"hospital acquired infection" AND "intensive care unit" AND prevention

"healthcare associated infection" AND ICU AND prevention

ls -la /home/daytona/workspace/ 2>/dev/null || echo "workspace empty or missing"

mkdir -p /home/daytona/workspace/hai-summary && python3 -c "from reportlab.lib i…

~/hai-summary/build_pdf.py

from reportlab.lib.pagesizes import A4
from reportlab.lib import colors
from reportlab.lib.units import cm
from reportlab.lib.styles import getSampleStyleSheet, ParagraphStyle
from reportlab.lib.enums import TA_CENTER, TA_LEFT, TA_JUSTIFY
from reportlab.platypus import (
    SimpleDocTemplate, Paragraph, Spacer, Table, TableStyle,
    HRFlowable, KeepTogether, PageBreak
)
from reportlab.platypus.flowables import HRFlowable
from reportlab.lib.colors import HexColor

OUTPUT = "/home/daytona/workspace/hai-summary/HAI_Bundles_Antibiotic_Regimens.pdf"

# ── Colour palette ────────────────────────────────────────────────────────────
DARK_BLUE  = HexColor("#1A3A5C")
MED_BLUE   = HexColor("#2563A8")
LIGHT_BLUE = HexColor("#D6E8FA")
TEAL       = HexColor("#0E7490")
TEAL_LT    = HexColor("#CCEFF5")
RED        = HexColor("#B91C1C")
RED_LT     = HexColor("#FEE2E2")
GREEN      = HexColor("#166534")
GREEN_LT   = HexColor("#DCFCE7")
ORANGE     = HexColor("#92400E")
ORANGE_LT  = HexColor("#FEF3C7")
PURPLE     = HexColor("#5B21B6")
PURPLE_LT  = HexColor("#EDE9FE")
GREY_DARK  = HexColor("#374151")
GREY_MID   = HexColor("#6B7280")
GREY_LT    = HexColor("#F3F4F6")
WHITE      = colors.white

doc = SimpleDocTemplate(
    OUTPUT,
    pagesize=A4,
    rightMargin=1.8*cm, leftMargin=1.8*cm,
    topMargin=2*cm, bottomMargin=2*cm,
    title="HAI Prevention Bundles & Antibiotic Regimens",
    author="Orris Clinical Summary"
)

W = A4[0] - 3.6*cm   # usable width

styles = getSampleStyleSheet()

def S(name, **kw):
    return ParagraphStyle(name, **kw)

# Custom styles
Title      = S("Title",      fontSize=22, leading=28, textColor=WHITE,
               alignment=TA_CENTER, fontName="Helvetica-Bold")
Subtitle   = S("Subtitle",   fontSize=11, leading=16, textColor=LIGHT_BLUE,
               alignment=TA_CENTER, fontName="Helvetica")
SecHead    = S("SecHead",    fontSize=13, leading=18, textColor=WHITE,
               fontName="Helvetica-Bold", spaceAfter=2)
SubHead    = S("SubHead",    fontSize=10, leading=14, textColor=DARK_BLUE,
               fontName="Helvetica-Bold", spaceBefore=6, spaceAfter=4)
Body       = S("Body",       fontSize=8.5, leading=13, textColor=GREY_DARK,
               fontName="Helvetica", spaceAfter=3)
BulletItem = S("BulletItem", fontSize=8.5, leading=13, textColor=GREY_DARK,
               fontName="Helvetica", leftIndent=12, bulletIndent=0, spaceAfter=2)
FootNote   = S("FootNote",   fontSize=7,  leading=10, textColor=GREY_MID,
               fontName="Helvetica-Oblique", alignment=TA_CENTER)
CellBold   = S("CellBold",   fontSize=8,  leading=11, textColor=WHITE,
               fontName="Helvetica-Bold")
CellBody   = S("CellBody",   fontSize=7.8, leading=11, textColor=GREY_DARK,
               fontName="Helvetica")
CellBodySm = S("CellBodySm", fontSize=7.2, leading=10.5, textColor=GREY_DARK,
               fontName="Helvetica")
TblHdr     = S("TblHdr",     fontSize=8,  leading=11, textColor=WHITE,
               fontName="Helvetica-Bold", alignment=TA_CENTER)

