Empirical Choice Research Articles

Bacteraemia over 4 years in a Greater Western Sydney Metropolitan Local Health District: a retrospective descriptive study.

Bacteraemia is associated with significant morbidity and mortality. Understanding local patterns of bacteraemia including pathogen distribution, infection source, clinical speciality team burden, susceptibility data and mortality rates can inform empiric antibiotic choices, prevention approaches and education strategies. To obtain descriptive data from positive blood cultures identified from Nepean Blue Mountains Local Health District in Greater Western Sydney. A retrospective descriptive study was performed from August 2018 to March 2023 with data extracted from electronic medical records. A total of 6720 isolates were identified from positive blood cultures, of which 71.2% were clinically significant. The median age was 69 years. A total of 74.6% of clinically significant isolates were acquired in the community. The most commonly isolated pathogen was Escherichia coli (31.3%), followed by Staphylococcus aureus (14.3%), and 8.6% of patients with clinically significant positive blood cultures were neutropenic. Neutropenic patients were more likely to have Pseudomonas aeruginosa as the causative pathogen (11.4%) compared to the entire study population (3.9%). The most commonly identified source of infection was the urinary tract. The 30-day all-cause mortality rate for clinically significant positive blood cultures was 16.8%, with higher mortality rates seen with Candida species (and species previously known as Candida), P. aeruginosa and Enterococcus species. 94% of bacteraemia from Enterobacterales tested susceptible in vitro to ampicillin and/or gentamicin. The rate of methicillin resistance in S. aureus was 24%. This study provides valuable insight into the local epidemiology of bacteraemia,which will allow for targeted prevention, management and educational strategies to improve outcomes.

A Comparison of Causative Pathogens in Bone and Prosthetic Joint Infections: Implications for Antimicrobial Therapy

Background: The microbiological profile of bone and joint infections is important for determining the empiric choice of both systemic and local antimicrobial therapy. This study assessed whether there was a difference in the bacterial species that were isolated on culture in osteomyelitis (OM), fracture-related infection (FRI) or prosthetic joint infection (PJI). This was a retrospective, observational cohort study of patients who had surgical intervention for PJI or OM or FRI with a positive microbial culture between 2019 and 2022. Methods: Data including patient demographics, the site of injury, JS-BACH score, organism classification and antibiotic resistance to vancomycin and gentamicin were extracted from the medical records. Results: A total of 440 patients were included in this study: 163 patients with osteomyelitis, 109 with fracture-related infection with fixation implants and 168 with prosthetic joint infection. The patients with PJI were older, more likely to be female and had a higher BMI and ASA score compared to those with OM. Patients with PJI were more likely to have a higher JS-BACH score and more complex infections. Staphylococcus aureus was the most commonly isolated organism in all three groups. It was more frequently isolated in osteomyelitis than in PJI (p = 0.016). In both osteomyelitis and FRI, after Staphylococcus aureus, the next most common organisms were Gram-negatives, whilst for PJIs, the most commonly isolated organisms were Staphylococcus aureus, followed by coagulase-negative Staphylococci and then Streptococcus species. The rates of other organisms were broadly similar between the three groups. When adjusted for confounders, including symptom duration, JS-BACH score, the location of injury, age and BMI, there was no statistically significant difference in the presence of Staphylococcus aureus (OR = 0.765; 95% CI 0.633–1.232; p = 0.465) or polymicrobial infection (OR = 1.175; 95% CI 0.803–1.721; p = 0.407). Conclusions: Causative pathogens are similar across bone and joint infections and are independent of the presence of prosthetic material.

Doripenem, Ertapenem, and Meropenem Sensitivity in Salmonella Typhi: A Cross-Sectional Study From Pakistan.

