Complicated parapneumonic effusions frequently represent pleural space infections. Approximately 1 in 7 cases of pneumonia have an associated parapneumonic effusion (PPE) on chest x-ray. Most of these effusions are small and usually resolve spontaneously with prompt antibiotic administration. However, moderate-to-large…
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In many hospitals, blood cultures have become a reflexive habit for patients presenting to the ER with any suspected infection.  This was, in part, due to the inappropriate addition of routine blood cultures as a core measure in 2001 by…
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The Infectious Diseases Society of America (IDSA) guidelines remain the gold standard guidelines for infectious disease problems.  The IDSA recommends treating patients with community-acquired pneumonia (CAP) for 5 days and it recommends treating those with healthcare-associated pneumonia (HCAP) for 7-8…
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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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Previous trials have investigated the use of B-type natriuretic peptide (BNP) to assess patients with dyspnea in the ED. The sentinel trial was the BNP (Breathe Not Properly) trial that evaluated nearly 800 patients presenting to the ED with complaints…
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A recent meta-analysis and systematic review of 13 randomized, placebo-controlled trials analyzed over 2000  patients hospitalized for CAP.  The analysis examined whether the addition of systemic corticosteroids doses (20–60 mg of prednisone or steroid equivalent) to empiric antibiotics was any better than…
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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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Among the 53% of patients with negative bronchoalveolar lavage results, alternative explanations for fever and for pulmonary infiltrates were established in 61% and 46%, respectively. Chest x-ray abnormalities, leukocytosis, purulent tracheal aspirate, or fever in a mechanically ventilated patient raise…
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This is an excellent review on the diagnosis, triage, and management of both community-acquired pneumonia and healthcare-associated pneumonia (HCAP).  This review also contains important information about clinical scoring tools to know which patients require admission, which patients require ICU care,…
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