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Bernard W. Dempsey, S. In a centralized economy, currency is issued by a central bank at a rate that is supposed to match the growth of the amount of goods that are exchanged so that these goods can be traded with stable prices. The monetary base is controlled by a central bank.

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Speir julie msw betting

Laurel Vaden Alsentzer, NR Clay Alspaugh, AS and Ms. Christina Wilson Altenau, AS Steven John Amigone, OG Anderholm, EN and Mrs. Lynn D. Anderholm, AS GS Frederick Stuart Anderson, AS Daniel Patrick Anderson. David G. Anderson Jr. Jonetta G. Anderson, GS JoAnna Todd Anderson Ph. Anderson, M. William J. Patricia W. Anderson, AS Jennifer Thau Andreas, AS Sandra Ward-Angell, DV Catherine Tananes Anthony, GS Erin Goldberg Applebaum, LW Keane Barger, LW Thomas Whit Armstrong Jr.

Elizabeth Miller Armstrong, AS Marisa Hudson-Arney, AS Rebecca Leigh Tyler, LW George Reed Arrants Jr. Kimberly Lynn Arrants, AS Joe Franklin Arterberry, M. Kathryn Ross Arterberry. John D. Arterberry, LW and Mrs. Lisa Wagner Arterberry, AS Katherine Marie Ashby, PB Carlton R. Asher Jr. Robert D. Asher, AS and Dr. George W. Atkins Jr. Martha Dance Atkins, AS Scott Alexander Atkinson, AS James B.

Atkinson, III, M. Deborah T. Atkinson, PB Joseph S. Atkinson, MD and Mrs. Lisa Wilmot Aulsebrook, AS Sandy Mitchell Ayers, AS Robert Irvin Ayerst Jr. Victoria Catherine Mitchell, LW Virginia Adkins Bailey, AS Joanna Leigh Baker, AS Jeffrey R. Melinda Snyder Balser, DV Heather B. Bankoff, AS Carol Ashbrook Bapty.

Judith Ann Barber. Lisa Anne Barbour, AS Mary Frist Barfield, PB Susan A. Barge, AS Brooks Patrick Barge. Katherine Simpson Barker, GS William E. Dorothy E. Barkman, AS GS Maxwell N. Barnes, LW Jeffrey L. Barnett, AS Ralph I. Donna R. Barr, PB PB Kelly M. Albert Joseph Bart Jr. David Harrison Bartley, OG Rebecca Herren Bashinsky, AS Heather Leigh Batchelor, AS Alexandra T. Yates Bateman, EN Albert Bates Jr.

Leslie Pearson Bates, AS John Mark Bauserman, EN Curtis L. Mary Roberts Baysinger, NR Franklin Russell Beard Jr. Marcela S. Beard, AS Pearson Beardsley, AS and Mrs. Stacey Woodruff Beardsley, AS John S. Allison T. Beasley, AS Roger H. Beckham, EN and Mrs. Joanne Lamphere Beckham, AS James Z. Bedford, EN and Ms. Beesley, Jr. Charles Timothy Bell Jr. Zylpha K. Pryor-Bell, LW Jennifer Rosson Bell, AS Steven Thomas Bellows, EN Saul C. Belz, LW and Mrs.

Abraham Agustin Benavides, AS Tracy Malcolm Benner, LW Kathy Grogan Bennett, PB Renee Reisel Bennett, AS Kendel J. Bennett, OG and Mrs. Julianne Tate Bennett, OG Jonathan Ryan Benoit, AS James A. Bentley Jr. Genie Bentley, AS David Brent Beougher, AS Daphne Hackley Berger, PB Corinne Q. Darryl David Berger Jr. Laura Michelle Bernick.

Ira H. Linda Greif Bernstein. Michelle Lynn Berolzheimer, AS Katherine Davis Berry, NR John Christopher Bertozzi, AS Lucy Grierson Bertsch, PB Philip Jude Betbeze. Nicole Mynatt Bickerstaff. Amanda Marie Biebighauser. Richard Gordon Bierwagen, OG Frederic T. Kathryn Kitchen Billings and Dr. Charles W. Billingsley Jr. Margaret Finney Billingsley, AS William Wallace Billington, Jr.

Leanne Binkley Esq. John Michael Birdsong, PB Austin Lyons Bischoff, EN Theresa S. Timothy Scott Blackwell, M. Lesa Penny Blackwell, AS William F. Jonathan Hamilton Bliley, AS Mary Beth Blinn, DV George R. Blue Jr. Clair Dasher Blue, AS Jeffery William Blum, DV Lawrence E.

Blumberg, AS and Ms. Leslie Wender Blumberg, AS Damond Williams Boatwright. Martha Hellman Bogdon, AS Aubrey W. Robert Edwin Bohren Jr. Robert Vern Bolen. Jonathan Bryan Bollinger. Taryn Marie Bolton, AS Charles Robert Bone, LW Amy Gordon Bono, AS Ellen Doramus Bookout, PB Valerie Kuznik Boshart, AS Kimberly Athan Bosworth, AS Dennis C. Bottorff, EN and Mrs. Jean Brewington Bottorff, PB Don W. Karen Dellinger Bouldin, PB Ryan Montgomery Bowie, AS John Maurice Bowler, LW Donald E.

Bowles Jr. Jane Ralston Bowles, AS Raymond Winston Bowling, OG Campbell Bowman, Jr. Emily Hatch Bowman, LW Shelley Elifson Bowman, OG Martha L. Richard Wesley Littlehale, LW Emily Cruze Boykin, NR Robert E. Sylvia T. Bozeman, GS Richard C. Bozian, GS and Dr. Marguerite W. Bozian, NR NR Janice L. William Haywood Hathaway Jr. Anthony N. Jane Montgomery Brannan, AS Branner, M.

Dewey Branstetter Jr. Julia H. Branstetter, AS PB Reginald Brantley, LW Dan L. Brasfield, AS and Mrs. Frances Joyner Brasfield, AS Breast, Sr. Margaret Mrozek Breeden, AS Carley Catherine Bremner, EN Theresa A. Randall S. Matthews, AS Gordon Lane Brewer, PB Nathan Cole Brewer, AS James Allan Lee, GS Matthew Thomas Brigger, EN John G.

Elaine Ann Brimmer, NR Talia Clare Brinkman, PB Larry Britt, Jr. Leslie R. Jerry H. Judy H. Brookshire, AS PB Michael David Brookshire, EN Jefferson Whitaker Brown, LW Martin S. Brown Jr. Eric Elton Brown, Jr. The Hon. Joe B.

Marilyn M. Brown, AS Jonathan M. Brown, AS and Mrs. Catherine Gallagher Brown, AS Randal Edward Brown Jr. Elizabeth Mulligan Brown. Clark Clayton Browne Jr. Elizabeth Thwaite Browne, PB John Caleb Browning, AS Emily G.

Bruno, AS NR Michael Charles Bryant, OG Robert N. Sarah L. Joel R. Buckberg, LW OG Sarah Elizabeth Ramos, MD Anton Joslyn Bueschen Jr. Paul Robert Buikema, LW Lindsay Builder Jr. Jean F. Builder, AS John Boyd Bullock, Jr. Lilia Urquiza Bunick, PB Robert R. Buntin II, AS Katharine M. Burns, MD Kenneth Michael Burke Jr. Lauren Byer Burke, PB Jacquelyn Jean S. Burkholder, EN William C. Burnette Jr. Jacqueline Burnette, PB Julie M. Maureen Sarah Burrows, AS Richard R.

Burslem, AS Eric Burton-Krieger, DV Norton S. Linda Lafrenaye Busby, GS Ashley A. Bush, AS and Mr. Jonathan E. Bush, AS LW Olivia J. Bushardt, AS and Mr. Scott Benjamin Gilleland, AS Alfredo Federico Bustamante, EN Catalina Lizarralde, OG Alyce Schloss Butner, OG Kathleen C. John N. Byington, PB Kevin Eugene Cadwell, LW Jerry W. Gerald Caldwell, Jr. Margaret Buford Caldwell, AS Margaret Patrick Caldwell.

Kimberly L. Matt M. Callihan, AS and Mrs. William Howard Cammack, Jr. Alan R. Campbell, DV and Mrs. Louise Katherine Campbell. Paul Campbell, AS and Mrs. Virginia Irwin Campbell, AS Michael Ray Canady, AS Richard O. Gail B. Cannon, NR Margaret Fesmire Canter, AS Barbara R. Luther E. Cantrell Jr. Dennis J. Patricia P. Carlson, NR Jeffrey C. Lynne F. Carlton, EN Malcolm N. Carmichael, LW and Mrs. Jeannine Hayes Carmichael, PB Elizabeth K.

Lavenia Buchanan Carpenter, M. Mary Truman W. John A. Carter Jr. Val C. Carter, AS William B. Mitchell Carter, LW and Mrs. Wilka M. Carter, PB PB Nathaniel M. Suzanne Pettus Cartmell, LW Virginia Rubel Caruso, AS William Alexander Caruthers, EN Cynthia M. Scott Cassity, OG Katherine Osusky Castle, AS Amy Elizabeth Castro. Richard Frame Cavenaugh. Anahi Gutierrez Dominguez, LW John Warden Chaffin, OG William H.

Challas, AS Gurney E. Chambers, PB PB Thomas Sidney Chambless Jr. Lola B. Chambless, MD Patricia Anne Chapman, AS Damien Rashid Charley, EN Alice Morgan Johnson Charron. Dean F. Chatlain, Jr. Charlotte H. Chatlain, GS Michael Lee Cheatham, MD Carole M. Cheatwood, AS and Mr. Alan D. Ruth Brown Cherry, AS Thomas M. Chesney, MD and Dr. Carolyn M. Chesney, AS MD Gilbert L. Sue T. Chilton, PB Marsha K. Joe M. Chisolm, AS MD Teresa Ford Chope, AS Emily M.

Christian Paul Christensen, MD Alexander F. Christensen, GS Jeanne T. John T. Christian, GS GS Betsy Kaufman Christof, NR Scott M. Andre' L. Churchwell, M. Doreatha Henderson Churchwell. Harold Whit Clark, Jr. Trudy Nichols Clark, AS Terry L.

Clark, DV and Mrs. Janice Earlene Clark, PB Deborah Yarber Clarke, PB Thomas Peyton Claycomb, LW Kenneth M. Amy Erbesfield Clayton, PB Rebecca Carly Feldman, PB Macy Rose Climo, LW Rosalie Norwood Clinton. Darby K. Ray, GS GS Peter Coccia, GS and Ms. However, its proper cut-off levels are often unknown. We reviewed physician practices regarding PCT test and antibiotic therapy prescription to all patients hospitalized for COPD exacerbation.

We then analyzed the rate of antibiotic prescriptions and the number of PCT tests prescribed before and after the introduction of a protocol validated by previous high-power studies. The primary endpoint was the rate of antibiotic prescriptions. Both antibiotic duration 8.

Disseminating information on the appropriate PCT cut-off level to use to decide whether or not to initiate antibiotics is effective. Its proper use should be clarified to reduce antibiotic prescriptions to these overexposed patients. Host-guest complexation with various hydrophobic drugs has been used to enhance the solubility, permeability, and stability of guest drugs. Physical changes in hydrophobic drugs by complexation have been related to corresponding increases in the bioavailability of these drugs.

Carbohydrates, including various derivatives of cyclodextrins, cyclosophoraoses, and some linear oligosaccharides, are generally used as host complexation agents in drug delivery systems. Many antibiotics with low bioavailability have some limitations to their clinical use due to their intrinsically poor aqueous solubility.

Bioavailability enhancement is therefore an important step to achieve the desired concentration of antibiotics in the treatment of bacterial infections. Antibiotics encapsulated in a complexation- based drug delivery system will display improved antibacterial activity making it possible to reduce dosages and overcome the serious global problem of antibiotic resistance.

Here, we review the present research trends in carbohydrate- based host-guest complexation of various hydrophobic antibiotics as an efficient delivery system to improve solubility, permeability, stability, and controlled release. Bacterial clonal diagnostics as a tool for evidence- based empiric antibiotic selection. Urinary tract infections UTIs , which account for a large share of antibiotic use, are caused predominantly by Escherichia coli, a highly clonal pathogen.

