Volume 35, Issue 4

This report outlines the German strategy to fight antimicrobial resistance consisting of ten objectives: strengthening of surveillance systems on antibiotic resistance and antibiotic consumption, systematic feedback of data on antibiotic resistance and antibiotic consumption, promoting the use of guidelines to ensure the diagnosis, promotion of training, further education and training of health professionals, pharmacists, and natural scientists, national and international cooperation, promotion of assessment measures in human medicine, promotion of knowledge transfer in the field of antibiotic resistance, as well as networking and strengthening of science in the field of antibiotic resistance. The proposed draft legislation and questions concerning sustainable maintenance of good laboratory practice and the corresponding means are addressed.

This report outlines the German strategy to fight antimicrobial resistance consisting of ten objectives: strengthening of surveillance systems on antibiotic resistance and antibiotic consumption, systematic feedback of data on antibiotic resistance and antibiotic consumption, promoting the use of guidelines to ensure the diagnosis, promotion of training, further education and training of health professionals, pharmacists, and natural scientists, national and international cooperation, promotion of assessment measures in human medicine, promotion of knowledge transfer in the field of antibiotic resistance, as well as networking and strengthening of science in the field of antibiotic resistance. The proposed draft legislation and questions concerning sustainable maintenance of good laboratory practice and the corresponding means are addressed.

Very recently a novel method for differentiation of bacteria and fungi has been developed, that is, identification by means of matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS). This differentiation relies on the exact measurement of species-specific protein spectra of ribosomal proteins. It is at least as accurate as conventional biochemical differentiation methods, but provides results within minutes. In addition to differentiation of bacteria and yeasts grown on agar plates, direct identification is feasible from positive blood cultures as well as from urine samples of patients suffering from urinary tract infections. Future developments of MALDI-TOF MS for clinical microbiological purposes include the detection of β-lactamase and carbapenemase activity as well as genotyping of bacteria below the species level.

Very recently a novel method for differentiation of bacteria and fungi was developed, that is, identification by means of matrix-assisted laser desorption/ionisation-time of flight mass spectrometry (MALDI-TOF MS). This differentiation relies on the exact measurement of species-specific protein spectra of ribosomal proteins. It is at least as accurate as conventional biochemical differentiation methods, but provides results within minutes. In addition to differentiation of bacteria and yeasts grown on agar plates, direct identification is feasible from positive blood cultures as well as from urine samples of patients suffering from urinary tract infections. Future developments of MALDI-TOF MS for clinical microbiological purposes include the detection of β-lactamase and carbapenemase activity as well as genotyping of bacteria below the species level.

Standardisation and Interpretation of Results Obtained in the Virologic Diagnostic Service. The laboratory diagnosis of an infectious disease is based on the detection of the infectious agent or on the analysis of the specific immunoreaction in terms of clinical plausibility. Virus isolation procedures using cell cultures are difficult to quantify and to standardize. Similar restrictions are seen in traditional fluid-phase antibody assays determining residual infectivity (neutralisation test) or using biologic test signals (e.g., complement-fixation/CFT, haem-agglutination/HI). Modern serologic and molecular biologic assays result in physicochemical test signals which are easily to quantitate and which can be better controlled by external proficiency tests. Infections and immunoreactions are dynamic processes and have to be logarithmicly quantitated in test evaluations. Because of biologic reasons, standard values of virus diagnostic investigations can only defined with some restriction. The results need more or less individual interpretation.

Vitamin D has historically been known to play a significant role in the regulation of mineral and bone metabolism. It is, however, increasingly recognized that vitamin D deficiency may also be relevant to various extraskeletal diseases. This may be of clinical significance when considering that the majority of the general population has 25-hydroxyvitamin D (25[OH]D) levels below the target concentration of at least 30 ng/mL (75 nmol/L). In this review, we briefly summarize available data on the association of vitamin D with cancer, cardiovascular, renal, and autoimmune diseases and we discuss further emerging fields of vitamin D research. Finally, we give some practical guidance for vitamin D treatment. In summary, the available evidence is still insufficient for general compelling recommendations for vitamin D treatment of extraskeletal diseases. However, in our opinion the high prevalence of vitamin D deficiency, the gradually accumulating knowledge on multiple health benefits of vitamin D, and the safety of vitamin D supplementation suggest that public health strategies should aim to improve the vitamin D status in the general population. Zusammenfassung Vitamin D ist historisch gesehen für seine Rolle in der Regulation des Mineral- und Knochenstoffwechsels bekannt. Es wird jedoch zunehmend erkannt, dass ein Mangel an Vitamin D auch von Relevanz für extraskelettale Erkrankungen ist. Das könnte von klinischer Bedeutung sein, wenn man bedenkt, dass der Großteil der Allgemeinbevölkerung 25-hydroxyvitamin D (25[OH]D)-Konzentrationen unter dem Zielwert von zumindest 30 ng/mL (75 nmol/L) hat. In diesem Übersichtsartikel fassen wir kurz die bekannten Zusammenhänge von Vitamin D mit Krebs, kardiovaskulären und renalen Erkrankungen sowie Autoimmunerkrankungen zusammen und wir diskutieren neu aufkommende Gebiete der Vitamin D-Forschung. Schließlich geben wir auch praktische Ratschläge für die Vitamin D-Behandlung. Zusammenfassend ist die derzeitige Evidenzlage zwar noch unzureichend für generelle und zwingende Empfehlungen zur Vitamin D-Behandlung von extraskelettalen Erkrankungen. Wir sind jedoch davon überzeugt, dass die hohe Prävalenz des Vitamin D-Mangels, die allmählich zunehmenden Erkenntnisse über multiple gesundheitsfördernde Effekte von Vitamin D und die Sicherheit einer Vitamin D-Behandlung daraufhin deuten, Public-Health-Strategien darauf auszurichten, den Vitamin D-Status in der Allgemeinbevölkerung zu verbessern.