Search

OBJECTIVES Changing microorganism distributions and decreasing antibiotic susceptibility with increasing length of hospital stay have been demonstrated for the colonization or infection of selected organ systems. We wanted to describe microorganism distribution or antibiotic resistance in bacteremia according to duration of the hospitalization using a large national epidemiological/microbiological database (ANRESIS) in Switzerland. METHODS We conducted a nationwide, observational study on bacteremia using ANRESIS data from 1st January 2008 to 31st December 2017. We analyzed data on bacteremia from those Swiss hospitals that sent information on a regular basis during the entire study period. We described the pathogen distribution and specific trends of resistance during the hospitalization for E. coli, K. pneumoniae, P. aeruginosa, S. marcescens and S. aureus. RESULTS We included 28,318 bacteremia isolates from 90 Swiss hospitals. The most common etiology was E. coli (33.4%, 9,459), followed by S. aureus (16.7%, 4,721), K. pneumoniae (7.1%, 2,005), E. faecalis (5.2%, 1,473), P. aeruginosa (4.3%, 1,228), S. pneumoniae (4.3%, 1,208) and E. faecium (3.9%, 1,101). We observed 489 (1.73%) Serratia marcescens isolates. We observed an increasing trend for Enterococcus faecium (from 1.5% at day 0 to 13.7% at day 30; p

Objectives Our objective was to systematically study the influence of length of hospital stay on bacterial resistance in relevant respiratory tract isolates. Methods Using prospective epidemiological data from the National Swiss Antibiotic Resistance Surveillance System, susceptibility testing results for respiratory isolates retrospectively retrieved from patients hospitalised between 2008 and 2014 were compiled. Generalized additive models were used to illustrate resistance rates relative to hospitalisation duration and to adjust for co-variables. Results In all, 19 622 isolates of six relevant and predominant species were included. Resistance patterns for the predominant species showed a species-specific and antibiotic-resistance-specific profile in function of hospitalisation duration. The oxacillin resistance profile in Staphylococcus aureus isolates was constantly increasing (monophasic). The pattern of resistance to cefepime in Pseudomonas aeruginosa was biphasic with a decreasing resistance rate for the first 5 days of hospitalisation and an increase for days 6–30. A different biphasic pattern occurred in Escherichia coli regarding amoxicillin-clavulanic acid resistance: odds/day increased for the first 7 days of hospitalisation and then remained stable for days 8–30. In the adjusted models epidemiological characteristics such as age, ward type, hospital type and linguistic region were identified as relevant co-variables for the resistance rates. The contribution of these confounders was specific to the individual species/antibiotic resistance models. Conclusions Resistance rates do not follow a dichotomic pattern (early versus late nosocomial) as suggested by current hospital-acquired pneumonia treatment guidelines. Duration of hospitalisation rather appears to have a more complex and non-linear relationship with bacterial resistance in hospital-acquired pneumonia, also depending on host and environmental factors.

Objectives Echinocandins represent the first-line treatment of candidaemia. Acquired echinocandin resistance is mainly observed among Candida albicans and Candida glabrata and is associated with FKS hotspot mutations. The commercial Sensititre YeastOne™ (SYO) kit is widely used for antifungal susceptibility testing, but interpretive clinical breakpoints are not well defined. We determined echinocandins epidemiological cut-off values (ECV) for C. albicans/glabrata tested by SYO and assessed their ability to identify FKS mutants in a national survey of candidaemia. Methods Bloodstream isolates of C. albicans and C. glabrata were collected in 25 Swiss hospitals from 2004 to 2013 and tested by SYO. FKS hotspot sequencing was performed for isolates with an MIC≥ECV for any echinocandin. Results In all, 1277 C. albicans and 347 C. glabrata were included. ECV 97.5% of caspofungin, anidulafungin and micafungin were 0.12, 0.06 and 0.03 μg/mL for C. albicans, and 0.25, 0.12 and 0.03 μg/mL for C. glabrata, respectively. FKS hotspot sequencing was performed for 70 isolates. No mutation was found in the 52 ‘limit wild-type' isolates (MIC=ECV for at least one echinocandin). Among the 18 ‘non-wild-type' isolates (MIC>ECV for at least one echinocandin), FKS mutations were recovered in the only two isolates with MIC>ECV for all three echinocandins, but not in those exhibiting a ‘non-wild-type' phenotype for only one or two echinocandins. Conclusion This 10-year nationwide survey showed that the rate of echinocandin resistance among C. albicans and C. glabrata remains low in Switzerland despite increased echinocandin use. SYO-ECV could discriminate FKS mutants from wild-type isolates tested by SYO in this population.

