Schuetz P et al. JAMA 2013;309:717-8 Schuetz P et al. Cochrane Database Syst Rev 2012;9:CD007498

1. 1 of 2 Efficacy and safety of procalcitonin measurement to guide antibiotic prescriptions for acute respiratory tract infections (ARIs): systematic review Systematic review of 14 RCTs (USA, Europe, China; 2004-2011): N=4,211 adult pts receiving antibiotics for ARIs (mean age: 59.8 yr): Group 1: Procalcitonin guidance for antibiotic prescriptions Group 2 (control): No procalcitonin guidance for antibioticprescriptions Primaryendpoints Schuetz P et al. JAMA 2013;309:717-8 Schuetz P et al. Cochrane Database Syst Rev 2012;9:CD007498

2. 2 of 2 Efficacy and safety of procalcitonin measurement to guide antibiotic prescriptions for acute respiratory tract infections (ARIs): systematic review Secondary endpoint • Similar results across: • Different clinical settings: Primary care (2 trials), emergency department (7 trials), ICU (5 trials) • Different ARI diagnosis: Community-acquired pneumonia (12 trials), exacerbation of COPD (6 trials) Use of procalcitonin to guide initiation and duration of antibiotic treatment in pts with ARI may significantly reduce antibiotic exposure without increasing all-cause mortality or treatment failure at 30 days Schuetz P et al. JAMA 2013;309:717-8 Schuetz P et al. Cochrane Database Syst Rev 2012;9:CD007498

3. 1 of 2 Procalcitonin (PCT) vs C-reactive protein (CRP) for guiding duration of antibiotic therapy in ICU pts with sepsis 2-centre, open-label RCT (Brasil; 2009-2012): N=94 pts with severe sepsis or septic shock (mean age: 59.8 yr), with <48h antibiotic therapy, Pts randomised to PCT (N=49) or CRP (N=45) as a marker to discontinue antibiotic therapy (Tx): Primary endpoint: Duration of antibiotic therapy for 1st episode of infection Oliveira CF et al. Crit Care Med 2013;41:2336-43

4. 2 of 2 Procalcitonin (PCT) vs C-reactive protein (CRP) for guiding duration of antibiotic therapy in ICU pts with sepsis A PCT-based protocol does not seem to be superior to a CRP-based protocol for reducing antibiotic use in ICU pts with sepsis Oliveira CF et al. Crit Care Med 2013;41:2336-43

5. 1 of 2 Use of a dog’s superior olfactory sensitivity to identify Clostridium difficile in stools and patients: diagnostic accuracy 2-centre, case-control, proof-of-principle study (2010-2011; Holland): Stool samples: 50 positive + 50 negative for C. difficile N=30 pts with C. difficile-associated diarrhoea (CDAD) (≥3 loose or watery stool passages/day + positive result for toxin by enzyme immunoassay + toxigenic C. difficile strains found on culture; ≤1 relapse after completing treatment for C. difficile) N=270 controls without CDAD (9 controls per patient; controls were from same ward and in close proximity to index patient) 2-year old beagle trained to identify smell of C. difficile(trainer blinded to patient’s infection status)(dog smelt air surrounding the patient by walking past the bed; no physical contact) Bomers MK et al. BMJ 2012;345:e7396

6. 2 of 2 Use of a dog’s superior olfactory sensitivity to identify Clostridium difficile in stools and patients: diagnostic accuracy • N=16 controls with diarrhoea not related to C. difficile: • Dog’s negative response: N=13 • Dog’s inconclusive response: N=3 Diagnosticaccuracy A trained dog may be able to detect C. difficile in infected stool samples and hospital patients with high sensitivity and specificity Bomers MK et al. BMJ 2012;345:e7396

7. Relationship between blood culture volume and rate of positivity of blood cultures • Minimum blood volume for culture and for determining clinical significance is currently unknown • Multi-centre study (February 2013): N=3,932 blood cultures from pts in ICUs and acute care floors collected in BD BACTEC Aerobic/F negative bottles • Blood volume: estimated using BD BACTEC FX instrument: Range: 1.0-7.0 ml There does not seem to be a correlation between blood culture volume and rate of true positive or contaminated blood cultures Mann T. IDWeek 2013 abs. 226 Data from poster

8. 1 of 2 Impact of sonication of cardiovascular implantable electronic devices (CIED) on microbial detection 12-month, prospective study (2011-2012): N=35 pts with CIED infections N=42 subjects with non-infected CIED who underwent elective generator replacement for end of battery life Collect for each subject: 1x swab from device pocket → cultured using routine methods 1x swab from device surface → cultured using routine methods 1x tissue specimen from pocket → cultured using routine methods CIED system: explanted generator + leads → processed using vortexing-sonication in 400 ml Ringer’s solution → culture resultant sonicate fluid Definitions of significant bacterial growth: Tissue/swab: bacterial colonies on ≥2 quadrants of the culture plate Device: ≥20 colonies/10 ml sonicate fluid Nagpal A. IDWeek 2013 abs. 228 Data from poster

9. 2 of 2 Impact of sonication of cardiovascular implantable electronic devices (CIED) on microbial detection SensitivitySpecificity (% of infected subjects with sign. growth) (1- % of non-infected subjects with sign. growth) Compared with swab/tissue specimen cultures, vortexing-sonication of a CIED may significantly increase the sensitivity of culture results without decreasing specificity Nagpal A. IDWeek 2013 abs. 228 Data from poster

10. 1 of 2 Accuracy of image-guided spinal biopsy for diagnosing spontaneous vertebral osteomyelitis (SVOM): meta-analysis Systematic review + meta-analysis: N=5 studies evaluating the diagnostic accuracy of image-guided percutaneous needle aspiration biopsy for the diagnosis of SVOM,using combined reference standards: Histopathological findings consistent with VOM AND/OR Identification of pathogens from open surgery and/or blood culturesAND/OR Evidence of clinical and radiological improvement following empiric antimicrobial therapy N=352 pts pooled Pupaibool J. IDWeek 2013 abs. 793

11. 2 of 2 Accuracy of image-guided spinal biopsy for diagnosing spontaneous vertebral osteomyelitis (SVOM): meta-analysis Image-guided spinal biopsy seems to have a high specificity and to perform well for predicting a diagnosis of SVOM, but it seems to have a modest accuracy for ruling out the diagnosis of SVOM Pupaibool J. IDWeek 2013 abs. 793