Things your mother never told you about antibiotics, UTI s, and Pneumonia. Rob Kaplan, MD July 12 and 14, 2017

Size: px
Start display at page:

Download "Things your mother never told you about antibiotics, UTI s, and Pneumonia. Rob Kaplan, MD July 12 and 14, 2017"

Transcription

1 Things your mother never told you about antibiotics, UTI s, and Pneumonia Rob Kaplan, MD July 12 and 14, 2017

2 Objectives After this talk participants will: Be able to articulate some of the principles and pitfalls of antibiotic use Have a working approach to management of UTI s and pneumonia Probably choose to subspecialize in infectious diseases

3 Common misconceptions/distortions about antibiotics

4 1. Let s just throw in some antibiotics-it can t hurt

5 1. The Problem Microbiome change->c. diff and other superinfections, resistance in patient and community Allergic and nonallergic drug toxicities Cost (materials,labor, indirect costs) Diagnostic pitfalls (impaired cultures, early closure, etc.)

6 2. Always cover Pseudomonas

7 2. The Problem Pseudomonas actually has a limited place. Mainly neutropenic patients, plantar infections in diabetics, hospital-acquired infections, severe chronic lung disease such as CF A lot of use of antipseudomonal drugs increasing antipseudomonal resistance

8 3. With the high prevalence of MRSA, Vancomycin should be used for all severe Staph infections

9 3. Why not? Vancomycin has a valuable role, but Not reliably bactericidal; better outcomes for MSSA infections with anti-staph beta lactams Some MRSA are VISA and better treated with daptomycin or other agents Need trough level monitoring both for efficacy and safety

10 4. I don t feel comfortable changing from the empiric regimen because the patient is doing well

11 4. Let me help you with this What does empiric therapy mean? What is the other kind of therapy? Why do we change regimens when a patient is dong poorly? Why do we change regimens when a patient is doing well? (DISCUSS WITH YOUR NEIGHBOR)

12 5. I know the organisms are sensitive to the antibiotics but the patient s not getting better

13 5. Why? Is it the antibiotics? Or the patient? Or the anatomy? Or the organisms? (TALK AMONGST YOURSELVES)

14 UTI Cases A 21-year-old sexually active woman has one day of dysuria but no fever. Exam is normal; urinalysis shows many wbc and bacteria.

15 SIMPLE CYSTITIS 3 day therapy with trimethoprim-sulfa or 5 days with nitrofurantoin** Culture not mandatory! Quinolones no longer first line because of collateral damage **

16 UTI-2 A 65-year-old man with BPH has 2 days of fever, rigors, vomiting, and severe left flank pain. T 102.8, marked left CVAT, moderately enlarged, nontender prostate. Urine-many WBC, WBC 16, cre 1.0.

17 GRAM STAIN???? What if I told you urine Gram stain was loaded with Gram positive cocci? Or with thin Gram negative rods without bipolar staining?

18 Men are complicated. (At least their urinary tracts are )

19 COMMUNITY-ACQUIRED PYELONEPHRITIS Admit, IV antibiotics. Must cover enteric GNR s, especially E. coli. Ceftriaxone fine. Don t count on quinolones! But if Gram stain has a twist.add Vanco or change to antipseudomonal agent Switch to po when doing well, sensis known. Total duration at least 2 weeks (in men)**

20 UTI-3 A 50 year old quadriplegic, long term resident of VA SCI service, develops fever, altered mentation, and hypotension. Exam shows no skin lesions or inflammation; CXR clear. Foley urine many wbc, mixed bacteria, ph8

21 HEALTH-CARE ASSOCIATED UROSEPSIS Supportive care with lots of fluid +/- pressors. Consider ICU. Empiric antibiotics to cover resistant GNR +MRSA. At VA Pseudomonas resistant to zosyn. Change based on results. Rec: Vancomycin, Cefepime, consider Amikacin

22 Did anyone notice anything interesting about the urinalysis?

23 ph 8 Urea splitter (e.g. Proteus) triple phosph crystals-> struvite staghorn calculi Mechanical approach to stones, not just antibiotics

24 UTI-4 Down the hall from case 3, another longterm resident of SCI gets a routine urinalysis from his Foley which shows 800 WBC and mixed bacteria. Afebrile, VSS, no new symptoms. No skin lesions; normal mental status. WBC 6, crea 0.5.

25 ASYMPTOMATIC BACTERIURIA (Do not treat)

26 UTI-5 A 79-year old paraplegic man with chronic neurogenic bladder has T 102.1, WBC 12, U/A 2600 WBC and many bacteria. Started on ceftriaxone. Urine grows Klebsiella pneumoniae resistant only to ampicillin. Fever continues

27 NOT UTI-5** Exam reveals RUQ tenderness above level of SCI Abd CT reveals edematous GB wall Metronidazole added for anaerobic coverage Cholecystectomy performed: Acute cholecystitis

28 Pulmonary Cases 60-year old previously healthy smoker with fever, cough with purulent sputum.

29 COMMUNITY-ACQUIRED PNEUMONIA Pneumococcus, Haemophilus, Moraxella, maybe Legionella. Consider anaerobes, special exposure/risk history TRY TO GET SPUTUM GRAM STAIN AND CULTURE Ceftriaxone/Azithromycin or respiratory quinolone

30 Alcoholic with 4 weeks of fever, weight loss, fetid sputum, leftsided chest pain. Pulmonary-2

31 LUNG ABSCESS Add Klebsiella and anaerobes to usual causes of CAP Ceftriaxone/Flagyl

32 Pulmonary-3 An SICU patient needs prolonged intubation after abd. surgery. Now fever, inc FiO2, purulent secretions.

33 VENTILATOR-ASSOCIATED PNEUMONIA Possibility of resistant hospital flora Get deep specimen Gram stain and culture Vancomycin, Cefepime (or Carbapenem if previously on beta lactam), probably Amikacin Consider hospital-acquired Legionella. At VA should probably include Azithromycin.**

