Antibiotic de-escalation in culture-negative healthcare-associated pneumonia

The guidelines from the American Thoracic Society (ATS) and the Infectious Disease Society of America (IDSA) recommend "early, appropriate antibiotics inadequate doses, while avoiding excessive antibiotics by de-escalation of initial antibiotic therapy,based on microbiologic cultures and the clinical response of the patient, and shortening the duration of therapy to the minimum effective period"1. But they offer no recommendations on how to de-escalate when the cultures are negative. They do mention that if lower respiratory tract cultures obtained before antibiotics are negative at 48-72 hours, discontinuation of antibiotics can be considered. However, unless the patient is intubated (i.e. intensive care setting), we are usually unable to obtain lower respiratory tract cultures

ID Corner : Infectious diarrhea guideline update

Key recommendations from the 2017 Infectious Diseases Society of America Clinical Practice Guidelines for the Diagnosis and Management of Infectious DiarrheaIncludes bibliographical reference

New Clostridium difficile infection guidelines : Pearls for the hospitalist

Clinical vignette: A 40 year-old female with no significant past medical history had a 3-day history of runny nose, headache, cough and post-nasal drip. Her physical exam showed erythematous pharyngeal wall but it was otherwise unremarkable. Her primary care provider prescribed amoxicillin-clavulanic acid for 7 days. She finished the antibiotic course, her symptoms gradually improved but she developed watery diarrhea up to 5 times per day. Her vital signs, blood cell counts, renal function and chemistries were normal. Her Clostridium difficile test returned positive. What treatment would you recommend for this patient?Includes bibliographical reference

ID Corner : Methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia pearls

Includes bibliographical reference

10 things to know about Influenza

Influenza is an acute, contagious and usually self-limited febrile illness caused by infection of the respiratory tract with the influenza virus. The most common clinical manifestations are fever, malaise, and cough. The epidemic nature of influenza results in outbreaks every winter (seasonal influenza) but it is important to remember that the potential to become a pandemic always exists, as in the 2009 H1N1 influenza pandemic (this virus was a unique combination of influenza virus genes never previously identified in either animals or people)

ID Corner : Influenza update

This flu season has been especially bad. As of epidemiological week 4 (week ending on January 27th), overall hospitalizations are now the highest we've seen in recent years and flu associated deaths in children and adults continue to be reported. According to the Centers for Disease Control and Prevention (CDC), latest tracking data indicate that the flu activity is still high and widespread across most of the nation and increasing overall. Influenza A H3N2 continues to dominate this season, but H1N1 and influenza B are also causing illness.Includes bibliographical reference

Importance of HIV screening

"Although it can be challenging to think about screenings while trying to fix potentially life-threatening conditions, hospitalists need to actively screen for HIV infection. According to the Centers for Disease Control and Prevention (CDC), 1.1 million people aged 13 and older had HIV infection in the United States at the end of 2016, including an estimated 162,500 (14%) people with undiagnosed infection. The number of new HIV diagnoses in the United States was 38,281 in 2017."Christian Rojas-Moreno (Division of Infectious Diseases, Department of Medicine, University of Missouri)Includes bibliographical reference

Oral versus Intravenous Antimicrobials for Serious Infections

"There is a common belief among physicians and patients, that “intravenous (IV) antibiotics are better than oral antibiotics, they are stronger, they work faster”. However, for many infectious conditions, including serious infections, there is no conclusive evidence that IV antibiotics are superior to oral antibiotics. The bacteria also do not know how the antibiotic gets to the infection site 1. Additionally, IV antibiotics are not a panacea without downsides. IV antibiotics are associated with prolonged hospital stays; they may be associated with more adverse events and higher costs. The line needed for outpatient parenteral antimicrobial therapy (OPAT) can complicate in 22% of cases, with almost half of them requiring emergency department visit or hospital admission 2."Christian Rojas-Moreno (Division of Infectious Diseases, Department of Medicine, University of Missouri)Includes bibliographical reference

Bone cultures

"Bone cultures are extremely important in the diagnosis and management of bone infections. The value of bone biopsies lies in obtaining accurate microbiological data and susceptibility profiles. Ideally, these cultures should be obtained before initiation of antimicrobials. In clinically stable patients without concerns for sepsis or other urgent indications for antimicrobial therapy, antimicrobials can be withheld until a good bone sample for culture is obtained."Christian Rojas-Moreno (Division of Infectious Diseases, Department of Medicine, University of Missouri)Includes bibliographical reference

Duration of antibiotic therapy

"With the emergence of multidrug resistant organisms, risks associated with antibiotic therapy and its complications, such as Clostridioides difficile infection or adverse reactions, there is increasing interest in shorter rather than longer durations of antibiotic therapy for common infections."Christian Rojas-Moreno (Division of Infectious Diseases, Department of Medicine, University of Missouri)Includes bibliographical reference