def section_banner(text, bg=DARK_BLUE):
    """Full-width coloured banner for section headings."""
    tbl = Table([[Paragraph(text, SecHead)]], colWidths=[W])
    tbl.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("TOPPADDING",    (0,0), (-1,-1), 6),
        ("BOTTOMPADDING", (0,0), (-1,-1), 6),
        ("LEFTPADDING",   (0,0), (-1,-1), 10),
        ("RIGHTPADDING",  (0,0), (-1,-1), 10),
        ("ROUNDEDCORNERS", [4]),
    ]))
    return tbl

def bullet(text, indent=12):
    return Paragraph(f"•  {text}", BulletItem)

def sub_bullet(text):
    s = S("sub_b", fontSize=8, leading=12, textColor=GREY_DARK,
          fontName="Helvetica", leftIndent=24, bulletIndent=12, spaceAfter=1)
    return Paragraph(f"– {text}", s)

def hr(color=LIGHT_BLUE, thickness=0.8):
    return HRFlowable(width="100%", thickness=thickness, color=color, spaceAfter=4, spaceBefore=4)

def sp(h=0.3):
    return Spacer(1, h*cm)


# ═══════════════════════════════════════════════════════════════════════════════
# STORY
# ═══════════════════════════════════════════════════════════════════════════════
story = []

# ── COVER BANNER ─────────────────────────────────────────────────────────────
cover_data = [[
    Paragraph("Hospital-Acquired Infections", Title),
    Paragraph("Prevention Bundles & Antibiotic Regimens", Subtitle),
    Paragraph("Quick-Reference Summary · ICU / MD Anaesthesia", FootNote),
]]
cover = Table(cover_data, colWidths=[W])
cover.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), DARK_BLUE),
    ("TOPPADDING",    (0,0), (-1,-1), 18),
    ("BOTTOMPADDING", (0,0), (-1,-1), 18),
    ("LEFTPADDING",   (0,0), (-1,-1), 16),
    ("RIGHTPADDING",  (0,0), (-1,-1), 16),
    ("ROUNDEDCORNERS", [6]),
]))
story.append(cover)
story.append(sp(0.5))

# ── DEFINITION BOX ───────────────────────────────────────────────────────────
def_box = Table([[
    Paragraph(
        "<b>Hospital-Acquired Infection (HAI)</b> — Also called <i>nosocomial infection</i>. "
        "An infection occurring ≥48 h after hospital admission, not present or incubating at admission. "
        "HAIs affect ~3% of hospitalised patients (CDC) and cost <b>$7.2–14.9 billion/year</b> (US). "
        "Many are <b>preventable</b> with evidence-based bundles.",
        S("defbox", fontSize=8.5, leading=13, textColor=DARK_BLUE,
          fontName="Helvetica", alignment=TA_JUSTIFY)
    )
]], colWidths=[W])
def_box.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), LIGHT_BLUE),
    ("BOX", (0,0), (-1,-1), 1, MED_BLUE),
    ("TOPPADDING",    (0,0), (-1,-1), 8),
    ("BOTTOMPADDING", (0,0), (-1,-1), 8),
    ("LEFTPADDING",   (0,0), (-1,-1), 10),
    ("RIGHTPADDING",  (0,0), (-1,-1), 10),
]))
story.append(def_box)
story.append(sp(0.5))

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 1: HAI OVERVIEW TABLE
# ═══════════════════════════════════════════════════════════════════════════════
story.append(section_banner("1. HAI Types in ICU — Overview", DARK_BLUE))
story.append(sp(0.3))

hai_hdr = [
    Paragraph("HAI Type", TblHdr),
    Paragraph("Acronym", TblHdr),
    Paragraph("Definition", TblHdr),
    Paragraph("Common Organisms", TblHdr),
]
hai_rows = [
    ["Ventilator-Associated Pneumonia",   "VAP",   "Pneumonia ≥48 h after intubation",
     "Early: H. influenzae, S. pneumoniae, MSSA\nLate: MRSA, Pseudomonas, Acinetobacter"],
    ["Catheter-Related Bloodstream Infx", "CRBSI/CLABSI", "BSI attributed to intravascular catheter (CVC ≥48 h in situ)",
     "S. epidermidis, S. aureus, Enterococcus, Enteric GNRs, Candida"],
    ["Catheter-Associated UTI",           "CAUTI", "UTI in catheterised patient",
     "Staphylococci, Enterococcus, Enteric GNRs, Pseudomonas"],
    ["C. difficile Infection",            "CDI",   "AAC; toxin-mediated colitis after antibiotics",
     "Clostridioides difficile (spore-forming)"],
    ["Surgical Site Infection",           "SSI",   "Infection at operative wound within 30 days",
     "S. aureus, MRSA, Enteric GNRs, Streptococci"],
    ["ICU-Acquired Sinusitis",            "—",     "Nasal/oral tubes block sinus ostia",
     "Same as VAP pathogens"],
    ["Invasive Fungal Infection",         "IFI",   "Candida/Aspergillus in susceptible host",
     "Candida albicans (~50%), C. tropicalis, C. glabrata, Aspergillus"],
]