The GLAM 2014 airborne campaign performed original in situ observations of gases and aerosols across the Mediterranean troposphere which, combined with satellite measurements and model outputs, highlight their summertime variability. The GLAM (Gradient in Longitude of Atmospheric constituents above the Mediterranean basin) airborne campaign was set up to investigate the summertime variability of gaseous pollutants, greenhouse gases and aerosols between the western (~3°E) and eastern (~35°E) sections of the Mediterranean Basin, as well as how this connects with the impact of the Asian monsoon anticyclone on the eastern Mediterranean in the mid-to-upper troposphere (~5-10 km). GLAM falls within the framework of the Chemistry-Aerosol Mediterranean Experiment (ChArMEx) program. GLAM used the French Falcon-20 research aircraft to measure aerosols, humidity and chemical compounds: ozone, carbon monoxide, methane and carbon dioxide. GLAM took place between August 6 and 10, 2014, following a route from Toulouse (France) to Larnaca (Cyprus) and back again, via Minorca (Spain), Lampedusa (Italy) and Heraklion (Crete, Greece). The aircraft flew at an altitude of 5 km on its outbound journey and 10 km on the return leg. GLAM also collected vertical profiles around the landing sites listed above. A combination of model outputs, chemical mapping analyses, and space-borne and surface station measurements gathered prior to and during the campaign were used to interpret the in situ airborne measurements. The main outcome of this study is the impact of intercontinental transport on the longitudinal variability of pollutants, greenhouse gases and aerosols at an altitude of 10 km. The eastern Mediterranean is affected by air masses from the Arabian Sea surface, and the western Mediterranean is impacted by air masses from North America (biomass burning) and West Africa (desert dust).

Background The isolation of Propionibacterium acnes in blood cultures is often considered a contaminant. On rare occasions, P. acnes can cause severe infections, including endocarditis and intravascular prosthesis-associated infections. To evaluate the discrimination between a contaminant and a clinically relevant infection we used an Ouchterlony test system to quantify the antibody response to P. acnes in a patient with a proven P. acnes endocarditis. Case presentation We report on a 64-year-old Caucasian man who developed P. acnes endocarditis four years following a composite valve-graft conduit replacement of the aortic root. Bacterial growth in blood cultures was detected after an incubation period of 6 days. However, the antibody titer to P. acnes was 1:8 at the time of diagnosis and declined slowly thereafter over 2½ years. The patient’s response to the antibiotic treatment was excellent, and no surgical re-intervention was necessary. Conclusion The working hypothesis of infective endocarditis can be substantiated by serologic testing, which, if positive, provides one additional minor criterion. Moreover, quantification of the antibody response to P. acnes, though not specific, may assist in the differentiation between contaminants and an infection. This quantification may have implications for the patient management, e.g. indication for and choice of the antibiotic therapy.

Objectives We determined the frequency of subsequent bloodstream infection more than 2 days after removal of a catheter with positive tip cultures. Methods We conducted a nationwide, observational study on intravascular catheter (IVC) tip cultures in Switzerland from 2008 to 2015 using data from the Swiss Antibiotic Resistance Surveillance System (ANRESIS). An IVC tip culture was included in the analysis if at least one microorganism could be cultivated from it. We excluded all data from patients with concurrent bacteraemia with the same microorganism identified 7 days before to 2 days after IVC removal. Subsequent bloodstream infection was defined as isolating (from blood cultures performed more than 2 days up to 7 days after catheter removal) the same microorganism as the one recovered from the IVC. Data on antibiotic therapy were not available in this surveillance study. Results Over the 8-year period, 15 033 positive IVC tip cultures were identified. Our study population comprised 12 513 episodes of positive IVC tip cultures without concurrent bacteraemia. The frequency of sBSI was 1.8% ( n = 219). Subsequent bloodstream infections were more frequently detected after identification of C. albicans (10/113, 8.8%), S. marcescens (9/169, 5.3%), and S. aureus (30/623, 4.8%) on a catheter tip. Conclusions A very low incidence of subsequent bloodstream infection was observed if a microorganism was identified on a removed IVC tip without concurrent bacteraemia. The risk of subsequent bloodstream infection increased if C. albicans , S. aureus , or S. marcescens were identified in this context.

