CDC Strategy	Strategy Has Barriers	Most Important Strategy
Prevent infection	28%	41%
Vaccinate	28%	44%
Get catheters out	28%	37%
Diagnose and treat	15%	26%
Pathogen-specific treatment	11%	31%
Consult experts	20%	20%
Use antibiotics wisely	29%	18%
Antibiotic control	33%	44%
Use local data	15%	5%
Treat infection, not contaminants	29%	17%
Treat infection, not colonization	35%	23%
Say "no" to vancomycin	24%	9%
Stop treatment when cured	35%	12%
Prevent transmission	21%	20%
Isolate pathogen	14%	15%
Break chain of contagion	28%	24%

CDC = US Centers for Disease Control and Prevention

	MIC >/= in mcg/mL	Susceptible MIC </= .1* (N = 10,000-18,000)	Intermediate Resistance MIC .1-1* 1600-2500	Resistance MIC 2-4* 2900-3100	Highly Resistant MIC >/= 8* 140-225
Amoxicillin	8	0*	.1	22	91
Cefotaxime	2 8	0 0	3 1	35 3	98 68
Cefuroxime	2	.1	42	99	100
Meropenem	1	0	1	49	99
Erythromycin	8	3	25	55	96
Tetracycline	8	2	4	27	14
Levofloxacin	8	.2	.3	1	1
Clindamycin	1	1	10	15	10

MIC = minimum inhibitory concentration
*Percentage resistant at designated MIC on the basis of resistance to penicillin in 4 categories

Source	Test
Antemortem
Skin biopsy	Ag detection: IFA on frozen section Rabies RNA: RT-PCR
Tears, saliva	Virus isolation
CSF	Virus RNA: RT-PCR
Serum	Serology: AB (IgG and IgM) appearing in second week must be unvaccinated
CSF	Serology: test with serum
Postmortem
Brain biopsy	Ag detection: IFA on impression smear
Needle necropsy with long needle at >/= 2	Viral RNA: RT-PCR Viral isolation: tissue culture or suckling mouse
Retrospective diagnosis	Ag detection with formalin fixed tissue

Ag = antigen; IFA = immunofluorescent assay; AB = antibodies; Ig = immunoglobulin; CSF = cerebrospinal fluid; RT-PCR = reverse-transcriptase polymerase chain reaction

	Single Antibiotics	Combination	P
Total number treated	343	155
Mortality (14 d)	11.5%	10.4%	NS
Total seriously ill*	47	47
Mortality	55.3%	23.4%	.002
ICU admissions** Mortality	23.1%	8.2%	.03
Regimens included beta-lactam	41	41
Mortality	58.4%	26.8%	.004

*Pitt bacteremia score >/= 4
**A total of 112 patients were admitted to the ICU, but the number of patients who received 1 vs 2 antibiotics was not stated.
ICU = intensive care unit

Setting	Number Affected/Number at Risk	Source
Cruise ships
Ship B	11 of 1895 (< 1%)	Person-person
Ship D	167 of 1318 ( 13%)* 189 of 1336 (14%)	Person-person
Ship F	399 of 1336 (30%)* 33 of 1269 (3%) 155 of 1273 (12%) 53 of 1253 (4%)	Person-person and foodborne
Ship G	416 of 2318 (18%)* 195 of 2456 (8%)	Foodborne, person-person, environmental
Ship G	55 of 2153 (3%) 30 of 2474 (1%)	Person-person and environmental Person-person and environmental
Ship H	288 of 1861 (15%)	Person-person
Ship I	224 of 3154 (7%)	Person-person and environmental
Land-based
Retirement home	42 of 136 (31%)	Person-person
Catered meal	11 of 23 (48%)	Foodborne
Catered meal	17 of 56 (30%)	Foodborne
Day care center	22 of 171 (13%)	Person-person
Wedding	85 of 170 (50%)	Foodborne
Restaurant	50 of 300 (17%)	Foodborne
Community	7150 of 10,000 (72%)	Waterborne
Nursing home	126 of 673 (19%)	Person-person
Nursing home	25 of 57 (44%)	Person-person
Nursing home	26 of 65 (40%)	Person-person

