Strategies to enhance rational use of antibiotics in hospital: a guideline by the German Society for Infectious Diseases.

Introduction: In the time of increasing resistance and paucity of new drug development there is a growing need for strategies to enhance rational use of antibiotics in German and Austrian hospitals. An evidence-based guideline on recommendations for implementation of antibiotic stewardship (ABS) programmes was developed by the German Society for Infectious Diseases in association with the following societies, associations and institutions: German Society of Hospital Pharmacists, German Society for Hygiene and Microbiology, Paul Ehrlich Society for Chemotherapy, The Austrian Association of Hospital Pharmacists, Austrian Society for Infectious Diseases and Tropical Medicine, Austrian Society for Antimicrobial Chemotherapy, Robert Koch Institute.

Materials And Methods: A structured literature research was performed in the databases EMBASE, BIOSIS, MEDLINE and The Cochrane Library from January 2006 to November 2010 with an update to April 2012 (MEDLINE and The Cochrane Library).

Trends in the occurrence of MRSA strains in Upper Austria from 2006 to 2009.

Between 2006 and 2009, all MRSA isolates recovered from human patients in Upper Austria were subjected to molecular biological analysis. Whereas the isolate number decreased from year to year, the proportion of the most common sequence types (ST5, ST8 and ST22) as well as the frequency of associated PFGE subtypes and spa-types remained similar. The rate of PVL-positive MRSA increased, whereupon the most common sequence types were ST152, ST8 including clone USA300, ST5, ST777 and ST88.

Citric acid inhibits growth of Helicobacter pylori in vitro: a new strategy for eradication.

Background: About 50% of the world population is infected with Helicobacter pylori. The association of peptic ulcer disease with Helicobacter pylori is well documented. Therefore eradication is obligatory.

Antiviral treatment of chronic hepatitis C in clinical routine.

Objective: Pegylated interferon plus ribavirin is the standard treatment for chronic hepatitis C. Sustained virological response (SVR) rates of up to 60% are reported in randomized controlled trials, but it is unclear whether the results from such trials are reproducible in the clinical routine setting. We investigated consecutive treatment-naïve chronic hepatitis C patients at our center to examine the efficacy of treatment with pegylated interferon plus ribavirin in clinical routine.

Chronic hepatitis C in Austria, 1992-2006: genotype distribution and demographic factors.

Chronic hepatitis C is a leading cause of end-stage liver disease and, with a worldwide prevalence of up to 3%, is a pandemic infectious disease. Austria, like most western European countries can be considered as a low prevalence country. This analysis aimed to assess the distribution of hepatitis C virus (HCV) genotypes in patients with chronic HCV infection in Upper Austria.

Ten years of antibiotic consumption in ambulatory care: trends in prescribing practice and antibiotic resistance in Austria.

Background: The primary aims of this study were (i) to determine the quantity and pattern of antibiotic use in Austria between 1998 and 2007 and (ii) to analyze antibiotic esistance rates in relation to antibiotic consumption in important clinical situations in order to provide data for empirical therapeutic regimens for key indications.

Methods: Consumption data and resistance data were obtained via the Austrian surveillance networks European Antimicrobial Resistance Surveillance System (EARSS) and European Surveillance on Antimicrobial Consumption (ESAC). The EARSS collects data on isolates from blood and cerebrospinal fluid obtained predominantly in the hospital setting.

Methicillin-Resistant Staphylococcus aureus ST398 from human patients, upper Austria.

Methicillin-resistant Staphylococcus aureus (MRSA) clonal type ST398 is usually associated with animals. We examined 1,098 confirmed MRSA samples from human patients and found that 21 were MRSA ST398. Most (16) patients were farmers.

The European surveillance activities EARSS and ESAC in the context of ABS International.

Development of resistance obstructs the successful use of antimicrobial drugs, since shortly after each and every introduction of a new antibiotic resistant pathogens have emerged. The hope of being able to reverse or at least slow down the occurrence of antibiotic resistance has led to a number of actions and initiatives. The project "ABS International - Implementing antibiotic strategies for appropriate use of antibiotics in hospitals in member states of the European Union", together with the European Antimicrobial Resistance Surveillance System (EARSS) and the European Surveillance on Antimicrobial Consumption (ESAC), covers a large proportion of possible actions against antibiotic resistance.

Antimicrobial stewardship.

The aim of antimicrobial management or stewardship programmes is to ensure proper use of antimicrobial agents in order to provide the best treatment outcomes, to lessen the risk of adverse effects (including antimicrobial resistance), and to promote cost-effectiveness. Increasingly, long-term sustainability is found to be the major focus of antimicrobial stewardship. Implementing structural measures in healthcare institutions is therefore a major, but not the sole, focus of attention in promoting prudent use of antibiotics.

MRSA in Austria--an overview.

