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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  GMS Infectious Diseases; VOL: 4; DOC02 /20160607/
    Publication Date: 2016-06-07
    Description: For calculated initial antifungal therapy, knowledge on parallel and cross-resistances are vitally important particularly in the case of multiresistant isolates. Based on a strain collection of 1,062 yeast isolates from a German/Austrian multicentre study, susceptibility pattern analysis (SPA) was used to determine the proportion of parallel and cross-resistances to eight antifungal agents (AFAs) encompassing flucytosine, amphotericin B, azoles (fluconazole, voriconazole and posaconazole) and echinocandins (caspofungin, micafungin and anidulafungin). A total of 414 (39.0%) isolates were resistant for one or more of the AFAs. Resistance to one AFA was shown for 18.1% of all isolates. For 222 isolates (20.9%), resistance to two to seven AFAs was noted (7.7%; 7.7%; 3.6%; 1.0%; 0.7% and 0.2% to 2, 3, 4, 5, 6 and 7 antifungal compounds, respectively). Partial parallel resistances within the azole and echinocandin classes, respectively, were found for 81 (7.6%) and 70 (6.6%) isolates. Complete parallel resistances for azoles, echinocandins and combined for both classes were exhibited by 93 (8.8%), 18 (1.7%) and 6 (0.6%) isolates, respectively. Isolates displaying cross-resistances between azoles and echinocandins were infrequently found. Highly resistant isolates (resistance to 〉=6 AFAs) were almost exclusively represented by Candida albicans . Highly standardized testing of AFAs in parallel and from the same inocula followed by SPA allows detailed insights in the prevalence and distribution of susceptibility patterns of microbial isolates.
    Keywords: Candida ; antifungals ; flucytosine ; amphotericin B ; fluconazole, voriconazole ; posaconazole, caspofungin ; micafungin ; anidulafungin ; susceptibility testing ; susceptibility pattern analysis ; parallel resistance ; cross-resistance ; ddc: 610
    Language: English
    Type: article
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  • 2
    ISSN: 1432-1440
    Keywords: Bronchoscopy ; Bronchoalveolar lavage ; Opportunistic infections ; Diagnosis ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Bronchoscopy was performed on 101 immunocompromised patients with fever and pulmonary infiltrates. Underlying diseases were mainly hematological malignancies. In 71% of cases, etiology of pneumonia was clarified by nonbioptic bronchoscopic methods (bronchoalveolar lavage, bronchial secretions, protected specimen brush). In 51% of cases, empirical antibiotic treatment was modified following bronchoscopy. In patients with early bronchoscopy a better prognosis regarding healing and survival was observed than in those cases, where bronchoscopy was performed later during pneumonia. Bronchoalveolar lavage was particularly suited for diagnosis of Pneumocystis carinii and pneumonia due to viruses or Legionella. Sensitivity and specificity of bronchoscopy were lower for diagnosis of mycotic pneumonia and of Gram-negative or Gram-positive bacteria.
    Type of Medium: Electronic Resource
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  • 3
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The results of a survey on the identification and resistance of causative organisms in the first half of 1979 at the university hospital in Münster are reported. A total of 8359 pathogenetically relevant bacterial strains were isolated. The percentage of the individual bacterial genera and their distribution in the most important hospitals and specimens sent in is given. The resistance of these strains to penicillins, cephalosporins, tetracycline, gentamycin and, in the case of cocci, erythromycin is presented. Strains resistant to or moderately sensitive to gentamicin are listed separately for each hospital. The results obtained with cefotaxime, a new cephalosporin derivative used since February 1979, are presented separately. In addition, a comparison is made of the antibacterial effect of cefotaxime, ticarcillin and azlocillin on 495 strains (Escherichia coli, Proteus, Klebsiella, Enterobacter, Pseudomonas) which are either resistant to or moderately sensitive to gentamycin. On the basis of the results of the resistance test (diffusion test), cefotaxime is highly active against most bacterial strains. As long as the results of the resistance test are still not available, cefotaxime can be recommended as an antibiotic for immediate therapy.
    Notes: Zusammenfassung Erhebungen über Keimnachweis und Resistenzsituation im ersten Halbjahr 1979 für den Bereich der Universitätskliniken Münster werden mitgeteilt. Insgesamt wurden 8359 pathogenetisch relevante Bakterienstämme isoliert. Die Anteile der einzelnen Keimarten, ihre Verteilung auf die wichtigsten Kliniken und im Einsendegut werden angeführt. Es folgt die Darlegung der Resistenzlage dieser Stämme gegen Penicilline, Cephalosporine, Tetracyclin, Gentamycin und bei den Kokken auch Erythromycin. Dabei werden die Gentamycin-resistenten und die Gentamycin-mäßig empfindlichen Stämme einzelner Kliniken gesondert erfaßt. Die Ergebnisse des seit Februar 1979 mitgeführten neuen Cephalosporin-Derivates Cefotaxim sind speziell aufgelistet. Ergänzend dazu wird der Vergleich der antibakteriellen Wirkung von Cefotaxim, Ticarcillin und Azlocillin bei 495 Gentamycin-resistenten und Gentamycin-mäßig empfindlichen Stämmen (Escherichia coli, Proteus, Klebsiella, Enterobacter, Pseudomonas) angeführt. Nach den Resultaten der Resistenzbestimmung (Diffusionstest) besitzt Cefotaxim gegenüber den meisten Bakterienstämmen eine bemerkenswert hohe Aktivität. Solange noch keine Ergebnisse der Resistenzbestimmung vorliegen, kann Cefotaxim als Antibiotikum für die Sofort-Therapie empfohlen werden.