*Ships removed for 1 week for extensive cleaning

Strains Tested	Number
WHO -- global
Number of strains tested	24,649
Influenza A	24,393 (99%)
Number subtyped	7,191
Influenza A (H3N2)	7189 (> 99.9%)
A (H1)	2
Influenza B	249 (1%)
CDC (United States)
Number subtyped	1024
Influenza A	953 (93%)*
A (H3N2)	949 (99.5%
A (H1)	3
A H7N2	1
Influenza B	71 (7%)

*843 (89%) were drift-variant A/Fujian/411/2002
WHO = World Health Organization; CDC = US Centers for Disease Control and Prevention

Strain	Location	Cases	Deaths
H5N1	Vietnam	22	15
	Thailand	12	8
	Total	34	23 (68%)
H9N2	Hong Kong, China	1	0
H7N3	Canada	2	0
H7N2	New York	1	0

Class	Agent	Regimen	Cost
Penicillin	Amoxicillin**	875 mg every 8 hours x 7 days	$19.74
	Amoxicillin-clavulanate	500/125 mg every 8 hours x 7 days	$85.05
	Amoxicillin-clavulanate	2000/125 x 7d	$55.00
Tetracycline	Doxycycline	100 mg every 12 hours x 1 then 50 mg twice daily	$9.04
Macrolide	Azithromycin	500 mg once daily x 3 days	$45.69
	Clarithromycin	500 mg every 12 hours x 14 days	$117.60
Folate inhibitor	TMP-SMX	1 Double-strength every 12 hours	$12.20
Cephalosporins	Cefpodoxime	200 mg twice daily x 10 days	$105.40
	Cefprozil	500 mg twice daily x 10 days	$169.60
	Cefuroxime	250 mg twice daily x 10 days	$20.80
	Cefdinir	300 mg twice daily x 10 days	$87.00
	Loracarbef	400 mg every 12 hours x 10 days	$120.80
Fluoroquinolones	Ciprofloxacin	500 mg every 12 hours x 10 days	$24.20
	Gatifloxacin	400 mg once daily x 10 days	$91.50
	Levofloxacin	500 mg once daily x 10 days	$99.50
	Moxifloxacin	400 mg once daily x 10 days	$93.80

*Cost for 2003 from Verispan's Source Prescription Audit (www.verispan.com)
**Preferred by American College of Physicians guidelines
TMP-SMX = trimethoprim-sulfamethoxazole

	Fluconazole 150 mg/Week x 6 Months (n = 170)	Placebo (n = 173)
Cure -- clinical
6 months (end of treatment)	90.8%*	35.9%
9 months	73.2%*	27.8%
12 months	42.9%*	21.9%
Cure -- fungal
6 months	81.2%*	28.2%
Time to relapse (median)	8.4 months*	1.9 months

P </= .05

	1999	2000/2001
Hospital fluoroquinolone use
(Defined daily doses/1000 patient-days)	132 ± 54*	155 ± 69**
Community fluoroquinolone use
(Defined daily doses/1000 inhabitant days)	2.3 ± 0.6	2.8 ± 0.7**
Fluoroquinolone-resistant
P aeruginosa	29%	36%**

*Mean ± standard deviation
**P < .001

Issue	Recommendation
Route of inhalation	Orotracheal
Systematic search for maxillary sinusitis	No recommendation
Frequency of ventilatory circuit changes	New circuit for each patient; change circuits only if soiled
Airway humidification	Heat and moisture in absence of contraindications; weekly changes in exchangers
Endotracheal suctioning	Closed suction system for each patient
Subglottic drainage	Consider
Chest physiology	No recommendation
Use of kinetic bed	Consider
Semirecumbent position	45° if no contradiction
Stress ulcer prophylaxis	Sucralfate should not be used to reduce risk of VAP
Selective decontamination	No recommendation

VAP = ventilator-associated pneumonia

	HIV	HBsAg	HCV	HTLV
Prevalence (%)	.09	.23	1.09	.07
Incidence rates/100,000 patient-years	30.12	18.33	12.38	5.59
Viremia at donation (1/)	55,000	34,000	42,000	128,000
Upper bounds (1/)	22,000	19,000	17,000	41,000
Nucleic acid-amplification screening (1/)	173,000	100,000	421,000	---

HBsAg = hepatitis B surface antigen; HCV = hepatitis C virus; HTLV= human T-cell lymphotrophic virus