Search PubMed⌕ Search

Biomedical subjects

H Mittermayer

Publications and source records attributed to H Mittermayer.

At least 19 recordsLinked to original sources
PubMed2004

European recommendations for antimicrobial resistance surveillance.

The problem of antimicrobial resistance surveillance in Europe has been debated extensively in many excellent documents issued by national committees that often assume the value of national guidelines. However, a comprehensive document addressing the whole matter from a European perspective, as well as reviewing its present status and drafting future perspectives, has been lacking. The present recommendations have been produced by the ESCMID Study Group for Antimicrobial Resistance Surveillance (ESGARS) through a consensus process involving all members of the Study Group. The recommendations focus on the detection of bacterial resistance and its reporting to clinicians, public health officers and a wider-and ever-increasing-audience. The leading concept is that the basis for resistance monitoring is microbiological diagnostics. The prerequisites for resistance monitoring are findings of adequate quality and quantity, which have been recorded properly and evaluated correctly. Different types of surveillance studies should fulfil different requirements with regard to data collection and reporting, the expected use of data, and the prerequisites for networking such activities. To generate relevant indicators, bacterial resistance data should be reported using adequate denominators and stratification. Reporting of antimicrobial resistance data is necessary for selection of empirical therapy at the local level, for assessing the scale of the resistance problem at the local, national or international levels, for monitoring changes in resistance rates, and for detecting the emergence and spread of new resistances types. Any type of surveillance study should conclude, where appropriate, with a proposal for intervention based on the data obtained.

Anti-Bacterial Agents↗
PubMed2002

Multicentre evaluation of the VITEK 2 Advanced Expert System for interpretive reading of antimicrobial resistance tests.

Interpretive reading analyses the complete resistance profiles of bacteria to multiple antibiotics and infers the resistance mechanisms present; it aids therapeutic choice and enhances surveillance data. We evaluated the Advanced Expert System (AES), which interprets MICs generated by the VITEK 2. Ten European laboratories tested 42 reference strains and 76-106 of their own strains, representing important resistance genotypes. Interpretive reading by the VITEK 2 AES achieved full agreement with genotype data for 88-89% of strains, with the correct mechanism identified as one of two possibilities for a further 5-6%. Mechanisms inferred with 90% agreement with reference data included methicillin resistance in staphylococci, glycopeptide resistance in enterococci, quinolone resistance in staphylococci and Enterobacteriaceae, AAC(6')-APH(2")-mediated aminoglycoside resistance in Gram-positive cocci, erm-mediated macrolide resistance in pneumococci, extended-spectrum beta-lactamases (ESBLs) in Enterobacteriaceae and Pseudomonas aeruginosa, and acquired penicillinases in Enterobacteriaceae. VanA, VanB and VanC phenotypes of enterococci were distinguished reliably, and ESBL production was accurately inferred in AmpC-inducible species as well as Escherichia coli and Klebsiella spp. Mechanisms identified, but only as possibilities among several, included IRT-type beta-lactamases and individual aminoglycoside-modifying enzymes in Enterobacteriaceae. Most disagreements with reference data concerned pneumococci found to have high-level penicillin resistance by the VITEK 2 AES but previously determined, phenotypically, to have intermediate resistance. When ESBL production was inferred in E. coli and klebsiellae, the VITEK 2 AES edited susceptible results for cephalosporins (except cefoxitin) to resistant; when an acquired penicillinase was inferred in Enterobacteriaceae, piperacillin results were edited to resistant; and when staphylococci were found methicillin resistant, resistance was reported for all beta-lactams. Further editing may be desirable (e.g. of cephalosporin results for salmonellas inferred to have ESBLs).

Data Interpretation, Statistical↗
PubMed2001

Enterovirus infection--a possible trigger for Graves' disease?

Viruses are potential environmental factors in autoimmune disease. Some evidence suggests a relationship between enteroviral infection (especially Coxsackie B virus) and autoimmunity. We investigated 21 individuals with recent onset of Graves' hyperthyroidism in regard of (subclinical) enterovirus infection. Thyrotoxic symptoms had started about two months before blood sample collection. The patients were from Upper Austria and mainly female (17/21). Their mean free thyroxin levels in blood were twice the maximum normal value and the majority achieved a euthyroid state 1 1/2 years later, after antithyroid medication. We employed a nested PCR reaction with primers of the enterovirus genome on blood samples. All were negative for RNA of the enterovirus group. Coxsackie and related viruses were not identified as a trigger factor in autoimmune thyrotoxic disease.

Adult↗
PubMed2001

Non-touch fittings in hospitals: a possible source of Pseudomonas aeruginosa and Legionella spp.

