SUMMARYA time-series analysis was performed to identify the impact of bed occupancy rates and length of hospital stay on the incidence ofClostridium difficileinfections (CDI). Between January 2003 and July 2008, a mean incidence of 0·5 CDI cases/1000 patient days was recorded. Application of a multivariate model (R2=0·50) showed that bed occupancy rates on general wards (P<0·01) and length of stay in intensive care units (ICUs) (P<0·01) influenced the incidence of CDI. Overcrowding on general wards and long periods in ICUs were identified as being positively associated with the incidence of CDI.

To compare the efficacy of two commercially available, alcohol-based antiseptic solutions for preparation and care of central venous catheter (CVC) insertion sites, with and without octenidine dihydrochloride, a double-blind, randomized, controlled trial was undertaken in the haematology units and in one surgical unit of two university hospitals. Adult patients with a non-tunnelled CVC were randomly assigned to two different skin disinfection regimens at the insertion site: 0.1% octenidine with 30% 1-propanol and 45% 2-propanol, and as control 74% ethanol with 10% 2-propanol. Endpoints were (i) skin colonization at the insertion site; (ii) positive culture from the catheter tip (> or = 15 CFU); and (iii) occurrence of CVC-associated bloodstream infection (defined according to criteria set by the CDC). Four hundred patients with inserted CVC were enrolled from May 2002 through April 2005. Both groups were similar in respect of patient characteristics and co-morbidities. Skin colonization at the CVC insertion site during the first 10 days was significantly reduced by octenidine treatment (relative difference octenidine vs. control: 0.21; 95%CI: 0.11-0.39, p <0.0001). Positive culture of the catheter tip was significantly less frequent in the octenidine group (7.9%) than in the control group (17.8%): OR = 0.39 (95%CI: 0.20-0.80, p 0.009). Patients treated with octenidine had a non-significant reduction in catheter-associated bloodstream infections (4.1% vs. 8.3%; OR = 0.44; 95%CI: 0.18-1.08, p 0.081). Side effects were similar in both groups. This randomized controlled trial supports the results of two observational studies demonstrating octenidine in alcoholic solution to be a better option than alcohol alone for the prevention of CVC-associated infections.

Das Problem der Behandlung der sensomotorischen diabetischen Neuropathie ist ungelöst. Die Wirksamkeit einer antihyperglykämischen Behandlung konnte bis jetzt nur für Typ-1-Diabetes-Patienten, nicht aber für Typ-2-Diabetes-Patienten bewiesen werden. Versuche während der letzten 30 Jahre, durch Substanzen, die in mögliche Pathomechanismen eingreifen, die manifesten Nervenschädigungen zu behandeln, waren nicht erfolgreich. In der Prophylaxe wurden neue Substanzen noch nicht untersucht. Mögliche Erklärungen für diese fehlenden Erfolge werden diskutiert. Erfolgreicher war die Entwicklung von Substanzen, die der Behandlung neuropathischer Schmerzen dienen, sodass zurzeit bei 4 Substanzgruppen (Antidepressiva, Antikonvulsiva, Antioxidanzien, Opioide) die Wirksamkeit erwiesen ist. Die Indikationsstellung erfordert die Kenntnis nicht nur der Leitlinien und des Zulassungsstatus in Deutschland, sondern auch des Krankheitszustandes des einzelnen Patienten und der Eigenschaften des verwendeten Präparates. Auch hier besteht noch Bedarf an neuen Substanzen, die dem Ideal einer Schmerzbehandlung näher kommen.

Drug Prescribing for Patients with Chronic Kidney Disease in General Practice: a Cross-Sectional Study

Die diabetische Polyneuropathie ist eine häufige Komplikation des Diabetes mellitus, die sowohl die Lebensqualität der Patienten erheblich beeinflusst als auch als Wegbereiter weiterer Komplikationen, z. B. des diabetischen Fußsyndroms, eine enorme Rolle spielt. Zurzeit ist die einzige zur Verfügung stehende kausale Therapie die Verbesserung der Stoffwechseleinstellung, die in der Prophylaxe deutlich wirksamer zu sein scheint als in der Behandlung bereits vorhandener Schädigungen. Die zum größten Teil aus Tierversuchen abgeleiteten hypothetischen Pathomechanismen haben zu einer Vielzahl medikamentöser Therapieversuche geführt. Keine der bislang überprüften Substanzen hat Eingang in die tägliche Behandlung der Diabetiker gefunden. Für die Schmerzbehandlung existieren allerdings durch Metaanalysen abgesicherte Therapieempfehlungen, mit denen der Mehrzahl der Diabetiker geholfen werden kann. Besonders in diesem Bereich haben in den letzten Jahren mehrere neue Medikamente zu einer Verbreiterung des therapeutischen Spektrums geführt.