hai_data = [hai_hdr]
for r in hai_rows:
    hai_data.append([Paragraph(x, CellBodySm) for x in r])

col_w = [W*0.22, W*0.11, W*0.32, W*0.35]
hai_tbl = Table(hai_data, colWidths=col_w, repeatRows=1)
hai_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), DARK_BLUE),
    ("ROWBACKGROUNDS",(0,1),(-1,-1),[WHITE, GREY_LT]),
    ("BOX",           (0,0), (-1,-1), 0.5, GREY_MID),
    ("INNERGRID",     (0,0), (-1,-1), 0.3, HexColor("#D1D5DB")),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 5),
    ("RIGHTPADDING",  (0,0), (-1,-1), 5),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story.append(hai_tbl)
story.append(sp(0.6))

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 2: CAUSES
# ═══════════════════════════════════════════════════════════════════════════════
story.append(section_banner("2. Causes / Risk Factors for HAI", MED_BLUE))
story.append(sp(0.3))

causes_cols = [
    ("Host Factors", RED_LT, RED, [
        "Critical illness — altered immunity, malnutrition",
        "Extremes of age (neonates, elderly)",
        "Immunosuppression: steroids, chemo",
        "Disrupted skin/mucosal barriers",
        "Altered microbiome (broad antibiotics)",
    ]),
    ("Device / Procedure Factors", ORANGE_LT, ORANGE, [
        "Endotracheal tube — bypasses mucociliary clearance",
        "Nasotracheal intubation — blocks sinus ostia",
        "Central venous catheter — skin/hub colonisation, biofilm",
        "Urinary catheter — bacteriuria → bacteraemia 5%",
        "NG tube — aspiration risk",
    ]),
    ("Environmental / Systemic", GREEN_LT, GREEN, [
        "Poor hand hygiene (single most preventable cause)",
        "Contaminated equipment/surfaces",
        "Crowding, understaffing (COVID ↑CLABSI 28–91%)",
        "HVAC/water (Legionella, Aspergillus)",
        "Prolonged antibiotics → C. difficile, resistance",
        "Parenteral nutrition → Candida risk",
    ]),
]

cause_cells = []
for (title, bg, fg, items) in causes_cols:
    cell_content = [Paragraph(title, S("ch", fontSize=8.5, leading=12,
                                        fontName="Helvetica-Bold", textColor=fg,
                                        spaceAfter=4))]
    for it in items:
        cell_content.append(Paragraph(f"• {it}", CellBodySm))
    t = Table([[cell_content]], colWidths=[(W-0.6)/3])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("BOX",        (0,0), (-1,-1), 0.5, fg),
        ("TOPPADDING",    (0,0), (-1,-1), 8),
        ("BOTTOMPADDING", (0,0), (-1,-1), 8),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("RIGHTPADDING",  (0,0), (-1,-1), 8),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ]))
    cause_cells.append(t)

cause_row = Table([cause_cells], colWidths=[(W-0.6)/3]*3,
                   hAlign="LEFT")
cause_row.setStyle(TableStyle([
    ("LEFTPADDING",  (0,0), (-1,-1), 3),
    ("RIGHTPADDING", (0,0), (-1,-1), 3),
    ("VALIGN",       (0,0), (-1,-1), "TOP"),
]))
story.append(cause_row)
story.append(sp(0.6))

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 3: PREVENTION BUNDLES
# ═══════════════════════════════════════════════════════════════════════════════
story.append(section_banner("3. ICU Prevention Bundles", TEAL))
story.append(sp(0.3))

