Dalbavancin Sequential Therapy for Gram-Positive Bloodstream Infection: A Multicenter Observational Study

Introduction Long-acting lipoglycopeptides such as dalbavancin may have utility in patients with Gram-positive bloodstream infections (BSI), particularly in those with barriers to discharge or who require prolonged parenteral antibiotic courses. A retrospective cohort study was performed to provide further multicenter real-world evidence on dalbavancin use as a sequential therapy for Gram-positive BSI. Methods One hundred fifteen patients received dalbavancin with Gram-positive BSI, defined as any positive blood culture or diagnosed with infective endocarditis, from 13 centers geographically spread across the United States between July 2015 and July 2021. Results Patients had a mean (SD) age of 48.5 (17.5) years, the majority were male (54%), with many who injected drugs (40%). The most common infection sources (non-exclusive) were primary BSI (89%), skin and soft tissue infection (SSTI) (25%), infective endocarditis (19%), and bone and joint infection (17%). Staphylococcus aureus accounted for 72% of index cultures, coagulase-negative Staphylococcus accounted for 18%, and Streptococcus species in 16%. Dalbavancin started a median (Q1–Q3) of 10 (6–19) days after index culture collection. The most common regimen administered was dalbavancin 1500 mg as one dose for 50% of cases. The primary outcome of composite clinical failure occurred at 12.2%, with 90-day mortality at 7.0% and 90-day BSI recurrence at 3.5%. Conclusions Dalbavancin may serve as a useful tool in facilitating hospital discharge in patients with Gram-positive BSI. Randomized controlled trials are anticipated to validate dalbavancin as a surrogate to current treatment standards

Development of model-based systems for integrated design of highway bridges

This paper presents a model-based approach to facilitate the implementation of integrated software systems that can support bridge design processes throughout the project lifecycle. The approach involves the use of an integrated data model and a centralized project data repository, where project data can be efficiently managed and shared across various project processes. An integrated bridge data model, based on the ISO STEP standards, has been developed. Four main views (or sub-schemas) have been identified to support the core model: structural design, structural analysis, construction scheduling, and cost estimating. An object-oriented project repository is implemented based on the proposed data model. The prototype software aims to support the design of concrete box girder bridges.Ce m\ue9moire pr\ue9sente une approche ax\ue9e sur des mod\ue8les visant \ue0 faciliter la mise en ?uvre de syst\ue8mes logiciels int\ue9gr\ue9s capables de soutenir des processus de conception de ponts pendant toute la dur\ue9e du projet. Il s'agit de mettre en valeur un mod\ue8le de donn\ue9es int\ue9gr\ue9 et un d\ue9p\uf4t centralis\ue9 de donn\ue9es de projet o\uf9 l'on peut g\ue9rer les donn\ue9es de projet avec efficacit\ue9 et les communiquer par le biais de divers processus de projet. On a \ue9labor\ue9 un mod\ue8le de donn\ue9es int\ue9gr\ue9 relatif \ue0 des ponts. Ce mod\ue8le est fond\ue9 sur les normes ISO STEP. \uc0 l'appui du mod\ue8le de base, on a pr\ue9cis\ue9 quatre perspectives (ou sous-sch\ue9mas) : la conception structurelle, l'analyse structurelle, l'ordonnancement des travaux de construction et l'estimation des co\ufbts. On a r\ue9alis\ue9 un d\ue9p\uf4t de projets ax\ue9 sur les objets et fond\ue9 sur le mod\ue8le de donn\ue9es propos\ue9. Le logiciel prototype est con\ue7u pour appuyer la conception de ponts \ue0 poutres et \ue0 dalots en b\ue9ton.Peer reviewed: YesNRC publication: Ye