Background Salmonella Typhi (S. Typhi) is increasingly resistant to multiple antibiotics, posing a challenge in treatment, particularly in multidrug-resistant (MDR) cases. Carbapenems, including doripenem, ertapenem, and meropenem, have been considered last-resort options. This study evaluates the effectiveness of these carbapenems against S. Typhi isolates in a clinical setting in Peshawar, Pakistan. Objective To assess the effectiveness of the carbapenem antibiotics, doripenem, ertapenem, and meropenem, against S. Typhi. Methods This study collected data from blood cultures of patients diagnosed with S. Typhi infections at the Hayatabad Medical Complex in Peshawar, Pakistan for two years: from January 1, 2022, to December 31, 2023. Sensitivity testing was performed using the disk diffusion method in accordance with Clinical and Laboratory Standards Institute (CLSI) guidelines.The analysis examined the sensitivity rates of the three antibiotics and compared their effectiveness. Results A total of 626 S. Typhi isolates were tested. Only 11.98% of the isolates were sensitive to doripenem, while 88.02% were resistant to it. In contrast, 35.5% of the isolates responded to ertapenem, with 64.5% being resistant. Meropenem showed the highest efficacy, with 42.7% of the isolates demonstrating sensitivity. These findings highlight the growing challenge of managing multidrug-resistant (MDR) S. Typhi infections, especially in regions where resistance to carbapenems is becoming prevalent. Conclusion Meropenem proved to be more effective against S. Typhi compared to doripenem and ertapenem. The study emphasizes the need for ongoing monitoring of resistance patterns and the exploration of alternative or combination treatment options. These findings have immediate clinical implications for empiric therapy choices and highlight the urgent need for antibiotic stewardship programs in endemic regions.

Microbiological Profile of Periprosthetic Joint Infections: A Retrospective Analysis from North India

With the rise in total joint arthroplasties, prosthetic joint infections (PJIs) have become a significant complication, leading to high morbidity. The causative organisms of PJIs vary by region, and the rates of drug-resistant organisms are growing, thus complicating the initial empiric choice of antibiotics. This retrospective study analyzed records of patients with orthopedic implants and intraoperative tissue samples sent for sonication and culture at a tertiary care hospital in India. The most common organism was Staphylococcus aureus (14 out of 86 bacterial isolates, 16.3%), followed by Pseudomonas aeruginosa (12 out of 86, 13.9%), and both Staphylococcus epidermidis and Klebsiella pneumoniae (11 each out of 86, 12.8%). There was a high prevalence of multidrug-resistant organisms, and 35% of the gram-negative organisms were carbapenem resistant. Our study reveals that in our setting, PJIs are chiefly driven by multidrug resistant gram-negative bacteria.

69 Urinary tract infections in preterm infants: Review in two Canadian tertiary centers

Abstract Background Urinary tract infections (UTI) in premature infants are commonly seen in the neonatal intensive care unit (NICU). The reported prevalence of UTI in this population ranges from 1.9-12.2% due to the lack of standardized criteria for UTI among infants less than two months of age. Enterococcus and Enterobacteriaceae are well known to cause UTI and their resistance pattern has been reported to be rising in the neonatal nosocomial infections worldwide. Objectives To describe the epidemiology, microbiology, and antimicrobial treatment for UTI in premature infants based on different diagnostic criteria. Design/Methods This retrospective study (2019-2022) included infants born at <33 weeks of gestational age (GA) with positive urine cultures and ≥5 days of antimicrobials treatment. We collected data from two tertiary level NICUs in Canada, including demographics, microbial susceptibility patterns, urinalysis and imaging results, and antibiotic treatment. Results We identified 43 infants managed as UTI based on physicians’ discretions. The median GA at birth was 26-27 weeks, while the median onset of first UTI ranged 39-80 days, with male predominance [Table 2]. Mixed growth of organisms constituted 21-42% of cases of UTI [Table 1]. Among UTI cases with only single growth organism, we found 53.5% and 18.6% cases fulfilled UTI diagnostic criteria based on the concentration of colony forming units (CFU) of >104/mL or >107/L and >105/mL or >108/L, respectively [Table 1]. Of these cases, 67.4% of infants had urinalysis sent with the culture, and the higher the concentration of CFU, the more likely the samples showed positive nitrites on urinalysis, with 100% correlation among those with CFU >105/mL or >108/L. [Table 1] The most common pathogens were Enterococcus species, E.Coli, Klebsiella species, Citrobacter species and Enterobacter cloacae complex [Table 2]. Among gram negative bacilli (E. Coli and Klebsiella species), greater than 42-80% were resistant to 3rd generation cephalosporins (3GC). We did not identify any vancomycin-resistant Enterococcus strains. Median duration of antimicrobial treatment ranged from 8-13 days, depending on the diagnostic criteria applied. At least 10% of infants with UTI showed abnormalities on kidney ultrasound [Table 2]. Conclusion There exists a large variation in UTI prevalence according to different diagnostic criteria. Abnormal urinalysis with presence of nitrites were frequently associated with UTI of high CFU count. High resistance to 3GC among gram negative bacilli was concerning and carried an impact on the appropriate empirical treatment choice.

