Antibiotic optimization. An evaluation of patient safety and economic outcomes

BACKGROUND: Although numerous reports have described interventions designed to influence antibiotic utilization, to our knowledge none have been evaluated in a randomized study. METHODS: Adult inpatients receiving 1 or more of 10 designated parenteral antibiotics for 3 or more days during a 3-month period were randomized to an intervention (n = 141) and a control (n = 111) group using an unblocked, computer-generated random number table. Obstetric patients and those seen in infectious disease consultation were excluded. The intervention group received antibiotic-related suggestions from a team consisting of an infectious disease fellow and a clinical pharmacist. Both groups were evaluated for clinical and microbiological outcomes as well as antibiotic utilization via prospective chart reviews and analysis of the hospital's administrative database. RESULTS: Sixty-two (49%) of the intervention group patients received a total of 74 suggestions. Sixty-three (84%) of these suggestions were implemented; the majority involved changes in antibiotic choice, dosing regimen, or route of administration. Per patient antibiotic charges were nearly $400 less in the intervention group vs controls (P = .05). Almost all the savings were related to lower intravenous antibiotic charges. Clinical and microbiological response, antibiotic-associated toxic effects, in-hospital mortality, and readmission rates were similar for both groups. Multiple linear regression analysis identified randomization to the intervention group and female sex as the sole predictors of lower antibiotic charges. There was a trend toward a shorter length of stay for the intervention group (20 vs 24.7 days, P = .11). CONCLUSIONS: This is the first randomized study to evaluate whether antibiotic choices can be influenced in a cost-effective fashion without sacrificing patient safety. We demonstrate that 50% of patients initially treated with expensive parenteral antibiotics can have their regimens refined after 3 days of therapy and that these modifications result in good clinical outcomes with a substantial reduction in antibiotic expense.     

On the effect of high-pressure treatment on the surface activity of β-casein

High-pressure treatment (up to 800 MPa) of the milk protein β-casein has an insignificant effect on the time-dependent surface tension of a dilute solution of this disordered protein at pH 7. This is in contrast to a solution of globular protein, bovine serum albumin (BSA), which is substantially affected at 200 MPa and above.     

Economic Preparation of Woven Cotton Fabrics

Presented to the Society's Manchester Region on 21 March 1985 Developments in the use of hydrogen peroxide allow major cost savings in bleaching cotton fabrics without loss of preparation quality. These developments make maximum use of the desizing and bleaching properties of hydrogen peroxide. Higher than normal alkali concentrations are used and this requires effective stabilisers. The paper considers important factors in developing more economic preparation by cold pad bleaching or pad-steam processing, requiring only one pass through a steamer.     

Combination antiretroviral therapy including a protease inhibitor eliminated the transfusion requirements of HIV-infected individuals with anemia of chronic disease

We report a case of intracoronary embolization of a ring marker on a stent sheath. The Microsnare device was unsuitable because of the distal position of the marker. After failing to retrieve the marker using an over-the-wire balloon and the two-wire technique, we succeeded in removing the marker using a balloon-on-wire system.     

Differential modulation of protein kinase C isozymes in rat parotid acinar cells. Relation to amylase secretion

We investigated the expression, distribution, and activation parameters of protein kinase C (PKC) isozymes in isolated rat parotid acinar cells. By analyzing cellular extracts by western blot analysis and for isozyme-specific RNA, the Ca(2+)-independent PKC-delta, -epsilon, and -zeta were detected in the cytosolic, particulate (plasma membrane), and nuclear fractions of unstimulated cells, whereas the Ca(2+)-dependent PKC-alpha was confined to the cytosolic and particulate fractions. The expressed isozymes showed distinct responses to phorbol 12-myristate 13-acetate (PMA), thymeleatoxin, and cell surface receptor agonists with respect to translocation from cytosol to particulate fraction and nucleus, as well as sensitivity to down-regulation caused by prolonged exposure to PMA (3-20 hr). The marked susceptibility to down-regulation displayed by PKC-alpha and -delta was accompanied by an enhanced secretory response to norepinephrine as compared with control cells. Further, the selective PKC inhibitors Ro 31-8220 and CGP 41,251 also produced a concentration-dependent enhancement of norepinephrine-induced amylase secretion. Our findings suggest that PKC-alpha or -delta plays a negative modulatory role, rather than an obligatory role, in amylase secretion. Also, the localization and redistribution of PKC-epsilon and -delta to the nucleus by PKC activators imply that one or both of these isozymes may regulate such processes as cellular proliferation and/or differentiation.     

Increased physiological dead space/tidal volume ratio during exercise in burned children

During a transjugular intrahepatic portosystemic shunt (TIPS) procedure, a Strecker stent was accidently pushed into the superior mesenteric vein. After successful shunt placement, the stent was withdrawn into the hepatic vein. A multipurpose basket catheter was attached to the distal end of the stent and a loop snare to the proximal end. In this way it was possible to stretch the stent and retrieve it percutaneously through the jugular sheath.     

Neutron reflectivity study of the competitive adsorption of β-casein and water—soluble surfactant at the planar air-water interface

Application of the technique of specular neutron reflection to the study of adsorbed layer structure is illustrated for the case of β-casein at the air—water interface in the presence and absence of nonionic water—soluble surfactant C₁₂E₆. Guinier analysis of reflectivity data for a 5 × 10⁻³ wt% solution of pure β-casein in air-contrast-matched water (8 vol% D₂O) at pH 7.0 gives a time-independent adsorbed amount of 2.05 ± 0.10 mg/m2 and an adsorbed layer thickness of 1.65 ± 0.07 nm; these values are found to increase quite substantially as the pH is reduced towards the protein's isoelectric point. In the presence of surfactant the loss of reflectivity is a direct measure of protein displacement from the interface because the hydrogenated surfactant is almost contrast matched to the aqueous phase. At a C₁₂E₆ concentration in the range 2–2.5 × 10⁻⁴ wt% (surfactant: protein molar ratio, R ≈ 2.2), there is roughly half the protein lost from the interface but little change in adsorbed layer thickness as inferred from the slopes of the Guinier plots. Protein is effectively completely removed from the surface for R 10. These results are in semi-quantitative agreement with complementary competitive adsorption data for β-casein in soya oil-in-water emulsions.