Intravenous colistin is used to treat resistant Gram-negative infections and is associated with nephrotoxicity. In overweight and obese adults, a paucity of data exists regarding the incidence and predictors of such toxicity. A retrospective nested case-control study was performed over 35 months for patients receiving intravenous colistin for >72 h with a body mass index (BMI) of >25 kg/m 2 . The objective was to investigate the incidence and predictors of nephrotoxicity. Severity of acute kidney injury was defined by RIFLE (risk, injury, failure, loss, and end-stage kidney disease) criteria. Dosing and mortality were secondarily investigated. Forty-two patients met the inclusion criteria, and 20 (48%) developed nephrotoxicity. Patients with toxicity were in the risk (15%), injury (5%), and failure (80%) categories based on RIFLE criteria. A logistic regression model identified four predictors of colistin-associated nephrotoxicity: a BMI of >31. . Among all of the patients, dosing based on the actual body weight and excessive dosing due to the use of the actual body weight were frequent at 64% and 92%, respectively. The 30-day all-cause in-hospital mortality rate was 40% in the toxicity group and 14% in the nontoxicity group (P ‫؍‬ 0.14). Patients receiving intravenous colistin should be monitored for nephrotoxicity, especially when the BMI exceeds 31.5 kg/m 2 . Prospective, randomized, controlled trials are warranted to further examine nephrotoxicity incidence and predictors and appropriate dosing strategies in this population. Intravenous colistimethate sodium (CMS, colistin) is a polymyxin-type antimicrobial currently used to treat multidrug-resistant (MDR) Gram-negative infections caused by bacteria such as Acinetobacter baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae (19). Although it was first used in the 1950s, CMS fell into disuse primarily due to significant associated nephrotoxicity (NTX), with incidence reports now ranging from 0% to 53.5% (8). Its unique history has been described in multiple reviews (8,18,21,24), and there is a notable lack of definitive recommendations regarding the most efficacious and least toxic way to administer CMS, including in overweight and obese patients (for whom the ideal body weight [IBW] is recommended by the package insert [13,28]). As the obesity epidemic continues within the United States, at a rate of Ͼ33% among adults (10), the questions of what the risk factors for NTX are and how clinicians should administer CMS to these patients remain critical.Limited data are available regarding NTX in overweight or obese patients receiving intravenous CMS. Following a thorough review of the literature, the only previously published evaluation of more than one overweight or obese individual receiving intravenous CMS included 10 obese patients (defined as those with an actual body weight [ABW] that is Ͼ140% of the IBW) (4). This analysis found that excessive CMS dosing was frequent and that use of the ABW to calculate doses was associated with a higher rate of N...

We surveyed faculty and residents to assess attitudes, perceptions, and knowledge about antimicrobial use and resistance. Most respondents were concerned about resistance when prescribing antibiotics and agreed that antibiotics are overused, that inappropriate use is professionally unethical, and that others, but not themselves, overprescribe antibiotics. Antimicrobial stewardship programs should capitalize on these perceptions.

Parents of young children with type 1 diabetes (T1DM) maintain full responsibility for their child’s daily diabetes self-care and thus may be vulnerable to experiencing parenting stress. This study examined several psychological correlates of pediatric parenting stress in parents of young children with T1DM. Parents of 39 young children with T1DM (ages 2–7 years) completed measures of pediatric parenting stress, mealtime behavior problems, depressive symptoms, and fear of hypoglycemia. For parents of young children, higher stress frequency and difficulty were associated with higher parental depressive symptoms and fear. Regression analyses identified that 58% of the variance in stress frequency was associated with parental depressive symptoms. For stress difficulty, 68% of the variance was associated with parental depressive symptoms and fear. Pediatric parenting stress is common in parents of young children with T1DM. Stress and the psychological correlates measured in this study are amenable to intervention and should be regularly assessed in parents of young children with T1DM.

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Objective. We have previously reported a defect in neutrophil activation in children with polyarticular juvenile idiopathic arthritis (JIA). The current study was undertaken to determine whether gene expression abnormalities persist in JIA in remission and to use systems biology analysis to elucidate pathologic pathways in polyarticular JIA.Methods. We performed gene expression profiling on neutrophils from children with polyarticular JIA. Children were grouped according to disease status. We studied 14 children with active disease who were taking medication, 8 children with clinical remission of disease who were taking medication (CRM status), and 6 children with clinical remission of disease who were not taking medication (CR status). We also studied 13 healthy children whose age ranges overlapped those of the patients.Results. Neutrophil abnormalities persisted in children with polyarticular JIA even after disease remission was achieved. Children with active disease and those with CRM status showed no differences in expression of specific genes, although they could be separated on cluster analysis. A comparison of children with CR status and healthy control children revealed networks of pro-and antiinflammatory genes that suggested that remission is a state of homeostasis and balance rather than a return to normal immune function. Furthermore, gene overexpression in patients with CR status supports the hypothesis that neutrophils play a role in regulating adaptive immunity in this disease.Conclusion. Neutrophil gene profiling in polyarticular JIA suggests important roles for neutrophils in disease pathogenesis. These findings suggest the presence of complex interactions between innate and adaptive immunity, that are not easily modeled in conventional, linear, reductionist systems.Juvenile idiopathic arthritis (JIA) is a term used to denote a family of diseases of unknown etiology characterized by chronic inflammation of synovial membranes (1). Distinct phenotypes are recognized clinically, with specific immunogenetic markers associated with each of the phenotypes (2,3).While the JIA subtypes have commonly been assumed to have an "autoimmune" origin, our growing understanding of biologic complexity makes any such simple, linear hypothesis of disease pathogenesis unlikely (4). We have hypothesized that the pathogenesis