In an observational clinical cohort study of urgent care patients with suspected UTI, we assessed the potential for E. A novel PCR- based clonotyping assay was applied to fresh urine samples to rapidly detect E. The test's performance characteristics and possible effects on prescribing were assessed. The rapid test identified E. In summary, a rapid clonotyping test showed promise for improving empiric antibiotic prescribing for E.

The clonal diagnostics approach merges epidemiologic surveillance, antimicrobial stewardship, and molecular diagnostics to bring evidence- based medicine directly to the point of care. Receptor- based screening assays for the detection of antibiotics residues - A review. Consumer and regulatory agencies have a high concern to antibiotic residues in food producing animals, so appropriate screening assays of fast, sensitive, low cost, and easy sample preparation for the identification of these residues are essential for the food-safety insurance.

Great efforts in the development of a high-throughput antibiotic screening assay have been made in recent years. Concerning the screening of antibiotic residue, this review elaborate an overview on the availability, advancement and applicability of antibiotic receptor based screening assays for the safety assessment of antibiotics usage i. This manuscript also tries to shed a light on the selection, preparation and future perspective of receptor protein for antibiotic residue detection.

These assays have been introduced for the screening of numerous food samples. Receptor based screening technology for antibiotic detection has high accuracy. It has been concluded that at the same time, it can detect a class of drugs for certain receptor, and realize the multi-residue detection.

These assays offer fast, easy and precise detection of antibiotics. Development of an antibiotic spectrum score based on veterans affairs culture and susceptibility data for the purpose of measuring antibiotic de-escalation: a modified Delphi approach. Development of a numerical score to measure the microbial spectrum of antibiotic regimens spectrum score and method to identify antibiotic de-escalation events based on application of the score.

Web- based modified Delphi method. Physician and pharmacist antimicrobial stewards practicing in the United States recruited through infectious diseases-focused listservs. Three Delphi rounds investigated: organisms and antibiotics to include in the spectrum score, operationalization of rules for the score, and de-escalation measurement. A 4-point ordinal scale was used to score antibiotic susceptibility for organism- antibiotic domain pairs.

Antibiotic regimen scores, which represented combined activity of antibiotics in a regimen across all organism domains, were used to compare antibiotic spectrum administered early day 2 and later day 4 in therapy. Changes in spectrum score were calculated and compared with Delphi participants' judgments on de-escalation with 20 antibiotic regimen vignettes and with non-Delphi steward judgments on de-escalation of pneumonia regimen vignettes.

Method sensitivity and specificity to predict expert de-escalation status were calculated. Twenty-four participants completed all Delphi rounds. Expert support for concepts utilized in metric development was identified. For vignettes presented in the Delphi, the sign of change in score correctly classified de-escalation in all vignettes except those involving substitution of oral antibiotics.

The sensitivity and specificity of the method to identify de-escalation events as judged by non-Delphi stewards were Identification of de-escalation events based on an algorithm that measures microbial spectrum of antibiotic regimens generally agreed with steward judgments of de-escalation status. Computational analysis of structure- based interactions and ligand properties can predict efflux effects on antibiotics.

AcrA-AcrB-TolC efflux pumps extrude drugs of multiple classes from bacterial cells and are a leading cause for antimicrobial resistance. Thus, they are of paramount interest to those engaged in antibiotic discovery. Accurate prediction of antibiotic efflux has been elusive, despite several studies aimed at this purpose.

Our models provide preliminary evidence that it is possible to predict the effects of antibiotic efflux if the passage of antibiotics into, and out of, bacterial cells is taken into account--something descriptor and field- based QSAR models cannot do. While the paucity of data in the public domain remains the limiting factor in such studies, these models show significant improvements in predictions over simple LogP- based regression models and should pave the path toward further work in this field.

This method should also be extensible to other pharmacologically and biologically relevant transport proteins. Antibiotic use and bacterial complications following upper respiratory tract infections: a population- based study. Objectives To investigate if use of antibiotics was associated with bacterial complications following upper respiratory tract infections URTIs. Design Ecological time-trend analysis and a prospective cohort study. Setting Primary, outpatient specialist and inpatient care in Stockholm County, Sweden.

All analyses were based on administrative healthcare data on consultations, diagnoses and dispensed antibiotics from January to January Prospective cohort study: Incidence of bacterial complications following URTIs in antibiotic -exposed and non-exposed patients. Bacterial complications following URTIs were uncommon in both antibiotic -exposed less than 1.

Conclusions Bacterial complications following URTIs are rare, and antibiotics may lack protective effect in preventing bacterial complications. Analyses of routinely collected administrative healthcare data can provide valuable information on the number of URTIs. The impact of antibiotic use on transmission of resistant bacteria in hospitals: Insights from an agent- based model. Extensive antibiotic use over the years has led to the emergence and spread of antibiotic resistant bacteria ARB.

Antibiotic resistance poses a major threat to public health since for many infections antibiotic treatment is no longer effective. Hospitals are focal points for ARB spread. Antibiotic use in hospitals exerts selective pressure, accelerating the spread of ARB.

We used an agent- based model to explore the impact of antibiotics on the transmission dynamics and to examine the potential of stewardship interventions in limiting ARB spread in a hospital. Agents in the model consist of patients and health care workers HCW. In the model, antibiotic use affects the risk of transmission by increasing the vulnerability of susceptible patients and the contagiousness of colonized patients who are treated with antibiotics.

The model shows that increasing the proportion of patients receiving antibiotics increases the rate of acquisition non-linearly. The effect of antibiotics on the spread of resistance depends on characteristics of the antibiotic agent and the density of antibiotic use. Antibiotic 's impact on the spread increases when the bacterial strain is more transmissible, and decreases as resistance prevalence rises. The individual risk for acquiring ARB increases in parallel with antibiotic density both for patients treated and not treated with antibiotics.

Antibiotic treatment in the hospital setting plays an important role in determining the spread of resistance. Interventions to limit antibiotic use have the potential to reduce the spread of resistance, mainly by choosing an agent with a favorable profile in terms of its impact on patient's vulnerability and contagiousness. Methods to measure these impacts of antibiotics should be developed, standardized, and incorporated into drug development programs and approval packages.

Irrigation waters and pipe- based biofilms as sources for antibiotic -resistant bacteria. The presence of antibiotic -resistant bacteria in environmental surface waters has gained recent attention. Wastewater and drinking water distribution systems are known to disseminate antibiotic -resistant bacteria, with the biofilms that form on the inner-surfaces of the pipeline as a hot spot for proliferation and gene exchange.

Pipe- based irrigation systems that utilize surface waters may contribute to the dissemination of antibiotic -resistant bacteria in a similar manner. We conducted irrigation events at a perennial stream on a weekly basis for 1 month, and the concentrations of total heterotrophic bacteria, total coliforms, and fecal coliforms, as well as the concentrations of these bacterial groups that were resistant to ampicillin and tetracycline, were monitored at the intake water.

Prior to each of the latter three events, residual pipe water was sampled and 6-in. Isolates of biofilm-associated bacteria were screened for resistance to a panel of seven antibiotics , representing five antibiotic classes. All of the monitored bacteria grew substantially in the residual water between irrigation events, and the biomass of the biofilm steadily increased from week to week.

The percentages of biofilm-associated isolates that were resistant to antibiotics on the panel sometimes increased between events. Multiple-drug resistance was observed for all bacterial groups, most often for fecal coliforms, and the distributions of the numbers of antibiotics that the total coliforms and fecal coliforms were resistant to were subject to change from week to week.

Results from this study highlight irrigation waters as a potential source for antibiotic -resistant bacteria, which can subsequently become incorporated into and proliferate within irrigation pipe- based biofilms. AN Agent- Based Approach. The response of bacterial populations to antibiotic treatment is often a function of a diverse range of interacting factors.

In order to develop strategies to minimize the spread of antibiotic resistance in pathogenic bacteria, a sound theoretical understanding of the systems of interactions taking place within a colony must be developed. The agent- based approach to modeling bacterial populations is a useful tool for relating data obtained at the molecular and cellular level with the overall population dynamics.

Here we demonstrate an agent- based model, called Micro-Gen, which has been developed to simulate the growth and development of bacterial colonies in culture. The model also incorporates biochemical rules and parameters describing the kinetic interactions of bacterial cells with antibiotic molecules. Simulations were carried out to replicate the development of methicillin-resistant S.

The model was explored to see how the properties of the system emerge from the interactions of the individual bacterial agents in order to achieve a better mechanistic understanding of the population dynamics taking place. Micro-Gen provides a good theoretical framework for investigating the effects of local environmental conditions and cellular properties on the response of bacterial populations to antibiotic exposure in the context of a simulated environment.

Preemptive antibiotic treatment based on gram staining reduced the incidence of ARDS in mechanically ventilated patients. Ventilator-associated pneumonia VAP is one of the major complications in the intensive care unit. We hypothesized that preemptive antibiotic therapy based on results of bedside gram staining would reduce the incidence of VAP.

Patients who were endotracheally intubated in our intensive care unit for more than 72 hours were included. Patients younger than 16 years of age or patients died because of brain death were excluded. The study was divided into two periods. During the first period, we used antibiotics according to the American Thoracic Society guidelines.

During the second period, antibiotics were given according to the results of bedside gram staining even before radiographic infiltrate appeared. One hundred twenty-eight patients and patients were included in the first and second periods, respectively. Immunisations and antibiotics in patients with anterior skull base cerebrospinal fluid leaks. This study aimed to define current UK practice in this area and inform appropriate guidelines for ENT surgeons.

A web- based survey of all members of the British Rhinological Society was carried out and the literature in this area was reviewed. Of those who responded to the survey, 14 per cent routinely give prophylactic antibiotics to patients with cerebrospinal fluid leaks, and There is no evidence to support the use of antibiotic prophylaxis in patients with a cerebrospinal fluid leak. We propose that all such patients are advised to seek immunisation against pneumococcus, meningococcus and haemophilus.

The microbiology and the efficacy of antibiotic-based medical treatment of chronic rhinosinusitis in Singapore. Medical therapy including appropriate antibiotic treatment is advocated for the management of chronic rhinosinusitis CRS , with sinus surgery reserved for treatment failures. This study investigates the microbiology of CRS and their response to culture-directed antibiotic treatment. Medical treatment which included initial empirical and subsequent culture-directed antibiotics was instituted.

A follow-up of 12 months was scheduled for all patients. One hundred and twenty Thirty-eight patients The microbiology of CRS in Singapore is described. Staphylococcus aureus appears to be the most common bacterial isolates in both CRS with and without nasal polyps. Medical treatment with CRS using culture-directed antibiotics is effective in the majority of patients, especially in patients without nasal polyps.

Symptomatic urinary tract infection is a complication of office based cystourethroscopy. Studies are mixed regarding the efficacy of antibiotic prophylaxis to prevent urinary tract infections. Our aim was to develop and evaluate an evidence- based protocol that reduces unnecessary antibiotic use while avoiding an increase in urinary tract infections. We created a clinic antibiogram based on all urology office visits performed during a 2-year period. Bacterial resistance rates, institutional risk related data and clinical guidelines were applied to create a protocol for antibiotic administration before cystourethroscopy.

We then analyzed 1, consecutive patients without a renal transplant who underwent outpatient cystourethroscopy, including after protocol initiation. Urinary tract infection rates and antibiotic use were analyzed for an association with the protocol change using the Fisher exact test. Before the protocol change of patients A local antibiogram with infection related risk data effectively risk stratifies patients before cystourethroscopy, decreasing the use of antibiotics without increasing the rate of symptomatic urinary tract.

Rapid bacterial antibiotic susceptibility test based on simple surface-enhanced Raman spectroscopic biomarkers. Rapid bacterial antibiotic susceptibility test AST and minimum inhibitory concentration MIC measurement are important to help reduce the widespread misuse of antibiotics and alleviate the growing drug-resistance problem.

We discovered that, when a susceptible strain of Staphylococcus aureus or Escherichia coli is exposed to an antibiotic , the intensity of specific biomarkers in its surface-enhanced Raman scattering SERS spectra drops evidently in two hours. The results obtained by this SERS-AST method were consistent with that by the standard incubation- based method, indicating its high potential to supplement or replace existing time-consuming methods and help mitigate the challenge of drug resistance in clinical microbiology.

In veterinary practice antibiotics are used and abused all over the world both to treat diseases and prevent infections and, to increase feed efficiency thus promoting growth in food producing animals. In particular, the reported preliminary study has been focused on cloxacillin and the reported results indicates that the method is potentially able to detect cloxacillin at a concentration of about one order of magnitude lower than the maximal residue limits MRL set by the European Commission.

