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Background: A total of three intensive care units (ICU) at a German university hospital were involved in an outbreak of Burkholderia cepacia complex (Bcc). Methods: Patients with microbiological detection of Bcc were evaluated. Products used for mouth hygiene were microbiologically tested. The clonal identity of Bcc was proven by pulse-field gel electrophoresis (PFGE). Results: On 3 ICUs 12 cases were identified whereby the first detection of Bcc was in respiratory specimens of 11 patients and 1 in a wound swab from the oral cavity. Of these patients six developed ventilator-associated pneumonia (VAP). Investigations revealed that five different batches of an alcohol-free mouthwash containing hexetidine were highly contaminated. Isolates of Bcc from patients and mouthwashes were genetically indistinguishable. A recall of the product was initiated. After elimination of the product from the ICUs no more cases were identified. Conclusions: The source of the outbreak was an intrinsically contaminated alcohol-free mouthwash. Detection of Bcc in specimens from ICU patients should lead to further investigations. Antiseptic oral care products are recommended for reducing the risk of VAP but they may be microbiologically contaminated and, in consequence, increase the risk. The safety of patient care products should be increased by stricter regulations. [ABSTRACT FROM AUTHOR]

Schizophrenia is one of the most expensive psychiatric conditions because of high direct and indirect costs associated with the nature of the illness, its resistance to treatment and the consequences of relapse. Long-acting risperidone is a new formulation of an atypical antipsychotic drug that also offers the improvements in compliance associated with haloperidol depot. The aim of this simulation study was to compare the benefits and costs of three pharmacological treatment strategies comprising first-line treatment with long-acting risperidone injection, a haloperidol depot or an oral atypical antipsychotic agent, over a 5-year period in Germany. A discrete event simulation model was developed to compare three treatment scenarios from the perspective of major third-party payers (sickness funds and social security ‘Sozialversicherung’). The scenarios comprised first-line treatment with haloperidol depot (scenario 1), long-acting risperidone (scenario 2) and oral olanzapine (scenario 3). Switches to second or third-line options were allowed when side-effects occurred or a patient suffered more than a fixed number of relapses. The model accounted for fixed patient characteristics, and on the basis of these, simulated patient histories according to several time-dependent variables. The time horizon for this model was limited to 5 years, and in accordance with German guidelines, costs and effects were discounted by between 3 and 10%. Direct costs included medication, type of physician visits and treatment location. Indirect costs were not included. Information on treatment alternatives, transition probabilities, model structure and healthcare utilization were derived from the literature and an expert panel. Outcomes were expressed in terms of the number and duration of psychotic episodes, cumulative symptom scores, costs, and quality-adjusted life-years (QALY). Univariate sensitivity analyses were carried out, as were subgroup analyses based on disease severity and for patients at high risk of being non-compliant. The long-acting risperidone strategy was calculated to avoid 0.23 and 0.33 relapses per patient, decrease the cumulative symptom score by 25 and 33 points, and decrease the costs by €2017 and €6096 per patient (€1608 and €5422 discounted), compared with the haloperidol depot and olanzapine strategies, respectively, over a 5-year period (year of costing 2004). Among high-risk non-compliant patients, long-acting risperidone was estimated to avoid 0.23 and 0.47 relapses and save €4822 and €10 646 per patient (€4107 and €9490 discounted), compared with the haloperidol depot and olanzapine strategies, respectively. Sensitivity analyses showed that the results were robust and mainly sensitive to changes in the reported relative effectiveness of atypical and conventional formulations for preventing symptom recurrence, and in the relative compliance with oral and long-acting formulations. In this model, long-acting risperidone is a dominant strategy compared with a haloperidol depot or oral atypical antipsychotic agent, being both more effective and less costly over a 5-year period. Results for long-acting risperidone are even more favourable among patients at high risk of being non-compliant or with more severe disease. [ABSTRACT FROM AUTHOR]

Assesses the sensitivity of the apple scab fungus Venturia inaequalis to anilinopyrimidine- and strobilurin-fungicides in Germany. Formation of conidiophore; Number of fungicide treatment per season to control apple scab disease; Availability of curative sterol demethylation inhibitors.