Correlation between Nosocomial Carriage of Vancomycin-Resistant Enterococci and Antimicrobial Use in Taiwan.

A rapid increase of nosocomial vancomycin-resistant enterococci (VRE) from 23.3% in 2009 to 44.5% in 2018 among all the medical centers in Taiwan was found. The aim of the study was to explore the relationship between antimicrobial usage and prevalence of VRE. We conducted the study between January 2010 and December 2019 in a tertiary teaching hospital in Taiwan. Antibiotic consumption was expressed as defined daily doses (DDDs) per 1,000 patient-days (PDs). The trend in antibiotic consumption and VRE prevalence were analyzed by regression analysis with yearly data. Pearson's correlation analysis was used to determine the relationship between antibiotic consumption and the prevalence of VRE. The total consumption of antibiotics increased significantly from 450.6 DDDs/1,000 PDs in 2010 to 520.1 DDDs/1,000 PDs in 2019 (P = 0.013). Positive correlations were found between the prevalence of vancomycin-resistant Enterococcus faecium and the consumption of amoxicillin/clavulanate, vancomycin, and carbapenems, which included meropenem (P < 0.05). The increase in total VRE prevalence was significantly correlated with increased consumption of vancomycin and carbapenems, which included meropenem (P < 0.05). This 10-year study in a hospital demonstrated changes in antimicrobial use, which may have affected VRE prevalence in the hospital. We found a rise in nosocomial VRE prevalence was associated with the use of specific antimicrobial agents.

Comparison of agomelatine and selective serotonin reuptake inhibitors/serotonin-norepinephrine reuptake inhibitors in major depressive disorder: A meta-analysis of head-to-head randomized clinical trials.

OBJECTIVE: Agomelatine is a new antidepressant with unique melatonin receptor type 1A (MTNR1A) and 1B ( MTNR1B) agonism and serotonergic receptor 5-hydroxytryptamine receptor 2C (5-HT-2C) antagonism. Several studies of patients with major depressive disorder (MDD) have confirmed the superior efficacy and safety of agomelatine in comparison with established treatments, such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). This meta-analysis comprehensively shows the efficacy, acceptability, and safety of agomelatine in comparison with SSRIs and SNRIs used as antidepressants in MDD. METHOD: Comprehensive electronic database searches were performed to identify reports of head-to-head randomized controlled trials that have compared agomelatine with SSRIs or SNRIs in terms of efficacy/effectiveness in treating MDD. Response and remission rates at both acute (6-12 weeks) and follow-up (24 weeks) phases, Clinical Global Impression-Improvement Scale response and remission rates, changes in depression scale scores, improvements in subjective sleep, dropout rates, and side effect rates were extracted and analysed. RESULTS: The meta-analysis included six head-to-head trials involving 1871 patients. In the acute phase, agomelatine had higher response rates (relative risk (RR) 1.08, 95% confidence interval (CI) 1.02-1.15) compared to SSRIs and SNRIs. In the remission analysis, only acute remission rates (RR 1.12, 95% CI 1.01-1.24) significantly differed. The action of agomelatine was superior on the Leeds Sleep Evaluation Questionnaire-Quality of Sleep score (mean difference 4.05, 95% CI 0.61-7.49). Discontinuation due to inefficacy did not differ between agomelatine and SSRIs/SNRIs (RR 0.74, 95% CI 0.42-1.28). Compared to SSRIs and SNRIs, however, agomelatine revealed a lower rate of discontinuation due to side effects (RR 0.38, 95% CI 0.25-0.57). CONCLUSIONS: Agomelatine has significantly higher efficacy and potential acceptability compared to SSRIs and SNRIs when treating MDD. However, the difference in efficacy is not considered clinically relevant. Because of its unique chronobiotic effects, agomelatine may be useful for the management of some MDD patients with circadian disturbance.

Nickel complexes incorporating an amido phosphine chelate with a pendant amine arm: synthesis, structure, and catalytic Kumada coupling.

A series of organonickel(II) complexes incorporating an amido phosphine ligand tethered with an amino pendant have been prepared and characterized. Deprotonation of N-(dimethylaminoethyl)-2-diphenylphosphinoaniline (H[PNN]) with one equivalent of n-BuLi in ethereal or hydrocarbon solutions at -35 °C generates cleanly dimeric {Li[PNN]}(2) as yellow crystals. The reaction of NiCl(2)(DME) with {Li[PNN]}(2) in THF at -35 °C affords green crystalline [PNN]NiCl. Treating [PNN]NiCl with NaX in acetone solutions gives [PNN]NiX (X = Br, I). Alkylation or arylation of [PNN]NiCl with appropriate Grignard reagents in THF at -35 °C produces red crystalline [PNN]NiR (R = Me, Et, i-Bu, n-hexyl, CH(2)Ph, Ph). The chloride complex [PNN]NiCl was found to be an active catalyst precursor for Kumada coupling reactions of PhX (X = I, Br, Cl) with aryl or alkyl Grignard reagents, including those containing ß-hydrogen atoms. The X-ray structures of {Li[PNN]}(2) and [PNN]NiX (X = Cl, Br, Me, Et, n-hexyl) are reported.

Amido phosphine complexes of zinc: synthesis, structure, and catalytic ring-opening polymerization of epsilon-caprolactone.

