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The objective of this study was to determine antibiotic appropriateness based on Loeb minimum criteria (LMC) in patients with and without altered mental status (AMS).
Retrospective, quasi-experimental study assessing pooled data from 3 periods pertaining to the implementation of a UTI management guideline.
Academic medical center in Lexington, Kentucky.
Adult patients aged ≥18 years with a collected urinalysis receiving antimicrobial therapy for a UTI indication.
Appropriateness of UTI management was assessed in patients prior to an institutional UTI guideline, after guideline introduction and education, and after implementation of a prospective audit-and-feedback stewardship intervention from September to November 2017–2019. Patient data were pooled and compared between patients noted to have AMS versus those with classic UTI symptoms. Loeb minimum criteria were used to determine whether UTI diagnosis and treatment was warranted.
In total, 600 patients were included in the study. AMS was one of the most common indications for testing across the 3 periods (19%–30.5%). Among those with AMS, 25 patients (16.7%) met LMC, significantly less than the 151 points (33.6%) without AMS (P < .001).
Patients with AMS are prescribed antibiotic therapy without symptoms indicative of UTI at a higher rate than those without AMS, according to LMC. Further antimicrobial stewardship efforts should focus on prescriber education and development of clearly defined criteria for patients with and without AMS.
We assessed breakpoint changes of 13,101 Enterobacterales and Pseudomonas aeruginosa isolates from the past decade. All β-lactams and fluoroquinolones demonstrated decreased susceptibilities following breakpoint changes. Enterobacter cloacae experienced the largest average decrease in susceptibility amongst the Enterobacterales at 5.3% and P. aeruginosa experienced an average decrease in susceptibility of 9.3%.
A total of 69 species of lichens have been collected from various locations around New Zealand. Screening of extracts of these species for antimicrobial, antiviral and cytotoxic activity showed a high proportion with biological activity. Active extracts were generally from species known to contain phenolic compounds. Bioactivity-directed isolation work on Cladia retipora, Pseudocyphellaria glabra and P. homoeophylla led to the identification of usnic acid as the main antimicrobial, cytotoxic and antiviral component in these three species.
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