Use of antibiotics in paediatric long-term care facilities.

BACKGROUND: Adult long-term care (LTC) facilities have high rates of antibiotic use, raising concerns about antimicrobial resistance. Few studies have examined antibiotic use in paediatric LTC facilities. AIM: To describe antibiotic use in three paediatric LTC facilities and to describe the factors associated with use. METHODS: A retrospective cohort study was conducted from September 2012 to December 2015 in three paediatric LTC facilities. Medical records were reviewed for demographics, healthcare-associated infections (HAIs), antimicrobial use and diagnostic testing. Logistic regression was used to identify predictors for antibiotic use. The association between susceptibility testing results and appropriate antibiotic coverage was determined using Chi-squared test. FINDINGS: Fifty-eight percent (413/717) of residents had at least one HAI, and 79% (325/413) of these residents were treated with at least one antibiotic course, totalling 2.75 antibiotic courses per 1000 resident-days. Length of enrolment greater than one year, having a neurological disorder, having a tracheostomy, and being hospitalized at least once during the study period were significantly associated with receiving antibiotics when controlling for facility (all P < 0.001). Diagnostic testing was performed for 40% of antibiotic-treated HAIs. Eighty-six percent of antibiotic courses for identified bacterial pathogens (201/233) provided appropriate coverage. Access to susceptibility testing was not associated with appropriate antibiotic choice (P = 0.26). CONCLUSION: Use of antibiotics in paediatric LTC facilities is widespread. There is further need to assess antibiotic use in paediatric LTC facilities. Evaluation of the adverse outcomes associated with inappropriate antibiotic use, including the prevalence of resistant organisms in paediatric LTC facilities, is critical.

Functional genomic, biochemical, and genetic characterization of the Salmonella pduO gene, an ATP:cob(I)alamin adenosyltransferase gene.

Salmonella enterica degrades 1,2-propanediol by a pathway dependent on coenzyme B12 (adenosylcobalamin [AdoCb1]). Previous studies showed that 1,2-propanediol utilization (pdu) genes include those for the conversion of inactive cobalamins, such as vitamin B12, to AdoCbl. However, the specific genes involved were not identified. Here we show that the pduO gene encodes a protein with ATP:cob(I)alamin adenosyltransferase activity. The main role of this protein is apparently the conversion of inactive cobalamins to AdoCbl for 1,2-propanediol degradation. Genetic tests showed that the function of the pduO gene was partially replaced by the cobA gene (a known ATP:corrinoid adenosyltransferase) but that optimal growth of S. enterica on 1,2-propanediol required a functional pduO gene. Growth studies showed that cobA pduO double mutants were unable to grow on 1,2-propanediol minimal medium supplemented with vitamin B(12) but were capable of growth on similar medium supplemented with AdoCbl. The pduO gene was cloned into a T7 expression vector. The PduO protein was overexpressed, partially purified, and, using an improved assay procedure, shown to have cob(I)alamin adenosyltransferase activity. Analysis of the genomic context of genes encoding PduO and related proteins indicated that particular adenosyltransferases tend to be specialized for particular AdoCbl-dependent enzymes or for the de novo synthesis of AdoCbl. Such analyses also indicated that PduO is a bifunctional enzyme. The possibility that genes of unknown function proximal to adenosyltransferase homologues represent previously unidentified AdoCbl-dependent enzymes is discussed.

Serum total homocysteine concentration is related to self-reported heart attack or stroke history among men and women in the NHANES III.

High circulating total homocysteine (tHcy) concentration, which is influenced by folate and vitamin B-12 status, is a suspected cause of cardiovascular events. This relation has been investigated in both case-control and prospective studies but has not been evaluated for different sex x age subgroups of the general U.S. population. We used data on adult (i.e., aged > or =40 y) male (n = 1097) and female (n = 1107) participants in the third National Health and Nutrition Examination Survey, excluding diabetics and those supplemented with estrogen, vitamins or minerals, to evaluate the association between serum tHcy concentration and self-report of heart attack or stroke. After adjustment for age, race-ethnicity, smoking, blood pressure, blood pressure medication, body mass index and serum concentrations of creatinine and cholesterol, past events were reported 2.4 (95% confidence interval 1.0-5.5) times as often by men with tHcy concentration of >12 micromol/L as by men with lower values. The odds ratio for women was 2.6 (95% confidence interval 1.1-6.6) after adjustment for the same factors plus menopausal status. A stronger relation in men aged < or =60 y compared with older men may help reconcile conflicting results of earlier studies.

