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To study the association between gastrointestinal colonization of carbapenemase-producing Enterobacteriaceae (CPE) and proton pump inhibitors (PPIs).
We analyzed 31,526 patients with prospective collection of fecal specimens for CPE screening: upon admission (targeted screening) and during hospitalization (opportunistic screening, safety net screening, and extensive contact tracing), in our healthcare network with 3,200 beds from July 1, 2011, through December 31, 2015. Specimens were collected at least once weekly during hospitalization for CPE carriers and subjected to broth enrichment culture and multiplex polymerase chain reaction.
Of 66,672 fecal specimens collected, 345 specimens (0.5%) from 100 patients (0.3%) had CPE. The number and prevalence (per 100,000 patient-days) of CPE increased from 2 (0.3) in 2012 to 63 (8.0) in 2015 (P<.001). Male sex (odds ratio, 1.91 [95% CI, 1.15–3.18], P=.013), presence of wound or drain (3.12 [1.70–5.71], P<.001), and use of cephalosporins (3.06 [1.42–6.59], P=.004), carbapenems (2.21 [1.10–4.48], P=.027), and PPIs (2.84 [1.72–4.71], P<.001) in the preceding 6 months were significant risk factors by multivariable analysis. Of 79 patients with serial fecal specimens, spontaneous clearance of CPE was noted in 57 (72.2%), with a median (range) of 30 (3–411) days. Comparing patients without use of antibiotics and PPIs, consumption of both antibiotics and PPIs after CPE identification was associated with later clearance of CPE (hazard ratio, 0.35 [95% CI, 0.17–0.73], P=.005).
Concomitant use of antibiotics and PPIs prolonged duration of gastrointestinal colonization by CPE.
Voriconazole is a broad-spectrum azole exhibiting strong anti-Aspergillus activity and good long-term tolerance. However, the evidence for voriconazole efficacy against refractory Aspergillus otomycosis is weak.
We reviewed the medical records of patients with Aspergillus otomycosis treated with voriconazole from January 2008 to June 2012 in a Taiwanese regional hospital. Demographic data and information regarding underlying diseases, clinical features, treatment and outcome were assessed.
In total, 14 cases of Aspergillus otomycosis were treated with voriconazole, including 5 patients with Aspergillus invasive otitis externa. All patients had failed to respond to local treatment, antibiotics or topical agents. One case was lost to follow up. The symptoms of two patients recurred after voriconazole treatment: one patient received a second 12-week course of voriconazole and was cured; and symptoms of the other patient recurred after a second 12-week course of voriconazole, leading to surgical debridement. The remaining 11 patients were cured by voriconazole treatment without extensive surgical debridement.
This study demonstrates that voriconazole can be a very effective and convenient therapeutic option for the management of refractory Aspergillus otomycosis.
In situ investigation of the interfacial reaction in the Sn/Cu thin film during aging, and reflow was carried out by synchrotron radiation with high intensity and high resolution of x-ray. With this technique, the phase transformation and evolution of the Sn/Cu thin film during heat treatment can be directly and continuously investigated. Moreover, the information for coefficient of thermal expansion in intermetallic compounds was also evaluated by this approach.
A CVD-based low κ film was evaluated for inter-metal dielectric in < 0.18 [.proportional]m generation devices. The film was deposited by conventional rf PECVD method using organosilane compound and oxygen. The measured dielectric constant of the film was 2.7∼2.75. The κ value of the film was stable over several weeks and the moisture absorption was minimal. The chemical composition was in the form of SiOxCyHz, where the carbon content was less than 5 atomic %. Blanket film integration study was conducted to find out the manufacturing compatibility. The largest increase in κ value occurred during etching and ashing steps. However, SIMS compositional analysis revealed that the damage from these steps were limited to within top 300 Å, and the initial low κ value was recovered after the top damaged layer was removed by CMP. The final integrated dielectric constant was less than 3.0. The film density was measured as 1.4, compared to 2.3 g/cm3 of conventional SiO2. The low density of the film resulted from the termination of SiO2 network structures by Si-CH3 and Si-H.
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