Bacteriostatic versus bactericidal antibiotics for patients with serious bacterial infections: systematic review and meta-analysis

Objectives Antibiotics are commonly classified into bactericidal and bacteriostatic agents based on their antimicrobial action. We aimed to assess whether this distinction is clinically relevant. Methods OVID MEDLINE, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL) and relevant references and conference proceedings using the Web of Science and Scopus databases were searched for randomized controlled trials comparing bactericidal with bacteriostatic antibiotics for treatment of severe infections. Main outcome measures were clinical cure rates and overall mortality. Abstracts of studies selected in the database search were screened by one reviewer; full-text screening and data extraction were performed by three independent reviewers. Results Thirty-three studies were included. Approximately half of patients were treated with bacteriostatic monotherapy. Infections covered were pneumonia (n = 13), skin and soft tissue infections (n = 8), intra-abdominal infections (n = 4) and others (n = 8). Neither clinical cure rates [risk ratio (RR), 0.99; 95% CI, 0.97-1.01; P = 0.11] nor mortality rates (RR, 0.91; 95% CI, 0.76-1.08; P = 0.28) were different between patients treated with bactericidal drugs and those treated with bacteriostatic drugs. Subgroup analyses showed a benefit for clinical cure rates associated with linezolid and increased mortality associated with tigecycline. In meta-regression, clinical cure rates remained higher in patients treated with linezolid (P = 0.01); tigecycline displayed a close to significant association with increased mortality (P = 0.05) if compared with other bacteriostatic agents. Conclusions The categorization of antibiotics into bacteriostatic and bactericidal is unlikely to be relevant in clinical practice if used for abdominal infections, skin and soft tissue infections and pneumonia. Because we were not able to include studies on meningitis, endocarditis or neutropenia, no conclusion regarding these diseases can be draw

Field Performance Of Domestic Heat Pumps For Heating And Hot Water In Switzerland Part I: Technology, Methods And State Of The Art Of The Field Studies

carried out by the Heat Pump Test Center (WPZ) in Buchs SG, Switzerland. In the current study, heat pumps for hydronic heating systems in single family houses within Switzerland have been investigated since 2016. So far, over 20 air-source and geothermal heat pumps have been added to this governmental quality assurance program (Swiss Federal authority EnergieSchweiz). For each heat pump system, more than 40 measured variables are recorded at a time interval of 10 s with calibrated sensors with very low measurement uncertainty. The aim of this field study is to record the real heat pump system efficiency in operation and to draw comparisons with characteristic values from laboratory measurements and manufacturer data. The study presented, is divided into two parts. The first part that is entitled “Technology, Methods and State of the Art of the field studies” focuses on the procedure, system boundaries and measuring technology of past and current field studies at WPZ Buchs and provides an insight to the state of the art of field performance measurements of domestic heat pumps carried out in Switzerland. The second part is entitled “Results, Analysis and Optimization of current field studies” and concentrates on various measured figures and the improvement potential of the investigated heat pump systems. Compared to the former studies made in the 1990s and early 2000s, the measurement methodology and data acquisition have changed considerably to date. Nowadays, thanks to digitalization, much more data is available. Short sampling intervals are used to describe temporal processes in heat pump systems in detail, enabling an easier detection of defects such as heat losses and unwanted circulation. Thanks to carefully defined system boundaries like JAZ, WNG and SNG heat pump systems can be compared and optimized effectively. Great importance is attached to the measurement of temperature because of its major influence on the overall uncertainty. Therefore, temperature is measured with an uncertainty of ±0.1 K/±0.02 K (absolute/relative) using directly immersed PT-100 sensors and four wire technology. Together with the prior calibration of the whole measuring equipment in the laboratory, an overall uncertainty of the target values (COP, JAZ) of 10% was achieved

Field Performance Of Domestic Heat Pumps For Heating And Hot Water In Switzerland Part II: Results, Analysis And Optimization

