Pharmacodynamics of teicoplanin against MRSA.

OBJECTIVES: The overall study aim was to identify the relevant preclinical teicoplanin pharmacokinetic (PK)/pharmacodynamic (PD) indices to predict efficacy and suppression of resistance in MRSA infection. METHODS: A hollow-fibre infection model and a neutropenic murine thigh infection model were developed. The PK/PD data generated were modelled using a non-parametric population modelling approach with Pmetrics. The posterior Bayesian estimates derived were used to study the exposure-effect relationships. Monte Carlo simulations from previously developed population PK models in adults and children were conducted to explore the probability of target attainment (PTA) for teicoplanin dosage regimens against the current EUCAST WT susceptibility range. RESULTS: There was a concentration-dependent activity of teicoplanin in both the in vitro and in vivo models. A total in vivo AUC/MIC of 610.4 (total AUC of 305.2 mg·h/L) for an MRSA strain with an MIC of 0.5 mg/L was needed for efficacy (2 log10 cell kill) against a total bacterial population. A total AUC/MIC ratio of ∼1500 (total AUC of ∼750 mg·h/L) was needed to suppress the emergence of resistance. The PTA analyses showed that adult and paediatric patients receiving a standard regimen were only successfully treated for the in vivo bactericidal target if the MIC was ≤0.125 mg/L in adults and ≤0.064 mg/L in children. CONCLUSIONS: This study improves our understanding of teicoplanin PD against MRSA and defines an in vivo AUC/MIC target for efficacy and suppression of resistance. Additional studies are needed to further corroborate the PK/PD index in a variety of infection models and in patients.

The road to a greener hospital.

The healthcare industry has as its major objective, the improvement of the health of the population. With this in mind it is a complete contradiction for hospitals to pollute the environment or unnecessarily consume resources. As part of the implementation of an environmental management system, we analysed the different environmental impacts the National Maternity Hospital has on the environment. In particular, we quantified the consumption of energy, water and wastes produced. RESULTS: Reduction of negative environmental impacts and cost savings can easily be achieved. Energy consumption can decrease by 20%, water consumption by 15%. Proper waste segregation requires continuous staff training and can result in reductions of up to 40% of healthcare risk waste. CONCLUSIOS: common sense, policies and procedures applied result in reductions of environmental impacts. Environmental management systems do not manage themselves and require dedicated staff to be successful. Hospital are obliged morally and legislatively to minimise environmental impacts by ensuring efficient use of resources.

Altering the NICU and measuring infants' responses.

UNLABELLED: The aim of the study was to measure the impact of a designated Quiet period on the NICU environment and its influence on the infants' physiological and movement responses. The study group comprised 10 preterm infants on assisted ventilation (mean gestational age 28.7 wk (range 24-32 wk), mean birthweight 1,322 g (range 600-2,060 g), mean age 5.2 d). The environment in which the infants were nursed was altered in terms of reduced light, noise, staff activity and infant handling. The infants' heart rate, blood pressure, oxygen saturation and movement responses were recorded during this Quiet period and compared with a period of Normal activity. When the Quiet period was compared with the Normal period (median values), the NICU environment had significantly altered in terms of Light: Quiet period 3.0 Lux, Normal period 254.5 Lux (p < 0.01); Noise: Quiet period 54.0 dB, Normal period 58.0 dB (p < 0.01); Alarm events: Quiet period 491.5 sec, Normal period 1,180.5 sec (p < 0.01); Staff conversation: Quiet period 16.0 occasions per hour, Normal period 60.0 occasions per hour (p < 0.01); Staff activity: Quiet period 25.5 occasions per hour, Normal period 59.0 occasions per hour (p <0.01); Infant handling: Quiet period 0.0 events per hour, Normal period 4.5 events per hour (p < 0.01). Infants' diastolic blood pressure and mean arterial pressure: median reduction of 2 mmHg for both during the Quiet period (p < 0.05). Infants' movements: Quiet period 14.5 movements per hour, Normal period 84.0 movements per hour (p < 0.05). DISCUSSION: This study demonstrates that Quiet periods are feasible for infants undergoing neonatal intensive care. The NICU environment was altered significantly for light, noise, infant handling and staff activity for a specified time period. These changes were associated with a reduced median diastolic blood pressure and mean arterial pressure and a decrease in infant movements.

Cold extremities: investigation and management of Raynaud's phenomenon.

Since Raynaud's description in 1862 of triphasic color changes in the digits, little progress has been made in diagnosis and treatment of this entity. Recent technologic advances such as laser Doppler fluxmetry and isolated cold stress testing offer promise in diagnosis and measuring response to various drugs. We review the pathophysiology and the clinical and laboratory evaluation of Raynaud's phenomenon, as well as medical and nondrug management.

Canine leptospirosis in Puerto Rico.

Among 116 stray dogs in Puerto Rico surveyed for leptospiral agglutinins, 73 (62.9%) has significant titers to one or more leptospiral serotypes. The most common serogroup identified serologically was icterohaemorrhagiae accounting for 53 (72.6%) of the infections. Although the infection rates were comparable for male and female dogs the older were found to be more frequently infected. The significance of the canine in the epidemiology of leptospirosis in Puerto Rico is probably of paramount importance due to the extensive direct and indirect contact dogs have with rats and the human population.