Comprehensive real-time epidemiological data from respiratory infections in Finland between 2010 and 2014 obtained from an automated and multianalyte mariPOC® respiratory pathogen test.

Respiratory viruses cause seasonal epidemics every year. Several respiratory pathogens are circulating simultaneously and typical symptoms of different respiratory infections are alike, meaning it is challenging to identify and diagnose different respiratory pathogens based on symptoms alone. mariPOC® is an automated, multianalyte antigen test which allows the rapid detection of nine respiratory infection pathogens [influenza A and B viruses, respiratory syncytial virus (RSV), human metapneumovirus, adenovirus, parainfluenza 1-3 viruses and pneumococci] from a single nasopharyngeal swab or aspirate samples, and, in addition, can be linked to laboratory information systems. During the study period from November 2010 to June 2014, a total of 22,485 multianalyte respi tests were performed in the 14 participating laboratories in Finland and, in total, 6897 positive analyte results were recorded. Of the tested samples, 25 % were positive for one respiratory pathogen, with RSV (9.8 %) and influenza A virus (7.2 %) being the most common findings, and 0.65 % of the samples were multivirus-positive. Only small geographical variations in seasonal epidemics occurred. Our results show that the mariPOC® multianalyte respi test allows simultaneous detection of several respiratory pathogens in real time. The results are reliable and give the clinician a picture of the current epidemiological situation, thus minimising guesswork.

The Minnesota model of subacute care.

HealthPartners, a nonprofit managed care organization in Minneapolis, Minn., has developed an integrated system of care for seniors in clinics, hospitals, and subacute care centers. The organization contracts for subacute care with a few skilled nursing facilities distributed throughout the area. Concentration of patients in these facilities allows for the presence of a nurse-practitioner on site. The nurse-practitioner collaborates with a geriatrician to provide care for 15 to 20 seniors. This team uses principles of geriatric assessment to optimize utilization and outcomes for frail seniors.

A between-species comparison of antimicrobial resistance in enterobacteria in fecal flora.

Enterobacteria in fecal flora are often reported to be highly resistant. Escherichia coli is the main species; resistance data on other species are rare. To assess the effect of the host's environment, antimicrobial resistance was determined in fecal species of the family Enterobacteriaceae from three populations: healthy people (HP)(n = 125) with no exposure to antimicrobials for 3 months preceding sampling, university hospital patients (UP) (n = 159) from wards where the antibiotic use was 112 defined daily doses (DDD)/bed/month, and geriatric long-term patients (LTP) (n = 74) who used 1.8 DDD/bed/month. The mean length of hospital stay was 5 days for the UP and 22 months for the LTP. The isolates were identified to at least genus level, and MICs of 16 antimicrobials were determined. From the university hospital, resistance data on clinical Enterobacteriaceae isolates were also collected. Resistance data for on average two different isolates per sample (range, 1 to 5) were analyzed: 471 E. coli isolates and 261 other Enterobacteriaceae spp. Resistance was mainly found among E. coli; even in HP, 18% of E. coli isolates were resistant to two or more antimicrobial groups, with MIC patterns indicative of transferable resistance. Other fecal enterobacteria were generally susceptible, with little typically transferable multiresistance. Clinical Klebsiella and Enterobacter isolates were significantly more resistant than fecal isolates. The resistance patterns at both hospitals mirrored the patterns of antibiotic use, but LTP E. coli isolates were significantly more resistant than those from UP. Conditions permitting an efficient spread may have been more important in sustaining high resistance levels in the LTP. E. coli was the main carrier of antimicrobial resistance in fecal flora; resistance in other species was rare in the absence of antimicrobial selection.

Clinical microbiology laboratories do not always detect resistance of Haemophilus influenzae with disk or tablet diffusion methods. Finnish Study Group for Antimicrobial Resistance (FiRe).

