Macrolide-resistant Staphylococcus aureus colonization in cystic fibrosis patients: is there transmission to household contacts?

OBJECTIVES: Patients with cystic fibrosis (CF) are frequently colonized by macrolide-resistant Staphylococcus aureus, a result of maintenance macrolide therapy. As transmission of S. aureus between household contacts is common, we examined the prevalence of macrolide-resistant S. aureus colonization in CF patients on maintenance azithromycin therapy and their household contacts and compared this with the S. aureus macrolide resistance prevalence in the community. PATIENTS AND METHODS: Sixty-five CF patients on maintenance macrolide therapy and 194 household contacts were screened for S. aureus colonization by culturing sputa, cough swabs and nasal swabs. Resistance to macrolide, lincosamide and methicillin was determined by disc diffusion tests. The prevalence of macrolide-resistant S. aureus colonization in both groups was compared with figures from a nationwide study into S. aureus carriership and resistance. To assess possible transmission, genotyping of S. aureus was performed using the spa-typing method. RESULTS: Macrolide resistance among CF patients with S. aureus colonization was 69.6%; 75% of these isolates displayed lincosamide resistance too. Among household contacts, macrolide resistance prevalence did not differ significantly from resistance prevalence in the community (9.6% versus 6.3%; P = 0.358). No methicillin resistance was observed. No identical (macrolide-resistant and -susceptible) S. aureus genotypes were observed between CF patients and their household contacts except for one household, suggesting a probable transmission. CONCLUSIONS: No significant increase in macrolide-resistant S. aureus colonization was observed among household contacts of CF patients on long-term azithromycin therapy. Transmission of macrolide-resistant S. aureus could not be proved by genotyping in the majority of households.     

Influence of controlled immediate loading and implant design on peri-implant bone formation

AIM: Tissue formation at the implant interface is known to be sensitive to mechanical stimuli. The aim of the study was to compare the bone formation around immediately loaded versus unloaded implants in two different implant macro-designs. MATERIAL AND METHODS: A repeated sampling bone chamber with a central implant was installed in the tibia of 10 rabbits. Highly controlled loading experiments were designed for a cylindrical (CL) and screw-shaped (SL) implant, while the unloaded screw-shaped (SU) implant served as a control. An F-statistic model with alpha=5% determined statistical significance. RESULTS: A significantly higher bone area fraction was observed for SL compared with SU (p<0.0001). The mineralized bone fraction was the highest for SL and significantly different from SU (p<0.0001). The chance that osteoid- and bone-to-implant contact occurred was the highest for SL and significantly different from SU (p<0.0001), but not from CL. When bone-to-implant contact was observed, a loading (SL versus SU: p=0.0049) as well as an implant geometry effect (SL versus CL: p=0.01) was found, in favour of the SL condition. CONCLUSIONS: Well-controlled immediate implant loading accelerates tissue mineralization at the interface. Adequate bone stimulation via mechanical coupling may account for the larger bone response around the screw-type implant compared with the cylindrical implant.     

[Sar1, Ile4, Ile8]‐angiotensin II Potentiates Insulin Receptor Signalling and Glycogen Synthesis in Hepatocytes

The angiotensin II type I receptor (AT1R) is involved in the regulation of cardiovascular function. Excessive activation of AT1R by angiotensin II (Ang II) leads to cardiovascular disease and may be involved in the development of insulin resistance and diabetes. Functionally selective Ang II analogues, such as the [Sar1, Ile4, Ile8]‐angiotensin II (SII Ang II) analogue, that only activate a subset of signalling networks have been demonstrated to have beneficial effects on cardiovascular function in certain settings, including lowering blood pressure and increasing cardiac performance. Here, we studied the effect of SII Ang II on insulin receptor (IR) signalling and glucose metabolism in primary rat hepatocytes. We show that long‐term pre‐treatment of hepatocytes with SII Ang II increased insulin‐stimulated glycogen synthesis, while Ang II and the AT1R antagonist losartan had no effect. Insulin‐stimulated suppression of hepatic glucose output was not affected by Ang II or SII Ang II. It is well known that insulin regulates glycogen synthesis and glucose output through Akt‐mediated phosphorylation of glycogen synthase kinase α/β (GSK3α/β) and forkhead box protein O1 (FOXO1), respectively. In line with this, we show that SII Ang II potentiated insulin‐stimulated phosphorylation of Akt and GSK3α/β, but not FOXO1. Furthermore, we demonstrate that the effect of SII Ang II on insulin‐stimulated signalling and glycogen synthesis was dependent on Src and Gαq, as inhibitors of these proteins abolished the potentiating effect of SII Ang II. Thus, our results demonstrate that SII Ang II may have a positive effect on IR signalling and glucose metabolism in hepatocytes.     

Sepsis with an Atopobium-Like Species in a Patient with Fournier's Gangrene

Atopobium species are Gram-positive, anaerobic, catalase-negative, fastidious bacteria belonging to the family Coriobacteriaceae. We report the isolation of an Atopobium-like species in a patient with Fournier''s gangrene and highlight the role of 16S rRNA gene sequencing in the identification of fastidious organisms in the clinical laboratory.     

Novel water-soluble block copolymers of dimethylaminoethyl methacrylate and dihydroxypropyl methacrylate

In this publication we describe the synthesis and properties of a novel type of block copolymer. The anionically synthesised block copolymer consists of a neutral, watersoluble block (2,3-dihydroxypropyl methacrylate, HMA) and a pH-dependently charged one (2-dimethylaminoethyl methacrylate, AMA). The adsorption on silica and its effect on the colloidal stability were evaluated. The adsorbed amount is mainly determined by the electrostatics, which leads to a maximum adsorbed amount at low AMA content. The block copolymers tend to destabilise colloidal silica, due to a charge neutralisation upon adsorption, which is not compensated by the formation of a steric layer.     

The relevance of team characteristics and team directed strategies in the implementation of nursing innovations: A literature review

BackgroundImplementation of innovations is a complex and intensive procedure in which different strategies can be successful. In nursing, strategies often focus on intrinsic motivation, competencies and attitudes of individual nurses while ignoring the social context. Since nurses often work in teams, identifying relevant team characteristics and successful team directed strategies may contribute to the implementation of innovations. The literature was searched for evidence.MethodsA literature review was performed including key words related to nursing teams, innovations, team characteristics and team-directed strategies. On-line databases were searched (MEDLINE, CINAHL, PsycINFO, ERIC database and Cochrane reviews CENTRAL). The journal Quality and Safety in Healthcare (QSHC) was hand searched. Methodological quality was assessed.ResultsInitially, 323 titles were found. Screening of titles and abstracts and full texts resulted in nine articles meeting the inclusion criteria. The methodological quality of the studies was generally low. The innovations included different types of practices. Fifteen different team characteristics were labeled according to six features of successful teams.Twenty-one different team-directed strategies were identified and inductively categorized.ConclusionFew studies and little evidence were found for the relevance of team characteristics and team directed strategies in the implementation of nursing innovations. Feedback was most frequently used as a strategy. Leadership could be labeled as a team characteristic as well as a team directed strategy. Further research should be of good methodological quality and focusing on patient outcomes and time and costs invested in strategy delivery. This increases scientific knowledge on nursing implementation strategies focusing on leadership.