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Antibody quantification by EIA is possible without a standard curve. Following the so-called alpha method only one test dilution is used, the resulting absorbance is corrected and the IU/ml will be calculated by means of a mathematical formula. This new kind of a single point measurement was evaluated in seven independent laboratories by comparison with commercial EIAs using a standard curve or a titer calibration line. For the quantification of IgG against rubella virus this study comprised 1,480 individual samples and three comparison EIAs. For IgG againstToxoplasma gondii a total of 743 samples was evaluated in two comparison tests. The results obtained by the alpha method show a precision and accuracy more than sufficient for routine testings. Also the technical expenses and reagent costs were reduced. Prerequisites and limitations are discussed against the background of the problem of immune status definition.

Although Klebsiella aerogenes (formerly Enterobacter aerogenes) and Enterobacter cloacae share many phenotypic characteristics, controversy exists as to whether they cause clinically distinguishable infections. The objective of this study was to determine the comparative incidence, determinants, and outcomes of K. aerogenes and E. cloacae bloodstream infections (BSI). Population-based surveillance was conducted among residents aged ≥ 15 years of Queensland, Australia during 2000–2019. Overall 695 and 2879 incident K. aerogenes and E. cloacae BSIs were identified for incidence rates of 1.1 and 4.4 per 100,000 population, respectively. There was a marked increase in incidence associated with older age and with males with both species. Patients with K. aerogenes BSIs were older, were more likely male, to have community-associated disease, and to have a genitourinary source of infection. In contrast, E. cloacae were more likely to have co-morbid diagnoses of liver disease and malignancy and be associated with antimicrobial resistance. Enterobacter cloacae were significantly more likely to have repeat episodes of BSI as compared to K. aerogenes. However, no differences in length of stay or all cause 30-day case-fatality were observed. Although significant demographic and clinical differences exist between K. aerogenes and E. cloacae BSI, they share similar outcomes.

Recommended regimens for pregnant women with HIV-1 are composed of two nucleoside reverse transcriptase inhibitors (NRTI) plus either a ritonavir-boosted protease inhibitor (PI) or an integrase strand transfer inhibitor (ISTI), with non-nucleoside reverse transcriptase inhibitors (NNRTI) representing an alternative drug class. The study’s purpose was to compare these three options in terms of pregnancy outcomes. Data from a national observational study of pregnant women with HIV-1 were used. The analysis included all pregnancies reported between 2008 and 2018, ending in live births and exposed within 32 weeks of gestation to three-drug regimens composed of a NRTI backbone plus a PI, a NNRTI or a ISTI, without class switching during pregnancy. Clinical and laboratory outcomes were evaluated in univariate and multivariable analyses. Overall, 794 exposed pregnancies were analyzed (PI 78.4%, NNRTI 15.4%, ISTI 6.2%). Almost all outcomes had similar rates in the three groups. Women who received PI in pregnancy were less likely to be virologically suppressed at third trimester. PI use was associated with higher bilirubin and triglyceride levels, and ISTI use with a lower rate of low birthweight. The differences in viral suppression at third trimester and in low birthweight were not maintained in multivariable analyses that were adjusted for confounders. We found no major differences in a wide range of outcomes relevant for pregnant women with HIV. Such results are reassuring, and this information may be helpful in a context of preconception counseling when therapeutic choices for pregnancy are discussed between women and care providers.

The handling of human remains may pose a risk for transmission of highly infectious agents. The use of appropriate biosafety measures is very important in case of management of patients deceased from highly infectious diseases (HIDs), such as Ebola virus disease. This paper presents the capabilities and resources in this field in 16 European countries, and suggests indications for the safe post-mortem management of HID patients. The European Network for Highly Infectious Diseases conducted in 2009 a survey in 48 isolation facilities in 16 European countries. A set of standardized checklists, filled during on-site visits, have been used for data collection. Thirty-nine facilities (81.2 %) reported to have written procedures for the management of human remains, and 27 (56.2 %) for the performance of autopsies in HID patients. A Biosafety Level 3 autopsy room was available in eight (16.6 %) facilities, other technical devices for safe autopsies were available in nine (18.7 %). Overall, four facilities (8.3 %) reported to have all features explored for the safe management of human remains. Conversely, in five (10.4 %) none of these features were available. The level of preparedness of surveyed isolation facilities in the field of post-mortem management in case of HIDs was not satisfactory, and improvements are needed.

