From October 1993 to August 1994, broiler chickens in four grow-out houses, two previously used (houses 1 and 2) and two newly constructed (houses 3 and 4), were used in a study to determine the source, time of infection, and prevalence of Campylobacter spp. Cecal droppings and cecal samples were obtained from the broilers. Samples were also obtained from water, feed, litter, soil, fans, and workers' boots. Samples were obtained from domestic animals and wildlife species (rectal swabs), including insects, on or near the premises. Broilers in houses 2, 3, and 4 became infected in the second or third week and were fully colonized by day 42. Campylobacter appeared in house 1 during week 2 in a low percentage of the birds, disappearing by the fourth week. Isolates were also recovered from domestic pigs and water on this farm. In house 3, the organism was isolated from workers' boots and a wild bird prior to isolation from the broilers. Following isolation from cecal droppings, the organism was isolated from water, feed, litter, feathers, flies, cattle, feces, and wild animals. In house 2, Campylobacter was isolated from cattle feces and wild birds prior to week 5, when the broilers first became infected, and thereafter from water, feed, insect, and wildlife, and cecal droppings. It was subsequently isolated from workers' boots, cattle feces, feathers, insects, and other wildlife. All ceca taken from 20 birds each from houses 2 and 3 were positive at time of slaughter (day 49). All ceca from house 1 were negative. No ceca were collected from birds originating in house 4. No specific source could be identified from the samples obtained, although apparently the organism permeates the environment and several potential sources are discussed in this paper.

Controlled medications collected by take-back events and permanent drug donation boxes constituted a miniscule proportion of the numbers dispensed. Our findings suggest that organized drug disposal efforts may have a minimal impact on reducing the availability of unused controlled medications at a community level.

Due to the inconsistent correlation of vancomycin trough concentrations with 24-hour area under the curve (AUC) and a desire to reduce rates of vancomycin-associated acute kidney injury, an institutional guideline was implemented by the Antimicrobial Stewardship Team in September 2017 to monitor vancomycin using AUC. Three stages were utilized to organize the process: preparation, implementation, and evaluation. The preparation stage was used to present literature to key stakeholders, and pharmacy meetings focused on the development of a dosing and monitoring guideline. Along with institution-wide education, the implementation stage included information technology development and support. The evaluation stage was comprised of quality improvement and clinical research. Future plans include dissemination of the results and analyses. Numerous lessons were learned due to barriers experienced during the process, but the transition was successful.

To determine how parents dispose of unused prescription medications and correlates of disposal, we recruited 3,043 parents of adolescents to complete a survey. Multivariate and multinomial logistic regression was conducted to examine correlates of disposal of prescription medication. Only 17.8% of parents in a household prescribed a controlled medication in the past year disposed of unused medications. Of those, 36.7% used organized disposal (e.g., take-back event or drop box) and 63.3% disposed of medications at home. Organized disposal was associated with awareness of disposal opportunities. Increasing awareness of organized disposal opportunities is a promising mechanism to increase their use by parents. Keywords adolescent; children; parent; prescription drugNonmedical prescription drug use (NMPDU), use of a prescription drug not prescribed to you or for the feeling the drugs caused (Center for Behavioral Health Statistics and Quality, 2015), is the second most common illicit drug use behavior among adolescents in the United States following marijuana. The most recent National Survey on Drug Use and Health (NSDUH) found that 1.6% of adolescents ages 12 to 17 reported NMPDU in the past 30 days (Center for Behavioral Health Statistics and Quality, 2017), and 11% of twelfth graders have reported NMPDU in the past 12 months (Johnston et al., 2018). Adverse health consequences of NMPDU include substance use disorders, emergency department visits, and death (Center for Behavioral Health Statistics and Quality, 2015).Peak risk of NMPDU initiation is 16 years of age with more recent cohorts of adolescents reporting earlier initiation (Austic, McCabe, Stoddard, Ngo, & Boyd, 2015). Early initiation CONTACT Kathleen Egan ✉

