Elevated Cardiac Troponin Levels Are Not Always Due to Acute Coronary Syndromes

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Hospital Procedures, Infections, Medical General, medical procedures, Respiratory diseases
More Tags – Aortic dissection, cardioversion, HPC updates, myocardial infarction, myocarditis, NSTEMI, pulmonary embolus, pulmonary hypertension, sepsis, stroke, troponin
Cardiac troponin assays have gone through a tremendous evolution since they were introduced into clinical labs in 1995 until the most recent ultra-sensitive assays became prevalent in 2007.  The original troponin T (TnT) and troponin I (TnI) assays had a…
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Continuous-Infusion Beta-Lactam Antibiotics is Superior to Intermittent Dosing in Septic Patients?

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, Medical General, medical procedures
More Tags – beta-lactam antibiotics, critical illness, HPC updates, sepsis, septic shock, severe sepsis
The bactericidal activity of antibiotics depends on the class of antibiotic used. Some antibiotics like vancomycin, aminoglycosides and fluoroquinolones are dose-dependent for their bactericidal activity. Other antibiotics like beta-lactam antibiotics are time-dependent antibiotics which depend on maintaining drug concentrations above…
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MRSA antibiotics are overprescribed in patients hospitalized for community-acquired pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, medical procedures, Respiratory diseases
More Tags – antibiotic stewardship, community-acquired pneumonia, HPC updates, mechanical ventilation, MRSA, pneumonia
Are MRSA Antibiotics Overprescribed for Community-Acquired Pneumonia? – NEJM Journal Watch Nearly 30% of hospitalized CAP patients received antibiotics for MRSA, even though fewer than 1% had MRSA-associated CAP. A recent multicenter, prospective, active-surveillance study of 2259 patients hospitalized with…
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Chronic corticosteroid use increases the risk of some infections

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Dermatology, Emergency Procedures, Endocrinology, Ginecology, Infections, Traumatology
More Tags – bloodstream infections, candidiasis, corticosteroids, HPC updates, respiratory tract infections, steroids, zoster
This population-based cohort study between 2000 and 2012 from the UK’s Health Improvement Network database compared diagnoses between 275,000 adults who had been prescribed corticosteroids and 626,000 who had not been prescribed corticosteroids.  The query was whether corticosteroid recipients had…
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Essential to Administer Antibiotics Immediately if Bacterial Meningitis is Suspected

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Infections, Lumbar Puncture, Medical General, medical procedures, Neurological diseases
More Tags – Acute Bacterial Meningitis, CT scan, Guidelines, HPC updates, lumbar puncture
Prior to the revised Swedish lumbar puncture guideline, a CT scan was often performed prior to lumbar puncture when acute bacterial meningitis was suspected. Taking the time to perform a CT scan of the head before lumbar puncture delays treatment…
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Arterial Lines Carry a Similar Risk of Catheter-Associated Bloodstream Infections as Central Lines

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Central line, Infections, medical procedures
More Tags – Arterial line insertion, Arterial line placement, Arterial line-associated bloodstream infections, Catheter-related bloodstream infections, Central line insertion, Central line-associated bloodstream infections, Device-related infections, HPC updates, Vascular access
Arterial line-associated bloodstream infections occur at rate of 0.9-3.4 infections per thousand catheter-days. This rate of infections is similar to the risk of central line-associated bloodstream infections (CLABSIs). The CDC guidelines for arterial line placement recommend the use of chlorhexidine…
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Antimicrobial impregnated caps decrease the rate of catheter-related bloodstream infections

Ultrasound-Guided Internal Jugular Line Placement
Joseph Esherick, M.D., FAAFP, FHM
More Articles – Cardiovascular diseases, Central line, Infections, medical procedures
More Tags – Catheter-related bloodstream infections, Central line-associated bloodstream infections, central lines, central venous catheters, Device-related infections, HPC updates, Vascular access
The goal of zero device-related infections is what CMS desires for all hospitals, but is not a realistic goal.  Nevertheless, we can do everything in our power to minimize central line-associated bloodstream infections (CLABSIs).  We now can appreciate that the…
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Antibiotic duration for intra-abdominal infections

