International - predominantly American - studies undertaken in the ICUs of teaching centres show that inadequate antibiotic therapy increases mortality and length of stay. We sought to ascertain ...whether this also pertains to smaller ICUs in the Veneto region of north-east Italy. To the best of our knowledge, this is the first such survey in the Veneto area or in Italy as a whole. A retrospective, observational study was performed across five general-hospital ICUs to examine appropriateness of microbiological sampling, empirical antibiotic adequacy, and outcomes. Among 911 patients (mean age, 65.8 years ± 16.2 SD; median ICU stay, 17.0 days IQR, 8.0–29.0), 757 (83.1 %) were given empirical antibiotics. Treatment adequacy could be fully assessed in only 212 patients (28.0 %), who received empirical treatment and who had a relevant clinical sample collected at the initiation of this antibiotic (T0). Many other patients only had delayed microbiological investigation of their infections between day 1 and day 10 of therapy. Mortality was significantly higher among the 34.9 % of patients receiving inadequate treatment (48.6 % vs 18.80 %;
p
< 0.001). Only 32.5 % of combination regimens comprised a broad-spectrum Gram-negative β-lactam plus an anti-MRSA agent, and many combinations were irrational. Inadequate treatment was frequent and was strongly associated with mortality; moreover, there was delayed microbiological investigation of many infections, precluding appropriate treatment modification and de-escalation. Improvements in these aspects and in antibiotic stewardship are being sought.
Introduction
Recent automated hematology analyzers (HAs) can identify and report nucleated red blood cells (NRBC) count as a separate population out of white blood cells (WBC). The aim of this study ...was to investigate the analytical performances of NRBC enumeration on five top of the range HAs.
Methods
We evaluated the within‐run and between‐day precision, limit of blank (LoB), limit of detection (LoD), and limit of quantitation (LoQ) of XE‐2100 and XN‐module (Sysmex), ADVIA 2120i (Siemens), BC‐6800 (Mindray), and UniCel DxH 800 (Beckman Coulter). Automated NRBC counts were also compared with optical microscopy (OM).
Results
The limits of detection for NRBC of the BC‐6800, XN‐module, XE‐2100, UniCel DxH 800, and ADVIA 2120i are 0.035×109/L, 0.019×109/L, 0.067×109/L, 0.038×109/L, and 0.167×109/L, respectively. Our data indicated excellent performance in terms of precision. The agreement with OM was excellent for BC‐6800, XN‐module, and XE‐2100 (Bias 0.023, 0.019, and 0.033×109/L, respectively). ADVIA 2120i displayed a significant constant error and UniCel DxH 800 both proportional and small constant error.
Conclusion
Regards to NRBC counting, the performances shown by BC‐6800, XN‐module, and XE‐2100 are excellent also a low count, ADVIA 2120i and UniCel DxH 800 need to be improved.
Background
The aims of this study were to compare the diagnostic accuracy of blood smear review criteria, by means of three different panel rules, those proposed by: the International Consensus Group ...for Hematology 41‐ICGH rules, the Italian Survey IS rules and the Working Group on Hematology‐SIBioC (WGH) consensus rules (WGH rules).
Methods
This study is based on 2707 peripheral blood (PB) samples referred for routine hematological testing to the WGH‐associated laboratories displaced all over the Italian territory. The PB samples were processed on seven different hematology analyzers (HAs): Advia 2120i, XE‐2100, BC‐6800, ABX Pentra, XN‐1000, Cell‐DYN Sapphire, and DxH800, respectively. All the results provided by the HAs were analyzed through the application of three different blood smear review criteria: that is, the 41‐ICGH, IS, and WGH rules. Finally, data were compared with those obtained by optical microscopy (OM), as the current gold standard.
Results
The overall the agreement OM classification with ICGH, IS, and WGH panel rules is 0.83, 0.83, and 0.85, respectively. The false negatives are 2.1%, 3.0%, and 2.9%, while false positives are 15.1%, 13.7%, and 11.7%, respectively. All the seven HAs showed variable interinstrument performance, as three different criteria for OM review were adopted on each of them from time to time.