Synthesis and biological evaluation of a new class of vaccine adjuvants: aminoalkyl glucosaminide 4-phosphates (AGPs).

A novel series of acylated omega-aminoalkyl 2-amino-2-deoxy-4-phosphono-beta-D-glucopyranosides (aminoalkyl glucosaminide 4-phosphates) was synthesized and screened for immunostimulant activity. Several of these compounds enhance the production of tetanus toxoid-specific antibodies in mice and augment vaccine-induced cytotoxic T cells against EG.7-ova target cells.

Folate status of Mexican American, Cuban, and Puerto Rican women.

The objective of this study was to estimate the prevalence of low serum and red blood cell (RBC) folate values of Mexican American (MA), Cuban (C), and Puerto Rican (PR) women examined in the Hispanic Health and Nutrition Examination Survey, 1982-1984. Serum and RBC folate were determined for all women aged 18-44 y by use of a radio-assay kit. The percent of women with low serum folate (less than 6.8 nmol/L) was 11.9% for MA, 10.1% for C, and 8.1% for PR. The prevalence of low concentrations of RBC folate (less than 363 nmol/L) was 7.8%, 16.7%, and 13.6% for MA, C, and PR, respectively. The percentages of women with reduced tissue stores of folate were 4.3% for MA, 6.0% for C, and 4.0% for PR. Years of education completed and poverty status did not significantly affect folate concentrations; however, the prevalence of low folate concentrations among users of vitamin or mineral supplements was significantly lower than it was among nonusers in selected subgroups.

An evaluation of a dry-fat product as a source of supplemental energy in pig diets.

Three feeding trials (278 pigs) and one balance trial (14 pigs) were conducted to evaluate acceptance and utilization of diets containing a dry-fat product containing 90% fat. The fat was a mixture of equal parts vegetable and animal fats. In Trial 1, 4-wk-old pigs fed diets with 5% dry-fat added had average daily gain (ADG), average daily feed intake (ADFI) and gain/feed (G/F) values equal to pigs fed the diet containing 4.5% liquid fat, the unprocessed equivalent to the dry-fat. Values for G/F with both diets were higher (P less than .05) than for pigs fed the unsupplemented control diet. In Trial 2, dry-fat and roasted soybeans were compared as sources of supplemental fat in diets for finishing pigs. Both were efficiently utilized, with no differences (P greater than .05) among diets. In Trial 3, diets with 0, 5 and 10% levels of added dry-fat were fed to pigs from 34 to 100 kg. Rates of gain were not affected, but ADFI decreased (P less than .05) and G/F increased (P less than .05) with increased fat level. Carcass measurements were not affected by dietary treatment, but iodine number of backfat increased (P less than .05) with dietary fat level. In Trial 4, values for grams of N absorbed and retained and megacalories of energy absorbed and metabolized did not differ (P greater than .05) between diets with 0 and 5% added dry-fat. These results show that the dry-fat product was efficiently utilized by growing and finishing pigs.

Ethnic and racial differences in serum vitamin A levels of children aged 4-11 years.

Interpretation of differences in serum vitamin A levels observed between Hispanic and non-Hispanic children may be complicated by confounding environmental factors. Data from the Mexican-American portion of the Hispanic Health and Nutrition Examination Survey and the second National Health and Nutrition Examination Survey were used to explore these differences in 4-11-y-old Mexican Americans and non-Hispanic blacks and whites before and after accounting for vitamin-mineral supplement use and poverty status. Initial differences in mean serum vitamin A levels and prevalences less than 20 micrograms/dL (0.70 mumol/L) or less than 25 micrograms/dL (0.87 mumol/L) among the three ethnic or racial groups were reduced or eliminated after accounting for the two descriptive variables. These results support the hypothesis that differences in serum vitamin A levels between Mexican-American and non-Hispanic children in the United States are due more to environmental factors than to ethnicity.

Microbiological assay of blood serum for the vitamin B12 status of dairy cows.

