Perception of unfamiliar caregivers during sickness - Using the new Caregiver Perception Task (CgPT) during experimental endotoxemia.

Social withdrawal is a well-established part of sickness behavior, but in some contexts sick animals might gain from keeping close instead of keeping away. For instance, sick individuals are more willing to be near known individuals who can provide care and safety (close others) compared to when healthy. Yet, interactions with some strangers might also be beneficial (i.e., healthcare professionals), but it is not known how sickness interplay with social behavior towards such individuals. Here, we assessed if sickness affects perception of caregivers, and developed a new task, the Caregiver Perception Task (CgPT). Twenty-six participants performed the CgPT, once after an injection of lipopolysaccharide (LPS, 0.8 ng/kg body weight, n = 24), and once after an injection of saline (n = 25), one hour and forty-five minutes post-injection. During the task, participants watched short video clips of three types of caregivers: a healthcare professional taking care of a sick individual, a healthcare professional not taking care of a sick individual, and a non-healthcare professional taking care of their sick adult child or partner. After each video clip, the likability, trustworthiness, professionalism, and willingness to interact with and receive care from the caregiver were rated on visual analogue scales. Results showed that participants injected with saline rated healthcare professionals who did not take care of a sick individual less positively on all aspects compared to healthcare professionals who took care of a sick individual. Moreover, compared to saline, LPS increased the participants' willingness to receive care from healthcare professionals and non-healthcare professionals providing care, but not from healthcare professionals not providing care. Thus, our results indicate that sick individuals may approach unknown individuals with potential to provide care and support.

Female Sex Hormones Influence the Febrile Response Induced by Lipopolysaccharide, Cytokines and Prostaglandins but not by Interleukin-1ß in Rats.

There are differences in the immune response, and particularly fever, between males and females. In the present study, we investigated how the febrile responses induced by lipopolysaccharide (LPS) and different endogenous pyrogens were affected by female gonadal hormones. The febrile response to i.p. injection of LPS (50 µg/kg) was 40% lower in female rats compared to male or ovariectomised (OVX) female rats. Accordingly, oestrogen replacement in OVX animals reduced LPS-induced fever. Treatment with the prostaglandin synthesis inhibitor indomethacin (2 mg/kg, i.p. 30 min before) reduced the febrile response induced by LPS in both OVX (88%) and sham-operated (71%) rats. In line with the enhanced fever in OVX rats, there was increased expression of cyclooxygenase-2 (COX-2) in the hypothalamus and elevated levels of prostaglandin E2 (PGE2 ). In addition, OVX rats were hyper-responsive to PGE2 injected i.c.v. By contrast to the enhanced fever in response to LPS and PGE2 , the febrile response induced by i.c.v. injection of interleukin (IL)-1ß was unaffected by ovariectomy, whereas the responses induced by tumour necrosis factor (TNF)-α and macrophage inflammatory protein (MIP)-1α were completely abrogated. These results suggest that the mediators involved in the febrile response in females are similar to males, although the reduction of female hormones may decrease the responsiveness of some mediators such as TNF-α and MIP-1α. Compensatory mechanisms may be activated in females after ovariectomy such as an augmented synthesis of COX-2 and PGE2 .

[Can the antibiotic prescription practice in a hospital be influenced by in-house guidelines? An interventional study at the University Hospital Halle (Saale), Germany]. / Lässt sich die Antibiotikaverordnungspraxis im Krankenhaus durch hausinterne Richtlinien beeinflussen? Interventionsstudie am Universitätsklinikum Halle (Saale).

