Common Abbreviations & Acronyms Used In Pharmaceuticals

 

Abbreviations data base is the best available abbreviation collection which extensively lists out common and useful acronyms and abbreviations related to the pharmaceutical industry.

 

This collection includes, abbreviations  connected with Regulatory affairs, Pharmacovigilance (PV), Clinical trials, cGMP, Quality Assurance, Quality Control etc. 

 

 

This data base is updated on regular basis (last updated on 10^th March 2020) to catch up new terminologies.

 

 

AADA:	Abbreviated Antibiotic Drug Application
AAO:	American Academy of Ophthalmology
ADE:	Adverse Drug Event
ADME:	Absorption, Distribution, Metabolism, and Excretion
ADI:	Acceptable Daily Intake
ADR:	Adverse Drug Reaction
ADRS:	Adverse Drug Reporting System
AGDUFA:	Animal Generic Drug User Fee Act
AHU:	Air Handling Unit
ALCOA:	Acronym referring to Attributable, Legible, Contemporaneous, Original and Accurate.
ALCOA PLUS:	Acronym referring to Attributable, Legible, Contemporaneous, Original and Accurate ‘plus’ Complete, Consistent, Enduring, and Available.
AME:	Absorption, Metabolism, Excretion
ANDA:	Abbreviated New Drug Application
ANOVA:	Analysis of Variance
ANVISA:	Agência Nacional de Vigilância Sanitária (National Health Surveillance Agency Brazil)
AP:	Applicants Part (of EDMF)
API:	Active Pharmaceutical Ingredient
APIC:	Active Pharmaceutical Ingredients Committee
APR:	Annual product review (APQR – Annual product quality review)
AQL:	Acceptable Quality Level
AR:	Analytical Reagent
ARB:	Angiotensin Receptor Blocker
ASHRAE:	American Society of heating, Refrgeration and  Air Conditioning Engineers
ASM:	Active Substance Manufacturer
ASME:	American Society of Mechanical Engineers
ASMF:	Active Substance Master File
ASQ:	American Society for Quality
AST:	Accelerated Stability Testing
ASTM:	American Society for Testing and Materials
BA/BE:	Bioavailability/Bioequivalence
BCS:	Biopharmaceutical Classification System
BET:	Bacterial Endotoxin Test
BFS:	Blow Fill Seal
BI:	Biological Indicator
BIND:	Biological Investigational New Drug
BLA:	Biologics License Application (CBER)
BMI:	Body Mass Index
BMR:	Batch Manufacturing/Processing Record
BOD:	Biological Oxygen Demand
BOM:	Bill of Materials
BOPP:	Biaxially Oriented Polypropylene
BP:	British Pharmacopoeia
BPC:	Bulk Pharmaceutical Chemical
BPR:	Batch Packaging Record
BRMS:	Biologics Regulatory Management System
BSA:	Body Surface Area
BSE:	Bovine Spongiform Encephalopathy (Mad Cow Disease)
BSI:	British Standards Institute
BST:	Bovine Somatotropin
BsUFA:	Biosimilar User Fee Act
BTD:	Breakthrough Therapy Designation
BVC:	British Veterinary Codex
CA:	Chemical Abstracts
CAPA:	Corrective and preventive action
CANDA:	Computer Assisted New Drug Application
CAPLA:	Computer Assisted Product License Application
CAS:	Chemical Abstracts Service
CBE:	Changes Being Effected
CBER:	Center for Biologics Evaluation and Research (FDA)
CCIT:	Container Closure Integrity Test
CDER:	Center for Drug Evaluation and Research (FDA)
CDRH:	Center for Devices and Radiological Health (FDA)
CDSCO:	Central Drug Standard Control Organization (India)
CEP:	Certification of Suitability of European Pharmacopoeia Monographs
CFR:	Code of Federal Regulations
CFU:	Colony Forming Unit
CJD:	Creutzfeldt Jakob Disease
cGMP:	Current Good Manufacturing Practices
CIP:	Clean in Place
CMC:	Chemistry, Manufacturing and Controls
CMO:	Contract Manufacturing Organization
CMS:	Continuous Monitoring System
CNS:	Central Nervous System
COA:	Certificate of Analysis
COI:	Conflict of Interest
COMSTAT:	Compliance Status Information System
COP:	Clean out of Place
COPP:	Certificate of Pharmaceutical Products
CoS:	Certificate of Suitability
CPI:	Consumer Price Index
CPP:	Critical Process Parameter
CQA:	Critical Quality Attribute
CR:	Complete Response (Letter)
CRO:	Contract Research Organization
CRS:	Contamination Response System
CSA:	Controlled Substances Act
CSV:	Computer System Validation
CT:	Clinical Trial
CTD:	Common Technical Document
CVMP:	Committee on Veterinary Medical Products (EMA)
DI:	Deionized Water
DIN:	Drug Identification Number (Canada)
DMF:	Drug Master File
DOA:	Drugs of Abuse
DOE:	Design of Experiment
DOP:	Dioctyl Phthalate
DQ:	Design Qualification
