IDSA releases new treatment guidance for drug-resistant pathogensThe Infectious Diseases Society of America (IDSA) yesterday released new guidelines for the treatment of three common antibiotic-resistant pathogens.The goal of the guidelines, the first in a series of narrowly focused guidance documents that IDSA will be publishing on multiple platforms, are to assist clinicians in selecting antibiotic therapy for extended-spectrum beta-lactamase–producing Enterobacterales (ESBL-E), carbapenem-resistant Enterobacterales (CRE), and Pseudomonas aeruginosa with difficult-to-treat resistance (DTR-P aeruginosa). The three pathogens have been designated as serious or urgent threats by the Centers for Disease Control and Prevention, cause a wide variety of infections, and have limited treatment options.Created as an alternative to comprehensive clinical practice guidelines, which can take years to produce and publish, the guidance was developed by a panel of six infectious diseases specialists with expertise in antibiotic-resistant bacterial infections to address specific clinical questions about difficult-to-manage infections that are not covered by current guidelines, and is based on a review of the literature.”Clinicians rely on evidence-based guidelines from other clinicians who have considered the literature and available data,” panel co-chair Cornelius J. Clancy, MD, VA Pittsburgh Healthcare System’s chief of infectious diseases and an associate professor of medicine and director of the XDR Pathogen Lab at the University of Pittsburgh, said in an IDSA press release. “This guidance provides clinicians with real-word recommendations on how to deal with real-world problems.”The guidance will be updated as new data emerge, and future iterations will address other resistant pathogens.Sep 8 IDSA guidance Sep 8 IDSA press release Study: Discordant antibiotics fairly common for bloodstream infectionsA study led by researchers with the National Institutes of Health found that nearly one in five patients with bloodstream infections in US hospitals received discordant antibiotic therapy, which was associated with antibiotic-resistant pathogens and increased mortality. The results appeared yesterday in The Lancet Infectious Diseases.The retrospective cohort analysis of electronic health record (EHR) data from 131 US hospitals looked at all patients with suspected and subsequently confirmed bloodstream infections who were treated empirically with antibiotics from 2005 through 2014.The researchers defined empiric antibiotic therapy as discordant if the bloodstream isolate from a patient did not display in-vitro susceptibility to any systemic antibiotic administered in the day of blood culture sampling. Using the EHR data, they estimated the prevalence of discordant antibiotic therapy, identified predictors of receiving discordant therapy, and calculated the adjusted odds ratio for the relationship between discordant therapy and in-hospital mortality.Of the 21,608 patients who received empiric antibiotics on the first day of blood culture collection, 4,165 (19%) received discordant empiric antibiotic therapy based on retroactive assessment of final susceptibility results. Of those patients, 1,958 (49%) had antibiotic-resistant bloodstream isolates. Most patients who received discordant therapy had infections caused by resistant Enterobacterales or Staphylococcus aureus. Patients infected with antibiotic-resistant pathogens were nine times more likely to receive discordant empiric therapy than those with susceptible infections (adjusted odds ratio, 9.09; 95% confidence interval [CI], 7.68 to 10.76).Discordant empiric therapy was independently associated with a significantly increased risk of mortality (adjusted odds ratio, 1.46; 95% CI, 1.28 to 1.66), which was unaffected by the presence or absence of resistance, sepsis, or septic shock.The study also found that discordant empiric therapy was not significantly affected by hospital-level characteristics, a finding the authors say suggests that the problem is widespread, and that any efforts to optimize empiric prescribing would need to be implemented on a large scale.”Such optimisation is likely to improve survival in all bacteraemic patients,” they wrote. “Early identification of bloodstream pathogens, especially Enterobacterales and S aureus, and associated resistance profiles could improve outcomes in patients with bloodstream infections on a population level.”Sep 8 Lancet Infect Dis abstract
