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Changing life expectancy in European countries 1990–2021: a subanalysis of causes and risk factors from the Global Burden of Disease Study 2021

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The Lancet Public Health 2025年第3期10卷 e172-e188页

作者： Steel, Nicholas Bauer-Staeb, Clarissa Maria Mercedes Ford, John A. Abbafati, Cristiana Abdalla, Mohammed Altigani Abdelkader, Atef Abdi, Parsa Zuñiga, Roberto Ariel Abeldaño Abiodun, Olugbenga Olusola Abolhassani, Hassan Abu-Gharbieh, Eman Abukhadijah, Hana J. Abu-Zaid, Ahmed Addo, Isaac Yeboah Addolorato, Giovanni Adekanmbi, Victor Adetunji, Juliana Bunmi Adeyeoluwa, Temitayo Esther Agardh, Emilie E. Agyemang-Duah, Williams Ahmad, Danish Ahmed, Ayman Ahmed, Syed Anees Akinosoglou, Karolina Akkaif, Mohammed Ahmed Al Awaidy, Salah Al Hasan, Syed Mahfuz Al Zaabi, Omar Ali Mohammed Aldridge, Robert W. Algammal, Abdelazeem M. Al-Gheethi, Adel Ali Saeed Ali, Abid Ali, Mohammed Usman Ali, Syed Shujait Ali, Waad Alicandro, Gianfranco Alif, Sheikh Mohammad Al-Jumaily, Adel Allebeck, Peter Alrawashdeh, Ahmad Al-Rifai, Rami H. Alsabri, Mohammed A. Alshahrani, Najim Z. Aluh, Deborah Oyine Al-Wardat, Mohammad Al-Zyoud, Walid A. Amiri, Sohrab Anderlini, Deanna Andrei, Catalina Liliana Anil, Abhishek Anvari, Saeid Anyasodor, Anayochukwu Edward Appiah, Seth Christopher Yaw Aquilano, Michele Arabloo, Jalal Arafat, Mosab Areda, Demelash Aremu, Abdulfatai Armani, Keivan Armocida, Benedetta Ärnlöv, Johan Asaduzzaman, Muhammad Astell-Burt, Thomas Aujayeb, Avinash Ausloos, Marcel Azadnajafabad, Sina Aziz, Shahkaar Azzam, Ahmed Y. Babu, Giridhara Rathnaiah Badache, Andreea Corina Badiye, Ashish D. Bahramian, Saeed Baig, Atif Amin Baker, Jennifer L. Bansal, Hansi Bärnighausen, Till Winfried Barone, Mark Thomaz Ugliara Barrow, Amadou Barteit, Sandra Bashir, Shahid Bashiru, Hameed Akande Basso, João Diogo Bastan, Mohammad-Mahdi Basu, Sanjay Batra, Kavita Bauckneht, Matteo Baune, Bernhard T. Beghi, Massimiliano Beiranvand, Maryam Béjot, Yannick Bell, Michelle L. Bello, Olorunjuwon Omolaja Belo, Luis Beloukas, Apostolos Beneke, Alice A. Bettencourt, Paulo J.G. Bhagavathula, Akshaya Srikanth Bhala, Neeraj Bhaskar, Sonu Bisulli, Francesca Bjørge, Tone Bodunrin, Aadam Olalekan Carvajal, Alejandro Botero Bouaoud, Souad Brayne, Carol Brenner, H Department of Primary Care and Public Health University of East Anglia Norwich United Kingdom Office for Health Improvement and Disparities Department of Health and Social Care London United Kingdom Department of Legal and Economic Studies La Sapienza University Rome Italy Rome Italy Hull York Medical School University of Hull Hull United Kingdom Department of Mathematics and Sciences Ajman University Ajman United Arab Emirates Department of Medicine Memorial University St. John's NL Canada Postgraduate Department University of Sierra Sur Miahuatlan de Porfirio Diaz Mexico Yhteiskuntadatatieteen keskus (Centre for Social Data Science) Helsinki Finland Department of Internal Medicine Federal Medical Centre Abuja Nigeria Research Center for Immunodeficiencies Tehran University of Medical Sciences Tehran Iran Department of Medical Biochemistry and Biophysics Karolinska Institutet (Karolinska Institute) Stockholm Sweden Department of Clinical Sciences University of Sharjah Sharjah United Arab Emirates Department of Biopharmaceutics and Clinical Pharmacy University of Jordan Amman Jordan Medical Research Center Hamad Medical Corporation Doha Qatar Department of Biochemistry and Molecular Medicine Alfaisal University Riyadh Saudi Arabia College of Graduate Health Sciences University of Tennessee Memphis TN United States School of Medicine Sydney NSW Australia Centre for Social Research in Health University of New South Wales Sydney NSW Australia Internal Medicine and Alcohol Related Disease Unit Fondazione Policlinico Universitario A. Gemelli IRCCS Rome Italy Department of Medical and Surgical Sciences Università Cattolica di Roma (Catholic University of Rome) Rome Italy Department of Obstetrics and Gynecology University of Texas Medical Branch Galveston TX United States Department of Biochemistry Osun State University Osogbo Nigeria Department of Pharmacology and Therapeutics University of Medical Sciences Ondo Ondo Nigeria Department of Veteri

