Long-term follow-up data over two years were available.RESULTS:\n\nAmong the patients studied click here (mean age 62 years), 64% presented with acute coronary syndrome. A PCI procedure was associated

with a significant increase in TnT levels (higher than 0.1 mu g/L) in 238 patients (20%). Multivariate logistic regression identified presentation with acute coronary syndrome or myocardial infarction, no statin use at the time of the procedure, increased CRP and increasing length of stent as independent predictors of TnT rise following PCI. Periprocedural TnT rise was not associated with adverse events in follow-up examinations (OR 1.09, 95% CI 0.73 to 1.65).CONCLUSIONS:\n\nMyocardial necrosis commonly occurred in otherwise successful PCI and was particularly prevalent in the proinflammatory milieu of a recent

myocardial infarction. This response was blunted with statin therapy. However, there was no long-term adverse sequelae of these troponin rises following otherwise uncomplicated PCI.”
“Near miss based analysis has been recently suggested to be more important in the medical field than focusing on adverse events, as in the industrial field To validate the utility of near miss-based analysis in the medical fields, we investigated whether or not predictors of near misses and adverse events were similar among nurses at teaching hospitals Of the 1,860 nurses approached, BAY 80-6946 ic50 1,737 (93 4%) were included in the final analysis Potential predictors provided for analysis included gender, age, years of nursing experience, frequency of alcohol consumption, work place, ward rotation, frequency of night shifts, sleepiness during work, frequency of feeling unskilled, nurses’ job stressors, working conditions, and depression Variables for multivariate analysis

were determined by bivariable analysis Ordinal logistic analysis showed that predictors of near misses and adverse events were markedly similar Parameters that were significantly related to both near misses and adverse events were years of experience, frequency of night shifts, Internal ward, and time pressure (p<0 05 for all) The present study suggested that there was a negligible difference between choosing near miss- or adverse event-based analysis when identifying possible causes EX 527 nmr of adverse events in the medical field”
“Background: There is a lack of evidence-based criteria to assist the diagnosis of infection following trauma splenectomy (TS). However, the literature suggests that white blood cell count (WBC) is associated with infection in patients who undergo TS. We sought to find whether there exist key differences in laboratory and clinical parameters that can assist the diagnosis of infection after TS. Methods: We evaluated all consecutive trauma patients who had undergone TS at a Level 1 trauma center from 2005 to 2011 for the development of infection.

All patients were screened with transesophageal echocardiography before the operation. All patients underwent intracardiac echocardiography study and attempted closure.\n\nResults Ten patients (7.1%) underwent an attempt at transcatheter closure in the presence of hypertrophy of the rims (eight patients)

or lipomatosis (two patients). All patients were aged more than 50 years and has multiple recurrent stroke events (nine patients) or need for a posterior cerebral surgical procedure (one patient) making closure mandatory. After intracardiac echocardiography study and measurements, two 25 mm Amplatzer and eight 25 mm Premere Occlusion System devices have been implanted successfully. On mean follow-up of 36.6 +/- 14.8 months, two patients had a small residual shunt: no recurrence of stroke or aortic erosion or device thrombosis was observed buy GDC-0973 during this BAY 73-4506 Protein Tyrosine Kinase inhibitor period.\n\nConclusion Transcatheter PFO closure in the presence of hypertrophy or lipomatosis of fossa ovalis rims is not contraindicated per se: careful evaluation of rim thickness with intracardiac echocardiography and selection of soft and asymmetrically opening devices may allow for a safe and effective PFO closure, at least in patients with no severe atrial septal aneurysm. J Cardiovasc Med 11:91-95 (C) 2010 Italian Federation of Cardiology.”
“Conventional

tissue fixation and processing is as old as 100 years and click here still remains the gold standard against which all new technologies and methods need to be assessed. Tissue processing is one of the important steps for obtaining good thin sections without artifacts. Though conventional tissue-processing methods are most commonly followed, they are well-known as very laborious and tedious procedures. Microwaves a form of electromagnetic wave-induced heat, when applied in histotechnology, reproducibly yields histolologic material of similar or superior quality to that provided by conventional processing methods, making it more popular in the recent years. A laboratory microwave offers features like

maximum output of 2000-3000 watts, an in-built source of adjustable temperature probe, facility for ventilation of hazardous fumes, but is expensive. Considering the usefulness of microwave in histotechnology, i.e., reducing the time required for the diagnosis, replacing the conventional equipments of laboratories by microwave-guided ones is a remarkable and an acceptable change.”
“Saimiri sciureus is one of the smallest Cebidae native of Amazon region and also found at the biological reserve of northeast Atlantic forest. It is an omnivore animal, with diversified diet that directly influences the lingual mucosa, which includes certain types of papillae with different organization levels. The present study attempted to describe the morphological and ultrastructure aspects of the dorsal surface of the S. sciureus. Five tongues of de S.