In patients, cefotaxime concentrations in skin were evaluated after injection of 2 g i. v. The high values found form a basis for the treatment of dermatological infections with cefotaxime sensitive bacteria.

Die international übliche Bezeichnung Septikämie bezeichnet Erkrankungen, bei denen pathogene Mikroorganismen in das Blut gelangen, besser als der herkömmliche Begriff Sepsis. Septikämien sollten nach den Erregern, der Eintrittspforte und der Grundkrankheit definiert werden. In den letzten 16 Jahren wurden in unserer Klinik als Erreger von 788 Septikämien in 38,1% grampositive Kokken, in 37,6% gramnegative Stäbchen und in 24,2% sonstige Erreger nachgewiesen. Dabei sind in den letzten Jahren insbesondere Pseudomonas-Infektionen häufiger geworden. Das Erregerspektrum septikämischer Infektionen ist bei den einzelnen klinischen Konstellationen stark unterschiedlich. So erkrankten Patienten mit einer myeloischen Insuffizienz in erster Linie an einer Gramnegativen-Sepsis. Die Erreger einer Endokarditis sind nach wie vor in erster Linie Streptokokken. Bei einer Hämodialyse sind Staphylokokken und grammnegative Stäbchen in gleicher Häufigkeit zu finden. Die wichtigste klinische Manifestation einer Septikämie ist Fieber mit Schüttelfrösten. Die schlechte Prognose bei Gramnegativen-Sepsis ist in erster Linie durch das Auftreten eines septischen Schocks bedingt. Bei septikämischen Infektionen bestehen häufig klinisch typische und manchmal auch diagnostisch hinweisgebende Hautabsiedlungen. Hämorrhagische Pusteln mit gerötetem Hof sind typisch für eine Meningokokken- oder Gonokokken-Sepsis. Hautherde bei einer Streptokokken- oder Staphylokken-Sepsis sind selten. Während Hautherde bei einer Sepsis durch Enterobakterien fehlen, sind sie recht häufig bei Pseudomonas-Sepsis. Ein breites Spektrum von Hautsymptomen kann bei bakterieller Endokarditis auftreten.

The traditional study of antibiotic activity in vitro obviously cannot incorporate all host factors that may increase or decrease the activity, which may be bacteriostatic and/or bactericidal. Some specific host factors which canincrease the activity of antibiotics, thus producing host-antibiotic synergy, are: 1) biotransformation of the administered antibiotic to a more active molecule, 2) pH of the infected focus, 3) elevated temperature of the host, 4) effect of heat labile serum factors on bacteria exposed to antibiotics, 5) effect of local tissue factors on antibacterial activity, and 6) effect of phagocytic cell son bacteria exposed to antibiotics. A seventh host factor, which increases the practical antibiotic effect, but not its actual activity, is concentrating mechanisms which are most conspicuous in the kidney and the liver. Conversely, host factors which maydecrease the activity of antibiotics in vivo are: 1) biotransformation (metabolism) of the antibiotic to less active forms, 2) pH of the infected focus, 3) binding to albumin or other serum or tissue components, 4) antagonism by local tissue components other than pH (e. g., bile, cations, osmolarity), 5) anaerobic conditions (low Eh), 6) nutritional factors on bacterial metabolism, 7) foreign body effect, and 8) barriers to drug entry into precise locus where bacteria dwell (e. g. abscess cavity, cerebrospinal fluid, intracellular location). These barriers do not change the actual activity of antibiotics — only their practical effects, by excluding them and thus lowering their concentrations. The same is true of a ninth factor, physiological mechanisms which remove antibiotic from systemic compartments, as in secretion of antibiotic by liver and kidney.

A 19-year-old patient was 27 weeks pregnant when admitted to hospital with fever, chills and premature labours. The following day she aborted.Campylobacter coli was isolated from blood cultures, maternal placenta and amniotic fluid and from the ear, nose and pharynx of the stillbirth. Campylobacter could not be isolated from stool specimens after antimicrobial treatment had been started.