BACKGROUND: In-house guidelines are an essential tool of antibiotic stewardship (ABS) programs to guide antimicrobial therapy. We studied the effect of in-house guidelines adapted to the local pathogen and resistance epidemiology on prescribing behavior. METHODS: At the University Hospital Halle (Saale) guidelines for the antimicrobial therapy and essential microbiological diagnostics were introduced. Main objectives were reducing the use of third generation cephalosporines and fluoroquinolones, decreasing selection pressure for enterococci and multidrug-resistant Gram-negative bacteria, minimizing Clostridium difficile infections (CDI), and improving microbiological diagnostics to enhance de-escalation strategies. 12 months thereafter a comparison of antibiotic consumption, pathogen and resistance statistics and use of blood cultures was performed. RESULTS: There was a decrease of third-generation cephalosporines (-18.6%) and fluoroquinolones (-9.8%), while consumption of broad- and intermediate-spectrum penicillins (+23.8% and +37%) as well as carbapenems (+11.9%) increased. The total volume of prescribed anti-infectives remained unchanged. The number of enterococcal isolates (-18.3%) and CDI (-26.3%) decreased considerably. Gram-negatives, particulary ESBL-producing Enterobacteriaceae, were detected more frequently due to an expanded screening program. The rate of blood cultures/1000 patient-days was unaffected. CONCLUSION: In-house guidelines for the empiric antiinfective therapy appear to be suitable to influence the prescribing behavior and the selection pressure on individual pathogen groups. The total volume of antibiotic prescriptions was not affected in this study.

[Antibiotic treatment of enterococcal infections in gastroenterology with daptomycin - first experiences from the EU-CORE registry study (European Cubicin® Outcomes Registry and Experience)]. / Antibiotische Therapie von Enterokokken-Infektionen in der Gastroenterologie mit Daptomycin - erste Erfahrungen aus der Registerstudie EU-CORE (European Cubicin® Outcomes Registry and Experience).

Enterococci are a frequent cause of nosocomial infections in gastroenterology. The increase of Enterococcus faecium infections with development of resistance to gentamicin and vancomycin as well as possible linezolid resistance require alternative antibiotic therapies. Study data show that daptomycin, a highly bactericidal antibiotic is effective in enterococcal infections. However, in Germany daptomycin is so far only approved for the treatment of complicated skin and soft tissue infections, bacteremia and infective endocarditis caused by Staphylococcus aureus. In the Department of Internal Medicine I, University Hospital Halle (Saale) from May 2 009 to April 2 010 all gastroenterological patients with evidence of invasive enterococcal infection received intravenous daptomycin treatment at inclusion in the European Cubicin® Outcomes Registry and Experience (EU-CORE). Gastroenterological diseases treated were necrotising pancreatitis, infected pancreatic pseudocysts, abscesses, obstructive cholangitis and sepsis. The clinical outcome was retrospectively detected by protocol-defined criteria. A total of 13 patients (8 male, 5 female, median age 59 years) with microbiologically assured enterococcal infections (10 × E. faecium, including 1 × VRE, 6 × E. faecalis, including double infections) were treated with intravenous daptomycin (6 mg per kg body weight). In the presence of polymicrobial infections (10 of 13 patients), an additional anti-infective therapy was initiated according to sensitivity testing. Concomitantly a direct focus approach with stenting, puncture or drainage was performed. The clinical cure rate was 92 % (12 of 13 patients). One patient died from a non-surgically uncontrollable malignancy (Klatskin tumour Bismuth IIIb). There were no adverse events. These results allow us to conclude that antibiotic therapy with daptomycin in invasive or bacteraemic enterococcal infections leads to high cure rates (up to 90 % and more) when concomitant and adequate focus relief is performed. Larger clinical studies to obtain an extended drug approval are desirable.

Microbial diagnostics in patients with presumed severe infection in the emergency department.

