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Aim: Treatment of bacterial soft tissue infections is an essential part of clinical dermatology, and the choice of antibiotic therapy is often empirical. The aim of this longitudinal retrospective study was to evaluate bacterial epidemiology, resistance patterns and antibiotic consumption in a dermatological inpatient ward. Method: Bacterial isolates and antimicrobial susceptibility testing from a dermatological inpatient ward were recorded retrospectively from 2011 to 2016. The antibiotic consumption was evaluated and given as the assumed defined daily dose [DDD] per 100 days of covering per year. Results: A total of 4,800 bacterial isolates were included (skin, mucous membrane and wounds 87%, urine 9.5%, blood 1.7%, tissue and tissue fluids 1.6%). The proportion of Gram-positive bacteria was 58% (Staphylococcus aureus 37.8%, coagulase-negative staphylococci 21.5%, Enterococcus spp. 16.7%). Pseudomonas aeruginosa (27.2%), Escherichia coli (17.5%) and Proteus spp. (13.1%) were the most common Gram-negative bacteria. The proportion of multi-resistant pathogens was 5.8% for methicillin-resistant S. aureus, 0.9%, 0.8% and 1.8% for multi-resistant P. aeruginosa, ESBL-producing E. coli and ESBL-producing Klebsiella pneumoniae of all isolates. Beta-lactam antibiotics were the most used drugs (14.4, 10.8, and 9.6 DDD/100 for aminopenicillins, cefalexin, and penicillin G), followed by clindamycin (9.0 DDD/100 patient days). Conclusion: In view of the frequency of bacterial soft tissue infections and their need for inpatient treatment with mostly empirically chosen antibiotics, systematic microbiological surveillance should be recommended for dermatological inpatient wards., Zielsetzung: Die Behandlung bakterieller Weichteilinfektionen ist ein wesentlicher Bestandteil der klinischen Dermatologie und die Wahl der antibiotischen Therapie erfolgt oft empirisch. Ziel dieser longitudinalen retrospektiven Studie war die Evaluierung der bakteriellen Epidemiologie, des Resistenzverhaltens und des Antibiotikaverbrauchs auf einer dermatologischen Bettenstation. Methode: Bakterienisolate und Resistogramme einer dermatologischen Bettenstation wurden im Zeitraum von 2011 bis 2016 retrospektiv erfasst. Der Antibiotikaverbrauch wurde ermittelt und als angenommene mittlere Tagesdosis [DDD] pro 100 Belagstage pro Jahr angegeben. Ergebnisse: Insgesamt wurden 4.800 Bakterienisolate gewonnen (Haut, Schleimhaut und Wunden 87%, Urin 9,5%, Blut 1,7%, Gewebe und Gewebsflüssigkeiten 1,6%). Der Anteil Gram-positiver Bakterien betrug 58% (Staphylococcus aureus 37,8%, Koagulase-negative Staphylokokken 21,5%, Enterococcus spp. 16,7%). Pseudomonas aeruginosa (27,2%), Escherichia coli (17,5%) und Proteus spp. (13,1%) waren die häufigsten Gram-negativen Bakterien. Der Anteil multiresistenter Erreger lag für Methicillin-resistenten S. aureus bei 5,8%, für multiresistentenP. aeruginosa, ESBL-bildendeE. coli und ESBL-bildendeKlebsiella pneumoniae bei 0,9%, 0,8% und 1,8% aller Isolate. Betalaktamantibiotika waren die häufigsten verwendeten Medikamente (14,4, 10,8 und 9,6 DDD/100 bei Aminopenicillinen, Cefalexin und Penicillin G), gefolgt von Clindamycin 9,0 DDD/100 Belegungstage. Schlussfolgerung: In Anbetracht der Häufigkeit bakterieller Weichteilinfektionen und ihres Bedarfs für stationäre Behandlung bei meist empirischer Antibiotikaauswahl sollte auch für dermatologische Bettenstationen eine systematische mikrobiologische Überwachung empfohlen werden.

