137 research outputs found
Clearance of imipenem/cilastatin in acute renal failure patients treated by continuous hemodiafiltration (CAVHD)
No full textIn patients with acute renal failure, who were treated with continuous arteriovenous hemofiltration (CAVH) or continuous arteriovenous hemodiafiltration (CAVHD), we measured clearance rates of imipenem and cilastatin (Tiënam-500®). Literature data on volume of distribution and on the endogenous clearance in normals and in anuric patients and the observed clearance rates by CAVH/CAVHD were used to develop guidelines for dose adaptations. Based on the desired peak levels of imipenem, normal subjects should receive the fixed imipenem/cilastatin dose combination (500 mg/500 mg) q.i.d. and patients with acute renal failure should receive the same dose b.i.d. After starting treatment with either CAVH, CAVHD or continuous venovenous hemofiltration (CVVH), no further dose adjustment is necessary. The non-renal clearance rate of cilastatin is very low compared to that of imipenem. If a patient develops anuria, the clearance rate of imipenem decreases from the normal value of 245 ml/min to 116 ml/min. Clearance rate of cilastatin, however, decreases from 230 ml/min to 3 ml/min. Therefore, in patients with renal failure accumulation of cilastatin will occur. On the other hand, if the patient is treated by CAVHD, the relative contribution of the dialyser clearance to the total drug clearance is much greater for cilastatin than for imipenem. As a result, the accumulation of cilastatin is reversed. During treatment by CAVHD, the clearance rate of imipenem raises 15%-25% and that of cilastatin 335%-600%. For this reason, we conclude that the use of the fixed dose combination (500 mg/500 mg) b.i.d. in patients with acute renal failure treated by CAVHD may be justified.</p
Drug Clearance by Continuous Haemodiafiltration:Results with the AN- 69 Capillary Haemofilter and Recommended Dose Adjustments for Seven Antibiotics
No full textWith continuous arteriovenous haemodiafiltration (CAVHD), time-averaged clearance rates are higher than with intermittent haemodialysis. Indeed, drug removal rates may be high enough to warrant dose adjustment. In this study we measured the rate of drug clearance by CAVHD for 7 commonly used antibiotics: cefuroxime, cefotaxime, ceftazidime, imipenem, ciprofloxacin, tobramycin and vancomycin. By combining our data on clearance rates by CAVHD with literature data on drug distribution volumes and nonrenal clearance rates, we developed guidelines for drug dosage in intensive care patients treated by CAVHD. Dose adjustments during CAVHD treatment were deemed necessary for cefuroxime, ceftazidime, tobramycin and vancomycin.</p
Strategies for controlling non-transmissible infection outbreaks using a large human movement data set
No full textPrediction and control of the spread of infectious disease in human populations benefits greatly from our growing capacity to quantify human movement behavior. Here we develop a mathematical model for non-transmissible infections contracted from a localized environmental source, informed by a detailed description of movement patterns of the population of Great Britain. The model is applied to outbreaks of Legionnaires' disease, a potentially life-threatening form of pneumonia caused by the bacteria Legionella pneumophilia. We use case-report data from three recent outbreaks that have occurred in Great Britain where the source has already been identified by public health agencies. We first demonstrate that the amount of individual-level heterogeneity incorporated in the movement data greatly influences our ability to predict the source location. The most accurate predictions were obtained using reported travel histories to describe movements of infected individuals, but using detailed simulation models to estimate movement patterns offers an effective fast alternative. Secondly, once the source is identified, we show that our model can be used to accurately determine the population likely to have been exposed to the pathogen, and hence predict the residential locations of infected individuals. The results give rise to an effective control strategy that can be implemented rapidly in response to an outbreak
P24.16 A parallel increase of ESBL producing Enterobacteriaceae in the hospital and outpatient setting in the Haarlem region, The Netherlands
No full textEvaluation of the bioNexia Legionella Test, Including Impact of Incubation Time Extension, for Detection of Legionella pneumophila Serogroup 1 Antigen in Urine
No full textABSTRACT
In this study, we compared the bioNexia test (bioMérieux, Marcy-l'Étoile, France), a new immunochromatographic assay for the detection of
Legionella pneumophila
serogroup 1 in urine, with the BinaxNOW urinary antigen test (Alere, Waltham, Massachusetts, USA). After 15 min of incubation (in accordance with the manufacturers' instructions), the sensitivities and specificities were, respectively, 76.5% and 97.2% for the bioNexia test and 87.1% and 100% for the BinaxNOW test. After a prolonged incubation time of 60 min, the sensitivities and specificities increased to, respectively, 89.4% and 97.2% for the bioNexia test and 91.8% and 100% for the BinaxNOW test. When the tests were read after 15 min, the concentration of discrepant urine samples increased the sensitivities to 94.1% for both tests. In conclusion, we found that although the bioNexia test showed lower sensitivity for the detection of
L. pneumophila
antigen in nonconcentrated urine compared to the BinaxNOW test, a prolonged incubation time as well as the use of concentrated samples showed comparable sensitivities for both tests.