Weighted-Incidence Syndromic Combination Antibiogram (WISCA) to Support Empirical Antibiotic Therapy Decisions in Infected Ischemic Leg Ulcers-A Feasibility Study.

Objective: Patients with peripheral artery occlusive disease (PAD) are at risk of developing foot ulcers, which can subsequently lead to foot infections and an increased risk of amputation. In cases of severe ischemic foot infections (IFIs), the empirical use of antibiotics can be limb-saving. However, there is currently no evidence-based guidance on the choice of empirical antibiotic therapy for IFI. Methods and Design: This retrospective single-center cohort study included 216 hospitalized patients with severe IFI undergoing endovascular revascularization. Weighted-Incidence Syndromic Combination Antibiograms (WISCAs) were calculated to guide empirical antibiotic choice. Results: The two most common causative pathogens for IFI were S. aureus and P. aeruginosa, with frequencies of 19.8% and 6.1%, respectively. The calculation of WISCAs revealed a low empirical coverage of amoxicillin (AMX) or clindamycin (CLN) with 21.6% and 27.7%, respectively. The empirical coverage of amoxicillin/clavulanic-acid (AMC), trimethoprim/sulfmethoxazole (SXT), and ciprofloxacin (CIP) was 50.6%, 53.1%, and 55.4%, respectively. Piperacillin/tazobactam (PT) exhibited the highest empirical coverage, with 82.5% as calculated by WISCAs. The calculated WISCAs did not significantly alter when stratified by the clinical characteristics of the patients. Conclusions: The empirical antibiotic coverage of CLN and AMX was low. SXT represents a promising empirical alternative in the case of IFI, irrespective of comorbidities and the WIfI score. WISCAs can assist in the decision-making process regarding empirical antibiotic therapy choices in cases of IFI.

Increasing Burden of Antibiotic Resistance in Children Suffering from Septicemia in Tertiary Care Hospitals

Abstract Introduction/Objective Invasion of the bloodstream by microorganisms constitutes one of the most serious situations in infectious disease. Children are the most susceptible groups to contract diseases specifically Blood Stream Infections (BSIs). BSIs have been considered to be the main cause of morbidity and mortality in children. It is associated with a high mortality rate of 20%–50%. The emerging causative agents and resistance to various antimicrobial agents are increasing from time to time. Methods/Case Report The present study was carried out to confirm the causative agents and their antibacterial susceptibility pattern in children with septicemia at Tertiary Care Hospitals, Peshawar, KP, Pakistan. This cross- sectional study involved about 873 pediatric patients (≤ 13 years). BACTEC BD 9050 system was used to identify the causative organism, and sub-cultures were done on MacConkey Agar and Blood Agar. The antibiotic susceptibility test was done using the Kirby Bauer Disk diffusion method as per CLSI guidelines. Results (if a Case Study enter NA) Among 873 study subjects 568 (65.06 %) were males followed by 305 (34.93 %) females. Out of the 873 tested blood samples, blood cultures were positive in 83 (9.51%) followed by 122 (13.98%) skin contaminants, and no growth was observed in 668 (76.51%) cases. The majority 43 (51.80 %) of them were neonates (≤ 28 days). Gram-positive and Gram-negative bacteria constituted 58 (69.87%) and 25 (30.13%), respectively. The most frequent pathogen found was Staphylococcus aureus 54 (65.06 %), followed by Klebsiella spp., E. coli, and Pseudomonas aeruginosa 6 (7.22 %), Salmonella spp. 5 (6.02 %) Enterococcus faecalis 3 (3.61 %), Acinetobacter baumannii 2 (2.40 %) and Staphylococcus epidermidis 1 (1.20 %). In Staphylococcus aureus about 6 (11.11) were MRSA. The majority of bacterial isolates showed high resistance to Ciprofloxacin, Ceftazidime, Cefuroxime, Co-trimoxazole, Cefepime, Cefotaxime, Minocycline, Tobramycin, Cefoxitin and Cephradine that are commonly used in the study area. Conclusion The majority of the isolates were multidrug resistant. These higher percentages of multi-drug resistant emerged isolates urge us to take infection prevention measures and to conduct other large studies for appropriate empiric antibiotic choice.

