Impact of single-room contact precautions on hospital-acquisition and transmission of multidrug-resistant Escherichia coli: a prospective multicentre cohort study in haematological and oncological wards.

OBJECTIVES: Colonization and infection with third-generation cephalosporin-resistant Escherichia coli (3GCR-EC) are frequent in haematological and oncological patients. In this high-risk setting, German guidelines recommend single-room contact precautions (SCP) for patients with 3GCR-EC that are non-susceptible to fluoroquinolones (F3GCR-EC). However, this recommendation is controversial, as evidence is limited. METHODS: We performed a prospective, multicentre cohort study at four haematology and oncology departments assessing the impact of SCP on hospital-acquired colonization or bloodstream infection (BSI) with F3GCR-EC. Two sites performed SCP for F3GCR-EC patients including single rooms, gloves and gowns (SCP sites), and two did not (NCP sites). Active screening for 3GCR-EC was performed and isolates were characterized with molecular typing methods including whole genome sequencing and core genome multiple locus sequence typing to assess patient-to-patient transmission. Potential confounders were assessed by competing-risk regression analysis. RESULTS: Within 12 months, 1386 patients at NCP sites and 1582 patients at SCP sites were included. Hospital-acquisition of F3GCR-EC was observed in 22/1386 (1.59%) and 16/1582 (1.01%) patients, respectively (p 0.191). There were 3/1386 (0.22%) patients with BSI caused by F3GCR-EC at NCP sites and 4/1582 (0.25%) at SCP sites (p 1.000). Patient-to-patient transmission occurred in three cases at NCP and SCP sites each (p 1.000). The number of patients needed to screen in order to prevent one patient-to-patient transmission of F3GCR-EC was determined to be 3729. CONCLUSIONS: Use of SCP had no significant impact on hospital-acquisition or patient-to-patient transmission of F3GCR-EC in this high-risk setting.

Impact of choice, timing, sequence and combination of broad-spectrum antibiotics on the outcome of allogeneic haematopoietic stem cell transplantation.

Recent data link the incidence of intestinal GvHD (iGvHD) after allogeneic haematopoietic stem cell transplantation (aSCT) to exposure with piperacillin-tazobactam or imipenem-cilastatin. To assess relevance of timing, duration, sequence and combination of antibiotic treatment in this setting, we applied a time-dependent model to our aSCT cohort. Patients from the prospective Cologne Cohort of Neutropenic Patients (CoCoNut) undergoing aSCT from January 2007 to April 2013 were included into a time-dependent multivariate Cox proportional hazards regression model with backward-stepwise selection. In 399 eligible patients, cumulative antibiotic exposure (hazard ratio (HR) 2.46; 95% confidence interval (95% CI) 1.59-3.81; P<0.001) and exposure to sequential treatment with penicillin derivatives and carbapenems (HR 6.22, 95% CI 1.27-30.31), but not to the individual classes, were associated with iGvHD at day 100. Glycopeptides were assessed as a risk factor (HR 3.73, 95% CI 1.51-9.19), but not considered independent, since their use was dependent on previous exposure to penicillin derivatives and carbapenems. Patients with iGvHD presented with increased non-relapse mortality at day 365 (HR 3.51; 95% CI 2.10-5.89; P<0.001). We identified sequential exposure to penicillin derivatives and carbapenems as well as overall exposure to antibiotics as independent risk factors for iGVHD. Confirmation of these findings in larger, prospective cohorts is necessary.

A randomized trial on chlorhexidine dressings for the prevention of catheter-related bloodstream infections in neutropenic patients.

BACKGROUND: Central venous catheter (CVC)-related bloodstream infections (CRBSI) are a frequent cause of morbidity and mortality in patients with chemotherapy-induced neutropenia. Chlorhexidine containing catheter securement dressings may prevent CRBSI. PATIENTS AND METHODS: A multicenter randomized, controlled trial was conducted at 10 German hematology departments. We compared chlorhexidine-containing dressings with non-chlorhexidine control dressings in neutropenic patients. The primary end point was the incidence of definite CRBSI within the first 14 days (dCRBSI14) of CVC placement. Secondary end points included combined incidence of definite or probable CRBSI within 14 days (dpCRBSI14), overall (dpCRBSI), incidence of unscheduled dressing changes and adverse events. RESULTS: From February 2012 to September 2014, 613 assessable patients were included in the study. The incidence of dCRBSI14 was 2.6% (8/307) in the chlorhexidine and 3.9% (12/306) in the control group (P = 0.375). Both dpCRBSI14 and dpCRBSI were significantly less frequent in the study group with dpCRBSI14 in 6.5% (20/307) of the chlorhexidine group when compared with 11% (34/306) in the control group (P = 0.047), and dpCRBSI in 10.4% (32/307) versus 17% (52/306), respectively (P = 0.019). The frequency of dressing intolerance with cutaneous and soft tissue abnormalities at the contact area was similar in both groups (12.4% and 11.8%; P = 0.901). CONCLUSIONS: Although the trial failed its primary end point, the application of chlorhexidine containing catheter securement dressings reduces the incidence of definite or probable CRBSI in neutropenic patients. CLINICAL TRIALS NUMBER: NCT01544686 (Clinicaltrials.gov).

[When is a doctor a good doctor? An analysis of the contents of statements by representatives of the medical profession ]. / Wann ist ein Arzt ein guter Arzt? Eine inhaltsanalytische Untersuchung von Aussagen medizinischer Professionsvertreter.

