Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia:a Multinational Point Prevalence Study of Hospitalised Patients

Pseudornonas aeruginosa is a challenging bacterium to treat due to its intrinsic resistance to the antibiotics used most frequently in patients with community-acquired pneumonia (CAP). Data about the global burden and risk factors associated with P. aeruginosa-CAP are limited. We assessed the multinational burden and specific risk factors associated with P. aeruginosa-CAP. We enrolled 3193 patients in 54 countries with confirmed diagnosis of CAP who underwent microbiological testing at admission. Prevalence was calculated according to the identification of P. aeruginosa. Logistic regression analysis was used to identify risk factors for antibiotic-susceptible and antibiotic-resistant P. aeruginosa-CAP. The prevalence of P. aeruginosa and antibiotic-resistant P. aeruginosa-CAP was 4.2% and 2.0%, respectively. The rate of P. aeruginosa CAP in patients with prior infection/colonisation due to P. aeruginosa and at least one of the three independently associated chronic lung diseases (i.e. tracheostomy, bronchiectasis and/or very severe chronic obstructive pulmonary disease) was 67%. In contrast, the rate of P. aeruginosa-CAP was 2% in patients without prior P. aeruginosa infection/colonisation and none of the selected chronic lung diseases. The multinational prevalence of P. aeruginosa-CAP is low. The risk factors identified in this study may guide healthcare professionals in deciding empirical antibiotic coverage for CAP patients

Scaling of the 4He(γ,p)t reaction in the Eγ = 80–160 MeV region

The 4He(γ,p) 3H reaction cross section has been measured with tagged photons of energy 81–158 MeV. Protons were detected over the angular range 55°–125°. The scaling of the data as a function of momentum mismatch has been examined for two reaction models, the modified quasideuteron mechanism and quasifree knockout. Both models show clear scaling behaviour but comparison of the predicted and measured scaling function shapes favours the modified quasideuteron mechanism at momenta up to ≈500 MeV/c

Scaling of the 4He(γ,p)t reaction in the Eγ = 80–160 MeV region

The 4He(γ,p) 3H reaction cross section has been measured with tagged photons of energy 81–158 MeV. Protons were detected over the angular range 55°–125°. The scaling of the data as a function of momentum mismatch has been examined for two reaction models, the modified quasideuteron mechanism and quasifree knockout. Both models show clear scaling behaviour but comparison of the predicted and measured scaling function shapes favours the modified quasideuteron mechanism at momenta up to ≈500 MeV/c

The 4He(gamma,2N) reaction measured with tagged photons

The results of tagged-photon measurements of the 4He(γ, pn)d, 4He(γ, pn)pn and 4He(γ, pp)nn reactions, carried out with photons of energies 80–131 MeV, are presented. The (γ, pn)d three-body-breakup cross section dominates the four-body-breakup cross section. The three-body-breakup cross section and the corresponding deuteron recoil-momentum spectrum are reasonably accounted for by a mechanism of photon absorption on correlated proton-neutron pairs. In contrast the four-body-breakup mechanism appears to have two components: absorption on correlated proton-neutron pairs and a more complex additional component which has a distribution similar to phase space. The data rule out substantial photon absorption on proton-proton pairs

The 16O(γ, 2N) reaction measured with tagged photons

TThe results of tagged photon measurements of the 16O(γ, pn) and 16O(γ, pp) reactions, carried out with photons of energies of 80–131 MeV, are presented. Missing energy spectra for both reactions, with an energy resolution of 7 MeV have been obtained. The 16O(γ, pn) missing energy spectrum is very similar to that recently measured for the 12C(γ, pN) reaction. In both cases the recoil momentum distributions are quantitavely described by a quasideuteron mechanism. Using normalisation factors based on this mechanism the average cross section for the 16O(γ, pn) reaction, for nucleons ejected from the 1p shell, is 510 ± 95 μb. The corresponding cross section for the 16O(γ, pp) reaction is 10.0 ± 3.0 μb

Mapping the 1992 courses of nursing and programmes of midwifery within the proposed Scottish Credit and Qualifications Framework Executive summary

SIGLEAvailable from British Library Document Supply Centre-DSC:f99/2215 / BLDSC - British Library Document Supply CentreGBUnited Kingdo

Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia

Background and objective Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP. Methods We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when >= 3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection. Results Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP. Conclusion This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP