Motivational interviewing for preventing early childhood caries: A systematic review and meta-analysis

OBJECTIVES

This systematic review with meta-analysis was performed to assess whether motivational interviewing (MI) is effective in the prevention of early childhood caries (ECC) and to examine potential sources of heterogeneity.

METHODS

Interventions based on motivational interviewing were considered eligible. The main outcome was new caries lesions (some studies included white-spot lesions in total count), and secondary outcomes included caregivers' oral health knowledge, home-care behaviours, plaque index, gingival index and fluoride varnish applications. Controls were any type of oral health education or negative controls without any specific intervention.

RESULTS

From a total of 1498 studies identified in the databases search, 1078 were assessed for eligibility by reading titles and abstracts, after removal of duplicates. Full-text screening was performed in 61 articles, with 18 reporting on 14 different studies included in the qualitative synthesis and 8 in the quantitative synthesis (four studies included new white-spot lesions in total count). Subgroup analysis was performed by the control group dmft/dmfs and the test for subgroup differences suggests that there is a subgroup effect (P = .06), so population caries experience modifies the effect of MI-based intervention. In populations with high caries experience, the MI-based approach proved preventing an average of 3.15 (95% CI: -6.14, -0.17) dmfs in young children. In samples with low caries experience, differences were smaller, since the caries levels were already lower (-0.31; 95% CI: -0.63, 0.00).

CONCLUSION

Motivational interviewing has the potential to modify knowledge and behaviours and reduce ECC with a more significant impact on children with high caries experience.

Motivational Interviewing for the control of type 2 diabetes mellitus and arterial hypertension

Background

Motivational Interviewing (MI) has been effective in promoting positive changes in various health-related behaviors, including chronic disease management. The main goal of this study was evaluating the effectiveness of this care technology in individual nursing consultations for the control of type 2 Diabetes Mellitus (2DM) and Arterial Hypertension (AH) in primary healthcare.

Methods

Double-blind, controlled, parallel randomized clinical trial conducted in Porto Alegre, Rio Grande do Sul - Brazil, from June 2018 to July 2019. The study subjects suffered from 2DM with associated diagnosis of AH and were randomized individually to the Test/MI Group and Control Group. The Test Group was subjected to an MI-based nursing consultation intervention with a professional who had been trained for 20 hours, while the Control Group received conventional nursing consultation. The variables were collected in order to measure the main glycated hemoglobin and blood pressure outcomes, and for the secondary adherence outcome.

Results

After an average follow-up of 6 months, 175 patients completed the study. There was a significant difference between the groups with improvement in the Test/MI group for the outcomes Systolic Blood Pressure - SBP (p < 0.01), Diastolic Blood Pressure - DBP (p < 0.01), Total Adherence Score in Martín-Bayarre-Grau Questionnaire (p = 0.011) and their dimensions 'Treatment compliance' and 'Personal implication' (p = 0.033; p = 0.031). The blood pressure levels of the patients who received the Motivational Interviewing Intervention showed a significant mean reduction of 15.2 mmHg in SBP and 6.4 mmHg in DBP, compared to the control group. The Test group also showed a significant average intragroup reduction of 0.5% in HbA1c at the completion of the study (p < 0.01).

Conclusions

It is concluded that the MI-based nursing consultation was effective in improving clinical control and adherence in diabetic and hypertensive patients in primary healthcare.

Key messages

MI-based nursing consultation is effective in reducing pressure and glycemic levels in primary healthcare. The MI improves adherence levels in diabetic and hypertensive patients.

Effect of subinhibitory exposure to quaternary ammonium compounds on the ciprofloxacin susceptibility of Escherichia coli strains in animal husbandry

BACKGROUND

Quaternary ammonium compound based disinfectants are commonly used in pig and poultry husbandry to maintain farm hygiene. However, studies have shown that subinhibitory concentrations of these disinfectants may increase antibiotic resistance. Investigation of antibiotic susceptibility is usually assessed via the microbroth dilution method, although this conventional culture-based technique only provides information on the bacteriostatic activity of an antimicrobial agent. Therefore, experiments were performed to investigate the effect of prior benzalkonium chloride (BKC) exposure on the viability of subsequent ciprofloxacin (CIP) treated Escherichia coli.

