR = 1.38 for each 1-point increase in Sequential Organ Failure Assessment (SOFA) score; 95% CI, 1.21, 1.56), independence in activities of daily living (ADL) on admission (OR = 3.40; 95% CI, 1.20, 9.67, for fully dependent vs. independent), surgery before bacteraemia (OR = 0.25; 95% CI, 0.11, 0.59) and clone group (OR = 7.76; 95% CI, 2.52, 23.85, for the most virulent group vs. the reference group). In the multivariate Cox model using a propensity score to adjust for SOFA, clone, ADL and surgery, active antibiotic treatment was protective (HR = 0.30; 95% CI, 0.15, 0.60). Differences in virulence between CRAB clones may partly explain heterogeneous results in previous studies of mortality following CRAB infection.

Risk factors for colonization with extended-spectrum beta-lactamase-producing enterobacteriaceae on admission to rehabilitation centres.

Patients newly admitted to rehabilitation centres are at high risk of colonization with multidrug-resistant bacteria because many of them have experienced prolonged stays in other healthcare settings and have had high exposure to antibiotics. We conducted a prospective study to determine the prevalence of and risk factors for colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) in this population. Subjects were screened by rectal swab for ESBL-PE within 2 days of admission. Swabs were plated on chromagar ESBL plates and the presence of ESBL was verified by a central laboratory. A multilevel mixed effects model was used to identify risk factors for ESBL-PE colonization. Of 2873 patients screened, 748 (26.0%) were positive for ESBL-PE. The variables identified as independently associated with ESBL-PE colonization were: recent stay in an acute-care hospital for over 2 weeks (OR=1.34; 95% CI, 1.12, 1.6), history of colonization with ESBL-PE (OR=2.97; 95% CI, 1.99, 4.43), unconsciousness on admission (OR=2.59; 95% CI, 1.55, 4.34), surgery or invasive procedure in the past year (OR=1.49; 95% CI, 1.2, 1.86) and antibiotic treatment in the past month (OR=1.80; 95% CI, 1.45, 2.22). The predictive accuracy of the model was low (area under the ROC curve 0.656). These results indicate that ESBL-PE colonization is common upon admission to rehabilitation centres. Some risk factors for ESBL-PE colonization are similar to those described previously; however, newly identified factors may be specific to rehabilitation populations. The high prevalence and low ability to stratify by risk factors may guide infection control and empirical treatment strategies in rehabilitation settings.

[Oral fluid nitrate reductase complex activity in teenagers dependent on oral hygiene level and DMFT-index].

This research is directed to determine the influence of carious process at the stage of forming of constant occlusion on nitratereductase complex activity in the oral liquid. The correlation between of nitratereductase complex activity and DMF index, as well as the sex and the age of children with variable and constant occlusions was discovered. It is possible to estimate objectively a condition of a oral cavity due to nitratereductase complex activity.

[The experimental and clinical validation of the use of a polikatan preparation in periodontal diseases]. / Eksperimental'no-klinicheskoe obosnovanie primeneniia preparata polikatan pri zabolevaniiakh parodonta.

Polycatane, a bischofite-based drug (bischofite is a mineral containing up to 95% dry residue of MgCl2 x 6H2O), exerted antiinflammatory and bacteriostatic effects and stimulated phagocytosis and healing of burn infected ulcer in the buccal mucosa of experimental animals. The drug was effective in the treatment of patients with chronic catarrhal gingivitis and generalized periodontitis of light and medium severity. By its antiinflammatory and wound-healing effects polycatane is superior to polyminerol, the reference drug.

[Clinical and experimental rationale of policatan administration in upper respiratory tract inflammation]. / Kliniko-éksperimental'noe obosnovanie primenenie polikatana pri vospalitel'nykh zabolevaniiakh verkhikh dykhatel'nykh putei.

Experimental and clinical trials of policatan in ENT inflammation have established that maximal antiinflammatory effect of the drug manifests in experimental serotonin, histamine and corragenin edema, less pronounced--in formaline-induced edema. The drug accelerated healing of infected burn ulcer in rabbit nose by 37%. This may be explained not only antiinflammatory effect of policatan, but also by stimulation of macrophage phagocytosis and bacteriostatic potential. Policatan proved effective in acute and chronic maxillary sinusitis, chronic frontal sinusitis and rhinitis, chronic hyperplastic maxilloethmoiditis. The drug reduced contamination with pathogenic and opportunistic microflora and reestablished saprophyte microflora.

Driving through: postpartum care during World War II.

In 1996, public outcry over shortened hospital stays for new mothers and their infants led to the passage of a federal law banning "drive-through deliveries." This recent round of brief postpartum stays is not unprecedented. During World War II, a baby boom overwhelmed maternity facilities in American hospitals. Hospital births became more popular and accessible as the Emergency Maternal and Infant Care program subsidized obstetric care for servicemen's wives. Although protocols before the war had called for prolonged bed rest in the puerperium, medical theory was quickly revised as crowded hospitals were forced to discharge mothers after 24 hours. To compensate for short inpatient stays, community-based services such as visiting nursing care, postnatal homes, and prenatal classes evolved to support new mothers. Fueled by rhetoric that identified maternal-child health as a critical factor in military morale, postpartum care during the war years remained comprehensive despite short hospital stays. The wartime experience offers a model of alternatives to legislation for ensuring adequate care of postpartum women.

[The anti-inflammatory action of the mineral bischofite]. / Protivovospalitel'noe deistvie minerala bishofit.

The anti-inflammatory effect of local application of a solution of the mineral bischofite was demonstrated in experiments with edema of the rat foot caused by phlogogenic agents serotonin, histamine, carragheenin, and formaldehyde. Per os administration of the solution increased the survival of mice with burns of the skin on the hind part of the body and reduced 1.74-fold the time of healing of a burn ulcer of the oral mucosa in a rabbit. The mineral bischofite stimulates phagocytizing activity of neutrophils and produces a bacteriostatic effect.

Turn-of-the-century nursing perspectives on venereal disease.

In the early 1900s, nurses, feminists, and social reformers focused on venereal disease as a symbol of women's powerlessness. Authors in popular literature and nursing journals debated the ethics of the "medical secret," whereby physicians collaborated with their male patients to keep wives uniformed of the risk of infection. The nurses Lavinia Dock and Emma Goldman used the topic of venereal disease as a springboard to discuss their contrasting feminist ideologies. Their writings provide a context for current debates about sexual partner notification for HIV and nurses' role in political activism.

Turn-of-the-century nursing perspectives on venereal disease.

In the early 1900s, nurses, feminists, and social reformers focused on venereal disease as a symbol of women's powerlessness. Authors in popular literature and nursing journals debated the ethics of the "medical secret," whereby physicians collaborated with their male patients to keep wives uninformed of the risk of infection. The nurses Lavinia Dock and Emma Goldman used the topic of venereal disease as a springboard to discuss their contrasting feminist ideologies. Their writings provide a context for current debates about sexual partner notification for HIV and nurses' role in political activism.