Acinetobacter spp. and Pseudomonas aeruginosa are common pathogens of ventilator-associated pneumonia (VAP). The presentation and outcome of VAP due to Acinetobacter spp. and P. aeruginosa susceptible to carbapenems (Carb-S; imipenem and/or meropenem) and to colistin only (Col-S) were compared in the present retrospective study in three intensive care units.A total of 61 episodes of VAP caused by Acinetobacter spp. or P. aeruginosa were studied, of which 30 isolates were Carb-S and 31 were Col-S.Demographics, worsening of renal function and mortality were not different. The univariate analysis showed that a later onset and a previous episode of VAP, prior antimicrobial therapy for .10 days and previous therapy with carbapenems during the present admission were more frequent in patients with Col-S strains. On multivariate analysis, prior antimicrobial therapy for .10 days and a previous episode of VAP remained significantly associated with Col-S VAP. Approximately 41% of the infections caused by Col-S isolates, but none of those due to Carb-S isolates, had received prior carbapenem therapy.Colistin-susceptible ventilator-associated pneumonia episodes can be effectively treated using colistin without significant renal dysfunction. This susceptibility pattern could be suspected in patients with a previous ventilator-associated pneumonia episode or prior antibiotic therapy for .10 days preceding the present ventilator-associated pneumonia episode.

Background People experiencing homelessness are at increased risk of COVID-19, but little is known about specific risk factors for infection within homeless shelters. Methods We performed widespread SARS-CoV-2 PCR testing and collected risk factor information at all homeless shelters in Chicago with at least one reported case of COVID-19 (n=21). Multivariable, mixed-effects log-binomial models were built to estimate adjusted prevalence ratios (aPRs) for SARS-CoV-2 infection for both individual and facility-level risk factors. Results During March 1 to May 1, 2020, 1717 shelter residents and staff were tested for SARS-CoV-2; 472 (27%) persons tested positive. Prevalence of infection was higher for residents (431/1435, 30%) than for staff (41/282, 15%) (prevalence ratio [PR] =2.52, 95% CI 1.78–3.58). The majority of residents with SARS-CoV-2 infection (293/406 with available information about symptoms, 72%) reported no symptoms at the time of specimen collection or within the following two weeks.Among residents, sharing a room with a large number of people was associated with increased likelihood of infection (aPR for sharing with >20 people compared to single rooms = 1.76, 95% CI 1.11–2.80), and current smoking was associated with reduced likelihood of infection (aPR=0.71, 95% CI 0.60–0.85). At the facility-level, a higher proportion of residents leaving and returning each day was associated with increased prevalence (aPR=1.08, 95% CI 1.01–1.16), while an increase in the number of private bathrooms was associated with reduced prevalence (aPR for one additional private bathroom per 100 people = 0.92, 95% CI 0.87–0.98). Conclusions We identified a high prevalence of SARS-CoV-2 infections in homeless shelters. Reducing the number of residents sharing dormitories might reduce the likelihood of SARS-CoV-2 infection. When community transmission is high, limiting movement of persons experiencing homelessness into and out of shelters might also be beneficial.

Acute hepatitis is an uncommon sequela of herbal supplement use. Regardless, considering the hepatotoxic effects of natural supplements is important, especially in patients taking other medications or substances. We herein describe a case of acute steatohepatitis in a patient who chronically consumed high doses of ashwagandha and other herbal supplements in the context of alcohol use and a multi-medication regimen.

Background The popularity of short-term global health experiences amongst US medical students has been increasing. However, it remains a challenge for medical schools to comprehensively prepare students to work in an international environment and to contribute in ethically responsible and meaningful ways. Students of the Global Medicine program (GMED) of the UIC College of Medicine Center for Global Health set out to develop a pre-and-post travel curriculum that addresses some of these challenges. Methods The students surveyed the literature and published global health curricula and identified aspects of pre-and-post travel training that were found to be under-addressed in the. They then developed a curriculum in conjunction with GMED faculty that incorporated these identified aspects of pre-and-post travel training. Results Five aspects of pre-and-post travel training were identified as being both under-addressed in the literature and in student’s personal experiences while traveling. These domains include: (1) examining power relations associated with neo-colonization between and within countries; (2) training for bi-directional learning; (3) examining motivations and goals for participating in global health; (4) addressing personal resiliency and psychosocial wellbeing related to students’ travel, and; (5) reflecting on the challenging aspects of the fieldwork experience. Conclusions The student-driven curriculum is being integrated into the GMED program through structured didactic sessions, one-on-one mentor meetings and small group discussions. Once students have traveled, an evaluation of the curriculum will be conducted together with the foreign partners they visited.