Emergence of a Teicoplanin-Resistant Small Colony Variant of Staphylococcus epidermidis During Vancomycin Therapy

Small colony variants of Staphylococcus aureus can cause persistent and recurrent infections. There are only a few reports of small colony variants of coagulase-negative staphylococci. Herein a case of infection with a teicoplanin-resistant small colony variant of Staphylococcus epidermidis is presented. The small colony variant was isolated from blood cultures of a patient with acute leukaemia and therapy-induced neutropenia who was treated with vancomycin for catheter-associated bloodstream infection. Despite removal of the catheter and adequate antibiotic therapy, the infection did not clear and the patient died 20days after continuous antibiotic therap

Emergence of SCC mec Type IV as the Most Common Type of Methicillin-Resistant Staphylococcus aureus in a University Hospital

Abstract : Background: : The epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) has dramatically changed over the last decade by the emergence of community-associated MRSA (CA-MRSA). Recent studies indicate that these strains have already spread to hospitals. To evaluate if SCCmec type IV and Panton-Valentine leukocidin (PVL) are unambiguous markers of CA-MRSA, we analyzed 77 sporadic MRSA strains isolated, in our low MRSA incidence university hospital, from inpatients between 2000 and 2004. Methods: : MRSA strains were analyzed by staphylococcal cassette chromosome mmecec (SCCmec) typing, PCR for PVL genes and pulsed-field gel electrophoresis (PFGE). MRSA was classified in HA-MRSA or CA-MRSA according to Centers for Disease Control and Prevention (CDC) criteria. Antimicrobial susceptibility testing was performed using microbroth dilution method following CLSI recommendations. Results: : Among 77 sporadic single-patient strains, SCCmec types I-IV and four subtypes were identified. Type IV/IVA was most common (42.9%).The distribution of SCCmec types changed over the years. Type IV/IVA strains increased from 33.3% in 2000 to 57.9% in 2004. Type IV strains were resistant to ciprofloxacin in 81.8%, and in 9.1% to tobramycin while type IVA strains were 100% resistant to both antimicrobials. In contrast, non-type IV/IVA strains were resistant to ciprofloxacin in 86.4%, and in 75.0% to tobramycin. Only one strain was PVL positive and harbored SCCmec type III variant. By PFGE analysis, the 33 SCCmec type IV/IVA strains comprised 12 distinct genotypes. 36.4% of 11 CA-MRSA and 43.9% of 66 HA-MRSA harbored SCCmec type IV/IVA. Conclusion: : Type IV/IVA has become the most common SCCmec type in inpatients of our university hospital. The SCCmec type IV/IVA is present in both CA-MRSA and HA-MRSA limiting its use as a marker for CA-MRS

Stronger correlation between antibiotic use and the incidence of Clostridium difficile determined by culture results instead of faecal toxin detection only

The detection of Clostridium difficile in previous studies evaluating antibiotic use as a risk factor was limited to toxin assay tests. The reported associations may have been misleading due to the low sensitivity of toxin assay tests compared to culture results. Antibiotic use and the incidence of C. difficile of 19 units (wards) over 5years were analysed. Stool samples were tested for toxin A/B and cultured. The correlation of antibiotic use with the incidence of C. difficile determined by culture results was compared to the correlation determined by toxin assay results. Additionally, single antibiotics were analysed as risk factors. Of 5,772 faecal samples tested for C. difficile, 154 single-first cases were detected by the toxin assay and 251 additional single-first cases by culture. Antibiotic use was a significantly stronger risk factor in the correlation based on the culture results (R 2 = 0.63) versus toxin assay results (R 2 = 0.40). Multivariate analysis did not improve the correlation significantly and only the group of broad-spectrum beta-lactams was identified as an independent risk factor. The correlation between antibiotic use and C. difficile incidence rates significantly improves if detection is not limited to faecal toxin assays. Therefore, antibiotic pressure was previously underestimated as a risk facto

Index of pretreatment intensity predicts outcome of high-dose chemotherapy and autologous progenitor cell transplantation in chemosensitive relapse of Hodgkin's disease