Microbial communities have an important role in health and disease. Candida spp. are ubiquitous commensals and sometimes opportunistic fungal pathogens of humans, colonizing mucosal surfaces of the genital, urinary, respiratory and gastrointestinal tracts and the oral cavity. They mainly cause local mucosal infections in immune competent individuals. However, in the case of an ineffective immune defense, Candida infections may become a serious threat. Lactobacillus spp. are part of the human microbiome and are natural competitors of Candida in the vaginal environment. Lactic acid, low pH and other secreted metabolites are environmental signals sensed by fungal species present in the microbiome. This review briefly discusses the ternary interaction between host, Lactobacillus species and Candida with regard to fungal infections and the potential antifungal and fungistatic effect of Lactobacillus species. Our understanding of these interactions is incomplete due to the variability of the involved species and isolates and the complexity of the human host.

Intensive care units (ICUs) are critical locations for the transmission of pathogenic and opportunistic microorganisms. Bacteria may develop a synergistic relationship with bacteriophages and more effectively resist various stresses, enabling them to persist despite disinfection and antimicrobial treatment. We collected 77 environmental samples from the surroundings of 12 patients with infection/colonizations by Escherichia coli, Staphylococcus aureus or Klebsiella spp in an ICU in Austria. Surface swabs were tested for lytic phages and bacterial isolates for mitomycin C-inducible prophages. No lytic bacteriophages were detected, but S. aureus was isolated from the surroundings of all patients. About 85% of the colonies isolated from surface samples were resistant to antimicrobials, with 94% of them multidrug resistant. Two inducible temperate bacteriophages&mdash, myovirus vB_EcoM_P5 and siphovirus vB_SauS_P9&mdash, were recovered from two clinical isolates. Staphylococci phage vB_SauS_P9 lysed S. aureus isolates from the surface swabs collected from the surroundings of three patients. No transductants were obtained on propagation in phage-sensitive antimicrobial-resistant isolates. The two phages were sensitive to 0.25% (v/v) of the disinfectant TPH Protect, which eliminated viable phages after 15 min. Coliphage vB_EcoM_P5 was inactivated at 70 &deg, C and staphylococci phage vB_SauS_P9 at 60 &deg, C after 60 min.

The interaction between bacteriophages, bacteria and the human host as a tripartite system has recently captured attention. The taxonomic diversity of bacteriophages, as a natural parasite of bacteria, still remains obscure in human body biomes, representing a so-called “viral dark matter.” Here, we isolated and characterized coliphages from blood, urine and tracheal aspirates samples collected at a tertiary care hospital in Austria. Phages were more often isolated from blood, followed by urine and tracheal aspirates. Phylogenetic analysis and genome comparisons allowed the identification of phages belonging to the Tunavirinae subfamily, and to the Peduovirus and Tequintavirus genera. Tunavirinae phages cluster together and are found in samples from 14 patients, suggesting their prevalence across a variety of human samples. When compared with other phage genomes, the highest similarity level was at 87.69% average nucleotide identity (ANI), which suggests that these are in fact a newly isolated phage species. Tequintavirus phages share a 95.90% with phage 3_29, challenging the ANI threshold currently accepted to differentiate phage species. The isolated phages appear to be virulent, with the exception of the Peduovirus members, which are integrative and seem to reside as prophages in bacterial genomes.

