Infectious Disease

Fluoroquinolone Resistance in UTI – Is It Time to Change Drugs?

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Fluoroquinolone-resistant (FQR) E. coli was present in 22.1% of UTI pathogens studied at 15 geographically diverse EDs. IDSA guidelines recommend changing empiric treatment if local resistance is >10% and adding a dose of parenteral antibiotic, such as ceftriaxone, prior to discharge home.

Source
High prevalence of fluoroquinolone-resistant UTI among US emergency department patients diagnosed with urinary tract infection, 2018-2020. Acad Emerg Med. 2022 Sep;29(9):1096-1105. doi: 10.1111/acem.14545. Epub 2022 Aug 5.

Spoon Feed – IDSA Guidelines for Pharmacologic Treatment of COVID-19

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The most recent IDSA guidelines recommend steroids in most patients who need oxygen. Consider nirmatrelvir or remdesivir in high-risk outpatients, and reserve most other therapies for particular circumstances, if at all.

Source
Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. Clin Infect Dis. 2022 Sep 5;ciac724. doi: 10.1093/cid/ciac724. Online ahead of print.

Does Nirmatrelvir Work for Vaccinated Patients In the Omicron Era?

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Nirmatrelvir (Paxlovid) use in a population of largely immune outpatients ≥65 years old, during the omicron variant era, was significantly associated with reduction in hospitalization and death.

Source
Nirmatrelvir Use and Severe Covid-19 Outcomes during the Omicron Surge. N Engl J Med. 2022 Sep 1;387(9):790-798. doi: 10.1056/NEJMoa2204919. Epub 2022 Aug 24.

Does Prepatellar Bursitis Need Aspiration?

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Empiric antibiotic therapy – without aspiration – is a reasonable approach for the management of suspected prepatellar septic bursitis in non-toxic patients with close outpatient follow up.

Source
Efficacy of empiric antibiotic therapy without aspiration for septic prepatellar bursitis in emergency department patients. Acad Emerg Med. 2022 Aug;29(8):1027-1032. doi: 10.1111/acem.14499. Epub 2022 Apr 25.

More Acute Kidney Injury With Vancomycin Plus… Pip/Tazo Or Ceftolozane/Tazo?

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Patients receiving vancomycin + piperacillin/tazobactam had greater adjusted odds of acute kidney injury than those receiving vancomycin + ceftolozane/tazobactam.

Source
Nephrotoxicity of Vancomycin in Combination with Beta-lactam Agents: Ceftolozane-tazobactam vs. Piperacillin-tazobactam. Clin Infect Dis. 2022 Aug 19;ciac670. doi: 10.1093/cid/ciac670. Online ahead of print.

Should We Use Plain Old Doxycycline for Pneumonia?

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Doxycycline is an accessible and effective option to treat both typical and atypical bacteria that may cause community acquired pneumonia (CAP).

Source
Efficacy of Doxycycline for Mild-to-moderate Community-acquired Pneumonia in Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Clin Infect Dis. 2022 Jul 29;ciac615. doi: 10.1093/cid/ciac615. Online ahead of print.

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