Infrared thermography of the pig thorax: an assessment of selected regions of interest by computed tomographical and anatomical parameters

Current methods of diagnosis of respiratory diseases in swine are invasive, time‐consuming and expensive. Infrared thermography (IRT) of the thorax might provide a new method of high specificity to select swine affected with lung alterations for further diagnostics. In this study, layer thickness of different tissues was determined in frozen thorax slices (FTS) by computed tomography (CT) and then related to skin temperatures measured by IRT in healthy pigs. The aim was to determine appropriate regions of interest (ROI) for evaluation of IRT images. Organ layer thicknesses measured in CT images correspond to those measured in FTS. Temperature differences between lung ROIs and abdomen ROIs were positively correlated with lung layer thickness at certain localizations, and negatively correlated with the thickness of the thorax wall and of inner organ layers. Reference values of differences between skin temperatures were established for two ROIs on the thorax with potential practical use for lung health status determination. Respective ROIs were located on vertical lines crossing the 7th (right) and the 10th (left) thoracic vertebrae. The presence of ribs affected skin temperature significantly.

Evaluation of an infectious disease consultation programme in a German tertiary care hospital

PURPOSE

To evaluate a newly implemented infectious disease (ID) consultation service in terms of patient care, outcome and antibiotic prescription and to describe factors influencing adherence to recommendations.

METHODS

Data from consultations during the first 6 months of the ID consultation program were collected and evaluated. Consultation requests, diagnostic results, treatment outcomes and antibiotic recommendations were categorised. Diagnostic and therapeutic recommendations were assessed and rated for adherence and outcome. Statistical analysis was performed to identify factors influencing adherence and treatment outcome.

RESULTS

A total of 251 consultations were assessed. In most cases, ID specialists were asked for further advice regarding a previously initiated anti-infective treatment (N = 131, 52 %). In 54 of 195 (28 %) first consultations, the ID specialist proposed a differential diagnosis that differed from that of the working diagnoses submitted with the consultation request, and which was subsequently confirmed in 80 % of these cases. Diagnostic and therapeutic recommendations were made in 190 (76 %) and 240 (96 %) of the consultations, respectively. A change in the current treatment was recommended in 66 % of consultations; 37 % of recommendations were cost-saving and 26 % were cost-neutral. Compliance with diagnostic and therapeutic recommendations was rated as good by pre-specified criteria in 65 and 86 % of consultations, respectively. Treatment outcome was correlated with adherence to diagnostic recommendations (P = 0.012). Twenty-nine patients (16 %) died during the same hospital stay.

CONCLUSION

Infectious disease consultations may help to establish the correct diagnosis, resulting in the appropriate treatment being provided to a severely sick patient population. Treatment outcome was improved in cases of good diagnostic adherence to the recommendations of the ID specialist.

Carbapenemase-producing Enterobacteriaceae in Europe: a survey among national experts from 39 countries, February 2013

The spread of carbapenemase-producing Enterobacteriaceae (CPE) is a threat to healthcare delivery, although its extent differs substantially from country to country. In February 2013, national experts from 39 European countries were invited to self-assess the current epidemiological situation of CPE in their country. Information about national management of CPE was also reported. The results highlight the urgent need for a coordinated European effort on early diagnosis, active surveillance, and guidance on infection control measures.

Formation of deposits on the surfaces of superheaters and economisers of MSW incinerator plants

Mineralogical and chemical investigations of deposits from superheaters and economisers from a MSWI plant in Mannheim, Germany, lead to a classification system which provides information about the most critical parameters leading to fouling and corrosion. With the help of this classification system parameters like the geometry of boilers and the waste input can be changed in order to prolong run times between revisions and enhance energy efficiency of MSWI plants.

Secular trends in nosocomial bloodstream infections: antibiotic-resistant bacteria increase the total burden of infection

BACKGROUND

It is unknown whether rising incidence rates of nosocomial bloodstream infections (BSIs) caused by antibiotic-resistant bacteria (ARB) replace antibiotic-susceptible bacteria (ASB), leaving the total BSI rate unaffected.

METHODS

We investigated temporal trends in annual incidence densities (events per 100 000 patient-days) of nosocomial BSIs caused by methicillin-resistant Staphylococcus aureus (MRSA), ARB other than MRSA, and ASB in 7 ARB-endemic and 7 ARB-nonendemic hospitals between 1998 and 2007.

RESULTS

33 130 nosocomial BSIs (14% caused by ARB) yielded 36 679 microorganisms. From 1998 to 2007, the MRSA incidence density increased from 0.2 to 0.7 (annual increase, 22%) in ARB-nonendemic hospitals, and from 3.1 to 11.7 (annual increase, 10%) in ARB-endemic hospitals (P = .2), increasing the incidence density difference between ARB-endemic and ARB-nonendemic hospitals from 2.9 to 11.0. The non-MRSA ARB incidence density increased from 2.8 to 4.1 (annual increase, 5%) in ARB-nonendemic hospitals, and from 1.5 to 17.4 (annual increase, 22%) in ARB-endemic hospitals (P < .001), changing the incidence density difference from -1.3 to 13.3. Trends in ASB incidence densities were similar in both groups (P = .7). With annual increases of 3.8% and 5.4% of all nosocomial BSIs in ARB-nonendemic and ARB-endemic hospitals, respectively (P < .001), the overall incidence density difference of 3.8 increased to 24.4.

CONCLUSIONS

Increased nosocomial BSI rates due to ARB occur in addition to infections caused by ASB, increasing the total burden of disease. Hospitals with high ARB infection rates in 2005 had an excess burden of BSI of 20.6 per 100 000 patient-days in a 10-year period, mainly caused by infections with ARB.

[Epidemiology, diagnosis and treatment of adult patients with nosocomial pneumonia. S-3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy]

Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However infections on general wards are also increasing. A central issue are infections with multi drug resistant (MDR) pathogens which are difficult to treat particularly in the empirical setting potentially leading to inappropriate use of antimicrobial therapy. This guideline was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and therapy of HAP on the basis of quality of evidence and benefit/risk ratio. The guideline has two parts. First an update on epidemiology, spectrum of pathogens and antiinfectives is provided. In the second part recommendations for the management of diagnosis and treatment are given. Proper microbiologic work up is emphasized for knowledge of the local patterns of microbiology and drug susceptibility. Moreover this is the optimal basis for deescalation in the individual patient. The intensity of antimicrobial therapy is guided by the risk of infections with MDR. Structured deescalation concepts and strict limitation of treatment duration should lead to reduced selection pressure.

Molecular epidemiology of Acinetobacter baumannii and Acinetobacter nosocomialis in Germany over a 5-year period (2005-2009)

To investigate the species distribution within the Acinetobacter calcoaceticus-Acinetobacter baumannii complex and the molecular epidemiology of A. baumannii and Acinetobacter nosocomialis, 376 Acinetobacter isolates were collected prospectively from hospitalized patients at 15 medical centres in Germany during three surveillance studies conducted over a 5-year period. Species identification was performed by molecular methods. Imipenem minimum inhibitory concentrations (MIC) were determined by broth microdilution. The prevalence of the most common carbapenemase-encoding genes was investigated by oxacillinase (OXA) -multiplex polymerase chain reaction (PCR). The molecular epidemiology was investigated by repetitive sequence-based PCR (rep-PCR; DiversiLab™). Acinetobacter pittii was the most prevalent Acinetobacter species (n = 193), followed by A. baumannii (n = 140), A. calcoaceticus (n = 10) and A. nosocomialis (n = 8). The majority of A. baumannii was represented by sporadic isolates (n = 70, 50%) that showed unique rep-PCR patterns, 25 isolates (18%) clustered with one or two other isolates, and only 45 isolates (32%) belonged to one of the previously described international clonal lineages. The most prevalent clonal lineage was international clone (IC) 2 (n = 34) and IC 1 (n = 6). According to CLSI, 25 A. baumannii isolates were non-susceptible to imipenem (MIC ≥ 8 mg/L), all of which produced an OXA-58-like or OXA-23-like carbapenemase. The rate of imipenem susceptibility among A. baumannii isolates decreased from 96% in 2005 to 76% in 2009. All other Acinetobacter isolates were susceptible to imipenem. The population structure of carbapenem-susceptible A. baumannii in Germany is highly diverse. Imipenem non-susceptibility was strongly associated with the clonal lineages IC 2 and IC 1. These data underscore the high clonality of carbapenem-resistant A. baumannii isolates.

