A new social contract. Catholic healthcare leaders rethink their relationship with employees.

The sea changes that have occurred recently in economics, technology, and social order have profoundly disturbed the relationships between organizations and their workers. The promise of lifelong employment--once the foundation of the "social contract" between employer and employee--has evaporated. The dissolution of this social contract has led managers of Catholic healthcare organizations to ask, if we can no longer guarantee lifelong employment, then what is our relationship with employees? Participants in two think tanks sponsored by the Catholic Health Association's Center for Leadership Excellence addressed this question. Participants in the first think tank (i.e., one senior executive and several human resources professionals from Catholic healthcare systems) agreed that a new social contract with employees was needed, one of mutual responsibility to replace the paternalistic relationships of the past. To begin constructing such a contract, the group articulated a set of values held by Catholic healthcare regarding employees. Based on the values they identified, participants in the first think tank drafted the "Social Contract for Turbulent Times." Participants in the follow-up think tank expanded this draft contract in the "Elements of a New Relationship Agreement with Employees."

Urinary tract infections in the city of Florence: epidemiological considerations over a twenty-year period.

Our study of significant bacteriurias indicated that the worldwide shift in the etiology of infections also holds true for the Florence area. In a twenty-year period (1970-1990), we noted a decreased frequency of Gram-negative bacilli, particularly of the family Enterobacteriaceae, and a significant increase of Gram-positive cocci in urinary patients. This finding was observed both in hospital and in community-acquired cases in the male sex and only in nosocomial bacteriurias in the female sex. There was a reduced isolation of "classic" urinary pathogens such as Proteus mirabilis: its prevalence in hospital-acquired urinary tract infection (UTI) decreased from 16% in 1970 to 5% in 1990 both in males and in females. On the other hand, we noted an increase of "difficult" microorganisms such as enterococci and methicillin-resistant staphylococci, particularly in the male sex; in 1970 enterococci were occasionally isolated in males both from hospital and from community-acquired UTIs (3% and 5%, respectively), whereas in 1990, on the contrary, they were encountered much more frequently (19% in both cases).

[The microbiological exam of the urine: what significance in urinary tract infections?]. / Esame microbiologico delle urine: quale significato nelle infezioni delle vie urinarie?

11,829 urine cultures, coming from the Pediatrics Department of Florence and other hospital divisions for adults in the period 1st of July-31st of December 1990, have been examined in the Bacteriology and Virology Laboratory of the University Hospital of Florence. Besides illustrating various methods of drawing, preservation and transport of the urinary specimen, the authors showed the incidence of bacterial species responsible of urinary tract infections (U.T.I.). E. coli was showed to be the most frequently isolated bacterial strain, followed by Streptococcus faecalis and Proteus indole negative. The incidence of fimbriated E. coli infections was studied in pediatric and adult patients with urinary tract infections; a higher isolation frequency of fimbriated E. coli was showed in pediatric patients and in these patients the correlation was studied between the presence of fimbriated E. coli and the severity of infection (pyelonephritis, recurrent U.T.I.). The percentages of resistance of the isolated strains against the most common chemotherapies was also showed, studying their variations, for some chemotherapies, during about twenty years.

In-vitro activity of vancomycin, teicoplanin, daptomycin, ramoplanin, MDL 62873 and other agents against staphylococci, enterococci and Clostridium difficile.

The minimum inhibitory concentrations (MICs) of different antibiotics were determined by a broth microdilution method for staphylococci, enterococci and Clostridium difficile. The antimicrobial agents tested were vancomycin, teicoplanin, daptomycin, ramoplanin, MDL 62873, rifampicin and piperacillin, the latter limited to enterococci. In terms of MIC90S, daptomycin (0.89 mg/l). MDL 62873 (0.99 mg/l), and teicoplanin (1.50 mg/l) were found to be highly active against methicillin-resistant Staphylococcus aureus (MRSA). Daptomycin (MIC90 0.48 mg/l), MDL 62873 (0.95 mg/l) and ramoplanin (1.45 mg/l) were the most active drugs against methicillin-resistant S. epidermidis (MRSE). Teicoplanin (MIC90 0.45 mg/l) was the most active agent against enterococci, followed by MDL 62873 (0.65 mg/l) and daptomycin (1.60 mg/l). MDL 62873 gave the lowest MIC90 (0.17 mg/l) for C. difficile. Teicoplanin (MIC90 0.42 mg/l), daptomycin (0.87 mg/l) and ramoplanin (0.98 mg/l) were also very active. Our results indicate that teicoplanin, daptomycin, ramoplanin and MDL 62873, a teicoplanin derivative, are potentially effective alternative antibiotics for treatment of infections caused by staphylococci, enterococci and C. difficile.

A modified bladder washout test to improve diagnostic results in chronic urinary tract infections.

Bladder washout (BWO) and antibody-coated bacteria (ACB) tests were performed on 25 patients with radiological and/or clinical evidence of chronic upper urinary tract infection (UTI) and 12 patients with asymptomatic bacteriuria. Using a traditional single-washout procedure, the BWO test gave equivocal results in many cases of chronic pyelonephritis; this seemed mainly due to the lack of complete bladder sterilization. A modified procedure, including double sterilization and irrigation, biochemical typing of isolated bacteria, and evaluation of temporal pattern of bacteriuria recurrence, was then introduced. Although preliminary results of the modified BWO test demonstrated a general improvement in the diagnosis of the infection site, it seemed rather difficult, at least in chronic UTI, to establish localizing criteria based on definite numeric changes in bacterial counts after washout.

Clinical chemotherapeutic evaluation of fosfomycin plus amoxicillin (co-fosfolactamine): a prospective double-blind clinical trial.

Seventy-three hospitalized patients with urinary tract infections (UTI) were included in a double-blind study and received at random either fosfomycin or fosfomycin plus amoxicillin (CFL) in a pre-fixed combination, in order to evaluate the effectiveness of the CFL. CFL was administered orally to 39 patients at the daily dosage of 1 g every 8 h for 6 days (666 mg of fosfomycin and 334 mg of amoxicillin) while fosfomycin was given orally to 34 patients at the daily dosage of 666 mg every 8 h for 6 days. A bacteriological cure was observed in 97.4% of the patients treated with CFL, while in the fosfomycin group the bacterial eradication was obtained only in 82.3% (P less than 0.05). CFL showed a more rapid bactericidal activity than fosfomycin. In addition, CFL was more effective than fosfomycin against "difficult" Gram-negative bacteria such as Proteus spp. and Pseudomonas aeruginosa. Both antibiotics were well tolerated. Our limited experience revealed that CFL induces a negligible degree of resistant strains, and fewer than fosfomycin. Thus we conclude that CFL seems to be a useful antibiotic combination in the treatment of UTI.

[Blood culture results from 1967 to 1975 and drug sensitivity of bacteria isolated by blood culture in the last three years (1974-1976) (author's transl)]. / Risultati di emocolture eseguite negli anni 1967-1975 e sensibilita ai chemioantibiotici di stipiti isolati nell'ultimo triennio.

The blood culture results of patients of S. M. Nuova Hospital of Florence (Italy) have been examined in a period of nine years (1967-1976). We can attest from this results that in the last years of this period we have had an increase of the number of Enterobacteriaceae from blood culture. In the meanwhile we have had a decrease of positive results that is not due to an increase of the number of blood culture; in fact it has been doubled, but this decrease is mostly due to a larger number of examinated patients that to an increase of blood culture for each patient. Introduction in the routine of a diphasic culture system (Castañeda) commercially available has allowed contaminants' decrease. Antibiotic resistance of most important bacteria isolated in the last three years (1974-1976) were carry out.