SummaryBackgroundStaphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection.MethodsIn this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants.FindingsBetween Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18–45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference −1·4%, 95% CI −7·0 to 4·3; hazard ratio 0·96, 0·68–1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3–4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005).InterpretationAdjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia.FundingUK National Institute for Health Research Health Technology Assessment.
Background Among nurses, skill retention after an electrocardiography blended-learning course is unknown. Objectives To compare 3-and 8-week electrocardiography test scores, compare scores by nurse and work characteristics and self-assessed electrocardiographic competence, and compare 1-year work retention with 3-and 8-week scores and change in scores from week 3 to week 8. Methods Data were collected on demographics, comfort with electrocardiography expectations, electrocardiography competence levels, and 1-year work retention. Correlational and comparative statistics were used in analyses. Results Of 69 nurses, 58% were somewhat comfortable with interventions for abnormal rhythms. Test scores were higher at 3 weeks than at 8 weeks: mean difference, 26%; P < .001. Scores at 8 weeks reflected intermediate skill retention and were not associated with nurse characteristics, electrocardiography background, comfort with rhythms and measurements, or 1-year work retention. Nurses with greater comfort for intervening when rhythm abnormalities occurred had higher median 8-week scores (P = .01) than did nurses with less comfort, and perceptions of electrocardiographic competence were associated with 8-week scores (r = 0.28; P = .02). Reduction in scores at 8 weeks was less severe in nurses with greater comfort at 3 weeks in measuring electrocardiographic intervals (P = .008) and applying therapeutic interventions (P = .009). Conclusions Skill retention and competence in electrocardiographic interpretation were intermediate and correlated with baseline self-assessment. Electrocardiographic interpretation, measurement, and interventions should be reinforced at the bedside.
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