Pseudomonas aeruginosa bloodstream infection is a serious infection with significant patient mortality and health-care costs. Nevertheless, the relationship between initial appropriate antimicrobial treatment and clinical outcomes is not well established. This study was a retrospective cohort analysis employing automated patient medical records and the pharmacy database at Barnes-Jewish Hospital. Three hundred five patients with P. aeruginosa bloodstream infection were identified over a 6-year period (January 1997 through Bacterial bloodstream infections are serious infections associated with significant mortality and health-care costs (36). In many hospitals, Pseudomonas aeruginosa has become the most common gram-negative bacterial species associated with serious hospital-acquired infections, particularly within intensive care units (24,29,33). The hospital mortality associated with P. aeruginosa bloodstream infections is reported to be greater than 20% in most series and is highest among patients receiving inappropriate initial antimicrobial treatment (4,6,25,32,37). Unfortunately, prior studies of P. aeruginosa bloodstream infection varied in how they defined appropriate antimicrobial therapy and did not specifically examine the influence of administering combination antimicrobial agents as a determinant of appropriate treatment. Additionally, two recent meta-analyses recommend the use of monotherapy with a beta-lactam antibiotic for the empirical treatment of neutropenic fever and severe sepsis, infections where P. aeruginosa is often an important pathogen (26,27).Due to the clinical importance of bloodstream infections due to P. aeruginosa, we performed a retrospective cohort analysis with two main goals. First, we wanted to determine whether the administration of appropriate initial antimicrobial treatment was associated with better clinical outcomes for P. aeruginosa bloodstream infections. Our second goal was to examine the relationship between the empirical administration of combination gram-negative antimicrobial therapy and appropriate treatment for P. aeruginosa bloodstream infections. MATERIALS AND METHODSStudy location and patients. This study was conducted at a university-affiliated, urban teaching hospital, Barnes-Jewish Hospital (1,200 beds). During a 6-year period (January 1997 to December 2002), all hospitalized patients with a positive blood culture for P. aeruginosa were eligible for this investigation. This study was approved by the Washington University School of Medicine Human Studies Committee.Study design and data collection. A retrospective cohort study design was employed with the main outcome measure being hospital mortality. We also assessed secondary outcomes, including the administration of appropriate initial antimicrobial treatment, length of hospitalization, and the occurrence of persistent bacteremia due to P. aeruginosa.For all study patients the following characteristics were recorded by one of the investigators (S. T. Micek, A. E. Lloyd, or R. M. Reichley): age, gender, rac...

The purpose of this report was to evaluate concordance with the most recent guidelines for the treatment of uncomplicated UTI based on antibiotic selection, dosage, frequency, and duration. A historical review of patients' medical records at a university-based internal medicine clinic was conducted. When aggregated across antibiotic type, frequency, and duration, overall concordance was 33.96 %. Prescribing concordance for uncomplicated UTI in the local region is suboptimal.

The helminths are multicellular organisms that are among the most common causes of infections worldwide. The highest prevalence of these occurs in warm, developing areas where poverty, climate, and environmental factors contribute to an abundance of vectors and increased exposure. Intestinal worms that infest humans include nematodes (pinworm, whipworm, hookworm), trematodes (flukes), and cestodes (tapeworm). Determining treatment can be challenging due to variability in preferred drug of choice and dose for specific worm infestations, as well as formulation and acquisition concerns. Mebendazole, once a mainstay in the treatment of helminth infections, has been discontinued in the United States without explanation by the sole manufacturer of the product. 1 The remaining treatment options include albendazole, ivermectin, nitazoxanide, praziquantel, and pyrantel pamoate (Table 1). These less commonly used agents may be unfamiliar to providers treating patients with helminth infestations, and consideration should be given to consultation with an infectious diseases expert when treating less common helminths. This review article discusses common human intestinal helminthic infections, treatment options, and pharmacological considerations with a focus on treating these infections in the United States.

National prescribing trends suggest partial implementation of AHA guidelines for NSAID prescribing in CVD from 2005 to 2010.