A retrospective analysis was performed using The Surveillance Network, USA, to examine the prevalence of antibiotic resistance among urine isolates from U.S. female outpatients in 2012 and assessed trends in antibiotic resistance comparing data from 2003 and 2012. The most common pathogen identified in 2012 (n ‫؍‬ 285,325) was Escherichia coli (64.9% of isolates). In 2012, E. coli resistance to nitrofurantoin was low (<3%) across all age groups. E. coli resistance to ciprofloxacin was high among adults (11.8%) and elderly outpatients (29.1%). When comparing the 2003 and 2012 data from isolates from adults, E. coli resistance to nitrofurantoin changed only slightly (from 0.7% to 0.9%), whereas increases in resistance to ciprofloxacin (3.6% to 11.8%) and trimethoprim-sulfamethoxazole (17.2% to 22.2%) changed substantially. In the United States, E. coli has become increasingly resistant to ciprofloxacin and trimethoprim-sulfamethoxazole (TMP-SMX) in adult female outpatients. Nitrofurantoin retains high levels of antibiotic activity against urinary E. coli. Antibiotic use is the single most important modifiable risk factor for antibiotic resistance (1). Urinary tract infection (UTI), accounting for Ͼ8 million office visits and 1 million emergency department visits annually in the United States, is one of the most frequent indications for antibiotic use in ambulatory care (2). For the treatment of uncomplicated UTIs, or cystitis, clinical practice guidelines recommend the empirical use of nitrofurantoin or trimethoprim-sulfamethoxazole (TMP-SMX) as first-line therapy (3, 4). Fluoroquinolones, including ciprofloxacin and levofloxacin, are considered alternative agents for the treatment of uncomplicated UTIs (3).An important consideration for the appropriate empirical treatment of UTIs is antibiotic susceptibility among uropathogens isolated from urine cultures (3). Urine cultures are often obtained for outpatients with UTIs, including those with recurrent infections, previous treatment failures, or complicated infections (5). Few investigations have explored national trends of outpatient antibiotic resistance among uropathogens in women. The objectives of this study were to examine the recent prevalence of in vitro antibiotic resistance among common bacteria isolated from urine cultures collected from U.S. female outpatients and to assess trends in antibiotic resistance by comparing data from 2003 and 2012. MATERIALS AND METHODSWe performed a retrospective analysis of antibiotic susceptibility test results from urine cultures collected from female outpatients in the United States comparing 2003 with 2012 data from The Surveillance Network (TSN) (Eurofins Medinet, Chantilly, VA). More than 200 institutions in the United States collected and submitted susceptibility data and corresponding demographic information (age, sex, and site of infection) to TSN during these years. Outpatients were defined as individuals who visited any ambulatory care setting, such as an emergency department, hospital-based outpatient clinic, or...

Bacteremic pneumococcal CAP patients were significantly associated with higher in-hospital mortality, lower TCS, and longer LOS. HIV-infected patients showed a greater mortality which was not statistically significant. Bacteremic pneumococcal CAP patients had higher levels of biomarkers and systemic cytokines.

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Background Ceftazidime-avibactam (caz-avi), a novel β-lactam/β-lactamase inhibitor, is commonly utilized for carbapenem-resistant gram-negative infections (CR-GNI). However, the benefits vs risks of combining caz-avi with other agents are unclear. Methods In this retrospective cohort study, inpatients with CR-GNI treated with caz-avi were identified at 9 U.S. hospitals. The impact of caz-avi monotherapy (MT) or combination therapy (CT; i.e., any concomitant use of gram-negative-active antibiotics) was studied using logistic regression, controlling for baseline patient and hospital factors. The primary outcome was in-hospital mortality or discharge to hospice (death), and secondary outcomes were length of stay (LOS), resolution of infectious signs and symptoms (clinical response), 90-day recurrent infection and future caz-avi–resistant organism. An adjusted odds ratio (aOR) with 95% confidence interval (CI) was used to assess the primary and secondary outcomes. Results 328/499 (65.7%) patients received caz-avi as targeted therapy for a CR-GNI. Overall patients treated with MT and CT were similar at baseline and had comparable baseline demographics although patients treated with CT were more likely to be in the ICU and receive a concomitant empiric in vitro-concordant antibiotic (table 1). The most common organism was Klebsiella spp. (44.6%) followed by Pseudomonas aeruginosa (27.7%) (table 2). Concomitant gram-negative agents are shown in table 3. Overall, 92 (28.1%) patients died and CT (vs MT) displayed similar adjusted mortality risk (27.7% vs 28.7%; aOR [95%CI]: 0.67 [0.34-1.33]) and LOS (19 [9, 37] and 20 [9, 42.5] days). CT (vs MT) was associated with greater odds of clinical response (aOR: 2.25 [95%CI:1.15-4.41]). Among survivors, similar rates of 90-day recurrent infection (50/154 (32.5%) were observed in CT vs 18/82 (22.0%) in MT group (p=0.09) and 5 (2.19%) patients had future infection with a caz-avi–resistant pathogen (3 in CT and 2 in MT group). Conclusion Compared to patients with CR-GNI treated with caz-avi alone, those who received CT including caz-avy had similar survival and LOS but higher clinical response. The role of CT in the era of novel antibiotics warrants additional study. Disclosures Helen W. Boucher, MD, American Society of Microbiology: Honoraria|Elsevier: Honoraria|Sanford Guide: Honoraria.

The paper discusses international jurisprudence in the regime of transboundary harm. Principles of good neighbourliness, due diligence and precaution are major guidelines forwarded by international jurisprudence dealing with trans-boundary problems. The paper examines the current status quo of customary and conventional international law that acts as a tool to combat trans-boundary harm. The paper ponders into the issues of territorial sovereignty, doctrine of necessity and conventional obligations to prevent transboundary harm making extensive use of the judicial and arbitral decisions to throw light on the existing regulations and obligation. The paper concludes that effects of customs, conventions, treaties and other international instruments have led to establishment of effective mechanism to determine the liability and the quantum of liability.