RESULTS

Following CIP treatment, bacterial cell counts were significantly higher after exposure to a subinhibitory BKC concentration than without BKC exposure. The flow cytometric results suggested a BKC-dependent onset of membrane damage and loss of membrane potential.

CONCLUSION

Our results indicate a lower bactericidal effect of CIP treatment on BKC-exposed E. coli isolates compared to unexposed E. coli isolates.

Emergency room presentation of lung cancer as a highly practical prognostic marker for consideration in clinical trials: A SEER database analysis

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Background: Multiple factors influencing lung cancer prognosis could be used for stratification in randomized intervention trials which are either observer-dependent (performance status) or poorly available (education/comorbidity index). In this study we explored the independence of ER presentation of lung cancer (an objective variable) as a prognostic factor. Methods: We performed a study using patients from the Surveillance, Epidemiology, and End Results-Medicare linked database, aged 66 years or older and diagnosed with lung cancer between 2007 and 2015. ER presentation was defined as ER visit ≤30 days prior to the earliest diagnostic procedure. Factors associated with ER versus non-ER presentation and the impact of ER presentation on overall survival (OS) and Cancer specific survival (CSS) were assessed. Results: Between 2007 and 2015, a total of 75,798 lung cancer patients met study criteria. 37% of small cell lung cancer (SCLC) and 28% non-small cell lung cancer (NSCLC) patients had ER presentation. For both histologies, in univariate Chi-Square analysis ER presentation was affected (p < 0.05) by sex, race, marital status, census tract poverty and education levels, number of comorbidities, geographic region, and cancer stage, but not by age (except with NSCLC) or rural/urban commute. Multivariable Logistic Regression showed that for both histologies, stage IV, Black or Hispanic race/ethnicity, East or mid-West region, ≥2 comorbidities, unmarried, and tract poverty level ≥ median were independent risk factors associated with ER presentation (odds ratio > 1). For NSCLC, year of diagnosis ≥2009, female, age ≥75, South region, tract education level > median; for SCLC, year of diagnosis ≥2012 and age 70-74 were also significantly associated with ER-presentation. ER versus non-ER presentation was associated with lower 1-yr OS in NSCLC (43% vs 61% HR 1.79, 95% CI 1.68, 1.77; p < 0.0001) and SCLC (33% vs 43% HR 1.32, 95% CI 1.25, 1.40; p < 0.0001). After adjusting for histology, year of diagnosis, age, sex, race, marital status, region, poverty level, education level, number of comorbidities, and stage in a multivariable Cox model, ER presentation remained an independent poor prognostic marker (HR for OS 1.34, 95% CI 1.31, 1.37; p < 0.0001; HR for CSS 1.32, 95% CI 1.29, 1.36; p < 0.0001). Conclusions: ER presentation of lung cancer is an independent, objective, highly practical poor prognostic risk factor which should be considered for patient stratification and data analyses within interventional clinical trials.

Adjuvant chemotherapy with or without an anthracycline in older adults with node-negative triple-negative breast cancer (TNBC): A SEER Medicare study