Background: Evidence suggests the standard vancomycin trough goal of 15 to 20 mg/L for serious Staphylococcus aureus infections is associated with acute kidney injury, whereas appropriate monitoring of 24-hour area under the curve (AUC) may decrease nephrotoxicity. As a result, institutions have transitioned to AUC monitoring, the predictive pharmacokinetic/pharmacodynamic parameter of vancomycin to improve safety outcomes. However, this method may require increased pharmacist time and effort. Pharmacist perception of the practice change is largely unknown and warrants investigation. Methods: An electronic survey was disseminated via e-mail to pharmacists 5 months post-AUC implementation. Items of interest were focused on pharmacist perception, including quantity of patients monitored using AUC, justification of the practice change, differences in efficacy and safety, and changes in monitoring time requirements. Results: The pharmacist survey was distributed to 196 pharmacists and 84 responded (43% response rate). Eighty-one pharmacists had monitored patients using AUC methods. Sixty-nine percent of these respondents perceived the change to result in increased or slightly increased patient safety, 27% described no difference, and 4% stated safety was decreased or slightly decreased. Forty-two percent perceived the transition to result in increased or slightly increased efficacy, while 48% noted no difference and 10% responded that efficacy was decreased or slightly decreased. Pharmacists stated the creation of an institutional calculator decreased the time required to calculate AUC. Conclusion: After the change to AUC monitoring, pharmacists perceived improvements in safety outcomes while efficacy was at least similar if not increased.

This study examined risk factors of nonmedical prescription opioid use (NMPOU) among adolescents and how risk factors differ by gender. In the fall of 2017, adolescents attending 6 th through 12 th grades across 44 schools in 10 south central Kentucky counties were invited to participate in an anonymous, school-based survey. A total of 11,761 adolescents completed the survey. Logistic regression was conducted to examine the association between NMPOU and constructs of the Theory of Reasoned Action (i.e., attitudes and subjective norms), descriptive norms (i.e., peer use), and parental control of prescription medications in the home. There were 297 (2.7%) adolescents who reported NMPOU in the past 12 months. In the adjusted multivariate logistic regression model, for both males and females, adolescents who perceived that more of their peers engaged in NMPOU were significantly more likely to endorse NMPOU. Whereas, male and female adolescents who perceived their peers disapproved of use were significantly less likely to report NMPOU. Parent disapproval was significantly associated with decreased NMPOU for females only. Moderated regression analyses revealed that gender moderated the relationship between parental disapproval and NMPOU. We found that during adolescence, NMPOU is influenced by peer norms for both genders and parental norms for females. These results indicate that prevention efforts should focus on changing adolescents' peer and parental norms related to NMPOU.

Stenotrophomonas maltophilia is an increasingly prevalent cause of nosocomial infections. This report describes a 5-month-old male diagnosed with a S maltophilia ventriculoperitoneal shunt infection after a neurosurgical procedure. Intravenous trimethoprim/sulfamethoxazole and moxifloxacin successfully treated the patient. A literature review revealed a scarcity of similar reports, with none using moxifloxacin as an effective concomitant treatment with trimethoprim-sulfamethoxazole.

Aims:The purpose of this study was to compare the effect of hop extracts with diverse βacid concentrations on Streptococcus mutans biofilm formation. Methods and Results:Ten different hop extracts, with αacid concentrations similar to those found in commercial beer products and βacid concentrations ranging from 2.6 to 8.1%, were added to distilled water to make standardized concentrations.S. mutans isolates were treated with hop extract dilutions varying from 1:2 to 1:256.The minimum inhibitory, minimum bactericidal and minimum biofilm inhibitory concentrations were determined and the optical density was evaluated. Live/dead staining confirmed the bactericidal effects. Biofilm formation of several strains of S. mutans was significantly inhibited by hop extract dilutions of 1:2, 1:4, 1:8, 1:16 and 1:32. Strong negative correlations were observed between αand βacid concentrations of the hop extracts and S. mutans total growth and biofilm formation. Conclusions:The use of hop extracts prepared similarly to commercial beer decreased S. mutans biofilm formation. Significance and Impact of the Study:The inclusion of hops in the commercial beer products may provide beneficial health effects. Further studies are warranted to determine an effect in vivo on the development of dental caries.