Conclusion
These results presented show that the customization of validation rules is necessary for enhancing the quality of hematological testing and optimizing workflow.
Background. The achievement of dialysis adequacy targets in peritoneal dialysis (PD) is assessed by the calculation of the Kt/V and creatinine clearance (CCr) obtained by collecting dialysate and ...urine, usually two or three times a year. Prescription decisions are based on such adequacy assessments, regardless of any variability in the single measurements. The aim of our study was to assess the day-to-day variability of common dialysis adequacy parameters and to evaluate its impact on the adequacy indexes in PD. Methods. Twenty-four patients (14 CAPD, 10 APD) at two centres were studied by means of a triple dialysate and urine collection for a period of 1 week. Variability in the findings for a given patient was expressed by the coefficient of variation (CV%) calculated for peritoneal (p), renal, and total (tot) adequacy parameters. The target Kt/V and CCr values were recalculated on the basis of variability. Results. Kt/V was less variable (CV 4.0 and 4.4% for peritoneal Kt/V (pKt/V) and total Kt/V (totKt/V) respectively) than CCr (4.7 and 6.0% for peritoneal creatinine clearance (pCCr) and total creatinine clearance (totCCr) respectively) and proved to be a more reliable indicator of adequacy in terms of the CV. Both variability parameters became worse if renal clearance was added to peritoneal clearance. CV in APD proved to be no different from CAPD for all the parameters considered. In our centres dialysis adequacy target correction for variability provided safe values for weekly Kt/V (pKt/V=1.78–2.10 and totKt/V=1.82–2.15 target 1.7–2.0) and CCr/1.73 (pCCr=53.7–64.4 l and totCCr=55.1–66.1 l; target 50–60 l). Conclusions. Evaluating the adequacy of PD by means of a single measurement should take into account the weekly variability as demonstrated by a triple dialysate and urine collection. Standard adequacy targets can be corrected to allow for variability. Thus one can obtain safe values for prescription decisions based on a single collection result.
This study gives the results in terms of precision and repeatability of a new on-line urea monitoring system (Ureascan P2 Hospal) capable of measuring the urea concentrations in the spent dialysate. ...The Ureascan P2 Hospal (UP2H), fitted on single-pass dialysis machines (Integra-Hospal), functions by the presence of a disposable mini-reactor containing urease. The passage through the reactor of a minimum quantity of spent dialysate from the filter diluted with a pH 7 buffer solution (1 ml/min) increases its ionic strength, which is detected by a differential measurement of conductivity in proportion to the urea concentration in the dialysis liquid. We studied 13 dialysis sessions, with bicarbonate buffer, in 8 anuric patients. From 4 to 7 dialysate samples were taken during each treatment to determine the urea and 65 samples were analysed overall. Urea values from the UP2H were compared with those measured on the Dimension Du Pont analyser. Simple linear regression analysis showed an excellent correlation between the 2 measuring methods (r=0.987; p<0.001). The Bland-Altman test gave an average difference between the urea values measured with the UP2H and in the laboratory of 1.3+/-1.2 mg/dl. The agreement limits between 2 SD were -1.2 mg/dl and +3.8 mg/dl respectively. In conclusion, the UP2H we have developed has proved to be a reliable and very useful instrument for adapting, through the urea kinetic mathematical models, the dialysis dose for individual patients.
In 32 noncirrhotic patients on peritoneal dialysis, mean serum beta 2-microglobulin (s beta 2M) was 26.58 +/- 12.32 mg/l (9.7-63.5). We found a significant correlation between s beta 2M and serum ...creatinine (sCr; r = 0.760), blood urea nitrogen (BUN; r = 0.573), total creatinine and BUN clearance (r = 0.623 and 0.599, respectively), 24-hour Kt/V (r = 0.638), glomerular filtration rate (r = 0.623), 24-hour urine output (r = 0.669), serum total protein (r = 0.584) (p < 0.01 for all the above r values); beta 2M peritoneal clearance and mass transfer (r = 0.414 and 0.427, respectively; p < 0.05). Our data demonstrate and confirm the contribution of residual renal function in determining s beta 2M levels and it is seemingly more important than beta 2M peritoneal clearance.
PDF