DP:	Drug Product
DPC-PTR Act:	Drug Price Competition and Patent Trade Restoration Act of 1984
DPI:	Dry Powder Inhaler
DS:	Drug Substance
DUNS:	Data Universal Numbering System
EC:	European Community
ED:	Effective Dose
EDMF:	European Drug Master File
EDQM:	European Directorate for the Quality of Medicines
EFOIA:	Electronic Freedom of Information Act
EFPIA:	European Federation of Pharmaceutical Industries and Associations
EFTA:	European Free Trade Association
EH&S:	Environmental Health and Safety
EIA:	Enzyme Immunoassay
EIR:	Establishment Inspection Report (FDA)
EMA:	European Medicines Agency (Formerly European Medicines Evaluation Agency -EMEA)
EP:	European Pharmacopoeia
EPAR:	European Public Assessment Reports (EMEA)
EPS:	Expanded Polystyrene
ERP:	Emergency Response Plan
ERS:	Electronic Regulatory Submission
ERSR:	Electronic Regulatory Submissions and Review
ESG:	Electronic Submissions Gateway
ETP:	Effluent Treatment Plant
EU:	Endotoxin Unit
EU:	European Union (EU 27)
FAI:	Further Action Indicated (FDA)
FAR:	Field Alert Report (FDA)
FAT:	Factory Acceptance Testing
FBD:	Fluid-Bed Dryer
FDA:	Food and Drug Administration, United States
FDA Form 482:	FDA form for Notice of Inspection
FDA-483:	FDA form Used as a Written Notice of Deficiencies Found in Inspections
FDA-SRS:	Spontaneous Reporting System of the Food and Drug Administration
FDC:	Food, Drug, & Cosmetic
FDC:	Fixed Dose Combination
FDCA:	Federal Food, Drug, and Cosmetic Act of 1938
FFDCA:	Federal Food, Drug, and Cosmetic Act of 1938
FEI:	Facility Establishment Identifier
FEFO:	First Expiry First Out
FG:	Finished Goods
FIFO:	First in First Out
FMEA:	Failure Modes and Effect Analysis
FMECA:	Failure Modes Effects and Criticality Analysis
FOI:	Freedom of Information
FOIA:	Freedom of Information Act
FR:	Federal Register
FTA:	Fault Tree Analysis
GAMP:	Good Automated Manufacturing Practice
GARR:	Grants Application Review Request
GC:	Gas Chromatography
GCLP:	Good Clinical Laboratory Practice
GCLP:	Good Clinical laboratory practice
GCP:	Good Clinical practice
GDP:	Good Distribution practice
GEO:	Genetically Engineered Organism
GEP:	Good Engineering Practice
GGP:	Good Guidance practice
GIT:	Gastrointestinal Tract
GLP:	Good Laboratory Practice
GMO:	Genetically Modified Organism
GMP:	Good Manufacturing Practice
GPT:	Growth Promotion Test
GRAS:	Generally Recognized as Safe
GRAS/E:	Generally Recognized as Safe and Effective
GRP:	Good Review Practice
GUDUFA:	Generic Drug User Fee Amendments
GxP:	"Good x"" Practices
HACCP:	Hazard Analysis Critical Control Point
HCI:	Human-Computer Interaction
HDPE:	High Density Polyethylene
HEPA:	High Efficiency Particulate Air (filter)
HMI:	Human Machine Interface
HPLC:	High Performance Liquid Chromatography
HSA:	Health Sciences Authority, Singapore
HVAC:	Heating, Ventilating, and Air Conditioning
ICAH:	International Council on Harmonisation (Formally known as International Conference on Harmonisation)
IH:	In House
IM:	Intramuscular
IND:	Investigational New Drug
INDA:	Investigational New Drug Application
INN:	International Nonproprietary Name
IP:	Indian Pharmacopeia
IPA:	Isopropyl Alcohol
IPC:	In process Control
IPCS:	International Programme on Chemical Safety (WHO)
IPEC:	International Pharmaceutical Excipients Council
IQ:	Installation Qualification
IR:	Immediate Release
IR:	Information Request (Letter)
ISO:	International Organization for Standardization
ISPE:	International Society for Pharmaceutical Engineering
IUPAC:	International Union of Pure and Applied Chemistry
IV:	Intravenous
JP:	Japanese Pharmacopoeia
KOS:	Knowledge Organization System
LAF:	Laminar air flow
LAL:	Limulus Amoebocyte  Lysate
LAN:	Local Area Network
LD:	Lethal Dose
LD50:	Lethal Dose where 50% of the Animal Population Die
LDPE:	Low Density Polyethylene
LIMS:	Laboratory Information Management System
LIR:	Laboratory Investigation Report
LOA:	Letter of Agreement
LOA:	Letter of Authorization
LOD:	Loss on Drying
LOD:	Limit of Detection
LOQ:	Limit of Quantification
LR:	Laboratory Reagent
LVPs:	Large Volume Parenterals
MA:	Marketing Authorisation
MAA:	Marketing Authorisation Application
mAb:	Monoclonal Antibody
MAC:	Maximum Allowable Carryover
MAH:	Marketing Authorisation Holder (EC)
MDA:	Medical Devices Agency (UK)