Background: Decades of steady improvements in life expectancy in Europe slowed down from around 2011, well before the COVID-19 pandemic, for reasons which remain disputed. We aimed to assess how changes in risk factors and cause-specific death rates in different European countries related to changes in life expectancy in those countries before and during the COVID-19 pandemic. Methods: We used data and methods from the Global Burden of Diseases, Injuries, and Risk Factors Study 2021 to compare changes in life expectancy at birth, causes of death, and population exposure to risk factors in 16 European Economic Area countries (Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, and Sweden) and the four UK nations (England, Northern Ireland, Scotland, and Wales) for three time periods: 1990–2011, 2011–19, and 2019–21. Changes in life expectancy and causes of death were estimated with an established life expectancy cause-specific decomposition method, and compared with summary exposure values of risk factors for the major causes of death influencing life expectancy. Findings: All countries showed mean annual improvements in life expectancy in both 1990–2011 (overall mean 0·23 years [95% uncertainty interval [UI] 0·23 to 0·24]) and 2011–19 (overall mean 0·15 years [0·13 to 0·16]). The rate of improvement was lower in 2011–19 than in 1990–2011 in all countries except for Norway, where the mean annual increase in life expectancy rose from 0·21 years (95% UI 0·20 to 0·22) in 1990–2011 to 0·23 years (0·21 to 0·26) in 2011–19 (difference of 0·03 years). In other countries, the difference in mean annual improvement between these periods ranged from –0·01 years in Iceland (0·19 years [95% UI 0·16 to 0·21] vs 0·18 years [0·09 to 0·26]), to –0·18 years in England (0·25 years [0·24 to 0·25] vs 0·07 years [0·06 to 0·08]). In 2019–21, there was an overall decrease in mean annual life expectancy a

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Evaluation of PIMA Point-of-care CD4 Analyzer in Yunnan, China

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Chinese Medical Journal 2015年第7期128卷 890-895页

作者： Jun Liang Song Duan Yan-Ling Ma Ji-Bao Wang Ying-Zhen Su Hui Zhang Chin-Yih Ou Ling Hao Ming-Shan Qi Marc Bulterys Larry Westerman Yan Jiang Yao Xiao Department of AIDS/STD Prevention National HIV/HCV Reference Laboratory National Center for AIDS/STD Control and Prevention Chinese Center for Disease Control and Prevention Beijing 102206 China Department of Laboratory Tongzhou Blood Center Beijing 101100 China Department of AIDS/STD Prevention Dehong Prefecture Center for Disease Control and Prevention Dehong Yunnan 678400 China Department of AIDS/STD Prevention Yunnan Provincial Center for Disease Control and Prevention Kunming Yunnan 650022 China Global AIDS Program-China Office US Center for Disease Control and Prevention Beijing 100600 China International Laboratory Branch Division of Global HIV/AIDS Center for Global Health U.S. Centers for Disease Control and Prevention Atlanta GA 30329 USA