INTRODUCTION: Sepsis in the early stage is a common disease in emergency medicine, and rapid diagnosis is essential. Our aim was to compare pathogen diagnosis using blood cultures (BC) and the multiplex polymerase chain reaction (PCR) test.Methods. At total of 211 patients admitted to the multidisciplinary emergency department of our university hospital between 2006 and 2009 with suspected severe infection from any origin were studied. Blood samples for BC (aerobic and anaerobic) and multiplex PCR were taken for identification of infectious microorganisms immediately after hospital admission. Results of the BC and PCR correlated with procalcitonin concentration (PCT) and clinical diagnosis of sepsis (≥2 positive SIRS criteria) as well as with severity of disease at admission and with clinical outcome measures. RESULTS: Results of the BC were available in 200 patients (94.8%) and PCR were available in 119 patients (56.3%), respectively. In total, 87 BC (43.5%) were positive and identified 94 pathogens. In 45 positive PCRs, 47 pathogens (37.8%) were found. Identical results were obtained in 81.4%. In addition, BC identified 9 Gram-positive and 3 Gram-negative bacteria, while PCR added 5 Gram-negative pathogens. Coagulase-negative staphylococci were detected in blood cultures only (n=20, 21.3%), whereas PCR identified significantly more Gram-negative bacteria than BC. In patients with positive PCR results, the PCT level was significantly higher than in patients with negative PCR (15.0±23.3 vs. 8.8±32.8 ng/ml, p<0.001). This difference was not observed for BC (10.6±25.7 vs. 11.6±44.9 ng/ml, p=0.075). The APACHE II score correlated with PCR (19.2±9.1 vs. 15.8±8.9, p<0.05) and was also higher in positive BC (18.7±8.7 vs. 14.4±8.0, p<0.01). Positive PCR and BC were correlated with negative clinical outcomes (e.g., transfer to ICU, mechanical ventilation, renal replacement therapy, death). CONCLUSION: In patients admitted with suspected severe infection, a high percentage of positive BC and PCR were observed. Positive findings in the PCR correlate with elevated levels of PCT and high APACHE II scores.

[Bacterial spectra and antibiotics in odontogenic infections. Renaissance of the penicillins?]. / Keimspektren und Antibiotika bei odontogenen Infektionen. Renaissance der Penicilline?

BACKGROUND: The role played by odontogenic infection in dental, oral, and maxillofacial surgery is not to be underestimated even at the present time. An extensive, standardized, prospective study was performed with the intention of verifying the bacterial spectrum of odontogenic infections to evaluate antibiotic sensitivity. MATERIAL AND METHODS: Bacterial spectra and resistograms of 65 patients with an odontogenic infection were analyzed in a prospective study under standardized conditions for specimen collection and transport. RESULTS: A total of 226 bacterial strains were analyzed. The ratio between anaerobes and aerobes was approximately 2:1. The most frequent aerobes were members of the genera Streptococcus (46 isolates), Staphylococcus (10 isolates), and Neisseria (9 isolates), respectively. The anaerobic gram-positive spectrum was dominated by members of the genera Eubacterium (19 isolates), Peptostreptococcus (16 isolates), and Actinomyces (12 isolates). The most frequently isolated gram-negative anaerobes were Prevotella (46 isolates), and Fusobacterium (21 isolates). The overall resistance to antibiotics was very low: only 7.3% of all bacteria were resistant to penicillin G/V, and 8.8% showed resistance to ampicillin. The resistance rates to other beta-lactam antibiotics were 4.4% to piperacillin and 0.6% to imipenem, respectively. Penicillin G presented the highest antimicrobial activity among aerobes: only 4.5% of anaerobic strains were resistant of penicillin G. The other resistance rates of anaerobic bacteria to antibiotics were as follows: ampicillin 24%, doxycycline 34%, erythromycin 18%, and clindamycin 9.3%. Penicillin G was also highly antimicrobially active to anaerobes. The resistance rates were: penicillin G 8.1%, ampicillin 2.6%, doxycycline 9.2%, erythromycin 10.2%, and clindamycin 1.4%, respectively.

[Soft tissue infections in oral, maxillofacial, and plastic surgery. Bacterial spectra and antibiotics]. / Weichteilinfektionen in der Mund-, Kiefer- und Plastischen Gesichtschirurgie. Keimspektren und Antibiotika.

