Early Appropriate Parenteral Antimicrobial Treatment of Complicated Skin and Soft Tissue Infections Caused by Methicillin-Resistant Staphylococcus aureus

Abstract Background: Complicated skin and soft tissue infections (cSSTIs) are a major clinical problem, in part because of the increasing resistance of infecting bacteria to our current antibiotic therapies. Prompt appropriate treatment of infections in hospitalized patients reduces the mortality rate. Furthermore, appropriate and timely antibiotic therapy improves outcomes for cSSTIs caused by methicillin-resistant Staphylococcus aureus (MRSA). This review delineates factors to consider in the choice of initial antibiotic treatment for cSSTIs and describes the antimicrobial agents available or under clinical development for the treatment of cSSTIs caused by MRSA. Methods: Review of the pertinent literature and recommendations. Results: The choice of antimicrobial agent for empiric treatment of cSSTIs should be guided by the site and type of infection, the presence of an immunocompromised state or neutropenia, and risk factors for hospital-acquired MRSA (HA-MRSA) or community-associated MRSA (CA-MRSA) infection. Most CA-MRSA strains remain susceptible to ciprofloxacin, clindamycin, gentamicin, and trimethoprim/sulfamethoxazole, although resistance to clindamycin can emerge during treatment. Of the agents available for the treatment of HA-MRSA cSSTIs, vancomycin has been the reference standard, but clinical failures have been reported increasingly. Alternative agents for HA-MRSA include linezolid, which has been well-studied for treatment of cSSTIs, as well as daptomycin and tigecycline. A number of antibiotic agents are undergoing clinical trials or are under development for the treatment of cSSTIs caused by MRSA. Conclusions: Severe and progressive cSSTIs should be treated promptly with appropriate antibiotic agents. The choice of agent should be guided by a number of factors, including suspected CA-MRSA or HA-MRSA infection. Available agents should be evaluated carefully for efficacy in the treatment of MRSA cSSTIs.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/63135/1/sur.2008.063.supp.pd

Reliability of home CPAP titration with different automatic CPAP devices

<p>Abstract</p> <p>Background</p> <p>CPAP titration may be completed by automatic apparatus. However, differences in pressure behaviour could interfere with the reliability of pressure recommendations. Our objective was to compare pressure behaviour and effective pressure recommendations between three Automatic CPAP machines (Autoset Spirit, Remstar Auto, GK 420).</p> <p>Methods</p> <p>Sixteen untreated obstructive sleep apnea patients were randomly allocated to one of the 3 tested machines for a one-week home titration trial in a crossover design with a 10 days washout period between trials.</p> <p>Results</p> <p>The median pressure value was significantly lower with machine GK 420 (5.9 +/- 1.8 cm H₂O) than with the other devices both after one night and one week of CPAP titration (7.4 +/- 1.3 and 6.6 +/- 1.9 cm H₂O). The maximal pressure obtained over the one-week titration was significantly higher with Remstar Auto (12.6 +/- 2.4 cm H₂O, Mean +/- SD) than with the two other ones (10.9 +/- 1.0 and 11.0 +/- 2.4 cm H₂O). The variance in pressure recommendation significantly differed between the three machines after one night and between Autoset Spirit and the two other machines after 1 week.</p> <p>Conclusion</p> <p>Pressure behaviour and pressure recommendation significantly differ between Auto CPAP machines both after one night and one week of home titration.</p

Prophylactic Cefazolin Dosing and Surgical Site Infections: Does the Dose Matter in Obese Patients?

Background Most surgical prophylaxis guidelines recommend a 3-g cefazolin intravenous dose in patients weighing ≥ 120 kg. However, this recommendation is primarily based on pharmacokinetic studies rather than robust clinical evidence. This study aimed to compare the prevalence of surgical site infections (SSIs) in obese and non-obese patients (body mass index ≥ 30 kg/m2 and < 30 kg/m2), and those weighing ≥ 120 kg and < 120 kg, who received 2- g cefazolin preoperatively. Methods A retrospective case-control study was conducted in adult elective surgical patients. Patients receiving 2- g cefazolin were grouped as obese and non-obese, and by weight (≥ 120 kg or < 120 kg). The 90-day prevalence of SSI and potential contributing factors were investigated. Results We identified 152 obese (median 134 kg) and 152 non-obese control (median 73 kg) patients. Baseline characteristics were similar between groups, except for an increased prevalence in the obese group of diabetes (35.5% vs 13.2%; p < 0.001) and an American Society of Anaesthesiologists Score of 3 (61.8% vs 17.1%; p < 0.001). While not statistically significant, the prevalence of SSI in the obese group was almost double that in the non-obese group (8.6% vs 4.6%; p = 0.25) and in patients weighing ≥ 120 kg (n = 102) compared to those weighing < 120 kg (n = 202) (9.8% vs 5.0%; p = 0.17). Conclusion The prevalence of SSI was not significantly increased in obese patients, or those weighing ≥ 120 kg, who received cefazolin 2- g prophylactically; however, trends toward an increase were evident. Large-scale randomised trials are needed to examine whether a 2-g or 3-g cefazolin is adequate to prevent SSI in obese (and ≥ 120 kg) individuals

Influence of Social Media Practices on the Fusion of Strategies Within Organisations

Part 5: Social Media and Open ComputingInternational audienceContemporary information technologies such as social media have brought into question the usefulness of the alignment perspective in understanding the role and influence of technology in organisational strategy. This has prompted some scholars to argue for a fusion view of Information Systems (IS) which sees IS as integral to business strategy. Despite the suggestion of the fusion view, there is little empirical evidence of how the fusion of strategy is realised. For instance, literature suggests that executives are struggling with how to implement social media strategy within an organisation. This paper uses the strategy as practice lens guided by the interpretivist philosophy to explore the influence of social media practices on the fusion of strategies within an organisation. The paper uses empirical evidence from the case study of a telecom organisation in Tanzania to gain theoretical insight into the role of social media in organisational strategy. This research contributes to the management literature by arguing that the fusion of strategy is achieved by the intertwinement of historical background, context, technological advances and social intent. Also, it contributes to IS literature by showing how social media extends the IS scope within an organisation while minimizing the need for organisational IT infrastructure. In practice, this research highlights the significance of informal social media practices such as WhatsApp communication in organisational processes such as knowledge sharing and customer service