ABSTRACT
CONTEXT: The use of explicit definitions of potentially inappropriate prescriptions of antibiotics (antibiotic PIPs) might constitute an innovative means to fight against antimicrobial resistance. Explicit definitions of PIPs can reduce the rate of inappropriate prescriptions, but explicit definitions of antibiotic PIPs in geriatric medicine are currently lacking. The objective of the study was to develop explicit definitions of antibiotic PIPs for hospitalized older patients. METHOD: We performed a qualitative study of focus groups involving geriatricians and infectious disease specialists. The study complied with the Consolidated Criteria for Reporting Qualitative Research. Transcripts of audio recordings were analyzed in a two-step independent reviewing process. The exact wording of the definitions was validated by a steering committee, an independent expert group, and the focus group participants. RESULTS: The four focus groups comprised 28 stakeholders. Our analysis identified 65 explicit definitions of antibiotic PIPs: 47 (73%) concerned misuse, 15 (23%) concerned overuse and three (5%) concerned underuse. Most definitions were related to critically important antibiotics: 11 (17%) for fluoroquinolones, eight (12%) for amoxicillin-clavulanic acid, eight (12%) for cephalosporins, seven (11%) for aminoglycosides, and five (8%) for carbapenems. CONCLUSION: To address the public health challenge of antimicrobial resistance, our study generated explicit definitions for antibiotic PIPs in older patients. We intend to refine and to validate these definitions through a national Delphi survey; the resulting consensus might provide key messages for prescribers and open up perspectives for reducing the incidence of antibiotic PIPs.
Subject(s)
Anti-Bacterial Agents , Inappropriate Prescribing , Aged , Anti-Bacterial Agents/therapeutic use , Cephalosporins , Humans , Inappropriate Prescribing/prevention & controlSubject(s)
Arthritis, Infectious/microbiology , Cardiobacterium/isolation & purification , Cervical Vertebrae/microbiology , Gram-Negative Bacterial Infections/microbiology , Neck Pain/etiology , Spondylitis/microbiology , Amoxicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Arthritis, Infectious/diagnosis , Arthritis, Infectious/drug therapy , Arthritis, Infectious/etiology , Bacteremia/drug therapy , Bacteremia/etiology , Bacteremia/microbiology , Dental Care , Diagnosis, Differential , Endocarditis, Bacterial/diagnosis , Gentamicins/therapeutic use , Gram-Negative Bacterial Infections/drug therapy , Gram-Negative Bacterial Infections/etiology , Humans , Male , Middle Aged , Mouth/microbiology , Spondylitis/diagnosis , Spondylitis/drug therapy , Spondylitis/etiology , Systemic Inflammatory Response Syndrome/etiologyABSTRACT
BACKGROUND: A cluster of indigenous typhoid fever cases in the greater Lille area, in January 2009, triggered investigations to identify the contamination source and to optimize care for infected individuals. METHODS: A case was defined as a person, living in the greater Lille area of, having presented with symptoms of typhoid fever, from January to March 2009. RESULTS: Sixteen cases of typhoid fever were identified between January 23 and March 22, 2009. Patients, none of whom had travelled, had all participated in a common meal on January 10, 2009. A woman, who helped prepare the meal and who had previously stayed in an endemic zone, was detected as the asymptomatic carrier of Salmonella Typhi. CONCLUSION: In France, although typhoid fever remains essentially an imported disease, there is a risk of indigenous epidemic and its diagnosis can be suggested for individuals who have not travelled. The features of this cluster illustrate the importance of respecting basic rules of hygiene in catering.
Subject(s)
Disease Outbreaks , Typhoid Fever/epidemiology , Female , France/epidemiology , Humans , Male , Middle Aged , Urban Health , Young AdultSubject(s)
Lung Diseases, Parasitic/diagnosis , Toxoplasmosis/diagnosis , Adult , Asthenia/etiology , Diagnosis, Differential , Fever/etiology , Headache/etiology , Humans , Immunocompetence , Lung Diseases, Parasitic/diagnostic imaging , Lung Diseases, Parasitic/parasitology , Male , Pneumonia, Bacterial/diagnosis , Pneumonia, Mycoplasma/diagnosis , Radiography , Roxithromycin/therapeutic use , Spiramycin/therapeutic use , Toxoplasmosis/complications , Toxoplasmosis/diagnostic imaging , Toxoplasmosis/drug therapyABSTRACT
We report an experimental investigation of high reflection mirrors used to fabricate gratings for pulse compression application at the wavelength of 1.053microm. Two kinds of mirrors are studied: the mixed Metal MultiLayer Dielectric (MMLD) mirrors which combine a gold metal layer with some e-beam evaporated dielectric bilayers on the top and the standard e-beam evaporated MultiLayer Dielectric (MLD) mirrors. Various samples were manufactured, damage tested at a pulse duration of 500fs. Damage sites were subsequently observed by means of Nomarski microscopy and white light interferometer microscopy. The comparison of the results evidences that if MMLD design can offer damage performances rather similar to MLD design, it also exhibits lower stresses; being thus an optimal mirror substrate for a pulse compression grating operating under vacuum.
Subject(s)
Lasers , Lenses , Refractometry/instrumentation , Computer-Aided Design , Equipment Design , Equipment Failure Analysis , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
A case of Salmonella paratyphi A infection was diagnosed late in a patient treated for febrile pneumonia after his returning from India. This case was remarkable in two aspects: first, it illustrated the reemergence of S.paratyphi A infections in people having traveled to India, with increasing fluoroquinolone resistance, and second the difficulty of diagnosing this disease, since the patient was initially treated for pneumonia and flu-like syndrome. Salmonella typhi or paratyphi infections should be evoked in case of persistent fever in patients having traveled to endemic areas, even if digestive signs are absent. Furthermore, choosing an empiric antibiotic treatment with fluoroquinolones could lead to treatment failure if the patient traveled in a country where fluoroquinolone resistance is high, as in Asia and especially in India.
Subject(s)
Paratyphoid Fever/diagnosis , Pneumonia, Bacterial/diagnosis , Salmonella paratyphi A/isolation & purification , Adult , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Bacteremia/diagnosis , Bacteremia/drug therapy , Bacteremia/microbiology , Bangladesh , Ceftriaxone/therapeutic use , Drug Resistance, Multiple, Bacterial , Endemic Diseases , Fluoroquinolones/pharmacology , Humans , India , Ketolides/therapeutic use , Male , Paratyphoid Fever/drug therapy , Paratyphoid Fever/microbiology , Pneumonia, Bacterial/drug therapy , Pneumonia, Bacterial/microbiology , Salmonella paratyphi A/drug effects , TravelABSTRACT
The phase transitions (by means of x-ray diffraction) and electrical resistivity of a Pu(0.92)Am(0.08) binary alloy were determined under pressure (up to 2 GPa). The evolution of atomic volume with pressure gives detailed information concerning the degree of localization of 5f electronic states and their delocalization process. A quasi-linear V = f(P) dependence reflects subtle modifications of the electronic structure when P increases. The electrical resistivity measurements reveal the very high stability of the δ phase for pressures less than 0.7 GPa, since no martensitic-like transformation occurs at low temperature. Remarkable electronic behaviours have also been observed. Finally, resistivity curves have shown the temperature dependence of the phase transformations together with unexpected kinetic effects.
