Bloodstream Infection Due to Piperacillin/Tazobactam Non-Susceptible, Cephalosporin Susceptible Escherichia Coli: A Missed Opportunity for DE-Escalation of Therapy

An increasing number of reports describing Escherichia coli isolates with piperacillin/tazobactam resistance, despite retained cephalosporin susceptibility, suggest further emergence of this phenotypic resistance pattern. In this report, a patient with metastatic breast cancer presented to medical care after two days of chills, nausea, vomiting, reduced oral intake, and generalized weakness. Blood and urine cultures grew E. coli as identified by rapid diagnostics multiplex PCR and MALDI-TOF, respectively. The patient continued to manifest signs of sepsis with hypotension and tachypnea during the first three days of hospitalization despite empirical antimicrobial therapy with intravenous piperacillin/tazobactam. After in vitro antimicrobial susceptibility testing demonstrated a piperacillin/tazobactam minimal inhibitory concentration (MIC) of 64 and a ceftriaxone MIC of ≤1 mcg/mL, antimicrobial therapy was switched from intravenous piperacillin/tazobactam to ceftriaxone. All symptoms and signs of infection resolved within 48 h of starting ceftriaxone therapy. This report describes the clinical failure of piperacillin/tazobactam in the treatment of a bloodstream infection due to E. coli harboring a phenotypic resistance pattern of isolated piperacillin/tazobactam non-susceptibility. The case demonstrates the role of cephalosporins as potential treatment options and highlights the value of early de-escalation of antimicrobial therapy based on rapid diagnostic testing for microbial identification

Direct Measurement of Performance: A New Era in Antimicrobial Stewardship

Penicillin allergies are among of the most commonly reported allergies, yet only 10% of these patients are truly allergic. This leads to potential inadvertent negative consequences for patients and makes treatment decisions challenging for clinicians. Thus, allergy assessment and penicillin skin testing (PST) are important management strategies to reconcile and clarify labeled penicillin allergies. While PST is more common in the inpatient setting where the results will immediately impact antibiotic management, this process is becoming of increasing importance in the outpatient setting. PST in the outpatient setting allows clinicians to proactively de-label and educate patients accordingly so beta-lactam antibiotics may be appropriately prescribed when necessary for future infections. While allergists have primarily been responsible for PST in the outpatient setting, there is an increasing role for pharmacist involvement in the process. This review highlights the importance of penicillin allergy assessments, considerations for PST in the outpatient setting, education and advocacy for patients and clinicians, and the pharmacist’s role in outpatient PST

Deep learning classification of chest x-ray images

We propose a deep learning based method for classification of commonly occurring pathologies in chest X-ray images. The vast number of publicly available chest X-ray images provides the data necessary for successfully employing deep learning methodologies to reduce the misdiagnosis of thoracic diseases. We applied our method to the classification of two example pathologies, pulmonary nodules and cardiomegaly, and we compared the performance of our method to three existing methods. The results show an improvement in AUC for detection of nodules and cardiomegaly compared to the existing methods.Comment: 4 pages, 4 figures, 2 tables, conference , SSIAI 202

Potential energy surface of the CO2-N2 van der Waals complex

Four-dimensional potential energy surface (4D-PES) of the atmospherically relevant CO2–N2 van der Waals complex is generated using the explicitly correlated coupled cluster with single, double, and perturbative triple excitation (CCSD(T)-F12) method in conjunction with the augmented correlation consistent triple zeta (aug-cc-pVTZ) basis set. This 4D-PES is mapped along the intermonomer coordinates. An analytic fit of this 4D-PES is performed. Our extensive computations confirm that the most stable form corresponds to a T-shape structure where the nitrogen molecule points towards the carbon atom of CO2. In addition, we located a second isomer and two transition states in the ground state PES of CO2–N2. All of them lay below the CO2 + N2 dissociation limit. This 4D-PES is flat and strongly anisotropic along the intermonomer coordinates. This results in the possibility of the occurrence of large amplitude motions within the complex, such as the inversion of N2, as suggested in the recent spectroscopic experiments. Finally, we show that the experimentally established deviations from the C2v structure at equilibrium for the most stable isomer are due to the zero-point out-of-plane vibration correction