Rapid evolution and spread of carbapenemases among Enterobacteriaceae in Europe

Plasmid-acquired carbapenemases in Enterobacteriaceae, which were first discovered in Europe in the 1990s, are now increasingly being identified at an alarming rate. Although their hydrolysis spectrum may vary, they hydrolyse most β-lactams, including carbapenems. They are mostly of the KPC, VIM, NDM and OXA-48 types. Their prevalence in Europe as reported in 2011 varies significantly from high (Greece and Italy) to low (Nordic countries). The types of carbapenemase vary among countries, partially depending on the cultural/population exchange relationship between the European countries and the possible reservoirs of each carbapenemase. Carbapenemase producers are mainly identified among Klebsiella pneumoniae and Escherichia coli, and still mostly in hospital settings and rarely in the community. Although important nosocomial outbreaks with carbapenemase-producing Enterobacteriaceae have been extensively reported, many new cases are still related to importation from a foreign country. Rapid identification of colonized or infected patients and screening of carriers is possible, and will probably be effective for prevention of a scenario of endemicity, as now reported for extended-spectrum β-lactamase (mainly CTX-M) producers in all European countries.

[Phantom studies using a high-resolution CT for ex-vivo imaging of degradable magnesium implants and simulated peri-implant bone formation in rabbit tibiae]

PURPOSE

Evaluation of the suitability of the high-resolution CT XtremeCT for ex vivo imaging of degradable magnesium implants with simulated peri-implant bone formation in rabbit tibiae and development of a method for calibrating the mass concentration of a magnesium alloy in an implant volume.

MATERIALS AND METHODS

Using specially designed phantoms, degradable magnesium implants of the alloys LAE442, ZEK100, AX30 and MgCa 0.8 %, without coating and with peri-implant bone formation simulated by a coating, as well as rabbit tibiae were scanned. CT numbers and the contrast-to-noise-ratio (CNR) of the studied materials were determined. The visual distinction between implant and coating was evaluated. To calibrate the implant density, exemplary LAE442 pins with different mass concentrations were scanned using a specially constructed phantom. Subsequently, CT numbers corresponding to the appropriate mass concentration were determined.

RESULTS

The implants, coating and substantia corticalis showed a similar density. Visual distinction between coating and implant was strongly dependent on the respective magnesium alloy and chosen scan parameter. A CNR of at least 0.2 was required for a distinction between implant and coating. For the mass concentration, a high CT number linearity (R2=0.99) throughout the measuring range (1811-1273 mg/cm3 LAE442) was found.

CONCLUSION

As expected, the XtremeCT is primarily suitable for the imaging of bone tissue and implants. Good visual distinction of peri-implant bone formation on magnesium implants in an ex vivo phantom model ranges from possible to difficult depending on the bone density and alloy composition.

Abstract 2494: A Transient Decrease in Spleen Size Following Stoke Corresponds to Splenocyte Release into Systemic Circulation

Objective: Splenectomy is protective in ischemic injuries to renal, hepatic, and gastrointestinal systems, showing that the splenic response promotes cellular degeneration. Removal of the spleen is also protective in ischemic and hemorrhagic stroke. Therefore, we investigated the cellular response of the spleen to brain ischemia.

Hypothesis: Immune cells are released from the spleen following cerebral ischemia contributing to neural injury.

