July 6, 2018

Background: Community acquired pneumonia (CAP), defined as lower bronchial tree infection in a patient that has not been hospitalized in the last 90 days is a commonly diagnosed disease. There rolex replica watches are between 2-4 million episodes per year in the US with roughly 500,000 hospital admissions (Rosen’s). Most outpatients are treated with azithromycin (or another macrolide antibiotic) as this drug gives a simple treatment regimen (single drug, simple dosing, short course). However, the efficacy of this regimen has been questioned in recent years as resistance patterns shift.

May 12, 2018

Abscess management has evolved somewhat in the 14 years since my residency graduation. The point at which antibiotics are likely to be more helpful than harmful is not always easy to assess, and evidence based expert opinion has flip flopped impressively. Based on current evidence, I would like to answer 3 big questions that every clinician may have when confronted with an abscess:
  1. Who needs antibiotics?
  2. Which abscesses need to be drained?
  3. How should abscesses be drained?

May 2, 2018

Friends, Concern regarding the Surviving Sepsis Campaign (SSC) guidelines dates back to their inception.  Guideline development was sponsored by Eli Lilly and Edwards Life Sciences as part of a commercial marketing campaign (1).  Throughout its history, the SSC has a track record of conflicts of interest, making strong recommendations based on weak evidence, and being poorly responsive to new evidence (2-6).

April 16, 2018

Background: It is well established that the rapid identification of patients with sepsis is needed in order to initiate timely care to improve morbidity and mortality.  The systemic inflammatory response syndrome (SIRS) criteria have been used for some time for screening, however the sensitivity and specificity of these criteria have been brought to question based on recent evidence [2]. This may have been one of the many reasons why the Sepsis-3 task force recommended the quick sequential (Sepsis-related) organ failure assessment (qSOFA) for prediction of mortality in sepsis. qSOFA consists of low blood pressure (SBP ≤100mmhg), increased respiratory rate (≥22bpm), and altered mental status (GCS ≤14).  2 or more of these criteria indicates  an increased risk of death.  There have been several studies calling into question the sensitivity of this criteria.  In this post, we will review a recent systematic review and meta-analysis assessing the prognostic value of qSOFA vs SIRS in adult patients with suspected infection in the ED, hospital wards, and the ICU.