BACKGROUND: Several professional bodies have developed influential documents which have tried to describe the essential competences of a good doctor. Such an initiative has not been previously conducted in German-speaking countries. Differences between the published statements point towards the significance of differences in the respective sociocultural setting. METHODS: The first step was to take advantage of a series of standardized written interviews [including the item "What makes a doctor a good doctor?"], conducted with leading German physicians and published serially in the Deutsche Medizinische Wochenschrift. Responses were qualitatively analysed by three assessors in accordance with Grounded Theory. Text fragmentation and assignment of categories was built successively: it was based on the actual material and repeatedly revised. RESULTS: 261 statements were extracted from a total of 83 interviews. It was possible to assign 249 of them to one of the following nine categories: "knowledge", "empathy" and "patient orientation" and, less frequently "practical competence", "genuineness", "helper", "awareness of limits", "life-long learning" and "cooperation". Results were similar for older and younger physicians, or when comparing representatives of clinical and theoretical disciplines. CONCLUSIONS: It will be worthwhile to survey and evaluate the opinion of additional members of the medical profession and of patients and others with a stake in the health system--comparing and delineating results from different countries--so that a more comprehensive picture can be drawn of "the good doctor".

Field trial to evaluate the immunogenicity of pseudorabies virus vaccines with deletions for glycoproteins G and E.

OBJECTIVE: To evaluate, under field conditions, the immunogenicity of 2 pseudorabies virus (PRV) vaccines (each with deletion of the gene for glycoprotein G [gG], and 1 with an additional deletion for glycoprotein E [gE]), particularly in the presence of maternal antibodies, and to investigate the effect of vaccination schedules in overcoming maternal antibody interference with vaccination. SAMPLE POPULATION: Two cohorts of 105 growing pigs each on a PRV-seronegative commercial swine farm where breeding stock had been vaccinated with a PRV vaccine containing deletions of genes for gG and gE. PROCEDURE: Within each cohort, pigs were randomly assigned to 1 of 7 treatment groups. For each vaccine, vaccination was done at 8, 12, or 8 and 12 weeks of age. One group remained unvaccinated. Blood and nasal swab specimens were obtained at 8, 10, 12, 14, and 16 weeks of age, and the immune response was measured, by use of an ELISA. RESULTS: In cohort 1, where prevalence of maternal antibodies at 8 weeks of age was lower, an immune response lasting until 16 weeks of age was induced in most pigs by either vaccine. In cohort 2, where prevalence of maternal antibodies at 8 weeks of age was higher, the gG- gE- vaccine elicited a lower immune response in the presence of maternal antibodies than did the gG- vaccine after single vaccination at 8 weeks of age. This maternal antibody interference with the response to vaccination was evident in serum and nasal mucosal antibodies. CONCLUSIONS: The gE deletion decreases the immunogenicity of PRV vaccine in the presence of maternal antibodies. Although evidence of maternal antibody interference for the gG- vaccine existed, its immunogenicity was diminished less in the presence of maternal antibodies than that of the gG- gE- vaccine.

Management and nutritional factors associated with the detection of Salmonella sp. from cattle fecal specimens from feedlot operations in the United States.

In a convenience sample of 100 feedlot operations (included in the United States Department of Agriculture: Animal and Plant Health Inspection Service 1994 Cattle on Feed Evaluation), up to 25 cattle fecal samples were collected and tested for the presence of Salmonella from each of two pens (the pen which contained the most-recent arrivals, and the pen with cattle that had been on feed the longest). One or more Salmonella spp. were recovered from 38 (38.0%) of the 100 feedlots, 52 (26.0%) of the 200 pens and 273 (5.5%) of the 4977 fecal samples collected. Multivariable logistic regression indicated that feeding tallow and feeding whole cottonseed or cottonseed hulls within seven days prior to fecal sample collection was associated with an increased risk of finding Salmonella in a pen. Variables not found to be significantly associated with the detection of Salmonella in a pen included region, operation size, use of sprinklers, time on feed, type of cattle in the pen, number and concentration of cattle in a pen, feeding probiotics, and various other feeds.

Specular, diffuse, and polarized light scattered by two wheat canopies.

Using polarization measurements, the reflectance factor R(theta(i),phi(i),theta(r),phi(r)) of two wheat canopies is divided into components due to specularly and diffusely reflected light. The data show that two key angles may be predicted, the angle of the polarizer for minimum flux and the angle of incidence of sunlight specularly reflected by a leaf to a sensor. The results show that specular reflection is a key aspect to radiation transfer by two canopies. Results suggest that the advent of heading in wheat may be remotely sensed from polarization measurements of the canopy reflectance.

Sulfamethazine residues in swine.

Two possible causes of violative sulfonamide residues in swine were studied. To determine if sulfamethazine accumulated in the tissues of swine when the drug was administered in feed, the rates of plasma drug disappearance following a single oral dose and continuous feeding of the drug were compared. The rate of plasma drug disappearance was not significantly different (alpha = 0.05) when the two methods of drug dosing were compared. When feed containing 2 micrograms sulfamethazine/gm was fed to swine during a 7-day period preceding slaughter, the animal's liver contained violative residues. Violative concentrations of sulfamethazine were detected in the livers, kidneys, and skeletal muscle of swine which consumed feed containing 8 micrograms sulfamethazine/gm.