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Emerg Infect Dis
No full textAfter a large outbreak of Legionnaires' disease in the Netherlands, we determined risk factors for intensive care unit (ICU) admission and death and the impact of adequate therapy on ICU-free survival among 141 hospitalized patients. Overall mortality rate was 13%, and ICU mortality rate was 36%. Smoking, temperature >38.5 degrees C, and bilateral infiltrates shown on chest x-ray were independent risk factors for ICU admission or death (all p<0.05). Starting adequate therapy within 24 hours after admission resulted in a higher ICU-free survival rate compared to therapy initiation after 24 hours: 78% versus 54%, respectively (p=0.005). However, delay in providing therapy to patients with urinary antigen tests with negative results did not influence outcome. These data suggest that by using the urinary antigen test on admission a more tailored approach to patients with community-acquired pneumonia may be applied
Follow-up of Staphylococcus aureus nasal carriage after 8 years: redefining the persistent carrier state
No full textStudies of Staphylococcus aureus nasal carriage have distinguished three
carriage patterns: persistent, intermittent, and noncarriage. The criteria
used to identify these carriage patterns have been inconsistent. In 1988
the S. aureus nasal carrier index, i.e., the proportion of nasal swab
specimen cultures yielding S. aureus, was determined for 91 staff members
of various departments of a large university hospital by obtaining weekly
nasal swab specimens for culture over a 12-week period. Thirty-three (36%)
persons had carrier indices of 0.80 or higher, 15 (17%) had indices
between 0.1 and 0.7, and 43 (47%) had indices of zero. In 1995, 17
individuals with carrier indices of 0.80 or higher in 1988 were available
for reexamination. For 12 (71%) of these individuals, S. aureus was again
isolated from a single nasal swab, i.e., from each individual with a 1988
carrier index of 1.0 but from only half of those with indices below 1.0.
