IntroductionTransport of critically ill patients from the Intensive Care Unit (ICU) to other departments for diagnostic or therapeutic procedures is often a necessary part of the critical care process. Transport of critically ill patients is potentially dangerous with up to 70% adverse events occurring. The aim of this study was to develop a checklist to increase safety of intra-hospital transport (IHT) in critically ill patients.MethodA three-step approach was used to develop an IHT checklist. First, various databases were searched for published IHT guidelines and checklists. Secondly, prospectively collected IHT incidents in the LUMC ICU were analyzed. Thirdly, interviews were held with physicians and nurses over their experiences of IHT incidents. Following this approach a checklist was developed and discussed with experts in the field. Finally, feasibility and usability of the checklist was tested.ResultsEleven existing guidelines and five checklists were found. Only one checklist covered all three phases: pre-, during- and post-transport. Recommendations and checklist items mostly focused on the pre-transport phase. Documented incidents most frequently related to patient physiology and equipment malfunction and occurred most often during transport. Discussing the incidents with ICU physicians and ICU nurses resulted in important recommendations such as the introduction of a standard checklist and improved communication with the other departments. This approach resulted in a generally applicable checklist, adaptable for local circumstances. Feedback from nurses using the checklist were positive, the fill in time was 4.5 minutes per phase.ConclusionA comprehensive way to develop an intra-hospital checklist for safe transport of ICU patients to another department is described. This resulted in a checklist which is a framework to guide physicians and nurses through intra-hospital transports and provides a continuity of care to enhance patient safety. Other hospitals can customize this checklist to their own situation using the methods proposed in this paper.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-015-0938-1) contains supplementary material, which is available to authorized users.

Background We aimed to determine the non-inferiority of fosfomycin, compared to ciprofloxacin, as oral stepdown treatment for E. coli febrile urinary tract infections (fUTIs) in women. Methods This was a double-blind, randomised controlled trial in 15 Dutch hospitals. Adult women receiving 2-5 days of empirical intravenous antimicrobials for E.coli fUTI, were assigned to stepdown treatment with once-daily 3 gr fosfomycin or twice-daily 0.5 gr ciprofloxacin, for 10 days of total antibiotic treatment. For the primary endpoint clinical cure at day 6-10 post-end-of-treatment a non-inferiority margin of 10% was chosen. The trial was registered on Trialregister.nl (NTR6449). Results After enrolment of 97 patients between 2017-2020, the trial ended prematurely because of the Covid-19 pandemic. The primary endpoint was met in 36/48 patients (75.0%) assigned to fosfomycin and 30/46 patients (65.2%) assigned to ciprofloxacin (Risk Difference: 9.6%, 95%-Confidence-Interval: -8.8% to 28.0%). In patients assigned to fosfomycin and ciprofloxacin, microbiological cure at day 6-10 post-end-of-treatment occurred in 29/37 (78.4%) and 33/35 (94.3%; RD: -16.2%, 95%CI: -32.7 to -0.0%), and clinical cure at day 30-35 post-end-of-treatment occurred in 35/47 (75.6%) and 33/44 (75.0%; RD: 0.4%, 95%CI: -18·4% to 17·6%) respectively. Any adverse event was reported in 35/48 (72.9%) and 32/46 (69.6%) patients (RD: 3.3%, 95%CI: -15.0% to 21.6%%), and any gastro-intestinal adverse event in 25/48 (52.1%) and 14/46 (30.4%) patients (RD: 20.8%, 95%CI: 1.6% to 40.0%), respectively. Conclusions Fosfomycin is non-inferior to ciprofloxacin as oral stepdown treatment for fUTI caused by E.coli in women. Fosfomycin use is associated with more gastro-intestinal events.

Objectives To evaluate the pharmacokinetics and clinical effectiveness of IV and oral fosfomycin treatment in patients with recurrent urinary tract infection (rUTI) with Escherichia coli. Patients and methods Patients with rUTI treated with 3 g of oral fosfomycin every 72 h for at least 14 days were included in a prospective open-label single-centre study. Serum samples were taken after oral and IV administration of fosfomycin. Urine was collected for 24 h on 3 consecutive days. Fosfomycin concentrations in serum and urine were analysed using validated LC–MS/MS. Pharmacokinetics were evaluated using a population model. EudraCT number 2018-000616-25. Results Twelve patients were included, of whom nine were also administered IV fosfomycin. Data were best described by a two-compartment model with linear elimination and a transit-absorption compartment. Median values for absolute bioavailability and serum half-life were 18% and 2.13 h, respectively. Geometric mean urine concentrations on Days 1, 2 and 3 were above an MIC of 8 mg/L after both oral and IV administration. Quality of life reported on a scale of 1–10 increased from 5.1 to 7.4 (P = 0.001). The average score of UTI symptoms decreased after fosfomycin dosing (by 3.1 points, 95% CI = −0.7 to 7.0, P = 0.10). Conclusions Oral fosfomycin at 3 g every 72 h provides plasma and urine concentrations of fosfomycin above the MIC for E. coli. This pharmacokinetic model can be used to develop optimal dosing regimens of fosfomycin in patients with UTI.

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Chronic bacterial prostatitis is increasingly difficult to treat due to rising antimicrobial resistance limiting oral treatment options. In this case series, 11 men with CBP (including patients with urological comorbidities) due to multi-resistant E. coli were treated with once-daily ceftriaxone intravenously for 6 weeks. Nine patients were clinically cured at 3 months follow up. No early withdrawal of medication due to side effects occurred. A literature review was conducted to describe the prostate pharmacokinetics of ceftriaxone and its use in prostatic infection. In conclusion, ceftriaxone can be considered an appropriate treatment of chronic bacterial prostatitis.