Reduction of nosocomial bloodstream infections and nosocomial vancomycin-resistant Enterococcus faecium on an intensive care unit after introduction of antiseptic octenidine-based bathing.

BACKGROUND: Vancomycin-resistant Enterococcus faecium (VRE) is emerging in German intensive care units (ICUs). On a 32-bed surgical ICU at a university hospital, increasing numbers of nosocomial cases occurred despite enforcement of hand hygiene and environmental disinfection. AIM: To introduce universal octenidine-based bathing in order to reduce the burden of VRE. METHODS: Between January 2012 and March 2014, patients were screened for VRE on admission and twice weekly. Active surveillance was undertaken for VRE infections and colonizations, and for bloodstream infections (BSI) with any pathogen. Intervention in this before-after study comprised of standardized octenidine-based bathing. Distinct subgroups of VRE colonizations or infections were defined and used for statistical analysis of frequency, prevalence and incidence density. FINDINGS: In the pre-intervention period (January 2012 to April 2013), the admission prevalence of VRE was 4/100 patients and the mean incidence density of nosocomial cases was 7.55/1000 patient-days (PD). Pulsed-field gel electrophoresis analysis revealed prevalence of three vanA and two vanB clusters. In the post-intervention period (August 2013 to March 2014), the admission prevalence of VRE was 2.41/100 patients and the mean incidence density of nosocomial cases was 2.61/1000 PD [P = 0.001 (pre- vs post-intervention)]. Thirteen nosocomial VRE infections were identified in the pre-intervention period, compared with one nosocomial VRE infection in the post-intervention period. Incidence densities of BSI pre- and post-intervention were 2.98 and 2.06/1000 PD (P = 0.15), respectively. CONCLUSION: The epidemiology of emerging VRE appeared as a complex mix of admitted cases and transmissions in small clusters, challenging infection control measures. The implementation of universal octenidine-based bathing combined with a standardized washing regime led to a significant reduction in nosocomial VRE.

Antepartal insulin-like growth factor 1 and insulin-like growth factor binding protein 2 concentrations are indicative of ketosis in dairy cows.

A study involving a small number of cows found that the concentrations of insulin-like growth hormone 1 (IGF1) may be a useful predictor of metabolic disease. Further, IGF1 may provide also a pathophysiological link to metabolic diseases such as ketosis. The objective of the current study was to test whether the low antepartal total IGF1 or IGF1 binding protein (IGFBP) concentrations might predict ketosis under field conditions. Clinical examinations and blood sampling were performed antepartum (262-270 d after artificial insemination) on 377 pluriparous pregnant Holstein Friesian cows. The presence of postpartum diseases were recorded (ketosis, fatty liver, displacement of the abomasum, hypocalcemia, mastitis, retention of fetal membranes, and clinical metritis or endometritis), and the concentrations of IGF1, IGFBP2, IGFBP3, and nonesterified fatty acids were measured. Cows with postpartum clinical ketosis had lower IGF1 concentrations antepartum than healthy cows. The sensitivity of antepartal IGF1 as a marker for postpartum ketosis was 0.87, and the specificity was 0.43; a positive predictive value of 0.91 and a negative predictive value of 0.35 were calculated. The cows with ketosis and retained fetal membranes had lower IGFBP2 concentrations compared with the healthy cows. It can be speculated that lower IGF1 production in the liver during late pregnancy may increase growth hormone secretions and lipolysis, thereby increasing the risk of ketosis. Lower IGFBP2 concentrations may reflect the suppression of IGFBP2 levels through higher growth hormone secretion. In conclusion, compared with nonesterified fatty acids as a predictive parameter, IGF1 and IGFBP2 may represent earlier biomarkers of inadequate metabolic adaptation to the high energy demand required postpartum.

[Surgical treatment of neovascular glaucoma]. / Operative Therapie des Neovaskularisationsglaukoms.

PURPOSE: The neovascular glaucoma is one of the leading causes for an enucleation. The cyclocryocoagulation, the peripheral retinal cryocoagulation and the intravitreal injection of bevacizumab as combined therapy aim at the reduction of the intraocular pressure and of neovascularisation. MATERIALS AND METHODS: This study follows up 135 patients with neovascular glaucoma who underwent the above-mentioned combined therapy consisting of cyclocryocoagulation, peripheral retinal cryocoagulation and intravitreal injection of bevacizumab. RESULTS: The most common causes of neovascular glaucoma in our study are diabetic retinopathy and central retinal vein occlusion. The intraocular pressure was 37.4 mmHg (± 15.8) mmHg preoperatively under maximum antiglaucomatous therapy and was reduced to 19.0 (± 8.5) mmHg direct postoperatively. In the long-term intraocular pressure remained within the normal range in 93.33 % of patients. A successful reduction of the local antiglaucomatous drops of 1.9 substances to 1.7 substances was observed after 3 months. The oral intake of acetazolamide was also statistically significantly reduced. 47.37 % of the patients were normotensive without local therapy and only 3 patients were still on acetazolamide even after 1 year. The most serious complication was a phthisis bulbi in 1.5 % of patients. Overall 98.5 % of patients remained free of pain and maintained visual acuity after the end of the follow-up. CONCLUSION: Long-term pressure regulation and freedom from pain were successfully achieved. For decompensated neovascular glaucoma with poor vision and painful bulb, the combination of retinal cryocoagulation and intravitreal application of bevacizumab is an important therapeutic option.