Non-health care-seeking male United States Army recruits were tested for Chlamydia trachomatis ( ) and Neisseria gonorrhoeae ( ), using a urine ligase chain reaction n p 2245 n p 884 test to determine prevalence and potential risk factors for infection. The prevalence of chlamydial infection was 5.3%. Black race, a new sex partner, a history of trichomonas, and the presence of symptoms were associated with chlamydial infection. The prevalence of N. gonorrhoeae infection was 0.6%. Only a reported history of or positive test for C. trachomatis was associated with gonorrheal infection. Of those testing positive for chlamydia, 14% reported symptoms versus 40% of those with gonorrhea. Younger age was not a predictor of either infection, as has been shown for women. A substantial number of male army recruits are infected with C. trachomatis, but few are infected with N. gonorrhoeae. Screening on the basis of symptoms alone would miss the majority of both infections.Chlamydia trachomatis and Neisseria gonorrhoeae are among the most commonly reported diseases in the United States [1]. Up to 80% of women with chlamydial infections and 40%-50% of women with gonorrheal infections of the cervix are asymptomatic [2]. The proportion of men with asymptomatic urogenital infections is less well defined, although several studies suggest it is high [2,3]. Asymptomatic persons are less likely to seek medical care, are potentially at increased risk for developing complications, and may represent a large reservoir of infection for continued transmission.With the development of urine-based screening, using highly The study protocol was approved by the Johns Hopkins University Joint Committee for Clinical Investigation and by the institutional review board for Fort Jackson, South Carolina, at Eisenhower Army Medical Center, Fort Gordon, Georgia. Informed consent was obtained from all study participants, and the human experimentation guidelines of the authors' institutions were followed in the conduct of this clinical research. sensitive and specific amplified nucleic acid assays, it has become relatively easy to screen large numbers of women and men in nonclinic settings [4,5]. The sensitivity (88%-98%), specificity (99%-100%), and positive predictive value (98%) of these assays are excellent for both genital and urine specimens in both symptomatic and asymptomatic persons [6][7][8][9].We conducted a prevalence survey and risk factor analysis for C. trachomatis and N. gonorrhoeae infections among young men beginning US Army basic training. We sought to determine the extent of infection among these mostly asymptomatic non-health care-seeking men from throughout the US and to assess risk factors associated with infection that might be useful in developing effective chlamydia and gonorrhea control programs.

Over the last 20 years, the frequency of life-threatening, invasive fungal infections has risen dramatically, corresponding to an increase in the number of immunocompromised patients. Thus, the development of newer, better tolerated, more effective antifungal drugs has become critically important. Voriconazole was the first second-generation triazole to be approved by the US FDA and the EMEA, both in 2002. Voriconazole is currently approved for the treatment of invasive aspergillosis, candidemia, candidal esophagitis and disseminated candidiasis in adults, and serious fungal infections due to Scedosporium apiospermum and Fusarium species. In addition to providing an alternative treatment option for Candida infections and many emerging and refractory invasive fungal infections, voriconazole is currently the treatment of choice for invasive aspergillosis. Voriconazole has excellent in vitro activity against a wide spectrum of yeasts and molds, with only a few notable exceptions. Although it has the potential for some unique and interesting side effects, as well as important drug-drug interactions, the use of therapeutic drug monitoring can be used to optimize its efficacy and safety.

Clostridium difficile was first reported as a cause of antibiotic-associated colitis in 1978. In more recent years we have witnessed disturbing trends associated with C. difficile infection (CDI). CDI has become more common, affecting populations previously considered at low risk, more severe with an associated increase in mortality, and more difficult to treat with some patients experiencing multiple relapses and a reduced responsiveness to previously effective antibiotics. These trends have been coincident with the emergence of a new hypervirulent strain responsible for several outbreaks in the last decade. Fortunately, we have also seen promising developments, particularly with regard to testing and treatment. This review discusses recent changes in the epidemiology of CDI and recent developments in the testing, treatment and prevention of CDI.

Objective: To determine whether cascade reporting is associated with a change in meropenem and fluoroquinolone consumption. Design: A quasi-experimental study was conducted using an interrupted time series to compare antimicrobial consumption before and after the implementation of cascade reporting. Setting: A 399-bed, tertiary-care, Veterans’ Affairs medical center. Participants: Antimicrobial consumption data across 8 inpatient units were extracted from the Center for Disease Control and Prevention (CDC) National Health Safety Network (NHSN) antimicrobial use (AU) module from April 2017 through March 2019, reported as antimicrobial days of therapy (DOT) per 1,000 days present (DP). Intervention: Cascade reporting is a strategy of reporting antimicrobial susceptibility test results in which secondary agents are only reported if an organism is resistant to primary, narrow-spectrum agents. A multidisciplinary team developed cascade reporting algorithms for gram-negative bacteria based on local antibiogram and infectious diseases practice guidelines, aimed at restricting the use of fluoroquinolones and carbapenems. The algorithms were implemented in March 2018. Results: Following the implementation of cascade reporting, mean monthly meropenem (P =.005) and piperacillin/tazobactam (P = .002) consumption decreased and cefepime consumption increased (P < .001). Ciprofloxacin consumption decreased by 2.16 DOT per 1,000 DP per month (SE, 0.25; P < .001). Clostridioides difficile rates did not significantly change. Conclusion: Ciprofloxacin consumption significantly decreased after the implementation of cascade reporting. Mean meropenem consumption decreased after cascade reporting was implemented, but we observed no significant change in the slope of consumption. cascade reporting may be a useful strategy to optimize antimicrobial prescribing.