Background： CD4 count is used to determine antiretroviral therapy （ART） eligibility. In China, flow cytometers are mostly located in urban areas with limited access by patients residing in remote areas. In an attempt to address this issue, we conducted a study to validate the performance ofAlere PIMA point-of-care CD4 analyzer. Methods： Venous and finger-prick blood specimens were collected from HIV-positive participants from two voluntary counseling and testing sites in Yunnan Province. Both venous and finger-prick blood specimens were tested with the PIMA analyzer. Venous blood specimens tested with the Becton Dickinson FACSCalibur were used as a reference. Results： Venous specimens from 396 and finger-prick specimens from 387 persons were available for analysis. CD4 counts by PIMA correlated well with those from FACSCalibur with an R2 of 0.91 for venous blood and 0.81 for finger-prick blood. Compared to FACSCalibur, the PIMA analyzer yielded lower counts with a mean bias of- 47.0 cells/μl （limit of agreement, [LOA]： -204-110 cells/μl） for venous blood and -71.0 cells/μl （LOA： -295-153 cells/μl） for finger-prick blood. For a CD4 threshold of 350 cells/μl, the positive predictive value （PPV） of PIMA was 84.2% and 75.7% and the negative predictive value （NPV） was 97.6% and 95.8% for venous and finger-prick blood, respectively. For an ART threshold of 500 cells/μl, the corresponding PPV was 90.3% and 84.0% and NPV was 94.3% and 93.4%, respectively. Conclusions： CD4 counting using venous blood with PIMA analyzers is a feasible alternative to a large flow cytometer to determine ART eligibility.

关键词： CD4 Counts Finger-prick HIV Point-of-care Venous Blood

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Nosocomial Burkholderia cepacia Outbreaks and Pseudo-Outbreaks

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Infection control & Hospital Epidemiology 2015年第11期17卷 718-720页

作者： Alicia Mangram William R. Jarvis Hospital Infections Program Centers for Disease Control and Prevention Atlanta Georgia

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Measles and Healthcare Workers

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Infection control & Hospital Epidemiology 2015年第1期15卷 5-7页

作者： William L. Atkinson National Immunization Program Centers for Disease Control and Prevention Atlanta Georgia

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Changes in invasive pneumococcal disease among adults living with HIV following introduction of 13-valent pneumococcal conjugate vaccine, 2008–2014

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Open Forum Infectious Diseases 2017年第SUPPL_1期4卷 S57-S58页

作者： Kobayashi, Miwako Adih, William Li, Jianmin Gierke, Ryan Almendares, Olivia M Watt, James Alden, Nisha Petit, Susan Farley, Monica Harrison, Lee Lynfield, Ruth Baumbach, Joan Thomas, Ann Schaffner, William Pilishvili, Tamara Centers for Disease Control and Prevention Atlanta Georgia Respiratory Diseases Branch Centers for Disease Control and Prevention Atlanta Georgia Center for Infectious Diseases California Department of Public Health Sacramento California Colorado Department of Public Health and Environment Denver Colorado Connecticut Emerging Infections Program New Haven Connecticut Department of Medicine Emory University School of Medicine and Atlanta VA Medical Center Atlanta Georgia University of Pittsburgh Pittsburgh Pennsylvania Minnesota Department of Health St. Paul MN New Mexico Department of Health Santa Fe New Mexico Oregon Public Health Division Portland Oregon Vanderbilt University School of Medicine Nashville Tennessee National Center for Immunizations and Respiratory Diseases Centers for Disease Control and Prevention Atlanta Georgia

Background People living with HIV (PLHIV) are at increased risk of invasive pneumococcal disease (IPD). Introduction of 13-valent pneumococcal conjugate vaccine (PCV13) in children in 2010 reduced adult IPD burden (indirect effects). In 2012, PCV13 was recommended in series with 23-valent polysaccharide vaccine (PPSV23) for adults with immunocompromising conditions, including PLHIV. We evaluated changes in IPD incidence in adults ≥19 years old with and without HIV after PCV13 introduction for children in 2010 and for immunocompromised adults in 2012. PCV13 coverage for adults 19–64 years old with indications was 6% in 2014. Methods IPD cases, defined as pneumococcal isolation from sterile sites, were identified through CDC’s Active Bacterial Core surveillance, with counts projected nationally. HIV status was obtained from medical records. Isolates were serotyped by Quellung reaction or PCR and grouped into PCV13-types, PPV11-types (unique to PPSV23), or non-vaccine types. We estimated IPD incidence (cases per 100,000 people) using national case-based HIV surveillance (for PLHIV) or US Census data (for non-PLHIV) as denominators. We compared IPD incidence in 2011–12 and 2013–14 to the pre-PCV13 baseline (2008–09) by serotype groups. Results Overall IPD incidence at baseline was 354.0 for PLHIV and 15.5 for non-PLHIV. From baseline to 2013–14, IPD rates declined in both PLHIV (-36.3%; 95% CI: -38.8, -33.7%) and non-PLHIV (-27.3%; 95% CI: -28.2, -26.5%). The largest reductions were noted in PCV13-type IPD in both PLHIV (Figure 1) and non-PLHIV (Figure 2) for both periods (-46.8% for PLHIV and -45.9% for non-PLHIV in 2011–12; -60.3% for PLHIV and -65.8% for non-PLHIV in 2013–14). Overall IPD rates were 22.8 (95% CI: 22.2, 23.4) times as high in PLHIV compared with non-PLHIV at baseline, and 19.4 (95% CI: 18.8, 20.0) times as high in 2013–2014. Conclusion IPD rates declined significantly in both PLHIV and non-PLHIV during the study period due to reductions in PCV13-type

