The American College of Physicians (ACP) Guidelines and the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) Guidelines on C. difficile were chosen as references for this guideline. The medical literature was searched from January 1, 2017 to March 16, 2020. The primary objective of the review was to describe the incidence, epidemiology and clinical presentation of C. difficile infection, and to review diagnostic methods, antimicrobial therapy, and health outcomes for patients with C. difficile infection. The secondary objective was to determine the outcomes of management of C. difficile infection in patients admitted to an inpatient setting. The last update of this guideline was in July 2020. The incidence of C. difficile is increasing in the United States. The highest incidence is among hospitalized patients. The most common manifestation of C. difficile infection is diarrhea. The majority of patients with C. difficile infection are cured with standard antibiotic therapy. The treatment of C. difficile infection is complicated by an increasing number of antibiotic-resistant strains. The mortality associated with C. difficile infection is low. C. difficile infection is a common nosocomial infection, increasing in prevalence and the burden of disease. The incidence of C. difficile infection is increasing in the United States. A common manifestation is diarrhea. The treatment is complicated by an increasing number of antibiotic-resistant strains. The mortality associated with C. difficile infection is low. Infect Control Hosp Epidemiol 2020;41(4):306-359. doi:10.1097/01.HEP.0000000000000089;doi:10.1097/01.HEP.0000000000000089.
Microbiology of acute otitis media (AOM) and acute otitis media associated with effusion (AOME) is mostly caused by Streptococcus pneumoniae, Haemophilus influenzae and non-typeable H. influenzae. Escherichia coli and Staphylococcus aureus are the main pathogens in chronic suppurative otitis media. The major concerns in managing pediatric infections include antibiotic resistance, in particular pneumococci and H. influenzae. Pneumococcal resistance is currently high to the main antibiotics used to treat infections. Resistance to erythromycin and beta-lactams have increased in recent years. H. influenzae resistance to ampicillin and trimethoprim-sulfamethoxazole is also increasing and resistance is common in children with AOM, or AOM associated with effusion [68,70].
Microbiological studies conducted on samples of wastewater have shown that fecal coliforms, fecal streptococci and enterococci are dominant microflora in untreated sewage effluent. The numbers of fecal coliforms, fecal streptococci and enterococci in treated effluent are lower than in untreated effluent. The total viable fecal coliforms in treated effluent ranged from 5 to 10 and000 colony forming units (CFU) per 100mL of effluent. The total viable fecal streptococci ranged from 3 to 10 and 1000 CFU per 100 mL of effluent. The range of enterococci detected was from 3 to 10 and 1000 CFU per 100 mL of effluent. 827ec27edc