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Background: TNBC is an aggressive breast cancer subtype comprising approximately 15% of breast cancers. Adjuvant chemotherapy reduces the risk of recurrence, particularly in patients with tumors > 1 cm or node positive disease. Anthracycline (A) + taxane (T)-containing regimens are more efficacious than T-based regimens, however, the risk of cardiac toxicity is greater in older patients. We investigated the use of AT and T-containing regimens in patients ≥ 66 years old with node negative TNBC and evaluated clinical outcomes and cardiac risk factors. Methods: We identified female patients ≥ 66 diagnosed between 2010-2015 with TNBC node negative disease in the Surveillance, Epidemiology, and End Results (SEER) Medicare database. Baseline characteristics, including age, tumor size, cardiac history, and adjuvant chemotherapy administration (AT vs. T) were collected. A logistic regression analysis was performed to estimate independent predictors of AT vs. T chemotherapy. Overall survival (OS) was estimated at 3 years. Results: We identified 3348 patients, including 1679 (50.2%) who received chemotherapy for T1a/bN0 (32.5%), T1cN0 (55.5%), T2N0 (57.0%) and T3/T4N0 (49.6%) disease. Of those, 984 (58.6%) received T, 420 (25.0%) received AT and 275 (16.4%) received other chemotherapy. AT use was associated with larger tumor size; T1a/bN0 (13.6%), T1cN0 (21.3%), T2N0 (31.6%) and T3/T4N0 (34.9%). In a multivariate analysis, independent predictors of AT vs. T were age, region treated in the USA, tumor size and presence of prior cardiac risk factors or pre-existing cardiac disease. OS at 3 years was 91% for T and 86% for AT (p 0.03). Conclusions: Approximately half of older patients diagnosed with node negative TNBC received adjuvant chemotherapy. T-based regimens were more commonly used than AT regimens. Younger age, higher stage and lack of cardiac comorbidities correlated with use of AT compared to T. Continued investigation of the benefit of adjuvant chemotherapy in older patients may assist in clinical decision making.

Repeated disinfectant use in broiler houses and pig nursery units does not affect disinfectant and antibiotic susceptibility in Escherichia coli field isolates

BACKGROUND

Disinfectants are frequently used in animal production to reduce or eliminate the load of infectious agents and parasites in buildings and equipment associated with the housing or transportation of animals. There are growing concerns that the use of disinfectants would select for resistance to antibiotics and disinfectants. The aim of this study was to determine the effect of repeated use of different disinfectants on the disinfectant and antibiotic susceptibility under practical conditions in a broiler and pig pilot farm. Therefore, the susceptibility of Escherichia coli (E. coli) to 14 antibiotics and 4 disinfectants was monitored over a one-year period.

RESULTS

High (20-50%) to very high (> 50%) resistance levels for ampicillin, sulfamethoxazole, trimethoprim and tetracycline were observed in both animal production types. Disinfectant susceptibility did not change over time and did not depend on the used disinfection product. Compared to in-use concentrations of formaldehyde, benzalkoniumchloride and a peracetic acid - hydrogen peroxide formulation, all E. coli strains remained susceptible indicating that the use of disinfectants did not select for disinfectant resistance. Moreover, no association could be found between the use of disinfectants and antibiotic resistance.

CONCLUSIONS

These findings suggest that repeated use of disinfectants in agricultural environments does not select for antibiotic resistance nor does it reduce disinfectant susceptibility.

Evaluation of acute kidney injury in dogs with complicated or uncomplicated Babesia rossi infection

Dogs with babesiosis can present with multiple complications, including acute kidney injury (AKI). The objective of this study was to characterize AKI in dogs with babesiosis caused by Babesia rossi at presentation and after treatment. Thirty-five client-owned dogs with B. rossi infection and 10 control dogs were included in this prospective observational study. Blood and urine were collected in Babesia-infected dogs at presentation (T₀, n = 35), after 24 h (T_24h, n = 11), and after 1 month (T_1m, n = 9). The following urinary kidney injury biomarkers were assessed: urinary protein to creatinine ratio (UPC), urinary glomerular injury biomarkers (immunoglobulin G (uIgG) and C-reactive protein (uCRP)), and urinary tubular injury biomarkers (retinol-binding protein (uRBP) and neutrophil gelatinase-associated lipocalin (uNGAL)). Serum functional renal biomarkers were creatinine (sCr) and symmetric dimethylarginine (sSDMA). Post-mortem kidney biopsies were analyzed by light and transmission electron microscopy. At T₀, all kidney injury biomarkers were significantly higher in Babesia-infected dogs compared to healthy controls (P < 0.001), while functional renal biomarkers were not significantly different (P > 0.05). At T_24h, all urinary tubular injury biomarkers and UPC decreased significantly (P < 0.01), while glomerular injury biomarkers did not (P = 0.084). At T_1m, all urinary kidney injury biomarkers decreased to values not significantly different from healthy controls (P > 0.5). Significant changes in functional renal biomarkers were not seen after treatment (P > 0.05). Dogs with complicated babesiosis had significantly higher glomerular injury biomarkers, UPC, and sSDMA compared to uncomplicated cases (P < 0.05), while all tubular injury biomarkers and sCr were not significantly different (P > 0.1). Dogs with babesiosis caused by B. rossi showed transient kidney injury, which was detected by all kidney injury biomarkers, but remained undetected by functional biomarkers. All infected dogs, irrespective of disease severity, suffered comparable kidney injury based on tubular injury biomarker concentrations, while loss of function was seen more often in dogs with complicated babesiosis based on sSDMA results.