MDD:	Maximum Daily Dose
MDI:	Metered Dose Inhaler
MDR:	Medical Device Reporting
MDUFMA:	Medical Device User Fee and Modernization Act of 2002
MDUFSA:	Medical Device User Fee Stabilization Act of 2005
MFR:	Master Formula Record
MEDSAFE:	Medicines and Medicinal Devices Safety Authority (New Zealand)
MHRA:	Medicines and Healthcare Products Regulatory Agency (UK)
MLD:	Minimum Lethal Dose
MOA:	Method Of Analysis
MRA:	Mutual Recognition Agreement
MS:	Mass Spectroscopy
MSDS:	Material Safety Data Sheets
MTD:	Maximum Tolerated Dose
NCE:	New Chemical Entity
NAI:	No Action Indicated(FDA)
NCR:	Non-Conformance Report
NDA:	New Drug Application
NDC:	National Drug Code (FDA)
NF:	National Formulary
NIR:	Near Infra Red Spectroscopy
NME:	New Molecular Entity
NMR:	Nuclear Magnetic Resonance Spectroscopy
NMT:	Not More Than
NOAEL:	No Observable Adverse Effect Level
NOC:	Notice of Compliance (Canada)
NOD:	Notice of Deficiency (Canada
NON:	Notice of Non-compliance (Canada)
NSAID:	Non-Steroidal Anti-Inflammatory Drug
OAI:	Official Action Indicated(FDA)
ODI:	Orally Disintegrating Tablet
OEL:	Occupational Exposure Level
OQ:	Operation Qualification
OSD:	Oral Solid Dosage
OSHA:	Occupational Safety And Health Administration
OOS:	Out of Specification
OOT:	Out of Trend
OTC:	Over-the-counter
PAC:	Post-approval changes
PACT:	Post-Approval Commitment Tracking
PAI:	Pre-Approval Inspection(FDA)
PAO:	Poly alpha olefin
PAS:	Prior Approval Supplement(FDA)
PAT:	Process Analytical technology
PD:	Pharmacodynamics
PDA:	Parenteral Drug Association
PDE:	Permitted Daily Exposure
PDUFA:	Prescription Drug User Fee Act
PEPFAR:	Presidential Emergency Plan for AIDS Relief
PET:	Preservative Efficacy Test
PET:	Polyethylene
Ph.Eur.:	Pharmacopeia Europa
PIC/S:	Pharmaceutical Inspection Co-operation Scheme
PK:	Pharmacokinetics
PLA:	Product License Application (CBER)
PLAIR:	Pre-Launch Activities Importation Request (USFDA)
PLC:	Programmable Logic Control
PMA:	Premarket Approval
PMF:	Public Master File
PMS:	Postmarketing Surveillance
POM:	Prescription-only medicine (UK)
ppb:	Parts per Billion
PPE:	Personal protective equipment
Ppm:	Parts per Million
PPM:	Planned Preventive Maintenance
PQ:	Performance Qualification
PQG:	Pharmaceutical Quality Group
PUDUFA:	Prescription Drug User Fee Act (FDA)
PV:	Process Validation
PVC:	Polyvinyl Chloride
PVDC:	Polyvinylidene Chloride
PW:	Purified Water
QA :	Quality Assurance
QC:	Quality Control
QbD:	Quality by design
QbR:	Question-based Review
QD:	Once Daily
QID:	Four Times a Day
QM:	Quality Manual
QMS:	Quality Management System
QOD:	Every Other Day
QP:	Qualified Person (EU)
QRM:	Quality Risk Management
QSD:	Quality System Dossier
QSM:	Quality System Management
QU:	Quality Unit
RCR:	Risk Control Review
R&D:	Research and Development
REMS:	Risk Evaluation and Mitigation Strategy
RH:	Relative Humidity
RLAF:	Reverse Laminar Air Flow
RLD:	Reference listed drug
RM:	Raw Material
RMS:	Reference Member State (Europe)
RO:	Reverse Osmosis
ROPP:	Roll On Pilfer Proof
RS:	Related Substance
RTR:	Refuse to Receive
Rx:	Prescription
SAL:	Sterility Assurance Level
SAT:	Site Acceptance Test
SDN:	Screening Deficiency Notice (Canada)
SHPRA	South African Health Products Authority [formally known as Medicines Control Council (MCC)]
SIP:	Sterilization in lace/Steam in place
SLS:	Sodium Lauryl Sulphate
SME:	Subject Matter Expert
SMF:	Site Master File
SOP:	Standard Operating Procedure
SPE:	Society for Pharmaceutical Engineering
STD:	Sexually Transmitted Disease
SUPAC:	Scale-up and Post Approval Changes
SVP:	Small Volume Parenteral
TC:	Thermocouple
TDI:	Tolerable Daily Intake
TDS:	Total Dissolved Solids
TGA:	Therapeutics Goods Administration (Australia)
TLC:	Thin Layer Chromatography
TID:	Three Times a Day
TOC:	Total Organic Carbon
TSE:	Transmissible Spongiform Encephalopathy
UDI:	Unique Device Identification
UNII:	Unique Ingredient Identifier
USFDA:	United States Foods and Drugs Administration
USP:	United States Pharmacopeia
USPC:	U.S. Pharmacopeial Convention
USP-NF:	United States Pharmacopeia-National Formulary
URS:	User Requirement Specification
UTI:	Urinary tract infection
VAI:	Voluntary Action Indicated
VMP:	Validation Master Plan
WFI:	Water for Injection
WHO:	World Health Organisation
WL:	Warning letter