BACKGROUND Povidone-iodine alone or in combination with antibiotics is commonly used for presurgical disinfection in cataract surgery. In spite of the use of the combination Povidone-iodine and ofloxacin, the rate of ocular contamination as assessed from surgical knives was reported to be as high as 26 %. The aim of this study was to investigate the efficacy of diluted Povidone-iodine alone for surgical disinfection. PATIENTS AND METHODS 126 consecutive patients undergoing elective cataract surgery with a conjunctival wound and a scleral tunnel received prior to surgery a disinfection with diluted Povidone-iodine eye drops (Braunol 1:10 diluted = 0.8 % Povidone-iodine, 3 times every 5 min). To assess residual bacteria on the ocular surface after disinfection, the surgical knives for the side ports and the scleral tunnel were cultured in thioglycolate broth. RESULTS In 8 out of 126 (6 %) patients the culture from the surgical knives revealed a positive result (89 % coagulase negative Staphylococci). Four of these 8 cases occurred during a single list. All control cultures remained negative. CONCLUSION Diluted Povidone-iodine eye drops alone are highly effective for bacterial disinfection when applied properly. The rate of contamination using 0.8 % Povidone-iodine in our series was considerably lower as compared to that of other studies.

Les douleurs chroniques du petit bassin de l'homme sont un grand problème en pratique quotidienne urologique. La classification des prostatites du National Institute of Health (NIH) qui a été publiée en 1988 pour le diagnostic et la stratégie thérapeutique est basée sur des analyses bactériologiques urinaires approfondies (test des 4 verres), sur l'analyse des substances de sécrétions prostatiques et sur l'analyse de l'éjaculat. Le but de ce travail était de savoir si l'utilisation du seul test des 2 verres: un examen avant et après massage prostatique permet d'avoir les mêmes résultats que le test complet des 4 verres et, par conséquent, est suffisant dans la plupart des cas. 148 patients avec le diagnostic de prostatite chronique ont été inclus dans cette étude. Les résultats montrent que le test des 4 verres qui est cher et compliqué peut être remplacé en routine par le test des 2 verres. Les analyses plus approfondies doivent être réservées aux cas complexes qui résistent au traitement.

Chronic pelvic pain syndrome is still an important clinical problem. The NIH prostatitis classification introduced in 1998 for diagnosis and treatment measures is based on extended microbiological analysis of urine and expressed prostate secretion (4-glass test). In 1997 J.C. Nickel proved that the culture and microscopic examination of urine before and after prostatic massage leads to the same results as the 4-glass test. In our prospective study on 143 patients with a diagnosis of chronic prostatitis, we analyzed this statement and came to the same results. We therefore recommend replacing the expensive and time-consuming 4-glass test by a simple preprostatic and postprostatic massage urine culture. Further examinations should only be performed in special cases.

Transient left ventricular apical ballooning syndrome is characterized by transient akinesis of the left ventricular apex with basal wall hyperkinesis; this is also known as Takotsubo cardiomyopathy. There are three distinct contractile LV patterns described in the literature: apical, midventricular, and basal ballooning. The apical ballooning pattern is the most frequent pattern. We describe the case of a transient anterolateral left ventricular ballooning fulfilling the definition of Takotsubo cardiomyopathy except for the contractile LV pattern. The diagnosis was supported by cardiac magnetic resonance imaging and by the fact that the anterolateral ballooning resolved completely after 6 weeks.

The Medtronic MICRA transcatheter pacing system (MICRA TPS) is a recently introduced leadless single-chamber pacing system. We compared the safety and performance of the MICRA TPS with conventional transvenous single chamber pacemakers (conventional VVI) implanted at our centre. This retrospective

Stools of 68 human immunodeficiency virus (HIV)-infected adults with diarrhea and 60 without diarrhea were examined for enteroaggregative Escherichia coli (EAggEc) by HeLa cell adherence assay. EAggEc were present in stools of 30 patients with and 18 without diarrhea (P = .05). CD4 cell counts of patients with EAggEc and diarrhea were significantly lower than those of patients with EAggEc without diarrhea (P = .02). There was no difference in the mean duration of diarrheal symptoms or in the number of stools per day between patients with EAggEc and those without. None of the EAggEc strains were positive by polymerase chain reaction for adherence fimbria, but 11 strains were positive for EAggEc heat-stable toxin EAST/1. Of the EAggEc strains, 51% were resistant to trimethoprim-sulfamethoxazole and 65% were resistant to ampicillin. EAggEc may be a pathogen in HIV-infected patients with diarrhea; HIV-infected patients with EAggEc appear to be more symptomatic when HIV disease is more advanced.

