staphylococcal and enterococcal pathogens. The Tigecycline Evaluation Surveillance Trial (TEST) determined the in vitro activity against methicillin-resistant Staphylococcus. aureus (MRSA) and vancomycin-resistant Enterococcus spp (VRE) sources. Only one isolate per patient was accepted into the study. Clinical isolates were collected and tested between 2006 and 2010 from 132 Critical Care Units in the United States. Isolates were identified to the species Genus/Species/Phenotypea Phenotype Total N Staphylococcus aureus 789 S. aureus, MRSA 423 (54%) S. aureus, MSSA 366 (46%) MIC (μg/ml) Organism / Phenotype Drug %Susa %Res MIC50 MIC90 Range E. faecalis Tigecycline 99.0 1.0 0.12 0.25 0.015 0.5 (n=383) Ampicillin 100 0.0 1 2 0.12 8 of TIG and 9 antimicrobials commonly prescribed for serious gram-positive infections: amoxicillin-clavulanic acid (A/C), piperacillin-tazobactam (P/T), levofloxacin (LVX), ceftriaxone (CAX), minocycline (MIN), vancomycin (VAN), ampicillin (AMP), penicillin (PEN), and meropenem (MER). Methods: A level and tested at each site by the participating laboratory. Confirmation of MRSA/MSSA status was performed by the central laboratory (IHMA Inc., Schaumburg, IL). Minimum inhibitory concentrations (MICs) were Enterococcus faecalis 383 E. faecalis, VRE 18 (4.7%) Enterococcus faecium 233 Levofloxacin 62.7 37.1 1 >32 0.12 >32 Linezolid 100 0.0 1 2 ≤0.5 2 Minocycline 35.5 24.5 8 >8 ≤0.25 >8 Penicillin 100 0.0 2 4 0.25 8 Vancomycin 95.0 4.7 1 2 0.25 >32
Background: The increasing incidence of multi-drug resistant (MDR) Acinetobacter baumannii represents a major threat to hospitalized patients, especially those in intensive care units (ICUs). The Tigecycline Evaluation and Surveillance Trial (TEST) program has monitored the in vitro activity of tigecycline and comparators since 2004. The current study investigated the activity of tigecycline and comparators against A. baumannii resistant to three or more antibiotic classes isolated from intensive care units during 2004-2010. Methods: A total of 4,241 A. baumannii were isolated from ICUs, with 2,491 of these MDR. All isolates were identified to the species level by participating sites from 61 countries and confirmed by the central laboratory. Isolates came from medical, pediatric and surgical ICUs. Minimum inhibitory concentrations (MICs) were determined by the local laboratory using supplied broth microdilution panels and interpreted according to CLSI guidelines. Results: Susceptibilities of the 2,491 MDR isolates are shown below. Conclusions: 58.7% of A. baumannii from ICUs were MDR. Tigecycline demonstrated excellent in vitro activity against MDR A. baumannii, with the lowest MIC 50/90 values of 1/2 mcg/ml, followed by minocycline, levofloxacin, and imipenem.
Background: Tigecycline, a member of a new class of antimicrobials (glycylcyclines), has been shown to have potent broad spectrum activity against most commonly encountered species responsible for hospital acquired infections. Cross-resistance to several classes of antimicrobials is often seen in nosocomial pathogens. The T.E.S.T. program determined the in vitro activity of tigecycline against strains of Enterobacteriaceae cross-resistant to one or more of the following antimicrobials: amoxicillin-clavulanic acid, piperacillin-tazobactam, levofloxacin, ceftriaxone, cefepime, ampicillin, amikacin, minocycline, ceftazidime and imipenem. The isolates were collected from 335 investigational sties in 47 countries throughout 2004–2007. Methods: A total of 26,791 clinical Enterobacteriaceae were identified to the species level at each site and confirmed by the central laboratory. Minimum Inhibitory Concentrations (MICs) were determined by the local laboratory using broth microdilution panels. Antimicrobial resistance was interpreted according to CLSI breakpoints with TIG susceptible and resistant breakpoints defined as = 8 mcg/ml, respectively. Results: 1,387/16,289 (8.5%) E. coli and Klebsiella spp were ESBL producers. Of the Enterobacteriaceae presented, 13% were resistance to levofloxacin, 8% to minocycline, 1.1% to amikacin, 0.2% to imipenem, and 0.8% to tigecycline. Of the 10,348 Enterobacter spp. and S. marcescens collected, 593 (5.7%) presented resistance to ceftriaxone and ceftazidime but susceptible to cefepime suggestive of AmpC phenotype. Only 877 (3.3%) of the Enterobacteriaceae showed any degree of non-susceptibility against tigecycline with MICs ranging from 4 to 8 mcg/mL. Tigecycline also showed excellent inhibitory activity against members of Enterobacteriaceae that were resistant to amikacin, levofloxacin, minocycline and imipenem inhibiting 94%, 92%, 72% and 91% of isolates respectively. Conclusions: The presented data suggest that tigecycline is little affected by this cross-resistance phenomenon and may be an effective and reliable therapeutic option against nosocomial or community pathogens regardless to the resistance patterns.
The American Thoracic Society and the Infectious Diseases Society of America have developed evidence-based guidelines for the therapy of hospitalized patients with community-acquired pneumonia (CAP). In an attempt to evaluate if the care provided to hospitalized patients with CAP is in compliance with the care recommended by national guidelines, an international network of investigators has been collecting data from 40 hospitals in 13 countries. The care provided in the following areas of antibiotic therapy was analyzed: empiric antibiotic therapy, timing of initial antibiotic therapy, and switch from intravenous to oral antibiotic therapy. Lack of compliance with national guidelines was identified in all areas of antibiotic therapy. Compliance at the local level can be improved with the implementation of a hospital-based pneumonia quality improvement team. Improving compliance with national guidelines recommendations will produce a beneficial effect in CAP clinical and economic outcomes.
Two free fully online courses were offered by Peoples-uni on its Open Online Courses site, both as self-paced courses available any time and as courses run over four weeks with tutor-led discussions. We tested the hypothesis that there are no measurable differences in outcomes between the two delivery methods. Similar numbers attended both versions of each course; students came from multiple countries and backgrounds. Numbers of discussion forum posts were greater in tutor-led than self-paced courses. Measured outcomes of certificates of completion, quiz completion and marks gained were very similar and not statistically significantly different between the tutor-led and the self-paced versions of either course. In light of little discernible difference in outcome between self-paced learning compared with courses including tutor-led discussions, the utility of the time cost to tutors is in question. The findings may be relevant to others designing online courses, including MOOCs.
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