Purpose To identify prognostic factors in patients with chemosensitive relapsed Hodgkin's disease treated by high-dose chemotherapy with autologous progenitor cell transplantation (HDC) and to compare the duration of treatment-free remission prior to HDC with the progression-free survival after HDC in individual patients. Patients and methods Forty-five consecutive patients were analyzed retrospectively. We devised an index of pretreatment intensity (IPTI) based number of different chemo- and radio-therapy regimens given between diagnosis and HDC and on the duration of disease. Results With a median follow-up of 47 months the post-transplant event-free survival (EFS) was 44% and the overall survival. (OAS) was 62% at four years. The IPTI allowed to discriminate between a low and a high-risk group with a four-year post-transplant EFS of 66% and 11% and a OAS of 87% and 28%, respectively (P = 0.0001). Of the 39 patients with sufficient follow-up after HDC, post-transplant EFS lasted on average ≥ 18.5 months longer than the pretransplant treatment-free remission. Conclusions HDC with the CBV regimen confers significant benefit to patients with chemosensitive relapsed Hodgkin's disease. The IPTI may help to select patients with a good response to HDC and to identify poor prognosis patients suitable for experimental protocols or palliative care onl

Electrical current distribution across a metal-insulator-metal structure during bistable switching

Combining scanning electron microscopy (SEM) and electron-beam-induced current (EBIC) imaging with transport measurements, it is shown that the current flowing across a two-terminal oxide-based capacitor-like structure is preferentially confined in areas localized at defects. As the thin-film device switches between two different resistance states, the distribution and intensity of the current paths, appearing as bright spots, change. This implies that switching and memory effects are mainly determined by the conducting properties along such paths. A model based on the storage and release of charge carriers within the insulator seems adequate to explain the observed memory effect.Comment: 8 pages, 7 figures, submitted to J. Appl. Phy

Shuntchirurgie in Europa und den USA: Ein kritischer Vergleich

Zusammenfassung: Nach einem anfänglich gemeinsamen Weg in der Fistelchirurgie begann in den USA ab etwa 1975 der bevorzugte Einsatz von Prothesenshunts. In bis zu 80% wurden bei Erstoperationen Gefäßprothesen implantiert, mit entsprechend hoher Komplikationsrate und hohen Folgekosten. Europa pflegte, mit lokalen Unterschieden, das Konzept der vorzugsweisen Verwendung von arteriovenösen Fisteln weiter (AVF). Der Prothesenanteil war nie höher als 40%. Unterstützt von Richtlinien, versuchen die USA seit 1997 einen deutlichen Umschwung herbeizuführen. Der Anteil primärer AVF ist seither angestiegen, bei allerdings wohl erhöhter initialer Versagerquote im internationalen Vergleich. Über Richtlinien hinaus sollte für beide Kontinente als vordringliche Aufgaben die interdisziplinäre Zusammenarbeit aller beteiligten Fachgebiete gelten: Durchführung zertifizierter, interdisziplinärer Kurse mit konsensfähigen Inhalten, Einrichtung von Referenzzentren mit einheitlicher, umfassender Dokumentation, Aufbau von Datenbanken zur Qualitätskontrolle mit abrufbaren Komplikations- und Funktionsraten, Standardisierung der Überwachung von Gefäßzugängen im Dialysezentru

The surface science of quasicrystals

The surfaces of quasicrystals have been extensively studied since about 1990. In this paper we review work on the structure and morphology of clean surfaces, and their electronic and phonon structure. We also describe progress in adsorption and epitaxy studies. The paper is illustrated throughout with examples from the literature. We offer some reflections on the wider impact of this body of work and anticipate areas for future development. (Some figures in this article are in colour only in the electronic version

Monolithically integrated DBR waveguidelaser and intensity modulator in erbiumdoped LiNbO3

For the first time, a DBR laser has been integrated with a Mach Zehnder intensity modulator in Er diffusion doped, Z cut LiNbO,, with Ti indiffused waveguides and dry etched Bragg gratings. The monolithically integrated device has a threshold of 54.8mW incident pump power (hp = 1480nm) and emits, in a single longitudinal mode, up to 0.65 mW CW output power at hs = 1561nm. The Mach-Zehnder type intensity modulator has an optical bandwidth > 3GHz