Non-touch fittings are gradually becoming very common in the bathrooms and toilets of public facilities and restaurants. Hospitals and other healthcare facilities have recently started to install these types of water taps to lower water consumption, thus saving costs, and to prevent healthcare workers from touching the tap, thus promoting hygiene. This study analysed the bacteriological water quality of 38 non-touch water taps in different settings in a 450-bed secondary-care hospital in Upper Austria. Two different tap types were installed: 23 taps were without temperature selection and 15 were with temperature selection (cold and warm). A membrane filtration method was used, and the authors screened for both indicator organisms and Pseudomonas aeruginosa in 100 ml water samples. In 10 non-touch taps without temperature selection, the authors also screened for Legionella spp. in 500 ml water samples. Seventy four percent of the taps without temperature selection and 7% of the taps with temperature selection showed contamination with P. aeruginosa (P<0.001). None of the taps showed contamination with indicator organisms. Detailed analysis of the source of contamination revealed that the magnetic valve and the outlet itself were heavily contaminated, whereas the junction from the central pipe system was free of contamination. All 10 analysed taps showed contamination with Legionella spp. It was concluded that the local contamination of non-touch fittings is a result of the low amount of water that flows through the outlet, the low water pressure and the column of water, which is 'still-standing' and has a temperature of about 35 degrees C, thus providing nearly ideal growth conditions for P. aeruginosa. Additionally, the presence of materials such as rubber, PVC, etc. in the fittings enhances the adhesion of P. aeruginosa and thus the production of biofilms. In conclusion, the authors wish to encourage infection control teams to evaluate the use of non-touch fittings in hospitals, especially when they are installed in risk areas.

Austria↗
PubMed1999

In vitro activity of newer broad spectrum beta-lactam antibiotics against enterobacteriaceae and non-fermenters: a report from Austrian intensive care units. Austrian Carbapenem Susceptibility Surveillance Group.

We compared the in vitro activity of broad spectrum beta-lactam antibiotics against 573 gram-negative isolates (enterobacteriaceae and non-fermenters) collected between November 1996 and May 1997 from 9 laboratories serving intensive care units throughout Austria. MIC's (Minimal Inhibitory Concentration) were obtained with the E-test for meropenem, imipenem, ceftazidime, cefepime, cefpirome and piperacillin/tazobactam. Pseudomonas aeruginosa was the most frequently isolated organism (22%), followed by E. coli (19%), Klebsiella spp. (16%), and Enterobacter spp. (14%). Acinetobacter spp., Proteus spp., Serratia spp., Stenotrophomonas maltophilia, Citrobacter spp., Morganella morganii, Burkholderia cepacia and Salmonella enteritidis were isolated less frequently. Overall meropenem, imipenem and ceftazidime were the most active compounds in vitro, inhibiting 90%, 89%, and 87% of the isolates, respectively. Pseudomonas aeruginosa was inhibited by piperacillin/tazobactam in 89%, by cefepime in 87% and by ceftazidime in 85%. Imipenem, meropenem and cefpirome were less active (79%, 75% and 69% respectively). All E. coli strains were inhibited by meropenem, 99% were inhibited by imipenem, cefepime and cefpirome. Ceftazidime was active against 95% and piperacillin/tazobactam against 92% of E. coli. All Klebsiella spp. were inhibited by meropenem, cefepime and cefpirome. Imipenem inhibited 99% and ceftazidime 98% of the Klebsiella isolates. Piperacillin/tazobactam was active against 95% of Klebsiella spp. In vitro carbapenems are still the most active of all antibiotics tested. The relatively high resistance of Pseudomonas spp. and Acinetobacter spp. to carbapenems reflects the wide use of carbapenems during the last years. However, most bacterial isolates are still sensitive to the tested broad spectrum beta-lactams.

Acinetobacter↗
PubMed1997

Vibrio cholerae non-O1 septicaemia in a patient with liver cirrhosis and Billroth-II-gastrectomy.

This report deals with the first diagnosed case of Vibrio cholerae non-O1 septicaemia in Austria. After a vacation in Tunisia, a 51-year-old male patient with liver cirrhosis and Billroth-II-gastrectomy was admitted to hospital because of abdominal pain, growing ascites, and jaundice. Four days later, the patient developed a single peak of high fever (39.6 degrees C). A blood culture was drawn and treatment with amoxycillin/clavulanic acid commenced. The blood culture yielded Gram-negative comma-like rods which were identified as V. cholerae non-O1.

Abdominal Pain↗
PubMed1997

[Community-acquired pneumonia--current status of pathogen diagnosis].

