RESUMEN
Two oxacillin disk methods were compared with a cefoxitin disk diffusion test for detection of methicillin-resistant Staphylococcus aureus (MRSA), with PCR for mecA as the reference method. When tested with 115 MRSA and 350 methicillin-susceptible S. aureus isolates, the cefoxitin disk test (specificity 100%, sensitivity 96.5%) was superior to the oxacillin disk methods (specificity 99.1%, sensitivity 90.4%). Testing with both oxacillin and cefoxitin disks would give better sensitivity (100%) than the cefoxitin test alone, but at the expense of specificity (99.1%). The cefoxitin disk test required no special test conditions and would improve the reliability of routine tests for detection of MRSA.
Asunto(s)
Antibacterianos/farmacología , Cefoxitina/farmacología , Resistencia a la Meticilina , Staphylococcus aureus/efectos de los fármacos , Humanos , Meticilina/farmacología , Resistencia a la Meticilina/genética , Pruebas de Sensibilidad Microbiana/métodos , Reacción en Cadena de la Polimerasa , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/genéticaRESUMEN
Authors expose in the first part of this article practical modes to implement the health insurance reform under the angle of the mastery of care expenses, at the micro and the macroeconomic levels. Thus they pass in review the different possibilities to master expenses, at the supply and the demand sides, by identifying advantages and risks of each of they and by specifying orientations of the health insurance reform in this area: the moderating ticket, contractual payment methods of hospitals and health professionals, the path of care, the refund of care expenses, the rationalization of consumption of medicines and complementary examinations and the harmonious development of care supply by a better public and private mix. A particular accent is put on preliminaries and implementation conditions of the prospective payment of providers and organizational conditions of care provision, from general practitioner that would become the main entry of the care system. In a second part, authors pass in review organization and management conditions of social security bodies, needed for the health insurance reform implementation. On the basis of decentralization and a three levels organization (local, regional and central), social security bodies will put in place the most appropriate organization to insure a steady efficient implementation of the health insurance reform, in dialogue with stakeholders. Consultative committees at regional and central levels, regrouping all the intervening in the health insurance, will be instituted. The sought-after objective through this organization is to administer the health insurance, at the strategic, decisional and operational levels, with suppleness, as a changing and dynamic project, in function of flexibility imperatives necessary for the reform implementation.