Public Health Efforts Can Impact Adoption of Current Susceptibility Breakpoints, but Closer Attention from Regulatory Bodies Is Needed.

Microbiological testing, including interpretation of antimicrobial susceptibility testing results using current breakpoints, is crucial for clinical care and infection control. Continued use of obsolete Enterobacteriaceae carbapenem breakpoints is common in clinical laboratories. The purposes of this study were (i) to determine why laboratories failed to update breakpoints and (ii) to provide support for breakpoint updates. The Los Angeles County Department of Public Health conducted a 1-year outreach program for 41 hospitals in Los Angeles County that had reported, in a prior survey of California laboratories, using obsolete Enterobacteriaceae carbapenem breakpoints. In-person interviews with hospital stakeholders and customized expert guidance and resources were provided to aid laboratories in updating breakpoints, including support from technical representatives from antimicrobial susceptibility testing device manufacturers. Forty-one hospitals were targeted, 7 of which had updated breakpoints since the prior survey. Of the 34 remaining hospitals, 27 (79%) assumed that their instruments applied current breakpoints, 17 (50%) were uncertain how to change breakpoints, and 10 (29%) lacked resources to perform a validation study for off-label use of the breakpoints on their systems. Only 7 hospitals (21%) were familiar with the FDA/CDC Antibiotic Resistance Isolate Bank. All hospitals launched a breakpoint update process; 16 (47%) successfully updated breakpoints, 12 (35%) received isolates from the CDC in order to validate breakpoints on their systems, and 6 (18%) were planning to update within 1 year. The public health intervention was moderately successful in identifying and overcoming barriers to updating Enterobacteriaceae carbapenem breakpoints in Los Angeles hospitals. However, the majority of targeted hospitals continued to use obsolete breakpoints despite 1 year of effort. These findings have important implications for the quality of patient care and patient safety. Other public health jurisdictions may want to utilize similar resources to bridge the patient safety gap, while manufacturers, the FDA, and others determine how best to address this growing public health issue.

In vivo anti-hypertensive effect of Pterocarpus indicus aqueous leaf extract in male cats

This study aimed to investigate the anti-hypertensive potential of crude leaf extracts of Pterocarpus indicus (Narra). Hypertension was induced using Epinephrine HCI, 15-20 ug/kg body weight IV in 6 male cats, followed by an administration of Narra leaf extracts with a concentration of 0.25 g/kg BW IV at the peak of the epinephrines hypertensive effect. To test for the possible dose-response effect, the procedure was repeated using 0.5 and 1 g/kg BW IV Narra extracts. The systolic, diastolic and mean arterial blood pressures, pulse pressure, respiratory rate (SBP, OBP, MABP, PP and RR, respectively), respiratory and ECG (Q-R interval) amplitude, and the time for the Narra extract to effect were monitored using GrassO polygraph. Analysis of the data using General Linear Model (GLM) Repeated Measures showed that crude Narra leaf extracts at 0.25, 0.5 and 1 g/kg BW significantly lowered an epinephrine-induced rise in SBP (p=0.001), MABP (p=0.001), PP (p=0.0001) and ECG (Q-R interval) amplitude (p=0.05). However, there was no observed effect on the DBP (p=0.698), HR (p=0.9), RR (p=0.846) and respiratory amplitude (p=0.762). Moreover, no dose-response relationship was observed among the 3 doses of the narra extract on all physiologic parameters mentioned. Also, none of the doses was able to return the MABP to baseline (p=0.053). The observed decline in the SBP may have probably been due to the resultant decrease in the amplitude or force of contraction of the heart. Concomitantly, this may cause a decrease in the anti-hypertensive effect. (Author)