Dealing With the ESBL Threat - Extended Spectrum β-lactamase Enterobacteriaceae

Dealing With the ESBL Threat - Extended Spectrum β-lactamase Enterobacteriaceae

Highly resistant, extended spectrum β-lactamase (ESBL) producing Enterobacteriaceae in the urine are becoming increasingly common in unexpected patients in the ED.

Vancomycin/Piperacillin-Tazobactam and AKI

Vancomycin/Piperacillin-Tazobactam and AKI

The combination of vancomycin plus piperacillin-tazobactam (VPT) was associated with increased risk of acute kidney injury (AKI) compared to either drug as monotherapy or other vancomycin - β-lactam combinations, NNH = 11.

Outpatient Antibiotic for Pyelonephritis - Ciprofloxacin, TMP/SMX, or Cephalosporins?

Outpatient Antibiotic for Pyelonephritis - Ciprofloxacin, TMP/SMX, or Cephalosporins?

Outpatient treatment failure for pyelonephritis occurred more often in patients treated with fluoroquinolones or trimethoprim-sulfamethoxazole (TMP-SMX) than in patient treated with cephalosporins.

POCUS for Kidney Stone - Be Careful

POCUS for Kidney Stone - Be Careful

Point-of-care ultrasound in patients with renal colic had tepid diagnostic accuracy for nephrolithiasis.  If hydronephrosis was present, specificity was 94% and often indicated a stone >5mm.

LR - When NOT to Use It

LR - When NOT to Use It

With all the talk of using balanced, lower chloride solutions for volume in the ED and ICU, we thought it might be a good idea to discuss the potential downsides of LR.

SMART Trial - Balanced Crystalloids vs NS in Critically Ill Adults

SMART Trial - Balanced Crystalloids vs NS in Critically Ill Adults

In patients admitted to the ICU, use of balanced fluids resulted in a lower rate of major acute kidney events (MAKE) at 30 days compared to normal saline (14.3% vs 15.4%). This is a NNT of 94 to avoid one MAKE.

SALT-ED Trial - Balanced Crystalloid vs NS

SALT-ED Trial - Balanced Crystalloid vs NS

In non-critically ill patients that received IV fluids in the ED, there was a lower incidence of major adverse kidney events in the balanced crystalloid group compared to saline (4.7% vs 5.6%) with a NNT of 111. There was no difference in terms of hospital-free days between the groups.

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