34 A previously healthy 70-year old has 2 weeks of fever, dry cough, increasing dyspnea. RA ABG 7.50/28/60 Pulmonary-4

35 Pneumonia in the compromised host HIV Antibody positive, CD4 56, VL 100K BAL: Stains positive for Pneumocystis In every patient we need to think about exposures and risks. Check HIV in everybody especially with confusing illness. Be ready for more than one infection at the same time

36 Pulmonary-5 (A surprise.) A 72-year old man with CLL on chemotherapy was admitted for 24 hours of fever, cough, dyspnea, and altered mentation. WBC 95 (mainly lymphs), Cre 2.2, ABG 6.99/65/61. CXR bilateral infiltrates. The patient died within 6 hours despite intubation, vancomycin, zosyn, pressors, steroids

37 Chest X-Ray

38 Blood Cultures The next day blood cultures grew facultative Gram negative coccobacilli with bipolar staining..

39 Pasteurella multocida Identified as..

40 Social History The patient s daughter told me that this crusty veteran was a great lover of cats, playing with every cat in the neighborhood and famous for kissing them!

Pneumonia Community-Acquired Healthcare-Associated

Pneumonia Community-Acquired Healthcare-Associated Pneumonia Community-Acquired Healthcare-Associated Edwin Yu Clin Infect Dis 2007;44(S2):27-72 Am J Respir Crit Care Med 2005; 171:388-416 IDSA / ATS Guidelines Microbiology Principles and Practice of Infectious

More information

Urinary Tract Infections in Hospitalized Patients

Urinary Tract Infections in Hospitalized Patients Urinary Tract Infections in Hospitalized Patients Puerto Rico Chapter Annual Meeting Daniel C. DeSimone, MD March 9, 2019 2017 MFMER slide-1 Disclosures for speaker: Date of presentation: 3/9/2019 No relevant

More information

Severe β-lactam allergy. Alternative (use for mild-moderate β-lactam allergy) therapy

Severe β-lactam allergy. Alternative (use for mild-moderate β-lactam allergy) therapy Recommended Empirical Antibiotic Regimens for MICU Patients Notes: The antibiotic regimens shown are general guidelines and should not replace clinical judgment. Always assess for antibiotic allergies.

More information

CAP, HCAP, HAP, VAP. 1. In 1898, William Osler described community-acquired pneumonia as:

CAP, HCAP, HAP, VAP. 1. In 1898, William Osler described community-acquired pneumonia as: 1. In 1898, William Osler described community-acquired pneumonia as: Brad Sharpe, M.D. Professor of Clinical Medicine Department of Medicine UCSF sharpeb@medicine.ucsf.edu I have no relevant financial

More information

Hospital-acquired Pneumonia

Hospital-acquired Pneumonia Hospital-acquired Pneumonia Hospital-acquired pneumonia (HAP) Pneumonia that occurs at least 2 days after hospital admission. The second most common and the leading cause of death due to hospital-acquired

More information

Antibiotic Protocols for Paediatrics Steve Biko Academic Hospital

Antibiotic Protocols for Paediatrics Steve Biko Academic Hospital Antibiotic Protocols for Paediatrics Steve Biko Academic Hospital Respiratory tract infections in children Uncomplicated URTI A child with a cold should not receive an antibiotic Paracetamol (15 mg/kg/dose

More information

URINARY TRACT INFECTIONS 3 rd Y Med Students. Prof. Dr. Asem Shehabi Faculty of Medicine, University of Jordan

URINARY TRACT INFECTIONS 3 rd Y Med Students. Prof. Dr. Asem Shehabi Faculty of Medicine, University of Jordan URINARY TRACT INFECTIONS 3 rd Y Med Students Prof. Dr. Asem Shehabi Faculty of Medicine, University of Jordan Urinary Tract Infections-1 Normal urine is sterile.. It contains fluids, salts, and waste products,

More information

Pneumonia. Definition of pneumonia Infection of the lung parenchyma Usually bacterial

Pneumonia. Definition of pneumonia Infection of the lung parenchyma Usually bacterial Pneumonia Definition of pneumonia Infection of the lung parenchyma Usually bacterial Epidemiology of pneumonia Commonest infectious cause of death in the UK and USA Incidence - 5-11 per 1000 per year Worse

More information

MICHIGAN MEDICINE GUIDELINES FOR TREATMENT OF URINARY TRACT INFECTIONS IN ADULTS

MICHIGAN MEDICINE GUIDELINES FOR TREATMENT OF URINARY TRACT INFECTIONS IN ADULTS When to Order a Urine Culture: Asymptomatic bacteriuria is often treated unnecessarily, and accounts for a substantial burden of unnecessary antimicrobial use. National guidelines recommend against testing

More information

URINARY TRACT INFECTIONS

URINARY TRACT INFECTIONS URINARY TRACT INFECTIONS Learning Objectives Identify signs and symptoms that may indicate presence of UTI (both complicated and uncomplicated) List common causative organisms and risk factors for UTIs

More information

Charles Krasner, M.D. University of NV, Reno School of Medicine Sierra NV Veterans Affairs Medical Center

Charles Krasner, M.D. University of NV, Reno School of Medicine Sierra NV Veterans Affairs Medical Center Charles Krasner, M.D. University of NV, Reno School of Medicine Sierra NV Veterans Affairs Medical Center Kathy Peters is a 63 y.o. patient that presents to your urgent care office today with a history

More information

UTI: A practical approach. Justin Seroy, DO Infectious Disease Attending BUMC-P

UTI: A practical approach. Justin Seroy, DO Infectious Disease Attending BUMC-P UTI: A practical approach Justin Seroy, DO Infectious Disease Attending BUMC-P UTI Pathophysiology Uropathogens colonize urethra, vagina or perineal area -> Enter lower urinary tract ->bladder ->kidney