BACKGROUND: Soft tissue infections in the maxillofacial region are mainly caused by Staphylococcus aureus, Pseudomonas aeruginosa, and Escherichia coli but also by members of the genera Enterococcus, Klebsiella, and Enterobacter, respectively. METHODS: In a prospective study 96 patients with severe maxillofacial non-odontogenic postoperative soft tissue infections were analyzed with regard to the bacterial spectrum and resistance patterns against antibiotics. The dominating bacteria were Streptococci (25% of the isolates) and Staphylococci (24% of the isolates). In addition, members of Enterobacteriaceae were isolated in approximately 10% of the cases. The most frequent anaerobes found were as follows: Peptostreptococcus, Eubacterium, Prevotella and Fusobacterium. RESULTS: The resistance rates against antibiotics found were: penicillin G 36%, ampicillin 42%, and doxycycline 36%. In addition, the resistance rate against erythromycin and clindamycin was 26% and 7%, respectively. No resistant strains were detected against vancomycin and teicoplanin. All anaerobes showed a low antimicrobial resistance as previously described for odontogenic infections. CONCLUSION: In summary, soft tissue infections in the maxillofacial region present a different spectrum of bacteria in contrast to the well-investigated odontogenic infections. Antibiotic administration should be, whenever possible, performed after differentiation of involved strains and resistogram. The most promising antibiotics are imipenem, meropenem, and ciprofloxacin as well as cefotiam. Modern fluoroquinolones will be the antibiotics of the future.

[Antimicrobial decontamination of corneal donor material: infection prevention and quality assurance]. / Antimikrobielle Dekontamination von Hornhautspendermaterial. Infektionsprophylaxe und Qualitätssicherung.

BACKGROUND: Microbiological examinations in eye banks have found an increased contamination rate in preservation media. We studied the effect of prolonged submersion time for decontaminating donor globes. MATERIALS AND METHODS: We retrospectively analyzed the primary contamination of conjunctival smears in 76 cornea donors. The submersion time of donor eyes in PVP iodine solution before preparation was prolonged from 1 min to 5 min, and the contamination rate of storage vessels was compared. RESULTS: In 13 of the 76 conjunctival smears we found no contamination. Before prolonging submersion time, the preservation medium was contaminated in 15 cases, but after 5 min no contamination was observed. CONCLUSION: Prolonging the submersion time of donor globes from 1 to 5 min was effective. The model presented here provides guidelines for existing eye banks as well as for those yet to be established.

Serotyping of 80 strains from the WHO multicentre international typing study of Listeria monocytogenes.

Serotyping was carried out on 80 coded strains, distribute to all laboratories taking part in the WHO L. monocytogenes multicenter subtyping study. All six laboratories used the method recommended by their coordinator. All 80 strains were typeable. There was complete agreement between the six laboratories on 49 (61.3%) strains (21 serovar 1/2a and 28 serovar 4b strains) which in turn were identical to the expected serovars, known only after decoding. The intralaboratory reproducibility carried out on 11 duplicate strains, ranged from 82 to 100%, with a medium value of 91%. Reproducibility of serotyping L. monocytogenes strains according to serovar varied from 33.3 to 100% for serotypes 3b and 1/2a, respectively, with serovar 4b (x) being incorrectly identified in all six laboratories. Serotyping of L. monocytogenes is easy and simple and is a useful prerequisite for other finer and more discriminatory typing methods. Problems may however, be encountered mainly with the flagellar antigenic factors. There is a need, therefore, for preparing antisera of good quality from which efficient antigenic factors can be obtained.

WHO study on subtyping Listeria monocytogenes: results of phage-typing.

A multi-centered study on phage typing of Listeria monocytogenes was carried out using 80 cultures sent under code and tested in six different laboratories. Phage typing was performed using an international phage set in five laboratories and phage sets unique to two laboratories. Testing of cultures sent in duplicate showed similar levels of reproducibility to that previously reported. Analysis of results from groups of epidemiologically related cultures showed a high level of agreement in all laboratories. Patterns of phage susceptibility were relatively stable on retesting strains in the same laboratory after long periods of time. However, there was limited comparability between results obtained from testing the same cultures using the same phages in different laboratories. It is recommended that the phages in the international set be reviewed, and that better inter-laboratory reproducibility may be achieved by standardisation of phage suspensions, propagation strains and methodology, together with the use of centrally propagated phages.

[Perioperative conjunctival flora]. / Untersuchungen der perioperativen Konjunktivalflora.