(J. Endocrinol. Invest. 33: 48-53, 2010) (c) 2010, Editrice Kurtis”
“Objectives: Dermatofibrosarcoma protuberans (DFSP) is a spindle cell tumor with a high local recurrence rate. Wide excision (WE) has been the standard treatment, but ideal margin width is poorly defined and Mohs micrographic

surgery (MMS) has emerged as an alternative procedure. This study examines the use of WE versus MMS for the treatment of primary DFSP at a single institution.\n\nMethods: Nirogacestat molecular weight Retrospective review of 48 primary DFSP cases treated from 1971 to 2006. Patient demographics, tumor features, surgical modality (WE vs. MMS), final pathology, and clinical outcome were evaluated.\n\nResults: Twenty-eight patients underwent WE versus 20 patients for MMS. Median age was 40 years. Median WE margin width was 2 cm. For MMS, the median number Dihydrotestosterone of layers required to clear the tumor was 2. Median maximal

defect size was 10 cm for WE versus 9.4 cm for MMS. Advanced closure techniques were required for 18% WE versus 65% MMS (P = 0.001). Median operative time was significantly lower for WE at 77 minutes versus 257 minutes for MMS (P < 0.001). Positive margins were present in 21.4% (6/28) WE versus 0% MMS (P = 0.01). At a median follow-up of 49.9 months for WE and 40.4 months for MMS, local recurrence rates were 3.6% (1/28) and 0%, respectively (P = 1.0).\n\nConclusions: From a surgical standpoint, WE was faster than MMS and resulted in a less complex defect/closure. Although positive margin resection was more common with WE, local control was ultimately similar for the 2 surgical modalities. The choice of WE versus MMS should be based on individualized patients/tumor characteristics and institutional expertise in these modalities.”
“The use of MRI in preoperative staging of breast cancer has escalated

recently. Breast MRI has greater sensitivity than mammography, ultrasound, and clinical examination in cancer detection. Because of its variable specificity, however, there has been concern that increased MRI use will result in increased rates of mastectomy for early-stage breast cancer. Dorsomorphin We postulated that mastectomy rates are not affected by trends in MRI use. We performed a retrospective analysis of imaging tests ordered by surgeons at our breast center from 2003 to 2007. We also reviewed all breast cancer cases reported to the National Cancer Database from our institution during the same time period and categorized them as having been treated with mastectomy or breast-conserving surgery. From 2003 to 2007, the number of breast MRIs ordered annually by surgeons increased from 68 to 358. The rate of MRI use increased from 4.1 per every 100 patients seen to 5.7 and from 1.6 per every 100 new patients seen to 2.9.

Our results reinforce a newly emerging theme in which multiple proteins of a complex are collectively SUMOylated in response to a specific stimulus, leading to accelerated complex formation and enhanced function.”
“A new quantum control scheme for general multilevel systems using intense laser fields is proposed. In the present scheme, the target subspace consisting of several quantum levels is effectively isolated by applying intense cw lasers with specific conditions. The formulation is carried out using the Green function with the help of projection operator

selleck inhibitor method. Dynamics of the isolated target subspace is governed by an effective Hamiltonian. The developed scheme is applied to the quantum control of dissipative four- and five-level systems. It is

clarified that the present method makes it possible not only to manipulate the coherent population dynamics but also to suppress the dissipative dynamics.”
“Aims: The purpose of the present study was to investigate the relationship between delusional thoughts (delusional ideation or misidentification) and frontal lobe function using the Japanese version of the Frontal Assessment Battery (FAB) bedside screening neuropsychological test in early stage Alzheimer’s disease ( AD) patients.\n\nMethods: Forty-eight probable AD patients with Mini-Mental State Examination score >= 18 points and a clinical dementia rating score of either 0.5 or PD-1/PD-L1 Inhibitor 3 in vitro 1.0 were divided into two groups based on data obtained from interviews with their caregivers: a delusional thought group (n = 19) and a non-delusional thought group (n = 29). The FAB total and subtest scores were then compared

