Triple combination antibiotic therapy for carbapenemase-producing Klebsiella pneumoniae: a systematic review

Abstract Background The spread of carbapenemase-producing K. pneumoniae (CPKP) has become a significant problem worldwide. Combination therapy for CPKP is encouraging, but polymyxin resistance to many antibiotics is hampering effective treatment. Combination therapy with three or more antibiotics is being increasingly reported, therefore we performed a systematic review of triple combination cases in an effort to evaluate their clinical effectiveness for CPKP infections. Methods The PubMed database was searched to identify all published clinical outcomes of CPKP infections treated with triple combination therapy. Articles were stratified into two tiers depending on the level of clinical detail provided. A tier 1 study included: antibiotic regimen, regimen-specific outcome, patient status at onset of infection, and source of infection. Articles not reaching these criteria were considered tier 2. Results Thirty-three studies were eligible, 23 tier 1 and ten tier 2. Among tier 1 studies, 53 cases were included in this analysis. The most common infection was pneumonia (31%) followed by primary or catheter-related bacteremia (21%) and urinary tract infection (17%). Different combinations of antibiotic classes were utilized in triple combinations, the most common being a polymyxin (colistin or polymyxin B, 86.8%), tigecycline (73.6%), aminoglycoside (43.4%), or carbapenem (43.4%). Clinical and microbiological failure occurred in 14/39 patients (35.9%) and 22/42 patients (52.4%), respectively. Overall mortality for patients treated with triple combination therapy was 35.8% (19/53 patients). Conclusions Triple combination therapy is being considered as a treatment option for CPKP. Polymyxin-based therapy is the backbone antibiotic in these regimens, but its effectiveness needs establishing in prospective clinical trials

An Expert Consensus Statement on the Management of Large Chondral and Osteochondral Defects in the Patellofemoral Joint

© The Author(s) 2020. Background: Cartilage lesions of the patellofemoral joint constitute a frequent abnormality. Patellofemoral conditions are challenging to treat because of complex biomechanics and morphology. Purpose: To develop a consensus statement on the functional anatomy, indications, donor graft considerations, surgical treatment, and rehabilitation for the management of large chondral and osteochondral defects in the patellofemoral joint using a modified Delphi technique. Study Design: Consensus statement. Methods: A working group of 4 persons generated a list of statements related to the functional anatomy, indications, donor graft considerations, surgical treatment, and rehabilitation for the management of large chondral and osteochondral defects in the patellofemoral joint to form the basis of an initial survey for rating by a group of experts. The Metrics of Osteochondral Allografts (MOCA) expert group (composed of 28 high-volume cartilage experts) was surveyed on 3 occasions to establish a consensus on the statements. In addition to assessing agreement for each included statement, experts were invited to propose additional statements for inclusion or to suggest modifications of existing statements with each round. Predefined criteria were used to refine statement lists after each survey round. Statements reaching a consensus in round 3 were included within the final consensus document. Results: A total of 28 experts (100% response rate) completed 3 rounds of surveys. After 3 rounds, 36 statements achieved a consensus, with over 75% agreement and less than 20% disagreement. A consensus was reached in 100.00% of the statements relating to functional anatomy of the patellofemoral joint, 88.24% relating to surgical indications, 100.00% relating to surgical technical aspects, and 100.00% relating to rehabilitation, with an overall consensus of 95.5%. Conclusion: This study established a strong expert consensus document relating to the functional anatomy, surgical indications, donor graft considerations for osteochondral allografts, surgical technical aspects, and rehabilitation concepts for the management of large chondral and osteochondral defects in the patellofemoral joint. Further research is required to clinically validate the established consensus statements and better understand the precise indications for surgery as well as which techniques and graft processing/preparation methods should be used based on patient- and lesion-specific factors

High throughput mechanical property testing of materials libraries using fluid, voltage, and piezoelectric

A method for high throughput mechanical property testing of materials libraries. A suitable system, such as an o automated system 100, is provided. A plurality of samples on a substrate are monito red for their response to a force directed by a Force Application source (FAS) 18, where the force applied is selected from thegroup consisting of a fluid, a voltage, a piezoelectric, and a combination thereof

Instrument for high throughput measurement of material physical properties and method of using same

An apparatus and method for screening combinatorial libraries of materials by measuring the response of individual library members to mechanical perturbations is described. The apparatus generally includes a sample holder for containing the library members, an array of probes for mechanically perturbing individual library members, and an array of sensors for measuring the response of each of the library members to the mechanical perturbations. Library members undergoing screening make up a sample array, and individual library members constitute elements of the sample array that are confined to specific locations on the sample holder. During screening, the apparatus mechanically perturbs individual library members by displacing the sample array (sample holder) and the array of probes. Typically, all of the elements of the sample array are perturbed simultaneously, but the apparatus also can also perturb individual or groups of sample array elements sequentially. The flexible apparatus and method can screen libraries of aterials based on many different bulk physical properties, including Young's modulus (flexure, uniaxial extension, biaxial compression, and shear); hardness (indentation), failure (stress and strain at failure, toughness), adhesion (tack, loop tack), and flow (viscosity, melt flow indexing, and rheology), among others

101 -Bringing the BLS Consumer Expenditure Survey into the 21st Century

Laura Paszkiewicz, Bureau of Labor Statistics. Adam Safir, Bureau of Labor Statistics.Increasing evidence in measurement error. Declining response rates. The emergence of new data collection technologies. The need for flexibility in addressing changes in the interviewing environment. These are some of the obstacles the U.S. Bureau of Labor Statistics (BLS) has faced with the Consumer Expenditure (CE) surveys. In 2009, BLS began the Gemini Project to re-imagine and re-design the CEs. In July 2013, BLS released a new design proposal based on input from outside experts and ongoing research. This new design will incorporate many updated features, such as newer technologies like web and smartphone diaries, along with more conventional improvements, including a single sample design using multi-mode collection methods

High throughput mechanical property testing of materials libraries using capacitance

One aspect of the present invention provides instruments for measuring mechanical properties of a combinatorial library of materials. The instruments include at least one capacitor to which a member of a library of material samples is removably secured for testing; at least one voltage source for delivering one or more forces to each library member; and at least one sensing device for monitoring the response each library member to the one or more forces. Another aspect of the present invention provides methods of screening a combinatorial library of materials where the method monitors the responses of a plurality of samples on a substrate to a force induced by a capacitor

High throughput mechanical property testing of materials libraries using a piezoelectric

The present invention provides instruments and methods for screening combinatorial libraries that addresses many of the problems encountered when using conventional instruments. For example, the disclosed instruments can measure mechanical properties of library members in rapid serial or parallel test format, and can perform tests on small amounts of material, which are easily prepared or dispensed using art-disclosed liquid or solid handling techniques. Compared to conventional instruments, the disclosed instruments afford fa"Ster sample loading and unloading, for example, through the use of disposable libraries of material samples