More information

EMPIRICAL TREATMENT OF SELECT INFECTIONS ADULT GUIDELINES. Refer to VIHA Algorithm for the empiric treatment of Urinary Tract Infection

EMPIRICAL TREATMENT OF SELECT INFECTIONS ADULT GUIDELINES. Refer to VIHA Algorithm for the empiric treatment of Urinary Tract Infection URINARY TRACT Refer to VIHA Algorithm for the empiric treatment of Urinary Tract Infection and Asymptomatic Bacteriuria on the VIHA Intranet: https://intranet.viha.ca/departments/pharmacy/clinical_pharmacy/pages/infec

More information

Dilemmas in Septic Shock

Dilemmas in Septic Shock Dilemmas in Septic Shock William Janssen, M.D. Assistant Professor of Medicine National Jewish Health University of Colorado Denver Health Sciences Center A 62 year-old female presents to the ED with fever,

More information

Urinary Tract Infections

Urinary Tract Infections Urinary Tract Infections Michelle Eslami, M.D., FACP Professor of Medicine Division of Geriatrics David Geffen SOM at UCLA Urinary Tract Infection (UTI) One of most common infections in outpatient and

More information

Upper...and Lower Respiratory Tract Infections

Upper...and Lower Respiratory Tract Infections Upper...and Lower Respiratory Tract Infections Robin Jump, MD, PhD Cleveland Geriatric Research Education and Clinical Center (GRECC) Louis Stokes Cleveland VA Medical Center Case Western Reserve University

More information

Customary urine test is the dip stick and the mid-stream culture of voided urine. Up to 77% of cystitis cases are cultured

Customary urine test is the dip stick and the mid-stream culture of voided urine. Up to 77% of cystitis cases are cultured 9 million visits/year! Customary urine test is the dip stick and the mid-stream culture of voided urine. Up to 77% of cystitis cases are cultured Interpretation of the culture result has been controversial-

More information

Treatment of febrile neutropenia in patients with neoplasia

Treatment of febrile neutropenia in patients with neoplasia Treatment of febrile neutropenia in patients with neoplasia George Samonis MD, PhD Medical Oncologist Infectious Diseases Specialist Professor of Medicine The University of Crete, Heraklion,, Crete, Greece

More information

KAISER PERMANENTE OHIO COMMUNITY ACQUIRED PNEUMONIA

KAISER PERMANENTE OHIO COMMUNITY ACQUIRED PNEUMONIA KAISER PERMANENTE OHIO COMMUNITY ACQUIRED PNEUMONIA Methodology: Expert opinion Issue Date: 8-97 Champion: Pulmonary Medicine Most Recent Update: 6-08, 7-10, 7-12 Key Stakeholders: Pulmonary Medicine,

More information

Index. urologic.theclinics.com. Note: Page numbers of article titles are in boldface type.

Index. urologic.theclinics.com. Note: Page numbers of article titles are in boldface type. Index Note: Page numbers of article titles are in boldface type. A Acinetobacter baumannii, carbapenem-resistant, 497 498 Adolescents, urinary tract infections in, 520 521 Aminoglycosides, for UTIs and

More information

UTI are the most common genitourinary disease of childhood. The prevalence of UTI at all ages is girls and 1% of boys.

UTI are the most common genitourinary disease of childhood. The prevalence of UTI at all ages is girls and 1% of boys. UTI are the most common genitourinary disease of childhood. The prevalence of UTI at all ages is girls and 1% of boys. 1-3% of Below 1 yr. male: female ratio is 4:1 especially among uncircumcised males,

More information

Neutropenic Fever. CID 2011; 52 (4):e56-e93

Neutropenic Fever.  CID 2011; 52 (4):e56-e93 Neutropenic Fever www.idsociety.org CID 2011; 52 (4):e56-e93 Definitions Fever: Single oral temperature of 101 F (38.3 C) Temperature 100.4 F (38.0 C) over 1 hour Neutropenia: ANC < 500 cells/mm 3 Expected

More information

Update in diagnosis and management of UTIs

Update in diagnosis and management of UTIs Update in diagnosis and management of UTIs I have no disclosures Brian S. Schwartz, MD UCSF, Division of Infectious Diseases Lecture outline Challenges in cystitis Complicated UTI/pyelonephritis Asymptomatic

More information

Urinary Tract Infections: From Simple to Complex. Adriane N Irwin, MS, PharmD, BCACP Clinical Assistant Professor Ambulatory Care October 25, 2014

Urinary Tract Infections: From Simple to Complex. Adriane N Irwin, MS, PharmD, BCACP Clinical Assistant Professor Ambulatory Care October 25, 2014 Urinary Tract Infections: From Simple to Complex Adriane N Irwin, MS, PharmD, BCACP Clinical Assistant Professor Ambulatory Care October 25, 2014 Learning Objectives Develop empiric antimicrobial treatment

More information

Community Acquired Pneumonia. Abdullah Alharbi, MD, FCCP

Community Acquired Pneumonia. Abdullah Alharbi, MD, FCCP Community Acquired Pneumonia Abdullah Alharbi, MD, FCCP A 68 y/ male presented to the ED with SOB and productive coughing for 2 days. Reports poor oral intake since onset due to nausea and intermittent

More information

How do we define pneumonia?

How do we define pneumonia? Robert L. Keith MD FCCP Associate Professor of Medicine Division of Pulmonary Sciences & Critical Care Medicine Denver VA Medical Center University of Colorado Denver How do we define pneumonia? Fever

More information

Pediatric urinary tract infection. Dr. Nariman Fahmi Pediatrics/2013

Pediatric urinary tract infection. Dr. Nariman Fahmi Pediatrics/2013 Pediatric urinary tract infection Dr. Nariman Fahmi Pediatrics/2013 objectives EPIDEMIOLOGY CAUSATIVE PATHOGENS PATHOGENESIS CATEGORIES OF URINARY TRACT INFECTIONS AND CLINICAL MANIFESTATIONS IN pediatrics

More information

Treatment Regimens for Bacterial Urinary Tract Infections. Characteristic Pathogen. E. coli, S.saprophyticus P.mirabilis, K.