for the two groups.\n\nResults: Significant differences were found between the FAB total ( P < 0.01) and subtest scores (similarities, motor series, conflicting instructions; P < this website 0.05) for the two groups. Multiple regression analysis showed that delusional thought was significantly associated with the FAB total score.\n\nConclusions: In addition to episodic memory disorders, a reduction in the FAB score may reflect frontal lobe dysfunctions, including executive function, in patients with AD, leading to delusional ideation.”
“A European Robin (Erithacus rubecula) found dead in England had marked blepharitis and periocular alopecia associated with Aprocta cylindrica (Nematoda: Aproctidae) and concurrent mixed fungal infections. Aprocta cylindrica should he considered a differential diagnosis in periocular abnormalities of robins and other insectivorous, migratory passerines in Western Europe.”
“Voltammetric behavior of dopamine was studied on a glassy carbon electrode (GCE) modified-NiFe2O4 magnetic nanoparticles decorated with multiwall carbon nanotubes. Impedance spectroscopy and cyclic voltammetry were used to characterize the behavior of dopamine at the surface of modified-GCE. The modified electrode showed a synergic effect toward the oxidation of dopamine.

Furthermore, Bradyrhizobium sp. strain 4-1, also very close to B. elkanii, isolated from Japanese paddy field soil, degraded methoxychlor. These B. elkanii and closely related strains degraded methoxychlor S63845 in vitro through almost identical metabolic pathways, and

cleaved the phenyl ring and mineralized. In contrast, another representative Bradyrhizobium species, B. japonicum (USDA110), did not degrade methoxychlor at all. Based on these findings, B. elkanii and closely related strains are likely to play an important role not only in providing the readily biodegradable substrates but also in completely degrading (mineralizing) methoxychlor by themselves in the soil and surface water environment.”
“Sterile injury can trigger an acute inflammatory response, which might selleck chemicals llc be responsible for the pathogenesis of several diseases, including rheumatoid arthritis, lung fibrosis and acute liver failure. A key event for

the pathogenesis of these diseases is the recruitment of leukocytes to necrotic areas. Much is known about the mechanisms of recruitment to sites of infection. However, only now is it becoming clear how leukocytes, especially neutrophils, are recruited to areas of tissue damage and necrosis in the absence of infection. Here, we review and discuss mechanisms responsible for sensing and driving the influx of leukocytes, specifically neutrophils, into sites of sterile injury. This knowledge clearly opens new opportunities for therapeutic intervention. (C) 2011 Elsevier Inc. All rights reserved.”
“Improved

methods for the accurate identification of both the presence and severity of cervical intraepithelial neoplasia (CIN) and extent of spread of invasive carcinomas of the cervix (IC) are needed. Differential scanning calorimetry (DSC) has recently been shown to detect specific changes in the thermal behavior of blood plasma proteins in several diseases. This methodology is being explored to provide a complementary approach for screening of cervical disease. The present study evaluated the utility of DSC in differentiating between healthy controls, increasing severity of CIN and early and advanced IC. Significant discrimination was apparent relative to the extent of disease with no clear effect of demographic factors such as age, ethnicity, smoking status and parity. Of most Citarinostat molecular weight clinical relevance, there was strong differentiation of CIN from healthy controls and IC, and amongst patients with IC between FIGO Stage I and advanced cancer. The observed disease-specific changes in DSC profiles (thermograms) were hypothesized to reflect differential expression of disease biomarkers that subsequently bound to and affected the thermal behavior of the most abundant plasma proteins. The effect of interacting biomarkers can be inferred from the modulation of thermograms but cannot be directly identified by DSC. To investigate the nature of the proposed interactions, mass spectrometry (MS) analyses were employed.

