Inhaled antibiotics for hospital- acquired and ventilator- associated pneumonia

To the Editor—We would like to comment on the hospital-acquired (HAP) and ventilator-associated pneumonia (VAP) guidelines recently published in Clinical Infectious Diseases [1]. These guidelines recommend inhaled antibiotics for patients with VAP due to gram-negative bacilli susceptible only to aminoglycosides or polymyxins and for patients not responding to intravenous (IV) antibiotics. It also suggests adjunctive inhaled colistin for HAP or VAP due to Acinetobacter strains susceptible only to polymyxins. Several important considerations related to inhaled antibiotics were not addressed

Preventable patient harm: A multidisciplinary, bundled approach to reducing clostridium difficile infections while using a glutamate dehydrogenase/toxin immunochromatographic assay/nucleic acid amplification test diagnostic algorithm

Health care facility-onset Clostridium difficile infections (HO-CDI) are an important national problem, causing increased morbidity and mortality. HO-CDI is an important metric for the Center for Medicare and Medicaid Service’s (CMS) performance measures. Hospitals that fall into the worst-performing quartile in preventing hospital-acquired infections, including HO-CDI, may lose millions of dollars in reimbursement. Under pressure to reduce CDI and without a clear optimal method for C. difficile detection, health care facilities are questioning how best to use highly sensitive nucleic acid amplification tests (NAATs) to aid in the diagnosis of CDI. Our institution has used a two-step glutamate dehydrogenase (GDH)/toxin immunochromatographic assay/NAAT algorithm since 2009. In 2016, our institution set an organizational goal to reduce our CDI rates by 10% by July 2017. We achieved a statistically significant reduction of 42.7% in our HO-CDI rate by forming a multidisciplinary group to implement and monitor eight key categories of infection prevention interventions over a period of 13 months. Notably, we achieved this reduction without modifying our laboratory algorithm. Significant reductions in CDI rates can be achieved without altering sensitive laboratory testing methods

Vestibular aqueduct measurements in the 45° oblique (pöschl) plane

10.3174/ajnr.A4735American Journal of Neuroradiology3771331-133