TY - JOUR A1 - Betts, Jonathan A1 - Nagel, Christopher A1 - Schatzschneider, Ulrich A1 - Poole, Robert A1 - La Ragione, Robert M. T1 - Antimicrobial activity of carbon monoxide-releasing molecule [Mn(CO)\(_3\)(tpa-\(\kappa^{3}N\))]Br versus multidrug-resistant isolates of Avian Pathogenic \(Escherichia\) \(coli\) and its synergy with colistin JF - PLoS ONE N2 - Antimicrobial resistance is a growing global concern in human and veterinary medicine, with an ever-increasing void in the arsenal of clinicians. Novel classes of compounds including carbon monoxoide-releasing molecules (CORMs), for example the light-activated metal complex [Mn(CO)\(_3\)(tpa-\(\kappa^{3}N\))]Br, could be used as alternatives/to supplement traditional antibacterials. Avian pathogenic \(Escherichia\) \(coli\) (APEC) represent a large reservoir of antibiotic resistance and can cause serious clinical disease in poultry, with potential as zoonotic pathogens, due to shared serotypes and virulence factors with human pathogenic \(E.\) \(coli\). The \(in\) \(vitro\) activity of [Mn(CO)\(_3\)(tpa-\(\kappa^{3}N\))]Br against multidrug-resistant APECs was assessed via broth microtitre dilution assays and synergy testing with colistin performed using checkerboard and time-kill assays. \(In\) \(vivo\) antibacterial activity of [Mn(CO)\(_3\)(tpa-\(\kappa^{3}N\))]Br alone and in combination with colistin was determined using the \(Galleria\) \(mellonella\) wax moth larvae model. Animals were monitored for life/death, melanisation and bacterial numbers enumerated from larval haemolymph. \(In\) \(vitro\) testing produced relatively high [Mn(CO)\(_3\)(tpa-\(\kappa^{3}N\))]Br minimum inhibitory concentrations (MICs) of 1024 mg/L. However, its activity was significantly increased with the addition of colistin, bringing MICs down to \(\geq\)32 mg/L. This synergy was confirmed in time-kill assays. \(In\) \(vivo\) assays showed that the combination of [Mn(CO)\(_3\)(tpa-\(\kappa^{3}N\))]Br with colistin produced superior bacterial killing and significantly increased larval survival. In both \(in\) \(vitro\) and \(in\) \(vivo\) assays light activation was not required for antibacterial activity. This data supports further evaluation of [Mn(CO)\(_3\)(tpa-\(\kappa^{3}N\))]Br as a potential agent for treatment of systemic infections in humans and animals, when used with permeabilising agents such as colistin. KW - Chemistry KW - Larvae KW - Antibacterials KW - Antibiotics KW - Birds KW - Bacterial pathogens KW - Manganese KW - Antibiotic resistance KW - Antibacterial therapy Y1 - 2017 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-173687 VL - 12 IS - 10 ER - TY - JOUR A1 - Bohmann, Ferdinand O. A1 - Kurka, Natalia A1 - du Mesnil de Rochemont, Richard A1 - Gruber, Katharina A1 - Guenther, Joachim A1 - Rostek, Peter A1 - Rai, Heike A1 - Zickler, Philipp A1 - Ertl, Michael A1 - Berlis, Ansgar A1 - Poli, Sven A1 - Mengel, Annerose A1 - Ringleb, Peter A1 - Nagel, Simon A1 - Pfaff, Johannes A1 - Wollenweber, Frank A. A1 - Kellert, Lars A1 - Herzberg, Moriz A1 - Koehler, Luzie A1 - Haeusler, Karl Georg A1 - Alegiani, Anna A1 - Schubert, Charlotte A1 - Brekenfeld, Caspar A1 - Doppler, Christopher E. J. A1 - Onur, Oezguer A. A1 - Kabbasch, Christoph A1 - Manser, Tanja A1 - Pfeilschifter, Waltraud T1 - Simulation-based training of the rapid evaluation and management of acute stroke (STREAM) — a prospective single-arm multicenter trial JF - Frontiers in Neurology N2 - Introduction: Acute stroke care delivered by interdisciplinary teams is time-sensitive. Simulation-based team training is a promising tool to improve team performance in medical operations. It has the potential to improve process times, team communication, patient safety, and staff satisfaction. We aim to assess whether a multi-level approach consisting of a stringent workflow revision based on peer-to-peer review and 2–3 one-day in situ simulation trainings can improve acute stroke care processing times in high volume neurocenters within a 6 months period. Methods and Analysis: The trial is being carried out in a pre-test-post-test design at 7 tertiary care university hospital neurocenters in Germany. The intervention is directed at the interdisciplinary multiprofessional stroke teams. Before and after the intervention, process times of all direct-to-center stroke patients receiving IV thrombolysis (IVT) and/or endovascular therapy (EVT) will be recorded. The primary outcome measure will be the “door-to-needle” time of all consecutive stroke patients directly admitted to the neurocenters who receive IVT. Secondary outcome measures will be intervention-related process times of the fraction of patients undergoing EVT and effects on team communication, perceived patient safety, and staff satisfaction via a staff questionnaire. Interventions: We are applying a multi-level intervention in cooperation with three “STREAM multipliers” from each center. First step is a central meeting of the multipliers at the sponsor's institution with the purposes of algorithm review in a peer-to-peer process that is recorded in a protocol and an introduction to the principles of simulation training and debriefing as well as crew resource management and team communication. Thereafter, the multipliers cooperate with the stroke team trainers from the sponsor's institution to plan and execute 2–3 one-day simulation courses in situ in the emergency department and CT room of the trial centers whereupon they receive teaching materials to perpetuate the trainings. Clinical Trial Registration: STREAM is a registered trial at https://clinicaltrials.gov/ct2/show/NCT03228251. KW - CRM KW - thrombolysis (tPA) KW - stroke KW - emergency care KW - simulation training Y1 - 2019 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-369239 SN - 1664-2295 VL - 10 ER -