# ── 3A: VAP Bundle ────────────────────────────────────────────────────────────
story.append(KeepTogether([
    Paragraph("3A. VAP Prevention Bundle", S("sh", fontSize=10, leading=14,
              fontName="Helvetica-Bold", textColor=TEAL, spaceBefore=4, spaceAfter=4)),
]))

vap_hdr = [Paragraph(x, TblHdr) for x in ["Measure", "Detail / Evidence"]]
vap_rows = [
    ("✔ Head-of-bed elevation ≥30°",
     "Reduces microaspiration of gastric contents. Simple, low-cost, strong evidence. Apply in ALL ventilated patients."),
    ("✔ Strict hand hygiene",
     "Between all patient contacts. Single most important cross-transmission prevention measure."),
    ("✔ Oral decontamination with chlorhexidine",
     "Reduces oropharyngeal bacterial burden; likely reduces VAP incidence. Use 0.12–0.2% CHX oral rinse."),
    ("✔ Subglottic suctioning ETT",
     "Meta-analysis supports reduction in VAP incidence + shorter ICU/hospital LOS. Use suction port ETTs in patients expected to be ventilated >72 h."),
    ("✔ Early weaning / extubation",
     "Daily spontaneous breathing trials (SBT). Minimise duration of mechanical ventilation. Prefer NIV where appropriate."),
    ("✔ Ventilator circuit management",
     "Change only when visibly soiled. Avoid unnecessary circuit breaks that increase contamination risk."),
    ("✔ Selective Digestive Decontamination (SDD)",
     "Non-absorbable enteral antibiotics; growing evidence but controversial (antibiotic resistance concerns)."),
    ("⚠ GI acid suppression",
     "Use only in HIGH-RISK patients (coagulopathy, MV). Acid suppression allows gastric bacterial overgrowth → ↑VAP risk. Consider sucralfate as alternative."),
    ("✔ Avoid routine ETT suctioning",
     "Only when clinically indicated; use closed suction systems."),
]
vap_data = [vap_hdr] + [[Paragraph(a, CellBodySm), Paragraph(b, CellBodySm)] for a,b in vap_rows]
vap_tbl = Table(vap_data, colWidths=[W*0.32, W*0.68], repeatRows=1)
vap_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), TEAL),
    ("ROWBACKGROUNDS",(0,1),(-1,-1),[WHITE, TEAL_LT]),
    ("BOX",           (0,0), (-1,-1), 0.5, TEAL),
    ("INNERGRID",     (0,0), (-1,-1), 0.3, HexColor("#A7D8E0")),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story.append(vap_tbl)
story.append(sp(0.5))

# ── 3B: CLABSI Bundle ─────────────────────────────────────────────────────────
story.append(KeepTogether([
    Paragraph("3B. CLABSI Prevention Bundle  (↓46% in US after implementation)",
              S("sh2", fontSize=10, leading=14, fontName="Helvetica-Bold",
                textColor=MED_BLUE, spaceBefore=4, spaceAfter=4)),
]))

clabsi_hdr = [Paragraph(x, TblHdr) for x in ["Phase", "Bundle Element", "Recommendation"]]
clabsi_rows = [
    # INSERTION
    ("INSERTION", "Hand hygiene",
     "Wash hands before insertion. Don gloves and mask."),
    ("INSERTION", "Maximal sterile barrier (MSB)",
     "Sterile gown + gloves + cap + mask + FULL BODY drape for patient."),
    ("INSERTION", "Skin antisepsis",
     "Chlorhexidine-alcohol solution — superior to povidone-iodine or alcohol alone."),
    ("INSERTION", "Optimal site selection",
     "Subclavian → lowest infection/DVT risk (highest mechanical risk).\nInternal jugular → intermediate.\nFemoral → highest infection risk; reserve for emergency/coagulopathy."),
    ("INSERTION", "Ultrasound guidance",
     "Reduces insertion attempts and trauma; strongly recommended."),
    ("INSERTION", "Replace emergency lines",
     "Catheters placed without aseptic technique must be replaced as soon as patient condition allows."),
    # MAINTENANCE
    ("MAINTENANCE", "Daily necessity review",
     "Remove CVC as soon as it is no longer required. Document date of insertion and removal."),
    ("MAINTENANCE", "Dressing changes",
     "Gauze dressing: every 2 days.\nTransparent film: every 7 days (sooner if soiled/damp/loose)."),
    ("MAINTENANCE", "'Scrub the hub'",
     "Disinfect all ports/hubs before and after each access. Cover open lumens with sterile end-caps."),
    ("MAINTENANCE", "Chlorhexidine at dressing change",
     "Apply CHX solution to catheter exit site at every dressing change."),
    ("MAINTENANCE", "Antimicrobial-impregnated catheter",
     "Use when expected duration >5 days OR local CRBSI rate >3.3/1000 catheter-days.\nOptions: CHX/silver sulfadiazine OR minocycline/rifampin."),
    ("MAINTENANCE", "Avoid routine guidewire exchange",
     "Does NOT reduce infection. Increases mechanical complications. Replace catheter if CRBSI confirmed — do NOT exchange over guidewire."),
    ("MAINTENANCE", "Staff education",
     "Standardised competency-based training for all staff manipulating CVCs."),
]

