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Analytical electron microscopy (AEM) was used to examine the initial interfacial reaction layers between a eutectic Sn–3.5Ag solder and an electroless nickel-immersion gold-plated (ENIG) Cu substrate during reflow at 255 °C for 1 s. AEM confirmed that a thick upper (Au,Ni)Sn2 layer and a thin Ni3Sn4 layer had formed through the reaction between the solder and ENIG. The amorphous electroless Ni(P) plated layer transformed into two P-rich Ni layers. One is a crystallized P-rich Ni layer, and the other is an intermediate state P-rich Ni layer before the crystallization. The crystallized P-rich layer consisted of Ni2P and Ni12P5. A thin Ni2P layer had formed underneath the Ni3Sn4 layer and is believed to be a predecessor of the Ni2SnP ternary phase. A Ni12P5 phase was observed beneath the Ni2P thin layer. In addition, nanocrystalline Ni was found to coexist with the amorphous Ni(P) phase in the intermediate state P-rich Ni layer.
To evaluate the outcome of attempted Hickman catheter salvage in neutropenic cancer patients with Staphylococcus aureus bacteremia who were not using antibiotic lock therapy.
Retrospective cohort study.
A university-affiliated, tertiary-care hospital with 1,500 beds for adult patients.
All neutropenic cancer patients who had a Hickman catheter andS. aureus bacteremia (32 episodes in 29 patients) between January 1998 and March 2002.
Salvage attempts were defined as cases where the Hickman catheter was not removed until we obtained the results of follow-up blood cultures performed 48 to 72 hours after starting treatment with antistaphylococcal antibiotics. Salvage was considered to be successful if the Hickman catheter was still in place 3 months later without recurrent bacteremia or death.
Catheter salvage was attempted in 24 (75%) of the 32 episodes. Of the salvage attempts, the success rate was 50% (12 of 24). Salvage attempts were successful in 14% (1 of 7) of the episodes with positive follow-up blood cultures, and in 65% (11 of 17) of those with negative follow-up blood cultures (P = .07). If the analysis is confined to cases with no external signs of catheter infection, salvage attempts were successful in 14% (1 of 7) of the episodes with positive follow-up blood cultures and in 80% (8 of 10) of those with negative follow-up blood cultures (P = .02).
In neutropenic cancer patients with S. aureus bacteremia, attempted catheter salvage without antibiotic lock therapy was successful in 50% of the cases.
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