Containment of carbapenem resistance rates of Klebsiella pneumoniae and Acinetobacter baumannii in a Greek hospital with a concomitant increase in colistin, gentamicin and tigecycline resistance.

In 2010 the Hellenic center for disease control and prevention launched the "Prokroustes" nationwide action plan to tackle the increasing rates of carbapenem resistance among gram-negative nosocomial pathogens. In the present report, data from a Greek tertiary-care hospital are presented three years after the adoption of the infection control measures. Carbapenem resistance rates have been contained for Klebsiella pneumoniae and Acinetobacter baumannii but not for Pseudomonas aeruginosa. More worryingly, in accordance with their overuse against carbapenem-resistant bacteria, resistance rates to colistin and tigecycline have risen significantly.

Effect of one-year oral alpha-tocopherol administration on the antioxidant defense system in hemodialysis patients.

Oxidative stress is increased in hemodialysis (HD) patients and contributes to the increased morbidity and mortality in this population. Vitamin E is an antioxidant agent. In the present study the effect of prolonged oral alpha-tocopherol administration on the antioxidant defense system was evaluated. The antioxidant factors plasma total antioxidant status (TAS), red blood cell superoxide dismutase (SOD) activity and glutathione peroxidase (GPX) activity were evaluated with spectrometry in 27 HD patients. Measurements were performed before and after oral administration of alpha-tocopherol at a dose of 500 mg/d for a one-year period. Twenty HD patients received a placebo and 22 healthy volunteers served as controls. TAS was increased in HD patients. No difference was detected in SOD and GPX activity between HD patients and healthy volunteers. Tocopherol administration induced a significant decrease in TAS and SOD activity. Levels of GPX activity remained unaffected. All the evaluated factors remained stable in the HD patients receiving a placebo. Prolonged oral alpha-tocopherol administration in HD patients induces a decrease in some components of the antioxidant defense system, raising the possibility for a pro-oxidative role of vitamin E. Vitamin E is an antioxidant agent, but it is also known to have pro-oxidant action under special conditions that can be encountered in HD patients.

Effect of 1-year oral alpha-tocopherol administration on anticardiolipin antibodies in hemodialysis patients.

BACKGROUND: Anticardiolipin antibodies (ACA) have been related to an increased incidence of thrombotic episodes and atherosclerosis progression. ACA levels are elevated in hemodialysis (HD) patients. Atheroembolic episodes are the major cause of morbidity and mortality in this population. Oxidative stress has been implicated in ACA formation, and it is increased in HD patients. Vitamin E is a known antioxidant factor. In this study, the effects of prolonged oral alpha-tocopherol administration on ACA levels were evaluated. METHODS: Serum anticardiolipin IgG antibodies (ACA-IgG) and IgM antibodies (ACA-IgM) levels were evaluated in 27 stable HD patients and 22 healthy volunteers. Then measurements were performed in the patients' group after oral administration of alpha-tocopherol at a dose of 500 mg/d for a 1-year period. ACA levels were assessed by solid-phase enzyme immunoassay. RESULTS: ACA-IgG levels were higher in HD patients compared with control (13.3 +/- 6.64 GPL/mL vs. 7.727 +/- 18.305 GPL/mL, p < .001). This was not the case for ACA-IgM levels (2.96 +/- 4.18 MPL/mL vs. 1.386 +/- 2.636 MPL/mL, p=.17). alpha-Tocopherol administration resulted in a further increase in ACA-IgG (26.7 +/- 14.7 GPL/mL vs. 13.3 +/- 6.64 GPL/mL, p < .001) and ACA-IgM levels (8.17 +/- 1.95 MPL/mL vs. 2.96 +/- 4.18 MPL/mL, p < .001) in HD patients. CONCLUSIONS: Prolonged oral alpha-tocopherol administration in HD patients increases ACA levels. The mechanism and the clinical significance of this finding need further evaluation.