clabsi_data = [clabsi_hdr]
prev_phase = None
for phase, elem, rec in clabsi_rows:
    display_phase = phase if phase != prev_phase else ""
    prev_phase = phase
    clabsi_data.append([
        Paragraph(display_phase, S("ph", fontSize=8, fontName="Helvetica-Bold",
                                    textColor=MED_BLUE if phase=="INSERTION" else TEAL,
                                    leading=11)),
        Paragraph(elem, CellBodySm),
        Paragraph(rec, CellBodySm),
    ])

ins_rows = [i+1 for i,(ph,_,_) in enumerate(clabsi_rows) if ph=="INSERTION"]
maint_rows = [i+1 for i,(ph,_,_) in enumerate(clabsi_rows) if ph=="MAINTENANCE"]

clabsi_tbl = Table(clabsi_data, colWidths=[W*0.13, W*0.27, W*0.60], repeatRows=1)
ts = TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), MED_BLUE),
    ("ROWBACKGROUNDS",(0,1),(-1,-1),[WHITE, GREY_LT]),
    ("BOX",           (0,0), (-1,-1), 0.5, MED_BLUE),
    ("INNERGRID",     (0,0), (-1,-1), 0.3, HexColor("#BFDBFE")),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
])
# Background for insertion rows
for r in ins_rows:
    ts.add("BACKGROUND", (0,r), (0,r), HexColor("#DBEAFE"))
for r in maint_rows:
    ts.add("BACKGROUND", (0,r), (0,r), HexColor("#D1FAE5"))

clabsi_tbl.setStyle(ts)
story.append(clabsi_tbl)
story.append(sp(0.5))

# ── 3C: CAUTI + CDI side by side ──────────────────────────────────────────────
cauti_items = [
    ("✔", "Aseptic technique during insertion"),
    ("✔", "Closed drainage system; bag below bladder level"),
    ("✔", "Daily necessity review — remove ASAP"),
    ("✔", "Use only when strictly indicated (not for convenience)"),
    ("✔", "Consider intermittent catheterisation as alternative"),
    ("✔", "Hand hygiene before any catheter manipulation"),
    ("⚠", "Antimicrobial coatings — insufficient evidence for routine use"),
]
cdi_items = [
    ("✔", "Antibiotic stewardship — restrict broad-spectrum, de-escalate"),
    ("✔", "Soap-and-water handwashing (alcohol gel INEFFECTIVE vs spores)"),
    ("✔", "Contact precautions — gown + gloves; isolate patients"),
    ("✔", "Sporicidal environmental cleaning (bleach-based)"),
    ("✔", "Avoid PPIs unless clearly indicated"),
    ("✔", "Treat: oral vancomycin; add IV metronidazole if shock/megacolon"),
]

def mini_bundle_cell(title, bg, fg, items, width):
    content = [Paragraph(title, S("mbt", fontSize=9, fontName="Helvetica-Bold",
                                   textColor=fg, leading=13, spaceAfter=5))]
    for icon, text in items:
        content.append(Paragraph(
            f'<font color="{"#166534" if icon=="✔" else "#B91C1C"}">{icon}</font>  {text}',
            CellBodySm
        ))
    t = Table([[content]], colWidths=[width])
    t.setStyle(TableStyle([
        ("BACKGROUND", (0,0), (-1,-1), bg),
        ("BOX",        (0,0), (-1,-1), 0.8, fg),
        ("TOPPADDING",    (0,0), (-1,-1), 8),
        ("BOTTOMPADDING", (0,0), (-1,-1), 8),
        ("LEFTPADDING",   (0,0), (-1,-1), 8),
        ("RIGHTPADDING",  (0,0), (-1,-1), 8),
        ("VALIGN",        (0,0), (-1,-1), "TOP"),
    ]))
    return t

half = (W - 0.4) / 2
cauti_cell = mini_bundle_cell("3C. CAUTI Prevention", TEAL_LT, TEAL, cauti_items, half)
cdi_cell   = mini_bundle_cell("3D. C. difficile (CDI) Prevention", ORANGE_LT, ORANGE, cdi_items, half)

pair_row = Table([[cauti_cell, cdi_cell]], colWidths=[half, half])
pair_row.setStyle(TableStyle([
    ("LEFTPADDING",  (0,0), (-1,-1), 2),
    ("RIGHTPADDING", (0,0), (-1,-1), 2),
    ("VALIGN",       (0,0), (-1,-1), "TOP"),
]))
story.append(pair_row)
story.append(sp(0.5))