Procedures for the microbiological diagnosis of acute community-acquired pneumonia are based on the expected pathogens. Although a great variety of microorganisms are able to cause community-acquired pneumonia only a few pathogens play an important role in daily practice. The most important investigations are blood cultures and sputum cultures to detect bacteria like pneumococci, Haemophilus influenzae and Staphylococcus aureus as well as antibody tests for Mycoplasma pneumonia and Chlamydia pneumonia. According to anamnesis and clinic presentation tests such as for Legionella or viruses have to be added. Sometimes also rare pathogens have to be considered such as Coxiella burnetii, Leptospira, Hantaviruses, cryptococci or Chlamydia psittaci. The standard procedure for diagnosis of tuberculosis is the microscopical examination and the standardized culture in liquid and on solid media. Amplification methods such as PCR are also useful for a rapid diagnosis. However, the application of amplification procedures alone without culture is not recommended.

Bacteriological Techniques↗
PubMed1996

Antibiotic susceptibility of pneumococci isolated in Austria over a four-year period.

The antibiotic susceptibility of pneumococci isolated from clinical specimens from 1991 through 1994 was investigated. Of 305 strains tested by the agar dilution method, 16 (5.2%) were resistant to penicillin (MICs > or = 0.12 mg/l). Of the resistant strains, 0.3% showed high-level resistance (MIC > or = 2 mg/l). The rate of resistance to erythromycin (MIC > or = 4 mg/l) was 2.3%, to tetracycline (MIC > or = 8 mg/l) 8.5%, to chloramphenicol (MIC > or = 8 mg/l) 1.0%, and to trimethoprim sulfamethoxazole (MIC > or = 3.2/64 mg/l) 3.3%. Penicillin-resistant strains showed significantly higher resistance to the other antibiotics tested. Resistance to penicillin was higher in isolates from the respiratory tract than in those from blood and cerebrospinal fluid (6.2% vs. 2.4%, respectively). There was no increase in penicillin resistance from 1991 through 1994 (5.3% vs. 4.9%, respectively).

Anti-Bacterial Agents↗
PubMed1994

Prevalence of fluoroquinolone resistance in Europe. Study Group 'Bacterial Resistance' of the Paul-Ehrlich-Society for Chemotherapy e. V.

Since 1984, when the first fluoroquinolone, norfloxacin, was marketed in Europe, there has been a marked increase in the usage of this class of drugs. In order to evaluate the influence of this drug usage on the prevalence of resistance to fluoroquinolones in clinical isolates of the family Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus aureus, coagulase-negative staphylococci and Enterococcus faecalis we reviewed the susceptibility data from four collaborative surveys conducted between 1983 and 1990 by the Study Group 'Bacterial Resistance' of the Paul-Ehrlich-Society for Chemotherapy. All participating laboratories used the same standardized methods. Minimal inhibitory concentrations were determined by the broth microdilution method. More than 20,000 bacterial strains were tested. The results are presented for ciprofloxacin, which is regarded as the representative of the fluoroquinolones. Using > or = 4 mg/l as a breakpoint for resistance to ciprofloxacin, the prevalence of resistant strains of the family Enterobacteriaceae in Central Europe between 1983 and 1990 remained below 1%. In contrast, the resistance rates in P. aeruginosa were 0.7%, 1.0%, 3.8% and 7.0%, in S. aureus 0%, 0.5%, 6.6% and 6.8%, and in E. faecalis 2.2%, 0.7%, 4.9% and 7.7% in 1983, 1986, 1989 and 1990, respectively. The latest study carried out in cooperation with 78 laboratories from 12 European countries revealed great differences in the prevalence of resistance to fluoroquinolones from one species to another ranging from 0% with Proteus vulgaris and Salmonella spp. to 26.7% with Providencia stuartii.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Infective Agents↗
PubMed1994

Yersinia enterocolitica septicemia in autologous blood transfusion.

BACKGROUND: Increasingly, autologous blood transfusions are used in elective surgical procedures to avoid the risk of infection due to allogeneic blood transfusion. CASE REPORT: A 64-year-old patient had to undergo the implantation of a total right hip endoprosthesis. During the transfusion of 1 unit of autologous packed red cells, the patient experienced high temperature and shock, which necessitated his observation in the intensive care unit for several days. Yersinia enterocolitica (type O:9) was isolated from the packed red cells, from the unit of fresh-frozen plasma separated from the same donation, and from one blood culture drawn from the patient. With appropriate therapy, the patient recovered without sequelae. CONCLUSION: Although autologous blood transfusions are safe with respect to transmission of human immunodeficiency virus or hepatitis B and C infections, the risk of bacterial septicemia remains.

Blood Transfusion, Autologous↗
PubMed1991

Educational programmes for infection control in Austria.

