Emergence and dissemination of a linezolid-resistant Staphylococcus capitis clone in Europe.

Objectives: We investigated the epidemiological, clinical, microbiological and genetic characteristics of linezolid-resistant (LZR) Staphylococcus capitis isolates from French ICUs, and compared them with LZR S. capitis isolates from other European countries. Methods: All LZR isolates were subjected to antimicrobial susceptibility testing (AST) and the presence of cfr and optrA genes as well as mutations in the 23S rRNA and ribosomal proteins were investigated using specific PCR with sequencing. The genetic relationship between isolates was investigated using PFGE and WGS. Epidemiological data concerning LZR S. capitis were collected retrospectively in French microbiology laboratories. Results: Twenty-one LZR isolates were studied: 9 from France, 11 from Greece and 1 from Finland. All were resistant to methicillin and aminoglycosides. In addition, this unusual AST profile was identified in S. capitis isolates from seven French hospitals, and represented up to 12% of the S. capitis isolates in one centre. A G2576T mutation in 23S rRNA was identified in all isolates; cfr and optrA genes were absent. All isolates belonged to the same clone on the basis of their PFGE profiles, whatever their geographical origin. WGS found at most 212 SNPs between core genomes of the LZR isolates. Conclusions: We identified and characterized an LZR S. capitis clone disseminated in three European countries, harbouring the same multiple resistance and a G2576T mutation in the 23S rRNA. The possible unrecognized wider distribution of this clone, belonging to a species classically regarded as a low-virulence skin colonizer, is of major concern not least because of the increasing use of oxazolidinones.

[Electronic parent-child health records--potentials, aims and international experience]. / Elektronischer Mutter(Eltern)-Kind Pass--Möglichkeiten, Zielsetzungen und internationale Erfahrungen.

AIM OF THE REVIEW: Against the background of a planned re-orientation of the Austrian maternity and child programme, which might include an electronic instead of paper-based realisation, this article aims to give an overview of international pilot projects of electronic parent-child preventive care initiatives (ePCPI) as well as their aims, potentials and constraints. METHODS: A literature search in databases and hand search for international (pilot) projects was undertaken. RESULTS: 9 of the 30 identified ePCPI can be treated as electronic parent and/or child health records, which have been realised within a comprehensive electronic health record, as an electronic version of a paper-based document or as a centre-based IT solution. Only a few ePCPI use the additional potential of health services planning and evaluation besides core components (e. g., administration of care) and facilitate systemic learning based on feedback and evaluation -cycles. CONCLUSION: Based on experiences from international ePCPIs some core components of successful planning and implementation, like the definition of aims and their monitoring, the constitution of teams responsible for planning and conception and the early involvement of end-users and stakeholders, should be considered to minimise avoidable mistakes. Consequent technology assessments, including those of IT-based interventions, are required to allow a reflected approach.

[Multidrug-resistant tuberculosis: A management problem that weighs heavily on the University Hospitals of Strasbourg]. / Tuberculose multirésistante : une prise en charge qui pèse lourd aux hôpitaux universitaires de Strasbourg.

INTRODUCTION: Multidrug-resistant tuberculosis (MDR-TB) is a major public health problem with great regional disparities. The aim of this study was to describe the epidemiological, clinical, and therapeutics aspects of MDR-TB in Alsace, France. PATIENTS AND METHODS: A 10 years retrospective study, conducted for the years 2006 to 2016, of all MDR-TB cases diagnosed in Alsace and particularly in Strasbourg University Hospitals. RESULTS: We included 22 patients with MDR-TB of whom 90% originated from Eastern Europe, 13.6% had extensively-resistant strains, and 41% reported previously treated tuberculosis. Clinically, 86,4% had a pulmonary form of tuberculosis. The mean length of antibiotic treatment was 21 months with several changes of drugs because of severe side effects. The mean follow-up was 48 months, during which time 2 patients were lost from contact and the 20 remaining patients were cured. CONCLUSIONS: Management of MDR-TB is a real social and medical challenge. Our study shows that the therapeutic protocols used in the management of these patients lead to an unusually high rate of success despite the occurrence of several, sometimes severe, side effects.

Sputum smear-positive pulmonary tuberculosis: Is sputum smear examination required to discontinue airborne precautions?

OBJECTIVE: Our aim was to evaluate the criteria required to discontinue airborne precautions for patients presenting with sputum smear-positive pulmonary tuberculosis as the need for sputum smear examinations is still a matter of debate. METHOD: We conducted a retrospective study in the University Hospitals of Strasbourg (France) from July 2011 to July 2013. Our aim was to describe the results of sputum smear examinations and cultures obtained from treated patients presenting with drug-sensitive pulmonary tuberculosis. We included 97 patients in the study. CONCLUSION: Nearly half of patients for whom a sputum smear examination was performed had a negative sputum direct examination but a positive culture. According to the literature, those patients are still likely to be contagious. This questions the safety of discontinuing airborne precautions in this situation. We also observed a great disparity in physicians' behaviors. Only half of them waited to get a negative sputum direct examination before discontinuing airborne precautions.