 

 

Pharmacist Vacancy

Pharmacist

Clinix Pvt Ltd,Lahore, Pakistan

 

            PKR. 40,000 - 50,000 /Month

Job Details

Industry:

Retail

Functional Area:

Health & Medicine

Total Positions:

2 Posts

Job Shift:

Rotating

Job Type:

Full Time/Permanent

Job Location:

Lahore, Pakistan

Gender

No Preference

Education

Pharm-D

Degree Title

Doctor Of Pharmacy(with Certificate of registration)

Career Level

Entry Level

Minimum Experience

Fresh (Having Pharmacy experience will be preferred)

Apply Before:

Jan 17, 2023

Posting Date:

Dec 17, 2022

 

 

 

 

https://www.rozee.pk/job/detail/1333311

 

CLINICAL PHARMACIST

 

 

 CLINICAL PHARMACIST

Clinical pharmacy services offer monitoring services for warded patients by the pharmacists. 

The services including therapeutic drug monitoring, medication counseling and dispensing medications to discharged patients. 

Clinical pharmacists are involved in ward round together with other medical team. 

Clinical pharmacists are responsible for ensuring that patient treatment is at an optimal level, to ensure the patient's condition is stable, provide counseling as well as to promote the proper and effective use of drugs.

Pharmacists are drug experts. Clinical pharmacists take this knowledge and apply it to clinical scenarios.