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Association entre un score mesurant le potentiel pro/anti-inflammatoire de l’alimentation (le DII) et la mortalité : modulation par une supplémentation en antioxydants dans l’essai randomisé ***

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Nutrition Clinique et Métabolisme 2017年第1期31卷 63-64页

作者： L. Graffouillère M. Deschasaux F. Mariotti L. Neufcourt N. Shivappa J. Hébert M. Wirth P. Latino-Martel S. Hercberg P. Galan C. Julia E. Kesse-Guyot M. Touvier Équipe de recherche en épidémiologie nutritionnelle (Éren) centre de recherche en épidémiologie et statistique Sorbonne Paris Cité U1153 Inserm U1125 Inra Cnam université Paris 13 Bobigny France UMR 914 physiologie de la nutrition et du comportement alimentaire AgroParisTech CRNH-IdF UMR 914 physiologie de la nutrition et du comportement alimentaire Inra CRNH-IdF Paris France Department of Epidemiology and Biostatistics Arnold School of Public Health Cancer Prevention and Control Program University of South Carolina Columbia États-Unis Département de santé publique hôpital Avicenne Bobigny France

Introduction et but de l’étude L’inflammation chronique est un mécanisme central impliqué dans quatre causes majeures de décès : les maladies cardiovasculaires, les cancers, le diab...

Introduction et but de l’étude L’inflammation chronique est un mécanisme central impliqué dans quatre causes majeures de décès : les maladies cardiovasculaires, les cancers, le diabète et les maladies respiratoires chroniques. L’alimentation est une source majeure de composés bioactifs pro- et anti-inflammatoires. Le Dietary Inflammatory Index (DII) a été conçu pour estimer le potentiel inflammatoire de l’alimentation. Notre objectif était, pour la première fois, d’étudier les associations entre le DII et la mortalité et d’investiguer si une supplémentation en antioxydants était susceptible de moduler cette relation. Matériel et méthodes L’étude *** est un essai randomisé en double-aveugle durant lequel les participants ont reçu des antioxydants à dose nutritionnelle ou un placebo entre 1994 et 2002. Cette étude prospective observationnelle incluait 7 997 participants suivis entre 1994 et 2007 (suivi médian de 12,4 ans). Le DII a été calculé à partir d’enregistrements alimentaires de 24 h répétés ; un score plus élevé correspondant à un régime alimentaire plus pro-inflammatoire. Au cours du suivi, 184 décès ont été enregistrés dont 102 dus à un cancer et 41 à une maladie cardiovasculaire. Les associations ont été caractérisées par des modèles multivariés de Cox à risques proportionnels. Résultats et analyse statistique Les tertiles de DII sexe-spécifiques étaient positivement associés à la mortalité par cancers et maladies cardiovasculaires (RR T3 vs T1 = 1,53 [1,01–2,33], p = 0,04) et par cancer uniquement (RR T3 vs T1 = 1,84 [1,12–3,00], p = 0,01). La p -value correspondante pour toutes causes de mortalité était de 0,07. Le DII était significativement associé à une augmentation de la mortalité dans le groupe placebo de l’essai *** (RR T3 vs T1 = 2,11 [1,15–3,85], p = 0,02), mais pas dans le groupe supplémenté en antioxydants ( p = 0,8 ; P-interaction = 0,1). Conclusion Ces résultats suggèrent qu’une alimentation pro-in

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Correction to: The association between the inflammatory potential of diet and risk of developing, and survival following, a diagnosis of ovarian cancer

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European journal of nutrition 2019年第4期58卷 1757页

