Antimicrobial resistance of Streptococcus pneumoniae recovered from outpatients with respiratory tract infections in Germany from 1998 to 1999: results of a national surveillance study.

Clinically significant pneumococcal isolates were prospectively collected from outpatients with respiratory tract infections by 19 different clinical microbiology laboratories in Germany. Resistance rates in a total of 961 isolates were as follows: penicillin, 6.6%; clarithromycin, 10.6%; tetracycline, 13.9%; and levofloxacin, 0.1%. Among 324 isolates from children, pneumococcal serotypes 19F (17.0%), 23F (13.0%), and 6B (11.7%) were the predominant types.

A comparative study of the in-vitro activity of levofloxacin against Streptococcus pneumoniae.

In this study, the in-vitro activity of levofloxacin against Streptococcus pneumoniae was compared with the activities of a range of other antibiotics. In total, 320 penicillin-susceptible and 30 penicillin-intermediate clinical isolates of S. pneumoniae were collected in Germany between 1992 and 1994 from patients with bacteraemic pneumonia. MICs were determined using the agar dilution methodology recommended by the NCCLS and the results with levofloxacin compared with those with ofloxacin, D-ofloxacin, ciprofloxacin, amoxycillin, cefpodoxime, cefixime, cefuroxime, faropenem, erythromycin and tetracycline. Levofloxacin (MIC50 1 mg/L) was approximately twice as active against the isolates as ofloxacin (MIC50 2 mg/L). D-ofloxacin (MIC90 32 mg/L) showed no activity, while beta-lactam antibiotics showed elevated MIC90 values against penicillin-intermediate strains (amoxycillin, 1 mg/L; cefpodoxime, 2 mg/L; cefixime, 32 mg/L; cefuroxime, 8 mg/L) in comparison with the MIC90 obtained with penicillin-susceptible strains (amoxycillin, 0.015 mg/L; cefpodoxime, 0.03 mg/L; cefixime, 0.5 mg/L; cefuroxime, 0.03 mg/L). Faropenem showed good activity against pneumococcal isolates (penicillin-susceptible strains, MIC90 0.016 mg/L; penicillin-intermediate strains, MIC90 0.25 mg/L). Erythromycin (MIC90 8 mg/L) and tetracycline (MIC90 64 mg/L) were also less active against penicillin-intermediate pneumococcal isolates. In conclusion, levofloxacin and faropenem may be useful in the treatment of pneumococcal infections caused by organisms with decreased susceptibility to penicillin.

In vitro activity of quinupristin/dalfopristin against erythromycin-susceptible and erythromycin-resistant Streptococcus pneumoniae.

Minimal inhibitory concentrations (MICs) of quinupristin/dalfopristin, penicillin, erythromycin, and clindamycin were determined by a standard agar dilution method for 93 Streptococcus pneumoniae strains isolated from patients with invasive disease in Germany. Quinupristin/dalfopristin showed good activity against 32 penicillin-susceptible/erythromycin-susceptible strains (MIC90 0.5 mg/l; range 0.25-0.5 mg/l) and 31 penicillin-intermediate/erythromycin-susceptible strains (MIC90 0.5 mg/l; range 0.25-1 mg/l). Erythromycin-resistant strains (n=30) were slightly less susceptible (MIC90 1 mg/l; range 0.125-2 mg/l). Quinupristin/dalfopristin was bactericidal (99.9% killing) for all six strains investigated after 2 h at a concentration of 4 mg/l.

PMMA-Microspheres (Artecoll) for long-lasting correction of wrinkles: refinements and statistical results.

The corium is diminished to about half of its thickness in skin defects and wrinkles. All biological materials that increase the thickness of the corium are resorbed within a certain time. Therefore, a lasting effect can be achieved only with nonresorbable synthetic substances. Artecoll consists of microspheres of 30-40 microm in diameter, of exceptional surface smoothness, purity, and homogeneity related to PMMA. These microspheres are suspended in atelocollagen which serves as a vehicle for subdermal implantation. Due to its smooth surface and consequential lack of electrical charges, each single microsphere is immediately encapsulated with the patient's own collagen fibers, thus preventing dislocation. Within 3 months, collagen (making up 75% of Artecoll) is replaced by the body's own connective tissue. The microspheres (25% of Artecoll) serve merely as a stimulus to the fibroblasts. Indications for Artecoll are all facial folds, lip- and philtrum augmentation, chin- and malar augmentation, dark-shadowed eyelids, enophthalmos, bony defects in face and hands, nipple reconstruction and augmentation, and urinary incontinence. Questionnaires were sent to all patients who had received Artecoll in 1993 and 1994. Of a total of 950 questionnaires sent, 515 were returned by September 1995. Satisfaction was rated "very good" in 29%, "good" in 38%, "satisfactory" in 23%, and "no difference" in 8% of the patients. The question, "Would you repeat the treatment again?" was answered by 91% of the patients with "yes." The overall complication rate was 3%. Strictly subdermal implantation will prevent longer lasting redness or visibility of the Artecoll.