Urinary tract infections in women are common. Drug resistance among Escherichia coli, the most frequent uropathogen, has increased worldwide. In a prevalence study we investigated the local antibiotic susceptibility of this microorganism in urinary specimens of three laboratories in Zurich. Resistance rates against trimethoprim-sulfamethoxazole 2010 were 28%, 16% against quinolones and 16% against amoxicillin/clavulanic acid. Resistance prevalence for nitrofurantoin and fosfomycin were low with 3,6%, resp. 0,7%. The rate of extended-spectrum beta-lactamase-producing E. coli has rapidly increased to 4,3% in 2010. Based on this data and according to the international guidelines for the treatment of uncomplicated cystitis, therapy with trimethoprim-sulfamethoxazole and quinolones are no longer recommended. Nitrofurantoin and Fosfomycin are an appropriate choice. Microbiological testing is advised.

A 27-year-old male patient had recurrent pyogenic granuloma with satellitosis. Histologically, Warthin-Starry staining of the lesions revealed clumps of dark bacilli as found in patients with bacillary angiomatosis. IgG antibodies against Bartonella (Rochalimaea) henselae were elevated as shown by an indirect immunofluorescence assay. The patient did not present an obvious risk for HIV infection or immunosuppression, and no antibodies against HIV-1 and HIV-2 were found. Recurrent pyogenic granuloma with satellitosis may be a localized variant of bacillary angiomatosis.

In the summer of 2004 several separate field programs intensively studied the photochemical, heterogeneous chemical and radiative environment of the troposphere over North America, the North Atlantic Ocean, and western Europe. Previous studies have indicated that the transport of continental emissions, particularly from North America, influences the concentrations of trace species in the troposphere over the North Atlantic and Europe. An international team of scientists, representing over 100 laboratories, collaborated under the International Consortium for Atmospheric Research on Transport and Transformation (ICARTT) umbrella to coordinate the separate field programs in order to maximize the resulting advances in our understanding of regional air quality, the transport, chemical transformation and removal of aerosols, ozone, and their precursors during intercontinental transport, and the radiation balance of the troposphere. Participants utilized nine aircraft, one research vessel, several ground-based sites in North America and the Azores, a network of aerosol-ozone lidars in Europe, satellites, balloon borne sondes, and routine commercial aircraft measurements. In this special section, the results from a major fraction of those platforms are presented. This overview is aimed at providing operational and logistical information for those platforms, summarizing the principal findings and conclusions that have been drawn from the results, and directing readers to specific papers for further details.

Povidone-iodine alone or in combination with antibiotics is commonly used for presurgical disinfection in cataract surgery. In spite of the use of the combination Povidone-iodine and ofloxacin, the rate of ocular contamination as assessed from surgical knives was reported to be as high as 26 %. The aim of this study was to investigate the efficacy of diluted Povidone-iodine alone for surgical disinfection.126 consecutive patients undergoing elective cataract surgery with a conjunctival wound and a scleral tunnel received prior to surgery a disinfection with diluted Povidone-iodine eye drops (Braunol 1:10 diluted = 0.8 % Povidone-iodine, 3 times every 5 min). To assess residual bacteria on the ocular surface after disinfection, the surgical knives for the side ports and the scleral tunnel were cultured in thioglycolate broth.In 8 out of 126 (6 %) patients the culture from the surgical knives revealed a positive result (89 % coagulase negative Staphylococci). Four of these 8 cases occurred during a single list. All control cultures remained negative.Diluted Povidone-iodine eye drops alone are highly effective for bacterial disinfection when applied properly. The rate of contamination using 0.8 % Povidone-iodine in our series was considerably lower as compared to that of other studies.