Treatment Regimens for Bacterial Urinary Tract Infections. Characteristic Pathogen. E. coli, S.saprophyticus P.mirabilis, K. HEALTHSPAN URINARY TRACT INFECTIONS (ADULT FEMALE) Methodology: Evidence-Based Issue Date: 1-98 Champion: Internal Medicine Most Recent Review: 4-10, 4-12, 4-14 Key Stakeholders: IM, Urology, Next Review:

More information

UTI IN ELDERLY. Zeinab Naderpour

UTI IN ELDERLY. Zeinab Naderpour UTI IN ELDERLY Zeinab Naderpour Urinary tract infection (UTI) is the most frequent bacterial infection in elderly populations. While urinary infection in the elderly person is usually asymptomatic, symptomatic

More information

URINARY TRACT INFECTIONS IN LONG TERM CARE. Tuesday, 8 November, 11

URINARY TRACT INFECTIONS IN LONG TERM CARE. Tuesday, 8 November, 11 URINARY TRACT INFECTIONS IN LONG TERM CARE OBJECTIVES UNDERSTAND THE SCALE OF DISEASE IN LTC SETTINGS DEVELOP AN UNDERSTANDING OF THE DIFFERENT PRESENTATIONS OF UTIs IN THIS SETTING AND WORKUP BECOME AWARE

More information

Urinary tract infection. Mohamed Ahmed Fouad Lecturer of pediatrics Jazan faculty of medicine

Urinary tract infection. Mohamed Ahmed Fouad Lecturer of pediatrics Jazan faculty of medicine Urinary tract infection Mohamed Ahmed Fouad Lecturer of pediatrics Jazan faculty of medicine Objectives To differentiate between types of urinary tract infections To recognize the epidemiology of UTI in

More information

Evidence Based Management of Urinary Tract Infections

Evidence Based Management of Urinary Tract Infections Evidence Based Management of Urinary Tract Infections Urinary tract infection (UTI) is the most common bacterial infection in humans. They account for more than 8.6 million physician visits (84% by women)

More information

URINARY TRACT INFECTIONS 3 rd Y Med Students. Prof. Dr. Asem Shehabi Faculty of Medicine, University of Jordan

URINARY TRACT INFECTIONS 3 rd Y Med Students. Prof. Dr. Asem Shehabi Faculty of Medicine, University of Jordan URINARY TRACT INFECTIONS 3 rd Y Med Students Prof. Dr. Asem Shehabi Faculty of Medicine, University of Jordan Urinary Tract Infections-1 Normal urine is sterile in urinary bladder.. It contains fluids,

More information

Chapter 22. Pulmonary Infections

Chapter 22. Pulmonary Infections Chapter 22 Pulmonary Infections Objectives State the incidence of pneumonia in the United States and its economic impact. Discuss the current classification scheme for pneumonia and be able to define hospital-acquired

More information

Fever Without a Source Age: 0-28 Day Pathway - Emergency Department Evidence Based Outcome Center

Fever Without a Source Age: 0-28 Day Pathway - Emergency Department Evidence Based Outcome Center Age: 0-28 Day Pathway - Emergency Department EXCLUSION CRITERIA Toxic appearing No fever Born < 37 weeks gestational age INCLUSION CRITERIA Non-toxic with temperature > 38 C (100.4 F) < 36 C (96.5 F) measured

More information

KAISER PERMANENTE OHIO URINARY TRACT INFECTIONS (ADULT FEMALE)

KAISER PERMANENTE OHIO URINARY TRACT INFECTIONS (ADULT FEMALE) KAISER PERMANENTE OHIO URINARY TRACT INFECTIONS (ADULT FEMALE) Methodology: Evidence-Based Issue Date: 1-98 Champion: Internal Medicine Most Recent Review: 4-10, 4-12 Key Stakeholders: IM, Urology, Next

More information

Lower Urinary Tract Infection (UTI) in Males

Lower Urinary Tract Infection (UTI) in Males Lower Urinary Tract Infection (UTI) in Males Clinical presentation For patients in care homes see UTI in adults where IV Antibiotics in the community may be appropriate (under development) History and

More information

Infectious Diseases Potpourri. Disclosures 7/24/2014. No conflict of interest to disclose. Pot-pour-ri \,pō-pu - rē\ noun

Infectious Diseases Potpourri. Disclosures 7/24/2014. No conflict of interest to disclose. Pot-pour-ri \,pō-pu - rē\ noun Infectious Diseases Potpourri Nick Gilpin, DO Section Head, Infectious Diseases Beaumont Health Systems Grosse Pointe Assistant Clinical Professor, OUWBSOM Assistant Clinical Professor, MSUCOM Presented

More information

WORKSHOP. The Multiple Facets of CAP. Community acquired pneumonia (CAP) continues. Jennifer s Situation

WORKSHOP. The Multiple Facets of CAP. Community acquired pneumonia (CAP) continues. Jennifer s Situation Practical Pointers pointers For for Your your Practice practice The Multiple Facets of CAP Dr. George Fox, MD, MSc, FRCPC, FCCP Community acquired pneumonia (CAP) continues to be a significant health burden

More information

PNEUMONIA. Patient Case: Chief Complaint: I have been short of breath and have been coughing up rust-colored phlegm for the past 3 days.