Staphylococcus aureus is a human pathogen that can cause a wide spectrum of diseases, including sepsis, pneumonia, arthritis, and endocarditis. Ineffective treatment of a number of staphylococcal infections with antibiotics is due to the development and spread of antibiotic -resistant strains following decades of antibiotic usage.

This has generated renewed interest within the scientific community in alternative therapeutic agents, such as anti-S. Although the role of antibodies in the management of S. In this review, we report an update on efforts to develop antibody- based agents, particularly monoclonal antibodies, and their therapeutic potential in the passive immunization approach to the treatment and prevention of S. To evaluate the trends associated with diagnosis and treatment of urinary tract infections UTI in a home- based primary care population of Veterans Health System patients from to Retrospective cohort study.

Veterans Healthcare System. Home- based primary care patients treated for UTI from to Appropriate therapy was determined based on the McGeer criteria. Multivariate logistic regression was used to determine factors leading to appropriate UTI treatment. Of available patients, 68 Antibiotics were overused for treating UTIs in the homebound population. Patients with flank pain, increased urinary frequency, and antibiotic allergy were more likely to receive appropriate treatment.

Pharmacists, therefore, have a viable opportunity to increase appropriate antibiotic prescribing in the home- based primary care population. Antibiotic stewardship: does it work in hospital practice? A review of the evidence base.

Guidelines for developing and implementing stewardship programmes include recommendations on appropriate antibiotic use to guide the stewardship team's choice of potential stewardship objectives. They also include recommendations on behavioural change interventions to guide the team's choice of potential interventions to ensure that professionals actually use antibiotics appropriately in daily practice. To summarize the evidence base of both appropriate antibiotic use recommendations the 'what' and behavioural change interventions the 'how' in hospital practice.

The literature shows low-quality evidence of the positive effects of appropriate antibiotic use in hospital patients. The literature shows that any behavioural change intervention might work to ensure that professionals actually perform appropriate antibiotic use recommendations in daily practice. Although effects were overall positive, there were large differences in improvement between studies that tested similar change interventions.

The literature showed a clear need for studies that apply appropriate study designs- randomized controlled designs-to test the effectiveness of appropriate antibiotic use on achieving meaningful outcomes. Most current studies used designs prone to confounding by indication. In the process of selecting behavioural change interventions that might work best in a chosen setting, much should be learned from behavioural sciences.

The challenge for stewardship teams lies in selecting change interventions on the careful assessment of barriers and facilitators, and on a theoretical base while linking determinants to change interventions. Future studies should apply more robust designs and evaluations when assessing behavioural change interventions.

Published by Elsevier Ltd. Antibiotic resistance genes show enhanced mobilization through suspended growth and biofilm- based wastewater treatment processes. Wastewater treatment plants WWTPs are known to harbor antibiotic resistance genes ARGs that are disseminated into the environment via effluent. However, few studies have compared abundance, mobilization and selective pressures for ARGs in WWTPs as a function of variations in secondary treatment bioprocesses.

We used shotgun metagenomics to provide a comprehensive analysis of ARG composition, relationship to mobile genetic elements and co-occurrences with antibiotic production genes APGs throughout two full-scale municipal WWTPs, one of which employs biofilm- based secondary treatment and another that uses a suspended growth system.

However, the fractions of ARGs associated with mobile genetic elements increased substantially between influent and effluent in each plant, indicating significant mobilization of ARGs throughout both treatment processes. Strong positive correlations between ARGs and APGs were found for the aminoglycoside antibiotic class in the suspended growth system and for the streptogramin antibiotic class in the biofilm system. However, clear differences were observed for within-plant ARG persistence.

These findings suggest that both biofilm and suspended growth- based WWTPs may promote genetic mobilization of persistent ARGs that are then disseminated in effluent to receiving water bodies. Antibiotics mineralization by electrochemical and UV- based hybrid processes: evaluation of the synergistic effect. Antibiotics are not efficiently removed in conventional wastewater treatments. In fact, different advanced oxidation process AOPs , including ozone, peroxide, UV radiation, among others, are being investigated in the elimination of microcontaminants.

Most of AOPs proved to be efficient on the degradation of antibiotics , but the mineralization is on the one hand not evaluated or on the other hand not high. The influence of the individual contributions of electrochemical oxidation EO and the UV- base processes on the hybrid process PEO was analysed.

Besides that, an increase in mineralization was found, when heterogeneous photocatalysis and EO are compared, due to the influence of UV radiation, which overcomes the mass-transport limitations. Although the UV- based processes control the reaction pathway that leads to mineralization, the best results to mineralize the antibiotics were achieved by PEO hybrid process.

This can be explained by the synergistic effect of the processes that constitute them. A higher mineralization was achieved, which is an important and useful finding to avoid the discharge of microcontaminants in the environment. Adding functionality with additive manufacturing: Fabrication of titanium- based antibiotic eluting implants.

Additive manufacturing technologies have been utilised in healthcare to create patient-specific implants. This study demonstrates the potential to add new implant functionality by further exploiting the design flexibility of these technologies. Selective laser melting was used to manufacture titanium- based Ti-6Al-4V implants containing a reservoir. Pore channels, connecting the implant surface to the reservoir, were incorporated to facilitate antibiotic delivery.

An injectable brushite, calcium phosphate cement, was formulated as a carrier vehicle for gentamicin. The controlled release of gentamicin sulphate from the calcium phosphate cement injected into the implant reservoir was demonstrated in short term elution studies using ultraviolet-visible spectroscopy.

Orientation of the implant pore channels were shown, using micro-computed tomography, to impact design reproducibility and the back-pressure generated during cement injection which ultimately altered porosity. The amount of antibiotic released from all implant designs over a 6hour period based antibiotic eluting implant, which is an attractive alternative to current treatment strategies of periprosthetic infections.

Requests for new oral antibiotic prescriptions in children within 2 days: a Norwegian population- based study. Children commonly refuse to take antibiotics , which may induce parents to request new antibiotic prescriptions with different pharmaceutical characteristics. To investigate prescription changes for children years receiving oral liquid or solid antibiotic formulations and to explore the relationships between prescription changes and characteristics related to the child, prescriber and antibiotic.

Antibiotic prescription changes were defined as the dispensing of subsequent antibiotics with different pharmaceutical characteristics to the same child within 2 days after initial prescriptions. Data were analysed using multivariable logistic regression and generalized estimating equations.

Requests for new prescriptions followed 3. Young children who received solid formulations In order of magnitude, the characteristics associated with requests for new prescriptions were the children's ages, poor taste and concentration of liquids, size and shape of solids, prescribers born in recent decades, and girl patients. Reimbursed prescriptions and scored solids were associated with fewer requests.

Avoiding the costs of children's refusal and consequent changes may thus be a motivation for choosing more preferred antibiotics. Antibiotic Resistance. But there is a growing problem of antibiotic resistance. It happens when bacteria change and become able To help prevent antibiotic resistance Don't use antibiotics for viruses like colds The aim of our research activity was to obtain a biocompatible nanostructured composite based on naturally derived biopolymers chitin and sodium alginate loaded with commercial antibiotics either Cefuroxime or Cefepime with dual functions, namely promoting wound healing and assuring the local delivery of the loaded antibiotic.

Compositional, structural, and morphological evaluations were performed by using the thermogravimetric analysis TGA , scanning electron microscopy SEM , and fourier transform infrared spectroscopy FTIR analytical techniques. In order to quantitatively and qualitatively evaluate the biocompatibility of the obtained composites, we performed the tetrazolium-salt MTT and agar diffusion in vitro assays on the L cell line.

The evaluation of antimicrobial potential was evaluated by the viable cell count assay on strains belonging to two clinically relevant bacterial species i. A novel protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery under cardiopulmonary bypass.

This study aimed to develop and assess the effectiveness of a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. We established a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. Surgical site infections SSIs were observed in 4 control group patients A single pre-operative antibiotic dose is as effective as continued antibiotic prophylaxis in implant- based breast reconstruction: A matched cohort study.

Infections following implant- based breast reconstruction can lead to devastating consequences. There is currently no consensus on the need for post-operative antibiotics in preventing immediate infection. This study compared two different methods of infection prevention in this group of patients. A retrospective matched cohort study was performed on consecutive women undergoing implant- based breast reconstruction at University Health Network, Toronto November December All patients received a single pre-operative intravenous antibiotic dose.

Group A received minimal interventions and Group B underwent maximal prophylactic measures. Patient age, smoking, diabetes, co-morbidities , oncologic and procedural variables timing and laterality were collected. Univariate and multivariate logistic regression were performed to compare outcomes between the two groups. Two hundred and eight patients underwent implant procedures. After matching the two treatment groups by BMI, 94 patients in each treatment group yielding a total of implant procedures were selected for analysis.

The two groups were comparable in terms of patient and disease variables. Univariate analysis revealed only pre-operative radiotherapy to be associated with the development of infection 0. Controlling for the effect of radiotherapy, multivariate analysis demonstrated that there was no statistically significant difference between the two methods for infection prevention. Our findings suggest that a single pre-operative dose of intravenous antibiotics is equally as effective as continued antibiotic prophylaxis in preventing immediate infection in patients undergoing implant- based breast reconstructions.

Comparing two types of macrolide antibiotics for the purpose of assessing population- based drug interactions. Objective Clarithromycin strongly inhibits enzyme cytochrome P 3A4, preventing the metabolism of some other drugs, while azithromycin is a weak inhibitor. Accordingly, blood concentrations of other drugs increase with clarithromycin coprescription leading to adverse events. These macrolide antibiotics also differ on other properties that may impact outcomes.

In this study, we compared outcomes in two groups of macrolide antibiotic users in the absence of potentially interacting drugs. Design Population- based retrospective cohort study. Setting Ontario, Canada, from to The secondary outcome was mortality. Results The baseline characteristics of the two groups, including patient demographics, comorbid conditions, infection type and prescribing physician specialty, were nearly identical. There was no difference between the groups in the risk of hospitalisation for any condition studied relative risk ranged from 0.

Compared with azithromycin, clarithromycin was associated with a slightly higher risk of all-cause mortality 0. Conclusions Clarithromycin can be used to assess drug interactions in population- based studies with azithromycin serving as a control group. However, any differences in mortality observed between the two. A cluster randomized trial for the implementation of an antibiotic checklist based on validated quality indicators: the AB-checklist.

Recently we developed and validated generic quality indicators that define 'appropriate antibiotic use' in hospitalized adults treated for a suspected bacterial infection. Our main objective in this project is to provide hospitals with an antibiotic checklist based on these quality indicators, and to evaluate the introduction of this checklist in terms of cost- effectiveness. The checklist applies to hospitalized adults with a suspected bacterial infection for whom antibiotic therapy is initiated, at first via the intravenous route.

A stepped wedge study design will be used, comparing outcomes before and after introduction of the checklist in nine hospitals in the Netherlands. At least patients will be included in both the control and the intervention group. The primary endpoint is length of hospital stay. Differences in numerical endpoints between the two periods will be evaluated with mixed linear models; for dichotomous outcomes generalized estimating equation models will be used.

A process evaluation will be performed to evaluate the professionals' compliance with use of the checklist. The key question for the economic evaluation is whether the benefits of the checklist, which include reduced antibiotic use, reduced length of stay and associated costs, justify the costs associated with implementation activities as well as daily use of the checklist. If cost- effective, the AB-checklist will provide physicians with a tool to support appropriate antibiotic use in adult hospitalized patients who start with intravenous antibiotics.

Dutch trial registry: NTR Occurrence of antibiotics in soils and manures from greenhouse vegetable production bases of Beijing, China and an associated risk assessment. The occurrence of 15 antibiotics in soil and manure samples from 11 large-scale greenhouse vegetable production GVP bases in Beijing, China was investigated. Results showed that the greenhouse soils were ubiquitously contaminated with antibiotics , and that antibiotic concentrations were significantly higher in greenhouses than in open field soils.

This investigation also indicated that fertilization with manure and especially animal feces might be the primary source of antibiotics. A risk assessment based on the calculated risk quotients RQs demonstrated that oxytetracycline, chlortetracycline, norfloxacin, ciprofloxacin and enrofloxacin could pose a high risk to soil organisms. These results suggested that the ecological effects of antibiotic contamination in GVP bases and their potential adverse risks on human health need to be given special attention.

