Antibiotic treatment with one single dose of gentamicin at admittance in addition to a ß-lactam antibiotic in the treatment of community-acquired bloodstream infection with sepsis.

BACKGROUND: Combination therapy in the treatment of sepsis, especially the value of combining a ß-Lactam antibiotic with an aminoglycoside, has been discussed. This retrospective cohort study including patients with sepsis or septic shock aimed to investigate whether one single dose of gentamicin at admittance (SGA) added to ß-Lactam antibiotic could result in a lower risk of mortality than ß-Lactam monotherapy, without exposing the patient to the risk of nephrotoxicity. METHODS AND FINDINGS: All patients with positive blood cultures were evaluated for participation (n = 1318). After retrospective medical chart review, a group of patients with community-acquired sepsis with positive blood cultures who received ß-Lactam antibiotic with or without the addition of SGA (n = 399) were included for the analysis. Mean age was 74.6 yrs. (range 19-98) with 216 (54%) males. Sequential Organ Failure Assessment score (SOFA score) median was 3 (interquartile range [IQR] 2-5) and the median Charlson Comorbidity Index for the whole group was 2 (IQR 1-3). Sixty-seven (67) patients (17%) had septic shock. The 28-day mortality in the combination therapy group was 10% (20 of 197) and in the monotherapy group 22% (45 of 202), adjusted HR 3.5 (95% CI (1.9-6.2), p = < 0.001. No significant difference in incidence of acute kidney injury (AKI) was detected. CONCLUSION: This retrospective observational study including patients with community-acquired sepsis or septic shock and positive blood cultures, who meet Sepsis-3 criteria, shows that the addition of one single dose of gentamicin to ß-lactam treatment at admittance was associated with a decreased risk of mortality and was not associated with AKI. This antibiotic regime may be an alternative to broad-spectrum antibiotic treatment of community-acquired sepsis. Further prospective studies are warranted to confirm these results.

Repeated nationwide point-prevalence surveys of antimicrobial use in Swedish hospitals: data for actions 2003-2010.

This study sought to analyse antimicrobial pressure, indications for treatment, and compliance with treatment recommendations and to identify possible problem areas where inappropriate use could be improved through interventions by the network of the local Swedish Strategic Programme Against Antibiotic Resistance (Strama) groups. Five point-prevalence surveys were performed in between 49 and 72 participating hospitals from 2003 to 2010. Treatments were recorded for 19 predefined diagnosis groups and whether they were for community-acquired infection, hospital-acquired infection, or prophylaxis. Approximately one-third of inpatients were treated with antimicrobials. Compliance with guidelines for treatment of community-acquired pneumonia with narrow-spectrum penicillin was 17.0% during baseline 2003-2004, and significantly improved to 24.2% in 2010. Corresponding figures for quinolone use in uncomplicated cystitis in women were 28.5% in 2003-2004, and significantly improved, decreasing to 15.3% in 2010. The length of surgical prophylaxis improved significantly when data for a single dose and 1 day were combined, from 56.3% in 2003-2004 to 66.6% in 2010. Improved compliance was possibly the effect of active local feedback, repeated surveys, and increasing awareness of antimicrobial resistance. Strama groups are important for successful local implementation of antimicrobial stewardship programs in Sweden.

[Physicians' well-being is deteriorating. Results from a prospective intervention study. The mental energy decreases as workload increases]. / Läkarna mår allt sämre. Resultat från en prospektiv interventionsstudie: den psykiska energin minskar samtidigt som produktionskraven ökar.

The impact of the current transformation of health care on the well-being and working conditions of physicians has been analyzed in a 6-year prospective intervention study at the Orebro University Hospital (USO). Physicians' ratings of their work, organization and health have been compared with those of other health care professionals at USO, as well as with ratings by physicians in other hospitals. Feedback on survey results has been periodically provided to employees in all hospital departments as well as to hospital senior management. The results have formed the basis for a range of improvement initiatives. The study identified a number of positive changes, such as increased ratings on scales measuring social climate, skills development and participatory management. However, workload has increased and mental energy decreased during the same period.