PNEUMONIA. Patient Case: Chief Complaint: I have been short of breath and have been coughing up rust-colored phlegm for the past 3 days. PNEUMONIA Relevant Guidelines: 2008 IDSA CAP guidelines: http://www.idsociety.org/guidelines/patient_care/idsa_practice_guidelines/infections_by_org an_system/lower/upper_respiratory/community-acquired_pneumonia_(cap)/

More information

PNEUMONIA. I. Background 6 th most common cause of death in U.S. Most common cause of infection related mortality

PNEUMONIA. I. Background 6 th most common cause of death in U.S. Most common cause of infection related mortality Page 1 of 8 September 4, 2001 Donald P. Levine, M.D. University Health Center Suite 5C Office: 577-0348 dlevine@intmed.wayne.edu Assigned reading: pages 153-160; 553-563 PNEUMONIA the most widespread and

More information

PULMONARY EMERGENCIES

PULMONARY EMERGENCIES EMERGENCIES I. Pneumonia A. Bacterial Pneumonia (most common cause of a focal infiltrate) 1. Epidemiology a. Accounts for up to 10% of hospital admissions in the U.S. b. Most pneumonias are the result

More information

Brice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine

Brice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine Brice Taylor Assistant Professor Division of Pulmonary and Critical Care Medicine Discuss advances in predicting prognosis Understand dwhat we know (and don t know) about the Microbiology Recognize important

More information

Citywide Infectious Disease Conference. March 27 th, 2018

Citywide Infectious Disease Conference. March 27 th, 2018 Citywide Infectious Disease Conference March 27 th, 2018 Citywide Show and Tell Case 1 Summary 60 s year old Puerto Rican born man SCC of Esophagus, treated with radiation and chemotherapy and then esophageal

More information

Laboratory Investigation of UTI. Quiz Feedback

Laboratory Investigation of UTI. Quiz Feedback Laboratory Investigation of UTI Quiz Feedback bpac nz better medicin e Laboratory Investigation of UTI Quiz Feedback bpac nz GP Review Panel: Dr Janine Bailey, Motueka Dr Stephen Kuzmich, Wellington Dr

More information

Lanny Hsieh, M.D. Infectious Diseases Hospitalist Program

Lanny Hsieh, M.D. Infectious Diseases Hospitalist Program Lanny Hsieh, M.D. Infectious Diseases Hospitalist Program Definition of Fever Arbitrary 38.0-38.4 (low grade may be significant in immunocompromised patients) > 38.5 (nurse will call you) Be aware of

More information

PBL RESPIRATORY SYSTEM DR. NATHEER OBAIDAT

PBL RESPIRATORY SYSTEM DR. NATHEER OBAIDAT PBL RESPIRATORY SYSTEM DR. NATHEER OBAIDAT Dr started to talk about his specialty at the hospital which is (ICU-Pulmonary-Internal Medicine). Pulmonary medical branch is a subspecialty of internal medicine.

More information

Bad Bugs in the Blood!

Bad Bugs in the Blood! Bad Bugs in the Blood! How to Work Up and Treat Bloodstream Infections Sharanjeet Thind M.D. Director of Inpatient Infectious Diseases, VA Medical Center Assistant Professor of Medicine, OUHSC, College

More information

Lecture Notes. Chapter 16: Bacterial Pneumonia

Lecture Notes. Chapter 16: Bacterial Pneumonia Lecture Notes Chapter 16: Bacterial Pneumonia Objectives Explain the epidemiology Identify the common causes Explain the pathological changes in the lung Identify clinical features Explain the treatment

More information

Antimicrobial Stewardship in Community Acquired Pneumonia

Antimicrobial Stewardship in Community Acquired Pneumonia Antimicrobial Stewardship in Community Acquired Pneumonia Medicine Review Course 2018 Dr Lee Tau Hong Consultant Department of Infectious Diseases National Centre for Infectious Diseases Scope 1. Diagnosis

More information

When should UTIs be treated in the Elderly? Shelby L. Wentworth, MS4 University of Florida College of Medicine 29 AUG 2018

When should UTIs be treated in the Elderly? Shelby L. Wentworth, MS4 University of Florida College of Medicine 29 AUG 2018 When should UTIs be treated in the Elderly? Shelby L. Wentworth, MS4 University of Florida College of Medicine 29 AUG 2018 UTIs in Patients >/ 65 yo - Most common infectious illness [1]. - Urinary tract

More information

ASPIRES Urinary Tract Infection Algorithm

ASPIRES Urinary Tract Infection Algorithm ASPIRES Urinary Tract Infection Algorithm Dr. Jennifer Grant Dr. Tim Lau Donna Leung February 2013 VCH Antimicrobial Stewardship 1 Programme: Innovation, Research, Education & Safety KEY PRINCIPLES 1.

More information

DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES

DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DISCLAIMER: This Clinical Practice Guideline (CPG) generally describes a recommended course of treatment for patients with the identified health

More information

Urine bench. John Ferguson Sept 2013

Urine bench. John Ferguson Sept 2013 Urine bench John Ferguson Sept 2013 Overview Specimen collection- separate presentation Urinalysis: protein, blood, white cells, nitrite Microscopy- crystals and casts- separate presentations quantitative

More information

All I Need Is The Air That I Breathe: A Case Study of Immunotherapy and Severe Pneumonitis

All I Need Is The Air That I Breathe: A Case Study of Immunotherapy and Severe Pneumonitis All I Need Is The Air That I Breathe: A Case Study of Immunotherapy and Severe Pneumonitis Presenter Disclosure Faculty/Speaker: Dr. Brett Finney BSc MD CCFP Relationships with financial sponsors: Grants/Research

More information

Lecture 1: Genito-urinary system. ISK

Lecture 1: Genito-urinary system. ISK Urinary Tract Infections Lecture 1: Genito-urinary system. ISK 07 08 2009. Getting Clear on the Terminology UTI Cystitis Urosepsis Asymptomatic Bacteriuria Asymptomatic UTI Pyuria Symptomatic UTI Pylonephritis

More information

DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES

DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DAYTON CHILDREN S HOSPITAL CLINICAL PRACTICE GUIDELINES DISCLAIMER: This Clinical Practice Guideline (CPG) generally describes a recommended course of treatment for patients with the identified health