Hosei scored six touchdowns while surviving a late scare on its way to winning a fifth Koshien Bowl title overall and a place in the Rice Bowl national championship on Jan. 3. Maruta was named the Most Valuable Player of Sunday’s game between the collegiate champions in the Kanto and Kansai leagues. NISHINOMIYA, Hyogo Pref. – Hosei University held off a fourth-quarter Kwansei Gakuin University rally Sunday to win the Koshien Bowl national collegiate American football championship for the second straight year.Running back Yasuhiro Maruta had an 80-yard touchdown run just 26 seconds into the game and sprinted into the end zone again with a kickoff return 12 minutes later as Hosei raced to a 21-7 lead after the first quarter and held on for a 45-43 win at Koshien Stadium. IN FIVE EASY PIECES WITH TAKE 5 GET THE BEST OF THE JAPAN TIMES
Sanchez now has six goals in five appearances against the Tigers, whose fine early season form has deserted them, not helped by the club’s on-going take-over talks and continued uncertainty over the future of caretaker manager Mike Phelan, who is yet to accept an offer to take the role full-time.Arsenal’s problems from the penalty spot continued as Sanchez missed the second of the four they’ve been awarded this season after Hull defender Jake Livermore was ordered off shortly before half-time for handball.Theo Walcott’s deftly chipped finish 10 minutes into the second half as the forward sprinted onto a perfectly weighted backheel from Alex Iwobi ensured there was to be no stirring comeback from the hosts.To their credit, Hull made light of their numerical disadvantage and pulled a goal back when Robert Snodgrass converted a penalty after Arsenal goalkeeper Petr Cech had been penalised for bringing down Dieumerci Mbokani.Sanchez made sure of the points four minutes later, powering home his side’s third after Walcott took the Chile forward’s pass in his stride, only to see his shot blocked by Eldin Jakupovic, the rebound falling invitingly for Arsenal’s outstanding performer.Granit Xhaka, a second-half substitute, provided Wenger with a reminder of his talents with a stoppage-time fourth, the summer arrival form Borussia Monchengladbach finding the top corner in impressive style from 30 yards after accepting a pass from Mohamed Elneny.– Dominance –Arsenal’s Chilean striker Alexis Sanchez shoots and scores during the English Premier League football match between Hull City and Arsenal on September 17, 2016Arsenal should have had more than a 17th minute strike by Sanchez to show for their first-half dominance.Jakupovic managed only to apply a weak parry to a driven cross from Walcott into the path of Iwobi, whose shot from 12 yards found the net via a minimal though significant touch from Sanchez, who was lurking six yards out.Sanchez had already fired over from close range from Walcott’s inviting cut-back, and Jakupovic produced a stunning save low to his right to block Hector Bellerin’s powerfully struck shot, with Mesut Ozil blazing the rebound over.The fortunes of Jakupovic continued on an upward curve after Livermore’s straight red card for blocking a goal-bound Francis Coquelin shot five minutes before the break.With regular penalty-taker Santi Cazorla — who has scored his last seven form the spot — looking on, Sanchez saw his effort saved by Jakupovic low to his right.Hull, who became the first club since Aston Villa eight years ago to name an unchanged line-up in their first five Premier League games, rarely looked likely to end their 101-year wait for a home victory against the Londoners.They created only one moment of danger in the first-half, Snodgrass shooting tamely at the recalled Cech from 15 yards at the culmination of a neat four-man move.Walcott’s first goal since the opening weekend defeat by Liverpool ensured Sanchez wasn’t left to ponder on his penalty miss for too long.And although Abel Hernandez sent an acrobatic kick against the bar, Hull posed only a sporadic threat until the late penalty from Snodgrass as the visitors made it 26 consecutive games without defeat against newly promoted teams.0Shares0000(Visited 1 times, 1 visits today) 0Shares0000Alexis Sanchez scored twice as Arsenal thrashed Hull City 4-1.PHOTO/courtesyKINGSTON UPON HULL, United Kingdom, Sep 17 – Alexis Sanchez scored twice as Arsenal secured three consecutive Premier League wins for the first time in nine months with a 4-1 victory at Hull City on Saturday.Sanchez could even afford to miss a first-half penalty at the KCom Stadium — where Hull were reduced to 10 men — as the Gunners continued their recovery following a slow start to the season which saw them take only a point from their first two games.