Significant increase in

the number of apoptotic cells was observed in embryos treated with PRL-MO compared to control embryos injected with control morpholino or non-injected controls. The number of apoptotic cells increased more significantly between 15 and 35 h post-fertilization in the PRL-MO treated group than that of the control. Interestingly, apoptotic cells were restricted to the central nervous system, particularly in the eyes and brain. Apoptosis of these cells was further demonstrated using the comet assay to detect DNA damage, a hallmark of apoptosis. it was found that the level Quizartinib cell line of DNA damage was dose-dependent on the concentration of PRL-MO injected and consistent with higher levels of nick ends detected by the TUNEL assay in PRL-MO embryos. Further examination of apoptotic

genes indicated the transcript of caspase-8, a representative caspase gene of the extrinsic pathway, Was Much higher in prolactin knockdown embryos than the non-injected control. Together, these results Suggest that prolactin acts as a Survival factor during zebrafish embryogenesis. (C) 2008 Elsevier Inc. All rights reserved.”
“Background: HIV-1 and HIV-2 are two related viruses with distinct clinical outcomes, where HIV-1 OICR-9429 solubility dmso is more pathogenic and transmissible than HIV-2. The pathogenesis of both infections is influenced by the dysregulation and deterioration of the adaptive immune system. However, their effects on the responsiveness of innate immunity are less well known. Here, we report on toll-like receptor (TLR) stimuli responsiveness

in HIV-1 or HIV-2 infections. Methods: Whole blood from 235 individuals living in Guinea-Bissau who were uninfected, infected with HIV-1, infected with HIV-2, and/or infected with HTLV-1, was stimulated with TLR7/8 and TLR9 agonists, R-848 and unmethylated CpG DNA. After TLR7/8 and TLR9 stimuli, the expression levels of IL-12 and IFN-alpha were related to gender, age, infection status, CD4(+) T cell counts. and plasma viral load. Results: Defective TLR9 responsiveness was observed in the advanced disease stage, along with CD4(+) T cell loss in both HIV-1 Fosbretabulin and HIV-2 infections. Moreover, TLR7/8 responsiveness was reduced in HIV-1 infected individuals compared with uninfected controls. Conclusions: Innate immunity responsiveness can be monitored by whole blood stimulation. Both advanced HIVA and HIV-2 infections may cause innate immunity dysregulation. (C) 2009 Elsevier Ltd. All rights reserved.”
“AMPA receptors are glutamate-gated ion channels that are essential mediators of synaptic signals in the central nervous system. They form tetramers that are assembled as combinations of subunits GluR 1-4, each of which contains a ligand-binding domain (LBD). Crystal structures of the GluR2 LBD have revealed an agonist-binding cleft, which is located between two lobes and which acts like a Venus flytrap.

\n\nResults: Obvious changes in electrocardiographic patterns were found in rats following MDMA administration. They were characterized by prolonged QRS duration associated with increased amplitude of QRS complex. The heart rates in treated rats were significantly decreased compared to the rats in the control group. The immunohistochemical findings revealed a significant decrease in Cx43 expression. The in vitro study also showed a marked decline in total Cx43 protein associated with reduction of Cx43 mRNA, whereas the phosphorylated Cx43 at Ser368 was increased. Decrease of junctional Cx43 was found correlated with reduction in

N-cadherin induced by high concentration LY2606368 of MDMA. Additionally, confocal microscopy findings revealed alteration of intracellular calcium oscillation patterns characterized by high frequency and increasing influx Ca2+.\n\nConclusions: MDMA reduces expression of cardiac gap junction protein Cx43. The increase of phosphorylation status of Cx43 at Ser368 induced by MDMA is attributed, at least in part, to the Ca2+-dependent regulation of

protein kinase C (PKC) activity. Our findings provide first evidence of MDMA-mediated changes in those cardiac gap junctions that may underlie MDMA-induced cardiac arrhythmia. (c) 2013 Elsevier Ireland Ltd. All rights reserved.”
“Alkylamides are a group of active components of the widely used herb Echinacea purpurea (E. purpurea), which have immunostimulatory and anti-inflammatory effects. For the most abundant