FedADMM-InSa: An inexact and self-adaptive ADMM for federated learning

Federated learning (FL) is a promising framework for learning from distributed data while maintaining privacy. The development of efficient FL algorithms encounters various challenges, including heterogeneous data and systems, limited communication capacities, and constrained local computational resources. Recently developed FedADMM methods show great resilience to both data and system heterogeneity. However, they still suffer from performance deterioration if the hyperparameters are not carefully tuned. To address this issue, we propose an inexact and self-adaptive FedADMM algorithm, termed FedADMM-InSa. First, we design an inexactness criterion for the clients’ local updates to eliminate the need for empirically setting the local training accuracy. This inexactness criterion can be assessed by each client independently based on its unique condition, thereby reducing the local computational cost and mitigating the undesirable straggle effect. The convergence of the resulting inexact ADMM is proved under the assumption of strongly convex loss functions. Additionally, we present a self-adaptive scheme that dynamically adjusts each client’s penalty parameter, enhancing algorithm robustness by mitigating the need for empirical penalty parameter choices for each client. Extensive numerical experiments on both synthetic and real-world datasets have been conducted. As validated by some tests, our FedADMM-InSa algorithm improves model accuracy by 7.8% while reducing clients’ local workloads by 55.7% compared to benchmark algorithms.

Do investor reactions to merger announcements shape the writing of SEC filings?

The way filings of mergers and acquisitions (M&A) with the Security Exchange Commission (SEC) are written might depend on investor reactions to initial public announcements of the deal. We examine this investor feedback hypothesis by focusing on the readability and timing of a large sample of SEC documents. We show that acquirers write documents with lower readability and file them faster when investors react negatively to the deal announcement, a finding consistent with strategic obfuscation efforts. The results are robust to alternative empirical choices, such as controlling for deal complexity or the firm's writing style. They are also confirmed using an instrumental variables approach.

Choice of Empirical Treatment in Patients With Wound Infection

Objective: We aimed to determine the distribution of infectious agents in wound culture specimens, their resistance rates, and to evaluate empirical treatment choices in wound infections. Methods: Wound culture results of adult patients between 2016-2020 were retrospectively investigated. Determination of bacteria and antibiotic sensitivity tests were done using conventional methods and automatized systems. Results: A total of 2576 wound specimens were sent, and significant bacterial growth was detected in 1254 (48.7%). Most frequently isolated agent was Escherichia coli (E.coli) (24.2%), followed by Staphylococcus aureus (S.aureus) (16.8%). The highest rate of resistance in Enterobacterales species was against amoxicillin-clavulanate (AMC), except Proteus mirabilis. Antibiotics that Enterobacterales species were most sensitive were amikacin and carbapenems, while it was trimethoprim – sulfamethoxazole (TMP-SXT) for Acinetobacter baumannii, and amikacin for Pseudomonas aeruginosa. The highest rate of resistance in S.aureus strains was against penicillin, with a methicillin resistance rate of 22.9%, while no resistance was found against vancomycin. Conclusion: Initial treatment in wound infections is empirical, and the range of treatment is narrowed when results of culture and sensitivity tests are obtained. Clindamycin, AMC, TMP – SXT and ciprofloxacin seem to be appropriate for outpatients, while TMP-SXT or vancomycin for gram-positive cocci, and TMP-SXT and amikacin combination for gram – negatives, and carbapenems as a last resort.

Antimicrobial Resistance in Uropathogens Associated with Community Acquired Urinary Tracts Infections in Port Harcourt, Nigeria