The performance of disk diffusion testing of Haemophilus influenzae was evaluated in 20 laboratories. Thirteen disk-medium-breakpoint-inoculum modifications were used in Finnish clinical microbiology laboratories. The performance of various methods was evaluated by testing a susceptible control strain and one with non-beta-lactamase-mediated ampicillin resistance 10 times in 16 laboratories. Gaps in millimeters were measured between these two groups of results. The strains were separated by a gap of at least 5 mm in 8/16 laboratories testing ampicillin, in 7/15 laboratories testing cefaclor, in 5/ 16 laboratories testing cefuroxime, and in 15/16 laboratories testing trimethoprim-sulfa. Detection of ampicillin resistance was better with 2.5 microg tablets than with 10 microg disks or 33 microg tablets. For MIC-determinations, 785 isolates and their disk diffusion results were collected. None of the 12 clinical isolates with non-beta-lactamase-mediated ampicillin resistance was detected as resistant in the participating laboratories. The ampicillin and cefaclor results of the isolates were no better even when a laboratory was able to separate the control strains. Cefaclor results were unreliable because of poor disk diffusion-MIC correspondence and incoherent breakpoint references. Interlaboratory variation of the zone diameters caused false intermediate results of cefuroxime-susceptible strains. When ampicillin, cefaclor and cefuroxime were tested, the discrimination of laboratories using disks and tablets was equal, whereas the laboratories using paper disks were better able to detect trimethoprim-sulfa resistance.

Reliability of disc diffusion susceptibility testing of Streptococcus pneumoniae and adjustment of laboratory-specific breakpoints. Finnish Study Group for Antimicrobial Resistance.

A routine disc diffusion method for detecting antibiotic-resistant Streptococcus pneumoniae was evaluated in 20 clinical microbiology laboratories. Fifty consecutive clinical isolates were tested by disc diffusion in each laboratory, and collected for MIC determinations. Participating laboratories used three disc types and several media; altogether 17 disc-medium-breakpoint reference combinations were used. Of the 781 isolates, 1.2% were resistant to penicillin and 4.2% were intermediately resistant. Eight of the nine resistant isolates had been classified as resistant to penicillin using a 1 microgram oxacillin disc screening test in the participating laboratories. If the MIC was taken as 0.125 mg/L, which is just above the intermediate breakpoint, 11 of 12 isolates were interpreted as susceptible to penicillin with the oxacillin disc test. The laboratories using Oxoid or Biodisk paper discs performed better in detecting co-trimoxazole resistance than the laboratories using Rosco tablets. Two control strains (one multiresistant and one susceptible) were each tested in the laboratories ten times. Based on these results laboratory-specific breakpoints for tetracycline were determined linearly. These adjusted breakpoints corrected three of five false-susceptible interpretations of the resistant clinical isolates and reduced the number of minor errors from 8.5% to 2.6%.

Increasing antimicrobial resistance in Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis in Finland.

Respiratory and otitis isolates of 807 Streptococcus pneumoniae, 816 Haemophilus influenzae and 446 Moraxella catarrhalis were collected from 21 clinical microbiology laboratories for antimicrobial susceptibility testing in 1995. After a period of relative stability in 1981 and 1987-1990, beta-lactamase production increased in H. influenzae. Among middle ear isolates from children under 6 years, beta-lactamase production increased from 8% to 24% in H. influenzae and from 81% to 96% in M. catarrhalis since the survey in 1987-1990. 1.2% of S. pneumoniae were penicillin-resistant and 4.2% intermediately resistant; 5 years earlier among otitis isolates of children only 1.7% intermediate resistance was found. Ampicillin resistance was seen among 1.9% of non-beta-lactamase-producing strains of H. influenzae. Resistance to trimethoprim-sulphamethoxazole occurred in 9.4% of S. pneumoniae, 7.4% of H. influenzae and 0.7% of M. catarrhalis. Frequencies of azithromycin resistance were 3.0% in S. pneumoniae and 1.6% in H. influenzae, and those of tetracycline resistance were 6.7% in S. pneumoniae and 1.2% in H. influenzae.

Disk diffusion susceptibility tests: need for laboratory-specific breakpoints.

Significant changes were observed in the measured resistance levels of Escherichia coli and Staphylococcus aureus when the Biodisk disk susceptibility test method used in 1992 was replaced with another commercial method, Oxoid. For example, when non-species-specific breakpoints were used, the frequency of cephalotin-resistant E. coli was 12% of all isolates in 1992 but only 4% in 1993; the corresponding figures for the intermediately resistant isolates were 84% and 8%. The population distribution histograms were however, practically unchanged. Thus, the resistance percentages apparently did not reflect the real development of resistance. Similar findings were also made for several other antimicrobials. Susceptibility test breakpoints should therefore be examined separately for all bacterial species in each laboratory, and the application of adjusted laboratory-specific breakpoints should be considered. For this purpose, the WHONET computer program provides excellent assistance.

What do you pay your volunteers? The benefits and bases of a hospital volunteer program.

All volunteers need something in return for their services, whether it's recognition, experience, or personal satisfaction. Successful volunteer programs identify and meet these expectations. Although this requires the same kind of commitment and energy administrators give their paid staff, the results--bottom-line and otherwise--are well worth the effort.