No abstract

Identification of extended-spectrum b-lactamase (ESBL)-producing organisms in clinical specimens was initiated recently by microbiology laboratories. We sought to determine if this practice influences patient management. Retrospective review identified 35 patients with infections caused by ESBL-producing Escherichia coli or Klebsiella species. After receipt of the ESBL report, antimicrobial therapy was changed in 33 patients (94%), and 23 (66%) were placed in isolation. Identification of ESBL producers by the clinical laboratory influenced antimicrobial therapy and infection control practices. (Infect Dis Clin Pract 2006;14:81-83)

Urban environments are undergoing rapid change as a result of a variety of environmental stresses. Rapidly growing population density, aging water treatment and distribution facilities, and toxic chemicals in urban runoff will combine to increase the stresses on existing water supplies. In the future, we can expect waterborne pathogens such as Giardia, Legionella, and Cryptosporidium to be joined by hybrids of themselves and by as‐yet‐unidentified bacteria and viruses. Retraining utility personnel will be imperative as we incorporate new technologies to ensure water quality. The pressure on water suppliers to protect public health requires new forms of interagency cooperation. Water departments and public health departments must engage in collaborative planning efforts.