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Infectious Disease Updates
Clostridioides difficile: Reduced Susceptibility to Vancomycin? Antibiotics Reduce Culture Yield in Joint Infection
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Unhurried Patient Care
Unhurried conversations during patient encounters can improve outcomes for patients and enhance career satisfaction of physicians. Specific communication strategies can foster unhurried conversations without adding undue time to clinical care.
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Procalcitonin-Guided Care Leads to Shorter Duration of Antibiotics in Sepsis Patients
In this multicenter, intervention-concealed, randomized clinical trial of 2,760 critically ill patients hospitalized with sepsis, the use of a daily procalcitonin-guided protocol resulted in shorter antibiotic duration as compared with standard care, without a significant difference in 28-day all-cause mortality. There was no significant difference in antibiotic duration between patients managed with a daily C-reactive protein-guided protocol and standard care, and the difference in all-cause mortality between these two groups was inconclusive.
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Aeromonas Infections — Do Not Go Near the Water
Infection with Aeromonas mostly involves skin and soft tissue and traumatic wounds occurring with exposure to water contaminated by the organism. The organism often is resistant to carbapenems because of the presence of a chromosomal carbapenemase, while often remaining susceptible to third-generation cephalosporins.
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Parvovirus and Increasing Danger in Pregnancy and Sickle Cell Disease
The incidence of human parvovirus B19 infection is increasing in the United States, putting vulnerable groups at risk of serious complications.
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Intrauterine Instillation of Mepivacaine at the Time of IUD Placement
In a randomized clinical trial of 151 women, intrauterine instillation of mepivacaine significantly reduced pain with intrauterine device insertion on visual analog scales both before (53.9 mm vs. 67.2 mm, respectively; P < 0.001) and after adjustment for individual provider variability (55.2 mm vs. 77.4 mm, respectively; P < 0.001), compared to placebo.
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Fidaxomicin Is More Clinically Effective than Vancomycin for C. difficile Infection
There is a lack of real-world data on using fidaxomicin for Clostridioides difficile infection (CDI). A retrospective, single-center study found that treatment of CDI with fidaxomicin leads to reduced clinical failure compared to oral vancomycin.
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Do Warm Compresses Combined with Perineal Massage Reduce Perineal Trauma During Labor?
In this randomized trial, the addition of warm compresses to perineal massage during the second stage of labor showed no significant difference in reducing perineal tears, obstetric anal sphincter injuries, or episiotomies compared to perineal massage alone.
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Interventions for Pain During Office Endometrial Biopsy
In this randomized controlled trial, the use of transcutaneous electric nerve stimulation during endometrial biopsy did not clinically significantly reduce pain compared to placebo (median [interquartile range], 50 mm [20 mm to 80 mm] vs. 60 mm [40 mm to 100 mm]; P = 0.039), but was associated with increased satisfaction with the procedure.
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Flank Pain and ‘Heartburn?’
The electrocardiogram (ECG) in the figure was obtained from a man in his 60s who presented to the emergency department for a suspected kidney stone. The patient also noted some intermittent heartburn in recent weeks. How would you interpret his ECG? Should you activate the cath lab?