The results of blood cultures and clinical data of 101 neonates with 110 episodes of septicaemia during a 7-y study period were reviewed. The overall incidence of culture-proven sepsis within the study period was 6.0 per 100 neonatal intensive care unit admissions and the mortality rate was 14%. Three groups of pathogens accounted for 70% of all isolates: coagulase-negative staphylococci (27%), aerobic Gram-negative rods (24%) and Enterococcus faecalis (19%). Group B streptococcus was the major pathogen of very early-onset septicaemia (within 24 h of birth), whereas late-onset infections were most commonly caused by coagulase-negative staphylococci. Birthweight

The aim of this study was to analyze the current practice of Ophthalmia neonatorum prophylaxis in Austria. Questionnaires were sent to 107 hospitals with obstetric units, as well as to 490 registered community midwives, together looking after a yearly total of approximately 70,000 births. The overall return of the hospitals and midwives was 91.6% and 7.6%, respectively.Ophthalmia neonatorum prophylaxis is being applied by 93.8% of all respondents (hospitals 96.9%, and community midwives 82.3%). The three most frequently applied substances were Erythromycin (41.8%), Gentamicin (21.3%) and Silver nitrate (19.7%). Other substances were Tetracycline, Povidone-Iodine, Neomycin and Chloramphenicol. The reported overall-observation of chemical conjunctivitis after application of a prophylactic agent was 42.3% (55/133), typically after the use of Silver nitrate, Erythromycin or Tetracycline. The agent was determined by pediatricians (29%), in accordance to governmental decree (15%), by hospital policy (12%), effectiveness against Chlamydia and Gonococci (9%), by pharmacists (3%) and ophthalmologists (3%). 18% did not give any reason for the choice of agent.The rationale for prophylaxis and the substances used in Austria show heterogeneity. Seven prophylactic agents are used, two antiseptics and five antibiotics. 25% of the routine applicants are using substances (Gentamicin, Neomycin or Chloramphenicol) for which no evidence based efficacy for prophylaxis of Ophthalmia neonatorum has been demonstrated through clinical trials. However, 83.5% of the maternity units do not want changes in their current routine, unless there is a nation-wide agreement for Ophthalmia neonatorum prophylaxis.

Objectives:To investigate and describe an outbreak ofSerratia marcescensin a neonatal intensive care unit (NICU) and to report the interventions leading to cessation of the outbreak.Setting:A 2,168-bed, tertiary-care, university teaching hospital in Vienna, Austria, with an 8-bed NICU.Design:We conducted a case–control study to identify risk factors for colonization and infection withS. marcescens. A case-patient was defined as any neonate in the NICU with a positive culture forS. marcescensbetween October 1, 2000, and February 28, 2001. Polymerase chain reaction was applied to type isolates.Methods:During unannounced observations, the NICU was examined and existing policies were reviewed. Staff were reinstructed in hand antisepsis and gloving policies. Admissions were halted on December 27. During previously planned technical maintenance of the ward, the NICU was closed for 10 days and thorough aldehyde-based disinfection of the NICU was performed.Results:Ten neonates met the case definition: 6 with infections (among them 3 with cerebral abscesses) and 4 with asymptomatic colonization. Previous antibiotic treatment of the mothers with cefuroxime was the single significant risk factor for colonization or infection (P= .028; odds ratio, 17; 95% confidence interval, 1.3 to 489.5).Conclusions:S. marcescenscan cause rapidly spreading outbreaks associated with fatal infections in NICUs. With aggressive infection control measures, such outbreaks can be stopped at an early stage. Affected neonates themselves may well be the source of cross-infection to other patients on the ward. Antibiotic treatment of mothers should be reevaluated to avoid unnecessary exposure to antibiotics with the potential of overgrowth of resistant organisms.

Recently, contamination of sensor-operated faucets (SOFs) withPseudomonas aeruginosawas observed. To evaluate odds ratios, we conducted a case–control study in which handle-operated faucets served as controls. No statistically significant difference inP. aeruginosacounts was observed between SOFs and regular faucets in our study (odds ratio, 0.0; 95% confidence interval, 0.0 to 39.0; two-sidedPexact = .99).

In an illustrative sequence of exercises, we teach our students how to don, use, and take off sterile gloves correctly and how to wash hands properly. During this sequence, the effect of a good handwashing technique as well as the effect of failures in aseptic technique with gloves is made directly visible by the use of finger paints. This technique helps medical staff to visualize microbial contamination of the hands and to increase the awareness of breaks in aseptic technique.