Blood culture of patient with #Fournier's-gangrene Resist | Figure 1

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Blood culture of patient with #Fournier's-gangrene Resistant to all available antibiotics

Key Points:

• Antimicrobial stewardship programs over the years have had several goals, including reducing costs, optimizing therapeutic outcomes, and reducing antimicrobial resistance. Reductions of antimicrobial resistance have been the most elusive.
• The relationship between antimicrobial usage and resistance is also not always direct, especially with molecular mechanisms that confer resistance to multiple classes of antibiotics or through transferable plasmids and transposons that contain multiple resistance genes.
• The understanding of which techniques are most effective is limited by the fact that many studies are descriptive or quasiexperimental.
• More recently, several meta-analyses or systematic reviews of stewardship programs have been published, offering encouragement that some interventions, especially those that involve prospective auditing and feedback, have the effect of reducing overall antimicrobial selective pressure, and are associated with infection control interventions, can have an important impact on resistance rates in individual institutions.

Nosocomial pneumonia. That moment when you think twice right before evaluate your patient.

A 52-year-old man presented with a 20-minute history of chest pain radiating to the left shoulder and neck, associated with dyspnea and diaphoresis.

A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets.

A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.

Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this ekg that would warrant further work-up or is this just a pediatric ekg?