Methods: A time course was conducted to investigate splenic size changes in rats over time following permanent middle cerebral artery occlusion (MCAO) and sham-MCAO (n≥3). In a second experiment, splenocytes were labeled in situ with carboxyfluorescein diacetate, succinimidyl ester (CFSE). Five evenly spaced splenic injections, 4 mg/ml in DMSO, were given to all groups five days prior to MCAO or sham-MCAO. The experimental groups were: 48 hr post-MCAO (n=4), 48 hr post-sham-MCAO (n=4), 96 hr post-MCAO (n=6), 96 hr post-sham-MCAO (n=4), and a CFSE only group that was euthanized five days following injection of CFSE without undergoing MCAO (n=4). Spleen, brain, thymus, and blood smears were collected for all groups.

Results: The spleen was found to decrease in size at 48 hrs following MCAO in rats compared to controls (p<0.01). However, by 96 hrs post-MCAO the spleen size returned to levels not different from sham operated rats. CFSE was found to be non-toxic at the 4 mg/ml concentration and five days following injection 15% of the splenocytes were labeled. In the spleen, there was a significant increase (p<0.0001) in CFSE positive cells in the 48 hr sham group versus the 96 hr sham and both 48 and 96 hr MCAO groups. Blood smears showed a significant increase in total CFSE positive cells (p<0.0007) at 48 hrs post-MCAO. CFSE positive cells in the blood were identified by Giemsa staining. A significant increase of lymphocytes (p<0.005), monocytes (p<0.02), and neutrophils (p<0.0005) was found at 48 hrs post-MCAO when compared to the other groups.

Conclusion: These results demonstrate that CFSE is a viable and safe way to track immune cells in situ in an animal model of stroke. The spleen transiently decreases in size post-MCAO in rats and releases splenocytes into systemic circulation at 48 hrs following MCAO. These cells are migrating to the brain or other lymphoid organs, affecting the overall immune response to ischemia. Brains and thymi from the CFSE injected animals will be analyzed for the presence of these cells.

Optimising μCT imaging of the middle and inner cat ear

This study's aim was to determine the optimal scan parameters for imaging the middle and inner ear of the cat with micro-computertomography (μCT). Besides, the study set out to assess whether adequate image quality can be obtained to use μCT in diagnostics and research on cat ears. For optimisation, μCT imaging of two cat skull preparations was performed using 36 different scanning protocols. The μCT-scans were evaluated by four experienced experts with regard to the image quality and detail detectability. By compiling a ranking of the results, the best possible scan parameters could be determined. From a third cat's skull, a μCT-scan, using these optimised scan parameters, and a comparative clinical CT-scan were acquired. Afterwards, histological specimens of the ears were produced which were compared to the μCT-images. The comparison shows that the osseous structures are depicted in detail. Although soft tissues cannot be differentiated, the osseous structures serve as valuable spatial orientation of relevant nerves and muscles. Clinical CT can depict many anatomical structures which can also be seen on μCT-images, but these appear a lot less sharp and also less detailed than with μCT.

Yersinia pseudotuberculosis bloodstream infection and septic arthritis: case report and review of the literature

Yersinia pseudotuberculosis belongs to the family Enterobacteriaceae and is known to cause enterocolitis, terminal ileitis, pseudoappendicitis, erythema nodosum, reactive polyarthritis, and, occasionally, bloodstream infections. Here, we report the first case of bacteremia and septic arthritis in a patient without obvious risk factors and review all of the published cases of Y. pseudotuberculosis bloodstream infections.