    Type of Medium: Electronic Resource
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  • 4
    ISSN: 1439-0973
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Zur Dokumentation nosokomialer Infektionen auf einer Intensivstation wurden in einer täglichen gemeinsamen Infektionsvisite von Untersucher und Hygienefachschwester alle infektionsrelevanten Daten auf einem zuvor entwickelten Erhebungsbogen erfaßt. Ausgewertet wurden die jeweils ersten Quartale (Februar-April) der Jahre 1980–1984. Die Untersuchung schloß 1009 Patienten ein. Das mittlere Lebensalter betrug 45,5 Jahre, die mittlere Behandlungsdauer 3,9 Tage. 733 Patienten (72,6%) mußten während der Intensivtherapie im Mittel 3 Tage lang beatmet werden. Die Mortalität im gesamten Beobachtungszeitraum betrug 13,2%. Über den gesamten Zeitraum wurden insgesamt 1129 nosokomiale Infektionen (NI) bei 331 Patienten beobachtet. Das entsprach einer Infektionsrate von 32,8%. Die häufigsten registrierten Infektionen bezogen auf die Anzahl insgesamt infizierter Patienten waren bronchopulmonale (BPI)(24,3%), Wund- (WI) (16,6%) und Harnwegsinfektionen (HWI) (8,8%). Hinzu kamen Septikämien (SI) (8,7%) und mit intravasalen Kathetern assoziierte Infektionen (ZVI) (6,7%). Nosokomial infizierte verstarben viermal häufiger (26%) als nicht infizierte Patienten (6,9%). Während der 5jährigen Infektionsüberwachung konnten die Infektionsraten nicht signifikant reduziert werden. Daher wurde eine einjährige prospektive, konsekutive, plazebokontrollierte Studie auf zwei Intensivtherapiestationen (ICU) durchgeführt, mit der das Konzept der selektiven Florasuppression überprüft werden sollte. 200 Patienten erfüllten die Aufnahmekriterien (mindestens drei Tage Intubation und fünf Tage Intensivtherapie, Klasse III oder IV im „Therapeutic Intervention Scoring System“). Die Patienten erhielten entweder Plazebo oder Prophylaxeregime aus Polymyxin E, Tobramycin und Amphotericin B. Die Raten der Bronchopneumonien (ICU I und II) und Harnwegsinfektionen (ICU II) wurden signifikant reduziert. Wundinfektionen, Septikämien und Mortalität wurde nicht signifikant vermindert. Resistenzentwicklungen oder Zunahmen multiresistenter Stämme wurden nicht beobachtet. Damit stellt selektive Florasuppression ein hochwirksames Verfahren zur Infektionsprophylaxe in der operativen Intensivmedizin dar.
    Notes: Summary All ICU patients were continuously monitored for infections according to a standard protocol by the physician in charge and an infection control nurse during the first quarter of five consecutive years (1980–1984). The number of patients surveyed was 1,009. The average age was 45.5 years and the average period of stay about four days. 733 patients (72.6%) were intubated and artificially ventilated for three days. A fatal outcome resulted in 13.2% of all patients. 1,129 nosocomial infections were registered in 331 patients, which means an infection rate of 32.8%. The most frequent nosocomial infections were those of the respiratory tract (24.3%). Wound infections developed in 16.6%. The urinary tract was affected in 8.8%. Nosocomial septicaemias were observed in 8.7%. Catheter-associated infections were found in 6.7% of the patients. A fatal outcome resulted in 26% of the patients with nosocomial infections and in 6.9% of the non-infected patients, respectively. There was no significant reduction in nosocomial infections over the five-year period in our ICU. Therefore, a study was designed to evaluate the concept of selective decontamination of the digestive tract (SDD) in critically ill patients in our two surgical/traumatological ICUs. A prospective, consecutive, placebo-controlled study in two ICUs was carried out during four six-month periods. 200 patients who were intubated for at least three days, required intensive care for a minimum of five days, and belonged to either class III or IV according to the “Therapeutic Intervention Scoring System” were included in the study. They received either placebo or a prophylaxis regimen, consisting of polymyxin E, tobramycin and amphotericin B. The rates of nosocomial bronchopulmonary infections (ICU I and II) and urinary tract infections (ICU II) were significantly reduced. There was no significant reduction in wound infection, septicaemia and mortality rates. Selective flora suppression is effective in reducing infection rates in critically ill patients without development of resistant strains.
    Type of Medium: Electronic Resource
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  • 5
    ISSN: 1432-1440
    Keywords: Human granulocytes ; Phagocytosis ; Staphylocidal activity ; Lysostaphin ; Corticosteroids ; Blood storage
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Lysostaphin, a staphylococcus-derived staphylocidal substance, has widely been used in assays of granulocyte phagocytic and bactericidal capability. It rapidly kills extracellular bacteria. Thus, a separate determination of intracellular surviving bacteria can be performed. One prerequisite for this approach is the safe inactivation of lysostaphin (usually brought about by trypsin) before the intracellular bacteria are externalized for plating. This inactivation has been found by others to be incomplete. Data are presented demonstrating a safe inactivation of lysostaphin by trypsin, if the pH value is maintained within the alkaline range. A low variation of results is obtained by plotting the total number of bacteria killed per incubate vs the logarithm of initial bacterial inoculum or of the intracellular surviving bacteria, leading to linear regression lines. The variation of the results increases greatly for initial bacteria/granulocyte proportions of 〉 5/1. The results obtained for two differentSt. aureus strains are significantly different. Dexamethasone pretreatment (12 mg p.o. within 8 h) had no detectable influence, when fresh blood was assayed, while blood storage at room temperature for 12 h (without dexamethasone pretreatment) led to a significant functional impairment, mainly of bactericidal capability when analyzed in a pairwise fashion. A major limitation of this kind of assays is that killed bacteria cannot be determined directly.
    Type of Medium: Electronic Resource
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