BACKGROUND: The conjunctival flora is of great interest for each case of intraocular operation preventing postoperative infections. Despite of negative cultures before the operation we investigated in a prospective randomized study perioperatively the bacterial situation of the conjunctiva in 105 patients. MATERIAL AND METHODS: We took conjunctival swabs for microbiological examination from patient's eye operated on cataract or glaucoma, on the day of admission to the eye clinic and in the morning of the operating day. In addition, specimens were taken by nurses with Transwab MW-172 P before the local anaesthesia, disinfection of the conjunctiva and lids and application of eye drops, after these procedures by a research worker, at the end of the operation by the surgeon and two to three days after the operation by nurses with Transwab MW-172 P again. In 53 patients we collected lacrimal fluid to measure the lysozyme concentration. RESULTS: Out of 686 conjunctival swabs we have found 126 (18.4%) positive cultures. Staphylococcus epidermidis had the highest incidence (109 = 86.5%) followed by Staphylococcus aureus (7 = 5.5%). Only in 28 eyes all conjunctival swabs, taken at different times, were negative. There was an increase of positive cultures from routine swabs on the day of admission from 13 (12.4%), to 33 (31.7%) in the swabs taken on the day of the operation in the morning. On the other side the positive cultures decreased then continuously before and after the preparation of the operation, at the end of the operation and during two to three days postoperatively. There was'nt any statistical correlation between the concentration of the lacrimal lysozyme and the rate of positive cultures. CONCLUSION: The preoperative bacteriological diagnostic of the conjunctiva is important mainly for the prevention of postoperative endophthalmitis despite the transience and fluctuation of the conjunctival flora but also in case of endophthalmitis for rapid specific antibiotical therapy.

[Effect of tonometry and nasolacrimal duct irrigation on bacterial flora of the conjunctiva]. / Einfluss der Tonometrie und TNW-Spülung auf die Keimflora der Konjunktiva.

This study was undertaken to assess the influence of preoperative ophthalmological examinations on the microbial flora of the conjunctiva. For this purpose, 112 patients awaiting ocular surgery were included in the study. Conjunctival swabs for microbiological investigation were taken by nurses on the day of admission. In addition, specimens were taken before an ophthalmological examination, after applanation and impression tonometry, after irrigation of the lacrimal duct and 2 h after the end of all examinations. A last swab was taken preoperatively. Comparison of the microbiological results of the first two specimens only showed an agreement in 53% of the cases. The increase after tonometry and irrigation of the lacrimal duct in the number of swabs that were positive was not permanent. Swabs that were primarily germ-free and those that were mostly contaminated also showed strong bacterial fluctuation. Based on the present results, there is no strong evidence that the microorganisms found at the preoperative examinations correlate with a higher risk of postoperative infection. Disinfection of the conjunctival sac and the application of antibiotic drops are necessary on the day before the operation and immediately before it.

Effects of leflunomide on the course of listeriosis in mice. Short communication.

The intensity of an infection with Listeria monocytogenes depends on the immunological stab1p4f the body. Impairment of the specific or unspecific defence can lead to severe and partly fatal complications such as meningitis or septicaemia. In a normal defence situation affected individuals are often not diagnosed because the infection appears as an unspecific indisposition. The new immunomodulator leflunomide (n-(4-trifluoro-methyl-phenyl)-5-methyl-isoxazol-4-carboxamide, CAS 75706-12-6, HWA 486) acts mainly as immunosuppressive. Therefore, the influence of leflunomide was investigated on the number of spleen bacteria in the first phase and on the lethality in both phases of mouse listeriosis. The infected mice were either in a normal defence state or in an immunocompromised situation, which was produced by injection of cyclophosphamide or by dextran sulfate. A treatment with leflunomide, 20 mg/kg i.p., twice daily over a period of 3 days, caused no change of the lethality compared with control mice. Likewise, combined administration of leflunomide and ampicillin produced no alteration of the lethal outcomes in comparison with the ampicillin medication alone, the latter being highly effective in any case. However, the number of spleen bacteria was significantly higher in the group with combined treatment than in the ampicillin group. In summary, the treatment with leflunomide most likely will cause no additional risk regarding an infection such as listeriosis, although in the case of an infection an increased care should be given to diagnostic and therapy.