139 Heat stress has a deleterious effect on bull semen quality and subsequent embryo development

High ambient temperature induces an increase in bovine body temperature above the physiological homeothermic point, leading to impaired reproductive performance. Belgian Blue bulls are more susceptible to heat stress compared with most other cattle breeds. Therefore, the aim of this study was to investigate whether high ambient temperature affected bull semen quality and subsequent embryo development. For this purpose, semen samples were collected from six Belgian Blue bulls during August (14-28 days after three consecutive warm days with temperature-humidity index between 63.8 and 83.7) and March 2016 (temperature-humidity index between 35.9 and 47.4). After semen collection, volume, sperm concentration, and motility of fresh semen were assessed. Furthermore, frozen sperm samples were used to assess the motion parameters and morphological abnormalities using computer-assisted sperm analysis, viability and reactive oxygen species (hydrogen peroxide and superoxide) production using flow cytometry, and acrosome integrity and chromatin condensation using fluorescence microscopy. Afterward, blastocysts were produced (r=4) by conventional invitro methods for assessment of embryo development (Wydooghe et al. 2014 Reprod. Fertil. Dev. 26, 717-724; https://doi.org/10.1071/RD13043). Cleavage rate was determined 48h after fertilisation, and the blastocyst rates were determined on Days 7 and 8 postinsemination. Moreover, Day 8 blastocysts underwent differential staining in order to determine the numbers of the inner cell mass, trophectoderm, total cell number, and apoptotic cells ratio. The data set was analysed using the GLM procedure of SAS (SAS Institute Inc.). Normal distribution was checked using the UNIVARIATE procedure, and the Shapiro-Wilk test and arcsine square root transformation were used when required. Furthermore, Duncan's test was applied to determine the significant differences (P=0.05). In fresh semen, samples from the non-heat-stressed (NHS) group showed a higher sperm concentration compared with samples from the heat-stressed (HS) group (P=0.05), whereas semen volume and motility were not affected by heat stress (P&gt;0.05). In frozen-thawed semen, total and progressive motility and straight-line velocity were lower in the HS group compared with the NHS group (P=0.05), whereas the generation of H2O2, percentages of aberrant chromatin condensation, total morphological abnormality, spermatozoa with bent tails, and distal protoplasmic droplets were higher in the HS group compared with the NHS group (P=0.05). The cleavage rate and blastocyst rates on Days 7 and 8 were higher (P=0.05) in the NHS group (70.4±1.13, 25.4±1.84, and 40.3±1.15, respectively) compared with the HS group (62.8±1.49, 15.4±1.56, and 23.3±1.84, respectively). However, there were no significant differences in hatched or hatching rate of two treatments (P&gt;0.05). The total cell number and trophectoderm were higher in NHS-derived blastocysts than in HS-derived blastocysts (P=0.05), whereas the apoptotic cells ratio was lower (P&lt;0.001) in NHS blastocysts (2.16±0.48% vs. 5.21±0.52%). In conclusion, these findings show that elevated ambient temperature during summer as a consequence of climate change can lead to decreased quality of fresh and frozen-thawed bull spermatozoa and subsequent embryo development.

