Aminoglycosides for Intra-Abdominal Infection: Equal to the Challenge?

Background: Aminoglycosides, combined with antianaerobic agents, have been used widely for the treatment of intra-abdominal infection. However, some prospective randomized controlled trials and other data suggested that aminoglycosides were less efficacious than newer comparators for the treatment of these infections. We therefore performed a meta-analysis of all prospective randomized controlled trials utilizing aminoglycosides to reevaluate the efficacy of these agents for the treatment of intra-abdominal infection. Methods: Published English-language prospective randomized controlled trials comparing aminoglycosides with other agents for treatment of intra-abdominal infection were identified by MEDLINE search. For each study, data were collected regarding the number of patients enrolled and evaluated, their basic demographic characteristics, the sources of the intra-abdominal infections, the number of failures as determined by the study investigators, quality score, and the use of serum drug concentrations to monitor aminoglycoside therapy. These data were combined to calculate odds ratios for risk of therapeutic failure, which were assessed for significance using Chi-square analysis. Results: Forty-seven prospective randomized controlled trials comparing aminoglycosides to other agents were identified. These were published between 1981 and 2000, and included a total of 5,182 evaluable patients. Analysis of all studies combined revealed an odds ratio that slightly, but significantly, favored the comparators. After excluding six trials using comparators that lacked accepted antianaerobic efficacy, the odds ratio more strongly favored comparators. Trials published since 1990 also notably favored comparators. Analyzing results by quality score or the use of aminoglycoside monitoring did not alter these findings. Conclusions: In this meta-analysis, aminoglycosides were less efficacious than newer comparators for the treatment of intra-abdominal infection. Given the well-known toxicities of these agents, we conclude that they should not be used as first-line therapy for these infections

The Surgical Infection Society Guidelines on Antimicrobial Therapy for Intra-Abdominal Infections: Evidence for the Recommendations

Revised guidelines for the use of antimicrobial therapy in patients with intra-abdominal infections were recently developed by the Therapeutic Agents Committee of the Surgical Infection Society (Mazuski et al., Surg Infect2002;3:161-173). These were based, insofar as possible, on evidence published over the past decade. The objective of this document is to describe the process by which the Committee identified and reviewed the published literature utilized to develop the recommendations and to summarize the results of those reviews. English-language articles published between 1990 and 2000 related to antimicrobial therapy for intra-abdominal infections were identified by a systematic MEDLINE search and an examination of references included in recent review articles. If current literature with regard to a specific issue was lacking, relevant articles published prior to 1990 were identified. All prospective randomized controlled trials, as well as other articles selected by the Committee, were evaluated individually and collectively. Data with regard to patient numbers, types of infections, and results of interventions were abstracted. Studies were categorized according to their design, and all included trials were graded according to quality. On the basis of this evidence, the Committee formulated recommendations for antimicrobial therapy for intra-abdominal infections and graded those recommendations. After receiving comments from invited reviewers and the general membership of the Society, the guidelines were finalized and submitted to the Council of the Surgical Infection Society for approval. The final recommendations related to the selection of patients needing therapeutic antimicrobials, acceptable antimicrobial regimens, duration of antimicrobial use, and the identification and treatment of higher-risk patients. Although numerous publications pertaining to these topics were identified, but nearly all of the prospective randomized controlled trials represented comparisons of different antimicrobial regimens for the treatment of intra-abdominal infections. A few prospective trials evaluated the need for therapeutic antimicrobial therapy in patients with peritoneal contamination following abdominal trauma. The quality of these prospective trials was highly variable. Many did not limit enrollment to patients with complicated intra-abdominal infections, lacked blinding of treatment assignment, did not provide a complete description of the criteria used to determine therapeutic success or failure, failed to identify the reasons why patients were excluded from analysis, or did not include an intention-to-treat analysis. For many issues, no prospective randomized controlled trials were encountered, and guidelines had to be formulated using evidence from studies with historical controls or uncontrolled data, or on the basis of expert opinion

Origin of Ultralow Friction andWear in Ultrananocrystalline Diamond

The impressively low friction and wear of diamond in humid environments is debated to originate from either the stability of the passivated diamond surface or sliding-induced graphitization/rehybridization of carbon. We find ultralow friction and wear for ultrananocrystalline diamond surfaces even in dry environments, and observe negligible rehybridization except for a modest, submonolayer amount under the most severe conditions (high load, low humidity). This supports the passivation hypothesis, and establishes a new regime of exceptionally low friction and wear for diamond

Evaluating Coastal Landscape Response to Sea-Level Rise in the Northeastern United States - Approach and Methods

The U.S. Geological Survey is examining effects of future sea-level rise on the coastal landscape from Maine to Virginia by producing spatially explicit, probabilistic predictions using sea-level projections, vertical land movement rates (due to isostacy), elevation data, and land-cover data. Sea-level-rise scenarios used as model inputs are generated by using multiple sources of information, including Coupled Model Intercomparison Project Phase 5 models following representative concentration pathways 4.5 and 8.5 in the Intergovernmental Panel on Climate Change Fifth Assessment Report. A Bayesian network is used to develop a predictive coastal response model that integrates the sea-level, elevation, and land-cover data with assigned probabilities that account for interactions with coastal geomorphology as well as the corresponding ecological and societal systems it supports. The effects of sea-level rise are presented as (1) level of landscape submergence and (2) coastal response type characterized as either static (that is, inundation) or dynamic (that is, landform or landscape change). Results are produced at a spatial scale of 30 meters for four decades (the 2020s, 2030s, 2050s, and 2080s). The probabilistic predictions can be applied to landscape management decisions based on sea-level-rise effects as well as on assessments of the prediction uncertainty and need for improved data or fundamental understanding. This report describes the methods used to produce predictions, including information on input datasets; the modeling approach; model outputs; data-quality-control procedures; and information on how to access the data and metadata online

Clinical Practice Guidelines for Antimicrobial Prophylaxis in Surgery

Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140217/1/sur.2013.9999.pd