[Pancreatic necrosis: pro-endoscopic therapy]

The transmural endoscopic debridement and other minimally invasive therapies of infected postpancreatic necroses have been developed over the last decade as alternatives to open surgery. In several clinical centers the endoscopic approach has become standard therapy. The mortality rate in published series is in the range 0-15% and additional surgery is needed in 0-40%.Out of 73 own patients treated endoscopically between 2006 and 2010, 4 were operated because of bleeding, 2 with an acute abdomen and 3 with sepsis. Of the patients 6 died because of multi-organ failure and in 3 cases despite surgery. Main complications such as bleeding (n=20) and acute abdomen (n=7) were mostly treated conservatively. There was no procedure-related mortality. The endoscopic therapy was successful in 59 patients (80%) of whom 7 required further transmural endoscopic interventions for cystic relapses.At present, finding the best combination of endoscopic-transmural, percutaneous, laparoscopic and sometimes finally open surgical therapy remains an interdisciplinary challenge. The only randomized study published in this context clearly indicates that such a step-up approach is the most favorable.

Clinical laboratory detection of AmpC β-lactamase: does it affect patient outcome?

Plasmid-mediated AmpC-producing Escherichia coli and Klebsiella pneumoniae have been associated with poor clinical outcomes, but they are not readily identified in hospital microbiology laboratories. We tested 753 gram-negative bloodstream isolates for AmpC by using the EDTA disk test and the modified Hodge test (n = 172) and the modified Hodge test alone (n = 581). The 30-day mortality for the AmpC group was 9% (2/23) and was 6% (3/51) for the control group. The clinical response was similar: afebrile on day 2 (AmpC group, 16/23 [70%]; control group, 32/45 [71%]) and on day 4 (AmpC group, 19/22 [86%]; control group, 37/44 [84%]). Patients with isolates in the AmpC group were more likely to be in an intensive care unit at the time of the positive blood culture (P = .01) and more likely to be intubated (P = .05) than patients with isolates in the control group. Effective antibiotic treatment within the first 48 hours was given to 47 (92%) of 51 patients with isolates in the control group but to only 14 (61%) of 23 patients with isolates in the AmpC group (P = .001). The modified Hodge test and the EDTA disk test did not identify patients at risk for a poor outcome from AmpC-producing bacterial infections.

Burden of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay associated with bloodstream infections due to Escherichia coli resistant to third-generation cephalosporins

OBJECTIVES

This study determined excess mortality and length of hospital stay (LOS) attributable to bloodstream infection (BSI) caused by third-generation-cephalosporin-resistant Escherichia coli in Europe.

METHODS

A prospective parallel matched cohort design was used. Cohort I consisted of patients with third-generation-cephalosporin-resistant E. coli BSI (REC) and cohort II consisted of patients with third-generation-cephalosporin-susceptible E. coli BSI (SEC). Patients in both cohorts were matched for LOS before infection with patients free of the respective BSI. Thirteen European tertiary care centres participated between July 2007 and June 2008.

RESULTS

Cohort I consisted of 111 REC patients and 204 controls and cohort II consisted of 1110 SEC patients and 2084 controls. REC patients had a higher mortality at 30 days (adjusted odds ratio = 4.6) and a higher hospital mortality (adjusted hazard ratio = 5.7) than their controls. LOS was increased by 8 days. For SEC patients, these figures were adjusted odds ratio = 1.9, adjusted hazard ratio = 2.0 and excess LOS = 3 days. A 2.5 times [95% confidence interval (95% CI) 0.9-6.8] increase in all-cause mortality at 30 days and a 2.9 times (95% CI 1.2-6.9) increase in mortality during entire hospital stay as well as an excess LOS of 5 days (95% CI 0.4-10.2) could be attributed to resistance to third-generation cephalosporins in E. coli BSI.

CONCLUSIONS

Morbidity and mortality attributable to third-generation-cephalosporin-resistant E. coli BSI is significant. If prevailing resistance trends continue, high societal and economic costs can be expected. Better management of infections caused by resistant E. coli is becoming essential.