A series of diarylamido phosphine ligands of the type N-(2-dihydrocarbylphosphinophenyl)-2,6-dialkylanilide 1a-d have been prepared and employed to investigate the coordination chemistry of zinc. Protonolysis of ZnMe2 with one equivalent of N-(2-diphenylphosphinophenyl)-2,6-dimethylaniline (H[1a]) produced a mixture of [1a]ZnMe (2a) and Zn[1a]2 (4a), whereas that involving ZnEt2 gave exclusively the three-coordinate [1a]ZnEt (3a). In contrast, treatment of ZnR2 (R = Me, Et) with N-(2-diphenylphosphinophenyl)-2,6-diisopropylaniline (H[1b]), N-(2-diisopropylphosphinophenyl)-2,6-dimethylaniline (H[1c]), or N-(2-diisopropylphosphinophenyl)-2,6-diisopropylaniline (H[1d]) under similar conditions generated quantitatively the corresponding three-coordinate zinc methyl 2b-d and zinc ethyl 3b-d. The bis-ligand complexes 4a,b,d were isolated by either protonolysis of alkyls 2-3 with one equivalent of H[1] or metathesis of ZnX2 (X = Cl, OAc) with the corresponding lithium derivatives 5. Attempts to prepare [1a-d]ZnX (X = Cl, OAc) were not successful regardless of stoichiometry of the starting materials employed. Alcoholysis of zinc alkyls 2-3 led undesirably to protonation on the amido nitrogen donor of 1, highlighting perhaps its higher basicity than alkyls. The reaction of ZnCl2 with H[1c] generated the phosphorus-bound adduct {H[1c]ZnCl(mu-Cl)}2 (6c). Interestingly, attempts to deprotonate 6c with n-BuLi produced unexpectedly the alkylated product [1c]Zn(n-Bu) (7c) instead of [1c]ZnCl; analogous reactions employing NEt3 led to Lewis base substitution to give H[1c] and [ZnCl2(NEt3)]2. Structural characterization of all new compounds was achieved by multi-nuclear NMR spectroscopy (1H, 13C, 31P, and 7Li) and X-ray crystallography (2c-d, 3c, 4d, 5c-d, and 6c) where appropriate. On the basis of the NMR and X-ray data, in combination with the synthetic investigations, the steric nature of these amido phosphine ligands is recognized to follow the order of 1a < 1b < 1c < 1d. Interestingly, zinc alkyls 2-3 are all active initiators for catalytic ring-opening polymerization of ε-caprolactone whereas the bis-ligand complexes 4 are not.

Fluorinated diarylamido complexes of lithium, zirconium, and hafnium.

Deprotonation of N-(2-fluorophenyl)-2,6-diisopropylaniline (H[ (i) PrAr-NF]) with 1 equiv of n-BuLi in toluene at -35 degrees C produced cleanly [ (i) PrAr-NF]Li. Subsequent recrystallization of [ (i) PrAr-NF]Li in diethyl ether generated the bis(ether) adduct [ (i) PrAr-NF]Li(OEt 2) 2. An X-ray study of [ (i) PrAr-NF]Li(OEt 2) 2 showed it to be a four-coordinate species with the coordination of the fluorine atom to the lithium center. The reactions of [ (i) PrAr-NF]Li with MCl 4(THF) 2 (M = Zr, Hf), regardless of the stoichiometry employed, afforded the corresponding dichloride complexes [ (i) PrAr-NF] 2MCl 2 (M = Zr, Hf). Alkylation of [ (i) PrAr-NF] 2MCl 2 with a variety of Grignard reagents generated [ (i) PrAr-NF] 2MR 2 (M = Zr, Hf; R = Me, i-Bu, CH 2Ph). The X-ray structures of [ (i) PrAr-NF] 2ZrCl 2, [ (i) PrAr-NF] 2HfCl 2, [ (i) PrAr-NF] 2ZrMe 2, [ (i) PrAr-NF] 2Zr( i-Bu) 2, and [ (i) PrAr-NF] 2Hf(CH 2Ph) 2 are all indicative of the coordination of the fluorine atoms to these group 4 metals, leading to a C 2-symmetric, distorted octahedral geometry for these molecules.

Benzene C-H activation by platinum(II) complexes of bis(2-diphenylphosphinophenyl)amide.

The amido diphosphine complexes [PNP]PtMe and [PNP]PtOTf, where [PNP]- is bis(2-diphenylphosphinophenyl)amide, effectively activate the benzene C-H bond in the presence of an appropriate Lewis acid or base, leading to the formation of [PNP]PtPh quantitatively.

Organoaluminium complexes incorporating an amido phosphine chelate with a pendant amine arm.

The palladium-catalyzed aryl amination of 1-bromo-2-fluorobenzene with N,N-dimethylethylenediamine quantitatively produces N-(dimethylaminoethyl)-2-fluoroaniline, which subsequently reacts with KPPh2 in 1,4-dioxane to afford N-(dimethylaminoethyl)-2-diphenylphosphinoaniline (H[PNN]). The reactions of trialkylaluminium with H[PNN] in toluene generate the corresponding aluminium dialkyl complexes [PNN]AlR2 (R = Me, Et, i-Bu). The solution NMR spectroscopic and X-ray crystallographic studies are indicative of a trigonal bipyramidal geometry for these aluminium complexes in which the amino nitrogen atom is trans to the phosphorus donor of the [PNN]- ligand. This study presents rare examples of structurally characterized, five-coordinate aluminium hydrocarbyl complexes supported by phosphine-derived ligands.

Amido phosphine complexes of zinc.

The first examples of amido phosphine complexes of zinc have been prepared. Addition of N-(2-diphenylphosphinophenyl)-2,6-diisopropylaniline (H[NP]) to ZnMe(2) or ZnEt(2) in diethyl ether at -35 degrees C generated the monomeric, three-coordinate [NP]ZnR (R = Me, Et), while the metathesis reaction of ZnCl(2) with [NP]Li(THF)(2) in diethyl ether at -35 degrees C produced homoleptic [NP](2)Zn.