This study presents the development, the methods, and the state of the art of heat pump field trials as they are currently carried out by the Heat Pump Test Center (WPZ) in Buchs SG, Switzerland. In the current study, heat pumps for hydronic heating systems in single family houses within Switzerland have been investigated since 2016. So far, over 20 air-source and geothermal heat pumps have been added to this governmental quality assurance program (Swiss Federal authority EnergieSchweiz). For each heat pump system, more than 40 measured variables are recorded at a time interval of 10 s using calibrated sensors with very low measurement uncertainty. The aim of this field study is to record the real system efficiency in operation and to draw comparisons with characteristic values from laboratory measurements and manufacturer data. The study presented is divided into two parts. The first part entitled “Technology, Methods and State of the Art of the field studies” focuses on the procedure and measuring technology of field studies performed at WPZ Buchs. The second part is entitled “Results, Analysis and Optimization of current field studies” and presents meaningful results of the current field study as well as identification and optimization of possible deficiencies in the planning, installation and handling of the investigated heat pump systems. Heat pumps installed in new and refurbished buildings have been investigated with different system boundaries. In terms of performance, the current study shows an average annual coefficient of performance (SPF) of 3.6 and a span from 3.5 to 3.7 for floor heating and domestic hot water production using air/water heat pumps. Geothermal heat pump systems reach an average annual coefficient of performance of almost 5. Although the systems are running quite satisfying overall, the results also show considerable differences between the systems as well as typical mistakes in the installation and handling of the heat pumps. A controller that does not work optimally in terms of application and consumption is a frequently found cause of decreased performance. After evaluating the baseline performance for two years, the systems are optimized to increase performance and avoid poor operation. The collected data is also used to better define guidelines for planner and installers

Documentation of adherence to infection prevention best practice in patient records: a mixed-methods investigation.

BACKGROUND Healthcare-associated infections remain a preventable cause of patient harm in healthcare. Full documentation of adherence to evidence-based best practices for each patient can support monitoring and promotion of infection prevention measures. Thus, we reviewed the extent, nature, and determinants of the documentation of infection prevention (IP) standards in patients with HAI. METHODS We reviewed electronic patient records (EMRs) of patients included in four annual point-prevalence studies 2013-2016 who developed a device- or procedure-related HAI (surgical site infection (SSI), catheter-associated urinary tract infection (CAUTI), ventilator-associated infection (VAP), catheter-related bloodstream infection (CRBSI)). We examined the documentation quality of mandatory preventive measures published as institutional IP standards. Additionally, we undertook semi-structured interviews with healthcare providers and a two-step inductive (grounded theory) and deductive (Theory of Planned Behaviour) content analysis. RESULTS Of overall 2972 surveyed patients, 249 (8.4%) patients developed 272 healthcare-associated infections. Of these, 116 patients met the inclusion criteria, classified as patients with SSI, CAUTI, VAP, CRBSI in 78 (67%), 21 (18%), 10 (9%), 7 (6%), cases, respectively. We found documentation of IP measures in EMRs in 432/1308 (33%) cases. Documentation of execution existed in the study patients' EMRs for SSI, CAUTI, VAP, CRBSI, and overall, in 261/931 (28%), 27/104 (26%), 46/122 (38%), 26/151 (17%), and 360/1308 (28%) cases, respectively, and documentation of non-execution in 67/931 (7%), 2/104 (2%), 0/122 (0%), 3/151 (2%), and 72/1308 (6%) cases, respectively. Healthcare provider attitudes, subjective norms, and perceived behavioural control indicated reluctance to document IP standards. CONCLUSIONS EMRs rarely included conclusive data about adherence to IP standards. Documentation had to be established indirectly through data captured for other reasons. Mandatory institutional documentation protocols or technically automated documentation may be necessary to address such shortcomings in patient safety documentation

Stratification of cumulative antibiograms in hospitals for hospital unit, specimen type, isolate sequence and duration of hospital stay

Background Empirical antibiotic therapy is based on patients' characteristics and antimicrobial susceptibility data. Hospital-wide cumulative antibiograms may not sufficiently support informed decision-making for optimal treatment of hospitalized patients. Methods We studied different approaches to analysing antimicrobial susceptibility rates (SRs) of all diagnostic bacterial isolates collected from patients hospitalized between July 2005 and June 2007 at the University Hospital in Zurich, Switzerland. We compared stratification for unit-specific, specimen type-specific (blood, urinary, respiratory versus all specimens) and isolate sequence-specific (first, follow-up versus all isolates) data with hospital-wide cumulative antibiograms, and studied changes of mean SR during the course of hospitalization. Results A total of 16 281 isolates (7965 first, 1201 follow-up and 7115 repeat isolates) were tested. We found relevant differences in SRs across different hospital departments. Mean SRs of Escherichia coli to ciprofloxacin ranged between 64.5% and 95.1% in various departments, and mean SRs of Pseudomonas aeruginosa to imipenem and meropenem ranged from 54.2% to 100% and 80.4% to 100%, respectively. Compared with hospital cumulative antibiograms, lower SRs were observed in intensive care unit specimens, follow-up isolates and isolates causing nosocomial infections (except for Staphylococcus aureus). Decreasing SRs were observed in first isolates of coagulase-negative staphylococci with increasing interval between hospital admission and specimen collection. Isolates from different anatomical sites showed variations in SRs. Conclusions We recommend the reporting of unit-specific rather than hospital-wide cumulative antibiograms. Decreasing antimicrobial susceptibility during hospitalization and variations in SRs in isolates from different anatomical sites should be taken into account when selecting empirical antibiotic treatmen

Surveillance quality correlates with surgical site infection rates in knee and hip arthroplasty and colorectal surgeries: A call to action to adjust reporting of SSI rates.

