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Background: Whether antibiotic rotation strategies reduce prevalence of antibiotic-resistant, Gram-negative bacteria in intensive care units (ICUs) has not been accurately established. We aimed to assess whether cycling of antibiotics compared with a mixing strategy (changing antibiotic to an alternative class for each consecutive patient) would reduce the prevalence of antibiotic-resistant, Gram-negative bacteria in European intensive care units (ICUs).Methods: In a cluster-randomised crossover study, we randomly assigned ICUs to use one of three antibiotic groups (third-generation or fourth-generation cephalosporins, piperacillin-tazobactam, and carbapenems) as preferred empirical treatment during 6-week periods (cycling) or to change preference after every consecutively treated patient (mixing). Computer-based randomisation of intervention and rotated antibiotic sequence was done centrally. Cycling or mixing was applied for 9 months; then, following a washout period, the alternative strategy was implemented. We defined antibiotic-resistant, Gram-negative bacteria as Enterobacteriaceae with extended-spectrum β-lactamase production or piperacillin-tazobactam resistance, and Acinetobacter spp and Pseudomonas aeruginosa with piperacillin-tazobactam or carbapenem resistance. Data were collected for all admissions during the study. The primary endpoint was average, unit-wide, monthly point prevalence of antibiotic-resistant, Gram-negative bacteria in respiratory and perineal swabs with adjustment for potential confounders. This trial is registered with ClinicalTrials.gov, number NCT01293071.Findings: Eight ICUs (from Belgium, France, Germany, Portugal, and Slovenia) were randomly assigned and patients enrolled from June 27, 2011, to Feb 16, 2014. 4069 patients were admitted during the cycling periods in total and 4707 were admitted during the mixing periods. Of these, 745 patients during cycling and 853 patients during mixing were present during the monthly point-prevalence surveys, and were included in the main analysis. Mean prevalence of the composite primary endpoint was 23% (168/745) during cycling and 22% (184/853) during mixing (p=0·64), yielding an adjusted incidence rate ratio during mixing of 1·039 (95% CI 0·837-1·291; p=0·73). There was no difference in all-cause in-ICU mortality between intervention periods.Interpretation: Antibiotic cycling does not reduce the prevalence of carriage of antibiotic-resistant, Gram-negative bacteria in patients admitted to the ICU.Funding: European Union Seventh Framework Programme. [ABSTRACT FROM AUTHOR]

Introduction: High-risk human papillomaviruses (HPV) play the leading etiological role in the development of cervical, anal, and vaginal cancers and a substantial proportion of penile, vulvar, and oropharyngeal (tonsillar) cancers., Methods: The article summarizes the results of the most important studies that examined tissue specimens of cervical, anal, and vulvar carcinoma from 16 central and eastern European countries for the presence of HPV DNA., Results: Twenty-eight eligible studies were identified. Among 2,531 invasive cervical cancers, 86.6% were HPV-positive. The combined prevalence of HPV-16/18 among HPV-positive cervical cancers was 87.5%. The overall prevalence of HPV DNA in six studies of anal carcinomas (43 cases) and vulvar carcinomas (164 cases) was 90.7% and 32.9%, respectively. HPV-16 DNA was detected in 86% of all anal carcinomas studied, and the proportion of HPV-16 positive vulvar carcinomas varied from 10.9% to 27.5%. HPV-18 DNA was not detected in any anal or vulvar carcinoma studied., Conclusions: HPV prevalence and type distribution among women with cervical cancer in central and eastern Europe is comparable with other European regions. Several gaps in knowledge exist in the region concerning HPV prevalence and type distribution among women with HPV-related cancers other than cervical cancer and in the general population.