Empirical use of antibiotics and adjustment of empirical antibiotic therapies in a university hospital: a prospective observational study

BACKGROUND: Several strategies to optimise the use of antibiotics have been developed. Most of these interventions can be classified as educational or restrictive. Restrictive measures are considered to be more effective, but the enforcement of these measures may be difficult and lead to conflicts with prescribers. Any intervention should be aimed at targets with the highest impact on antibiotic prescribing. The aim of the present study was to assess the adequacy of empirical and adjusted antibiotic therapies in a Swiss university hospital where no antibiotic use restrictions are enforced, and to identify risk factors for inadequate treatment and targets for intervention. METHODS: A prospective observational study was performed during 9 months. All patients admitted through the emergency department who received an antibiotic therapy within 24 hours of admission were included. Data on demographic characteristics, diagnoses, comorbidities, systemic inflammatory response syndrome (SIRS) parameters, microbiological tests, and administered antibiotics were collected prospectively. Antibiotic therapy was considered adequate if spectrum, dose, application modus, and duration of therapy were appropriate according to local recommendations or published guidelines. RESULTS: 2943 admitted patients were evaluated. Of these, 572 (19.4%) received antibiotics within 24 hours and 539 (94%) were analysed in detail. Empirical antibiotic therapy was inadequate in 121 patients (22%). Initial therapy was adjusted in 168 patients (31%). This adjusted antibiotic therapy was inadequate in 46 patients (27%). The main reason for inadequacy was the use of antibiotics with unnecessarily broad spectrum (24% of inadequate empirical, and 52% of inadequate adjusted therapies). In 26% of patients with inadequate adjusted therapy, antibiotics used were either ineffective against isolated pathogenic bacteria or antibiotic therapy was continued despite negative results of microbiological investigations. CONCLUSION: The rate of inadequate antibiotic therapies was similar to the rates reported from other institutions despite the absence of a restrictive antibiotic policy. Surprisingly, adjusted antibiotic therapies were more frequently inappropriate than empirical therapies. Interventions aiming at improving antibiotic prescribing should focus on both initial empirical therapy and streamlining and adjustment of therapy once microbiological results become available

Clarifying the role of three-dimensional transvaginal sonography in reproductive medicine: an evidenced-based appraisal

This overview describes and illustrates the clinical applications of three-dimensional transvaginal sonography in reproductive medicine. Its main applications include assessment of uterine anomalies, intrauterine pathology, tubal patency, polycystic ovaries, ovarian follicular monitoring and endometrial receptivity. It is also useful for detailed evaluation of failed and/or ectopic pregnancy. Three-dimensional color Doppler sonography provides enhanced depiction of uterine, endometrial, and ovarian vascularity

The effector T cell response to influenza infection

Influenza virus infection induces a potent initial innate immune response, which serves to limit the extent of viral replication and virus spread. However, efficient (and eventual) viral clearance within the respiratory tract requires the subsequent activation, rapid proliferation, recruitment, and expression of effector activities by the adaptive immune system, consisting of antibody producing B cells and influenza-specific T lymphocytes with diverse functions. The ensuing effector activities of these T lymphocytes ultimately determine (along with antibodies) the capacity of the host to eliminate the viruses and the extent of tissue damage. In this review, we describe this effector T cell response to influenza virus infection. Based on information largely obtained in experimental settings (i.e., murine models), we will illustrate the factors regulating the induction of adaptive immune T cell responses to influenza, the effector activities displayed by these activated T cells, the mechanisms underlying the expression of these effector mechanisms, and the control of the activation/differentiation of these T cells, in situ, in the infected lungs

Operation and performance of the ATLAS Tile Calorimeter in Run 1

The Tile Calorimeter is the hadron calorimeter covering the central region of the ATLAS experiment at the Large Hadron Collider. Approximately 10,000 photomultipliers collect light from scintillating tiles acting as the active material sandwiched between slabs of steel absorber. This paper gives an overview of the calorimeter’s performance during the years 2008–2012 using cosmic-ray muon events and proton–proton collision data at centre-of-mass energies of 7 and 8TeV with a total integrated luminosity of nearly 30 fb−1. The signal reconstruction methods, calibration systems as well as the detector operation status are presented. The energy and time calibration methods performed excellently, resulting in good stability of the calorimeter response under varying conditions during the LHC Run 1. Finally, the Tile Calorimeter response to isolated muons and hadrons as well as to jets from proton–proton collisions is presented. The results demonstrate excellent performance in accord with specifications mentioned in the Technical Design Report

Collegiale toetsing van AWARE

Voor producten met vluchtige organische oplosmiddelen, zoals sommige industriele schoonmaakmiddelen, is een nieuwe code ontwikkeld die het risico aangeeft voor gebruikers die hieraan staan blootgesteld. De methode die hieraan ten grondslag ligt, de AWARE-methode, levert ten opzichte van het nieuwe Europese stoffenbeleid (REACH) echter weinig meerwaarde op. Dat blijkt uit een evaluatie van het RIVM van de methode. De AWARE-methode is ontwikkeld door de Universiteit van Amsterdam, in opdracht van het ministerie van Sociale Zaken en Werkgelegenheid (SZW), om het aantal gevallen van de schildersziekte terug te dringen. AWARE wil het gebruik van minder schadelijke producten stimuleren door het risico van schadelijke producten inzichtelijk te maken. De AWARE-code is bedoeld om gebruikers te laten kiezen voor het veiligste product. Producenten kunnen het relatieve risico en gevaar bepalen tijdens de productontwikkeling. De AWARE-methode geeft een indicatie van het risico op basis van een onduidelijke beschrijving en beperkte onderbouwing. Bovendien komt het verschil tussen de AWARE-code op producten niet altijd overeen met het verschil tussen de risico's van producten. De methode zou verbeterd kunnen worden door gebruik te maken van de limietwaarden voor risicobeoordelingen die voor REACH worden afgeleid in de komende jaren. De REACH-wetgeving heeft - net als AWARE - als doel een veilig gebruik van chemische stoffen te bereiken. Bovendien is REACH wettelijk verplicht en geeft meer inzicht in veilig gebruik van stoffen. AWARE communiceert alleen het relatieve risico van een product. De toegevoegde waarde ervan is hierdoor beperkt zodra REACH is geimplementeerd.For products containing volatile organic compounds, like some industrial cleaning agents, a new code has been developed which indicates the risk for exposed users. The method, on which this is based, named the AWARE-method, has limited added value in comparison to the new European legislation on chemicals (REACH). This results from the peer review of the method by the RIVM. The AWARE-method was developed by the University of Amsterdam, by order of the Ministry of Social Affairs and Employment (SZW) to reduce the incidence of organic solvent neurotoxicity. AWARE wants to stimulate the use of less harmful products by providing insight in the risk of harmful products. The AWARE code allows users to choose the safest product. Producers can determine the relative risk and hazard during product development. The AWARE method provides an indication of the risk based on a limited method description and justification. Further, the difference in AWARE code between products does not always match with the difference in risks of products. The method could be improved by using the limit values that will be derived for REACH over the coming years. The REACH legislation aims, just like AWARE, at the safe use of chemicals. Also, REACH is a legal obligation and provides additional insights in the safe use of chemicals. AWARE only communicates the relative risk of a product. Therefore, AWARE has limited added value after entry into force of REACH.SZ