Insular Cortical Thickness in Patients With Somatoform Pain Disorder: Are There Associations With Symptom Severity and Childhood Trauma?

BACKGROUND

Studies show significant alterations in insular cortical thickness in patients with somatoform pain disorder (SPD). Additionally, associations between childhood maltreatment and morphometric alterations in insular cortex have been observed. Since patients with SPD often report about adverse childhood experiences, we were interested in the interrelationship of exposure to childhood maltreatment and insular cortical thickness in patients with SPD.

METHODS

Fifteen adult patients with SPD (ICD-10 F 45.40/41, DSM-Code 307.80) and thirteen healthy adult controls underwent T1-weighted MR brain imaging. In the voxel-based morphometry (VBM) analysis we compared whole brain cortical thickness between patients and controls using a Student's two-sampled t-test (p < .05). Then we performed a secondary analysis to detect differences in cortical thickness levels in the insular cortex between both groups. For further analysis of differences in insular cortical thickness we used gender, age, depressive symptoms [Patient Health Questionnaire (PHQ)-9], and whole brain cortical thickness as nuisance covariates. Subsequently we explored associations between insular cortical thickness, symptom severity (PHQ-15) and past experiences of childhood maltreatment (CTQ) in both groups.

RESULTS

Patients showed reduced insular cortical thickness in a subregion of right Brodmann area (BA) 13 (anterior part of the insular cortex), whereas whole brain cortical thickness did not differ between groups. The between-group difference in the identified insular subregion of right BA 13 was not diminished by any of the covariates. This implies that the reduction in cortical thickness in the identified insular subregion might be due to a specific group effect. The effect sizes indicate that the group of patients experienced more childhood maltreatment than the control group. Nonetheless, significant correlations of insular cortical thickness with symptom severity and childhood maltreatment in the total collective could not be demonstrated for the group of patients.

CONCLUSIONS

Our data suggest that alterations in the identified insular subregion of right BA 13 are associated with somatoform pain, independent of gender, age, or coincident depression levels. To identify significant associations of insular cortical thickness and experiences of childhood maltreatment in patients with SPD investigations within larger samples are highly recommended.

Cerumen Impaction Removal in General Practices: A Comparison of Approved Standard Products

Background

Ear irrigation is a commonly used method for removing earwax in general practice. There is no firm evidence if no pre-treatment is as good as pre-treatment with various standard preparations.

Aim

To assess the effectiveness of no pre-treatment compared to pre-treatment with commercially available cerumenolytics and to assess which preparation is best suited for pre-treatment.

Methods

This is a pragmatic observational study of patients with cerumen treated from a single GP with 3 different preparations or no preparation prior to standardized ear irrigation. Generalized linear mixed models with logit link function were performed to assess the effectiveness of pre-treatment with different preparations and no pre-treatment. The models were adjusted for age group (<70, ≥70) and sex.

Results

A total of 168 patients (298 ears, 58 % female, median age 65 years) consulted for obstructive cerumen, some of them several times. The cerumen was successfully removed in 70% (208/298). Comparing any preparation to no preparation (aggregated comparison), the odds ratio for complete clearance was 1.35 (95%confidence interval: 0.69-2.65). Comparing the preparations individually, the odds ratio of the docusate-sodium-based preparation was 1.87 (95% CI: 0.79-4.42) indicating a higher effectiveness. Although, not statistically significant. Ear irrigation was less successful for patients aged ≥ 70 years (OR = 0.48, 95% CI: 0.23-0.98).

Conclusions

The aggregated comparison indicates a slight trend toward a higher effectiveness of any pre-treatment compared to no pre-treatment. The effect-size of docusate-sodium-based pre-treatment indicates a higher effectiveness of cerumen impaction removal. Nevertheless, superiority could not be shown conclusively according to the statistical significance given the restricted sample size.

