The impact of rainfall change on rainwater source control in Beijing

Abstract Background Altered pharmacokinetics in obese patients raise concerns over worse clinical outcomes. This study assessed whether obese patients receiving a beta-lactam (BL) have worse clinical outcomes compared to non-obese patients and to identify if therapeutic drug monitoring (TDM) may be beneficial. Methods This multi-center, retrospective cohort included hospitalized adults admitted from July 2015-July 2017 treated with a BL as definitive monotherapy against a Gram-negative bacilli for ≥72 hours. Patients were excluded if there was lack of source control or if polymicrobial infections required >1 antibiotic for definitive therapy. Patients were classified based on body mass index (BMI): non-obese (BMI ≤29.9 kg/m 2) and obese (BMI ≥30.0 kg/m 2). The primary outcome was clinical treatment failure, and secondary were hospital length of stay (LOS), inpatient all-cause mortality, and 30-day all-cause readmission. Results There were 257 (43.6%) obese patients and 332 (56.4%) non-obese patients included. The most common infections were urinary (50.9%) and respiratory (31.4%). Definitive treatment was driven by 3 rd generation cephalosporins (46.9%) and cefepime (44.7%). Treatment failure occurred in 131 (51%) obese patients and 109 (32.8%) non-obese patients (p<0.001). Obesity and respiratory source were independently associated with increased likelihood of treatment failure. Obese patients were hospitalized longer than non-obese patients (p=0.002), but no differences were found for all-cause mortality (p=0.117) or infection-related readmission (0=0.112). Conclusions Obese patients treated with BLs have higher rates of treatment failure and longer hospitalization periods than non-obese patients. Future studies are needed to assess the impact of TDM and specific dosing recommendations for targeted infection types.

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216. Are Automatic Antimicrobial Stop Orders an Effective Stewardship Tool for Urinary Tract and Intra-Abdominal Infections?

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.260 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S110-S110

Author(s):

Christina Maguire ◽

Dusten T Rose ◽

Theresa Jaso

Keyword(s):

Urinary Tract ◽

Antimicrobial Therapy ◽

Source Control ◽

Clostridioides Difficile ◽

Days Of Therapy ◽

Before And After ◽

The Difference ◽

Tract Infections ◽

Length Of Therapy ◽

The Impact

Abstract Background Automatic antimicrobial stop orders (ASOs) are a stewardship initiative used to decrease days of therapy, prevent resistance, and reduce drug costs. Limited evidence outside of the perioperative setting exists on the effects of ASOs on broad spectrum antimicrobial use, discharge prescription duration, and effects of missed doses. This study aims to evaluate the impact of an ASO policy across a health system of adult academic and community hospitals for treatment of intra-abdominal (IAI) and urinary tract infections (UTI). ASO Outcome Definitions ASO Outcomes Methods This multicenter retrospective cohort study compared patients with IAI and UTI treated before and after implementation of an ASO. Patients over the age of 18 with a diagnosis of UTI or IAI and 48 hours of intravenous (IV) antimicrobial administration were included. Patients unable to achieve IAI source control within 48 hours or those with a concomitant infection were excluded. The primary outcome was the difference in sum length of antimicrobial therapy (LOT). Secondary endpoints include length and days of antimicrobial therapy (DOT) at multiple timepoints, all cause in hospital mortality and readmission, and adverse events such as rates of Clostridioides difficile infection. Outcomes were also evaluated by type of infection, hospital site, and presence of infectious diseases (ID) pharmacist on site. Results This study included 119 patients in the pre-ASO group and 121 patients in the post-ASO group. ASO shortened sum length of therapy (LOT) (12 days vs 11 days respectively; p=0.0364) and sum DOT (15 days vs 12 days respectively; p=0.022). This finding appears to be driven by a decrease in outpatient LOT (p=0.0017) and outpatient DOT (p=0.0034). Conversely, ASO extended empiric IV LOT (p=0.005). All other secondary outcomes were not significant. Ten patients missed doses of antimicrobials due to ASO. Subgroup analyses suggested that one hospital may have influenced outcomes and reduction in LOT was observed primarily in sites without an ID pharmacist on site (p=0.018). Conclusion While implementation of ASO decreases sum length of inpatient and outpatient therapy, it may not influence inpatient length of therapy alone. Moreover, ASOs prolong use of empiric intravenous therapy. Hospitals without an ID pharmacist may benefit most from ASO protocols. Disclosures All Authors: No reported disclosures

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The impact of infectious diseases consultation on the management and outcomes of Pseudomonas aeruginosa bacteraemia in adults: a retrospective cohort study

BMC Infectious Diseases ◽

10.1186/s12879-021-06372-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Fabian Chiong ◽

Mohammed S. Wasef ◽

Kwee Chin Liew ◽

Raquel Cowan ◽

Danny Tsai ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Infectious Diseases ◽