Educational aims and strategies (simply arousing awareness, sensitivity and understanding; and/or training in practical skills and knowledge; or the ability to teach infection control, and to convince those taught) depend on the target group. Infection control is part of the curriculum for students of medicine and other health care professions, and is included in course examinations. Postgraduate doctors may seek training on courses which are organized by the Hygiene Institute of the University of Vienna in co-operation with the Austrian Society of Hygiene, Microbiology and Preventive Medicine. Registered nurses may enroll in the Austrian Nurses' Association training scheme (6 weeks of theory with professional work for 2 years), leading to approval as Hygieneschwester/-pfleger. Postgraduate in-hospital education for all health-care professions occurs in many Austrian hospitals, with resources from Vienna and Linz. Hospital managements, health authorities and politicians are influenced via their own educational activities and via publications.

Austria↗
PubMed1990

Resistance of gram-negative bacilli and staphylococci from blood cultures to aminoglycoside antibiotics. Comparison of 3 in vitro investigations from Austria 1982-1988.

A total of 790 blood culture isolates was collected during 3 study periods in 1982/83, 1984/85 and 1987/88. Staphylococci were the most frequent bacteria in the first two periods (56.5% and 63%, respectively). During the last period, E. coli was the most frequent of all species (27%). Differences in the distribution of bacteria between the laboratories were considerable. In one laboratory in Vienna, coagulase-negative staphylococci dominated in all 3 study periods (32%, 33% and 47%). Susceptibility against gentamicin, tobramycin and netilmicin (MIC less than or equal to 4 mg/l), as well as against amikacin (MIC less than or equal to 8 mg/l) were determined by a microdilution method. The resistance rates against gentamicin (G) were 25%, 21% and 25%, against tobramycin (T) 27%, 19% and 25%, against netilmicin (N) 6%, 4% and 19%, and against amikacin (A), 5%, 2% and 19%. Most resistant strains were staphylococci (G 26%-41%, T 26%-46%, N 3%-31%, A 3%-36%), whereas gram-negative bacilli were more susceptible (G 12%-14%, T 7%-11%, N 7%-9%, A 1%-7.5%). The increase of resistance against netilmicin and amikacin in staphylococci was most striking. Nearly all those strain could be attributed to one laboratory in Vienna. Most of them were coagulase-negative staphylococci. In the first study period, the most frequent pattern was resistance against gentamicin and tobramycin, whereas in the last period resistance to all 4 aminoglycosides dominated. The study demonstrates considerable local differences in antibiotic resistance. Monitoring of antibiotic resistance in collaborative studies using standardized methods should be a valuable tool in planning strategies for controlling an epidemic spread of resistance.

Amikacin↗
PubMed1989

[Diarrhea induced by antibiotics].

The most frequent cause of antibiotic-associated colitis is Clostridium difficile. This gram-positive, spore-forming anaerobic bacillus releases toxins, which produce diarrhea and damage the colonic mucosa. Endoscopy shows a wide range of alterations, "unspecific colitis" with reddening or edema, ulcerations or at the worst pseudomembranous colitis. Nearly all antibiotics are able to trigger Clostridium difficile colitis. An enhanced risk is exerted by broad spectrum substances, which act also on the anaerobic flora protecting the gastrointestinal tract from unphysiological colonization. Clusters of cases were observed in hospitalized patients. The patients risk factors coincide with the administration of antibiotics. Furthermore Clostridium difficile is likely to be spread as a nosocomial infection in many instances. Less often colitis is observed in connection with oral antibiotics outside the hospital. However, substantial underreporting of cases has to be considered. Clinical symptoms usually start 4 to 10 days after first administration of the antibiotic. Leading symptoms are frequent profuse watery stools. Abdominal cramps and tenderness as well as fever and leukocytosis are common. Intense symptoms can simulate serious conditions like perforation. Upon clinical suspicion the diagnosis is made by endoscopy, stool culture and possibly demonstration of toxin. The predictive value of the stool culture equals that of toxin detection. In adult patients there is a good correlation between positive stool culture and clinical presentation. Infants can carry Clostridium difficile as part of their normal flora, therefore positive stool culture or toxin detection in an infant cannot necessarily be linked to clinical symptoms. In some cases Clostridium difficile has to be regarded as etiologic organism also in infants.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1988

Antibacterial treatment of otitis and sinusitis with ciprofloxacin and penicillin V--a comparison.

80 adult outpatients suffering from otitis media, sinusitis (maxillaris or frontalis) or peritonsillitis were treated with 500 mg ciprofloxacin b.i.d. (n = 40) or with 2 g penicillin V t.i.d. (n = 40). The patients were randomly allocated. Three groups of patients resulted, clinically and bacteriologically evaluable, or only clinically evaluable because the isolated strains were resistant to ciprofloxacin or penicillin V or because no strains were isolated. Ciprofloxacin was superior to penicillin V; there were fewer resistant strains (one compared to 11), and the eradication rate (57% compared to 43%) as well as the clinical efficacy (60% compared to 48%) of ciprofloxacin were better than those of penicillin V--even in a daily dose of 6.0 g. Both treatments were well tolerated; side effects were neither reported nor found.

Adult↗