More information

Prospective audit and feedback of piperacillin-tazobactam use in a 1115 bed acute care hospital

Prospective audit and feedback of piperacillin-tazobactam use in a 1115 bed acute care hospital Prospective audit and feedback of piperacillin-tazobactam use in a 1115 bed acute care hospital Final Results Nathan Beahm, BSP, PharmD(student) September 10, 2016 Objectives Review background information

More information

Prevention of Important HAIs: Principle & Case Scenario in VAP/CAUTI. CPT. Pasri Maharom MD, MPH Dec 15, 2015

Prevention of Important HAIs: Principle & Case Scenario in VAP/CAUTI. CPT. Pasri Maharom MD, MPH Dec 15, 2015 Prevention of Important HAIs: Principle & Case Scenario in VAP/CAUTI CPT. Pasri Maharom MD, MPH Dec 15, 2015 Catheter Associated Urinary Tract Infection CAUTI CAUTI Epidemiology Key Principles of Preventing

More information

Michael S. Niederman, M.D. Clinical Director Pulmonary and Critical Care Medicine New York Presbyterian Hospital Weill Cornell Medical Center

Michael S. Niederman, M.D. Clinical Director Pulmonary and Critical Care Medicine New York Presbyterian Hospital Weill Cornell Medical Center CA-MRSA Pneumonia Michael S. Niederman, M.D. Clinical Director Pulmonary and Critical Care Medicine New York Presbyterian Hospital Weill Cornell Medical Center Professor of Clinical Medicine Weill Cornell

More information

Clinical Pearls Infectious Diseases. Pritish K. Tosh, MD MN ACP Nov 7, [Answers and discussion slides will be posted after the meeting]

Clinical Pearls Infectious Diseases. Pritish K. Tosh, MD MN ACP Nov 7, [Answers and discussion slides will be posted after the meeting] Clinical Pearls Infectious Diseases Pritish K. Tosh, MD MN ACP Nov 7, 2014 [Answers and discussion slides will be posted after the meeting] Case 1 A 33-year-old male with diffuse large B-cell lymphoma

More information

Aspiration pneumonia in older people

Aspiration pneumonia in older people Aspiration pneumonia in older people Ayman Morish, M.D. Internal medicine, Critical care Medicine and Geriatrics Fellow. Contents Epidemiology Causes of aspiration pneumonia Issues of older age Management

More information

UPDATE IN HOSPITAL MEDICINE

UPDATE IN HOSPITAL MEDICINE UPDATE IN HOSPITAL MEDICINE FLORIDA CHAPTER ACP MEETING 2016 Himangi Kaushal, M.D., F.A.C.P. Program Director Memorial Healthcare System Internal Medicine Residency DISCLOSURES None OBJECTIVES Review some

More information

6/4/2018. Conflicts Disclosure. Objectives. Introduction. Classifications of UTI. Host Defenses. Management of Recurrent Urinary Tract Infections

6/4/2018. Conflicts Disclosure. Objectives. Introduction. Classifications of UTI. Host Defenses. Management of Recurrent Urinary Tract Infections Conflicts Disclosure Presenter has no conflicts of interest to disclose Management of Recurrent Urinary Tract Infections COLIN M. GOUDELOCKE, M.D. JUNE 14, 2018 Objectives Attendees will review the identification

More information

Bacterial Infections of the Urinary System *

Bacterial Infections of the Urinary System * OpenStax-CNX module: m64804 1 Bacterial Infections of the Urinary System * Douglas Risser This work is produced by OpenStax-CNX and licensed under the Creative Commons Attribution License 4.0 1 Learning

More information

11/15/2010. Asymptomatic Bacteriuria UTI. Symptomatic UTI. Asymptomatic UTI. Cystitis. Pylonephritis. Pyuria. Urosepsis

11/15/2010. Asymptomatic Bacteriuria UTI. Symptomatic UTI. Asymptomatic UTI. Cystitis. Pylonephritis. Pyuria. Urosepsis Urinary Tract Infections Renal vein Inferior vena cava Urinary bladder Urethra Renal artery Kidney Aorta Ureter Lecture 1: Genito-urinary system. 06 08 2010. (a) Sherwood Fig. 12-6a, p.530 An introduction

More information

The McMaster at night Pediatric Curriculum

The McMaster at night Pediatric Curriculum The McMaster at night Pediatric Curriculum Robinson, J, et al. and the Canadian Pediatric Society. Urinary tract infection in infants and children: Diagnosis and management. Pediatr Child Health 2014;

More information

UTI. Monica Tegeler, MD

UTI. Monica Tegeler, MD 4 UTI Monica Tegeler, MD 2 Diagnosis Stone criteria >100,000 colonies of bacteria growing in urine with no more than 2 species of microorganisms Dysuria OR Fever AND 1 of following: Frequency Urgency Suprapubic

More information

NHSN Catheter-Associated Urinary Tract Infection Surveillance in 2016

NHSN Catheter-Associated Urinary Tract Infection Surveillance in 2016 NHSN Catheter-Associated Urinary Tract Infection Surveillance in 2016 Presented by: Susan Steeves MSN, RN, CNL, CIC June 28,2016 Taken from: NHSN Training 2016 March 3, 2016 Eileen Scalise, MSN, RN Nurse

More information

Community-Acquired Pneumonia. Lisa G. Winston, MD University of California, San Francisco San Francisco General Hospital. Nothing to disclose.

