Clostridium difficile infection in an endemic setting in the Netherlands

The purpose of this investigation was to study risk factors for Clostridium difficile infection (CDI) in an endemic setting. In a 34-month prospective case–control study, we compared the risk factors and clinical characteristics of all consecutively diagnosed hospitalised CDI patients (n = 93) with those of patients without diarrhoea (n = 76) and patients with non-CDI diarrhoea (n = 64). The incidence of CDI was 17.5 per 10,000 hospital admissions. C. difficile polymerase chain reaction (PCR) ribotype 014 was the most frequently found type (15.9%), followed by types 078 (12.7%) and 015 (7.9%). Independent risk factors for endemic CDI were the use of second-generation cephalosporins, previous hospital admission and previous stay at the intensive care unit (ICU). The use of third-generation cephalosporins was a risk factor for diarrhoea in general. We found no association of CDI with the use of fluoroquinolones or proton pump inhibitors (PPIs). The overall 30-day mortality among CDI patients, patients without diarrhoea and patients with non-CDI diarrhoea was 7.5%, 0% and 1.6%, respectively. In this endemic setting, risk factors for CDI differed from those in outbreak situations. Some risk factors that have been ascribed to CDI earlier were, in this study, not specific for CDI, but for diarrhoea in general. The 30-day mortality among CDI patients was relatively high

Current inpatient treatment options for COVID-19:an update

In dit overzichtsartikel geven wij een update van de adviezen voor de medicamenteuze behandeling van covid-19 in de tweede lijn.Deze adviezen zijn opgesteld door de Stichting Werkgroep Antibioticabeleid (SWAB) in samenwerking met onder andere de Federatie Medisch Specialisten (FMS).Zowel opties voor behandeling in het ziekenhuis als opties voor behandeling in de ambulante setting worden besproken.De behandeling omvat zowel anti-inflammatoire als antivirale therapie.In this article we provide an overview of the current treatment recommendations for COVID-19. These recommendations are made by the SWAB (StichtingWerkgroepAntibioticabeleid), in cooperation with the FMS (FederatieMedischSpecialisten (online: swab.nl/nl/covid-19.). Treatment options for patients in both ambulatory care and admitted to the hospital are listed. These treatment options include both antiinflammatory and antiviral therapy.</p

Renal failure and leukocytosis are predictors of a complicated course of clostridium difficile infection if measured on day of diagnosis

Nonsevere Clostridium difficile infection (CDI) and severe CDI, which carries a higher risk than nonsevere CDI for treatment failure and CDI recurrence, are difficult to distinguish at the time of diagnosis. To investigate the prognostic value of 3 markers of severe CDI suggested by recent guidelines (fever, leukocytosis, and renal failure), we used the database of 2 randomized controlled trials, which contained information for 1105 patients with CDI. Leukocytosis (risk ratio [RR], 2.29; 95% confidence interval [CI], 1.63–3.21) and renal failure (RR, 2.52; 95% CI, 1.82–3.50) were associated with treatment failure. Fever, although associated with treatment failure (RR, 2.45; 95% CI, 1.07–5.61), was rare. Renal failure was the only significant predictor of recurrence (RR, 1.45; 95% CI, 1.05–2.02). Different timing of measurements of leukocyte count and serum creatinine level around the CDI diagnosis led to a different severity classification in many cases. In conclusion, both leukocytosis and renal failure are useful predictors, although timing of measurement is important

High-resolution spatial patterns and drivers of terrestrial ecosystem carbon dioxide, methane, and nitrous oxide fluxes in the tundra

Arctic terrestrial greenhouse gas (GHG) fluxes of carbon dioxide (CO2), methane (CH4), and nitrous oxide (N2O) play an important role in the global GHG budget. However, these GHG fluxes are rarely studied simultaneously, and our understanding of the conditions controlling them across spatial gradients is limited. Here, we explore the magnitudes and drivers of GHG fluxes across fine-scale terrestrial gradients during the peak growing season (July) in sub-Arctic Finland. We measured chamber-derived GHG fluxes and soil temperature, soil moisture, soil organic carbon and nitrogen stocks, soil pH, soil carbon-to-nitrogen (C/N) ratio, soil dissolved organic carbon content, vascular plant biomass, and vegetation type from 101 plots scattered across a heterogeneous tundra landscape (5 km2). We used these field data together with high-resolution remote sensing data to develop machine learning models for predicting (i.e., upscaling) daytime GHG fluxes across the landscape at 2 m resolution. Our results show that this region was on average a daytime net GHG sink during the growing season. Although our results suggest that this sink was driven by CO2 uptake, it also revealed small but widespread CH4 uptake in upland vegetation types, almost surpassing the high wetland CH4 emissions at the landscape scale. Average N2O fluxes were negligible. CO2 fluxes were controlled primarily by annual average soil temperature and biomass (both increase net sink) and vegetation type, CH4 fluxes by soil moisture (increases net emissions) and vegetation type, and N2O fluxes by soil C/N (lower C/N increases net source). These results demonstrate the potential of high spatial resolution modeling of GHG fluxes in the Arctic. They also reveal the dominant role of CO2 fluxes across the tundra landscape but suggest that CH4 uptake in dry upland soils might play a significant role in the regional GHG budget.</p

The reaction coordinate mapping in quantum thermodynamics

We present an overview of the reaction coordinate approach to handling strong system-reservoir interactions in quantum thermodynamics. This technique is based on incorporating a collective degree of freedom of the reservoir (the reaction coordinate) into an enlarged system Hamiltonian (the supersystem), which is then treated explicitly. The remaining residual reservoir degrees of freedom are traced out in the usual perturbative manner. The resulting description accurately accounts for strong system-reservoir coupling and/or non-Markovian effects over a wide range of parameters, including regimes in which there is a substantial generation of system-reservoir correlations. We discuss applications to both discrete stroke and continuously operating heat engines, as well as perspectives for additional developments. In particular, we find narrow regimes where strong coupling is not detrimental to the performance of continuously operating heat engines.Comment: 17 pages, 2 tables, 7 figures. As a chapter of: F. Binder, L. A. Correa, C. Gogolin, J. Anders, and G. Adesso (eds.), "Thermodynamics in the quantum regime - Recent Progress and Outlook", (Springer International Publishing