The Dolly case, the Polly drug, and the morality of human cloning.

The year 1996 witnessed the cloning of the lamb Dolly, based on the revolutionary somatic cell nuclear transfer (SCNT) technique, developed by researchers from the Roslin Institute in Edinburgh, Scotland. This fact marked a relevant biotechnoscientific innovation, with probable significant consequences in the field of public health, since in principle it allows for expanding possibilities for the reproductive autonomy of infertile couples and carriers of diseases of mitochondrial origin. This article expounds on 1) the experiment's technical data and the theoretical implications for the biological sciences; 2) the public's perception thereof and the main international documents aimed at the legal and moral regulation of the technique; and 3) the moral arguments for and against cloning, from the point of view of consequentialist moral theory. We conclude that in the current stage of the debate on the morality of cloning, in which there are no cogent deontological arguments either for or against, weighing the probability of risks and benefits is the only reasonable way of dealing with the issue in societies that consider themselves democratic, pluralistic, and tolerant.

[Bioethics and health care technology assessment]. / Bioética e avaliação tecnológica em saúde.

The simultaneous existence of a biotechnoscientific paradigm (which emphasizes technological incorporation) and a culture of limits (which selects technologies) challenges current health systems, raising ethical and political discussions as to the choices to be made. Health care technology assessment is mainly concerned with the consequences of health care and health care policies. Thus, there is significant overlap between this activity and bioethics, even though they are different fields of knowledge. Although the importance of ethical and social issues arising in technology assessment has been recognized, most publications emphasize only methodological and scientific aspects. There are different interests involved in technological incorporation, and many value conflicts arise. Ethical implications include those related to clinical trials, medical care assessment, incorporation of technology, resource allocation, equity, and the effectiveness gap. Incorporating the ethical dimension into technology assessment will foster a better understanding of health care practice and progress in its improvement.

Paradigm shift, metamorphosis of medical ethics, and the rise of bioethics.

Both the increasing incorporation of medical technology and new social demands (including those for health care) beginning in the 1960s have brought about significant changes in medical practice. This situation has in turn sparked a growth in the philosophical debate over problems pertaining to ethical practice. These issues no longer find answers in the Hippocratic ethical model. The authors believe that the crisis in Hippocratic ethics could be described as a period of paradigm shift in which a new set of values appears to be emerging. Beginning with the bioethics movement, the authors expound on the different ethical theories applied to medical practice and conclude that principlism is the most appropriate approach for solving the new moral dilemma imposed on clinical practice.

Ethics and animal experimentation: what is debated?

The purpose of this article is to raise some points for an understanding of the contemporary debate over the ethics of using animals in scientific experiments. We present the various positions from scientific and moral perspectives establishing different ways of viewing animals, as well as several concepts like 'animal ethics', 'animal rights', and 'animal welfare'. The paper thus aims to analyze the importance and growth of this debate, while proposing to expand the academic approach to this theme in the field of health.

[Bioethical principles in public health: limitations and proposals]. / Principios bioéticos en salud pública: limitaciones y propuestas.

We propose to analyze the specificity of ethical problems in public health issues and to elucidate the applicability of principlism as a problem-solving strategy in this realm. Although well-established in clinical ethics, principlism is not an adequate model to be used in public health, since it is basically intended to serve as a moral guide in the physician-patient encounter. We discuss the possible adequacy of principles like "solidarity", "ontic responsibility" (as proposed by Jonas), and "caring or diaconal responsibility" as presented by Lévinas. Solidarity appears to be insufficiently specified, whereas the other two perspectives may be adapted to public health issues by bringing together Jonas' ontological and Lévinas' transcendental concerns to form a principle of protection that might better serve the purposes of such an ethics. This principle would help to identify more clearly the goals and agents involved in the implementation of public policies that are expected to be both morally correct and pragmatically effective.

[Ethical implications of domestic violence against child for the health care professionals]. / Implicações éticas da violência doméstica contra a criança para profissionais de saúde.

Based upon some problems faced by health professionals in the care of abused children, this is a discussion of the ethical implications in family interventions aiming to protect these children. Accepting the prima facie principle that violence is morally wrong, some issues related to the children's rights as well as some ethical theories such as consequentialism, utilitarianism and deontology are discussed. The conclusion is that the protection of these children is morally justifiable and the maintenance of the families' unity should always be attempted.

[Legal questions regarding medical centers : Positions and perspectives]. / Rechtsfragen zum Medizinischen Versorgungszentrum : Positionen und Ausblicke.

Medical centers were introduced into the system of statutory health insurance as contractual service providers by the Statutory Health Insurance Modernization Act of 2003. Since 2004 in addition to accredited physicians, authorized physicians, and authorized medical facilities, approved medical centers can also participate in offering contractual care. The introduction of medical centers was intended to permit a new form of patient management that was considered to have the advantage of facilitating close cooperation between the different medical specialties as well as non-medical health care providers.