On October 2, 2020, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). During the course of the coronavirus disease 2019 (COVID-19) pandemic, reports of a new multisystem inflammatory syndrome in children (MIS-C) have been increasing in Europe and the United States (1-3). Clinical features in children have varied but predominantly include shock, cardiac dysfunction, abdominal pain, and elevated inflammatory markers, including C-reactive protein (CRP), ferritin, D-dimer, and interleukin-6 (1). Since June 2020, several case reports have described a similar syndrome in adults; this review describes in detail nine patients reported to CDC, seven from published case reports, and summarizes the findings in 11 patients described in three case series in peer-reviewed journals (4-6). These 27 patients had cardiovascular, gastrointestinal, dermatologic, and neurologic symptoms without severe respiratory illness and concurrently received positive test results for SARS-CoV-2, the virus that causes COVID-19, by polymerase chain reaction (PCR) or antibody assays indicating recent infection. Reports of these patients highlight the recognition of an illness referred to here as multisystem inflammatory syndrome in adults (MIS-A), the heterogeneity of clinical signs and symptoms, and the role for antibody testing in identifying similar cases among adults. Clinicians and health departments should consider MIS-A in adults with compatible signs and symptoms. These patients might not have positive SARS-CoV-2 PCR or antigen test results, and antibody testing might be needed to confirm previous SARS-CoV-2 infection. Because of the temporal association between MIS-A and SARS-CoV-2 infections interventions that prevent COVID-19 might prevent MIS-A. Further research is needed to understand the pathogenesis and long-term effects of this newly described condition. Potential MIS-A patients were identified from several sources: reports from clinicians and health departments, published case reports, and published case series. Clinicians and health departments in the United States voluntarily reported adult patients with suspected MIS-A to CDC using the case report form* developed for MIS-C after a Health Advisory was published on May 14, 2020, calling for reporting of MIS-C

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There is significant variation in the use of polymyxin B (PMB), and optimal dosing has not been defined. The purpose of this retrospective study was to evaluate the relationship between PMB dose and clinical outcomes. We included patients with bloodstream infections (BSIs) due to carbapenem-resistant Gram-negative rods who received >48 h of intravenous PMB. The objective was to evaluate the association between PMB dose and 30-day mortality, clinical cure at day 7, and development of acute kidney injury (AKI). A total of 151 BSIs were included. The overall 30-day mortality was 37.8% (54 of 151), and the median PMB dosage was 1.3 mg/kg (of total body weight)/day. Receipt of PMB dosages of <1.3 mg/kg/day was significantly associated with 30-day mortality (46.5% versus 26.3%; P ‫؍‬ 0.02), and this association persisted in multivariable analysis (odds ratio [OR] ‫؍‬ 1.58; 95% confidence interval [CI] ‫؍‬ 1.05 to 1.81; P ‫؍‬ 0.04). Eighty-two percent of patients who received PMB dosages of <1.3 mg/kg/day had baseline renal impairment. Clinical cure at day 7 was not significantly different between dosing groups. AKI was more common in patients receiving PMB dosages of >250 mg/day (66.7% versus 32.0%; P ‫؍‬ 0.03), and this association persisted in multivariable analysis (OR ‫؍‬ 4.32; 95% CI ‫؍‬ 1.15 to 16.25; P ‫؍‬ 0.03). PMB dosages of <1.3 mg/kg/day were administered primarily to patients with renal impairment, and this dosing was independently associated with 30-day mortality. However, dosages of >250 mg/day were independently associated with AKI. These data support the use of PMB without dose reduction in the setting of renal impairment. O ver the last decade, carbapenem-resistant Gram-negative rods (CRGNRs) have emerged as important health care-associated pathogens that are associated with significant morbidity and mortality (1, 2). Due to broad antimicrobial resistance among CRGNRs, clinicians have been increasingly forced to rely upon polymyxins for the treatment of infections caused by these organisms (3-5). The polymyxins, colistin and polymyxin B, came into use in the 1960s, but due to high rates of nephrotoxicity and neurotoxicity, they were replaced with less toxic alternatives (6, 7). Unfortunately due to the early development of polymyxins and a subsequent lack of use in a clinical setting, there is a paucity of information describing optimal dosing (6).Several recent studies have provided a better description of polymyxin B pharmacokinetics (PK) and pharmacodynamics (PD). As with colistin, the bactericidal activity of polymyxin B is concentration dependent and appears to be best correlated with the area under the concentration-time curve over 24 h in steady state divided by the MIC (AUC/MIC) (8). However, unlike with colistin, polymyxin B elimination is minimally affected by creatinine clearance, and dose reduction in the setting of renal impairment may result in subtherapeutic serum drug concentrations and decreased efficacy (9-11). In clinical practice, polymyxin B doses have traditionally been reduced ...