The unrelenting rise of antimicrobial-resistant bacteria has necessitated the search for novel antibiotic solutions. Herein we describe further mechanistic studies on a 2. This antibiotic exhibits bactericidal activity against the Gram-negative bacterium Escherichia coli at 1. LAL treatment inhibits cellular division, daughter cell separation, and twin-arginine translocation Tat pathway dependent shuttling of proteins to the periplasm.

Furthermore, we have found that the cedA gene imparts increased resistance to LAL, and shown that an E. Taken together, these studies further implicate cell division pathways as the target for this nanoparticle- based antibiotic and demonstrate that there may be inherently higher barriers for resistance evolution against nanoscale antibiotics in comparison to their small molecule counterparts.

An electrochemical quartz crystal nanobalance EQCN , which provides real-time analysis of dynamic surface events, is a valuable tool for analyzing biomolecular interactions. EQCN biosensors are based on mass-sensitive measurements that can detect small mass changes caused by chemical binding to small piezoelectric crystals. Among the various biosensors, the piezoelectric biosensor is considered one of the most sensitive analytical techniques, capable of detecting antigens at picogram levels.

The analysis of antibiotic residues requires high sensitivity, rapidity, reliability and cost effectiveness. For analytical purposes the general approach is to take advantage of the piezoelectric effect by immobilizing a biosensing layer on top of the piezoelectric crystal. The sensing layer usually comprises a biological material such as an antibody, enzymes, or aptamers having high specificity and selectivity for the target molecule to be detected.

The biosensing layer is usually functionalized using surface chemistry modifications. When these bio-functionalized quartz crystals are exposed to a particular substance of interest e. This causes a frequency or mass change that can be used to determine the amount of material interacted or bound. EQCN biosensors can easily be automated by using a flow injection analysis FIA setup coupled through automated pumps and injection valves. Such FIA-EQCN biosensors have great potential for the detection of different analytes such as antibiotic residues in various matrices such as water, waste water, and milk.

Antibiotic use in acute cholecystitis: practice patterns in the absence of evidence- based guidelines. Antibiotics are frequently administered in acute cholecystitis for preoperative prophylaxis or postoperative treatment. The optimal timing, choice, and duration of antibiotics are unclear. We conducted a retrospective review of all cases of acute cholecystitis between and at the American University of Beirut Medical Centre. A survey among general surgeons was also performed to describe the pattern of antibiotic prescribing in uncomplicated acute cholecystitis.

The number of cases of acute cholecystitis was The mean duration of postoperative antibiotic therapy was 5 days. There was no correlation between the severity of symptoms, gallbladder description, or positive gallbladder culture and the use of antibiotics postoperatively. Sixty five percent of interviewed surgeons would continue antibiotic therapy postoperatively for 3 or more days.

Search of the medical literature failed to provide clear guidelines for antibiotic use in acute cholecystitis. The use of antibiotics in patients with acute cholecystitis is erratic and costly. Prospective studies are needed to better study the effectiveness of a short course of antibiotics in uncomplicated cases. The role of gallbladder culture in guiding antibiotic therapy should be defined as routine cultures add to the cost without evident benefit.

This study's purpose was to determine the percentage of patients with HAP, VAP, and HCAP who received guideline- based empiric antibiotic therapy and to determine the average time to receipt of an appropriate empiric regimen. The hospital's electronic medical record system utilized International Classification of Diseases, Ninth Revision ICD-9 codes to identify patients diagnosed with pneumonia.

The percentage of patients who received guideline- based empiric antibiotic therapy was calculated. The mean time from suspected diagnosis of pneumonia to initial administration of the final antibiotic within the empiric regimen was calculated for patients who received guideline- based therapy.

Ninety-three patients met the inclusion criteria. The overall guideline adherence rate for empiric antibiotic therapy was Guideline adherence rates were lower and time to appropriate empiric therapy was greater for patients with HCAP compared to patients with HAP. Long-term antibiotic delivery by chitosan- based composite coatings with bone regenerative potential.

Composite coatings with bone-bioactivity and drug-eluting capacity are considered as promising materials for titanium bone implants. In this work, drug-eluting chitosan-bioactive glass coatings were fabricated by a single-step electrophoretic deposition technique. Drug-loading and -releasing capacity of the composite coatings were carried out using the vancomycin antibiotic. The coatings were bioactive in terms of apatite-forming ability in simulated body fluid and showed favorable cell adhesion and growth.

In vitro biological tests also indicated that the composite coatings had better cellular affinity than pristine chitosan coatings. Antibacterial tests using survival assay against Gram-positive Staphylococcus aureus bacteria determined the effect of vancomycin release on reduction of infection risk. The developed chitosan- based composite coatings with bone bioactivity and long-term drug-delivery ability may be potentially useful for metallic implants to reduce infection risk.

Individual maternal and child exposure to antibiotics in hospital - a national population- based validation study. Exposure to antibiotics in early life may affect future health. Most antibiotics are prescribed in outpatient care, but inpatient exposure is also important. We estimated how specific diagnoses in hospitals corresponded to individual antibiotic exposure. All pregnant women and children from birth to 5 years of age with infectious diseases and common inpatient diagnoses between July and November were identified from the Swedish National Patient Register.

Random samples of individuals from predefined groups were drawn, and medical records received from the clinics were manually reviewed for antibiotics. Pregnant women who had undergone a Caesarean section were more likely to be treated with antibiotics than those who had had a vaginal delivery This study defines the proportion of new mothers and young children who received individual antibiotic treatment for specific inpatient diagnoses in Sweden and provides a useful basis for future studies focusing on antibiotic use.

The use of an aptamer specific to ampicillin assures good selectivity and sensitivity for the detection of ampicillin from different matrice. This new approach is dedicated for a portable, remote sensing platform based on low-cost, small size and low-power consumption solution. The simple experimental hybrid platform integrates the results from the D-shape surface plasmon resonance plastic optical fiber SPR-POF and from the electrochemical bio sensor, for the analysis of ampicillin, delivering sensitive and reliable results.

The SPR-POF already used in many previous applications is embedded in a new experimental setup with fluorescent fibers emitters, for broadband wavelength analysis, low-power consumption and low-heating capabilities of the sensing platform. Strategies to Minimize Antibiotic Resistance. Antibiotic resistance can be reduced by using antibiotics prudently based on guidelines of antimicrobial stewardship programs ASPs and various data such as pharmacokinetic PK and pharmacodynamic PD properties of antibiotics , diagnostic testing, antimicrobial susceptibility testing AST , clinical response, and effects on the microbiota, as well as by new antibiotic developments.

The controlled use of antibiotics in food animals is another cornerstone among efforts to reduce antibiotic resistance. All major resistance-control strategies recommend education for patients, children e. The problem of antibiotic resistance can be minimized only by concerted efforts of all members of society for ensuring the continued efficiency of antibiotics.

Implementation of an evidence- based order set to impact initial antibiotic time intervals in adult febrile neutropenia. To evaluate the impact of the implementation of a standardized order set on the time interval in initiation of antibiotic therapy for adult patients with cancer and febrile neutropenia. Practice change. The oncology unit of an urban hospital in the south-eastern United States. Literature regarding febrile neutropenia, use of order sets, and change process was reviewed. In addition, a retrospective and concurrent chart review was conducted for adult patients admitted with febrile neutropenia.

Initial antibiotic times, order-set use, and length of stay. Findings in the presence of low order-set usage suggest that staff education and placement of the order-set antibiotics in unit- based medication dispensing machines helped reduce time intervals for initial antibiotic therapy. The use of an evidence- based approach to nursing care is essential to achieving the best outcomes for patients with febrile neutropenia.

Incorporation of current evidence into an order set to guide clinical practice and comprehensive nurse, pharmacy, and physician education are needed for the successful implementation of evidence- based practice changes. Antibiotic regimen based on population analysis of residing persister cells eradicates Staphylococcus epidermidis biofilms.

Yang, Shoufeng; Hay, Iain D. Biofilm formation is a major pathogenicity strategy of Staphylococcus epidermidis causing various medical-device infections. Persister cells have been implicated in treatment failure of such infections. We sought to profile bacterial subpopulations residing in S. Population analysis was performed by challenging single biofilm cells with antibiotics at increasing concentrations ranging from planktonic minimum bactericidal concentrations MBCs to biofilm MBCs MBCbiofilm.

Antibiotic regimens targeting dormant cells were tested in vitro for their efficacies in eradicating persister cells and intact biofilms. This study confirmed that there are at least three subpopulations within a S. Biofilms comprise more TBK cells and dormant cells than their log-planktonic counterparts.

Using antibiotic regimens targeting dormant cells, i. Potential uses for this strategy are in antibiotic lock techniques and inhaled aerosolized antibiotics. Wastewater- and drinking water distribution systems are known to disseminate antibiotic -resistant bacteria, with the biofilms that form on the inner-surfaces of the pipeline as a hotspot for pr Decline in extractable antibiotics in manure- based composts during composting.

A wide variety of antibiotics have been detected in natural water samples and this is of potential concern because of the adverse environmental effects of such antibiotic residues. One of the main sources of antibiotics effluence to the surrounding environment is livestock manures which often contain elevated concentrations of veterinary antibiotics VAs which survive digestion in the animal stomach following application in animal husbandry practices.

In Korea, livestock manures are normally used for compost production indicating that there is potential for antibiotic release to the environment through compost application to agricultural lands. Therefore, reduction of the amount of VAs in composts is crucial. The purpose of this study was to understand the influence of the composting process and the components of the compost on the levels of three common classes of antibiotics tetracyclines, sulfonamides, and macrolides.

Composted materials at different stages of composting were collected from compost manufacturing plants and the variation in antibiotic concentrations was determined. Three different antibiotics , chlortetracycline CTC , sulfamethazine SMZ , and tylosin TYL at three different concentrations 2, 10, and 20mgkg -1 were also applied to a mixture of pig manure and sawdust and the mixtures incubated using a laboratory scale composting apparatus to monitor the changes in antibiotic concentrations during composting together with the physicochemical properties of the composts.

During composting, in both field and lab-scale investigations, the concentrations of all three different antibiotics declined below the relevant Korean guideline values 0. The decline of tetracycline and sulfonamide concentrations was highly dependent on the presence of sawdust while there was no influence of sawdust on TYL decline. The efficacy of social cognitive theory- based self-care intervention for rational antibiotic use: a randomized trial. Misuse of antibiotics can be described as a failure to complete treatment, skipping of the doses and reuse of leftover medicines and overuse of antibiotics.

Health education interventions are expected to enhance awareness and general belief on rational antibiotics use. Therefore, the study aimed to determine the efficacy of social cognitive theory SCT - based self-care intervention for rational antibiotic use. This randomized trial was conducted in a sample of adults. The intervention group received self-care educational intervention of four sessions lasting min augmented with the text messages and the control groups attended usual education program in health centers.

The study participants were invited to complete questionnaires at the baseline and end of the intervention. The data were analyzed using SPSS version Chi-square X2 , independent t-test and covariance analysis were used for data analysis. P antibiotic use showed a significant difference in intervention group before and after six months P 0. The study suggested that tailored appropriate educational programs based on SCT constructs can reflect a positive impact on appropriate antibiotics use.

Therefore, a tailored health promotion intervention should be provided to enhance the awareness and general beliefs of the target groups. Fluorescent carbon dots CDs have received considerable attention in recent years due to their superior optical properties. To take further advantages of these unique features, herein, a CDs- based "lab-on-a-nanoparticle" approach for the detection and discrimination of antibiotics is developed.

The sensing platform was designed based on the different channel's fluorescence recoveries or further quenching of the full-color emissive CDs F-CDs and metal ion ensembles upon the addition of antibiotics. The F-CDs exhibited unusually comparable emission intensity nearly across the entire visible spectrum even as the excitation wavelength is shifted, making it very suitable for the construction of multi-channel sensing systems.

The sensing platform was fabricated on the basis of the competing interaction of metal ions with the F-CDs and antibiotics. Three metal ions i.

UFC BETTING ODDS HISTORY ALIVE

Jean Brewington Bottorff, PB Don W. Karen Dellinger Bouldin, PB Ryan Montgomery Bowie, AS John Maurice Bowler, LW Donald E. Bowles Jr. Jane Ralston Bowles, AS Raymond Winston Bowling, OG Campbell Bowman, Jr. Emily Hatch Bowman, LW Shelley Elifson Bowman, OG Martha L. Richard Wesley Littlehale, LW Emily Cruze Boykin, NR Robert E.

