Hyperlactatemia appears to arise from impaired oxygen utilization more often than decreased O2 delivery but doesn’t cause acidemia unless there is impaired renal function. The novel “alactic base excess” may give us an early way to tell when the kidneys are failing to compensate.
In this survey of physicians from Canada and UK/Ireland, the strongest predictors of performing a LP in neonates with a clinical diagnosis of bronchiolitis were: practice location in Canada, <10 years in practice, and less comfort diagnosing bronchiolitis.
Infants ≤60 days are low risk for serious bacterial infection (SBI) if they have a negative urinalysis, ANC ≤4090/µL, and procalcitonin ≤1.71 ng/mL. NPV was 99.6%; negative likelihood ratio (NLR) 0.04. Keep in mind, this hasn’t yet been externally validated.
Presence of any virus on multiplex PCR (particularly influenza, parainfluenza, and RSV) in critically ill hematology patients was associated with an increased risk for respiratory failure and ICU mortality.
Treating skin and soft tissue abscesses with antibiotics in addition to incision and drainage (I&D) resulted in significantly increased clinical cure rate (NNT = 14) and decreased incidence of new lesions (NNT = 10) compared to I&D alone.
”Tachypnea at triage, chronic ulcers, history of MRSA colonization or infection, and cellulitis within the past year,” were the risk factors associated with failure of oral antibiotic therapy for non-purulent cellulitis.
Topical antibiotic use for bacterial conjunctivitis was associated with improved rate of clinical cure compared to placebo. For early and late clinical cure with topical antibiotics, the NNT was 9 and 11, respectively.
The modified Philadelphia criteria had high enough sensitivity to rule out invasive bacterial infection in infants 29-60 days old without obtaining CSF. No infants 29-60 days old who were classified as low risk had bacterial meningitis.
Corticosteroids did not reduce the incidence of post-herpetic neuralgia at 6 months or pain severity at 3, 6, or 12 months. However, the evidence for this review was fairly weak. Two trials indicated that steroids may reduce short-term pain and speed healing at one month.