RESUMO
Acute bacterial upper respiratory infections are common indications for antibiotics in pediatrics, and many prescriptions may be inappropriate. Novel approaches to outpatient antimicrobial stewardship interventions are needed. This quasi-experimental study of an order set and best practice advisory alert targeting cefdinir prescriptions demonstrated an 8.4% decrease in cefdinir prescribing (P ≤ .001).
Assuntos
Antibacterianos , Gestão de Antimicrobianos , Cefdinir , Sistemas de Apoio a Decisões Clínicas , Registros Eletrônicos de Saúde , Humanos , Antibacterianos/uso terapêutico , Criança , Infecções Respiratórias/tratamento farmacológico , Pacientes Ambulatoriais , Pré-Escolar , Adolescente , Padrões de Prática Médica/estatística & dados numéricos , LactenteRESUMO
A neonatal male injured by the family dog developed meningitis secondary to Pasteurella multocida . After initially defervescing with IV antibiotic treatment, he became febrile again, and imaging revealed a skull fracture and fluid collection. Following neurosurgical evacuation and an extended course of antibiotics, the patient was discharged home.
Assuntos
Empiema , Meningite , Infecções por Pasteurella , Pasteurella multocida , Animais , Antibacterianos/uso terapêutico , Cães , Empiema/tratamento farmacológico , Humanos , Masculino , Meningite/tratamento farmacológico , Infecções por Pasteurella/complicações , Infecções por Pasteurella/diagnóstico , Infecções por Pasteurella/tratamento farmacológicoRESUMO
The relative impact of 23 mutations on biofilm formation was evaluated in the USA300, methicillin-resistant strain LAC. Mutation of sarA, atl, codY, rsbU, and sigB limited biofilm formation in comparison to the parent strain, but the limitation imposed by mutation of sarA was greater than that imposed by mutation of any of these other genes. The reduced biofilm formation of all mutants other than the atl mutant was correlated with increased levels of extracellular proteases. Mutation of fur- and mgrA-enhanced biofilm formation but in LAC had no impact on protease activity, nuclease activity, or accumulation of the polysaccharide intercellular adhesin (PIA). The increased capacity of these mutants to form a biofilm was reversed by mutation of sarA, and this was correlated with increased protease production. Mutation of sarA, mgrA, and sigB had the same phenotypic effect in the methicillin-sensitive strain UAMS-1, but mutation of codY increased rather than decreased biofilm formation. As with the UAMS-1 mgrA mutant, this was correlated with increased production of PIA. Examination of four additional clinical isolates suggests that the differential impact of codY on biofilm formation may be a conserved characteristic of methicillin-resistant versus methicillin-sensitive strains.