Vaginal colonization of extended-spectrum beta-lactamase-producing bacteria during pregnancy: An observational study.

OBJECTIVE: Extended-spectrum beta-lactamase (ESBL) is a rapidly evolving enzyme that cleaves beta-lactam-containing antibiotics, forming resistance to certain types of antibiotics, such as penicillin, cephalosporins and monobactams. Colonization with ESBL-producing bacteria during pregnancy is harmful, however this topic is currently underrepresented in the literature. STUDY DESIGN: Using a retrospective design, we analyzed data of all consecutive pregnant women who were identified with a vaginal colonization of ESBL-producing bacteria from 2011 to 2016 at the Medical University of Vienna, Department of Obstetrics and Gynecology. Swabs were taken during pregnancy and/or at delivery, as well as from neonates. Demographic and clinical data were obtained from the central in-house alert system and patients' clinical records. RESULTS: Of the 14,279 deliveries performed in our department during the study period, we identified 13 women with vaginal colonization of ESBL-producing bacteria during pregnancy. Of these cases, 6 born neonates were tested ESBL positive. The maternal-to-neonatal transmission rate was 43 %, associated with a 70 % rate of preterm premature rupture of the membranes (pPROM) and a preterm birth rate of 83 %. Of the 6 neonates with ESBL colonization, 4 neonates (67 %) were born to mothers who were still tested positive at the time of delivery. CONCLUSION: Maternal colonization of ESBL-producing bacteria is an important risk factor for transmission. The vaginal presence of ESBL-producing bacteria during pregnancy is associated with preterm birth and pPROM, which shows the need for clear diagnostic and therapeutic guidelines.

Frequency, type and treatment of fungal pathogens in toenail onychomycosis in the central Alpine region of South Tyrol, northern Italy - a 10-year retrospective study from 2004 to 2013.

Onychomycosis is one of the most common dermatological diseases, primarily caused by dermatophytes, and sometimes, also by yeast and moulds. This study aims to clarify the frequency of isolated pathogens from mycotic toenails in the reference centre of the central Alpine mountain region of South Tyrol, northern Italy. Age and gender differences, types of pathogens and initial therapy used were also investigated. This is a retrospective study from 2004 to 2013 on the files of all patients with suspected onychomycosis in whom a cultural pathogen detection was performed. A total of 1565 patients were studied (943 women; 622 men), with a median age of 55 years. Fungal pathogens could be detected by culture in 49.5%. Significantly more pathogens could be grown in men (63.8%) than in women (39.9%, P < 0.0001). The most common pathogens grown were dermatophytes (53.3%), especially T. rubrum and T. interdigitale, followed by moulds (24.7%) and yeast (22%). Therapies prescribed were topical in 64.2% and systemic in 35.8% of the cases. Topical treatment was more frequent in older patients (P < 0.05). In northern Italy, dermatophytes are the most common causative agents for onychomycosis. Fungal pathogens were more commonly found in men than in women and topical treatment was more frequent in older patients.

Social and clinical determinants of quality of life in Parkinson's disease in Austria: a cohort study.

Parkinson's disease (PD) is associated with a reduction of health-related quality of life (HrQoL). Demographic and clinical determinants of HrQoL in PD have been previously investigated, but less is known about its social determinants. Data on HrQoL in Austrian patients with PD are not available. The objective of this cross-sectional survey was to evaluate HrQoL of Austrian patients with PD and to provide a comprehensive analysis of its social and clinical determinants. Outpatients (n = 100) with idiopathic PD were recruited in the Department of Neurology of the University Innsbruck. Clinical status was estimated using the Unified Parkison's Disease Rating Scale (UPDRS). HrQoL was evaluated using a generic instrument, the EuroQol (EQ5D and EQ-VAS). Independent determinants of HrQoL were assessed in multivariate regression analysis. The proportion of PD patients with moderate or severe problems in at least one dimension of the EQ5D was significantly higher than in the general population (90.1 vs. 35.1%, P < 0.001). The mean EQ-VAS score in PD was lower than in the general population (48.9 +/- 19.6 vs. 77.0 +/- 20.8, P < 0.001). Social support (number of household members) was identified as an independent social determinant of HrQoL. Demographic and clinical determinants were age, depression, UPDRS and motor fluctuations. The analysis of determinants of HrQoL showed that a greater attention should be paid to social support and home care. Our data on HrQoL in PD should be considered in the development of new health care programs.

[Cost of illness and health service patterns in Morbus Parkinson in Austria]. / Krankheitskosten und Versorgungssituation bei Morbus Parkinson - eine Analyse in Osterreich.

OBJECTIVE: The objective of this study was to analyse the costs and the situation of care in patients with idiopathic Parkinson's disease (PD) in Austria. Continuously increasing healthcare costs and the fact that the prevalence of PD is expected to double in the next 25 years highlight the importance of health-economic evaluation in PD. METHOD: Patient survey with 81 patients with idiopathic Parkinson's disease. A bottom-up approach has been used to calculate direct and indirect costs from a societal perspective. Cost-driving factors were identified by multiple regression analysis. RESULTS: The overall costs from the perspective of society was 9280 per patient within a six-month period and consisted of 60% direct costs (5910 ) and 40% indirect costs (3910 ). The major part (59%) of direct costs was paid by the national healthcare. Co-payments of patients were 810 per six-months. The annual nationwide costs of PD in Austria are estimated to be approximately 320 million . CONCLUSION: PD is an economic challenge for the Austrian healthcare system. Direct costs account for the most part and are on account of the national healthcare system. In addition, patients bear considerable costs by personal contribution.