Clinical pharmacists perform functions beyond fundamental dispensing and order-processing activities. This typically involves optimization of medication selection, dosing, and monitoring. There are a wide variety of activities that can be considered clinical pharmacy activities.

Under the clinical context there are three types of pharmacists. First is a “staff pharmacist” who performs no or limited clinical pharmacist activities. Second is a “hybrid pharmacist” who performs dispensing and order-processing activities sometimes, then clinical activities other times. Third is a “clinical pharmacist” who only performs clinical pharmacy activities. It is not very common to find a pharmacist position that solely requires clinical pharmacist activities. Which pharmacists and activities healthcare administrators consider “clinical” can vary between organizations.

Clinical pharmacists are not superior to non-clinical pharmacists, they just practice pharmacy in a different way.

Examples of clinical pharmacist activities:

• Providing pharmacotherapy support to diagnosticians during inpatient medical ward rounds so that drug selection and dosing can be optimized
• Interviewing and counseling patients in an ambulatory care clinic to ensure appropriate monitoring for safety and efficacy during treatment of hepatitis C
• Developing institutional tools that help healthcare providers make smarter decisions related to medications

2021 World Health Organization guideline on pharmacological treatment of hypertension: Policy implications for the region of the Americas

 

 

Cardiovascular disease (CVD) is the leading cause of death in the Americas and raised blood pressure accounts for over 50% of CVD. In the Americas over a quarter of adult women and four in ten adult men have hypertension and the diagnosis, treatment and control are sub optimal. In 2021, the World Health Organization (WHO) released an updated guideline for the pharmacological treatment of hypertension in adults. This policy paper highlights the facilitating role of the WHO Global HEARTS initiative and the HEARTS in the Americas initiative to catalyze the implementation of this guideline, provides specific policy advice for implementation, and emphasizes that an overarching strategic approach for hypertension control is needed. The authors urge health advocates and policymakers to prioritize the prevention and control of hypertension to improve the health and well being of their populations and to reduce CVD health disparities within and between populations of the Americas.

 

https://doi.org/10.1016/j.lana.2022.100219 

BE CAREFUL . . . . . . HIV DURING A MANICURE

Be careful......

A 22-year-old female may have contracted HIV during a manicure.
Be aware , when you're sharing the manicure equipments and utensils which in contact with blood of HIV infected patient

https://ph.theasianparent.com/hiv-risks-of-getting-a-manicure?fbclid=IwAR23YWP639jsf2EKxDw2N_0QZBn8MztOzkw7Iop4us9_3VQDFTi95vphG7g

No Antibiotic In The U.S. Could Save This Woman. We Should All Be Worried

This is one of the first cases of a pan-resistant infection in America.

The recent death of a woman in Reno, Nevada, from an infection resistant to every available kind of antibiotic in the U.S. highlights how serious the threat of antibiotic-resistant superbugs has become. 

Experts say that while cases of a bacteria resistant to all antibiotics are still extremely rare in the U.S., we should expect to see more in the future. 

“This is an important case because it serves as a reminder to the health care community that these kinds of things can show up, even though they are rare,” said Randall Todd, director of epidemiology and public health preparedness at the Washoe County Health District, who co-wrote a study on this case. “We do have other forms of drug resistance, but this is the first time we’ve seen one that is pan-resistant, meaning there was nothing in the medicine cabinet available to treat this case.”

A woman in her 70s had just come back from a long visit to India when she was hospitalized on Aug. 18 and diagnosed with systemic inflammatory response syndrome: a fever, high heart rate, abnormal white blood cell count or an abnormal breathing rate in response to either an infection or some other trauma.

Before returning to the U.S., she had been hospitalized in India several times because she had fractured her femur and gotten an infection in the thigh bone and also her hip. 

One week after she was admitted, the hospital confirmed her infection was caused by a carbapenem-resistant Enterobacteriaceae (CRE) called Klebsiella pneumoniae. Enterobacteriaceae is a kind of bacteria that can be a normal part of the human gut, but carbapenem-resistant ones don’t succumb to carbapenems — a class of antibiotics considered the last line of defense against bacterial infections. 

Doctors reacted immediately to the identification of the CRE. In keeping with national guidelines, they dedicated a select few staff to treat her exclusively and instituted strict hand-washing protocol to keep the bug from spreading to other parts of the hospital. Thankfully, she was already in a single room.

