Before a comprehensive educational program on preoperative autologous blood donation was begun, 118 surgeons from three different areas of the country were tested to assess their baseline knowledge and attitude about this practice. Test results were correlated with the percentage of eligible patients that the surgeons actually referred for preoperative donation during a period of observation. The purpose of this preliminary effort was to identify areas in the educational program that required emphasis. Overall, the surgeons' attitude toward preoperative donation was quite favorable, but their depth of knowledge varied. Misunderstandings may have led to diminished use of this service (eg, about 50% didn't realize that many patients with medical conditions or low hematocrits are permitted to donate). However, it is not clear that simply bolstering surgeons' knowledge will increase their appropriate use of preoperative donation. When all 118 surgeons were studied, their knowledge and attitude were unrelated to the percentage of eligible patients referred. However, when 44 surgeons who managed the largest number of eligible patients were analyzed separately, their use of preoperative donation was directly correlated with their knowledge and attitude. The local awareness of AIDS also significantly influenced the use of this service. It is proposed that knowledge of preoperative donation may be important for inducing surgeons to begin referring patients for this service. Once a pattern of successful participation is established, referral seems to increase with the acquisition of working knowledge.
BackgroundAvibactam (AVI) is a non-β-lactam β-lactamase inhibitor that restores the in vitro activity of ceftazidime (CAZ) against class A, class C, and some class D β-lactamases, including extended-spectrum β-lactamases, serine carbapenemases, and the chromosomal AmpC of Pseudomonas aeruginosa (Pae). This study evaluated the in vitro activity of CAZ-AVI and comparators against Enterobacteriaceae (Eba) and Pae collected from patients with lower respiratory tract infections (LRTI) in Asia/Pacific in 2014–2016 as part of the INFORM surveillance program.MethodsNon-duplicate isolates from patients with LRTI were collected from 28 medical centers in Australia, Hong Kong, Japan, Malaysia, Philippines, South Korea, Taiwan, and Thailand. Susceptibility (S) testing was performed by broth microdilution and interpreted using FDA breakpoints for CAZ-AVI and CLSI breakpoints for comparators. AVI was tested at a fixed concentration of 4 µg/mL with doubling dilutions of CAZ. Multidrug resistance (MDR) phenotype was defined as resistant by CLSI breakpoints to sentinel agents from ≥3 drug classes.ResultsCAZ-AVI showed potent in vitro activity against the overall population of Eba (MIC90, 0.5 µg/mL; 98.0% S) and against ceftazidime-nonsusceptible (CAZ-NS), colistin-resistant (CST-R), and MDR isolates, with >91% of these resistant subsets testing as susceptible (MIC ≤8 µg/mL). Reduced activity against meropenem-nonsusceptible (MEM-NS) Eba was attributable to the presence of class B metallo-β-lactamases (MBL); 95.7% of MEM-NS, MBL-negative isolates were susceptible to CAZ-AVI. CAZ-AVI also showed good activity against most Pae isolates (MIC90, 8 µg/mL; 92.5% S), as well as CST-R isolates (MIC90, 8 µg/mL; 100% S). Activity of CAZ-AVI was reduced against CAZ-NS, MEM-NS, MEM-NS MBL-negative, and MDR Pae subsets (46.9–82.3% S) but exceeded the activity of CAZ and MEM.ConclusionCAZ-AVI is a potential therapeutic option for treating respiratory infections in the Asia/Pacific region caused by Eba and Pae isolates resistant to commonly used and last-in-line agents.Disclosures G. G. Stone, Pfizer: Employee, Salary AstraZeneca: Shareholder, Capital Gains
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