Four vitamin B12 assays were compared using blood sera from Friesian cows on winter diets or grazing. In herd 1, ten animals were blood-sampled three times at monthly intervals and the vitamin B12 concentration of the sera determined by the Poteriochromonas malhamensis and Lactobacillus delbrueckii assays. At all three sampling dates the results produced by the P. malhamensis assay were significantly greater than those produced by the L. delbrueckii assay. Cows in herd 2 were divided into two groups, each of 30 animals. One group was given a soluble glass bolus releasing cobalt and the other was unsupplemented. Milk yields were recorded throughout the experimental period and herbage samples were taken at intervals for cobalt determinations. Blood samples were taken at intervals from January to September 1983 and the vitamin B12 concentration of the sera determined by four different assay methods: the P. malhamensis and L. delbrueckii microbiological assays and the Becton Dickinson and RIA Products 'No-boil' radioassays. The last of these failed to detect vitamin B12 in any sample. There was a significant difference between the results obtained by the three other assays, with the Becton Dickinson radioassay consistently producing the lowest result and the P. malhamensis assay the highest result of the three. There was no significant effect of cobalt supplementation on milk yield.

Comparison of dietary intakes and iron status of vitamin-mineral supplement users and nonusers, aged 1-19 years.

Despite widespread use of supplements, few studies have been conducted to determine if supplement users have better nutritional status. Using data from the second National Health and Nutrition Examination Survey (NHANES II), mean values of five iron status indicators (hemoglobin, mean corpuscular volume, transferrin saturation, erythrocyte protoporphyrin, and serum ferritin) and dietary intakes of several nutrients and food groups were compared between regular supplement users and nonusers aged 1-19 y. Users consumed more vitamin C and fruits and vegetables than nonusers in several age-sex groups. No significant differences in mean Fe status indicator values were observed except for hemoglobin for the 3-4-y olds and serum ferritin for the 5-10-y olds. In both cases, users had higher values than nonusers. In general, Fe status was not associated with supplement use but the reason cannot be identified from this survey.

Treatment of bulimia with brief psychoeducational group therapy.

Two groups of 10 normal-weight bulimic women received short-term, structured group treatment beginning 3 weeks apart in a multiple baseline design. The multifaceted treatment approach incorporated education, self-monitoring, goal setting, assertion training, relaxation, and cognitive restructuring. Results showed an overall reduction of 70% in binge/purge episodes. There were significant improvements in psychological functioning, including self-esteem, depression, assertiveness, and pathological attitudes about eating.

Prevalences of anemia and iron deficiency anemia in Black and White women in the United States estimated by two methods.

Prevalences of anemia were estimated by two methods for 742 Black and 3,074 White nonpregnant women of childbearing age drawn from a large probability sample of the United States civilian noninstitutionalized population (NHANES I). One method defines the prevalence of anemia as the proportion of women with hemoglobin levels below a 12 g/dl "cut-off". The second method defines the prevalence of anemia as the proportion of women whose hemoglobin values are shifted downwards relative to a distribution of hemoglobin values of non-anemic women. Estimates produced by both methods suggest a higher prevalence of anemia in Black than in White women. Estimates produced by the "cut-off" method, however, are higher than those from the "distribution" method for both racial groups, probably because the "cut-off" method results in large overestimates in populations where anemia prevalence is low. The "distribution" method is further used to estimate the contribution of iron deficiency to anemia. Essentially all anemia in White women and a high proportion of anemia in Black women is associated with iron deficiency in the US civilian noninstitutionalized population. Iron supplementation trials are needed in order to define the magnitude of the problem accurately and plan appropriate public health programs.

Therapy with cromolyn sodium.

Cromolyn is a prototype of a new series of drugs, the pharmacologic activities of which may offer an entirely new approach in the treatment of asthma. Whereas bronchodilator drugs and steroids act primarily at tissue sites to counteract the effects of various toxic mediators released from tissue mast cells, cromolyn prevents the release of such mediators from mast cell membranes. The advent of cromolyn sodium therapy has been recognized as a significant advance by the pharmaceutical industry, which is rapidly developing a series of cromolyn-like drugs with similar properties. Many of these compounds are active orally, and some preliminary investigations suggest that they also could be clinically effective. Cromolyn has therapeutic value in immunologic and nonimmunologically induced bronchospasm, being particularly suited for conditions amenable to long-term prophylactic therapy. The risk-to-benefit ratio of cromolyn sodium therapy is excellent. Cromolyn sodium is an important adjunct in the treatment of asthma. By topical administration the drug has been effective in seasonal and perennial rhinoconjunctivitis and in selected cases of gastrointestinal allergy to foods.