Methicillin-Resistant Staphylococcus aureus ST398 from Human Patients, Upper Austria

Methicillin-resistant Staphylococcus aureus (MRSA) clonal type ST398 is usually associated with animals. We examined 1,098 confirmed MRSA samples from human patients and found that 21 were MRSA ST398. Most (16) patients were farmers. Increasing prevalence from 1.3% (2006) to 2.5% (2008) shows emergence of MRSA ST398 in humans in Austria

European surveillance of antimicrobial consumption (ESAC) : systemic antiviral use in Europe

Objectives: To assess the total systemic antiviral use in Europe and to identify the antiviral substances most commonly used.Methods: Within the European Surveillance of Antimicrobial Consumption (ESAC; www.esac.ua.ac.be), using the anatomical therapeutic chemical (ATC) classification and defined daily dose (DDD) measurement unit, data on total (out- and inpatient) systemic antiviral use (ATC J05), aggregated at the level of the active substance, were collected for 2008, and use was expressed in DDD (WHO ATC/DDD, version 2010) per 1000 inhabitants per day (DID). Antiviral substances were grouped according to their main indication.Results: In Europe, 12 countries (Belgium, Croatia, Denmark, Estonia, Finland, France, Hungary, Italy, Luxembourg, Russia, Slovenia and Sweden) provided total (out- and inpatient) data and 4 countries (Austria, the Netherlands, Portugal and Norway) provided outpatient data only. Total systemic antiviral use varied by a factor of 10.95 between the country with the highest (3.53 DID in France) and the country with the lowest (0.32 DID in Croatia) use. HIV/AIDS antivirals represented more than 50% of the total antiviral use in most countries. The amount and spectrum of antivirals used varied greatly between countries.Conclusions: Our study demonstrated a wide variation of total systemic antiviral use in several European countries, as striking as that of outpatient systemic antibiotic, antimycotic and antifungal use. The variation is mainly determined by the use of HIV/AIDS antivirals. These observations should stimulate further analysis to understand the variation of specific antiviral substances. The ESAC data facilitate auditing of antiviral prescriptions and evaluation of the implementation of guidelines and public health policies.peer-reviewe

Staphylococcal Toxic Epidermal Necrolysis (Ten): The Expanded Mouse Model**From the Division of Experimental Dermatology, I. Hautklinik (PME, PF, KW), the Institute of Pathology (GT), and the Hygiene Institute (HM) of the University of Vienna: and the Department of Dermatology. Harved Medical School, Boston, Massachusetts. (Reprint requests to: Dr. Elias, Departtment of Pathology, University of California School of Medicine, San Francisco, California 941143.)

Strains of phage Group 2 staphylococci and cell-free fractions isolated from the same strains induced toxic epidermal necrolysis (TEN) when injected into neonatal mice. Furthermore, adult mice developed TEN in both hairy and glabrous skin following intracutaneous (but not systemic) administration of cell-free fractions. While normal adult mice did not develop TEN after inoculation of cocci, generalized TEN could be produced in adult mice pretreated with systemically injected corticosteriods for 3 weeks. Mice which had survived injections of cell-free fractions as neonates remained susceptible to intracutaneously administered fractions in adulthood. Regardless of the age of the animal and the cause of TEN (cocci or cell-free filtrates), the pathogenesis appeared identical both hitologically and ultrastructurally, i.e., via intercellular cleavage without evidence of cell necrosis. These studies demonstrate that neither maturation nor hair development, as previously proposed, confer cutaneous resistance to TEN. Instead, an extracutaneous factor(s) probably confers resistance to the normal adult mouse. Since similar factors lead to naturally occurring and experimental staphylococcal TEN in adult humans and adult mice, the adult mouse may prove to be a valuable model for the study of factors resulting in staphylococcal TEN in adult human

Prospective multicentre feasibility study of a quality of care indicator for intravenous to oral switch therapy with highly bioavailable antibiotics

Background: Enhanced oral (po) bioavailability of antimicrobial drugs allows conversion to po therapy once a patient meets defined clinical criteria. This can reduce length of hospital stay, healthcare costs and risk of complications related to intravenous (iv) access. We developed a quality indicator for assessing the appropriate iv-to-po switch of bioavailable antibiotics and evaluated its feasibility and clinical relevance across acute healthcare systems. Methods: The study was designed as a multicentre, multinational observational audit. The indicator was the proportion of inappropriate iv treatments at any point in time in adult patients treated with fluoroquinolones, clindamycin, linezolid or metronidazole. Treatments were prospectively evaluated by a trained physician or clinical pharmacist using predefined clinical criteria. The feasibility of the indicator was evaluated by measuring data availability, data collection workload and sensitivity to improvement. Results: Data were collected over a 3 month period in five university hospitals in Austria, Belgium and Germany and iv treatment was assessed in 211 patients. The indicator was measurable in 99.1% of cases. By intention-to-treat analysis, 37.0% (95% CI 30.5-43.9) of treatments were inappropriate, ranging from 17.5% to 53.8% across hospitals. The median time needed for case assessment and documentation was 29 min. Conclusions: This quality indicator was found to be generally feasible in hospitals across three European countries, and informative about the local need for clinical quality improvement. © The Author 2012. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved.SCOPUS: ar.jinfo:eu-repo/semantics/publishe