作者： C M Nagle T Ibiebele N Shivappa J R Hébert A DeFazio P M Webb Gynaecological Cancers Group QIMR Berghofer Medical Research Institute Locked Bag 2000 Royal Brisbane Hospital Herston QLD 4029 Australia. christina.nagle@qimrberghofer.edu.au. Faculty of Medicine School of Public Health The University of Queensland Brisbane Australia. christina.nagle@qimrberghofer.edu.au. Gynaecological Cancers Group QIMR Berghofer Medical Research Institute Locked Bag 2000 Royal Brisbane Hospital Herston QLD 4029 Australia. Cancer Prevention and Control Program University of South Carolina 915 Greene Street Suite 241-2 Columbia SC 29208 USA. Department of Epidemiology and Biostatistics Arnold School of Public Health University of South Carolina 915 Greene Street Suite 400 Columbia SC 29208 USA. Connecting Health Innovations LLC (CHI) 1417 Gregg Street Columbia SC 29201 USA. Centre for Cancer Research The Westmead Institute for Medical Research The University of Sydney Sydney Australia. Department of Gynaecological Oncology Westmead Hospital Sydney Australia. Faculty of Medicine School of Public Health The University of Queensland Brisbane Australia.

In the original publication of this article on page 6, paragraph "Discussion", line 4, 'In a U.S. population-based case-control study (n = 493 cases) Peres et al., reported a non-significant association between DII score and risk of developing ovarian cancer of similar magnitude (OR DII score 1.35, 95% CI 0.93-1.97) [20]'. It should read as 'In a U.S. population-based case-control study (n = 493 cases) Peres et al., reported a significant association between DII score and risk of developing ovarian cancer (OR DII score 1.72, 95% CI 1.18-2.51) [20]'.

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Spatial and temporal analysis of tuberculosis in Zhejiang Province, China, 2009-2012

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Infectious Diseases of Poverty 2016年第1期5卷 87-96页

作者： Erjia Ge Xin Zhang Xiaomeng Wang Xiaolin Wei School of Biomedical Sciences The Chinese University of Hong KongHong KongS.A.R.China The Chinese University of Hong Kong Shenzhen Research InstituteShenzhenChina TB Program Zhejiang Centre for Disease Control and PreventionNo.630 Xincheng RoadBinjiang DistrictHangzhouZhejiang 310051China JC School of Public Health The Chinese University of Hong Kong2/FSchool of Public HealthPrince of Wales HospitalShatinHong KongChina. Dalla Lana School of Public Health University of Toronto155 College StreetTorontoON M5T 3 M7Canada

Background:Tuberculosis(TB)is an infectious disease of major public health *** disease has demonstrated large space-time *** study aims to explore the space-time dynamics of TB cases in an economically and geographically dynamic province in China with specific references of TB control for policy ***:Data on all reported TB cases from 2009 to 2012 were collected from the TB program at the Zhejiang Provincial Center for Disease control and *** employed time series and exploratory spatial data analyses,including Moran’s I,Local Getis’s G_(i)^(*),and Kulldorff’s space-time scan statistics,to identify the temporal trends and spatial patterns of TB at a county ***:A total of 147,941 TB cases were reported during 2009–2012 in Zhejiang.A higher proportion of TB cases were younger,male,and registered permanent residents among all TB cases notified in the *** cases were reported most frequently in April with small peaks in June,July,and *** disease was spatially clustering with Moran’s I values ranged from 0.29 to 0.32(p<0.001).A most likely cluster and ten secondary clusters were identified,mainly concentrated in the southeast and west counties of the ***:This study identified seasonal patterns and significant space-time clusters of TB cases in Zhejiang,***,migration,and seasonal effects may play important roles in potential clusters.

关键词： Tuberculosis spatial analysis space-time clusters Zhejiang China

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2498. Association of Increasing Age With Hospitalization Rates, Clinical Presentation, and Outcomes Among Older Adults Hospitalized With Influenza—US Influenza Hospitalization Surveillance Network (FluSurv-NET)

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Open Forum Infectious Diseases 2018年第SUPPL_1期5卷 S750–S750页