Retrospective Cohort ◽

Source Control ◽

First Episode ◽

Oral Antibiotic ◽

Genotypic Analysis ◽

Infectious Diseases Consultation ◽

Staphylococcal Aureus ◽

The Impact

Abstract Background Pseudomonas aeruginosa bacteraemia (PAB) is associated with high mortality. The benefits of infectious diseases consultation (IDC) has been demonstrated in Staphylococcal aureus bacteraemia and other complex infections. Impact of IDC in PAB is unclear. This study aimed to evaluate the impact of IDC on the management and outcomes in patients with PAB. Methods This is a retrospective cohort single-centre study from 1 November 2006 to 29 May 2019, in all adult patients admitted with first episode of PAB. Data collected included demographics, clinical management and outcomes for PAB and whether IDC occurred. In addition, 29 Pseudomonas aeruginosa (PA) stored isolates were available for Illumina whole genome sequencing to investigate if pathogen factors contributed to the mortality. Results A total of 128 cases of PAB were identified, 71% received IDC. Patients who received IDC were less likely to receive inappropriate duration of antibiotic therapy (4.4%; vs 67.6%; p < 0.01), more likely to be de-escalated to oral antibiotic in a timely manner (87.9% vs 40.5%; p < 0.01), undergo removal of infected catheter (27.5% vs 13.5%; p = 0.049) and undergo surgical intervention (20.9% vs 5.4%, p = 0.023) for source control. The overall 30-day all-cause mortality rate was 24.2% and was significantly higher in the no IDC group in both unadjusted (56.8% vs 11.0%, odds ratio [OR] = 10.63, p < 0.001) and adjusted analysis (adjusted OR = 7.84; 95% confidence interval, 2.95–20.86). The genotypic analysis did not reveal any PA genetic features associated with increased mortality between IDC versus no IDC groups. Conclusion Patients who received IDC for PAB had lower 30-day mortality, better source control and management was more compliant with guidelines. Further prospective studies are necessary to determine if these results can be validated in other settings.

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Does Infection Site Matter? A Systematic Review of Infection Site Mortality in Sepsis

Journal of Intensive Care Medicine ◽

10.1177/0885066615627778 ◽

2016 ◽

Vol 32 (8) ◽

pp. 473-479 ◽

Cited By ~ 5

Author(s):

Christine A. Motzkus ◽

Roger Luckmann

Keyword(s):

Hospital Mortality ◽

Respiratory Infections ◽

Source Control ◽

Soft Tissue Infections ◽

Infection Site ◽

Treatment Protocols ◽

Disease States ◽

Pubmed Database ◽

The Impact ◽

Lower Mortality Risk

Purpose: Sepsis treatment protocols emphasize source control with empiric antibiotics and fluid resuscitation. Previous reviews have examined the impact of infection site and specific pathogens on mortality from sepsis; however, no recent review has addressed the infection site. This review focuses on the impact of infection site on hospital mortality among patients with sepsis. Methods: The PubMed database was searched for articles from 2001 to 2014. Studies were eligible if they included (1) one or more statistical models with hospital mortality as the outcome and considered infection site for inclusion in the model and (2) adult patients with sepsis, severe sepsis, or septic shock. Data abstracted included stage of sepsis, infection site, and raw and adjusted effect estimates. Nineteen studies were included. Infection sites most studied included respiratory (n = 19), abdominal (n = 19), genitourinary (n = 18), and skin and soft tissue infections (n = 11). Several studies found a statistically significant lower mortality risk for genitourinary infections on hospital mortality when compared to respiratory infections. Conclusion: Based on studies included in this review, the impact of infection site in patients with sepsis on hospital mortality could not be reliably estimated. Misclassification among infections and disease states remains a serious possibility in studies on this topic.

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Surgeon-led 7-VINCut Antibiotic Stewardship Intervention Decreases Duration of Treatment and Carbapenem Use in a General Surgery Service

Antibiotics ◽

10.3390/antibiotics10010011 ◽

2020 ◽

Vol 10 (1) ◽

pp. 11

Author(s):

Josep M. Badia ◽

Maria Batlle ◽

Montserrat Juvany ◽

Patricia Ruiz-de León ◽

Maria Sagalés ◽

...

Keyword(s):

Antibiotic Stewardship ◽

Sharp Decrease ◽

Antibiotic Consumption ◽

Source Control ◽

Duration Of Treatment ◽

Development Of Resistance ◽

Multiresistant Bacteria ◽

The Impact ◽

Improve Patient ◽

Therapy Treatment

Antibiotic stewardship programs optimize the use of antimicrobials to prevent the development of resistance and improve patient outcomes. In this prospective interventional study, a multidisciplinary team led by surgeons implemented a program aimed at shortening the duration of antibiotic treatment <7 days. The impact of the intervention on antibiotic consumption adjusted to bed-days and discharges, and the isolation of multiresistant bacteria (MRB) was also studied. Furthermore, the surgeons were surveyed regarding their beliefs and feelings about the program. Out of 1409 patients, 40.7% received antibiotic therapy. Treatment continued for over 7 days in 21.5% of cases, and, as can be expected, source control was achieved in only 48.8% of these cases. The recommendations were followed in 90.2% of cases, the most frequent being to withdraw the treatment (55.6%). During the first 16 months of the intervention, a sharp decrease in the percentage of extended treatments, with R2 = 0.111 was observed. The program was very well accepted by surgeons, and achieved a decrease in both the consumption of carbapenems and in the number of MRB isolations. Multidisciplinary stewardship teams led by surgeons seem to be well received and able to better manage antibiotic prescription in surgery.