In their search for a potential cure for her infection, doctors later found out that the cause was resistant to all 14 antibiotics the facility had to offer. Further testing at the U.S. Centers for Disease Control and Prevention confirmed that it was, in fact, resistant to all 26 antibiotics in the U.S. 

The patient developed sepsis and died in early September.

The CDC published the details of this case Thursday and noted that there are three lessons to draw from her case. 

The first thing they emphasized is that bacteria resistant to all available antimicrobials are very uncommon. Of the more than 250 carbapenem-resistant bacteria samples they have tested so far, 80 percent could be controlled with at least one aminoglycoside (another class of antibiotics) and 90 percent were susceptible to tigecycline, an antibiotic that is effective against drug-resistant bacteria. 

The case also underscored the importance of infection control, as the bug posed a serious threat to other patients in the hospital. The study notes that the hospital tested all the other patients who were in the same unit and found that the CRE had not spread to them. 

Finally, knowing that the woman had been hospitalized frequently in India gave her doctors much-needed insight on the infection she could be facing. Antibiotic-resistant bacteria are more common in other parts of the world, and knowing about international hospitalizations could give doctors clues into what they’re looking for, says Lei Chen, lead author of the report and the epidemiology program manager at Washoe County Health District in Nevada. 

Chen was in close contact with the treating hospital throughout the case, and her department interviewed the woman’s household family members for any signs of illness. They were all healthy. 

A ‘slowly dripping faucet’

One problem with superbugs is that there’s no way to know where they are within a healthy population, explains Tim Johnson, an antibiotic resistance expert at the University of Minnesota’s Veterinary School.

“These are what have been referred to as the silent killers, because it’s not like salmonella, where you ingest the salmonella and get sick,” Johnson said. “You can acquire these things, and they can hang out asymptomatically without causing disease for extended periods of time in your gut.” 

He called the superbug issue a “slowly dripping faucet” that is going to leak more over time. In the meantime, the bottom line for U.S. doctors is that they should become more aware of the possibility that people can bring these superbugs back from different parts of the world.

“This is one of the first examples of a completely resistant bug,” Johnson concluded. “It’s definitely concerning — there’s no doubt about that. But it’s not something that we’re going to see rise dramatically.” 

How to resist antibiotic resistance 

We’ve known about the threat of pan-resistant bacteria for a long time but haven’t done enough to prepare, said David Weiss, director of the Emory Antibiotic Resistance Center in Atlanta. While the U.S. is taking encouraging steps to promote safe use of antibiotics, cut down on the use of antibiotics in livestock and invest in surveillance, the Nevada case demonstrates that this is a global problem that requires a global solution.

“One of the things that this case highlights is that people can pick up really nasty infections in other countries and then come home with them, so this is really a global problem,” Weiss said. “This isn’t a problem that we’ll be able to address just domestically.”

In America, about 2 million people a year are infected with bacteria resistant to some antimicrobial agent, and of those, 23,000 die of their infections. Antibiotic resistance is also a rising threat throughout the rest of the world. European analysts modeling a “worst-case scenario,” in which all microbes became resistant to medicine, estimated in 2014 that fatal superbug infections around the world could increase from 700,000 in 2014 to 10 million by 2050.

The World Health Organization launched a global action plan in November 2015 that involves raising awareness of antimicrobial resistance, investing in research and making sure that antimicrobial medicines are used properly. However, Johnson notes that antibiotic use in other parts of the world remain either unregulated or poorly regulated.

There are steps people can take to protect themselves. Antibiotic use causes antibiotic resistance, which is why it’s important for doctors to prescribe them only when they have confirmed the presence of a bacterial infection, not for a viral illness. Those who are prescribed antibiotics should take them exactly as instructed and not stop a course of treatment early, even though they might be feeling better.

Chen also advised patients to let their health care providers know if they’ve ever been hospitalized in another facility, state or country, and she said they should insist that doctors wash their hands before examining or touching them.

Outside of the health care facility, people can also protect themselves from antibiotic resistance by washing their hands regularly, staying up to date on vaccines, preparing and cooking foods safely, and using protection during sex to prevent the spread of infections.


Anna Almendrala

Soure: http://www.huffingtonpost.com/entry/infection-all-antibiotic-resistant_us_587960f4e4b0b3c7a7b16e29