Extraction methods in bovine obstetrics: comparison of the demanded energy and importance of calf and traction method in the variance of force and energy

In a previous study we could demonstrate that in terms of the required forces alternate traction is preferable to simultaneous traction for the obstetrical delivery of calves. The aims of this study were to examine the required energies for delivery of calves and to compare the effects of the factors of calf and traction method on the forces and energies required for the delivery. In a biomechanical in vitro model 12 stillborn Holstein-Friesian calves were pulled through the pelvic specimen of a cow at a controlled speed using two electric motors. Traction was applied simultaneously (ST) to both legs or alternately (AT) to one leg at a time to advance it 10 cm (AT 10) or 5 cm (AT5). Energies on each limb were measured digitally using load cells. The lowest energy for the entrance of the elbows in the pelvis was necessary using AT10 (19.9 ± 7.2 kJ, P < 0.05). In contrast, for the entrance of the chest, AT10 (104.9 ± 24.7 kJ) demanded 9% (P < 0.01) and 16% (P < 0.001) more energy than AT5 (96.7 ± 21.0 kJ) and ST (90.5 ± 24.9 kJ), respectively. Simultaneous traction tended to be better than AT5 (P = 0.09). Variance component estimates revealed that the factor calf contributed the main effect to the emerging forces and required energy. The traction method was responsible for up to 13% of the variance in most of the cases, but it accounted for 42% of the variance regarding the forces on the lower limb as the chest entered the pelvis. Based on these findings, the decision of the clinician whether or not to perform a manual traction should depend mainly on the calf. However, when such a decision has been made, alternate limb traction, 10 cm at a time, should be used until both elbows have entered the pelvis and a simultaneous traction should then be applied to complete extraction of the chest.

Prevention, diagnosis, therapy and follow-up care of sepsis: 1st revision of S-2k guidelines of the German Sepsis Society (Deutsche Sepsis-Gesellschaft e.V. (DSG)) and the German Interdisciplinary Association of Intensive Care and Emergency Medicine (Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI))

Practice guidelines are systematically developed statements and recommendations that assist the physicians and patients in making decisions about appropriate health care measures for specific clinical circumstances taking into account specific national health care structures. The 1^st revision of the S-2k guideline of the German Sepsis Society in collaboration with 17 German medical scientific societies and one self-help group provides state-of-the-art information (results of controlled clinical trials and expert knowledge) on the effective and appropriate medical care (prevention, diagnosis, therapy and follow-up care) of critically ill patients with severe sepsis or septic shock. The guideline had been developed according to the “German Instrument for Methodological Guideline Appraisal” of the Association of the Scientific Medical Societies (AWMF). In view of the inevitable advancements in scientific knowledge and technical expertise, revisions, updates and amendments must be periodically initiated. The guideline recommendations may not be applied under all circumstances. It rests with the clinician to decide whether a certain recommendation should be adopted or not, taking into consideration the unique set of clinical facts presented in connection with each individual patient as well as the available resources.

[Spondylodiscitis - an interdisciplinary challenge]

HISTORY AND ADMISSION FINDINGS

A 21-year-old man presented with severe lumbar back pain and progressive paraparesis with clinical signs of spondylitis. Laboratory findings revealed elevated infectious parameters. Because of a positive Mantoux-Test he had been treated with quadruple tuberculostatic drugs for eight weeks without prior identification of the causative pathogen.

INVESTIGATIONS

Magnetic resonance imaging of the spine revealed a multisegmental spondylitis of the lumbar vertebrae (L3 - L5) with epidural empyema. Computed tomography (CT) of the abdomen confirmed large bilateral abscesses in the psoas muscles.

TREATMENT AND COURSE

The findings supported the diagnosis of spondylitis. The antibiotic regimen was continued. CT-guided drainage was placed in both psoas muscles. Laminectoma of L3 - 5 and dorsal spondylodesis of L2 - S1 were performed immediately. Mycobacterium tuberculosis was cultured from the intraoperative biopsies and treated according to the drug sensitivity test. After further surgical debridment and corporectomy of L4 and L5 the infection was successfully treated. Ten weeks after admission the patient was transferred to a neurologic rehabilitation unit for mobilization.