Sylvia T. Bozeman, GS Richard C. Bozian, GS and Dr. Marguerite W. Bozian, NR NR Janice L. William Haywood Hathaway Jr. Anthony N. Jane Montgomery Brannan, AS Branner, M. Dewey Branstetter Jr. Julia H. Branstetter, AS PB Reginald Brantley, LW Dan L. Brasfield, AS and Mrs. Frances Joyner Brasfield, AS Breast, Sr. Margaret Mrozek Breeden, AS Carley Catherine Bremner, EN Theresa A.

Randall S. Matthews, AS Gordon Lane Brewer, PB Nathan Cole Brewer, AS James Allan Lee, GS Matthew Thomas Brigger, EN John G. Elaine Ann Brimmer, NR Talia Clare Brinkman, PB Larry Britt, Jr. Leslie R. Jerry H. Judy H. Brookshire, AS PB Michael David Brookshire, EN Jefferson Whitaker Brown, LW Martin S. Brown Jr. Eric Elton Brown, Jr. The Hon. Joe B. Marilyn M. Brown, AS Jonathan M. Brown, AS and Mrs. Catherine Gallagher Brown, AS Randal Edward Brown Jr.

Elizabeth Mulligan Brown. Clark Clayton Browne Jr. Elizabeth Thwaite Browne, PB John Caleb Browning, AS Emily G. Bruno, AS NR Michael Charles Bryant, OG Robert N. Sarah L. Joel R. Buckberg, LW OG Sarah Elizabeth Ramos, MD Anton Joslyn Bueschen Jr. Paul Robert Buikema, LW Lindsay Builder Jr. Jean F. Builder, AS John Boyd Bullock, Jr. Lilia Urquiza Bunick, PB Robert R. Buntin II, AS Katharine M. Burns, MD Kenneth Michael Burke Jr. Lauren Byer Burke, PB Jacquelyn Jean S. Burkholder, EN William C.

Burnette Jr. Jacqueline Burnette, PB Julie M. Maureen Sarah Burrows, AS Richard R. Burslem, AS Eric Burton-Krieger, DV Norton S. Linda Lafrenaye Busby, GS Ashley A. Bush, AS and Mr. Jonathan E. Bush, AS LW Olivia J. Bushardt, AS and Mr. Scott Benjamin Gilleland, AS Alfredo Federico Bustamante, EN Catalina Lizarralde, OG Alyce Schloss Butner, OG Kathleen C. John N. Byington, PB Kevin Eugene Cadwell, LW Jerry W. Gerald Caldwell, Jr.

Margaret Buford Caldwell, AS Margaret Patrick Caldwell. Kimberly L. Matt M. Callihan, AS and Mrs. William Howard Cammack, Jr. Alan R. Campbell, DV and Mrs. Louise Katherine Campbell. Paul Campbell, AS and Mrs. Virginia Irwin Campbell, AS Michael Ray Canady, AS Richard O. Gail B. Cannon, NR Margaret Fesmire Canter, AS Barbara R.

Luther E. Cantrell Jr. Dennis J. Patricia P. Carlson, NR Jeffrey C. Lynne F. Carlton, EN Malcolm N. Carmichael, LW and Mrs. Jeannine Hayes Carmichael, PB Elizabeth K. Lavenia Buchanan Carpenter, M. Mary Truman W. John A. Carter Jr. Val C. Carter, AS William B. Mitchell Carter, LW and Mrs. Wilka M. Carter, PB PB Nathaniel M. Suzanne Pettus Cartmell, LW Virginia Rubel Caruso, AS William Alexander Caruthers, EN Cynthia M. Scott Cassity, OG Katherine Osusky Castle, AS Amy Elizabeth Castro.

Richard Frame Cavenaugh. Anahi Gutierrez Dominguez, LW John Warden Chaffin, OG William H. Challas, AS Gurney E. Chambers, PB PB Thomas Sidney Chambless Jr. Lola B. Chambless, MD Patricia Anne Chapman, AS Damien Rashid Charley, EN Alice Morgan Johnson Charron.

Dean F. Chatlain, Jr. Charlotte H. Chatlain, GS Michael Lee Cheatham, MD Carole M. Cheatwood, AS and Mr. Alan D. Ruth Brown Cherry, AS Thomas M. Chesney, MD and Dr. Carolyn M. Chesney, AS MD Gilbert L. Sue T. Chilton, PB Marsha K. Joe M. Chisolm, AS MD Teresa Ford Chope, AS Emily M. Christian Paul Christensen, MD Alexander F. Christensen, GS Jeanne T. John T. Christian, GS GS Betsy Kaufman Christof, NR Scott M.

Andre' L. Churchwell, M. Doreatha Henderson Churchwell. Harold Whit Clark, Jr. Trudy Nichols Clark, AS Terry L. Clark, DV and Mrs. Janice Earlene Clark, PB Deborah Yarber Clarke, PB Thomas Peyton Claycomb, LW Kenneth M. Amy Erbesfield Clayton, PB Rebecca Carly Feldman, PB Macy Rose Climo, LW Rosalie Norwood Clinton. Darby K. Ray, GS GS Peter Coccia, GS and Ms. Layla M. Cochran, M. Christopher Ray Cochran, OG Kyle Matthew Cochran, AS Daniel Adam Cohen, LW Kristen K.

Colander, AS and Mr. Zachary Bo Colander, AS Mary Louise Ledbetter Cole. Tracey Kendall Coleman, AS Michael Anthony Colletti Jr. Carla S. Reed W. Colley, EN and Mrs. Molly Fuller Collins, PB Robert K. Jamie Lynn Colon, NR John M. Colvin Jr. Beth E. Ashley Whitsitt Conner, AS Lewis Forrest Conner, OG Walter Dorman Conyers, PB Alice Clark Coogan, MD Charles Eugene Cook Jr. Elaine Covington Cook, PB Andrew Peter Cordeiro, AS Scott Michael Corley, PB Sean Patrick Correll, EN Alden Koste Corrigan, AS Travis Langston Counts, AS Lisa Quillman Coviello, PB Covington, LW and Mrs.

Eugenia A. Cowles, LW Charles L. Cox, III, M. Donald A. William James Coxhead, OG Peter Francis Cozzi, AS George B. Craddock, III. Stephen Dibrell Cragon Jr. Anna Johnson Cramer, LW David L. Crecraft, AS and Mrs.

Julia Stinson Crecraft, PB Marion V. Creekmore Jr. Linda R. David Lee Crenshaw, AS Richard Louis Cretella Jr. Monica Kravos Cretella, AS Carolyn R. Crocker, DU Lucas W Croslow, LW Kathryn D. Leslie Cross, NR Jack Peter Salerno, GS Michael Scott Cross Jr.

Anne McFadden Cross. Susan Nordin Crosswy, EN Raymond R. Crowe, Jr. Sally Crowe, NR Ronald E. Crutcher, EN and Mrs. Eleanor Joyce Crutcher, PB William Donald Birdsley, OG Tricia Ann Kinney, LW Maribeth Cunningham. Ashley Renee Curbelo, OG Emily Mosby Curran, AS Kathryn Jennings Currey, EN Richard M.

Currie Jr. Sarah Price Currie, PB D'Antonio, LW Todd Edward Dahmann, PB Kelly Buckner Dallas, AS Eslick E. Daniel, AS and Mrs. Daniel, AS PB Elizabeth Sondey Daniel, PB Betty Wells Daniel, AS Katheryn P. Darr, GS GS Carl W. Myra Agee Davenport, PB Heather A. Michael Gregory Stahl, GS Jo Ann Davis, NR Lyle Andrew Davis, AS Richard Hugh Davis Jr. Rebecca Hut Davis, PB Russell B. Davis, Jr. Timothy Edward Davis Jr. Lyle Kennington Hull Davis, Ph. Warren W. Carolyn B. Davis, NR Samuel Guy Davison, AS Trevor Jonathan Dean, OG Anne Proffitt Dean, AS Meagan Elizabeth Deaner, EN Mary H.

Deaton, AS and Dr. Steven Burruss Deaton Jr. Deborah S. Gonzales Deaton, PB Amy Atkinson Dees, PB Katherine S. Degerberg, AS and Mr. John Patrick Parker, AS Mykolas Danielius Degesys, OG William R. DeLoache Jr. Susan Quest Demark, AS William A. Myrtice A.

Demonbreun, NR Evanna Derkach. Tiffany Rose des Cognets, AS Woodworth, Ph. Kathryn K. Dettwiller, AS Bishop William P. Olga Marie Urbieta-Di Stefano. Erin Crosby Dickerman, EN Joseph L. Dickson, LW and Dr. Nancy D. Dickson, PB PB Sallie C. Smartt Diehl, AS and Mr.

Jennifer L. Carolyn Thrift Dillard, PB Samuel H. Dillard Jr. Allison S. Dillard, PB Joseph Doyle Dillingham Jr. Shannon L. Robert L. Philip Rodger Dinwiddie Jr. Suzanne P. Dinwiddie, PB PB Laurel Scruggs Ditto, AS Brian David Setzer, OG Julia Noel Dobish, GS Thomas Clifford Dolson Jr.

William S. Marguerite D. Erin Martin Dorf, AS Walter I. Cheryl C. Dothard, NR Richard E. Dotson, EN and Mrs. Barbara Minter Dotson, PB Bennett B. Doubleday Jr. Josephine D. Doubleday, AS Emily A. Douglas, PB and Mr. James Christopher Douglas, OG Suzette Fry Douglas, NR Whitney Walker Douglas, PB Leonidas W.

Dowlen, Jr. According to the British National Formulary, sulfonamides, trimethoprim, tetracycline and quinolones were classified as antibiotics potentially harmful to the fetus. A multivariate logistic regression analysis was performed to evaluate the independent effect of various characteristic on antibiotic prescriptions, during pregnancy, potentially harmful to the fetus. Among the 19 pregnant subjects, Antibiotic prescriptions potentially harmful to the fetus accounted for 6.

Pregnant women aged antibiotic prescriptions potentially harmful to the fetus. Measures to improve the quality of practices should include efforts to increase awareness of antibiotic prescription guidelines for the treatment of infections in the pregnant population. Prescribing antibiotics for COPD exacerbations is not easy. Procalcitonin PCT is a useful biomarker that helps reduce the rate of antibiotic therapies.

However, its proper cut-off levels are often unknown. We reviewed physician practices regarding PCT test and antibiotic therapy prescription to all patients hospitalized for COPD exacerbation. We then analyzed the rate of antibiotic prescriptions and the number of PCT tests prescribed before and after the introduction of a protocol validated by previous high-power studies.

The primary endpoint was the rate of antibiotic prescriptions. Both antibiotic duration 8. Disseminating information on the appropriate PCT cut-off level to use to decide whether or not to initiate antibiotics is effective. Its proper use should be clarified to reduce antibiotic prescriptions to these overexposed patients. Host-guest complexation with various hydrophobic drugs has been used to enhance the solubility, permeability, and stability of guest drugs.

Physical changes in hydrophobic drugs by complexation have been related to corresponding increases in the bioavailability of these drugs. Carbohydrates, including various derivatives of cyclodextrins, cyclosophoraoses, and some linear oligosaccharides, are generally used as host complexation agents in drug delivery systems.

Many antibiotics with low bioavailability have some limitations to their clinical use due to their intrinsically poor aqueous solubility. Bioavailability enhancement is therefore an important step to achieve the desired concentration of antibiotics in the treatment of bacterial infections. Antibiotics encapsulated in a complexation- based drug delivery system will display improved antibacterial activity making it possible to reduce dosages and overcome the serious global problem of antibiotic resistance.

Here, we review the present research trends in carbohydrate- based host-guest complexation of various hydrophobic antibiotics as an efficient delivery system to improve solubility, permeability, stability, and controlled release.

Bacterial clonal diagnostics as a tool for evidence- based empiric antibiotic selection. Urinary tract infections UTIs , which account for a large share of antibiotic use, are caused predominantly by Escherichia coli, a highly clonal pathogen. In an observational clinical cohort study of urgent care patients with suspected UTI, we assessed the potential for E.

A novel PCR- based clonotyping assay was applied to fresh urine samples to rapidly detect E. The test's performance characteristics and possible effects on prescribing were assessed. The rapid test identified E. In summary, a rapid clonotyping test showed promise for improving empiric antibiotic prescribing for E.

