New IDSA Guideline on Asymptomatic Bacteriuria

New IDSA Guideline on Asymptomatic Bacteriuria

The IDSA now only recommends screening for and treating asymptomatic bacteriuria (ASB) in pregnant women and those undergoing an invasive urologic procedure.

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.

Predicting Severe Alcohol Withdrawal

Predicting Severe Alcohol Withdrawal

Individual risk factors associated with the development of severe alcohol withdrawal syndrome (SAWS) included a history of delirium tremens and baseline BP ≥ 140mmHg but no individual symptoms or signs associated with exclusion of SAWS. Composite measures fared better, such as the Prediction of Alcohol Withdrawal Severity Scale; a score ≥ 4 had a LR of 174 (95% CI 43-696).

Who's Giving Inappropriate Antibiotics - Urgent Care, Retail, Emergency, or Medical Office?

Who's Giving Inappropriate Antibiotics - Urgent Care, Retail, Emergency, or Medical Office?

Urgent care centers wrote the most inappropriate antibiotic prescriptions for viral respiratory illnesses.  They were followed by the ED, medical offices, and finally by retail health clinics.

Can We Use Beta-Blockers With COPD?

Can We Use Beta-Blockers With COPD?

Patients with cardiovascular disease and concomitant COPD can be safely treated with a combination long-acting beta-agonist and a long-acting muscarinic antagonist when on a baseline beta-blocker.

Predicting Outpatient Failure for Cellulitis

Predicting Outpatient Failure for Cellulitis

Tachypnea, chronic ulcers, prior MRSA colonization, and prior cellulitis in the past 12 months were all associated with an increased risk of oral antibiotic failure for treatment of non-purulent cellulitis.

Syncope/Pre-syncope and Outcome in PE Patients

Syncope/Pre-syncope and Outcome in PE Patients

Syncope or pre-syncope in patients with PE was associated with an increased risk for 30-day mortality (43% vs 6%) and was an independent predictor of 30-day mortality when accompanied by hemodynamic instability on admission.  Don't try to treat them as an outpatient.

ECG Predictors of Arrhythmia in Syncope

ECG Predictors of Arrhythmia in Syncope

In the evaluation of older patients with syncope, certain ECG abnormalities increase the risk of 30-day serious cardiac arrhythmias. These ECG abnormalities include non-sinus rhythm; multiple premature ventricular conductions; short PR interval; first degree atrioventricular block; complete left bundle branch block; and ST, T, and Q-wave abnormalities consistent with acute or chronic ischemia.

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