The MOZAIC programme collects ozone and water vapour data using automatic equipment installed on board five long-range Airbus A340 aircraft flying regularly all over the world since August 1994. Those measurements made between September 1994 and August 1996 allowed the first accurate ozone climatology at 9–12 km altitude to be generated. The seasonal variability of the tropopause height has always provided a problem when constructing climatologies in this region. To remove any signal from the seasonal and synoptic scale variability in tropopause height we have chosen in this further study of these and subsequent data to reference our climatology to the altitude of the tropopause. We define the tropopause as a mixing zone 30 hPa thick across the 2 pvu potential vorticity surface. A new ozone climatology is now available for levels characteristic of the upper troposphere (UT) and the lower stratosphere (LS) regardless of the seasonal variations of the tropopause over the period 1994–2003. Moreover, this new presentation has allowed an estimation of the monthly mean climatological ozone concentration at the tropopause showing a sine seasonal variation with a maximum in May (120 ppbv) and a minimum in November (65 ppbv). Besides, we present a first assessment of the inter-annual variability of ozone in this particular critical region. The overall increase in the UTLS is about 1%/yr for the 9 years sampled. However, enhanced concentrations about 10–15 % higher than the other years were recorded in 1998 and 1999 in both the UT and the LS. This so-called "1998–1999 anomaly" may be attributed to a combination of different processes involving large scale modes of atmospheric variability, circulation features and local or global pollution, but the most dominant one seems to involve the variability of the North Atlantic Oscillation (NAO) as we find a strong positive correlation (above 0.60) between ozone recorded in the upper troposphere and the NAO index. A strong anti-correlation is also found between ozone and the extremes of the Northern Annular Mode (NAM) index, attributing the lower stratospheric variability to dynamical anomalies. Finally this analysis highlights the coupling between the troposphere, at least the upper one, and the stratosphere, at least the lower one.

The aim of this prospective study was to observe immunophenotypic patterns in the ejaculate of patients with noninflammatory chronic pelvic pain syndrome (Cat IIIB CPPS) and to test for a possible autoimmune aetiology. Thirty-five patients of a total of 88 patients with chronic prostatitis Cat IIIB were consecutively selected. Monthly ejaculate testing was carried out for IgG, IgA, IgM, IL-1alpha, sIL-2R and IL-6. The control group for ejaculate analysis was composed of 96 normal ejaculates (according to the WHO criteria). Immunohistochemical detection of CD3 cells (T lymphocytes) and CD20 cells (B lymphocytes) was performed in 71 biopsy cylinders of Cat IIIB CPPS patients and in 25 prostate biopsy cylinders of subjects without symptoms or obstruction. Intra-acinar T-lymphocytic infiltrates were dominated by T-cytotoxic cells (P = 0.05). Ejaculate IL-6 and ejaculate IgA increased significantly and dropped again, correlating with a release of clinical symptoms. Inflammatory ejaculate interleukin concentrations correlated with the immunohistochemical findings with presence of large numbers of T cells (all P-valuesor = 0.01). Immunomodulation was performed in a pilot series of three patients by five monthly cycles of IgG (Sandoglobulin), 1 g kg-1 body weight. Immunomodulation with IgG decreased pain moderately and did not change ejaculate interleukin and immunoglobulin concentrations. In summary, interleukin and immunoglobulin determinations in the ejaculate revealed an inflammatory process even in Cat IIIB CPPS. The findings of intra-acinar T-cell rich infiltrates and the associated inflammatory reaction may indicate a possible autoimmune component in the aetiology of CPPS. Exact origin and role of interleukin changes in the ejaculate of CPPS patients need to be further evaluated. Unfortunately, pilot series with immunomodulation with IgG do not seem to provide clear clinical benefit.

Chronic pelvic pain syndrome is still an important clinical problem. The NIH-prostatitis classification introduced 1998 for diagnosis and treatment measures is based on extended microbiological analysis of urine, expressed prostate secretion (4-glass test), and ejaculate. We investigated if a simple urine analysis of an urine sample before and after prostatic massage (2-glass test) could replace the 4-glass test. 143 patients with the diagnosis chronic prostatitis were included in this prospective study. The results showed that the expensive and time consuming 4-glass test can be replaced by a simple 2-glass test. Extended examinations should only be performed in special cases.

Chronic pelvic pain syndrome is still an important clinical problem. The NIH prostatitis classification introduced in 1998 for diagnosis and treatment measures is based on extended microbiological analysis of urine and expressed prostate secretion (4-glass test). In 1997 J.C. Nickel proved that the culture and microscopic examination of urine before and after prostatic massage leads to the same results as the 4-glass test. In our prospective study on 143 patients with a diagnosis of chronic prostatitis, we analyzed this statement and came to the same results. We therefore recommend replacing the expensive and time-consuming 4-glass test by a simple preprostatic and postprostatic massage urine culture. Further examinations should only be performed in special cases.