alkylamides, dodeca-2E,4E,8Z,10E/Z-tetraenoic acid isobutylamides (DTAI), an LC-MS/MS assay has been developed and validated LY3023414 mw for quantification in human plasma. This assay will OSI-906 price be used to support a clinical interaction study with E. purpurea. A 300 mu L plasma aliquot underwent liquid-liquid extraction with diethylether-n-hexane (50:50, v/v). After evaporization and reconstitution in 100 mu L of acetonitrile-water (50:50, v/v) 20 mu L. of sample were injected into the HPLC system. Chromatographic separation was achieved with a Polaris 3 C18-A column (50 mm x 2 mm ID, particle size 3 mu m), a flow rate of 0.3 mL/min and isocratic elution with acetonitrile-water (50:50, v/v) containing 0.1% formic acid during the first 5 min. Hereafter, gradient elution was applied for 0.5 min, followed by restoration of the initial isocratic conditions. The total run time was 7.5 min. The assay was validated over a concentration range from 0.01 to 50 ng/mL for DTAI, with a lower limit of quantification of 0.01 ng/mL Validation results show that DTAI can be accurately and precisely quantified in human plasma. DTAI also demonstrated to be chemically stable under relevant conditions. Finally, the applicability of this assay has been successfully demonstrated by measuring the plasma concentration of DTAI in patients after ingestion of a commercial extract of E. purpurea. (C) 2012 Elsevier B.V. All rights reserved.”
“Tools restricting the movements of invasive species (e.g.

The three-factor model of illness self-management and recovery was represented by dimensions of recovery, management, and substance use. These reliable psychometric properties support the use of both the original one-factor and revised three-factor models to assess illness self-management and recovery among a broad spectrum of clients with mental illness. (C) 2012 Elsevier Ireland Ltd. All rights reserved.”
“Viruses are thought to spread across susceptible cells through an iterative process of infection,

replication, and release, so that the rate of spread is limited by replication kinetics. Here, we show that vaccinia virus spreads across one cell every 75 minutes, fourfold faster than its replication cycle would permit. To explain this phenomenon, we found that newly infected cells express two surface proteins that mark cells as infected and, via exploitation of cellular

machinery, induce the repulsion GSK690693 mouse of superinfecting virions away toward uninfected cells. Mechanistically, early expression of proteins A33 and A36 was critical for virion repulsion and rapid spread, and cells expressing these proteins repelled exogenous virions rapidly. Additional spreading mechanisms may exist for other viruses that also spread faster than predicted by replication kinetics.”
“Pregnant women with a mechanical heart prosthesis are at a higher risk of thromboembolic www.selleckchem.com/products/z-vad-fmk.html complications. The optimal anticoagulation learn more strategy in this setting remains unclear. When prosthesis thrombosis happens and cardiac surgery must be performed, the risk of fetal mortality is high. Special attention must be paid to improve the placental perfusion during cardiopulmonary bypass (CPB) in order to improve fetal outcomes. A 31-year-old woman, nine weeks pregnant, was admitted to our institution due to a mitral mechanical

prosthesis thrombosis. She had been receiving low molecular weight heparin (LMWH) since pregnancy was detected. She underwent a mitral valve replacement with CPB at 34 degrees C and a short cardiac arrest time. Both mother and fetus survived. We briefly review the different anticoagulation options during pregnancy and perfusion strategies on CPB to improve fetal outcomes. (c) 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.”
“Purpose. To assess patient expectation, visual improvement, and patient satisfaction after macular hole surgery.\n\nMethods. Fifty-three consecutive patients completed a self-administered questionnaire after macular hole surgery. Responses for expectation of visual improvement before surgery and subjective visual assessment after surgery were scored from 0 to 10 (0 = no improvement in vision, 10 = full improvement). Visual acuity was measured using Snellen charts and converted to logMAR equivalent for statistical analysis. Wilcoxon and Mann-Whitney U tests were performed using the Minitab statistical software program; p < 0.

We showed that the Toll-like receptor ligands lipopolysaccharides and cytosine-phosphatidyl-guanines significantly induce HIF-1 alpha mRNA and protein, leading to elevated HIF-1 Bcl-2 inhibitor target gene expression of vascular

endothelial growth factor. In contrast, polyinosinic: polycytidylic acid did not show comparable effects. Furthermore the potential to up-regulate inflammatory cytokines critically influences DC function. Our data demonstrate that HIF-1 alpha protein is needed for adequate production of interferon-alpha and -beta. In co-cultures of DCs and cytotoxic T cells, we observed that DCs lacking active HIF-1 alpha protein induce significantly less CD278 and granzyme B mRNA in T cells. We conclude that HIF-1 a plays a crucial role in DC interferon production and T cell activation, linking the innate and adaptive immune system.”
“Background: Smoking is not associated