OBJECTIVE The incidence of surgical site infections may be underreported if the data are not routinely validated for accuracy. Our goal was to investigate the communicated SSI rate from a large network of Swiss hospitals compared with the results from on-site surveillance quality audits. DESIGN Retrospective cohort study. PATIENTS In total, 81,957 knee and hip prosthetic arthroplasties from 125 hospitals and 33,315 colorectal surgeries from 110 hospitals were included in the study. METHODS Hospitals had at least 2 external audits to assess the surveillance quality. The 50-point standardized score per audit summarizes quantitative and qualitative information from both structured interviews and a random selection of patient records. We calculated the mean National Healthcare Safety Network (NHSN) risk index adjusted infection rates in both surgery groups. RESULTS The median NHSN adjusted infection rate per hospital was 1.0% (interquartile range [IQR], 0.6%-1.5%) with median audit score of 37 (IQR, 33-42) for knee and hip arthroplasty, and 12.7% (IQR, 9.0%-16.6%), with median audit score 38 (IQR, 35-42) for colorectal surgeries. We observed a wide range of SSI rates and surveillance quality, with discernible clustering for public and private hospitals, and both lower infection rates and audit scores for private hospitals. Infection rates increased with audit scores for knee and hip arthroplasty (P value for the slope = .002), and this was also the case for planned (P = .002), and unplanned (P = .02) colorectal surgeries. CONCLUSIONS Surveillance systems without routine evaluation of validity may underestimate the true incidence of SSIs. Audit quality should be taken into account when interpreting SSI rates, perhaps by adjusting infection rates for those hospitals with lower audit scores

Correlation between case mix index and antibiotic use in hospitals

Background To compare the quantitative antibiotic use between hospitals or hospital units and to explore differences, adjustment for severity of illness of hospitalized patients is essential. The case mix index (CMI) is an economic surrogate marker (i.e. the total cost weights of all inpatients per a defined time period divided by the number of admissions) to describe the average patients' morbidity of individual hospitals. We aimed to investigate the correlation between CMI and hospital antibiotic use. Methods We used weighted linear regression analysis to evaluate the correlation between in-hospital antibiotic use in 2006 and CMI of 18 departments of the tertiary care University Hospital Zurich and of 10 primary and 2 secondary acute care hospitals in the Canton of Zurich in Switzerland. Results Antibiotic use varied substantially between different departments of the university hospital [defined daily doses (DDD)/100 bed-days, 68.04; range, 20.97-323.37] and between primary and secondary care hospitals (range of DDD/100 bed-days, 15.45-57.05). Antibiotic use of university hospital departments and the different hospitals, respectively, correlated with CMI when calculated in DDD/100 bed-days [coefficient of determination (R2), 0.57 (P = 0.0002) and 0.46 (P = 0.0065)], as well as when calculated in DDD/100 admissions [R2, 0.48 (P = 0.0008) and 0.85 (P < 0.0001), respectively]. Conclusions Antibiotic use correlated with CMI across various specialties of a university hospital and across different acute care hospitals. For benchmarking antibiotic use within and across hospitals, adjustment for CMI may be a useful tool in order to take into account the differences in hospital category and patients' morbiditie

Candida auris - recommendations on infection prevention and control measures in Switzerland.

Candida auris, a globally emerging pathogen, has been repeatedly introduced into European healthcare settings, leading to large and long-lasting nosocomial outbreaks. The pathogen has already been isolated in Switzerland, requiring clinicians and microbiologists to become alert. This is the first comprehensive guidance document on prevention and control of C. auris in Swiss acute care hospitals. It brings to light the most recent evidence from published original articles and reviews. We emphasise the importance of quickly identifying this yeast by means of screening in order to prevent an outbreak that could be difficult to contain. Key containment strategies include reinforcing early detection, hand hygiene, application of strict contact precautions for colonised and infected patients, and thorough specific environmental cleaning and disinfection

South Africa - CGIAR Partnership Results in New Maize Varieties with 30 to 50 percent higher yields

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