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Green–blue water in the city: quantification of impact of source control versus end-of-pipe solutions on sewer and river floods

Water Science & Technology ◽

10.2166/wst.2014.306 ◽

2014 ◽

Vol 70 (11) ◽

pp. 1825-1837 ◽

Cited By ~ 15

Author(s):

K. De Vleeschauwer ◽

J. Weustenraad ◽

C. Nolf ◽

V. Wolfs ◽

B. De Meulder ◽

...

Keyword(s):

Adaptation Strategies ◽

Green Water ◽

Source Control ◽

Strong Reduction ◽

Water Integration ◽

River Flood ◽

River Floods ◽

The Impact ◽

The City ◽

Stormwater Retention

Urbanization and climate change trends put strong pressures on urban water systems. Temporal variations in rainfall, runoff and water availability increase, and need to be compensated for by innovative adaptation strategies. One of these is stormwater retention and infiltration in open and/or green spaces in the city (blue–green water integration). This study evaluated the efficiency of three adaptation strategies for the city of Turnhout in Belgium, namely source control as a result of blue–green water integration, retention basins located downstream of the stormwater sewers, and end-of-pipe solutions based on river flood control reservoirs. The efficiency of these options is quantified by the reduction in sewer and river flood frequencies and volumes, and sewer overflow volumes. This is done by means of long-term simulations (100-year rainfall simulations) using an integrated conceptual sewer–river model calibrated to full hydrodynamic sewer and river models. Results show that combining open, green zones in the city with stormwater retention and infiltration for only 1% of the total city runoff area would lead to a 30 to 50% reduction in sewer flood volumes for return periods in the range 10–100 years. This is due to the additional surface storage and infiltration and consequent reduction in urban runoff. However, the impact of this source control option on downstream river floods is limited. Stormwater retention downstream of the sewer system gives a strong reduction in peak discharges to the receiving river. However due to the difference in response time between the sewer and river systems, this does not lead to a strong reduction in river flood frequency. The paper shows the importance of improving the interface between urban design and water management, and between sewer and river flood management.

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Experimental research on the impact of annular airflow on the spraying flow field: A source control technology of paint mist

Building and Environment ◽

10.1016/j.buildenv.2021.108444 ◽

2021 ◽

pp. 108444

Author(s):

QianwenWang ◽

Jinyu Liu ◽

Junjie Liu ◽

Jiayu Li

Keyword(s):

Flow Field ◽

Experimental Research ◽

Source Control ◽

Control Technology ◽

The Impact

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The Effect of the Covid-19 Lockdown on Air Quality in Three Italian Medium-Sized Cities

Atmosphere ◽

10.3390/atmos11101118 ◽

2020 ◽

Vol 11 (10) ◽

pp. 1118 ◽

Cited By ~ 2

Author(s):

Gabriele Donzelli ◽

Lorenzo Cioni ◽

Mariagrazia Cancellieri ◽

Agustin Llopis Morales ◽

Maria Morales Suárez-Varela

Keyword(s):

Air Quality ◽

Heavy Traffic ◽

Urban Environments ◽

Meteorological Conditions ◽

Control Measures ◽

Source Control ◽

Vehicular Traffic ◽

Urban Centers ◽

Italian Government ◽

The Impact

Despite the societal and economic impacts of the COVID-19 pandemic, the lockdown measures put in place by the Italian government provided an unprecedented opportunity to increase our knowledge of the effect transportation and industry-related emissions have on the air quality in our cities. This study assessed the effect of reduced emissions during the lockdown period, due to COVID-19, on air quality in three Italian cities, Florence, Pisa, and Lucca. For this study, we compared the concentration of particulate matter PM10, PM2.5, NO2, and O3 measured during the lockdown period, with values obtained in the same period of 2019. Our results show no evidence of a direct relationship between the lockdown measures implemented and PM reduction in urban centers, except in areas with heavy traffic. Consistent with recently published studies, we did, however, observe a significant decrease in NO2 concentrations among all the air-monitoring stations for each city in this study. Finally, O3 levels remained unchanged during the lockdown period. Of note, there were slight variations in the meteorological conditions for the same periods of different years. Our results suggest a need for further studies on the impact of vehicular traffic and industrial activities on PM air pollution, including adopting holistic source-control measures for improved air quality in urban environments.

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