Strategies for the management and control of antibiotic resistant organisms on a spinal cord injury unit.

Individuals with a spinal cord injury (SCI) are at an increased risk of infection and colonization. Frequent lengthy hospitalizations, invasive procedures, and skin breakdown contribute to this risk. Intermittent antibiotic use influences the emergence of antibiotic resistance in these organisms. As a result, there is risk of transmission of these antibiotic resistant organisms (ARO). This article describes the application of a continuous quality improvement model to evaluate ARO management strategies in a SCI unit. A conservative, labor intensive, crisis management approach to the control of ARO was replaced with a more cost effective prospective plan. The new strategies were aimed at control rather than eradication and included collaborative, multidisciplinary planning and improved resource utilization. Efforts have been successful and have resulted in the control of ARO.

Uric acid excretion: quantitative assessment from spot, midmorning serum and urine samples.

Uric acid excretion can be measured in milligrams of urinary uric acid per decilitre of glomerular filtrate by obtaining the product of urinary uric acid and serum creatinine concentrations and dividing by the urine creatinine (all concentrations in mg/dL). In 29 normal adult men, the excretion rate in spot, midmorning samples was 0.4 +/- 0.1 (SD) mg of uric acid per decilitre of glomerular filtrate. Eight of 36 untreated gouty men excreted acid at a rate more than three standard deviations above normal. Excretion of uric acid is conveniently and physiologically assessed by this simple method.