The clonal diagnostics approach merges epidemiologic surveillance, antimicrobial stewardship, and molecular diagnostics to bring evidence- based medicine directly to the point of care. Receptor- based screening assays for the detection of antibiotics residues - A review. Consumer and regulatory agencies have a high concern to antibiotic residues in food producing animals, so appropriate screening assays of fast, sensitive, low cost, and easy sample preparation for the identification of these residues are essential for the food-safety insurance.

Great efforts in the development of a high-throughput antibiotic screening assay have been made in recent years. Concerning the screening of antibiotic residue, this review elaborate an overview on the availability, advancement and applicability of antibiotic receptor based screening assays for the safety assessment of antibiotics usage i.

This manuscript also tries to shed a light on the selection, preparation and future perspective of receptor protein for antibiotic residue detection. These assays have been introduced for the screening of numerous food samples. Receptor based screening technology for antibiotic detection has high accuracy. It has been concluded that at the same time, it can detect a class of drugs for certain receptor, and realize the multi-residue detection.

These assays offer fast, easy and precise detection of antibiotics. Development of an antibiotic spectrum score based on veterans affairs culture and susceptibility data for the purpose of measuring antibiotic de-escalation: a modified Delphi approach. Development of a numerical score to measure the microbial spectrum of antibiotic regimens spectrum score and method to identify antibiotic de-escalation events based on application of the score.

Web- based modified Delphi method. Physician and pharmacist antimicrobial stewards practicing in the United States recruited through infectious diseases-focused listservs. Three Delphi rounds investigated: organisms and antibiotics to include in the spectrum score, operationalization of rules for the score, and de-escalation measurement.

A 4-point ordinal scale was used to score antibiotic susceptibility for organism- antibiotic domain pairs. Antibiotic regimen scores, which represented combined activity of antibiotics in a regimen across all organism domains, were used to compare antibiotic spectrum administered early day 2 and later day 4 in therapy.

Changes in spectrum score were calculated and compared with Delphi participants' judgments on de-escalation with 20 antibiotic regimen vignettes and with non-Delphi steward judgments on de-escalation of pneumonia regimen vignettes.

Method sensitivity and specificity to predict expert de-escalation status were calculated. Twenty-four participants completed all Delphi rounds. Expert support for concepts utilized in metric development was identified. For vignettes presented in the Delphi, the sign of change in score correctly classified de-escalation in all vignettes except those involving substitution of oral antibiotics.

The sensitivity and specificity of the method to identify de-escalation events as judged by non-Delphi stewards were Identification of de-escalation events based on an algorithm that measures microbial spectrum of antibiotic regimens generally agreed with steward judgments of de-escalation status. Computational analysis of structure- based interactions and ligand properties can predict efflux effects on antibiotics. AcrA-AcrB-TolC efflux pumps extrude drugs of multiple classes from bacterial cells and are a leading cause for antimicrobial resistance.

Thus, they are of paramount interest to those engaged in antibiotic discovery. Accurate prediction of antibiotic efflux has been elusive, despite several studies aimed at this purpose. Our models provide preliminary evidence that it is possible to predict the effects of antibiotic efflux if the passage of antibiotics into, and out of, bacterial cells is taken into account--something descriptor and field- based QSAR models cannot do.

While the paucity of data in the public domain remains the limiting factor in such studies, these models show significant improvements in predictions over simple LogP- based regression models and should pave the path toward further work in this field. This method should also be extensible to other pharmacologically and biologically relevant transport proteins. Antibiotic use and bacterial complications following upper respiratory tract infections: a population- based study.

Objectives To investigate if use of antibiotics was associated with bacterial complications following upper respiratory tract infections URTIs. Design Ecological time-trend analysis and a prospective cohort study.

Setting Primary, outpatient specialist and inpatient care in Stockholm County, Sweden. All analyses were based on administrative healthcare data on consultations, diagnoses and dispensed antibiotics from January to January Prospective cohort study: Incidence of bacterial complications following URTIs in antibiotic -exposed and non-exposed patients.

Bacterial complications following URTIs were uncommon in both antibiotic -exposed less than 1. Conclusions Bacterial complications following URTIs are rare, and antibiotics may lack protective effect in preventing bacterial complications. Analyses of routinely collected administrative healthcare data can provide valuable information on the number of URTIs.

The impact of antibiotic use on transmission of resistant bacteria in hospitals: Insights from an agent- based model. Extensive antibiotic use over the years has led to the emergence and spread of antibiotic resistant bacteria ARB. Antibiotic resistance poses a major threat to public health since for many infections antibiotic treatment is no longer effective. Hospitals are focal points for ARB spread.

Antibiotic use in hospitals exerts selective pressure, accelerating the spread of ARB. We used an agent- based model to explore the impact of antibiotics on the transmission dynamics and to examine the potential of stewardship interventions in limiting ARB spread in a hospital. Agents in the model consist of patients and health care workers HCW. In the model, antibiotic use affects the risk of transmission by increasing the vulnerability of susceptible patients and the contagiousness of colonized patients who are treated with antibiotics.

The model shows that increasing the proportion of patients receiving antibiotics increases the rate of acquisition non-linearly. The effect of antibiotics on the spread of resistance depends on characteristics of the antibiotic agent and the density of antibiotic use. Antibiotic 's impact on the spread increases when the bacterial strain is more transmissible, and decreases as resistance prevalence rises.

The individual risk for acquiring ARB increases in parallel with antibiotic density both for patients treated and not treated with antibiotics. Antibiotic treatment in the hospital setting plays an important role in determining the spread of resistance. Interventions to limit antibiotic use have the potential to reduce the spread of resistance, mainly by choosing an agent with a favorable profile in terms of its impact on patient's vulnerability and contagiousness.

Methods to measure these impacts of antibiotics should be developed, standardized, and incorporated into drug development programs and approval packages. Irrigation waters and pipe- based biofilms as sources for antibiotic -resistant bacteria. The presence of antibiotic -resistant bacteria in environmental surface waters has gained recent attention. Wastewater and drinking water distribution systems are known to disseminate antibiotic -resistant bacteria, with the biofilms that form on the inner-surfaces of the pipeline as a hot spot for proliferation and gene exchange.

Pipe- based irrigation systems that utilize surface waters may contribute to the dissemination of antibiotic -resistant bacteria in a similar manner. We conducted irrigation events at a perennial stream on a weekly basis for 1 month, and the concentrations of total heterotrophic bacteria, total coliforms, and fecal coliforms, as well as the concentrations of these bacterial groups that were resistant to ampicillin and tetracycline, were monitored at the intake water.

Prior to each of the latter three events, residual pipe water was sampled and 6-in. Isolates of biofilm-associated bacteria were screened for resistance to a panel of seven antibiotics , representing five antibiotic classes. All of the monitored bacteria grew substantially in the residual water between irrigation events, and the biomass of the biofilm steadily increased from week to week. The percentages of biofilm-associated isolates that were resistant to antibiotics on the panel sometimes increased between events.

Multiple-drug resistance was observed for all bacterial groups, most often for fecal coliforms, and the distributions of the numbers of antibiotics that the total coliforms and fecal coliforms were resistant to were subject to change from week to week. Results from this study highlight irrigation waters as a potential source for antibiotic -resistant bacteria, which can subsequently become incorporated into and proliferate within irrigation pipe- based biofilms.

AN Agent- Based Approach. The response of bacterial populations to antibiotic treatment is often a function of a diverse range of interacting factors. In order to develop strategies to minimize the spread of antibiotic resistance in pathogenic bacteria, a sound theoretical understanding of the systems of interactions taking place within a colony must be developed.

The agent- based approach to modeling bacterial populations is a useful tool for relating data obtained at the molecular and cellular level with the overall population dynamics. Here we demonstrate an agent- based model, called Micro-Gen, which has been developed to simulate the growth and development of bacterial colonies in culture. The model also incorporates biochemical rules and parameters describing the kinetic interactions of bacterial cells with antibiotic molecules.

Simulations were carried out to replicate the development of methicillin-resistant S. The model was explored to see how the properties of the system emerge from the interactions of the individual bacterial agents in order to achieve a better mechanistic understanding of the population dynamics taking place.

Micro-Gen provides a good theoretical framework for investigating the effects of local environmental conditions and cellular properties on the response of bacterial populations to antibiotic exposure in the context of a simulated environment. Preemptive antibiotic treatment based on gram staining reduced the incidence of ARDS in mechanically ventilated patients. Ventilator-associated pneumonia VAP is one of the major complications in the intensive care unit.

We hypothesized that preemptive antibiotic therapy based on results of bedside gram staining would reduce the incidence of VAP. Patients who were endotracheally intubated in our intensive care unit for more than 72 hours were included. Patients younger than 16 years of age or patients died because of brain death were excluded. The study was divided into two periods. During the first period, we used antibiotics according to the American Thoracic Society guidelines.

During the second period, antibiotics were given according to the results of bedside gram staining even before radiographic infiltrate appeared. One hundred twenty-eight patients and patients were included in the first and second periods, respectively. Immunisations and antibiotics in patients with anterior skull base cerebrospinal fluid leaks. This study aimed to define current UK practice in this area and inform appropriate guidelines for ENT surgeons.

A web- based survey of all members of the British Rhinological Society was carried out and the literature in this area was reviewed. Of those who responded to the survey, 14 per cent routinely give prophylactic antibiotics to patients with cerebrospinal fluid leaks, and There is no evidence to support the use of antibiotic prophylaxis in patients with a cerebrospinal fluid leak.

We propose that all such patients are advised to seek immunisation against pneumococcus, meningococcus and haemophilus. The microbiology and the efficacy of antibiotic-based medical treatment of chronic rhinosinusitis in Singapore. Medical therapy including appropriate antibiotic treatment is advocated for the management of chronic rhinosinusitis CRS , with sinus surgery reserved for treatment failures.

This study investigates the microbiology of CRS and their response to culture-directed antibiotic treatment. Medical treatment which included initial empirical and subsequent culture-directed antibiotics was instituted. A follow-up of 12 months was scheduled for all patients. One hundred and twenty Thirty-eight patients The microbiology of CRS in Singapore is described. Staphylococcus aureus appears to be the most common bacterial isolates in both CRS with and without nasal polyps.

Medical treatment with CRS using culture-directed antibiotics is effective in the majority of patients, especially in patients without nasal polyps. Symptomatic urinary tract infection is a complication of office based cystourethroscopy. Studies are mixed regarding the efficacy of antibiotic prophylaxis to prevent urinary tract infections. Our aim was to develop and evaluate an evidence- based protocol that reduces unnecessary antibiotic use while avoiding an increase in urinary tract infections.

We created a clinic antibiogram based on all urology office visits performed during a 2-year period. Bacterial resistance rates, institutional risk related data and clinical guidelines were applied to create a protocol for antibiotic administration before cystourethroscopy.

We then analyzed 1, consecutive patients without a renal transplant who underwent outpatient cystourethroscopy, including after protocol initiation. Urinary tract infection rates and antibiotic use were analyzed for an association with the protocol change using the Fisher exact test. Before the protocol change of patients A local antibiogram with infection related risk data effectively risk stratifies patients before cystourethroscopy, decreasing the use of antibiotics without increasing the rate of symptomatic urinary tract.

Rapid bacterial antibiotic susceptibility test based on simple surface-enhanced Raman spectroscopic biomarkers. Rapid bacterial antibiotic susceptibility test AST and minimum inhibitory concentration MIC measurement are important to help reduce the widespread misuse of antibiotics and alleviate the growing drug-resistance problem.

We discovered that, when a susceptible strain of Staphylococcus aureus or Escherichia coli is exposed to an antibiotic , the intensity of specific biomarkers in its surface-enhanced Raman scattering SERS spectra drops evidently in two hours. The results obtained by this SERS-AST method were consistent with that by the standard incubation- based method, indicating its high potential to supplement or replace existing time-consuming methods and help mitigate the challenge of drug resistance in clinical microbiology.

In veterinary practice antibiotics are used and abused all over the world both to treat diseases and prevent infections and, to increase feed efficiency thus promoting growth in food producing animals. In particular, the reported preliminary study has been focused on cloxacillin and the reported results indicates that the method is potentially able to detect cloxacillin at a concentration of about one order of magnitude lower than the maximal residue limits MRL set by the European Commission.