PMMA microspheres (Artecoll) for skin and soft-tissue augmentation. Part II: Clinical investigations.

Artecoll is an injectable implant for long-lasting correction of wrinkles and other skin defects. Artecoll consists of fine polymethyl-methacrylate (PMMA) microspheres suspended 1:3 in a 3.5% collagen solution. The microspheres are characterized by exceptional surface smoothness, homogenicity, and purity. The size of the microspheres of 30-40 microns diameter is small enough to allow subdermal implantation using a 27-gauge needle. Phagocytosis and dislocation of the implant is prevented by fast encapsulation of each single microsphere with connective tissue. Increased scarring but no granuloma formation has been detected as is common with other injectable implants with irregular surfaces. The experience from more than 600 patients and a prospective study in 118 patients with 200 implantation sites were evaluated. The good early results have continued for 5 years. Of the patients evaluated, 89.5 percent were satisfied and would ask for the treatment again. The overall complication rate is very low, and prolonged redness or visible granules are due to implantations that are too superficial. Other applications in soft-tissue augmentation are discussed.

[Changes in the blood and plasma volumes during diagnostic angiocardiography. Differences between high- and low-osmolality contrast media]. / Veränderungen des Blut- und Plasmavolumens während einer diagnostischen Angiokardiographie. Unterschiede zwischen Kontrastmitteln mit hoher und niedriger Osmolalität.

Changes in blood and plasma volumes were investigated in the course of diagnostic cardiac catheterizations, comparing the effect of a high and a low osmolar contrast medium in 30 patients (5 women and 25 men; mean age 53 [19-76] years) with coronary heart disease (n = 27) or valvular defect (n = 3). Using a randomized, double-blind protocol 15 patients received amidotrizoic acid (2.1 osmol/kg; mean dosage 166 +/- 68 or 2.2 +/- 1.1 ml/kg), while 15 patients received iopamidol (0.8 osmol/kg; mean dosage 154 +/- 78 ml or 2.1 +/- 1.0 ml/kg). The indocyanine-green method and the haematocrit were used to measure blood and plasma volumes immediately before and after the angiocardiography. Blood volume after amidotrizoic acid injection increased by a mean of 4.9% (228 +/- 242 ml) and by 0.4% (17 +/- 197 ml) after iopamidol (P less than 0.05). Plasma volume increased by a mean of 11.8% (331 +/- 150 ml) after amidotrizoic acid and 5.7% (157 +/- 97 ml) after iopamidol (P less than 0.01). The increase in plasma volume correlated with the dose of contrast medium: 2 ml per ml amidotrizoic acid (r = 0.93) and 1 ml per ml iopamidol (r = 0.82).--During angiocardiography blood and plasma volume may increase by up to 500 ml, an increase which depends not only on dosage but also on the osmolality of the injected contrast medium.

PMMA microspheres for intradermal implantation: Part I. Animal research.

In search of a biocompatible implant for the correction of small deficiencies within the dermal corium as in wrinkles and acne scars, polymethylmethacrylate (PMMA) microspheres, 10 to 63 microns in diameter, were dispersed in Tween 80 medium and injected intradermally and subdermally into the abdominal skin of rats. Histological examination of specimens for up to 7 months revealed a modest tissue reaction, forming a delicate fibrous capsule around each individual microsphere within 4 months. Foreign body giant cells were seen rarely (in up to 1.5% of all cells). No break-down, corrosion, or phagocytosis of the spheres was observed at 7 months. The Tween 80 dispersion medium did not produce any histologically detectable reaction. Because PMMA products (Paladon, Palacos) have been used in medicine for almost 50 years without causing biological degradation or cancer, the material may be applied safely in the form of microspheres (Arteplast) in corium and subcutis of human patients with wrinkles or acne scars.