[Listeria abortions in cattle--bacteriology, serology and epizootiology]. / Listerienabort des Rindes--Bakteriologie, Serologie und Epizootiologie.

Listeria abortions were established in foetuses of cattle in 1.2% of the cases investigated in the Erfurt region and 1.8% in the Cottbus region from 1984 to 1989. The isolated strains have been found biochemically to be L. monocytogenes. The serological discrimination revealed a majority of serovar O I, II. Typing by phages of a part of isolated strains showed a clear predominance of code number 000 124 by the 1/2 a isolate (corresponds to O I, II). This type of phages seems to have a epizootiological importance. Listeria abortions were found in (a lot of 63) flocks in the Erfurt region. Nevertheless there were almost no accumulations of listeria abortions and listeria encephalitis at the same time in the analysed flocks.

[Studies on the occurrence of Listeria in Cheese]. / Untersuchungen zum Vorkommen von Listerien im Käse.

Various outbreaks of Listeria registered in the USA and Europe after eating cheese were the motive to investigate different cheese sorts of the GDR-production on the occurrence of Listeria species. Out of 100 samples of different cheese brands 11 curdled milk cheeses (11%) showed Listeria innocua, an nonpathogenic Listeria species.

Preliminary studies on monocine typing of Listeria monocytogenes strains.

About 58% of Listeria monocytogenes strains produced monocines. The titres of 1/2a monocines were higher than those of 4b strains.

The moon: sources of the crustal magnetic anomalies.

Previously unmapped Apollo 16 subsatellite magnetometer data collected at low altitudes over the lunar near side are presented. Medium-amplitude magnetic anomalies exist over the Fra Mauro and Cayley Formations (primary and secondary basin ejecta emplaced 3.8 to 4.0 billion years ago) but are nearly absent over the maria and over the craters Copernicus, Kepler, and Reiner and their encircling ejecta mantles. The largest observed anomaly (radial component approximately 21 gammas at an altitude of 20 kilometers) is exactly correlated with a conspicuous light-colored deposit on western Oceanus Procellarum known as Reiner gamma. Assuming that the Reiner gamma deposit is the source body and estimating its maximum average thickness as 10 meters, a minimum mean magnetization level of 5.2 +/- 2.4 x 10(-2) electromagnetic units per gram, or approximately 500 times the stable magnetization component of the most magnetic returned sample, is calculated. An age for its emplacement of

Mariner 9 television reconnaissance of Mars and its satellites: preliminary results.

At orbit insertion on 14 November 1971 the Martian surface was largely obscured by a dust haze with an extinction optical depth that ranged from near unity in the south polar region to probably greater than 2 over most of the planet. The only features clearly visible were the south polar cap, one dark, spot in Nix Olympica, and three dark spots in the Tharsis region. During the third week the atmosphere began to clear and surface visibility improved, but contrasts remained a fraction of their normal value. Each of the dark spots that apparently protrude through most of the dust-filled atmosphere has a crater or crater complex in its center. The craters are rimless and have featureless floors that, in the crater complexes, are at different levels. The largest crater within the southernmost spot is approximately 100 kilometers wide. The craters apparently were formed by subsidence and resemble terrestrial calderas. The south polar cap has a regular margin, suggsting very flat topography. Two craters outside the cap have frost on their floors; an apparent crater rim within the cap is frost free, indicating preferentia loss of frost from elevated ground. If this is so then the curvilinear streaks, which were frost covered in 1969 and are now clear of frost, may be low-relief ridges. Closeup pictures of Phobos and Deimos show that Phobos is about 25 +/-5 by 21 +/-1 kilometers and Deimos is about 13.5 +/- 2 by 12.0 +/-0.5 kilometers. Both have irregular shapes and are highly cratered, with some craters showing raised rims. The satellites are dark objects with geometric albedos of 0.05.