Genotyping (by randomly amplified polymorphic DNA analysis and
pulsed-field gel electrophoresis) of all S. aureus strains showed that
strains isolated from only three individuals, all with 1988 carrier
indices of 1.0, in 1988 and 1995 showed genetic similarity. In conclusion,
persistent S. aureus nasal carriage is a unique characteristic of a
fraction of the population, and the attribute "persistent" should be
confined to those individuals for whom serial nasal swab specimen cultures
consistently yield S. aureus
Use of surface water in drinking water production associated with municipal Legionnaires' disease incidence
No full textSTUDY OBJECTIVES: Given an observed geographical variation in Legionnaires' disease incidence in The Netherlands, the aim of the study was to test the hypothesis that the type of drinking water production was an independent determinant of the incidence of Legionnaires' disease. DESIGN: For the 1987-2005 period, the incidence of Legionnaires' disease in The Netherlands and the price of water as a proxy for production type was studied at the municipal level. The data on the price of water were available at the municipal level. METHODS: For each of the 466 municipalities in The Netherlands a mean standardised incidence rate per 100,000 inhabitants over the 1987-2005 period was calculated, excluding patients with the most probable source of infection abroad or in hospital. Logistic regression was used to assess the relation of the price of water to the incidence rates. In order to control for diagnostic and inclusion bias, they were estimated using questionnaire data collected from all 62 medical microbiology laboratories in the country. MAIN RESULTS: The incidence of Legionnaires' disease varied between municipalities from 0.0 to 5.6 per 100,000 person-years. In univariate analysis high versus low water price was positively associated with a high municipal incidence rate (odds ratio (OR) 1.9; 95% CI 1.5-2.6). The association persisted (OR 5.1; 95% CI 3.2-8.0) after correction for diagnostic and inclusion bias. CONCLUSIONS: The price of water as a proxy for the type of water production was an independent risk factor for high municipal Legionnaires' disease incidence in The Netherlands. This can guide future prevention policie
Antibiotic Resistance Pattern of Isolated Strains of Staphylococcus Aureus from Personnel Nasal Specimens in Meshgin Shahr Valiasr Hospita
No full textBackground & Objectives: Staphylococcus aureus is known as an important pathogen causing a variety of bacterial infections. Treatment of this bacterium with antibiotics has led to antibiotic-resistancy, especially against methicillin (MRSA) and more recently rare resistance against vancomycin. The aims of this study were to determine nasal carriage rates of S. aureus in Meshgin Shahr Valiasr hospital's personnel and to determine antibiotic-resistance patterns in the mentioned isolates.
Methods: Staphylococcus aureus isolates were collected from the nose of 200 hospital personnel in Meshgin Shahr Valiasr hospital in a 2 month period in 2006. Antibiotic sensitivity of the collected strains were tested against antibiotics used in routine treatment of S. aureus infections. Oxacillin agar was also used to screen for MRSA according to NCCLS recommendation.
Results: Our results showed there were 45% and 16% nasal carrier for S. aureus and MRSA (methicillin resistant staphylococcus aureus) strains, respectively in hospital personnel. Thirty two isolates were able to grow in oxacillin agar media, indicating 35% MRSA strains. Antibiotic resistant pattern of strains in disk method were as follows: 35% to oxacillin, 97.8% to penicillin, 34% to erythromycin, 2.1% to chloramphenicol, 39.36% to tetracycline, 11.7% to gentamicin, 30.85% to trimetohoprim sulfamethoxazol and 19% to clindamycin. All of the isolates were sensitive to vancomycin and ciprofloxacin.
Conclusion: In this study, nasal carriage rate of Staphylococcus aureus among hospital Personnel was more than community expected rate (%40) and lower than hospital expected rate (%50-80). All of the test strains were sensitive to Vancomyci
High mass photon pairs in lepton+ lepton-gamma gamma events at LEP
No full textHigh mass photon pairs in lepton+ lepton-gamma gamma events at LEP Adriani, O.; Aguilar-Benitez, M.; Ahlen, S.P.; Alcaraz, J.; Aloisio, A.; Alverson, G.; Alviggi, M.G.; Ambrosi, G.; Linde, F.L. Published in: Physics Letters B DOI: 10.1016/0370-2693(92)91576-U Link to publication Citation for published version (APA): Adriani, O., Aguilar-Benitez, M., Ahlen, S. P., Alcaraz, J., Aloisio, A., Alverson, G., ... Linde, F. L. (1992). High mass photon pairs in lepton+ lepton-gamma gamma events at LEP. Physics Letters B, 295,[337][338][339][340][341][342][343][344][345][346] https://doi.org/10.1016/0370-2693(92)91576-U General rights It is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulations If you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: https://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Download date: 28 Jun 2019 Physics Letters B 295 (1992) From the analysis of the reactions e + e-~ g + g-(n?) (g = e, #, ~) we observe four events, one e+e -~'7 and three #+ ~-??, with the invariant mass of the photon pairs close to 60 GeV. These events were selected from a data sample collected in the L3 detector corresponding to 950000 produced Z°'s. More data are necessary to ascertain the origin of these events
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