Impact of bodyweight-adjusted antimicrobial prophylaxis on surgical-site infection rates.

BACKGROUND: Antimicrobial prophylaxis (AMP) adjustment according to bodyweight to prevent surgical-site infections (SSI) is controversial. The impact of weight-adjusted AMP dosing on SSI rates was investigated here. METHODS: Results from a first study of patients undergoing visceral, vascular or trauma operations, and receiving standard AMP, enabled retrospective evaluation of the impact of bodyweight and BMI on SSI rates, and identification of patients eligible for weight-adjusted AMP. In a subsequent observational prospective study, patients weighing at least 80 kg were assigned to receive double-dose AMP. Risk factors for SSI, including ASA classification, duration and type of surgery, wound class, diabetes, weight in kilograms, BMI, age, and AMP dose, were evaluated in multivariable analysis. RESULTS: In the first study (3508 patients), bodyweight and BMI significantly correlated with higher rates of all SSI subclasses (both P < 0.001). An 80-kg cut-off identified patients receiving single-dose AMP who were at higher risk of SSI. In the prospective study (2161 patients), 546 patients weighing 80 kg or more who received only single-dose AMP had higher rates of all SSI types than a group of 1615 who received double-dose AMP (odds ratio (OR) 4.40, 95 per cent c.i. 3.18 to 6.23; P < 0.001). In multivariable analysis including 5021 patients from both cohorts, bodyweight (OR 1.01, 1.00 to 1.02; P = 0.008), BMI (OR 1.01, 1.00 to 1.02; P = 0.007) and double-dose AMP (OR 0.33, 0.23 to 0.46; P < 0.001) among other variables were independently associated with SSI rates. CONCLUSION: Double-dose AMP decreases SSI rates in patients weighing 80 kg or more.

Detectivity enhancement in quantum well infrared photodetectors utilizing a photonic crystal slab resonator.

We characterize the performance of a quantum well infrared photodetector (QWIP), which is fabricated as a photonic crystal slab (PCS) resonator. The strongest resonance of the PCS is designed to coincide with the absorption peak frequency at 7.6 µm of the QWIP. To accurately characterize the detector performance, it is illuminated by using single mode mid-infrared lasers. The strong resonant absorption enhancement yields a detectivity increase of up to 20 times. This enhancement is a combined effect of increased responsivity and noise current reduction. With increasing temperature, we observe a red shift of the PCS-QWIP resonance peak of -0.055 cm(-1)/K. We attribute this effect to a refractive index change and present a model based on the revised plane wave method.