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Obtain a blood culture for the hospitalized patients with complicated CAP (Community Acquired Pneumonia), requiring ICU care (in shock or with advanced respiratory support), and requiring antibiotic ...
Choosing Wisely ® : Things we do for no reason
David P. J. Hosp. Med. 2020 February;15(2):107-110. Published online first September 18, 2019
Given the low prevalence of penicillin resistance among these types of patients, they should use blood cultures to identify patients with non-pneumococcal CAP (they are more likely to require antibiotics other than penicillin or aminopenicillin). Children with complicated pneumonia are more likely to have nonpneumococcal etiologies than uncomplicated ones. Furthermore, the IDSA guidelines indicate that the incidence of bacteremia in complicated pneumonia is higher than in uncomplicated ...
ver más ... 2019Do not obtain blood culture routinely for children aged >3 months hospitalized for uncomplicated CAP (community-acquired pneumonia).
Choosing Wisely ® : Things we do for no reason
David P. . Hosp. Med. 2020 February;15(2):107-110. Published online first September 18, 2019
New evidence has revealed a decreasing incidence of bacteremia in pediatric populations. Moreover, viruses were the most frequently identified pathogens in children hospitalized with CAP in a large study, which were isolated in 66% of patients, whereas typical bacteria (either alone or in combination with a virus) were identified in only 7% of cases. Blood cultures are obtained for pediatric CAP has an incidence of a true bacterial bloodstream pathogen is 1.4%-7% of patients in USA in the ...
ver más ... 2019Apply the 4T’s (platelet count, timing of platelet fall, presence of thrombotic events, and the likelihood of another cause of thrombocytopenia) score in those who have thrombocytopenia and recent ...
Choosing Wisely ® : Things we do for no reason
Amanda L. J. Hosp. Med. 2019 June;14(6):374-376. Published online first April 8, 2019
A low scores 4T’s score (≤3) predicts a low pretest probability and further testing is not required. Patients with moderate or high 4T’s score (≥4) should have the ELISA (confers high sensitivity, due to its detection of nonpathogenic antibodies) test. During this time, heparin should be discontinued and nonheparin agents initiated while waiting for test results. Negative ELISA (OD < 0.4) helps to rule out HIT and allow heparin to be safely reintroduced without any further testing. ...
ver más ... 2019Do not use prealbumin to screen for or diagnose malnutrition in the Hospitalized Patients.
Choosing Wisely ® : Things we do for no reason
Lacy M. J. Hosp. Med. 2019 April;14(4):239-241. Published online first October 31, 2018. | 10.12788/
Prealbumin Is Not Specific, an ideal nutritional marker should be specific enough that changes in this marker reflect changes in nutritional status. Prealbumin is a negative acute phase reactant that decreases in concentration during the stress response due to slowed synthesis and extravasation. Neither prealbumin nor CRP, however, correlated with total body protein changes. A consensus statement from the Academy of Nutrition and Dietetics (AND) and ASPEN noted that prealbumin is an indicator ...
ver más ... 2019Consider a broad differential diagnosis when presented with a hospitalized patient with new thrombocytopenia given the low incidence of Heparin-induced thrombocytopenia (HIT) (<5%).
Choosing Wisely ® : Things we do for no reason
Amanda L. J. Hosp. Med. 2019 June;14(6):374-376. Published online first April 8, 2019
Diagnosis of HIT can be made initially through the enzyme-linked immunosorbent assay (ELISA). Management of HIT involves immediate cessation of heparin and initiation of therapeutic anticoagulation with nonheparin agents in order to prevent or treat the thrombotic events.4,5 The true incidence of HIT remains low, occurring in 0.2% to 5% of patients exposed to heparin and less than 1% in the ICU population.2,3,6,7 However, given the high incidence of thrombocytopenia in the ICU, the diagnosis ...
ver más ... 2019