Staphylococcus aureus is a human pathogen that can cause a wide spectrum of diseases, including sepsis, pneumonia, arthritis, and endocarditis. Ineffective treatment of a number of staphylococcal infections with antibiotics is due to the development and spread of antibiotic -resistant strains following decades of antibiotic usage. This has generated renewed interest within the scientific community in alternative therapeutic agents, such as anti-S. Although the role of antibodies in the management of S.

In this review, we report an update on efforts to develop antibody- based agents, particularly monoclonal antibodies, and their therapeutic potential in the passive immunization approach to the treatment and prevention of S. To evaluate the trends associated with diagnosis and treatment of urinary tract infections UTI in a home- based primary care population of Veterans Health System patients from to Retrospective cohort study. Veterans Healthcare System. Home- based primary care patients treated for UTI from to Appropriate therapy was determined based on the McGeer criteria.

Multivariate logistic regression was used to determine factors leading to appropriate UTI treatment. Of available patients, 68 Antibiotics were overused for treating UTIs in the homebound population. Patients with flank pain, increased urinary frequency, and antibiotic allergy were more likely to receive appropriate treatment. Pharmacists, therefore, have a viable opportunity to increase appropriate antibiotic prescribing in the home- based primary care population.

Antibiotic stewardship: does it work in hospital practice? A review of the evidence base. Guidelines for developing and implementing stewardship programmes include recommendations on appropriate antibiotic use to guide the stewardship team's choice of potential stewardship objectives.

They also include recommendations on behavioural change interventions to guide the team's choice of potential interventions to ensure that professionals actually use antibiotics appropriately in daily practice. To summarize the evidence base of both appropriate antibiotic use recommendations the 'what' and behavioural change interventions the 'how' in hospital practice. The literature shows low-quality evidence of the positive effects of appropriate antibiotic use in hospital patients.

The literature shows that any behavioural change intervention might work to ensure that professionals actually perform appropriate antibiotic use recommendations in daily practice. Although effects were overall positive, there were large differences in improvement between studies that tested similar change interventions.

The literature showed a clear need for studies that apply appropriate study designs- randomized controlled designs-to test the effectiveness of appropriate antibiotic use on achieving meaningful outcomes. Most current studies used designs prone to confounding by indication. In the process of selecting behavioural change interventions that might work best in a chosen setting, much should be learned from behavioural sciences.

The challenge for stewardship teams lies in selecting change interventions on the careful assessment of barriers and facilitators, and on a theoretical base while linking determinants to change interventions. Future studies should apply more robust designs and evaluations when assessing behavioural change interventions. Published by Elsevier Ltd. Antibiotic resistance genes show enhanced mobilization through suspended growth and biofilm- based wastewater treatment processes.

Wastewater treatment plants WWTPs are known to harbor antibiotic resistance genes ARGs that are disseminated into the environment via effluent. However, few studies have compared abundance, mobilization and selective pressures for ARGs in WWTPs as a function of variations in secondary treatment bioprocesses.

We used shotgun metagenomics to provide a comprehensive analysis of ARG composition, relationship to mobile genetic elements and co-occurrences with antibiotic production genes APGs throughout two full-scale municipal WWTPs, one of which employs biofilm- based secondary treatment and another that uses a suspended growth system. However, the fractions of ARGs associated with mobile genetic elements increased substantially between influent and effluent in each plant, indicating significant mobilization of ARGs throughout both treatment processes.

Strong positive correlations between ARGs and APGs were found for the aminoglycoside antibiotic class in the suspended growth system and for the streptogramin antibiotic class in the biofilm system. However, clear differences were observed for within-plant ARG persistence. These findings suggest that both biofilm and suspended growth- based WWTPs may promote genetic mobilization of persistent ARGs that are then disseminated in effluent to receiving water bodies.

Antibiotics mineralization by electrochemical and UV- based hybrid processes: evaluation of the synergistic effect. Antibiotics are not efficiently removed in conventional wastewater treatments. In fact, different advanced oxidation process AOPs , including ozone, peroxide, UV radiation, among others, are being investigated in the elimination of microcontaminants. Most of AOPs proved to be efficient on the degradation of antibiotics , but the mineralization is on the one hand not evaluated or on the other hand not high.

The influence of the individual contributions of electrochemical oxidation EO and the UV- base processes on the hybrid process PEO was analysed. Besides that, an increase in mineralization was found, when heterogeneous photocatalysis and EO are compared, due to the influence of UV radiation, which overcomes the mass-transport limitations. Although the UV- based processes control the reaction pathway that leads to mineralization, the best results to mineralize the antibiotics were achieved by PEO hybrid process.

This can be explained by the synergistic effect of the processes that constitute them. A higher mineralization was achieved, which is an important and useful finding to avoid the discharge of microcontaminants in the environment. Adding functionality with additive manufacturing: Fabrication of titanium- based antibiotic eluting implants. Additive manufacturing technologies have been utilised in healthcare to create patient-specific implants. This study demonstrates the potential to add new implant functionality by further exploiting the design flexibility of these technologies.

Selective laser melting was used to manufacture titanium- based Ti-6Al-4V implants containing a reservoir. Pore channels, connecting the implant surface to the reservoir, were incorporated to facilitate antibiotic delivery. An injectable brushite, calcium phosphate cement, was formulated as a carrier vehicle for gentamicin. The controlled release of gentamicin sulphate from the calcium phosphate cement injected into the implant reservoir was demonstrated in short term elution studies using ultraviolet-visible spectroscopy.

Orientation of the implant pore channels were shown, using micro-computed tomography, to impact design reproducibility and the back-pressure generated during cement injection which ultimately altered porosity. The amount of antibiotic released from all implant designs over a 6hour period based antibiotic eluting implant, which is an attractive alternative to current treatment strategies of periprosthetic infections.

Requests for new oral antibiotic prescriptions in children within 2 days: a Norwegian population- based study. Children commonly refuse to take antibiotics , which may induce parents to request new antibiotic prescriptions with different pharmaceutical characteristics. To investigate prescription changes for children years receiving oral liquid or solid antibiotic formulations and to explore the relationships between prescription changes and characteristics related to the child, prescriber and antibiotic.

Antibiotic prescription changes were defined as the dispensing of subsequent antibiotics with different pharmaceutical characteristics to the same child within 2 days after initial prescriptions. Data were analysed using multivariable logistic regression and generalized estimating equations. Requests for new prescriptions followed 3. Young children who received solid formulations In order of magnitude, the characteristics associated with requests for new prescriptions were the children's ages, poor taste and concentration of liquids, size and shape of solids, prescribers born in recent decades, and girl patients.

Reimbursed prescriptions and scored solids were associated with fewer requests. Avoiding the costs of children's refusal and consequent changes may thus be a motivation for choosing more preferred antibiotics. Antibiotic Resistance.

But there is a growing problem of antibiotic resistance. It happens when bacteria change and become able To help prevent antibiotic resistance Don't use antibiotics for viruses like colds The aim of our research activity was to obtain a biocompatible nanostructured composite based on naturally derived biopolymers chitin and sodium alginate loaded with commercial antibiotics either Cefuroxime or Cefepime with dual functions, namely promoting wound healing and assuring the local delivery of the loaded antibiotic.

Compositional, structural, and morphological evaluations were performed by using the thermogravimetric analysis TGA , scanning electron microscopy SEM , and fourier transform infrared spectroscopy FTIR analytical techniques. In order to quantitatively and qualitatively evaluate the biocompatibility of the obtained composites, we performed the tetrazolium-salt MTT and agar diffusion in vitro assays on the L cell line. The evaluation of antimicrobial potential was evaluated by the viable cell count assay on strains belonging to two clinically relevant bacterial species i.

A novel protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery under cardiopulmonary bypass. This study aimed to develop and assess the effectiveness of a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery. We established a protocol for antibiotic prophylaxis based on preoperative kidney function in patients undergoing open heart surgery.

Surgical site infections SSIs were observed in 4 control group patients A single pre-operative antibiotic dose is as effective as continued antibiotic prophylaxis in implant- based breast reconstruction: A matched cohort study. Infections following implant- based breast reconstruction can lead to devastating consequences. There is currently no consensus on the need for post-operative antibiotics in preventing immediate infection.

This study compared two different methods of infection prevention in this group of patients. A retrospective matched cohort study was performed on consecutive women undergoing implant- based breast reconstruction at University Health Network, Toronto November December All patients received a single pre-operative intravenous antibiotic dose. Group A received minimal interventions and Group B underwent maximal prophylactic measures. Patient age, smoking, diabetes, co-morbidities , oncologic and procedural variables timing and laterality were collected.

Univariate and multivariate logistic regression were performed to compare outcomes between the two groups. Two hundred and eight patients underwent implant procedures. After matching the two treatment groups by BMI, 94 patients in each treatment group yielding a total of implant procedures were selected for analysis.

The two groups were comparable in terms of patient and disease variables. Univariate analysis revealed only pre-operative radiotherapy to be associated with the development of infection 0. Controlling for the effect of radiotherapy, multivariate analysis demonstrated that there was no statistically significant difference between the two methods for infection prevention. Our findings suggest that a single pre-operative dose of intravenous antibiotics is equally as effective as continued antibiotic prophylaxis in preventing immediate infection in patients undergoing implant- based breast reconstructions.

Comparing two types of macrolide antibiotics for the purpose of assessing population- based drug interactions. Objective Clarithromycin strongly inhibits enzyme cytochrome P 3A4, preventing the metabolism of some other drugs, while azithromycin is a weak inhibitor. Accordingly, blood concentrations of other drugs increase with clarithromycin coprescription leading to adverse events.

These macrolide antibiotics also differ on other properties that may impact outcomes. In this study, we compared outcomes in two groups of macrolide antibiotic users in the absence of potentially interacting drugs. Design Population- based retrospective cohort study. Setting Ontario, Canada, from to The secondary outcome was mortality. Results The baseline characteristics of the two groups, including patient demographics, comorbid conditions, infection type and prescribing physician specialty, were nearly identical.

There was no difference between the groups in the risk of hospitalisation for any condition studied relative risk ranged from 0. Compared with azithromycin, clarithromycin was associated with a slightly higher risk of all-cause mortality 0.

Conclusions Clarithromycin can be used to assess drug interactions in population- based studies with azithromycin serving as a control group. However, any differences in mortality observed between the two. A cluster randomized trial for the implementation of an antibiotic checklist based on validated quality indicators: the AB-checklist. Recently we developed and validated generic quality indicators that define 'appropriate antibiotic use' in hospitalized adults treated for a suspected bacterial infection.

Our main objective in this project is to provide hospitals with an antibiotic checklist based on these quality indicators, and to evaluate the introduction of this checklist in terms of cost- effectiveness. The checklist applies to hospitalized adults with a suspected bacterial infection for whom antibiotic therapy is initiated, at first via the intravenous route.

A stepped wedge study design will be used, comparing outcomes before and after introduction of the checklist in nine hospitals in the Netherlands. At least patients will be included in both the control and the intervention group. The primary endpoint is length of hospital stay. Differences in numerical endpoints between the two periods will be evaluated with mixed linear models; for dichotomous outcomes generalized estimating equation models will be used.

A process evaluation will be performed to evaluate the professionals' compliance with use of the checklist. The key question for the economic evaluation is whether the benefits of the checklist, which include reduced antibiotic use, reduced length of stay and associated costs, justify the costs associated with implementation activities as well as daily use of the checklist. If cost- effective, the AB-checklist will provide physicians with a tool to support appropriate antibiotic use in adult hospitalized patients who start with intravenous antibiotics.

Dutch trial registry: NTR Occurrence of antibiotics in soils and manures from greenhouse vegetable production bases of Beijing, China and an associated risk assessment. The occurrence of 15 antibiotics in soil and manure samples from 11 large-scale greenhouse vegetable production GVP bases in Beijing, China was investigated. Results showed that the greenhouse soils were ubiquitously contaminated with antibiotics , and that antibiotic concentrations were significantly higher in greenhouses than in open field soils.

This investigation also indicated that fertilization with manure and especially animal feces might be the primary source of antibiotics. A risk assessment based on the calculated risk quotients RQs demonstrated that oxytetracycline, chlortetracycline, norfloxacin, ciprofloxacin and enrofloxacin could pose a high risk to soil organisms.