作者： Czaja, Christopher Miller, Lisa Alden, Nisha Wald, Heidi Cummings, Charisse Nitura Rolfes, Melissa Garg, Shikha Anderson, Evan J Bennett, Nancy M Billing, Laurie Chai, Shua J Eckel, Seth Mansmann, Robert McMahon, Melissa Monroe, Maya Muse, Alison Risk, Ilene Schaffner, William Thomas, Ann Yousey-Hindes, Kimberly Herlihy, Rachel Epidemiology Colorado School of Public Health Aurora Colorado Colorado Department of Public Health and Environment Denver Colorado Preventive Medicine Residency Program University of Colorado School of Public Health Aurora Colorado SCL Health Broomfield Colorado Influenza Division Centers for Disease Control and Prevention Atlanta Georgia Georgia Emerging Infections Program (EIP) Atlanta Georgia Pediatrics and Medicine Emory University School of Medicine Atlanta Georgia University of Rochester School of Medicine and Dentistry Rochester New York Ohio Department of Health Columbus Ohio California Department of Public Health Oakland California Communicable Disease Division Michigan Department of Health and Human Services Lansing Michigan New Mexico Emerging Infections Program Albuquerque New Mexico Minnesota Department of Health St. Paul Minnesota Maryland Department of Health and Mental Hygiene Baltimore Maryland New York State Department of Health Albany New York Salt Lake County Health Department Salt Lake City Utah Vanderbilt University School of Medicine Nashville Tennessee Oregon Public Health Division Portland Oregon Connecticut Emerging Infections Program Yale School of Public Health New Haven Connecticut

Background Few data describe the epidemiology of influenza among adults ≥65 years old according to age strata. We evaluated age-related differences in influenza-associated hospitalization rates, clinical presentation, and outcomes among older adults at 14 FluSurv-NET sites during the 2011–2012 through 2014-2015 influenza seasons. Methods Study patients were hospitalized ≤14 days after and ≤3 days before a positive influenza test. Age strata were 65–74, 75–84, and ≥85 years old. We adjusted hospitalization rates for under detection and assessed for age-related trends in risk factors and symptoms. We used logistic regression to calculate odds ratios (OR) for pneumonia and in-hospital death adjusted for season, sex, nursing home residence, smoking, medical comorbidities, influenza vaccination, and study site. Results There were 19,760 patients, including 5,956 aged 65–74 years, 6,998 aged 75–84 years, and 6,806 aged ≥85 years. There was a stepwise increase in hospitalization rates with age (figure). Increasing age was positively associated with female sex, nursing home residence, neurologic disorder, cardiovascular and renal disease, and vaccination, and inversely associated with morbid obesity, smoking, asthma, chronic metabolic disease, and immunosuppression ( P < 0.01). Among 10,548 (53.3%) patients with symptom data from 2014 to 2015, increasing age was associated with a higher prevalence of altered mental status and lower prevalence of fever, myalgias, respiratory or gastrointestinal symptoms, and headache ( P ≤ 0.01). Compared with 65–74 year olds, older patients had a higher risk of pneumonia (≥85 year-olds: OR 1.2, 95% CI 1.0, 1.3, P = 0.01) and death (75–84 year olds: OR 1.4, 95% CI 1.2, 1.7, P < 0.01; ≥85 year-olds: OR 2.1, 95% CI 1.7, 2.6, P < 0.01). Conclusion There are age-related differences in the epidemiology, clinical presentation, and outcomes of older adults hospitalized with influenza. These may reflect differences in health status and healthcare pr

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Preventing the Emergence of Multidrug-Resistant Microorganisms Through Antimicrobial Use controls: The Complexity of the Problem

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Infection control & Hospital Epidemiology 2015年第8期17卷 490-495页

作者： William R. Jarvis Investigation and Prevention Branch Hospital Infections Program National Center for Infectious Diseases Centers for Disease Control and Prevention Atlanta Georgia

Widespread use of antimicrobials in the inpatient and outpatient setting has been associated with the emergence of multidrug-resistant microorganisms. A variety of methods exist to improve the appropriateness of antimicrobial use in the inpatient setting, including guidelines, antimicrobial use evaluations, microbiology laboratory guidance, formulary development and antimicrobial restriction, use of antimicrobial order or automatic stop order forms, and antimicrobial audits. To decrease the selective pressure that leads to development of pathogen resistance and to reduce antimicrobial expenditures, infectious disease, infection control, pharmacy, and administrative staff need to improve clinician use of antimicrobials through development and implementation of antimicrobial use committees. Through the implementation of a comprehensive, multidisciplinary approach to antimicrobial use and development of clinician education programs, inappropriate antimicrobial use can be reduced, patient care can be improved, and substantial cost savings can be realized.

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