CONCLUSION

Spondylodiscitis treatment is complex and requires a multidisciplinary approach.

[Microbiological monitoring of ventilator-associated pneumonia in an intensive care unit]

Ventilator-associated pneumonia is the most frequent nosocomial infection in intensive care units (ICU) and causes high mortality. Approximately 50% of all antibiotics in ICUs are administered for the treatment of respiratory tract infections. Prompt and appropriate antibiotic treatment is paramount for a favourable clinical outcome as any delay in diagnosis and treatment will result in increased mortality. Therefore it is common practice in many ICUs to perform routine surveillance cultures of lower respiratory tract samples so that when pneumonia occurs, the empiric antibiotic regime can be based on the pathogens previously identified in surveillance cultures. This article highlights the advantages and disadvantages of routine surveillance cultures and provides a critical review of the recent literature. The majority of published studies favour surveillance cultures, because these can often predict the pathogens responsible for pneumonia and lead to timely administration of adequate antimicrobial therapy. Although the rationale behind this approach appears evident, the impact of surveillance cultures on clinical outcome as well as their cost effectiveness remains to be determined. Therefore, at this point, national and international guidelines do not recommend the routine use of surveillance cultures in mechanically ventilated patients but stress the need for larger, well designed clinical studies.

Transluminal endoscopic necrosectomy after acute pancreatitis: a multicentre study with long-term follow-up (the GEPARD Study)

BACKGROUND

As with endoscopic transmural drainage of peripancreatic fluid collections, the same transluminal access can be expanded to introduce an endoscope through the gastrointestinal wall into the retroperitoneum and remove infected pancreatic necroses under direct visual control. This study reports the first large series with long-term follow-up.

METHODS

Data for all patients undergoing transluminal endoscopic removal of (peri)pancreatic necroses between 1999 and 2005 in six different centres were collected retrospectively, and the patients were followed up prospectively until 2008. The initial patient and treatment outcome data were recorded, as were long-term results.

RESULTS

Ninety-three patients (63 men, 30 women; mean age 57 years) underwent a mean of six interventions starting at a mean of 43 days after an attack of severe acute pancreatitis. After establishment of transluminal access to the necrotic cavity and subsequent endoscopic necrosectomy, initial clinical success was obtained in 80% of the patients, with a 26% complication and a 7.5% mortality rate at 30 days. After a mean follow-up period of 43 months, 84% of the initially successfully treated patients had sustained clinical improvement, with 10% receiving further endoscopic and 4% receiving surgical treatment for recurrent cavities; 16% suffered recurrent pancreatitis.

CONCLUSIONS

Direct transluminal endoscopic removal of pancreatic necroses is associated with good long-term maintenance of the high initial efficacy; complications can occur, with an associated mortality of around 7.5%. Further studies are necessary in order to optimise endotherapy and define its role in relation to surgery in the clinical management of such patients.

Susceptibility of clinical isolates of frequently encountered bacterial species to tigecycline one year after the introduction of this new class of antibiotics: results of the second multicentre surveillance trial in Germany (G-TEST II, 2007)

Tigecycline, a broad-spectrum antibiotic for parenteral use, was introduced in Germany in May 2006. In the G-TEST-II trial, the susceptibility of isolates, recovered in 2007 from hospitalised patients in 15 centres, was assessed against tigecycline and comparators. Susceptibility tests were performed by the microdilution procedure. This study reports on the susceptibility of the isolates of 16 bacterial species and compares the results with those of a trial (G-TEST I) conducted prior to the introduction of tigecycline. Between 2005 and 2007, tigecycline retained activity against Gram-positive and Gram-negative organisms. By contrast, the rate of vancomycin-resistant strains among Enterococcus faecium isolates almost doubled. Moreover, an increase in resistance to broad-spectrum beta-lactams and fluoroquinolones was observed for members of the family Enterobacteriaceae. Against a background of a steadily rising number of pathogens that are resistant to various antibiotic classes, tigecycline represents an important treatment option.