Emergence and dissemination of a linezolid-resistant Staphylococcus capitis clone in Europe

Objectives

We investigated the epidemiological, clinical, microbiological and genetic characteristics of linezolid-resistant (LZR) Staphylococcus capitis isolates from French ICUs, and compared them with LZR S. capitis isolates from other European countries.

Methods

All LZR isolates were subjected to antimicrobial susceptibility testing (AST) and the presence of cfr and optrA genes as well as mutations in the 23S rRNA and ribosomal proteins were investigated using specific PCR with sequencing. The genetic relationship between isolates was investigated using PFGE and WGS. Epidemiological data concerning LZR S. capitis were collected retrospectively in French microbiology laboratories.

Results

Twenty-one LZR isolates were studied: 9 from France, 11 from Greece and 1 from Finland. All were resistant to methicillin and aminoglycosides. In addition, this unusual AST profile was identified in S. capitis isolates from seven French hospitals, and represented up to 12% of the S. capitis isolates in one centre. A G2576T mutation in 23S rRNA was identified in all isolates; cfr and optrA genes were absent. All isolates belonged to the same clone on the basis of their PFGE profiles, whatever their geographical origin. WGS found at most 212 SNPs between core genomes of the LZR isolates.

Conclusions

We identified and characterized an LZR S. capitis clone disseminated in three European countries, harbouring the same multiple resistance and a G2576T mutation in the 23S rRNA. The possible unrecognized wider distribution of this clone, belonging to a species classically regarded as a low-virulence skin colonizer, is of major concern not least because of the increasing use of oxazolidinones.

Elektronischer Mutter(Eltern)-Kind Pass – Möglichkeiten, Zielsetzungen und internationale Erfahrungen

Vor dem Hintergrund einer Neugestaltung des Eltern-Kind-Vorsorgeprogramms in Österreich, welche auch eine elektronische statt papierbasierte Umsetzung beinhalten könnte, soll ein Überblick internationaler Pilotierungen elektronischer Eltern-Kind-Vorsorge Initiativen (eEKVI) gegeben, und für die Umsetzung relevanten Grenzen, Möglichkeiten und Zielsetzungen dieser Projekte aufgezeigt werden.

Datenbankrecherche sowie Handsuche nach internationalen (Pilot-) Projekten.

Von 30 ausgewählten eEKVI können 9 als elektronische Eltern- bzw. Kinder-Gesundheitsakten angesehen werden, welche entweder im Kontext einer umfassenden elektronischen Gesundheitsakte, als elektronische Umsetzung eines papierbasierten Dokuments oder als an eine Einrichtung gebundene IT-Lösung realisiert wurden. eEKVI sind bislang international noch kaum flächendeckend implementiert, einige wenige bedienen neben klassischen Kern-Zielen (Abwicklung und Administration der Versorgung usw.) auch planerische Zielsetzungen und ermöglichen dadurch ein systemisches Lernen aufgrund von Feedback und Evaluationszyklen.

Basierend auf Erfahrungen internationaler eEKVI sollten Kernaspekte einer erfolgreichen Planung und Umsetzung, wie beispielsweise die Definition von erwarteten Nutzen-Zielen und deren Monitoring oder die Bildung eines für Planung und Konzeption verantwortlichen Teams unter früher Einbeziehung von Endnutzern und Akteuren, berücksichtigt werden, um vermeidbare Fehler zu minimieren. Eine konsequente Technikfolgenabschätzung – auch von IT-basierten Interventionen im Gesundheitswesen – ist jedenfalls zu fordern, um ein reflektiertes Vorgehen zu ermöglichen.

[Study of hepatitis C virus leukotropism by characterization of viral quasispecies in the liver transplantation setting]

Besides hepatocytes, representing the main replication site of hepatitis C virus, peripheral blood mononuclear cells also represent a crucial target for viral infection. Hepatitis C virus compartmentalization (i.e., non-random distribution) of viral variants between plasma and peripheral blood mononuclear cells, more frequently observed in liver transplant patients compared to non-transplanted patients, makes liver transplantation an interesting model for the analysis of hepatitis C leukotropism. This article aims to present, firstly, in clinical and biological features arguing favour of hepatitis C virus infection leukotropism and, secondly, to review current knowledge about compartmentalization between plasma and peripheral blood mononuclear cells, especially in the liver transplantation setting.

Histamine mediates osteoclastic resorption only during the acute phase of bone loss in ovariectomized rats

Short-term studies have shown that histamine is involved, via its H2 receptors (H2R), in the mediator network regulating trabecular bone loss in long bones of ovariectomized (OVX) rats. It is not known whether this effect of histamine persists over time or involves other skeletal sites. In this study, rats were maintained for 6 months postOVX and treated daily with saline or famotidine (10 mg kg(-1)), an H2R antagonist. At the end of the experimental period, femur trabecular bone mass was markedly decreased in OVX rats, whether or not they were treated with famotidine. In contrast, in the fourth lumbar vertebra, where bone loss starts later than in the femur, famotidine treatment attenuated the decline in trabecular bone volume, protected the trabecular architecture, maintained the thickness of the cortices and reduced the numbers of osteoclasts and tartrate-resistant acid phosphatase-positive preosteoclasts, whereas it had no influence on bone formation parameters. In vertebral bone marrow of OVX rats, the numbers of mast cells (MCs) and non-MC histamine-producing cells increased, while famotidine treatment significantly diminished both cell populations. These data show that H2R antagonism does not protect trabecular bone mass in the long term, and that short-term protection involves all bones. Histamine is involved during the early phase of strong osteoclastic resorption but not during the late phase of slower resorption, suggesting that different mediator networks control the two phases of destruction. Histamine would be part of the network mediating the early phase.

Rechtliche Möglichkeiten und Grenzen der Integrierten Versorgung in der Kardiologie

Regulations of Integrated Health Care are capable of overriding the barriers of separated outpatient and inpatient health care. These regulations create a situation of competition among health care providers, but not among payers. Since the laws exclude common regulations of competition laws, antitrust laws and public procurement laws from Integrated Health Care, insurance companies gain a relatively strong position in the competition for contracts. This is even enforced by the fact that no health care provider is entitled to request a contract with a specific insurance company. The main result is that insurance companies can determine the contracts deliberately.