# ── 3E: Fungal + Sinusitis ────────────────────────────────────────────────────
fungal_items = [
    ("✔", "Limit CVC duration, PN use, broad-spectrum antibiotics"),
    ("✔", "Prophylactic fluconazole in high-risk surgical ICU patients"),
    ("✔", "β-D-glucan assay: ~80% sensitive/specific (Candida, Aspergillus)"),
    ("✔", "Whole-blood PCR: >90% sensitivity; result within hours"),
    ("✔", "Candiduria alone: usually resolves with catheter removal"),
    ("⚠", "Candida peritonitis: treat if clinical signs of infection (mortality ~50%)"),
]
sinus_items = [
    ("✔", "Prefer OROTRACHEAL over nasotracheal intubation"),
    ("✔", "Sinusitis rate: nasal ~95% vs oral ~25% at 1 week"),
    ("✔", "Remove nasal tubes (ETT, NG) as early as clinically possible"),
    ("✔", "Suspect sinusitis in ICU fever of unknown origin (~16% of FUO in surgical ICU)"),
    ("✔", "Quantitative cultures needed to confirm bacterial vs radiographic sinusitis"),
]

fungal_cell = mini_bundle_cell("3E. Invasive Fungal Infection Prevention", PURPLE_LT, PURPLE, fungal_items, half)
sinus_cell  = mini_bundle_cell("3F. ICU-Acquired Sinusitis Prevention", RED_LT, RED, sinus_items, half)

pair_row2 = Table([[fungal_cell, sinus_cell]], colWidths=[half, half])
pair_row2.setStyle(TableStyle([
    ("LEFTPADDING",  (0,0), (-1,-1), 2),
    ("RIGHTPADDING", (0,0), (-1,-1), 2),
    ("VALIGN",       (0,0), (-1,-1), "TOP"),
]))
story.append(pair_row2)
story.append(sp(0.6))

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 4: ANTIBIOTIC REGIMENS
# ═══════════════════════════════════════════════════════════════════════════════
story.append(PageBreak())
story.append(section_banner("4. Empiric Antibiotic Regimens for Common ICU Infections", RED))
story.append(sp(0.3))
story.append(Paragraph(
    "<i>Based on Barash, Cullen &amp; Stoelting's Clinical Anesthesia, 9e. "
    "Always tailor to LOCAL ANTIBIOGRAM. De-escalate after 48–72 h culture results.</i>",
    S("note", fontSize=8, fontName="Helvetica-Oblique", textColor=RED,
      leading=12, spaceAfter=6)
))

