Rhinopharynx irrigations and mouthwash with dissolved mupirocin in treatment of MRSA throat colonization - proof-of-concept study.

BACKGROUND: To prevent transmission of, and infection with, meticillin-resistant Staphylococcus aureus (MRSA), eradication treatment of colonized individuals is recommended. Throat colonization is a well-known risk factor for eradication failure. Staphylococcus aureus throat colonization is associated with colonization of the rhinopharynx, but in the currently recommended Danish MRSA eradication strategies, rhinopharynx colonization is not directly targeted. Rhinopharynx colonization could therefore be an important risk factor for prolonged MRSA throat carriage. AIM: To determine whether irrigation and wash of the rhinopharynx and mouth with dissolved mupirocin is a feasible and potentially efficacious supplementary strategy against treatment-resistant MRSA throat carriage. METHODS: The patient study was an open, non-blinded, trial including 20 treatment-resistant MRSA throat carriers. In the study, the patients received a supplementary treatment besides the standard treatment according to the Danish MRSA eradication strategy. The supplementary treatment consisted of rhinopharyngeal irrigation and mouth-gurgling twice a day for 14 days with a mupirocin ointment (22 g 2% ointment per litre of isotonic sterile saline solution) in a 37°C solution. FINDINGS: Eighteen patients (90%) complied with the treatment protocol and none ex-perienced any major adverse events. Out of the 18 patients who finished the study per protocol, 15 (83%) and seven (39%) patients had negative MRSA sampling results one and six months after end of treatment, respectively. CONCLUSION: This study demonstrates the feasibility and clinical potential of also targeting the rhinopharynx and oropharynx in non-systemic throat MRSA eradication strategies.

The disposition of five therapeutically important antimicrobial agents in llamas.

The disposition of five therapeutic antimicrobial agents was studied in llamas (Lama glama) following intravenous bolus administration. Six llamas were each given ampicillin, tobramycin, trimethoprim, sulfamethoxazole, enrofloxacin and ceftiofur at a dose of 12 mg/kg, 1 mg/kg, 3 mg/kg, 15 mg/kg, 5 mg/kg, and 2.2 mg/kg of body weight, respectively, with a wash out period of at least 3 days between treatments. Plasma concentrations of these antimicrobial agents over 12 h following i.v. bolus dosing were determined by reverse phase HPLC. Disposition of the five antimicrobial agents was described by a two compartment open model with elimination from the central compartment, and also by non-compartmental methods. From compartmental analysis, the elimination rate constant, half-life, and apparent volume of distribution in the central compartment were determined. Statistical moment theory was used to determine noncompartmental pharmacokinetic parameters of mean residence time, clearance, and volume of distribution at steady state. Based on the disposition parameters determined, and stated assumptions of likely effective minimum inhibitory concentrations (MIC) a dose and dosing interval for each of five antimicrobial agents were suggested as 6 mg/kg every 12 h for ampicillin; 4 mg/kg once a day or 0.75 mg/kg every 8 h for tobramycin; 3.0 mg/kg/15 mg/kg every 12 h for trimethoprim/sulfamethoxazole; 5 mg/kg every 12 h for enrofloxacin; and 2.2 mg/kg every 12 h for ceftiofur sodium for llamas. Steady-state peak and trough plasma concentrations were also predicted for the drugs in this study for llamas.

Comparison of some European external quality assessment schemes in the field of occupational and environmental medicine.

In most European countries an increasing number of external quality assessment schemes (EQAS) are organized, and it seems appropriate to reinforce collaboration at the European level between organizers of EQAS related to occupational and environmental medicine. Since differences between these EQAS have been recognized, a collaborative project was set up focused on the ways the present occupational and environmental medicine EQAS evaluate results obtained by the same pool of laboratories analysing identical control samples for blood lead. The results confirmed that the samples delivered to the laboratories were homogeneous. Considering the performance as judged by five different schemes the study revealed that laboratories were not ranked identically. For laboratories, which either had a very bad or a very good performance, however, the ranking were comparable. The statistical design of the evaluated EQAS poses problems and requires attention.

Serum ferritin and iron status in mothers and newborn infants.

Iron status, including hemoglobin, S-ferritin, S-iron, S-transferrin, transferrin saturation and the erythrocyte zinc protoporphyrin/hemoglobin (ZPP:Hb) ratio, was evaluated in 85 healthy iron-supplemented mothers at parturition and in 74 of their term newborn infants. Of the mothers, 17% had a S-ferritin level less than 15 micrograms/l (i.e. depleted iron stores), 9.9% had S-ferritin less than 15 micrograms/l and transferrin saturation less than 15% (i.e. latent iron deficiency), and 2.4% had S-ferritin less than 15 micrograms/l, transferrin saturation less than 15% and Hb less than 120 g/l (i.e. iron deficiency anemia). Newborn infants had higher S-ferritin than mothers: median 128 micrograms/l versus 21 micrograms/l (p less than 0.0001), higher transferrin saturation: 48% vs. 21% (p less than 0.0001), and higher ZPP:Hb ratio: 74 mumol/mol Hb vs. 41 mumol/mol Hb (p less than 0.0001). During the first 5 post-natal days, median S-ferritin rose from 128 to 236 micrograms/l (p less than 0.0001). S-ferritin appeared to be the best single indicator of maternal iron status. Ferritin levels in newborn infants were correlated to levels in mothers (rs = 0.36, p less than 0.01), indicating that fetal iron reserves are dependent on maternal iron stores.