The aim of this study was to provide an overview of predominant and sporadic methicillin-resistant Staphylococcus aureus (MRSA) strains in large regions of Austria, and to compare the results with those from other European countries. In total, 1439 MRSA isolates, collected routinely between January 1996 and June 2006 from five Austrian federal provinces, were investigated. The isolates were confirmed as MRSA using mecA/femA multiplex PCR assays.

PVL-positive MRSA in Austria.

The objective of this study was to present, for the first time, an overview of the existing Panton-Valentine leukocidin (PVL)-positive methicillin-resistant Staphylococcus aureus (MRSA) strains in Austria and to compare the situation with that found in other countries. Between 2001 and 2006 we analysed 1150 MRSA isolates - from infections as well as from colonisation - for the presence of PVL genes. The most common multilocus sequence types of the 94 PVL-positive MRSA strains were ST8, ST152, ST30, ST80, and ST5; the ST22, and ST777 sequences were also detected.

European recommendations for antimicrobial resistance surveillance.

The problem of antimicrobial resistance surveillance in Europe has been debated extensively in many excellent documents issued by national committees that often assume the value of national guidelines. However, a comprehensive document addressing the whole matter from a European perspective, as well as reviewing its present status and drafting future perspectives, has been lacking. The present recommendations have been produced by the ESCMID Study Group for Antimicrobial Resistance Surveillance (ESGARS) through a consensus process involving all members of the Study Group.

Multicentre evaluation of the VITEK 2 Advanced Expert System for interpretive reading of antimicrobial resistance tests.

Interpretive reading analyses the complete resistance profiles of bacteria to multiple antibiotics and infers the resistance mechanisms present; it aids therapeutic choice and enhances surveillance data. We evaluated the Advanced Expert System (AES), which interprets MICs generated by the VITEK 2. Ten European laboratories tested 42 reference strains and 76-106 of their own strains, representing important resistance genotypes.

Non-touch fittings in hospitals: a possible source of Pseudomonas aeruginosa and Legionella spp.

Non-touch fittings are gradually becoming very common in the bathrooms and toilets of public facilities and restaurants. Hospitals and other healthcare facilities have recently started to install these types of water taps to lower water consumption, thus saving costs, and to prevent healthcare workers from touching the tap, thus promoting hygiene. This study analysed the bacteriological water quality of 38 non-touch water taps in different settings in a 450-bed secondary-care hospital in Upper Austria.

Enterovirus infection--a possible trigger for Graves' disease?

Viruses are potential environmental factors in autoimmune disease. Some evidence suggests a relationship between enteroviral infection (especially Coxsackie B virus) and autoimmunity. We investigated 21 individuals with recent onset of Graves' hyperthyroidism in regard of (subclinical) enterovirus infection.

In vitro activity of newer broad spectrum beta-lactam antibiotics against enterobacteriaceae and non-fermenters: a report from Austrian intensive care units. Austrian Carbapenem Susceptibility Surveillance Group.

We compared the in vitro activity of broad spectrum beta-lactam antibiotics against 573 gram-negative isolates (enterobacteriaceae and non-fermenters) collected between November 1996 and May 1997 from 9 laboratories serving intensive care units throughout Austria. MIC's (Minimal Inhibitory Concentration) were obtained with the E-test for meropenem, imipenem, ceftazidime, cefepime, cefpirome and piperacillin/tazobactam. Pseudomonas aeruginosa was the most frequently isolated organism (22%), followed by E.

[Community-acquired pneumonia--current status of pathogen diagnosis].

Procedures for the microbiological diagnosis of acute community-acquired pneumonia are based on the expected pathogens. Although a great variety of microorganisms are able to cause community-acquired pneumonia only a few pathogens play an important role in daily practice. The most important investigations are blood cultures and sputum cultures to detect bacteria like pneumococci, Haemophilus influenzae and Staphylococcus aureus as well as antibody tests for Mycoplasma pneumonia and Chlamydia pneumonia.

Vibrio cholerae non-O1 septicaemia in a patient with liver cirrhosis and Billroth-II-gastrectomy.

This report deals with the first diagnosed case of Vibrio cholerae non-O1 septicaemia in Austria. After a vacation in Tunisia, a 51-year-old male patient with liver cirrhosis and Billroth-II-gastrectomy was admitted to hospital because of abdominal pain, growing ascites, and jaundice. Four days later, the patient developed a single peak of high fever (39.

Antibiotic susceptibility of pneumococci isolated in Austria over a four-year period.

The antibiotic susceptibility of pneumococci isolated from clinical specimens from 1991 through 1994 was investigated. Of 305 strains tested by the agar dilution method, 16 (5.2%) were resistant to penicillin (MICs > or = 0.

Yersinia enterocolitica septicemia in autologous blood transfusion.

Background: Increasingly, autologous blood transfusions are used in elective surgical procedures to avoid the risk of infection due to allogeneic blood transfusion.

Case Report: A 64-year-old patient had to undergo the implantation of a total right hip endoprosthesis. During the transfusion of 1 unit of autologous packed red cells, the patient experienced high temperature and shock, which necessitated his observation in the intensive care unit for several days.