This paper describes the frequency of susceptibility of Gram-negative and Gram-positive bacteria against antibacterial agents. Data are based on all susceptibility tests performed at the Department of Medical Microbiology of the University of Zurich in 2000. The evaluation of the results from 1987 to 2000 shows that susceptibilities against the antimicrobial agents tested have not markedly changed with the following exceptions: 7% of Staphylococcus aureus are resistant against methicillin, 8% of pneumococci have a reduced susceptibility to penicillin, 1% is resistant to penicillin, and 10% are resistant to macrolides. 9% of group A streptococci are resistant to macrolides. Quinolone resistance is markedly high in the medical practice with 10% of E. coli strains and 32% of Campylobacter sp. Strains of Klebsiella pneumoniae and E. coli producing extended spectrum betalactamases are isolated occasionally. Of all strains of Mycobacterium tuberculosis isolated from clinical specimens in 2000, 4% were multi-drug resistant. The tables may be a help for the physician in his decision for a "calculated chemotherapy" of bacterial infections.

OBJECTIVES: Three filters were tested for in situ efficacy in reducing bacterial contamination associated with injection drug use. METHODS: In a self-matched control design with blinded laboratory testing, injection drug users were asked to use 3 filters in random succession when loading their syringes with drug solute. RESULTS: The 0.22-micron filter proved significantly better than both the cigarette filter (relative risk [RR] = 18.0) and the 20-micron filter (RR = 4.5) in rendering syringes bacteria-free. CONCLUSIONS: The 15- to 20-micron syringe filter currently provided injection drug users in Switzerland does not significantly reduce contamination associated with common bacterial infections among users. Filters with pore width 1/100th as large are recommended.

Persons infected with human immunodeficiency virus (HIV) are at increased risk for diarrhea and enteric infections. We studied (1) the epidemiology of enteric pathogens associated with diarrhea, (2) the diagnostic yield of stool examination and endoscopic evaluation, (3) risks to develop diarrhea, and (4) the impact of diarrhea on patients' survival.A total of 1933 participants in the Swiss HIV Cohort Study were prospectively followed up for a median of 25.5 months. A total of 560 diarrheal episodes were evaluated by standardized stool examination. Endoscopic evaluation was performed in 25% of patients with chronic diarrhea.The incidence of diarrhea was 14.2 per 100 person-years (95% confidence interval, 13.0-15.4). Among patients with CD4 cell counts below 0.05 x 10(9)/L, the probability to develop diarrhea within 1, 2, and 3 years was 48.5%, 74.3%, and 95.6%, respectively. The risk to develop diarrhea was increased among patients with severe immunodeficiency, homosexual men, and patients taking antiretroviral therapy. Pneumocystis carinii chemoprophylaxis did not reduce the risk of diarrhea. Diarrhea was an independent negative predictor of survival. Enteric pathogens were detected in 16.5% of 212 acute diarrheal episodes and in 46% of 348 chronic diarrheal episodes. The sensitivity of histological and stool examination was similar except for the diagnosis of intestinal cytomegalovirus infection and leishmaniasis, which required invasive evaluation.Intestinal infections were diagnosed in less than 50% of chronic diarrheal episodes. The prevalence of enteric pathogens tended to decrease during the observation period, possibly because of improved antiretroviral therapy. Endoscopic evaluation did not improve the diagnostic yield compared with stool examination except for the diagnosis of cytomegalovirus enteritis and leishmaniasis.

Since it is possible to identify the subgroups of RSV, A-subtype and B-subtype, there are findings indicating that the subtype may influence severity of RSV infection. Our study was designed to assess the hypothesis that A-subtype infections were more severe than B-subtype infections among hospitalized children.All medical records of patients hospitalized with RSV infection between March 1990 and March 1993 were reviewed. A total of 107 children with proven RSV infection were identified.Nasal waste specimens for culture were obtained from infants with suspected RSV infection. Subtype determination was done on frozen virus cultures. The following risk factors were defined: ageor = 3 months, weight5 kg, prematurity and underlying cardiac or respiratory disease and immune deficiency. To analyse the relationship between risk factors, subtype and severity a multivariate analysis was performed. Severity was measured by clinical observations as following: pH, PCO2, SaO2, oxygen supplementation, history of apnea and length of hospital stay.Of the enrolled patients 11 had underlying disease and 17 were premature. The age range was 1 week to 4.2 years, median 3.5 months. 46 children were younger than 3 months, 33 had a weight of less than 5 kg. The isolates of 84 children were typeable: 63 isolates were subtype A and 21 subtype B. Underlying disease and prematurity were associated with SaO287% (p = 0.003) and oxygen supplementation (p = 0.017). A weight of less than 5 kg was correlated with a PCO2or = 50 mmHg. The RSV subtype was not significantly correlated with severity.RSV infection even in very young children is predominantly influenced by underlying disease, prematurity and weight. The RSV subtype was no independent risk factor for an increased morbidity in this retrospective study. Therefore, in our opinion, RSV subtype is less meaningful to predict the severity of RSV infection than known risk factors.

