Prophylactic Antibiotics After Cleft Lip and Palate Reconstruction: A Review From a Global Health Perspective.

Orofacial clefts are common congenital deformities. Global initiatives have increased access to cleft care and reconstruction surgeries for cleft lip with or without cleft palate (CL/P), but there is no consensus on the use of postoperative prophylactic antibiotics. We conducted a narrative review using PubMed on the use of postoperative prophylactic antibiotics in CL/P surgery. A search of PubMed identified 30 potentially relevant articles, of which 15 were reviewed. There was no consensus among surgeons on prescribing patterns, but there was limited evidence that postoperative antibiotics reduce palatal fistulas. Notably, microbiological screening is not used to guide the choice of antimicrobial or to predict postoperative complications. Based on limited available data, we cannot make any strong evidence-based recommendations on prescribing postoperative antibiotics; however, we recommend that each cleft surgeon performing these procedures in lower-income countries without access to tertiary care centers consider the cost-benefit analysis of prescribing antimicrobials postoperatively, without antimicrobial screening, which showed no benefit.

Development of the National Otolaryngology Interest Group: Conception to Implementation.

Otolaryngology is a small and highly sought-after surgical subspecialty with sparse residency positions, making it competitive to match into. Allopathic (MD) students without home otolaryngology residency programs, osteopathic (DO) medical students, and underrepresented minorities have historically faced additional challenges in matching into otolaryngology. These specific populations generally experience limited opportunities in establishing mentors, engaging in scholarly activity, and gaining early exposure to clinical settings. Even though the American Osteopathic Association and the Accreditation Council for Graduate Medical Education merger was in part established to create equity among applicants, there remains a substantial disparity among the match rates of medical students of various educational and cultural backgrounds. The National Otolaryngology Interest Group is a student-led interest group created to provide all medical students, especially those facing barriers, with the resources needed to best prepare for matching into an otolaryngology residency program and ultimately a career in otolaryngology.

Current Barriers in Pursuing Otolaryngology as an Osteopathic Applicant and Proposed Goals for the Future.

The osteopathic (DO) medical profession has seen a substantial increase in popularity, evident by the drastic increase in the DO physician workforce and increasing number of DO graduates in the United States. Osteopathic medical schools have historically been primary care focused, resulting in a majority of their graduates pursuing practice in those specialties. This focus may be inadvertently creating a disadvantageous environment for DO students who aim to pursue specialized or traditionally competitive fields in medicine. Otolaryngology is a prime example of osteopathic underrepresentation, as there is currently a significantly low percentage of DO residents in otolaryngology residency programs and practicing DO otolaryngologists. Given the recent American Council on Graduate Medical Education (ACGME) and American Osteopathic Association (AOA) merger between osteopathic and allopathic (MD) residency programs, it is of great value to further discuss avenues for progress and mitigation of barriers.

Urban and agricultural soils in Southern California are a reservoir of carbapenem-resistant bacteria.

Carbapenems are last-resort ß-lactam antibiotics used in healthcare facilities to treat multidrug-resistant infections. Thus, most studies on identifying and characterizing carbapenem-resistant bacteria (CRB) have focused on clinical settings. Relatively, little is still known about the distribution and characteristics of CRBs in the environment, and the role of soil as a potential reservoir of CRB in the United States remains unknown. Here, we have surveyed 11 soil samples from 9 different urban or agricultural locations in the Los Angeles-Southern California area to determine the prevalence and characteristics of CRB in these soils. All samples tested contained CRB with a frequency of <10 to 1.3 × 104  cfu per gram of soil, with most agricultural soil samples having a much higher relative frequency of CRB than urban soil samples. Identification and characterization of 40 CRB from these soil samples revealed that most of them were members of the genera Cupriavidus, Pseudomonas, and Stenotrophomonas. Other less prevalent genera identified among our isolated CRB, especially from agricultural soils, included the genera Enterococcus, Bradyrhizobium, Achromobacter, and Planomicrobium. Interestingly, all of these carbapenem-resistant isolates were also intermediate or resistant to at least 1 noncarbapenem antibiotic. Further characterization of our isolated CRB revealed that 11 Stenotrophomonas, 3 Pseudomonas, 1 Enterococcus, and 1 Bradyrhizobium isolates were carbapenemase producers. Our findings show for the first time that both urban and agricultural soils in Southern California are an underappreciated reservoir of bacteria resistant to carbapenems and other antibiotics, including carbapenemase-producing CRB.