Internal Medicine
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Infectious Disease Alert Updates
Utility of GI Multiplex Assay; ‘The World Is Covered by a Thin Layer of Feces’
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Why IDSA Did Not Support the Surviving Sepsis Campaign
The Infectious Diseases Society of America withheld its support for the Surviving Sepsis guidelines. The general concerns included vagueness and inconsistency in definition of sepsis, “one size fits all” prescription of time to administer antibiotics, lack of clarity around drawing blood cultures through IV catheters, recommendation of combination antibiotics, lack of definition around when to use procalcitonin levels, when and how to use pharmacokinetic and pharmacodynamic data effectively, prolonged antibiotic “prophylaxis,” and duration of therapy.
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Oral Antibiotics May Increase the Risk for Nephrolithiasis
A case-control study found that receipt of an oral antibiotic in the preceding three to 12 months was associated with nephrolithiasis. The risk persisted up to five years, and younger patients were at increased risk.
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Reduced Noninfectious Adverse Events After Discontinuation of Contact Precautions in Patients Colonized or Infected With MRSA and/or VRE
Discontinuation of contact precautions for patients colonized or infected with either MRSA or VRE is associated with a decrease in rates of noninfectious adverse events.
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VRE and MRSA: Time to Assign Contact Precautions to the Dust Heap of History
In the context of other horizontally implemented, effective infection prevention measures, the use of contact precautions for most patients colonized or infected with MRSA or VRE fails to provide benefit.
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Rotavirus Vaccine and Intussusception
Using active surveillance, researchers enrolled 717 infants with intussusception from sub-Saharan Africa. The risk of intussusception was no higher in those who received the monovalent rotavirus vaccine than in non-immunized infants.
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Antibiotic Use in Infancy Associated With Allergic Disease During Childhood
In a large population-based study, antibiotic use during the first six months of life was associated with a two-fold increase in asthma and a 1.5-fold increase in allergic disease during early childhood.
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Sepsis-related Neurologic Dysfunction Strongly Associated With Long-term Mortality
In this multicenter, retrospective study, acute neurologic dysfunction was the organ dysfunction most strongly associated with short- and long-term mortality in patients surviving a sepsis hospitalization.
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Selection of Isotonic Crystalloid for Fluid Resuscitation: How Much Does It Matter?
Using balanced crystalloids rather than normal saline for intravenous fluid administration in critically ill adults leads to statistically significant lower rates of major adverse kidney events, including death from any cause, new renal replacement therapy, and persistent renal dysfunction, compared to normal saline in critically ill adults. Clinical judgment should be applied when selecting fluid.
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Re-evaluating Steroid Therapy in Septic Shock
Septic shock carries a significant risk of mortality despite increasing knowledge of its pathophysiology and clinical management. Studies dating back to the 1960s suggested steroid treatment may alter the course of septic shock and led to the concept of critical illness-related corticosteroid insufficiency. Two recent trials have provided more data regarding steroid therapy for septic shock. Comparing these seminal studies provides context for the decision about whether to treat septic shock with steroid therapy.