Leadership Vision

Background: Pneumonia is the leading infectious cause of death in the United States.1 The microorganism most commonly responsible for community-acquired pneumonia (CAP) is S. pneumoniae. Current treatment focuses on eradicating the causative microorganism with antimicrobial therapy.2 Severe CAP often leads to complications such as sepsis and organ failure, such that many patients require mechanical ventilation and admission to the intensive care unit.1 Corticosteroids are currently FDA approved and indicated for the treatment and prophylaxis of asthma.3 The bronchial anti-inflammatory action is achieved through direct inhibition of the mediating cells, including macrophages, T-lymphocytes, and eosinophils. An additional benefit is reduced mucus secretion in airways. These actions spark the question of whether or not there may be a use for corticosteroids in the treatment of CAP. Current American Thoracic Society guidelines recommend corticosteroids only in patients with proven low cortisol levels.4 Interest in systemic corticosteroids has led to studies seeking a possible benefit in reducing mortality in CAP patients.5,6 Literature search strategy: A search was conducted using MEDLINE® via Ovid (1946 to February Week 3 2012).

Once resistance builds in one patient, it is possible for the strain to be transmitted to others through improper hygiene and failure to isolate patients in hospitals. Resistance arises from mutations that are not under the control of humans, but the evolution of bacteria has been sped along by the overexposure of antibiotics to both people and animals. The number of antibiotic-resistant strains of bacteria in an area is closely related to the frequency that antibiotics that are prescribed (Todar, 2012). Patients often unnecessarily demand antibiotics to treat common colds or simple illnesses that are not caused by bacteria. Instead, these infections are caused by viruses which, unlike bacteria, are unaffected by antibiotics.

(2008). Healthcare epidemiology: active surveillance cultures and contact precautions for control of multidrug-resistant organisms: ethical considerations. Clinical Infectious Diseases: An Official Publication Of The Infectious Diseases Society Of America, 47(1), 110-116. doi:10.1086/588789 Yang, Y., McBride, M., Rodvold, K., Tverdek, F., Trese, A., Hennenfent, J., & ... Schumock, G. (2010). Hospital policies and practices on prevention and treatment of infections caused by methicillin-resistant Staphylococcus aureus. American Journal Of Health-System Pharmacy, 67(12), 1017-1024. doi:10.2146/ajhp090563

Community-Associated MRSA has caused a huge concern for public health professionals because of who can get it. All CA-MRSA strains typically carry a novel type of methicillin resistance locus that appears to cause less of a fitness burden (Otto, 2013). Unlike hospitalized MRSA, which can usually be traced back to a speci... ... middle of paper ... ...es/mrsa/pages/default.aspx Heymann, D. (2008). Control of communicable diseases manuel. (19 ed.).

Retrieved November 3, 2011, from U.S. National Library of Medicine National Institutes of Health: http://www.ncbi.nlm.nih.gov/pubmed U.S. Food and Drug Administration. (2010, September 1). Tygacil (tigecycline): Label Change - Increased Mortality Risk. Retrieved October 27, 2011, from U.S. Food and Drug Administration: www.fda.gov World Health Organization. (2011).

(2008). Colonization, Fomites, and Virulence: Rethinking the Pathogenesis of Community-Associated Methicillin-Resistant Staphylococcus aureus Infection. Clinical Infectious Diseases, 46(5), 752-760. doi:10.1086/526773 Newland, J. G., & Kearns, G. L. (2008). Treatment Strategies for Methicillin-Resistant Staphylococcus aureus Infections in Pediatrics. Pediatric Drugs, 10(6), 367-378.

American Journal of Respiratory and Critical Care Medicine, 186(12), 1264-1271. doi:10.1164/rccm.201204-0713OC Trautmann, M., Scheibe, C., Wellinghausen, N., Holst, O., & Lepper, P. M. (2010). Low endotoxin release from escherichia coli and bacteroides fragilis during exposure to moxifloxacin. Chemotherapy, 56(5), 364-370. doi:10.1159/000321622 Vincent, J. L., & De Backer, D. (2013). Circulatory Shock. New England Journal of Medicine, 369(18), 1726-1734. doi: 10.1056/NEJMc1314999 Ward, P. A.

Clinical management of staphylococcus aureus bacteraemia. The Lancet Infectious Diseases, 11(3), 208-22. Retrieved from http://dx.doi.org/10.1016/S1473-3099(10)70285-1

Marinella, L.B. et al: (2010). Acute Diverticulitis. The New England Journal of Medicine. 327: 1521-1526 Painter, P.V.

2012 http://www.emedicine.medscape.com/article/120619-overview#showall Dr. Asha Thomas. “Treatment of Graves’ Disease” Baltimore Sun. 19 Oct. 2009 10 Mar. 2012. http://www.baltimoresun.com/2009-10-19/news/0910180070_1_graves-disease-underactive-thyroid-thyroid-disease Mark F. Prummel, Wilmar M. Wiersinga. “Smoking and Risk of Graves’ Disease” The Journal of the American Medical Association.