MiBAlert-a new information tool to fight multidrug-resistant bacteria in the hospital setting.

BACKGROUND: Although the timely isolation of patients is an essential intervention to limit spread of drug-resistant bacteria, information about the colonization status is often unavailable or lost when patients are readmitted or transferred between hospitals. Therefore, carriers of drug resistant bacteria are not recognized sufficiently early, and proper and timely isolation precautions are not taken. Consequently, resistant bacteria of public health concerns including vancomycin resistant enterococci (VRE) and methicillin resistant Staphylococcus aureus (MRSA) can spread epidemically. To ensure timely identification and proper isolation of such patients we developed an automatic real-time alert of carriers of drug resistant bacteria. OBJECTIVES: The aim of this paper is to describe the system, called MiBAlert, and share the initial experiences in connection with an outbreak of VRE in the greater Copenhagen area (the Capital region), Denmark. METHODS: We obtained data on cases of VRE from hospitals in Copenhagen during the period when the first version of MiBAlert was implemented and log-data on the use of MiBAlert. Furthermore, a survey was conducted among 88 staff members to investigate their experiences of MiBAlert. RESULTS: The alert is a tool directed toward healthcare personnel accessing the electronic health record (EHR) and those further involved in the care and treatment of the patient. It is based on a web service using data from the national microbiological database, MiBa. MiBAlert is a real-time electronic non-intrusive alert generated automatically in the header of the EHR each time record is accessed. On February 15, 2015 a pilot version of MiBAlert was launched. All positive tests for VRE throughout 1year were shown with alert status by MiBAlert visible to all medical staff with access to EHR. The alert system was automatically updated directly in the EHR across the five hospitals in the Capital region. We found that the system performed satisfactorily, being operational 24/7 all 135 trial days, apart from 72min, for all the hospitals. Of the staff who responded to the survey, 82% considered that MiBAlert overall improved compliance with isolation precautions regarding VRE-positive patients. We found a marked decline of new patients infected or colonized with VRE concomitant with the implementation of MiBAlert and the survey results. CONCLUSION: We found that MiBAlert was a valuable tool in a bundle approach to counter a multiple hospital outbreak of VRE, and that it has a great potential to improve the control of other drug-resistant bacteria.

Synthesis of Oligosilanyl Compounds of Group 4 Metallocenes with the Oxidation State +3.

Recently, we showed that titanocene silyls are much more stable with Ti in the oxidation state +3. The current study demonstrates that analogous Zr and Hf compounds can also be obtained by reaction of a suitable metalate precursor with an oligosilanyl dianion. As the obtained complexes formally possess a d(1) electron configuration, they were investigated using EPR spectroscopy. The corresponding spectra indicate that the compounds can be considered to also exhibit some cyclosilanyl radical anion character. In order to understand the strong preference of disilylated titan(IV)ocenes for reductive elimination, a theoretical study of the thermodynamics of these reactions was conducted, revealing that this behavior is essentially caused by the weak Si-Ti(IV) bond.

High pressure ESR studies of electron self-exchange reactions of organic radicals in solution.

Simple electron self-exchange reactions are often used to study the role of the reaction medium on a chemical process, commonly implying the use of various solvents with different physical properties. In principle, similar studies may be conducted using a single solvent, changing its physical properties by application of elevated pressures, but so far only little information is available on pressure dependent exchange reactions. In this work, we have used a recently constructed high pressure apparatus for use with electron spin resonance (ESR) spectroscopy to investigate simple electron self-exchange reactions involving 2,3-dichloro-5,6-dicyanobenzoquinone (DDQ) and tetracyanoethylene (TCNE) and their respective radical anions as well as TMPPD and its radical cation in three different solvents. The self-exchange was observed by ESR line broadening experiments, yielding rate constants and volumes of activation. The experimental results were compared to theoretical calculations based on Marcus theory and taking into account solvent dynamic effects. The use of elevated pressures has enabled the study of solvent effects without commonly encountered problems like solubility issues or chemical reactions between solvent and solute which sometimes limit the range of useable solvents.

Positioning of micelle-bound peptides by paramagnetic relaxation enhancements.

Many peptides, proteins, and drugs interact with biological membranes, and knowing the mode of binding is essential to understanding their biological functions. To obtain the complete orientation and immersion depth of such a compound, the membrane-mimetic system (micelle) is placed in an aqueous buffer containing the soluble and inert paramagnetic contrast agent Gd(DTPA-BMA). Paramagnetic relaxation enhancements (PREs) of a specific nucleus then depend only on its distance from the surface. The positioning of a structurally characterized compound can be obtained by least-squares fitting of experimental PREs to the micelle center position. This liquid-state NMR approach, which does not rely on isotopic labeling or chemical modification, has been applied to determine the location of the presumed transmembrane region 7 of yeast V-ATPase (TM7) and the membrane-bound antimicrobial peptide CM15 in micelles. TM7 binds in a trans-micelle orientation with the N-terminus being slightly closer to the surface than the C-terminus. CM15 is immersed unexpectedly deep into the micelle with the more hydrophilic side of the helix being closer to the surface than the hydrophobic one.

Electron-self-exchange kinetics of the cyclooctatetraene/cyclooctatetraene radical-anion couple.

Rate constants k(hom) and k(het) are reported for the homogeneous electron-self-exchange and the heterogeneous electrochemical electron-transfer reactions, respectively, of the cyclooctatetraene/cyclooctatetraene(-) (COT/COT(.-)) redox couple. In acetonitrile, the values k(hom) (298 K)=(5+/-3) x 10(5) M(-1) s(-1) and k(het) (295 K)=8 x 10(-3) cm s(-1) are found, whereas slightly faster rates are obtained in dimethylformamide, namely, k(hom) (298 K)=(1.6+/-0.6) x 10(6) M(-1) s(-1) and k(het) (295 K)=2 x 10(-2) cm s(-1). The k(hom) rates are obtained from electron spin resonance (ESR) line broadening whereas the k(het) rates are measured at a mercurized Pt electrode by using Nicolson's method. The slowness of both electron-transfer reactions is caused by the high inner-sphere reorganization energy that results from the inevitable conformational change that takes place upon going from the tub-like COT molecule to the planar COT(.-) anion. The rates are well-understood in terms of Marcus theory, including an additional medium inner-sphere mode which is responsible for the flattening of COT.