Mechanical dissipation via image potential states on a topological insulator surface

Joule energy loss due to resistive heating is omnipresent in today's electronic devices whereas quantum-mechanical dissipation is largely unexplored. Here, we experimentally observe a suppression of the Joule dissipation in Bi₂Te₃ due to topologically protected surface states. Instead, a different type of dissipation mechanism is observed by pendulum atomic force microscopy, which is related to single-electron tunnelling resonances into image potential states that are slightly above the Bi₂Te₃ surface. The application of a magnetic field leads to the breakdown of the topological protection of the surface states and restores the expected Joule dissipation process. Nanomechanical energy dissipation experienced by the cantilever of the pendulum atomic force microscope provides a rich source of information on the dissipative nature of the quantum-tunnelling phenomena on the topological insulator surface, with implications for coupling a mechanical oscillator to the generic quantum material.

A Langevin equation that governs the irregular stick-slip nano-scale friction

Friction force at the nanoscale, as measured from the lateral deflection of the tip of an atomic force microscope, usually shows a regular stick-slip behavior superimposed by a stochastic part (fluctuations). Previous studies showed the overall fluctuations to be correlated and multi-fractal, and thus not describable simply by e.g. a white noise. In the present study, we investigate whether one can extract an equation to describe nano-friction fluctuations directly from experimental data. Analysing the raw data acquired by a silicon tip scanning the NaCl(001) surface (of lattice constant 5.6 Å) at room temperature and in ultra-high vacuum, we found that the fluctuations possess a Markovian behavior for length scales greater than 0.7 Å. Above this characteristic length, the Kramers-Moyal approach applies. However, the fourth-order KM coefficient turns out to be negligible compared to the second order coefficients, such that the KM expansion reduces to the Langevin equation. The drift and diffusion terms of the Langevin equation show linear and quadratic trends with respect to the fluctuations, respectively. The slope 0.61 ± 0.02 of the drift term, being identical to the Hurst exponent, expresses a degree of correlation among the fluctuations. Moreover, the quadratic trend in the diffusion term causes the scaling exponents to become nonlinear, which indicates multifractality in the fluctuations. These findings propose the practical way to correct the prior models that consider the fluctuations as a white noise.

Exposure of ciprofloxacin-resistant Escherichia coli broiler isolates to subinhibitory concentrations of a quaternary ammonium compound does not increase antibiotic resistance gene transfer

Resistance to antibiotics threatens to become a worldwide health problem. An important attributing phenomenon in this context is that pathogens can acquire antibiotic resistance genes through conjugative transfer of plasmids. To prevent bacterial infections in agricultural settings, the use of veterinary hygiene products, such as disinfectants, has gained popularity and questions have been raised about their contribution to such spreading of antibiotic resistance. Therefore, this study investigated the effect of subinhibitory concentrations of benzalkoniumchloride (BKC), a quaternary ammonium compound (QAC), on the conjugative transfer of antibiotic resistance genes. Five Escherichia coli field strains originating from broiler chickens and with known transferable plasmid-mediated ciprofloxacin resistance were exposed to subinhibitory BKC concentrations: 1/3, 1/10 and 1/30 of the minimum bactericidal concentration. Antibiotic resistance transfer was assessed by liquid mating for 4 h at 25°C using E. coli K12 MG1655 as recipient strain. The transfer ratio was calculated as the number of transconjugants divided by the number of recipients. Without exposure to BKC, the strains showed a ciprofloxacin resistance transfer ratio ranging from 10-4 to 10-7. No significant effect of exposure to subinhibitory concentrations of BKC was observed on this transfer ratio.