Introduction: Antimicrobial resistance (AMR) in uropathogens remain an intractable public health concern due to the associated mortality, morbidity and economic and manpower losses worldwide. This retrospective study was aimed at ascertaining the prevalence of the bacterial uropathogens and the antimicrobial resistance patterns of the dominant strains. Methodology: It involved a review of laboratory records of the over 1426 males (38%) and females (62%) of various s age brackets between January 1, 2021 and December 31, 2022. Results: Out of 1426 urine culture samples 58.5% were negative cultures while 592 (41.5%) yielded bacterial growths. A total of 403 uropathogens comprising 11 species were obtained. Gram negative bacteria constitute 73.9% of the isolates while gram positive bacteria were 26.1% Escherichia coli (54.7%) was the dominant strains, followed by Staphylococcus aureus (10.3%, Enterococcus faecalis (9.5%), Proteus mirabilis (7.7%, Staphylococcus saprophyticus (5.7%, Streptococcus pneumoniae (3.9%), Klebsiella pneumoniae 17 (3.0%), Pseudomonas aeruginosa (2.7%), Enterobacter cloacae (1.1%), Acinetobacter baumannii (0.9%) and Serratia marcescens (0.5%). A cumulative of 50.5% of the strains were resistant to at least on antimicrobial agent. The most resistant uropathogen was Pseudomonas aeruginosa with a resistant profile of 64.1%, followed by Klebsiella pneumoniae (63.7%), Staphylococci (55.7%), Streptococcus pneumoniae (55.2%), Acinetobacter baumannii (51.7%), Proteus mirabilis (51.4%), Escherichia coli (48.0%), Enterobacter cloacae (47.1%), Enterococcus faecalis (46.5%) and Serratia marcescens (43.3%) The least effective antimicrobial agent was nitrofurantoin which resisted by 87.1% strains, the most effective was streptomycin (22.2%). Conclusion: This study will benefit healthcare practitioners in the empirical choice of antibiotics against UTI; however, the high prevalence of AMR necessitates conduct of urine cultures to identify particular uropathogens appropriate antimicrobials in other to curtail increase in AMR among uropathogens.

Perfil epidemiológico y microbiológico de la primera infección urinaria en una población pediátrica

Introduction: urinary tract infection (UTI) is the second cause of bacterial infection in children, generates high costs for the health system, may be the first manifestation of urinary tract anomalies and is a risk factor for multiple pathologies. Objective: to characterize the epidemiological and microbiological profile of the first UTI episode in the pediatric population of a referral center in Pereira, Colombia. Methods: a cross-sectional study, conducted during 2016- 2017, including patients aged 2 months to 10 years, with their first UTI episode, based on the American Academy of Pediatrics criteria. Bacterial resistance was defined using current CLSI (Clinical and Laboratory Standards Institute) guidelines. Descriptive statistics and STROBE guidelines were used for reporting this study results. Results: 81 patients were included, 28% were males, most were aged 2 to 12 months (40%), 49% were nitrite-positive, 39% had hematuria and 37% proteinuria, and 87% had a positive Gram stain. Ultrasound imaging revealed urinary tract anomalies in 18%; the most common uropathogens were: Escherichia coli (86%), Proteus mirabilis (5%) and Klebsiella pneumoniae (5%). E. coli showed resistance for trimethoprim-sulfamethoxazole, ampicillin-sulbactam and cephalothin in 51.4%, 32.8% and 17.1%, respectively; 2.8% were extended-spectrum betalactamase/ESBL-positive. The median time of empiric management was 3 days and full treatment was of 10 days. Discussion: high resistance rates were recorded for ampicillin, ampicillin-sulbactam and trimethoprim-sulfamethoxazole, which discourage their use. The sensitivity of E coli to cephalothin and amikacin, reported in this study, favors their use as first empirical therapeutic choices in our setting. Conclusion: ultrasound examination of the urinary tract is recommended in patients experiencing their first febrile UTI episode, due to the high prevalence of urinary anomalies identified.

Outcome of Empirical Antibiotic Prescription for the Treatment of Community Acquired Pneumonia

Background: The primary cause of illness and death in Bangladesh is community acquired pneumonia (CAP). Many hospitals in Bangladesh lack the resources to perform sputum cultures and sensitivity tests, making it difficult to identify the etiological agent of an infection. As a result, antibiotics are prescribed on a "empirical basis" rather than as part of a specific anti microbial treatment. The optimal antibiotic for treating CAP should be chosen using an empirical approach. Objective: The purpose of this study is to evaluate the effectiveness of various empirical antibiotic choices in the management of CAP. Methods: Eighty-two patients with CAP were included in this prospective observational research at a tertiary medical college hospital in Bangladesh. Inclusion and exclusion criteria were used to choose patients. Chest x-rays confirmed the diagnosis of CAP. The antibiotic was chosen based on clinical experience, which is an empirical method. The majority of patients received a combination antibiotic, whereas the remaining handful received monotherapy. The result served as an evaluation of the empiricism used in selecting the antibiotic. During the research, data were recorded in standardized formats. SPSS was used for the statistical analysis. Results: A total of 82 people were treated, and of them, 62 (or 76%) were men and 20 (or 24%) were women. The average age was 54.4% (9.6%). The round of antibiotics was supposed to last for a week. There were no unwanted medication reactions. No cases of lung abscess or parenchymal damage to the lungs occurred, and only one patient had paraneumonic effusion. Every single person made a full recovery. Conclusion: In many hospitals in Bangladesh, the choice of antibiotic for treating CAP is made on a "empirical" basis. Selecting an appropriate antibiotic requires better sputum culture and sensitivity testing in hospital labs.