These results suggested that the ecological effects of antibiotic contamination in GVP bases and their potential adverse risks on human health need to be given special attention. The unrelenting rise of antimicrobial-resistant bacteria has necessitated the search for novel antibiotic solutions. Herein we describe further mechanistic studies on a 2. This antibiotic exhibits bactericidal activity against the Gram-negative bacterium Escherichia coli at 1.

LAL treatment inhibits cellular division, daughter cell separation, and twin-arginine translocation Tat pathway dependent shuttling of proteins to the periplasm. Furthermore, we have found that the cedA gene imparts increased resistance to LAL, and shown that an E. Taken together, these studies further implicate cell division pathways as the target for this nanoparticle- based antibiotic and demonstrate that there may be inherently higher barriers for resistance evolution against nanoscale antibiotics in comparison to their small molecule counterparts.

An electrochemical quartz crystal nanobalance EQCN , which provides real-time analysis of dynamic surface events, is a valuable tool for analyzing biomolecular interactions. EQCN biosensors are based on mass-sensitive measurements that can detect small mass changes caused by chemical binding to small piezoelectric crystals.

Among the various biosensors, the piezoelectric biosensor is considered one of the most sensitive analytical techniques, capable of detecting antigens at picogram levels. The analysis of antibiotic residues requires high sensitivity, rapidity, reliability and cost effectiveness. For analytical purposes the general approach is to take advantage of the piezoelectric effect by immobilizing a biosensing layer on top of the piezoelectric crystal. The sensing layer usually comprises a biological material such as an antibody, enzymes, or aptamers having high specificity and selectivity for the target molecule to be detected.

The biosensing layer is usually functionalized using surface chemistry modifications. When these bio-functionalized quartz crystals are exposed to a particular substance of interest e. This causes a frequency or mass change that can be used to determine the amount of material interacted or bound. EQCN biosensors can easily be automated by using a flow injection analysis FIA setup coupled through automated pumps and injection valves.

Such FIA-EQCN biosensors have great potential for the detection of different analytes such as antibiotic residues in various matrices such as water, waste water, and milk. Antibiotic use in acute cholecystitis: practice patterns in the absence of evidence- based guidelines. Antibiotics are frequently administered in acute cholecystitis for preoperative prophylaxis or postoperative treatment. The optimal timing, choice, and duration of antibiotics are unclear.

We conducted a retrospective review of all cases of acute cholecystitis between and at the American University of Beirut Medical Centre. A survey among general surgeons was also performed to describe the pattern of antibiotic prescribing in uncomplicated acute cholecystitis.

The number of cases of acute cholecystitis was The mean duration of postoperative antibiotic therapy was 5 days. There was no correlation between the severity of symptoms, gallbladder description, or positive gallbladder culture and the use of antibiotics postoperatively.

Sixty five percent of interviewed surgeons would continue antibiotic therapy postoperatively for 3 or more days. Search of the medical literature failed to provide clear guidelines for antibiotic use in acute cholecystitis. The use of antibiotics in patients with acute cholecystitis is erratic and costly.

Prospective studies are needed to better study the effectiveness of a short course of antibiotics in uncomplicated cases. The role of gallbladder culture in guiding antibiotic therapy should be defined as routine cultures add to the cost without evident benefit.

This study's purpose was to determine the percentage of patients with HAP, VAP, and HCAP who received guideline- based empiric antibiotic therapy and to determine the average time to receipt of an appropriate empiric regimen. The hospital's electronic medical record system utilized International Classification of Diseases, Ninth Revision ICD-9 codes to identify patients diagnosed with pneumonia. The percentage of patients who received guideline- based empiric antibiotic therapy was calculated.

The mean time from suspected diagnosis of pneumonia to initial administration of the final antibiotic within the empiric regimen was calculated for patients who received guideline- based therapy. Ninety-three patients met the inclusion criteria. The overall guideline adherence rate for empiric antibiotic therapy was Guideline adherence rates were lower and time to appropriate empiric therapy was greater for patients with HCAP compared to patients with HAP.

Long-term antibiotic delivery by chitosan- based composite coatings with bone regenerative potential. Composite coatings with bone-bioactivity and drug-eluting capacity are considered as promising materials for titanium bone implants. In this work, drug-eluting chitosan-bioactive glass coatings were fabricated by a single-step electrophoretic deposition technique. Drug-loading and -releasing capacity of the composite coatings were carried out using the vancomycin antibiotic.

The coatings were bioactive in terms of apatite-forming ability in simulated body fluid and showed favorable cell adhesion and growth. In vitro biological tests also indicated that the composite coatings had better cellular affinity than pristine chitosan coatings. Antibacterial tests using survival assay against Gram-positive Staphylococcus aureus bacteria determined the effect of vancomycin release on reduction of infection risk.

The developed chitosan- based composite coatings with bone bioactivity and long-term drug-delivery ability may be potentially useful for metallic implants to reduce infection risk. Individual maternal and child exposure to antibiotics in hospital - a national population- based validation study.

Exposure to antibiotics in early life may affect future health. Most antibiotics are prescribed in outpatient care, but inpatient exposure is also important. We estimated how specific diagnoses in hospitals corresponded to individual antibiotic exposure. All pregnant women and children from birth to 5 years of age with infectious diseases and common inpatient diagnoses between July and November were identified from the Swedish National Patient Register.

Random samples of individuals from predefined groups were drawn, and medical records received from the clinics were manually reviewed for antibiotics. Pregnant women who had undergone a Caesarean section were more likely to be treated with antibiotics than those who had had a vaginal delivery This study defines the proportion of new mothers and young children who received individual antibiotic treatment for specific inpatient diagnoses in Sweden and provides a useful basis for future studies focusing on antibiotic use.

The use of an aptamer specific to ampicillin assures good selectivity and sensitivity for the detection of ampicillin from different matrice. This new approach is dedicated for a portable, remote sensing platform based on low-cost, small size and low-power consumption solution.

The simple experimental hybrid platform integrates the results from the D-shape surface plasmon resonance plastic optical fiber SPR-POF and from the electrochemical bio sensor, for the analysis of ampicillin, delivering sensitive and reliable results. The SPR-POF already used in many previous applications is embedded in a new experimental setup with fluorescent fibers emitters, for broadband wavelength analysis, low-power consumption and low-heating capabilities of the sensing platform.

Strategies to Minimize Antibiotic Resistance. Antibiotic resistance can be reduced by using antibiotics prudently based on guidelines of antimicrobial stewardship programs ASPs and various data such as pharmacokinetic PK and pharmacodynamic PD properties of antibiotics , diagnostic testing, antimicrobial susceptibility testing AST , clinical response, and effects on the microbiota, as well as by new antibiotic developments.

The controlled use of antibiotics in food animals is another cornerstone among efforts to reduce antibiotic resistance. All major resistance-control strategies recommend education for patients, children e. The problem of antibiotic resistance can be minimized only by concerted efforts of all members of society for ensuring the continued efficiency of antibiotics.

Implementation of an evidence- based order set to impact initial antibiotic time intervals in adult febrile neutropenia. To evaluate the impact of the implementation of a standardized order set on the time interval in initiation of antibiotic therapy for adult patients with cancer and febrile neutropenia. Practice change. The oncology unit of an urban hospital in the south-eastern United States.

Literature regarding febrile neutropenia, use of order sets, and change process was reviewed. In addition, a retrospective and concurrent chart review was conducted for adult patients admitted with febrile neutropenia. Initial antibiotic times, order-set use, and length of stay. Findings in the presence of low order-set usage suggest that staff education and placement of the order-set antibiotics in unit- based medication dispensing machines helped reduce time intervals for initial antibiotic therapy.

The use of an evidence- based approach to nursing care is essential to achieving the best outcomes for patients with febrile neutropenia. Incorporation of current evidence into an order set to guide clinical practice and comprehensive nurse, pharmacy, and physician education are needed for the successful implementation of evidence- based practice changes. Antibiotic regimen based on population analysis of residing persister cells eradicates Staphylococcus epidermidis biofilms.

Yang, Shoufeng; Hay, Iain D. Biofilm formation is a major pathogenicity strategy of Staphylococcus epidermidis causing various medical-device infections. Persister cells have been implicated in treatment failure of such infections.

We sought to profile bacterial subpopulations residing in S. Population analysis was performed by challenging single biofilm cells with antibiotics at increasing concentrations ranging from planktonic minimum bactericidal concentrations MBCs to biofilm MBCs MBCbiofilm. Antibiotic regimens targeting dormant cells were tested in vitro for their efficacies in eradicating persister cells and intact biofilms. This study confirmed that there are at least three subpopulations within a S.

Biofilms comprise more TBK cells and dormant cells than their log-planktonic counterparts. Using antibiotic regimens targeting dormant cells, i. Potential uses for this strategy are in antibiotic lock techniques and inhaled aerosolized antibiotics. Wastewater- and drinking water distribution systems are known to disseminate antibiotic -resistant bacteria, with the biofilms that form on the inner-surfaces of the pipeline as a hotspot for pr Decline in extractable antibiotics in manure- based composts during composting.

A wide variety of antibiotics have been detected in natural water samples and this is of potential concern because of the adverse environmental effects of such antibiotic residues. One of the main sources of antibiotics effluence to the surrounding environment is livestock manures which often contain elevated concentrations of veterinary antibiotics VAs which survive digestion in the animal stomach following application in animal husbandry practices.

In Korea, livestock manures are normally used for compost production indicating that there is potential for antibiotic release to the environment through compost application to agricultural lands. Therefore, reduction of the amount of VAs in composts is crucial. The purpose of this study was to understand the influence of the composting process and the components of the compost on the levels of three common classes of antibiotics tetracyclines, sulfonamides, and macrolides.

Composted materials at different stages of composting were collected from compost manufacturing plants and the variation in antibiotic concentrations was determined. Three different antibiotics , chlortetracycline CTC , sulfamethazine SMZ , and tylosin TYL at three different concentrations 2, 10, and 20mgkg -1 were also applied to a mixture of pig manure and sawdust and the mixtures incubated using a laboratory scale composting apparatus to monitor the changes in antibiotic concentrations during composting together with the physicochemical properties of the composts.

During composting, in both field and lab-scale investigations, the concentrations of all three different antibiotics declined below the relevant Korean guideline values 0. The decline of tetracycline and sulfonamide concentrations was highly dependent on the presence of sawdust while there was no influence of sawdust on TYL decline. The efficacy of social cognitive theory- based self-care intervention for rational antibiotic use: a randomized trial.

Misuse of antibiotics can be described as a failure to complete treatment, skipping of the doses and reuse of leftover medicines and overuse of antibiotics. Health education interventions are expected to enhance awareness and general belief on rational antibiotics use. Therefore, the study aimed to determine the efficacy of social cognitive theory SCT - based self-care intervention for rational antibiotic use. This randomized trial was conducted in a sample of adults.

The intervention group received self-care educational intervention of four sessions lasting min augmented with the text messages and the control groups attended usual education program in health centers. The study participants were invited to complete questionnaires at the baseline and end of the intervention.

The data were analyzed using SPSS version Chi-square X2 , independent t-test and covariance analysis were used for data analysis. P antibiotic use showed a significant difference in intervention group before and after six months P 0.

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Accepts Medicare Assignment She does accept the payment amount Medicare approves and not to bill you for more than the Medicare deductible and coinsurance. Clinical social work is a healthcare profession based on theories and methods of prevention and treatment in providing behavioral healthcare mental health and substance use disorder services, with special focus on bio-psychosocial problems and disorders. They work with clients in order to help them deal with issues involving their mental and emotional health.

This could be related to substance abuse, past trauma or mental illness. There are a wide variety of specializations the Licensed Clinical Social Worker can focus on. These include specialties such as: working with mental health issues, substance abuse, public health, school social work, medical social work, marriage counseling or children and family therapy. Some may choose to work purely in a research, policy making or administrative capacity.

The possible career paths as a Licensed Clinical Social Worker are many and varied. Julia A Speir has been primarily specialized in Clinical for over 21 years of experience. The social worker must be licensed, certified, or registered at the clinical level in the jurisdiction of practice.

A clinical social worker provides direct services, including interventions focused on interpersonal interactions, intrapsychic dynamics, and life management issues. Clinical social work services are based on bio-psychosocial perspectives. Services consist of assessment, diagnosis, treatment including psychotherapy and counseling , client-centered advocacy, consultation, evaluation, and prevention of mental illness, emotional, or behavioral disturbances.

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