Predictors of colonization with Staphylococcus species among patients scheduled for cardiac and orthopedic interventions at tertiary care hospitals in north-eastern Germany-a prevalence screening study.

As methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in humans are a global challenge. In Mecklenburg and Western Pomerania (Germany) 1,517 patients who underwent surgical interventions were systematically screened for MRSA and MSSA colonization on the day of hospital admission and discharge. Demographic data, risk factors and colonization status of the (i) nose, (ii) throat, (iii) groin, and (iv) thorax or site of surgical intervention were determined. Of the 1,433 patients who were included for further evaluation, 331 (23.1%) were colonized with MSSA, while only 17 (1.2%) were MRSA carriers on the day of hospital admission. A combination of nose, throat and groin swabs returned a detection rate of 98.3% for MSSA/MRSA. Trauma patients had lower prevalence of MRSA/MSSA (OR 0.524, 95% CI: 0.37-0.75; p < 0.001) than patients with intended orthopedic interventions. Males showed significantly higher nasal S. aureus carrier rates than females (odds ratio (OR) = 1.478; 95% CI: 1.14-1.92; p = 0.003). Nasal S. aureus colonization was less frequent among male smokers as compared to non-smokers (chi2 = 16.801; phi = 0.154; p < 0.001). Age, gender and smoking had a significant influence on S. aureus colonization. Combining at least three different swabbing sites should be considered for standard screening procedure to determine S. aureus colonization at patients scheduled for cardiac or orthopedic interventions at tertiary care hospitals.

[Interface between preclinical and clinical trauma care: Analysis of the processes in a trauma network]. / Schnittstelle präklinische/klinische Traumaversorgung: Analyse der Abläufe in einem Traumanetzwerk.

INTRODUCTION: In the initial treatment of severely injured patients a good cooperation of the emergency medical service (EMS) with the hospital team is mandatory. The aim of this investigation was to evaluate the quality of cooperation between hospitals working within a trauma network and the rescue service and to develop a tool allowing assessment of the preclinical and clinical interface. METHODS: Specific surveys concerning preclinical management and transfer to the target hospital were developed within a modified Delphi process. Injured trauma patients were included if the EMS involved was participating in the network and they were transferred to one of the participating hospitals. RESULTS: Over an 11-month period a total of 360 patients were included in the study. The notification of transferring injured patients to the target hospital was carried out in a regular manner. Transport accompanied by an emergency physician occurred in 97% of the cases and no emergency physician was available although needed in only 1% of cases. Correct choice of target hospital was documented in 98.2%. The average waiting time for transferring the patient to the hospital team was 0.15 min. In 95.7% of cases a hospital physician was available to directly receive the patient in the emergency room. On a scale ranging from 1 (poor) to 10 (very good) clinical personnel as well as rescue teams rated the cooperation between both with a median of 10 points (IQR 8;10). From the clinicians point of view airway and circulation problems and external bleeding were correctly treated in the preclinical setting (airway 93.9%, circulation 97.3% and external bleeding 95.3%); however, for extremity injuries only in 78.5% of the cases. CONCLUSION: This survey presents an adequate tool to identify weak spots within the primary management and to point out elements for improvement.

Detection and partial characterization of activity of chlorophyll synthetase in etioplast membranes.

The esterification of chlorophyllide a was investigated an irradiated etioplast-membrane fractions ('broken etioplasts') from oat seedlings (Avena sativa L.). As a substrate, [1(-3)H]geranylgeraniol and its monophosphate and diphosphate derivatives were prepared by chemical synthesis. Geranylgeraniol and its monphosphate derivative are incorporated into chlorophyll only in the presence of ATP whereas the diphosphate derivative is incorporated also without ATP. The yield of esterified chlorophyll is 80-90% of chlorophyllide with saturating substrate concentrations. The term 'chlorophyll synthetase' is used to describe the enzyme activity which is different from chlorophyllase. Other substrates are phytol and farnesol either with ATP or as the diphosphate derivatives. The relative specificity of 'chlorophyll synthetase' for thse substrates is geranylgeraniol:phytol:farnesol = 6:3:1. In these experiments in vitro, a new chlorphyll esterified with farnesol was detected which does not occur in intact plants. Geraniol and n-pentadecanol are no substrates for the enzyme. Protochlorphyllide which is present in non-irradiated etioplast membrane fractions is not esterified under the same conditions.