Epidemiology and antimicrobial resistance rates for Shigella species in a resource-rich setting

Shigellosis is an acute, often dysenteric, diarrhoeal illness that is responsible for much morbidity and mortality worldwide. Increasing rates of multidrug-resistant (MDR) and extensively drug-resistant (XDR) ​Shigella species have been detected worldwide and a regular review of local epidemiological and resistance rates is necessary to help guide empirical antibiotic choice. This retrospective laboratory study of faecal isolates between 2013 and 2023 demonstrates increasing rates of resistance to third-generation cephalosporins, azithromycin and ciprofloxacin, alongside an overall increase in MDR and XDR isolates.

Back to school after COVID-19 pandemic: Resumption or transitional disruption?

Since its onset in 2020, the COVID-19 pandemic has globally disrupted school operations, leading to a shift to some form of homeschooling arrangements. After two years, in March 2022, the government of Malaysia officially reopened all schools, ending its homeschooling program. In this paper, we exploit a purposefully designed, nationwide, cross-sectional survey of government-owned primary and secondary schools in Malaysia to document student learning experiences during the early months of the home-to-school transition. Our empirical analysis and choice of indicators is guided by a conceptual framework that distinguishes between two competing hypotheses related to school reopening experiences: resumption vs transitional disruption. We find that 59 % of secondary and 72 % of primary level students report that they are happy to be back in school. School reopening also coincides with a significant reduction in educational-related worries (e.g., concerns over dropout, learning loss, and loss of interest in study) and indices of negative emotions (i.e., feelings of being tense, depressed, and restless), particularly among secondary school students. More importantly, those satisfied upon return to school report a statistically significant reduction in worries related to learning loss. These correlations support the resumption hypothesis. Yet our data highlights an important puzzle: Even after school reopening, one-third of students report that they do not learn more, at least one-fifth report a struggle to catch up on studies, and up to 40 % are concerned about learning loss. The majority of learners additionally report not receiving more support from teachers and parents. Recipients of public aid as well as private (i.e., parental) support report being happy about school reopening and are less likely to report “not learning more.” We conclude by discussing these somewhat paradoxical findings and the need for remedial measures beyond financial support for struggling learners to minimize post school reopening, transitional disruptions.

Friends, experts or witches: doing feminist research in challenging political contexts

The article explores methodological and ethical tensions arising from positionality and reflexivity while doing feminist research in a challenging parliamentary setting, specifically one that includes radical-right populist actors that use anti-gender rhetoric. Reflecting upon positionality is vital for qualitative researchers, especially those engaged in critical feminist research, where gendered power hierarchies between researchers and their environment demand daily manoeuvring and subsequent analytical concern. We explore how the gender of the researchers, gender equality as a research topic, our feminist positionalities, and intersectional aspects shaped the research process in the context of the European Parliament. The article contributes to the literature on feminist positionalities and reflexivity by discussing not only the ambiguities emerging from our empirical research choices, such as engaging with radical-right actors, but also the other ‘critical ingredients’ that feminism handles, such as identities, relationships, power and affects, reflecting how they are interwoven with relationships and interactions in the field.

Trauma

The June 2024 Trauma Roundup360 looks at: Skin antisepsis before surgical fixation of limb fractures; Comparative analysis of intramedullary nail versus plate fixation for fibula fracture in supination external rotation type IV ankle injury; Early weightbearing versus late weightbearing after intramedullary nailing for distal femoral fracture (AO/OTA 33) in elderly patients: a multicentre propensity-matched study; Long-term outcomes with spinal versus general anaesthesia for hip fracture surgery; Operative versus nonoperative management of unstable medial malleolus fractures: a randomized clinical trial; Impact of smoking status on fracture-related infection characteristics and outcomes; Reassessing empirical antimicrobial choices in fracture-related infections; Development and validation of the Nottingham Trauma Frailty Index (NTFI) for older trauma patients.