abx_hdr = [Paragraph(x, TblHdr) for x in
           ["Infection", "Sub-type / Notes", "Empiric Regimen", "Duration"]]
abx_rows = [
    # VAP
    ("VAP\n(Ventilator-Associated\nPneumonia)",
     "Early (<72 h of intubation)\nCommunity/sensitive flora",
     "Ceftriaxone + Azithromycin\n\n+ Vancomycin or Linezolid\nif MRSA history/risk",
     "5–8 days\n(narrow on\ncultures)"),
    ("VAP",
     "Late (>72 h)\nMDR organisms likely\n(MRSA, Pseudomonas,\nAcinetobacter)",
     "Vancomycin OR Linezolid\n+ Cefepime\n± Ciprofloxacin\n  (if MDR GNRs likely)",
     "8 days\n(14 days for\nPseudomonas)"),
    # BSI
    ("Bloodstream Infection\n(CRBSI/CLABSI/BSI)",
     "Cover MRSA + MDR GNRs;\nadd anti-Pseudomonal if high\nlocal incidence",
     "Vancomycin OR Linezolid\n+ Cefepime\n± Ciprofloxacin\n  (MDR GNRs / ESBLs)",
     "≥7 days\n(≥14 days for\nS. aureus)"),
    # CAUTI
    ("CAUTI\n(Urinary Tract Infection)",
     "Non-catheter-associated",
     "Ceftriaxone",
     "5–7 days"),
    ("CAUTI",
     "Catheter-associated;\nGPCs on Gram stain\nor MDR GNRs/ESBL risk",
     "Ceftazidime\n+ Vancomycin (if GPCs on stain)\nor Meropenem\n  (MDR/ESBL concern)",
     "7–14 days"),
    # CDI
    ("C. difficile Infection\n(CDI)",
     "Non-severe; first episode",
     "Oral Vancomycin 125 mg QDS × 10 days\n(alternative: oral Fidaxomicin)",
     "10 days"),
    ("CDI",
     "Severe (shock, megacolon,\nileus, peritonitis)",
     "Oral Vancomycin 500 mg QDS\n+ IV Metronidazole 500 mg TDS\n± surgical consult",
     "10–14 days"),
    # Meningitis
    ("Meningitis",
     "Non-surgical / community",
     "Dexamethasone + Ceftriaxone\n+ Vancomycin + Ampicillin\n+ Acyclovir",
     "10–21 days\n(per organism)"),
    ("Meningitis",
     "Post-surgical / post-trauma\n(GNRs + S. aureus likely)",
     "Cefepime + Metronidazole\n+ Vancomycin",
     "10–21 days"),
    # IAI
    ("Intra-Abdominal Infection\n(IAI)",
     "Community-acquired",
     "Ceftriaxone + Metronidazole",
     "4–7 days\nafter source\ncontrol"),
    ("IAI",
     "Hospital-acquired / post-op\nMDR risk",
     "Vancomycin\n+ Piperacillin-Tazobactam\nOR Meropenem",
     "5–7 days\nafter source\ncontrol"),
    # Sepsis
    ("Sepsis / Septic Shock\n(Unknown Source)",
     "Broad empiric cover;\nnarrow urgently on cultures",
     "Vancomycin + Meropenem\n± Ciprofloxacin\n  (MDR GNRs / ESBLs)",
     "Reassess at\n48–72 h;\nde-escalate"),
    # Fungal
    ("Invasive Candidiasis\n(Candidaemia)",
     "Non-neutropenic ICU patient;\nremove CVCs if feasible",
     "Echinocandin (Caspofungin,\nMicafungin, Anidulafungin)\nOR Fluconazole if sensitive,\nnon-critically ill",
     "14 days after\nlast positive\nculture"),
]

abx_data = [abx_hdr]
prev_infx = ""
for infx, sub, reg, dur in abx_rows:
    display_infx = infx if infx != prev_infx else ""
    prev_infx = infx
    abx_data.append([
        Paragraph(display_infx, S("ai", fontSize=8, fontName="Helvetica-Bold",
                                   textColor=DARK_BLUE, leading=11)),
        Paragraph(sub, CellBodySm),
        Paragraph(reg, S("reg", fontSize=8, fontName="Helvetica", leading=11.5,
                          textColor=GREY_DARK)),
        Paragraph(dur, CellBodySm),
    ])

abx_tbl = Table(abx_data, colWidths=[W*0.20, W*0.22, W*0.38, W*0.20], repeatRows=1)
abx_ts = TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), RED),
    ("ROWBACKGROUNDS",(0,1),(-1,-1),[WHITE, RED_LT]),
    ("BOX",           (0,0), (-1,-1), 0.5, RED),
    ("INNERGRID",     (0,0), (-1,-1), 0.3, HexColor("#FECACA")),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 5),
    ("RIGHTPADDING",  (0,0), (-1,-1), 5),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
])
abx_tbl.setStyle(abx_ts)
story.append(abx_tbl)
story.append(sp(0.5))

# ── De-escalation box ─────────────────────────────────────────────────────────
deesc = Table([[
    Paragraph(
        "<b>De-Escalation Principle:</b> "
        "Start empiric broad-spectrum antibiotics AFTER cultures are sent. "
        "Narrow or discontinue based on 48–72 h culture + sensitivity results. "
        "This approach ensures adequate initial treatment while minimising "
        "antibiotic resistance and Clostridioides difficile risk.",
        S("deesc", fontSize=8.5, leading=13, fontName="Helvetica",
          textColor=DARK_BLUE, alignment=TA_JUSTIFY)
    )
]], colWidths=[W])
deesc.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), LIGHT_BLUE),
    ("BOX",        (0,0), (-1,-1), 1.2, MED_BLUE),
    ("LEFTPADDING",  (0,0), (-1,-1), 10),
    ("RIGHTPADDING", (0,0), (-1,-1), 10),
    ("TOPPADDING",   (0,0), (-1,-1), 8),
    ("BOTTOMPADDING",(0,0), (-1,-1), 8),
]))
story.append(deesc)
story.append(sp(0.6))

