Development of a strategy for decreasing multi-drug resistant bacteria with implementation of a program emphasizing appropriate antibiotic utilization and strict infection control measures in western South Dakota.

In this follow-up of an article written in the South Dakota Journal of Medicine, February 2001, Antimicrobial Resistance: Steps to Reduce the Problem with Emphasis on Antibiotic Utilization--The Rapid City Experience, subsequent local analysis based on evolving literature, local measures undertaken, and results of these measures will be presented. With national numbers of Methicillin resistant Staphylococcus aureus (MRSA) and Vancomycin resistant enterococcus (VRE) rising, steps taken in the Rapid City Region have shown reduction in these two pathogens. The two key components of these programs have been appropriate antibiotic utilization and strict adherence to aggressive infection control measures.

Antimicrobial resistance: steps to reduce the problem with emphasis on antibiotic utilization the Rapid City experience.

In summary, as the SHEA/IDSA Joint Committee on Prevention of Antimicrobial Resistance suggested, it should be easier to prevent the acquisition of resistance than to respond after the problem is extensive. We have taken that approach in the measures undertaken and outlined above. Our lower rates of resistant microorganisms are, in part, due to this, but also due to the diligent use of antibiotics by the medical staff-largely in avoiding empiric broad-spectrum antibiotic therapy when not needed. Our formulary is not restrictive but new antibiotics are not added unless there is a proven niche. The most appropriate and effective antibiotic at our hospital for Streptococcus pneumoniae is penicillin, for Streptococcus pyogenes, penicillin, for Staphylococcus aureus, nafcillin, for a severe Escherichia Coli infection, gentamicin, and for Pseudomonas aeurginosa, gentamicin and ceftazidime. Our efforts are to maintain this favorable situation for our patients and clinicians. Additionally, we will continue to explore and implement new avenues of prevention, with an emphasis on optimal antibiotic utilization, toward the goal of protecting our patients and health care workers from resistant bacteria.

Internal/structures containing transcriptase-related proteins in top component particles of mammalian orthoreovirus.

The structure of mammalian orthoreovirus top component particles, which are profoundly deficient in the content of double-stranded RNA genome, was determined at 30 A resolution by transmission cryoelectron microscopy and three-dimensional image reconstruction. Previously undetected, ordered densities, appearing primarily as pentameric flowers in the reconstruction, were seen to extend 65 A inwardly from the inner capsid at the icosahedral fivefold axes. Identically positioned but lower density elements were observed in two types of partially uncoated top component particles obtained by limited proteolysis. The levels of three inner-capsid proteins-lamda 1, lamda 3, and mu 2-were reduced in concert with the internal densities during proteolytic uncoating. Since lamda 3 contains the catalytic regions of the viral RNA polymerase and since both lamda 1 and mu 2 appear to play roles in transcription or mRNA capping, the internal structures are concluded to be complexes of the viral transcriptase-related enzymes. The findings have implications for the mechanisms of transcription and mRNA capping by orthoreovirus particles.

Parenteral and oral acyclovir for management of varicella pneumonia in pregnancy: a case report with review of literature.

Varicella pneumonia is a relatively rare disease in the reproductive-aged woman, but has a reported 41 percent maternal mortality rate in pregnancy. Seventeen cases managed with intraveneous acyclovir are reviewed. We report successful management with the unpublished addition of oral acyclovir to complete antiviral therapy on an outpatient basis.