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We conducted a prospective cohort study between 1 January 2010 and 31 December 2012 at five adult and paediatric academic medical centres to identify factors associated with persistent methicillin-resistant Staphylococcus aureus (MRSA) colonisation. Adults and children presenting to ambulatory settings with a MRSA skin and soft tissue infection (i.e. index cases), along with household members, performed self-sampling for MRSA colonisation every 2 weeks for 6 months. Clearance of colonisation was defined as two consecutive negative sampling periods. Subjects without clearance by the end of the study were considered persistently colonised and compared with those who cleared colonisation. Of 243 index cases, 48 (19·8%) had persistent colonisation and 110 (45·3%) cleared colonisation without recurrence. Persistent colonisation was associated with white race (odds ratio (OR), 4·90; 95% confidence interval (CI), 1·38–17·40), prior MRSA infection (OR 3·59; 95% CI 1·05–12·35), colonisation of multiple sites (OR 32·7; 95% CI 6·7–159·3). Conversely, subjects with persistent colonisation were less likely to have been treated with clindamycin (OR 0·28; 95% CI 0·08–0·99). Colonisation at multiple sites is a risk factor for persistent colonisation and may require more targeted decolonisation efforts. The specific effect of clindamycin on MRSA colonisation needs to be elucidated. [ABSTRACT FROM PUBLISHER]

Resistance to extended-spectrum cephalosporins complicates treatment of Pseudomonas aeruginosa infections. To elucidate risk factors for cefepime-resistant P. aeruginosa and determine its association with patient death, we conducted a case-control study in Philadelphia, Pennsylvania. Among 2,529 patients hospitalized during 2001-2006, a total of 213 (8.4%) had cefepime-resistant P. aeruginosa infection. Independent risk factors were prior use of an extended-spectrum cephalosphorin (p<0.001), prior use of an extended-spectrum penicillin (p = 0.005), prior use of a quinolone (p<0.001), and transfer from an outside facility (p = 0.01). Among those hospitalized at least 30 days, mortality rates were higher for those with cefepime-resistant than with cefepime-susceptible P. aeruginosa infection (20.2% vs. 13.2%, p = 0.007). Cefepime-resistant P. aeruginosa was an independent risk factor for death only for patients for whom it could be isolated from blood (p = 0.001). Strategies to counter its emergence should focus on optimizing use of antipseudomonal drugs. [ABSTRACT FROM AUTHOR]

Purpose: Scientific manuscripts sometimes have two or more authors explicitly designated as having "contributed equally" to the study. The prevalence and characteristics of this practice are not known. The goal of this study was to identify longitudinal trends and characteristics of the practice of explicitly giving authors equal credit in publications found in major medical journals.Methods: We conducted electronic keyword searches looking for original research articles with equally credited authors (ECAs) published between Jan. 1, 2000 and Dec. 31, 2009 in the five general medicine journals with the highest impact factors (New England Journal of Medicine, Journal of the American Medical Association, Lancet, Annals of Internal Medicine, and British Medical Journal). The annual prevalence of original research articles with ECAs for each journal.Results: Original research articles with authors explicitly given equal credit were found in all five journals. Articles with ECAs formed a greater proportion of the total number of articles published in each journal in 2009 versus published in 2000 (NEJM: 8.6% vs. <1%; JAMA: 7.5% vs. 0%; Annals: 3.8% vs. 0%; Lancet: 3.6% vs. <1%; BMJ: 1.0% vs. 0%). There was a statistically significant increasing trend in yearly prevalence of ECA articles for all the journals (NEJM: p < 0.0001; JAMA: p < 0.001; Annals: p < 0.001; Lancet: p < 0.001, BMJ: p = 0.001]. The first two authors listed in the byline received equal credit the majority of the time, but the practice was also applied to authors in nearly every position in the byline. Finally, none of the journals provided specific guidance regarding this practice in their instructions to authors.Conclusions: The practice of explicitly giving authors equal credit is increasingly common in original research publications. Scientific journals should consider providing guidance for authors regarding this practice. Furthermore, the potential impact of this practice on evaluations for academic promotion should be assessed. [ABSTRACT FROM AUTHOR]

In pediatric bloodstream infections with fluoroquinolone (FQ)-resistant Escherichia coli and Klebsielia species, we noted an association between FQ resistance and extended-spectrum beta-lactamase (ESBL) production (OR, 12; 95% CI: 2.28-83.8). A case control study revealed no significant risk factors (including prior antibiotic use) for FQ resistance among ESBL E coli and Klebsiella species (ESBL-EK). [ABSTRACT FROM AUTHOR]