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Background Antibiotic exposure is a primary predictor of subsequent antibiotic resistance; however, development of cross-resistance between antibiotic classes is also observed. The impact of changing to a different antibiotic from that of previous exposure is not established. Methods This was a retrospective, single-center cohort study of hospitalized adult patients previously exposed to an anti-pseudomonal beta-lactam (APBL) for at least 48 hours in the 90 days prior to the index infection with a gram-negative bloodstream or respiratory infection. Susceptibility rates to empiric therapy were compared between patients receiving the same (repeat group) versus a different antibiotic from prior exposure (change group). Results A total of 197 patients were included (N = 94 [repeat group] and N = 103 [change group]). Pathogen susceptibility to empiric therapy was higher in the repeat group compared to the change group (76.6% vs 60.2%; P = 0.014). After multivariable logistic regression, repeat APBL was associated with an increased likelihood of pathogen susceptibility (adjusted OR = 2.513; P = 0.012). In contrast, there was no difference in susceptibility rates between the repeat group and the subgroup of change patients that received an empiric APBL (76.6% vs 78.5%; P = 0.900). Longer APBL exposure duration (P = 0.012) and chronic kidney disease (P = 0.002) were associated with higher non-susceptibility to the exposure APBL. In-hospital mortality was not significantly different between the repeat and change groups (18.1% vs 23.3%; P = 0.368). Conclusions The common practice of changing to a different APBL from that of recent exposure may not be warranted.

Corruption has been a serious problem since the days of our ancestors until now. Whatever means have been used to prevent this from happening again. But unfortunately the deterrent effect that is felt does not really make the perpetrator repent. Once the perpetrator commits an act of corruption, then once he feels the punishment. Then he does it again or even new seeds of corruption perpetrators emerge. Recently the RKUHP being drafted by the DPR has drawn a lot of criticism. How could I not, instead of creating fear and a deterrent effect, this RKUHP actually eases the punishment for corruptors. The RKUHP, which is considered to be inconsistent with the existing laws, has caused confusion among law enforcers. Weakening the side of punishments suchas fines and prison terms for corruptors will lead to more rampant corruption cases. The purpose of writing this article is to analyze what kind of punishment we have applied and assess whether the punishment is appropriate to be applied or there are still many shortcomings. Then in compiling this article the writing method used is descriptive qualitative with the data source used by the author, namely the research library, which is data obtained from existing literature from books, journals, the internet and other references that are in accordance with the research problem. Eradicating corruption from above through the KPK without any reinforcement by including provisions from the United Nation Convention Against Corruption (UNCAC), such as an eagle preying on rats in a bottle of bars. Because so far, the Corruption Act has not met all the standards of the UNCAC.