In the population evaluated, hypotension and trough concentrations were predictors of nephrotoxicity; elevated vancomycin trough concentration had the highest odds of association. These data reinforce the close therapeutic monitoring guidelines for vancomycin trough concentrations, especially when targeting troughs of 15-20 mg/L.

The Centers for Disease Control and Prevention has promoted the appropriate use of antibiotics since 1995 when it initiated the National Campaign for Appropriate Antibiotic Use in the Community. This study examined upper respiratory tract infections included in the campaign to determine the degree to which antibiotics were appropriately prescribed and subsequent admission rates in a veteran population. This study was a retrospective chart review conducted among outpatients with a diagnosis of a respiratory tract infection, including bronchitis, pharyngitis, sinusitis, or nonspecific upper respiratory tract infection, between January 2009 and December 2011. The study found that 595 (35.8%) patients were treated appropriately, and 1,067 (64.2%) patients received therapy considered inappropriate based on the Get Smart Campaign criteria. Overall the subsequent readmission rate was 1.5%. The majority (77.5%) of patients were prescribed an antibiotic. The most common antibiotics prescribed were azithromycin (39.0%), amoxicillin-clavulanate (13.2%), and moxifloxacin ( T he Centers for Disease Control and Prevention (CDC) haspromoted the appropriate use of antibiotics since 1995 when it initiated the National Campaign for Appropriate Antibiotic Use in the Community (1). In 2003, this program was renamed Get Smart: Know When Antibiotics Work in conjunction with the launch of a national media campaign. The purpose of this campaign was to curb the rise of antimicrobial resistance, which has been deemed a hazard to public health by groups such as the Institute of Medicine (1, 2). Antibiotic prescribing rates for upper respiratory infections (URIs) alarmingly account for three-quarters of all antibiotic prescriptions written by office-based prescribers (1). There are many different symptoms of respiratory illnesses that bring patients to seek medical attention in the outpatient setting. Cough, congestion, fever, chills, nasal discharge, and sputum production are common symptoms of URIs, most of which are self-limiting and viral in origin (3-6). As part of the Get Smart Campaign, the CDC provides diagnostic criteria and prescribing guidelines for URIs (1).This study examines URIs included in the CDC's Get Smart Campaign to determine the degree to which antibiotics were appropriately prescribed in an outpatient veteran population. It also aims to determine symptoms associated with inappropriate treatment and subsequent admission rates. Other published studies were limited by the use of quantities of antibiotics used but were unable to utilize patient specific data, such as diagnoses and patient visits (7). Bronchitis, pharyngitis, sinusitis, and nonspecific upper respiratory infections were included to determine appropriateness of treatment per the Get Smart Campaign recommendations (8-11). MATERIALS AND METHODSStudy design. This study was a retrospective chart review conducted among adult patients who had a diagnosis of a respiratory tract infection.Respiratory tract infections were identified by International Classification...

The pathogenic bacterium Staphylococcus aureus is the most common pathogen isolated in skin-and-soft-tissue infections (SSTIs) in the United States. Most S. aureus SSTIs are caused by the epidemic clone USA300 in the USA. These infections can be serious; in 2019, SSTIs with S. aureus were associated with an all-cause, age-standardized mortality rate of 0.5 globally. Clinical presentations of S. aureus SSTIs vary from superficial infections with local symptoms to monomicrobial necrotizing fasciitis, which can cause systemic manifestations and may lead to serious complications or death. In order to cause skin infections, S. aureus employs a host of virulence factors including cytolytic proteins, superantigenic factors, cell wall-anchored proteins, and molecules used for immune evasion. The immune response to S. aureus SSTIs involves initial responders such as keratinocytes and neutrophils, which are supported by dendritic cells and T-lymphocytes later during infection. Treatment for S. aureus SSTIs is usually oral therapy, with parenteral therapy reserved for severe presentations; it ranges from cephalosporins and penicillin agents such as oxacillin, which is generally used for methicillin-sensitive S. aureus (MSSA), to vancomycin for methicillin-resistant S. aureus (MRSA). Treatment challenges include adverse effects, risk for Clostridioides difficile infection, and potential for antibiotic resistance.

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