These observations suggest that drug-resistant, uropathogenic human-associated E. coli strains potentially have an animal origin. The possibility that human drug-resistant UTI could be a foodborne illness has serious public health implications.

This study provides epidemiologic evidence that antimicrobial resistant, UTI-causing E. coli could have a food reservoir, possibly in poultry or pork.

Recent studies from North America and Europe have demonstrated community-wide clonal spread of uropathogenic Escherichia coli (UPEC). To investigate if a similar pattern of spread occurs in Brazil, we characterized UPEC from women with community-acquired urinary tract infection (UTI) in Rio de Janeiro. E. coli isolates from women with UTI in one public outpatient clinic were evaluated for antibiotic susceptibility, E. coli phylogenetic grouping, enterobacterial repetitive intergenic consensus (ERIC) 2 PCR and pulsed-field gel electrophoresis fingerprinting, and multilocus sequence typing. From March 2005 to November 2006, 344 patients were studied. Of these, 186 (54%) had confirmed UTI, 118 (63.4%) of which were caused by E. coli. More than 50% of these isolates were resistant to ampicillin and trimethoprim/sulfamethoxazole. Of these, 96 (81%) belonged to 19 ERIC2 clonal groups. The largest group included 15 isolates, all belonging to multilocus sequence typing group ST69 and phylogenetic group D; they had pulsed-field gel electrophoresis patterns sharing at least 89% similarity compared with the CgA reference strain ATCC BAA-457. CgA strains have been found to be widespread in the United States in the early 2000s. Clonal group E. coli strains accounted for a large proportion (52%) of all UTIs and 82% of the trimethoprim/sulfamethoxazole-resistant E. coli UTIs. Thus, as in North America and Europe, UPECs that cause UTI in Rio de Janeiro also show clonal distribution, and a substantial proportion of drug-resistant UTI is caused by a small set of genetically related E. coli strains.

This study revealed no obvious trend in the prevalence of drug-resistant community-acquired UTI in a single community. Prevalence at any time was influenced by a small number of E. coli clonal groups. This observation suggests that the introduction of strains that are drug resistant into a community plays a greater role in changing the prevalence of drug-resistant UTI than does the drug use or prescribing habits in that community.

Faced with the problem of managing over 3,000 records with no systematic location and retrieval mechanism, a project management team relied on health information management skills, including those of project management, data modeling, and records management, to plan and implement an effective system for managing patient data.

In recent years, health care consumers have become increasingly sophisticated in their selection and use of health care services. Empowered initially by the Internet, they are seeking medical information to become better informed as they interact with physicians and other health care providers. This article addresses (1) the new patient-provider relationship with more provider accountability, the impact of Baby Boomers on health care, and the evolving consumer-driven marketplace with emerging patient-centered care; (2) emerging technologies being used to transform the patient experience; (3) how the use of cutting-edge technologies affect the health care consumer; and (4) the future impact of the use of patient-centered technology initiatives on the health care industry. The personal health record is predicted by experts to be the primary technology that will promote advancement of the electronic health record; therefore, this article focuses on patients' use of the personal health record.

No abstract

No abstract