The effect of carbapenem-resistant versus carbapenem-susceptible infections on patient outcomes at an academic medical center.

Objective: We sought to compare patient outcomes between carbapenem-resistant (CRE) and carbapenem-susceptible (CSE) infections at our academic medical center.

Design: We conducted a retrospective cohort study of adult patients with a positive culture of E. coli, E.

Comparing the activity of broad-spectrum beta-lactams in combination with aminoglycosides against VIM-producing .

Metallo-beta-lactamase (MBL)-producing carbapenem-resistant (CRE) infections continue to pose a serious threat to healthcare. Due to their unique active site, MBLs evade the activity of many novel beta-lactam/beta-lactamase inhibitor combinations, which have been specifically targeted toward those carbapenemases with serine active sites. Furthermore, resistance to most, if not all, other clinically relevant antimicrobial classes leaves few reliable therapeutic options.

Changing times: The impact of gram-negative breakpoint changes over the previous decade.

We assessed breakpoint changes of 13,101 Enterobacterales and isolates from the past decade. All β-lactams and fluoroquinolones demonstrated decreased susceptibilities following breakpoint changes. experienced the largest average decrease in susceptibility amongst the Enterobacterales at 5.

Time Above All Else: Pharmacodynamic Analysis of β-Lactams in Critically Ill Patients.

β-Lactams are the most commonly used antibiotics in intensive care units (ICUs). As critically ill patients often experience pharmacokinetic aberrations, and rates of antimicrobial resistance vary between hospital settings, reliance on tertiary sources or package labeling to guide empiric dosing often results in suboptimal β-lactam exposure. The primary objective was to identify β-lactam regimens capable of achieving ≥90% cumulative fraction of response (CFR) against 7 Gram-negative pathogens within 4 ICUs at our institution.

In vitro activity of eravacycline compared with tigecycline against carbapenem-resistant Enterobacteriaceae.

Eravacycline has been shown to have broad-spectrum activity against Gram-negative bacteria, including carbapenem-resistant Enterobacteriaceae (CRE). We compared the activity of eravacycline with that of tigecycline in CRE isolates cultured from patients at an academic medical centre. Eravacycline was more potent than tigecycline [mean minimum inhibitory concentration (MIC) ratio = 0.

Plazomicin: a new aminoglycoside in the fight against antimicrobial resistance.

Objective: To review the mechanism of action, mechanisms of resistance, activity, pharmacokinetics, pharmacodynamics, and clinical data for a novel aminoglycoside.

Data Sources: A PubMed search was performed from January 2006 to August 2019 using the following search terms: plazomicin and ACHN-490. Another search was conducted on clinicaltrials.

In vitro activity of plazomicin compared to other clinically relevant aminoglycosides in carbapenem-resistant Enterobacteriaceae.

We evaluated the in vitro activity of plazomicin against other aminoglycosides in 122 clinical carbapenem-resistant Enterobacteriaceae isolates using several clinical susceptibility breakpoints. Plazomicin had excellent in vitro activity with 98% overall susceptibility. Amikacin was the next most active with 86% overall susceptibility.

Killing activity of meropenem in combination with amikacin against VIM- or KPC-producing Enterobacteriaceae that are susceptible, intermediate, or resistant to amikacin.

Amikacin is administered with a carbapenem to treat serious infections caused by carbapenem-resistant Enterobacteriaceae (CRE). The varying degrees of activity of the individual agents correspond to differences in activity of the 2 in combination. Amikacin and meropenem are not bactericidal against amikacin-resistant CRE.

Staggering the administration of polymyxin B and meropenem in time-kill against carbapenem-resistant Enterobacteriaceae exhibiting a wide range of meropenem MICs.

Little is known regarding the appropriate timing and sequencing of a carbapenem and polymyxin in combination against carbapenem-resistant Enterobacteriaceae. Meropenem and polymyxin B were administered simultaneously or 1 agent 2 h prior to the other, in vitro. The carbapenem should be administered prior to the polymyxin when used in combination.

Compound-Specific Isotope Analyses to Assess TCE Biodegradation in a Fractured Dolomitic Aquifer.

The potential for trichloroethene (TCE) biodegradation in a fractured dolomite aquifer at a former chemical disposal site in Smithville, Ontario, Canada, is assessed using chemical analysis and TCE and cis-DCE compound-specific isotope analysis of carbon and chlorine collected over a 16-month period. Groundwater redox conditions change from suboxic to much more reducing environments within and around the plume, indicating that oxidation of organic contaminants and degradation products is occurring at the study site. TCE and cis-DCE were observed in 13 of 14 wells sampled.

Initial experience using an endoscopic simulator to train surgical residents in flexible endoscopy in a community medical center residency program.

Introduction: The importance of training surgical residents in GI endoscopy has been recognized for years. Despite advice from SAGES and the RRC, few programs have managed to incorporate effective flexible endoscopy training into their curriculum, making it difficult for their graduates to be credentialed in GI endoscopy. Prior to October 2001, our residents obtained their entire clinical experience in the endoscopy unit with staff surgical endoscopists.