Effectiveness of Motivational Interviewing Training for Primary Care Dentists and Dental Health Technicians: Results from a Community Clinical Trial

Motivational interviewing (MI) is an approach that uses dialogue about behavioral change to encourage a constructive relationship between professionals and patients. The aim of this study was to evaluate the maintenance of basic MI skills in the daily practice of dentists and oral health technicians (OHTs) after a training course and for two years of follow-up in the context of primary health care (PHC). A randomized community trial, from September 2012 to September 2014, was conducted at the Community Health Service of Conceição Hospital Group in Porto Alegre, RS, Brazil. The experimental group consisted of all 41 dentists and OHTs who received an intensive eight-hour training course in basic MI principles; the control group consisted of 31 dentists and OHTs who did not receive MI training. The follow-up assessments were at one and two years using three instruments validated for MI. In the one- and two-year follow-ups, improvement was maintained in responses with a statistically significant difference for use of open questioning, reflective listening, and total percentage of correct answers (p<0.001), with a large effect size (ES=1.12). On the Helpful Responses Questionnaire, the participants continued using open questioning and reflective listening (p<0.001), maintaining an increase in the percentage of responses compatible with MI (p<0.001). Likewise, the effect size remained large (ES=1.33) over time. These results suggest that the training course with dentists and OHTs of the PHC oral health staff was effective over the two-year follow-up in enabling them to act in the spirit and techniques of MI.

Entrevista Motivacional para Estudantes da Área da Saúde: Resultados de um Treinamento

Resumo Este estudo procurou avaliar a efetividade de um treinamento em Entrevista Motivacional (EM) para estudantes do último ano de diferentes cursos na área da saúde. Usando um delineamento pré e pós-teste quase-experimental, 60 estudantes receberam um treinamento de oito horas de habilidades básicas da Entrevista Motivacional. As habilidades foram avaliadas por meio de uma vinheta clínica, das Réguas de Confiança e Importância e do Questionário de Resposta Útil, codificado utilizando o Motivational Interviewing Skill Code. O treinamento foi associado com melhora no uso das habilidades básicas da Entrevista Motivacional. Os alunos também aumentaram a percepção da importância em utilizar essas habilidades com os pacientes, mesmo com um treinamento breve.

Surveillance of Antibiotic Use and Resistance in Intensive Care Units (SARI)

BACKGROUND

The project entitled Surveillance of Antibiotic Use and Resistance in Intensive Care Units (SARI) was initiated in Germany in 2000. In this article, we describe developments in antibiotic use and resistance rates in the participating intensive care units over the years 2001-2015.

METHODS

The intensive care units supplied monthly figures on patient days, antibiotic use (in defined daily doses, DDD), and resistance data for 13 pathogens. The density of antibiotic use per 1000 patient days was calculated on the basis of antibiotic use, DDD, and patient days, and the resistance density per 1000 patient days was calculated from the number of resistant pathogens.

RESULTS

In the years 2001-2015, data on 2 920 068 patient days were collected in 77 intensive care units. The average overall antibiotic use rose by 19% over this period, with a marked increase in the density of carbapenem use (from 76 to 250 DDD per 1000 patient days, +230%) and piperacillin-tazobactam use (from 42 to 146 DDD per 1000 patient days, +247%). The proportion of Escherichia coli and Klebsiella pneumoniae isolates that were resistant to third-generation cephalosporins increased markedly initially, then remained stable over the remainder of the observation period. The proportion of methicillin-resistant Staphylococcus aureus was stable over the entire period. The rates of vancomycin resistance among Enterococcus faecium isolates and imipenem resistance among gram-negative pathogens increased from 2.3% to 13.3% and from 0.1% to 0.3%, respectively.

CONCLUSION

The resistance density of gram-negative multiresistant pathogens in the participating intensive care units increased markedly. The rise in imipenem-resistant pathogens arouses particular concern. The increased use of broad-spectrum/reserve antibiotics may well have contributed to this development. Efforts to use antibiotics rationally, e.g., with the support of multidisciplinary "antibiotic stewardship" teams, are therefore vitally important. As participation in SARI is voluntary, these surveillance data cannot be considered representative of Germany as a whole.

Correction to: Spectrum of movement disorders and neurotransmitter abnormalities in paediatric POLG disease

Due to a typesetting error the wrong Table 2 was used. The correct Table 2 is shown here.