Imipenem resistance of Pseudomonas in pneumonia: a systematic literature review

<p>Abstract</p> <p>Background</p> <p>Pneumonia, and particularly nosocomial (NP) and ventilator-associated pneumonias (VAP), results in high morbidity and costs. NPs in particular are likely to be caused by <it>Pseudomonas aeruginosa </it>(PA), ~20% of which in observational studies are resistant to imipenem. We sought to identify the burden of PA imipenem resistance in pneumonia.</p> <p>Methods</p> <p>We conducted a systematic literature review of randomized controlled trials (RCT) of imipenem treatment for pneumonia published in English between 1993 and 2008. We extracted study, population and treatment characteristics, and proportions caused by PA. Endpoints of interest were: PA resistance to initial antimicrobial treatment, clinical success, microbiologic eradication and on-treatment emergence of resistance of PA.</p> <p>Results</p> <p>Of the 46 studies identified, 20 (N = 4,310) included patients with pneumonia (imipenem 1,667, PA 251; comparator 1,661, PA 270). Seven were double blind, and 7 included US data. Comparator arms included a β-lactam (17, [penicillin 6, carbapenem 4, cephalosporin 7, monobactam 1]), aminoglycoside 2, vancomycin 1, and a fluoroquinolone 5; 5 employed double coverage. Thirteen focused exclusively on pneumonia and 7 included pneumonia and other diagnoses. Initial resistance was present in 14.6% (range 4.2-24.0%) of PA isolates in imipenem and 2.5% (range 0.0-7.4%) in comparator groups. Pooled clinical success rates for PA were 45.2% (range 0.0-72.0%) for imipenem and 74.9% (range 0.0-100.0%) for comparator regimens. Microbiologic eradication was achieved in 47.6% (range 0.0%-100.0%) of isolates in the imipenem and 52.8% (range 0.0%-100.0%) in the comparator groups. Resistance emerged in 38.7% (range 5.6-77.8%) PA isolates in imipenem and 21.9% (range 4.8-56.5%) in comparator groups.</p> <p>Conclusions</p> <p>In the 15 years of RCTs of imipenem for pneumonia, PA imipenem resistance rates are high, and PA clinical success and microbiologic eradication rates are directionally lower for imipenem than for comparators. Conversely, initial and treatment-emergent resistance is more likely with the imipenem than the comparator regimens.</p

L'acolliment al professorat: com ho veuen i com ho viuen els protagonistes

L'article presenta el resultat del treball sobre acollida de nous professionals als centres educatius, que ha elaborat GROC. Partint de la veu dels protagonistes, vol aportar elements d'anàlisi i pautes d'intervenció per als equips directiu

Spanish principals: Motives for accession and difficulties in enacting the role

This work explores the relationships between principals’ motivations for entering the principalship and the difficulties they experienced during their first year as principals. Survey data were collected from a sample of 2042 Spanish principals. They answered a questionnaire assessing intrinsic and extrinsic motivations, difficulties experienced when doing instructional, informational, and administrative tasks, and other personal and contextual characteristics. The scales developed to measure motivations and difficulties displayed adequate psychometric properties. The results showed the preponderance of intrinsic motivations. Administrative mundane tasks were perceived as the most difficult ones. We also found that non-administrative instructional tasks were more difficult for those principals who were more extrinsically motivated. Some gender differences were observed in motivations and difficulties. Women placed lower value on extrinsic motivations than men. Furthermore, while the difficulty of administrative tasks in their first year as principal was placed higher by women than men, those tasks that are more relationship-oriented (i.e. informative and instructional tasks) were rated as more difficult by men than women. Although internal incentives and administrative overload characterize most of the public Spanish principals, some findings pointed to the possibility of other profiles of principals that should be investigated in further studies. Implications for the design of principalship training are also discussed. </jats:p

Risk-factors for acquisition of extended-spectrum β-lactamase-producing Escherichia coli among hospitalised patients

ABSTRACTBetween 1996 and 2002, 103 hospitalised patients yielding one or more clinical isolates of extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) were identified. A significant increase was observed in the incidence of ESBL-EC colonisation or infection during the study period (1.65 episodes/100 000 patient-days in 1996 to 12.6 episodes/100 000 patient-days in 2002; p 0.01). Infection developed in 70 (68%) patients (75 episodes), with surgical site (44%) and urinary tract (17%) infections being the most frequent. Pulsed-field gel electrophoresis showed extensive clonal diversity among the isolates. A case-control study and multivariate analysis identified female gender (OR 2.1; p 0.01), use of a nasogastric tube (OR 3.5; p 0.001) and previous antibiotic therapy (OR 3.9; p < 0.001) as independent variables associated with acquisition of ESBL-EC. The study demonstrated a progressive increase in the number of ESBL-EC isolates in a non-epidemic setting. Most cases of ESBL-EC colonisation or infection occurred in hospitalised patients exposed to invasive procedures and antibiotic pressure

Què es pot fer per millorar la convivencia?: la visió dels docents

A partir de la conferència titulada La millora de la convivència. Tot allò que hom voldria saber i no gosa preguntar, pronunciada el mes de setembre de 2008 com a activitat inaugural del PFZ de la comarca del Montsià, el centenar de docents que hi assistiren hi van poder fer les aportacions o les preguntes que van creure oportunes respecte al tema plantejat a la sessió. En aquest article, s'hi analitzen i s'hi categoritzen les opinions que els mestres i els professors van exposar en relació amb la convivència als centres educatiu

Impact of early central venous catheter removal on outcome in patients with candidaemia

ABSTRACTRemoval of central venous catheters (CVCs) from candidaemic patients is considered the reference standard of care, although this practice is not always possible. The impact of prompt catheter removal on outcome was investigated by analysing data from an active population-based surveillance study in Barcelona, Spain. Patients with candidaemia and a CVC were identified between January 2002 and December 2003. Cases with CVC removal within 2 days were classified as having early CVC removal. Outcome, defined as in-hospital mortality 2–30 days after diagnosis of candidaemia, was determined among hospitalised adults using univariate, Kaplan–Meier and multivariate logistic regression analysis. Outpatients, paediatric patients and those who died or were discharged within 2 days were excluded. The study identified 265 patients with candidaemia and a CVC. Median time from diagnosis of candidaemia to catheter removal was 1 day (range 0–29 days). Overall, 172 patients met the criteria for inclusion in the outcome study. Patients with early CVC removal differed significantly from those with delayed CVC removal. According to univariate, Kaplan–Meier and multivariate analysis, the marker most predictive of in-hospital mortality among candidaemic patients with CVCs was severity of illness. These data suggest that timing of CVC removal may best be determined after carefully considering the risks and benefits to individual patients