Transport behavior of holes in boron delta-doped diamond structures

Boron delta-doped diamond structures have been synthesized using microwave plasma chemical vapor deposition and fabricated into FET and gated Hall bar devices for assessment of the electrical characteristics. A detailed study of variable temperature Hall, conductivity, and field-effect mobility measurements was completed. This was supported by Schr€dinger-Poisson and relaxation time o calculations based upon application of Fermi’s golden rule. A two carrier-type model was developed with an activation energy of $0.2 eV between the delta layer lowest subband with mobility$1 cm2/Vs and the bulk valence band with high mobility. This new understanding of the transport of holes in such boron delta-doped structures has shown that although Hall mobility as high as 900 cm2/Vs was measured at room temperature, this dramatically overstates the actual useful performance of the device

Asthma and Risk of Non-Respiratory Tract Infection: A Population-Based Case-Control Study

OBJECTIVES: Asthmatics have increased risks of airway-related infections. Little is known about whether this is true for non-airway-related serious infections such as Escherichia coli bloodstream infection (BSI). We assessed whether asthma is associated with a risk of developing community-acquired E coli BSI. DESIGN: The study was designed as a population-based retrospective case-control study. SETTING: This population-based study was conducted in Olmsted County, Minnesota. PARTICIPANTS: The study included 259 all eligible community-acquired E coli BSI cases in Olmsted County, MN between 1998 and 2007 and 259 birthday-matched, gender-matched and residency-matched controls. PRIMARY AND SECONDARY OUTCOME MEASURES: Only community-acquired E coli BSI cases as the primary outcome was included. Asthma status as an exposure was ascertained by predetermined criteria. An adjusted OR and 95% CI for the association between asthma and risk of community-acquired E coli BSI was calculated using conditional logistic regression. RESULTS: Of 259 eligible cases, 179 (69%) were women and mean age was 61±22 years. Of the 259 cases 37 (14%) and 16 (6%) of 259 controls had a prior history of asthma (adjusted OR 2.74; 95% CI 1.11 to 6.76; p=0.029). The population attributable risk of asthma for community-acquired E coli BSI was 9%. Although not statistically significant, there was a borderline association between having a history of food allergy and increased risk of community-acquired E coli BSI (6% vs 2%; adjusted OR 3.51; 95% CI 0.94 to 13.11; p=0.062). CONCLUSIONS: Based on the findings of the current population-based, case-control investigation, a history of asthma may be associated with risk of community-acquired E coli BSI. The impact of asthma on risk of microbial infections may go beyond airways

Effect of Recycled Aggregate Concrete and Steel Fibers on the Fresh Properties of Self-Compacting Concrete

Globally, the amount of solid waste is constantly increasing, and its disposal is one of the critical issues in recent research studies. Concrete waste includes the rubble of demolished buildings, whether old buildings or those that have been subjected to earthquakes, etc. This research project aims to improve sustainability in the construction industry by recycling and reusing coarse aggregate that was previously used in concrete buildings. The objective is to utilize this recycled material to produce self-compacting concrete (SCC) and assess its performance in its fresh state. By finding new ways to repurpose materials that would otherwise go to waste, this research contributes to developing environmentally friendly practices and reducing the industry's carbon footprint. Furthermore, evaluating the performance of the recycled coarse aggregate in SCC will provide insights into its potential for future use in construction projects, which could ultimately lead to cost savings and improved efficiency in the industry. Recycled coarse aggregate (RCA) was used as a substitute for the natural coarse aggregate (NCA) with volume ratios of 0, 25, 50, 75, and 100%, and steel fibers (SF) were added to the concrete with different volumes ratios (0, 0.5, and 1 %). Workability tests such as slump flow, V-funnel, and L-box tests were carried out for the mixtures in their fresh state. In general, the results of the experimental work showed that the fresh properties indicated that almost all SCC mixtures were within the specified range, as stated in EFNARC requirements