This paper describes the frequency of susceptibility of Gram-negative and Gram-positive bacteria against antibacterial agents. The data are based on all susceptibility tests performed in 1996 at the Department of Medical Microbiology of the University of Zurich and at the private medical laboratory "medica" in Zurich. The evaluation of the results from 1975 to 1996 shows that susceptibilities against the antimicrobial agents tested have not changed markedly in this period with few exceptions. The tables may be a help for the physician in his decision for a "calculated chemotherapy" of bacterial infections.

The mechanism of penicillin-resistance of Streptococcus pneumoniae involves the development of altered forms of penicillin-binding proteins (PBPs) that have a decreased affinity for penicillin. PBPs are involved in the assembly of the cell wall. Normal forms of PBPs are inhibited by penicillin but altered forms are not. It appears that the altered PBP genes arose by interspecies recombinational events in which segments of the PBPs structural genes had been replaced by regions derived from PBP genes of oral streptococcal species. Altered PBP genes of penicillin-resistant pneumococci can be spread horizontally to sensitive pneumococci by transformation. Highly resistant pneumococci have several altered PBPs and also show resistance to the third-generation cephalosporins and other antibiotics. Some clones of resistant pneumococci seem to have an increased epidemic potential to spread. In Austria, Germany, Italy, and Switzerland approximately 95% of pneumococci are still penicillin-sensitive. However, an increase of the highly resistant pneumococci would change the empirical therapy of severe pneumococcal infections in the near future. Reasonable use of antimicrobials might reduce the selective antimicrobial pressure and the spread of penicillin-resistant strains.

Lansoprazole, a potent antisecretory drug, possesses on an equimolar basis a 4-fold higher in vitro anti-Helicobacter pylori activity than omeprazole. In a prospective randomized study we compared lansoprazole 30 mg b.i.d. and amoxicillin 1 g b.i.d. with omeprazole 40 mg b.i.d. and amoxicillin 1 g b.i.d. for 14 days followed by lansoprazole 30 mg q.d. or omeprazole 20 mg q.d. for 14 additional days in 50 H. pylori positive duodenal ulcer patients (14f, 36m, age 27-83 [mean 43] years). H. pylori infection was diagnosed by histology (3 antral biopsies and 2 from gastric body, HE- and Giemsa stain), rapid urease test (CLO) and culture in 39 patients, or by histology and rapid urease test in 11 patients. Control endoscopy was performed 4-6 weeks after the end of treatment. For eradication, a negative result in all 3 diagnostic modalities was required. The eradication rate was 43% (9/21 patients) in both treatment groups. 8 patients were lost to follow-up. The ulcer healing rate was 100% in both groups. Nonsmokers had a significantly higher (p = 0.026) eradication rate than smokers. No relevant adverse effects of the therapy occurred. 24 patients with persistent H. pylori infection were subsequently treated with lansoprazole 60 mg b.i.d. and amoxicillin 1 g b.i.d. for 14 days. Eradication was achieved in 5/22 (23%) patients (3/14 smokers, 2/8 nonsmokers), while 2 patients were lost to follow-up. 17 patients with persistent H. pylori infection after the second treatment received quadruple therapy consisting of metronidazole 500 mg t.i.d., tetracycline 500 mg q.i.d. bismuth-subcitrate 120 mg q.i.d. and lansoprazole 30 mg for 10 days. H. pylori eradication was achieved in 12/15 patients (80%). In conclusion, lansoprazole plus amoxicillin was equal to omeprazole plus amoxicillin in the treatment of H. pylori infected duodenal ulcer patients. Patients with eradication failure after dual therapy were successfully treated by quadruple therapy. In contrast, high dose lansoprazole and amoxicillin therapy was effective in only 23% of patients with persistent infection after standard dual therapy.