On October 2, 2020, this report was posted as an MMWR Early Release on the MMWR website (https://www.cdc.gov/mmwr). During the course of the coronavirus disease 2019 (COVID-19) pandemic, reports of a new multisystem inflammatory syndrome in children (MIS-C) have been increasing in Europe and the United States (1-3). Clinical features in children have varied but predominantly include shock, cardiac dysfunction, abdominal pain, and elevated inflammatory markers, including C-reactive protein (CRP), ferritin, D-dimer, and interleukin-6 (1). Since June 2020, several case reports have described a similar syndrome in adults; this review describes in detail nine patients reported to CDC, seven from published case reports, and summarizes the findings in 11 patients described in three case series in peer-reviewed journals (4-6). These 27 patients had cardiovascular, gastrointestinal, dermatologic, and neurologic symptoms without severe respiratory illness and concurrently received positive test results for SARS-CoV-2, the virus that causes COVID-19, by polymerase chain reaction (PCR) or antibody assays indicating recent infection. Reports of these patients highlight the recognition of an illness referred to here as multisystem inflammatory syndrome in adults (MIS-A), the heterogeneity of clinical signs and symptoms, and the role for antibody testing in identifying similar cases among adults. Clinicians and health departments should consider MIS-A in adults with compatible signs and symptoms. These patients might not have positive SARS-CoV-2 PCR or antigen test results, and antibody testing might be needed to confirm previous SARS-CoV-2 infection. Because of the temporal association between MIS-A and SARS-CoV-2 infections interventions that prevent COVID-19 might prevent MIS-A. Further research is needed to understand the pathogenesis and long-term effects of this newly described condition. Potential MIS-A patients were identified from several sources: reports from clinicians and health departments, published case reports, and published case series. Clinicians and health departments in the United States voluntarily reported adult patients with suspected MIS-A to CDC using the case report form* developed for MIS-C after a Health Advisory was published on May 14, 2020, calling for reporting of MIS-C

This is the first randomized study to evaluate whether antibiotic choices can be influenced in a cost-effective fashion without sacrificing patient safety. We demonstrate that 50% of patients initially treated with expensive parenteral antibiotics can have their regimens refined after 3 days of therapy and that these modifications result in good clinical outcomes with a substantial reduction in antibiotic expense.

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A middle-aged woman developed fatal urosepsis due to a multidrug-resistant Escherichia coli strain representing sequence type ST131, a recently emerged, disseminated, multidrug-resistant extraintestinal pathogen, after presumably having acquired it from her extensively antibiotic-exposed sister with chronic recurrent cystitis. Susceptibility results (reported on day 4) showed resistance to the initially selected regimen. CASE REPORTThe index patient was a middle-aged female with chronic, recurrent symptomatic urinary tract infections (UTIs) due to Escherichia coli. Her urine isolates had become increasingly antimicrobial resistant over a 5-year period, including having become, for the past several years, extended-spectrum betalactamase (ESBL) positive.Both the index patient and a younger sister had alpha-1-antitrypsin deficiency. Whereas the index patient was only mildly affected, the younger sister was severely affected, leading to long-term care facility placement and a referral for lung transplantation (which was denied, because of continued smoking). The index patient had cared for the younger sister in the index patient's home for several months during the summer prior to the younger sister's acute illness.Shortly after the younger sister's temporary residence in the index patient's home, she began to experience mild dysuria when voiding (no indwelling or intermittent urinary catheter use) and low-grade fever. After a week of progressive symptoms, she was admitted to the hospital for presumed pyelonephritis.On admission, the patient appeared to be in mild distress with right-sided flank pain. Her temperature was 37.6°C, pulse was 52 beats per minute, blood pressure was 153/82 mm Hg, and respirations were 24 per minute. Oxyhemoglobin saturation was 92% on 4 liters of oxygen. The right flank was tender. Laboratory findings included leukocytosis (17,800 cells/l) with 88% neutrophils. Urinalysis showed marked pyuria and bacteriuria. Ciprofloxacin (400 mg intravenously every 12 h) and stress-dose corticosteroids were administered.Over 3 days, her clinical status worsened, and she was transferred to the intensive care unit for septic shock, presumed to be secondary to pyelonephritis. Her white blood cell (WBC) count rose to 18,400 cells/l (29% band forms), and her serum creatinine level increased to 2.7 mg/dl. The patient received mechanical ventilation and vasopressor therapy. Renal ultrasonography revealed moderate right hydronephrosis; a right percutaneous nephrostomy tube was placed. Blood and urine cultures grew E. coli.Due to the patient's precipitous decline, antimicrobial therapy was broadened empirically by adding piperacillin-tazobactam, based on local antibiogram data. On hospital day 4, septic shock worsened, requiring additional vasopressor support. Susceptibility data, which were now reported, showed the E. coli isolates to be resistant to fluoroquinolones and extended-spectrum cephalosporins but susceptible to piperacillin-tazobactam, amikacin, carbapenems, and trimethoprim-sulfamethoxazole. Therap...