with prostate cancer incidence in most studies, but associations between smoking and fatal prostate cancer have been reported.\n\nMethods: During 1992 and 2000, lifestyle information was assessed via questionnaires and personal interview in a cohort of 145112 European men. Until 2009, 4623 incident cases of prostate cancer were identified, ALK tumor including 1517 cases of low-grade, 396 cases of high grade, 1516 cases of localised, 808 cases of advanced disease, and 432 fatal cases. Multivariable Cox proportional hazards regression models were used to examine the association of smoking status, smoking intensity, and smoking duration

with the risk of incident and fatal prostate cancer.\n\nResults: Compared with never smokers, current smokers had a reduced risk of prostate selleck kinase inhibitor cancer (RR = 0.90, 95% CI: 0.83-0.97), which was statistically significant for localised and low-grade disease, but not for advanced or high-grade disease. In contrast, heavy smokers (25+ cigarettes per day) and men who had smoked for a long time (40+ years) had a higher risk of prostate cancer death (RR = 1.81, 95% CI: 1.11-2.93; RR = 1.38, 95% CI: 1.01-1.87, respectively).\n\nConclusion: The observation of an increased prostate cancer mortality among heavy smokers confirms the results of previous prospective studies.”
“Oxidative stress occurs as a result of imbalance between generation and detoxification of reactive oxygen species (ROS). This kind of stress was rarely discussed in connection with foreign protein production in Escherichia coli. Relation between cytoplasmic recombinant protein expression with H2O2 concentration and catalase activity variation was already reported. The periplasmic space of E. coli has different oxidative environment in relative to cytoplasm and there are some benefits in periplasmic expression of recombinant proteins. In this study, hydrogen peroxide concentration and catalase activity following periplasmic expression of mouse IL-4 were measured in E. coli.

BubR1-depleted oocytes then arrest before completing MI, marked by failure of polar body extrusion. Both meiotic defects in BubR1-depleted oocytes are due to reduced activity of the master regulator known as the anaphase-promoting complex (APC), Smoothened Agonist brought about through diminished levels of the APC coactivator Cdh1.”
“The CO2-concentrating mechanism (CCM) of Chlamydomonas reinhardtii and other microalgal species is essential for photosynthetic growth in most natural settings. A great deal has been learned regarding the CCM in cyanobacteria, including identification of inorganic carbon (Ci;

CO2 and HCO3-) transporters; however, specific knowledge of analogous transporters has

remained elusive in eukaryotic microalgae such as C. reinhardtii. Here we investigated whether the limiting-CO2-inducible, putative ABC-type transporter HLA3 might function as a HCO3- transporter by evaluating the effect of pH on growth, photosynthetic Ci affinity, and [C-14]-Ci uptake in very low CO2 conditions following RNA interference (RNAi) knockdown of HLA3 mRNA levels in wild-type and mutant cells. Although knockdown of HLA3 mRNA Selleckchem BVD-523 alone resulted in only modest but high-pH-dependent decreases in photosynthetic Ci affinity and Ci uptake, the combination of nearly complete knockdown of HLA3 mRNA with mutations in LCIB (which encodes limiting-Ci-inducible plastid-localized protein required for normal Ci uptake or accumulation in low-CO2 conditions) and/or simultaneous, apparently off-target knockdown of LCIA mRNA (which encodes limiting-Ci-inducible plastid envelope protein reported to transport HCO3-) resulted in dramatic decreases in growth, Ci uptake, and photosynthetic Ci affinity, especially at pH 9, at which HCO3- is the predominant form of available Ci. Collectively, the data presented here provide compelling evidence that HLA3 is directly or indirectly involved in HCO3- transport, along with additional evidence supporting a role for

LCIA in chloroplast envelope HCO3- transport and a role for LCIB in chloroplast Ci accumulation.”
“Antimicrobial Bromosporine research buy resistance has emerged as a significant healthcare quality and patient safety issue in the twenty-first century that, combined with a rapidly dwindling antimicrobial armamentarium, has resulted in a critical threat to the public health of the United States. Antimicrobial stewardship programs optimize antimicrobial use to achieve the best clinical outcomes while minimizing adverse events and limiting selective pressures that drive the emergence of resistance and may also reduce excessive costs attributable to suboptimal antimicrobial use. Therefore, antimicrobial stewardship must be a fiduciary responsibility for all healthcare institutions across the continuum of care.