Journal für Klinische Endokrinologie und Stoffwechsel Austrian Journal of Clinical Endocrinology and Metabolism 2017; 10 (Sonderheft

Lipoprotein lipase (LPL) is the major enzyme responsible for the hydrolysis of triglyceride-rich lipoproteins in plasma. The purpose of this study was to examine the molecular pathogenesis of type I hyperlipoproteinemia in a patient suffering from recurrent severe pancreatitis. Apolipoprotein (apo) CII concentration was normal as well as apo CII-activated LPL in an in vitro assay. In postheparin plasma neither LPL mass nor activity was detectable, whereas hepatic lipase activity was normal. Direct sequencing of all 10 exons of the LPL gene revealed that the patient was homozygous for a hitherto unknown mutation in exon 6, Cys(239)-->Trp. The mutation prevents the formation of the second disulfide bridge of LPL, which is an essential part of the lid covering the catalytic center. Consequently, misfolded LPL is rapidly degraded within the cells, causing the absence of LPL immunoreactive protein in the plasma of this patient. In conclusion, we have identified a novel loss of function mutation in the LPL gene (Cys(239)-->Trp) of a patient with type I hyperlipoproteinemia suffering from severe recurrent pancreatitis. After initiation of heparin therapy (10,000 U/day sc), the patient experienced no more episodes of pancreatitis, although heparin therapy did not affect serum triglyceride levels.

OBJECTIVE:To investigate the role of ultrasound in the diagnosis of osteomyelitis in the diabetic foot compared with magnetic resonance imaging (MRI), bone scintigraphy (BS), and plain film radiography (PFR).RESEARCH DESIGN AND METHODS:We investigated 19 consecutive diabetic patients (2 women, 17 men, age 60.7 +/- 9.8 years, BMI 27.0 +/- 3.8 kg/m2) with clinical suspicion of bone infection of the foot. A high-resolution ultrasound system (Esaote/Biosound, Munich) with a linear array transducer up to 13.0 MHz was used. The prospective and blinded results of each method were compared with histopathology as the reference method after metatarsal resection.RESULTS:In 14 of 19 patients, histopathology confirmed osteomyelitis. Ultrasound showed a sensitivity of 79% (PFR, 69%; BS, 83%; MRI, 100%), a specificity of 80% (PFR, 80%; BS, 75%; MRI, 75%), a positive predictive value of 92% (PFR, 90%; BS, 91%; MRI, 93%), and a negative predictive value of 57% (PFR, 50%; BS, 60%; MRI, 100%).CONCLUSIONS:Our data indicate that ultrasound might have a better diagnostic power for detecting chronic osteomyelitis in the diabetic foot than PFR and has similar sensitivity and specificity as BS. MRI is superior to the other three methods. We conclude that the use of ultrasound in the management of the diabetic foot is worthy of further investigation.

Since with currently available technical equipment normoglycemic metabolic control cannot be attained in diabetic patients to prevent diabetic neuropathy, in addition to optimizing metabolic control, drugs will be necessary for prophylaxis and treatment of diabetic neuropathy to reduce compromising symptoms, to prevent debilitating late sequelae and to reduce the prognostic impact. Long-term treatment requires optimal risk-benefit-cost ratios of drugs used. For the practicing physician, it may be difficult to judge from the literature whether proposed treatments are in fact beneficial when used in general practice. The following points should be kept in mind when drawing conclusions from the literature: 1) homogeneity of the neuropathy under discussion, 2) severity of the neuropathy, 3) metabolic control, 4) sufficient numbers of probands, 5) sufficient duration of treatment, 6) definition of treatment goals and the impact of surrogate variables, 7) reproducibility of outcome measures, 8) definition of successful treatment, 9) time-dependent changes in both treatment and placebo groups, 10) adequate statistical evaluation, 11) numerical presentation of treatment results, 12) generalization of trial results, 13) tolerable side effects, and 14) publication bias.