CA-MRSA colonization with PVL-positive strains was associated with a significant risk of soft-tissue infection, suggesting that CA-MRSA may be more virulent than MSSA. Previous antibiotic use may play a role in CA-MRSA colonization.

Acinetobacter osteomyelitis appears suppressed with extended antimicrobial drug therapy based on susceptibility patterns.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen that primarily manifests as uncomplicated skin and soft tissue infections. We conducted a cluster randomized, double-blind, placebo-controlled trial to determine whether targeted intranasal mupirocin therapy in CA-MRSA-colonized soldiers could prevent infection in the treated individual and prevent new colonization and infection within their study groups. We screened 3,447 soldiers comprising 14 training classes for CA-MRSA colonization from January to December 2005. Each training class was randomized to either the mupirocin or placebo study group, and the participants identified as CA-MRSA colonized were treated with either mupirocin or placebo. All participants underwent repeat screening after 8 to 10 weeks and were monitored for 16 weeks for development of infection. Of 3,447 participants screened, 134 (3.9%) were initially colonized with CA-MRSA. Five of 65 (7.7%; 95% confidence interval [95% CI], 4.0% to 11.4%) placebo-treated participants and 7 of 66 (10.6%; 95% CI, 7.9% to 13.3%) mupirocin-treated participants developed infections; the difference in the infection rate of the placebo-and mupirocin-treated groups was ؊2.9% (95% CI, ؊7.5% to 1.7%). Of those not initially colonized with CA-MRSA, 63 of 1,459 (4.3%; 95% CI, 2.7% to 5.9%) of the placebo group and 56 of 1,607 (3.5%; 95% CI, 2.6% to 5.2%) of the mupirocin group developed infections; the difference in the infection rate of the placebo and mupirocin groups was 0.8% (95% CI, ؊1.0% to 2.7%). Of 3,447 participants, 3,066 (89%) were available for the second sampling and completed follow-up. New CA-MRSA colonization occurred in 24 of 1,459 (1.6%; 95% CI, 0.05% to 2.8%) of the placebo group participants and 23 of 1,607 (1.4%; 95% CI, 0.05% to 2.3%) of the mupirocin group participants; the difference in the infection rate of the placebo and mupirocin groups was 0.2% (95% CI, ؊1.3% to 1.7%). Despite CA-MRSA eradication in colonized participants, this study showed no decrease in infections in either the mupirocin-treated individuals or within their study group. Furthermore, CA-MRSA eradication did not prevent new colonization within the study group.

Forewordantimicrobial prescribing guidelines for poultry Antimicrobials are essential to modern medicine for treating a range of infections in humans and animals. Importantly, antimicrobial resistance (AMR) is a growing global threat that presents a serious risk to human and animal health. Inappropriate and/or unrestrained use of antimicrobials in humans and animals exerts a strong selection pressure on microbial populations to evolve resistant traits. As a result, antimicrobials have become less effective over time leading to treatment complications and failures, and increased healthcare costs for people and animals. Resistant organisms spread between people, animals and the environment. Globalisation and international travel facilitates this spread between countries.Here in Australia, the veterinary profession and food-producing animal industries have a long history of addressing AMR. Their previous and ongoing worka result of partnerships across the animal sectorhas resulted in demonstrated low levels of AMR in our food-producing animals. Over the past 5 years, the veterinary profession has consolidated its partnership with industry and government by helping to successfully implement Australia's First National Antimicrobial Resistance Strategy 2015-19. With the recent release of Australia's National Antimicrobial Resistance Strategy -2020 and Beyond (2020 AMR Strategy), the veterinary profession will continue to play a critical role in how we minimise AMR.One of the seven key objectives of the 2020 AMR Strategy relates to appropriate antimicrobial usage and antimicrobial stewardship practices. Resistance to antimicrobials occurs naturally in microorganisms, but it is significantly amplified by antimicrobial overuse, growth promotion use, and poor husbandry and management.The antimicrobial prescribing guidelines for poultry directly addresses the fourth objective of the 2020 AMR Strategy, and in particular, Priority Area for Action 4.1, that seeks to 'ensure that coordinated, evidence-based antimicrobial prescribing guidelines and best-practice supports are developed and made easily available, and encourage their use by prescribers'. These guidelines for Australian poultry veterinarians are sure to be a ready resource. They have been developed specifically for the Australian poultry industry and contain best-practice prescribing information to help clinical veterinarians in their day-to-day use of antimicrobials. The guidelines encourage veterinarians to first pause and consider the need to use antimicrobials in that circumstance: Are there effective non-antimicrobial alternatives? Prevention and control of infections through strict on-farm biosecurity is a recognised approach to minimising disease entry and the need to use antimicrobials. Vaccination may also be available to control several important poultry diseases. If antimicrobial use is indicated, have you considered the five rights: right drug, right time, right dose, right duration and right route? Using a lower rating or narrow-spectrum antimicrobial i...

Pertussis, once a serious respiratory disease in children, has recently been identified as a common cause of chronic cough in adults. Military personnel are known to be vulnerable to this disease. After a training barracks exposure to pertussis, routine arrangements for contact prophylaxis with erythromycin failed. This experience is reported here as well as that of our subsequent aggressive attempts using directly observed prophylaxis (DOP) with standard erythromycin regimens. No secondary cases occurred. However, many contacts (35%) could not finish a 14-day course despite DOP, mostly because of nausea (85%) or diarrhea (72%). Seventeen (18%) soldiers missed classes because of erythromycin side effects; five required emergency department visits or hospital admission for the same. Sixteen (17%) soldiers were switched to azithromycin because of side effects; all were able to complete a 14-day course without symptoms. High adherence rates with erythromycin administration using DOP are attainable but may trigger unacceptable toxicities; alternative prophylactic regimens should be considered for active duty personnel.