Community-Acquired Pneumonia. Lisa G. Winston, MD University of California, San Francisco San Francisco General Hospital. Nothing to disclose. Community-Acquired Pneumonia Lisa G. Winston, MD University of California, San Francisco San Francisco General Hospital Nothing to disclose. Community-Acquired Pneumonia Talk will focus on adults Guideline

More information

No Need to Agonize! Tips for the Diagnosis and Treatment of Complicated UTIs

No Need to Agonize! Tips for the Diagnosis and Treatment of Complicated UTIs ASCENSION TEXAS No Need to Agonize! Tips for the Diagnosis and Treatment of Complicated UTIs Austin Area Society of Health-System Pharmacists April 26, 2018 Amy Carr, PharmD PGY-2 Infectious Diseases Pharmacy

More information

Septic Shock. Kathryn Sims, PGY I

Septic Shock. Kathryn Sims, PGY I Septic Shock Kathryn Sims, PGY I A 6 y.o. previously healthy boy presents to the ED with 7 days of fever accompanied by chills. Further history reveals the patient has also been experiencing dysuria for

More information

Community Acquired & Nosocomial Pneumonias

Community Acquired & Nosocomial Pneumonias Community Acquired & Nosocomial Pneumonias IDSA/ATS 2007 & 2016 Guidelines José Luis González, MD Clinical Assistant Professor of Medicine Outline Intro - Definitions & Diagnosing CAP treatment VAP & HAP

More information

Pneumonia. Dr. Rami M Adil Al-Hayali Assistant professor in medicine

Pneumonia. Dr. Rami M Adil Al-Hayali Assistant professor in medicine Pneumonia Dr. Rami M Adil Al-Hayali Assistant professor in medicine Definition Pneumonia is an acute respiratory illness caused by an infection of the lung parenchyma, associated with recently developed

More information

Sepsis new definitions of sepsis and septic shock and Novelities in sepsis treatment

Sepsis new definitions of sepsis and septic shock and Novelities in sepsis treatment Sepsis new definitions of sepsis and septic shock and Novelities in sepsis treatment What is sepsis? Life-threatening organ dysfunction caused by a dysregulated host response to infection A 1991 consensus

More information

The Challenge of Managing Staphylococcus aureus Bacteremia

The Challenge of Managing Staphylococcus aureus Bacteremia The Challenge of Managing Staphylococcus aureus Bacteremia M A R G A R E T G R A Y B S P F C S H P C L I N I C A L P R A C T I C E M A N A G E R N O R T H / I D P H A R M A C I S T A L B E R T A H E A

More information

Mixed gram positive organisms uti

Mixed gram positive organisms uti Mixed gram positive organisms uti The Borg System is 100 % Mixed gram positive organisms uti Complicated UTIs are caused by a broader spectrum of bacteria, including Gram- positive in addition to Gramnegative

More information

OHSU URGE OVERKILL - UTIS GRAEME FORREST, MBBS, FIDSA ASSOCIATE PROFESSOR OF MEDICINE VA PORTLAND HEALTHCARE SYSTEM AND OHSU

OHSU URGE OVERKILL - UTIS GRAEME FORREST, MBBS, FIDSA ASSOCIATE PROFESSOR OF MEDICINE VA PORTLAND HEALTHCARE SYSTEM AND OHSU URGE OVERKILL - UTIS GRAEME FORREST, MBBS, FIDSA ASSOCIATE PROFESSOR OF MEDICINE VA PORTLAND HEALTHCARE SYSTEM AND DISCLOSURES NOTHING TO DISCLOSE THE INFORMATION PRESENTED IS MY MINE AND NOT A RECOMMENDATION

More information

SHABNAM TEHRANI M.D., MPH ASSISTANT PROFESSOR OF INFECTIOUS DISEASESE &TROPICAL MEDICINE RESEARCH CENTER, SHAHID BEHESHTI UNIVERSITY OF MEDICAL

SHABNAM TEHRANI M.D., MPH ASSISTANT PROFESSOR OF INFECTIOUS DISEASESE &TROPICAL MEDICINE RESEARCH CENTER, SHAHID BEHESHTI UNIVERSITY OF MEDICAL URINARY TRACT INFECTION SHABNAM TEHRANI M.D., MPH ASSISTANT PROFESSOR OF INFECTIOUS DISEASESE &TROPICAL MEDICINE RESEARCH CENTER, SHAHID BEHESHTI UNIVERSITY OF MEDICAL SCIENCES Definition inflammatory

More information

Mortality Rate was unsightly!!! 4/24/2013. Sepsis Quality Improvement Project

Mortality Rate was unsightly!!! 4/24/2013. Sepsis Quality Improvement Project Libby, MT Sepsis Quality Improvement Project Barb Dumont RN, Director of Quality and Risk Management Mike Julius RN, ED Manager Cathy Wolfe RN, Chief Nursing Officer. Mortality Rate was unsightly!!! percent

More information

Case studies. Stephen Mark Rob Walker

Case studies. Stephen Mark Rob Walker Case studies Stephen Mark Rob Walker Case 1 31 yr old woman with 3 rd UTI. E coli Frequency and dysuria Asymptomatic after treatment Recurrent UTI Lower tract symptoms Coliforms Asymptomatic after treatment

More information

Antibiotic Stewardship for Skin and Soft Tissue Infection and Respiratory Tract Infections

Antibiotic Stewardship for Skin and Soft Tissue Infection and Respiratory Tract Infections Antibiotic Stewardship for Skin and Soft Tissue Infection and Respiratory Tract Infections Ghinwa Dumyati, MD Professor of Medicine Center for Community Health and Infectious Diseases Division University

More information

TMP/SMZ DS Ciprofloxacin Norfloxacin Ofloxacin Cefadroxil * 30 Amoxicilin 86* 19 25

TMP/SMZ DS Ciprofloxacin Norfloxacin Ofloxacin Cefadroxil * 30 Amoxicilin 86* 19 25 Evidence-Based Evaluation and Treatment of UTI UTI Prevalence Leslee L. Subak, MD Associate Professor Obstetrics, Gynecology & RS Epidemiology & Biostatistics University of California, San Francisco 50%

More information

Bronchitis/Pneumonia Core Content Keith Conover, M.D., FACEP /15/02 Clinical Spectrum Chest pain, shoulder pain, neck pain, abdominal pain,