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, medical procedures
More Tags – HPC updates, intra-abdominal infections, sepsis
In an open-label trial involving adults with complicated intra-abdominal infections at 23 centers in the U.S. and Canada, researchers have investigated whether fixed-duration antimicrobial therapy (4 days) after source control is as effective as the traditional strategy (antibiotic administration until 2 days…
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Lung ultrasound for diagnosis of pneumonia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, medical procedures, Respiratory diseases
More Tags – HPC updates, lung ultrasound, pneumonia, sepsis
Lung ultrasound can detect pneumothorax and pulmonary edema, but limited data exist to quantify its accuracy for diagnosing pneumonia. In a prospective study, investigators compared lung ultrasound to chest computed tomography (CT) and chest x-ray among adult patients presenting with…
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Steroids beneficial in refractory septic shock

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Infections, medical procedures
More Tags – HPC updates, septic shock
Steroids beneficial in refractory septic shock Preface:  This multi-center observational study of over 1,800 patients examined whether low-dose steroids (<80 mg prednisone equivalents) was superior to placebo for patients in septic shock.  There results showed that there was a slight…
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Organisms That Cause Sepsis Are Changing, and Sepsis Management and Recognition Has Improved

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Infections, Medical General, medical procedures
More Tags – HPC updates, ICU, quality care, sepsis, sepsis management, sepsis treatment
Preface: Nice summary of the changing pathogenic organisms causing severe sepsis.  This summary also displays how improved sepsis recognition and management has decreased mortality from 40% to 28% over the last decade. Mortality decreased from 40% to 28% overall. Although…
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The absence of fever, elevated CRP and SIRS indicates 99.5% negative predictive value for excluding bacteremia

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Emergency Procedures, Infections, Medical General, medical procedures
More Tags – bacteremia, elevated CRP, fever, HPC updates, SIRS, Systemic inflammatory response syndrome
A large cohort study out of Denmark examining over 17,000 ER visits by adults determined that the absence of all three criteria fever, elevated CRP and SIRS criteria had a 99.5% negative predictive value for excluding bacteremia. Fever, elevated CRP level,…
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Antiretroviral therapy recommended for all HIV-infected patients

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Hospital Procedures, Infections, medical procedures
More Tags – antiretroviral, antiretroviral therapy, antiretroviral treatment, antiviral, antiviral society, HIV, HPC updates, infection
New guidelines from the International Antiviral Society recommend antiretroviral therapy for ALL HIV-infected patients Sponsoring Organization: International Antiviral Society–USA (IAS-USA) Target Population: Clinicians who treat HIV-infected patients Key Recommendations Antiretroviral therapy (ART) is recommended for all HIV-infected patients, including those with acute HIV infection—but…
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Early Goal Directed Therapy for Sepsis: No Longer?

Dr. Rick Rutherford, M.D., FAAFP
More Articles – Central line, Hospital Procedures, Infections, medical procedures
More Tags – Central Line; Central Venous Catheter; Septic Shock; Sepsis; Early Goal Directed Therapy; ProCESS, HPC updates
In 2001, the Rivers trial showed that Early Goal Directed Therapy for septic shock resulted in a 16% absolute mortality risk reduction1. In the treatment arm of this trial, septic patients with a lactate above 4 mmol/L or systolic blood…
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Arterial Lines Do Cause Bloodstream Infections

Joseph Esherick, M.D., FAAFP, FHM
More Articles – Arterial line, Cardiovascular diseases, Infections, medical procedures
More Tags – Arterial lines, bloodstream infections, HPC updates, Vascular access
Arterial lines are not completely benign.  They can definitely cause catheter-related bloodstream infections.  This study shows that arterial lines have a rate of bloodstream infection of about 1 in 1,000 catheter days.  Femoral arterial lines have a higher rate of…
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