# ═══════════════════════════════════════════════════════════════════════════════
# SECTION 5: MASTER SUMMARY TABLE
# ═══════════════════════════════════════════════════════════════════════════════
story.append(section_banner("5. Master Summary — HAI Bundles at a Glance", DARK_BLUE))
story.append(sp(0.3))

sum_hdr = [Paragraph(x, TblHdr) for x in ["HAI", "Core Bundle Elements"]]
sum_rows = [
    ("VAP",
     "HOB ≥30° | Hand hygiene | Oral CHX | Subglottic suctioning ETT | Early weaning/SBT | Minimise acid suppression | Closed suction"),
    ("CLABSI",
     "Hand hygiene | Full sterile barrier | CHX-alcohol skin prep | Optimal site (subclavian preferred) | Daily necessity review | 'Scrub the hub' | Antimicrobial catheter if >5 days"),
    ("CAUTI",
     "Aseptic insertion | Closed drainage | Bag below bladder | Daily review | Shortest duration possible | Prefer intermittent catheterisation"),
    ("CDI",
     "Antibiotic stewardship | Soap-and-water handwashing (not alcohol) | Contact precautions + isolation | Sporicidal cleaning | Avoid unnecessary PPIs"),
    ("Invasive Fungal",
     "Limit CVC / PN / antibiotics | Fluconazole prophylaxis (high-risk) | Early β-D-glucan / PCR diagnosis | Prompt antifungal treatment"),
    ("Sinusitis",
     "Oral > nasal intubation | Early removal of nasal tubes | Suspect in ICU FUO"),
    ("General",
     "Care bundles | Antimicrobial stewardship | Daily device review | Active IPC surveillance | Staff education | Environmental cleaning"),
]

sum_data = [sum_hdr] + [[Paragraph(a, S("sk", fontSize=8.5, fontName="Helvetica-Bold",
                                         textColor=DARK_BLUE, leading=12)),
                          Paragraph(b, CellBodySm)] for a,b in sum_rows]
sum_tbl = Table(sum_data, colWidths=[W*0.15, W*0.85], repeatRows=1)
sum_tbl.setStyle(TableStyle([
    ("BACKGROUND",    (0,0), (-1,0), DARK_BLUE),
    ("ROWBACKGROUNDS",(0,1),(-1,-1),[WHITE, LIGHT_BLUE]),
    ("BOX",           (0,0), (-1,-1), 0.5, DARK_BLUE),
    ("INNERGRID",     (0,0), (-1,-1), 0.3, HexColor("#D1D5DB")),
    ("TOPPADDING",    (0,0), (-1,-1), 5),
    ("BOTTOMPADDING", (0,0), (-1,-1), 5),
    ("LEFTPADDING",   (0,0), (-1,-1), 6),
    ("RIGHTPADDING",  (0,0), (-1,-1), 6),
    ("VALIGN",        (0,0), (-1,-1), "TOP"),
]))
story.append(sum_tbl)
story.append(sp(0.6))

# ── Footer note ───────────────────────────────────────────────────────────────
footer = Table([[
    Paragraph(
        "Sources: Barash, Cullen &amp; Stoelting's Clinical Anesthesia 9e · Miller's Anesthesia 10e · "
        "Current Surgical Therapy 14e · Tietz Textbook of Laboratory Medicine 7e · Goldman-Cecil Medicine. "
        "Generated by Orris Clinical AI · May 2026",
        FootNote
    )
]], colWidths=[W])
footer.setStyle(TableStyle([
    ("BACKGROUND", (0,0), (-1,-1), GREY_LT),
    ("BOX",        (0,0), (-1,-1), 0.5, HexColor("#D1D5DB")),
    ("TOPPADDING",   (0,0), (-1,-1), 6),
    ("BOTTOMPADDING",(0,0), (-1,-1), 6),
]))
story.append(footer)

# ── BUILD ─────────────────────────────────────────────────────────────────────
doc.build(story)
print(f"PDF created: {OUTPUT}")