Bronchitis/Pneumonia Core Content Keith Conover, M.D., FACEP /15/02 Clinical Spectrum Chest pain, shoulder pain, neck pain, abdominal pain, Bronchitis/Pneumonia Core Content Keith Conover, M.D., FACEP 1.0 10/15/02 Clinical Spectrum Chest pain, shoulder pain, neck pain, abdominal pain, headache Links with smoking, pollen count, FH of asthma

More information

ASK THE ID SPECIALIST

ASK THE ID SPECIALIST ASK THE ID SPECIALIST Raymond E. Pontzer, MD, FACP Chief, Infectious Diseases UPMC St. Margaret Hospital Interim Medical Director of Infection Prevention for UPMC I have no conflict of interest with any

More information

Infectious Diseases in Clinical Practice February 2011 Lisa G. Winston, MD

Infectious Diseases in Clinical Practice February 2011 Lisa G. Winston, MD Infectious Diseases in Clinical Practice February 2011 Lisa G. Winston, MD A 60 year old man was hospitalized 2 months ago for CABG. His course was uncomplicated, and he was discharged after 5 days. He

More information

Community-Acquired Pneumonia OBSOLETE 2

Community-Acquired Pneumonia OBSOLETE 2 Community-Acquired Pneumonia OBSOLETE 2 Clinical practice guidelines serve as an educational reference, and do not supersede the clinical judgment of the treating physician with respect to appropriate

More information

INFECTION SURVEILLANCE

INFECTION SURVEILLANCE INFECTION SURVEILLANCE IN LONG-TERM CARE 5 TH ANNUAL WYOMING INFECTION PREVENTION CONFERENCE, 2015 Russ Forney, PhD, MT(ASCP), Mountain-Pacific Quality Health THE PROBLEM Long-Term Care Acute Care Time

More information

What is sepsis? RECOGNITION. Sepsis I Know It When I See It 9/21/2017

What is sepsis? RECOGNITION. Sepsis I Know It When I See It 9/21/2017 Sepsis I Know It When I See It September 15, 2017 Matthew Exline, MD MPH Medical Director, Medical ICU What is sepsis? I shall not today attempt further to define the kinds of material [b]ut I know it

More information

Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana, Anis Karuniawati, Yulia Rosa, Budiman Bela

Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana, Anis Karuniawati, Yulia Rosa, Budiman Bela Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana, Anis Karuniawati, Yulia Rosa, Budiman Bela Microbiology Department Medical Faculty, University of Indonesia Urinary Tract Infection

More information

The McMaster at night Pediatric Curriculum

The McMaster at night Pediatric Curriculum The McMaster at night Pediatric Curriculum Community Acquired Pneumonia Based on CPS Practice Point Pneumonia in healthy Canadian children and youth and the British Thoracic Society Guidelines on CAP Objectives

More information

Supplementary Appendix

Supplementary Appendix Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Sprung CL, Annane D, Keh D, et al. Hydrocortisone therapy for

More information

Accurate Diagnosis Of Postoperative Pneumonia Requires Objective Data

Accurate Diagnosis Of Postoperative Pneumonia Requires Objective Data Accurate Diagnosis Of Postoperative Pneumonia Requires Objective Data David Ebler, MD David Skarupa, MD Andrew J. Kerwin, MD, FACS Jhun de Villa, MD Michael S. Nussbaum, MD, FACS J.J. Tepas III, MD, FACS

More information

CHALLENGING UTI S: PRIMARY CARE MANAGEMENT

CHALLENGING UTI S: PRIMARY CARE MANAGEMENT CHALLENGING UTI S: PRIMARY CARE MANAGEMENT Wendy L. Wright, MS, RN, APRN, FNP, FAANP Adult/Family Nurse Practitioner Owner Wright & Associates Family Healthcare, PLLC @ Amherst and @ Concord, NH Partner

More information

Fever. National Pediatric Nighttime Curriculum Written by Debbie Sakai, M.D. Institution: Lucile Packard Children s Hospital

Fever. National Pediatric Nighttime Curriculum Written by Debbie Sakai, M.D. Institution: Lucile Packard Children s Hospital Fever National Pediatric Nighttime Curriculum Written by Debbie Sakai, M.D. Institution: Lucile Packard Children s Hospital Case 1 4-month-old well-appearing girl admitted for croup and respiratory distress.

More information

None. Appropriate collection minimizes contamination Sample should be delivered to the laboratory in a timely fashion to limit bacterial growth

None. Appropriate collection minimizes contamination Sample should be delivered to the laboratory in a timely fashion to limit bacterial growth None Christopher J. Graber, MD MPH Assistant Clinical Professor of Medicine, UCLA Infectious Diseases Section VA Greater Los Angeles Healthcare System November 19, 2011 Clin Infect Dis 2005;40:643-54 Clin

More information

Investigators Meeting

Investigators Meeting Outcomes of Urinary Tract Infection Management by Pharmacists (R x OUTMAP) Investigators Meeting June 11, 2017 Overview 1. Introductions and Opening Remarks 2. Epidemiology and Definitions 3. UTI Assessment

More information

ANTIBIOTIC USE DURING ENDOUROLOGIC SURGERY

ANTIBIOTIC USE DURING ENDOUROLOGIC SURGERY ANTIBIOTIC USE DURING ENDOUROLOGIC SURGERY Comprehensive Kidney Stone Center at Duke University Medical Center Durham, North Carolina Glenn M. Preminger LEADING EDGE UROLOGY 49th Annual Duke Urologic Assembly

More information

DRUG ALLERGIES WT: KG

DRUG ALLERGIES WT: KG DRUG AND TREATMENT Available ONLY at: BMC-A BMC-B BMC-C BMC-D BMC-N BMC-S BMC-T Non Categorized SUB (SUB)* SUB Alert Protocol(SUB)* SUB Alert Protocol Lab Tests(SUB)* Quality Measure Sepsis Bundle Nursing

More information