Regional variations in antimicrobial susceptibility of community-acquired uropathogenic Escherichia coli in India: Findings of a multicentric study highlighting the importance of local antibiograms

ObjectivesEvidence-based prescribing is essential to optimize patient outcomes in cystitis. This requires knowledge of local antibiotic resistance rates. Diagnostic and Antimicrobial Stewardship (DASH) to Protect Antibiotics (https://dashuti.com/) is a multicentric mentorship program guiding centers in preparing, analyzing and disseminating local antibiograms to promote antimicrobial stewardship in community urinary tract infection. Here, we mapped the susceptibility profile of Escherichia coli from 22 Indian centers. MethodsThese centers spanned 10 Indian states and three union territories. Antibiograms for urinary E. coli from the outpatient departments were collated. Standardization was achieved by regional online training; anomalies were resolved via consultation with study experts. Data were collated and analyzed. ResultsNationally, fosfomycin, with 94% susceptibility (inter-center range 83-97%), and nitrofurantoin, with 85% susceptibility (61-97%), retained the widest activity. The susceptibility rates were lower for co-trimoxazole (49%), fluoroquinolones (31%), and oral cephalosporins (26%). The rates for third- and fourth-generation cephalosporins were 46% and 52%, respectively, with 54% (33-58%) extended-spectrum β-lactamase prevalence. Piperacillin-tazobactam (81%), amikacin (88%), and meropenem (88%) retained better activity; however, one center in Delhi recorded only 42% meropenem susceptibility. Susceptibility rates were mostly higher in South, West, and Northeast India; centers in the heavily populated Gangetic plains, across north and northwest India, had greater resistance. These findings highlight the importance of local antibiograms in guiding appropriate antimicrobial choices. ConclusionsFosfomycin and nitrofurantoin are the preferred oral empirical choices for uncomplicated E. coli cystitis in India, although elevated resistance in some areas is concerning. Empiric use of fluoroquinolones and third-generation cephalosporins is discouraged, whereas piperacillin/tazobactam and aminoglycosides remain carbapenem-sparing parenteral agents.

Is Long‐Run Risk Really Priced? Revisiting Liu and Matthies (2022)

ABSTRACTThe claim by Liu and Matthies (LM) that their macro news risk factor (NI) prices 51 portfolios (associated with four different portfolio groups) is not appropriate. In fact, their single‐factor model is successful only in explaining the momentum deciles, while producing strongly negative performance for the remaining groups. The pricing performance is more doubtful in the case of the alternative news factor (HNI), as the respective risk price is not identified. LM's conclusions stem from a combination of questionable empirical choices and misinterpretation of their results. Moreover, the NI model cannot explain prominent capital asset pricing model anomalies not considered in their study.

Mitigating antimicrobial resistance, an approach to stewardship in canine urinary tract infection.

Urinary tract infection (UTI) caused by antimicrobial resistant bacteria is common in dogs leading to serious health impact in pet animal as well as on human health. Understanding the prevalent uropathogens and their drug susceptibility is essential for limiting the antimicrobial resistance through implementation of stewardship policies. In view of this, present study was envisaged to determine the prevalent bacterial uropathogens and their antibiogram from clinical cases of canine UTI. Urine samples were collected from 35 dogs presented with clinical signs of UTI and a total of 27 bacterial isolates were recovered. Among that Escherichia coli was the most predominant isolate followed by Klebsiella aerogenes, Staphylococcus aureus, Proteus mirabilis, Enterococcus sp. and Citrobacter freundii. All isolates were found resistant to one or more 1st line antibiotics recommended by consensus guidelines and 70% of total isolates showed multidrug resistance. Additionally, this study evaluated the weightage of empirical therapy as per the consensus guidelines over antimicrobial susceptibility test guided treatment. Dogs with uncomplicated UTI were selected and categorized into three different groups (n = 6). Group 1 was treated with common empirical choice amoxycillin-clavulanic acid and dogs showed susceptible to ciprofloxacin were kept in Group 2 and treated with ciprofloxacin along with urinary alkalizer disodium hydrogen citrate. Nitrofurantoin susceptible cases were kept in Group 3 and treated with a combination of nitrofurantoin and urinary acidifier ammonium chloride. Therapeutic outcome was evaluated and success rate was higher in Group 2 and 3 than Group 1 suggested that selection of antibiotics with the use of local or institutional antibiogram data is more considerate than acknowledged international guidelines in the existing situation.