Antimicrobial susceptibility testing of dermatophytes - Comparison of the agar macrodilution and broth microdilution tests

Fifty dermatophyte strains, recently obtained from clinical material, belonging to 4 different species were examined for their susceptibility to 5 systemic or topical antimycotic agents using both an agar macrodilution and a broth microdilution test. Antimycotics compared were griseofulvin, itraconazole, sertaconazole, terbinafine and ciclopiroxolamine. A comparison of the minimum inhibitory concentrations (MIC) clearly showed differences between the two test methods applied. For all 5 antimycotics, MIC data were three- to seventyfold lower in the microdilution test system. These differences, depending on the test method, have to be taken into account when comparing MIC data in the literature or when relating the in vitro data to the tissue concentrations determined in vivo

Pathogenitätsfaktoren bei Pilzinfektionen

Für die starke Zunahme von Infektionen durch opportunistische Pilze sind vor allem prädisponierende Faktoren verantwortlich,welche die natürliche Abwehr des Wirtes abschwächen.Trotzdem müssen pathogene Pilze, wie die medizinisch bedeutende Hefe Candida albicans, über Virulenzfaktoren verfügen, die dem Mikroorganismus das Überleben auf und in einem Wirt sichern oder das Vordringen zu tieferen Geweben und Organen ermöglichen.Das Ziel der Forschungsprojekte der Nachwuchsgruppe „Pathogenitätsfaktoren bei Pilzinfektionen“ am Robert Koch-Institut (RKI) ist, solche Faktoren von Pilzen zu identifizieren und zu analysieren, von denen vermutet wird, dass sie bei einer Infektion eine wichtige Rolle spielen.Damit sollen nicht nur die Pathogenitätsmechanismen besser verstanden werden, sondern auch Ansatzpunkte für neue Medikamente gefunden werden.Schließlich gilt es,aufgrund der zunehmenden Resistenzen gegenüber den wenigen zur Verfügung stehenden Antimykotika, die Wirkungsweise existierender Medikamente zu verstehen

Policy challenges for the pediatric rheumatology workforce: Part I. Education and economics

For children with rheumatic conditions, the available pediatric rheumatology workforce mitigates their access to care. While the subspecialty experiences steady growth, a critical workforce shortage constrains access. This three-part review proposes both national and international interim policy solutions for the multiple causes of the existing unacceptable shortfall. Part I explores the impact of current educational deficits and economic obstacles which constrain appropriate access to care. Proposed policy solutions follow each identified barrier

The national database of the German Collaborative Arthritis Centres: II. Treatment of patients with rheumatoid arthritis

OBJECTIVE—To describe current treatment of patients with rheumatoid arthritis (RA) in German rheumatology.
METHODS—Data from the German rheumatological database of 1998, comprising clinical and patient questionnaire data of 12 992 outpatients with RA seen at 24 collaborative arthritis centres in Germany, were analysed.
RESULTS—At the time of documentation, 88% of the patients with RA were undergoing disease modifying antirheumatic drug (DMARD) treatment. Methotrexate (MTX) was prescribed to 56% of the patients (61% with seropositive and 45% with seronegative RA). Combination treatment was used in 15%. MTX was the drug of first choice even in patients with up to one year's disease duration (49%), followed by antimalarial drugs (21%). Patients treated by non-rheumatologists within the previous year had received DMARD treatment in only 33% of the cases. In steroid treatment, low doses (⩽7.5 mg/day) were used by rheumatologists much more often (44%) than higher doses (12%). 16% of the patients had been inpatients during the previous year, with a median length of stay accumulated over the year of 21 days. Together with stays in inpatient rehabilitation, 22% of all patients had had some form of inpatient treatment. Comprehensive measures such as occupational therapy and patient education were prescribed to fewer than 12% of the patients, mostly during their hospital stay.
CONCLUSION—German rheumatologists do follow recent recommendations about early and effective treatment. However, there are still deficits in outpatient care with non-medicinal measures like occupational therapy and patient education, which may partly explain the high hospital admission rates.