Study links antibiotic use to CDI risk in Swiss hospitals

🦟 #LymeDisease #Prophylaxis – #MCCQE1 Tick Bite Triage A patient comes to your clinic after being bitten by a tick. Do you give them antibiotics? Knowing the specific criteria for post-exposure prophylaxis (PEP) is a must for the MCCQE1. Not every bite needs treatment! 🧠 The 5 Key Criteria for Prophylaxis You should ONLY provide prophylaxis if ALL of the following five conditions are met: ✅ 1. Tick Identified: The attached tick is confirmed to be an adult or nymphal Ixodes scapularis (deer tick). ✅ 2. Attachment Time ≥ 36 hours: The tick is estimated to have been attached for 36 hours or more, based on how engorged it is or the patient's history. ✅ 3. Prophylaxis Started Within 72 hours: You can start the antibiotic within 72 hours of the tick being removed. ✅ 4. Endemic Area: The patient acquired the tick in an area where Lyme disease is endemic (local tick infection rate with Borrelia burgdorferi is ≥ 20%). ✅ 5. No Contraindications: The patient has no contraindications to doxycycline (i.e., not pregnant, not lactating, and not under 8 years of age). 💊 Management If all 5 criteria are met: Give a single dose of Doxycycline 200 mg. If ANY criterion is NOT met OR if contraindications exist: Do NOT give prophylaxis. Reassure the patient and instruct them to watch for signs and symptoms of early Lyme disease (fever, malaise, erythema migrans) over the next 30 days. 💡 Key MCCQE1 Exam Points There is no alternative antibiotic recommended for prophylaxis in children < 8 or pregnant/lactating women. The recommendation for these groups is watchful waiting. Blood tests for Lyme disease are NOT useful immediately after a tick bite and are not indicated. 📌 MCCQE1 Takeaway: ✔️ Remember the numbers: Tick attached for ≥ 36 hours, prophylaxis started within 72 hours. ✔️ Drug of choice: Doxycycline 200 mg as a one-time single dose. ✔️ Prophylaxis is an "all or nothing" deal based on the 5 criteria. ✔️ If there are contraindications to doxycycline, the answer is observation, not an alternative antibiotic. Follow 👉 MCCQE1 Study Hub for more high-yield #infectious_disease topics! 🩺 #MCCQE1 #LymeDisease #InfectiousDisease #Doxycycline #IMGSuccess #CanadianMLE #HighYieldMedicine #FamilyMedicine #MedicalEducation

Enhancing Antibiotic Stewardship: Insights from Urinary Tract Infection Management Trials #UTIManagement #AntibioticStewardship #HealthcareInnovation #PatientCare #ClinicalTrials https://lnkd.in/gB5ACw-y Understanding the Trial Results The trial tested a new way to manage urinary tract infections (UTIs) in women using quick tests at the doctor’s office. This approach included: Phase contrast microscopy: A method to look for bacteria in urine. Urinary dipsticks: Simple tests to check for blood in urine. What Worked? The new testing method was easy to use in clinics. Doctors were able to recruit a good number of patients for the trial. What Didn’t Work? There was no significant reduction in antibiotic prescriptions between the new method and usual care. The microscopy tests were not very accurate, especially for ruling out infections. How Does This Help Patients or Clinics? This trial shows that while the new testing method can be used, it may not lead to fewer antibiotics being prescribed. This is important because overusing antibiotics can lead to resistance, making infections harder to treat. Real-World Opportunities Doctors can try using the new testing method to see if it fits their practice. Clinics can focus on improving follow-up strategies to keep patients engaged. Measurable Outcomes Clinics should track the following after using these results: Number of patients treated for UTIs. Antibiotic prescriptions before and after using the new method. Patient follow-up rates and satisfaction. AI Tools to Consider AI tools can help analyze patient data and predict outcomes. For instance: AI can assist in identifying patients who might need more follow-up. AI can help monitor antibiotic usage trends in the clinic. Step-by-Step Plan for Clinics Start Small: Begin by using the new testing method with a few patients. Gather Data: Track outcomes like antibiotic use and patient feedback. Evaluate: Assess how the new method is working in your clinic. Expand: If successful, gradually increase the number of patients using the new tests. For more detailed information, you can read the full research article here. Source Smart Healthcare #UTIManagement #AntibioticStewardship #HealthcareInnovation #PatientCare #ClinicalTrials

Should we still culture after antibiotics? Almost every physician working in a hospital encounters this daily scenario: A patient is admitted with suspected infection, antibiotics are started — but oops, cultures weren’t taken beforehand. The question arises: should we still culture, or is it useless? In 2020 we started a prospective cohort of patients admitted to an internal medicine ward in the Tel Aviv Medical Center to answer this question: Last year we published our results regarding blood cultures: We found 42% of patients have positive blood cultures after a single dose of antibiotics and this rate was still substantial at 38% when bacteria was sensitive to the antibiotics administered (https://lnkd.in/d3Mz7wty) Currently, I'm happy to share our results regarding urine cultures (https://lnkd.in/d63YXTWJ): * 67% of patients had positive post-antibiotic urine cultures. * Even when the pathogen was sensitive, positivity remained high at 58%. * Importantly, the earlier the culture is obtained, the higher the yield of pathogen isolation. Taken together, these findings suggest that cultures remain valuable even after antibiotics are started — but timing matters. The answer, in my view, is yes — culture the patient, and do it as soon as possible. Great work by Neta Sror who led this study!

Mucormycosis is a rare fungal infection that can spread quickly and become life-threatening. It is acquired through inhalation, inoculation, or ingestion of mucormycete molds. These molds are commonly found in the environment and pose no danger to most people, but they can lead to serious infections in those with weakened immune systems. Mucormycosis most commonly infects the nasal passages, brain, and lungs. Symptoms can include facial swelling, headaches, nasal congestion, vision changes, and ultimately tissue death. Treatment consists of aggressive antifungal therapy and often surgery. What are some of the unmet needs of people who become infected with mucormycosis? High mortality: Mucormycosis can be associated with a mortality rate of more than 50%, depending on the person’s condition and the site of infection. Limited surveillance: There is no national surveillance system for mucormycosis in the US, making it difficult to track trends and respond to outbreaks effectively. Outbreaks have been linked to contaminated medical supplies and poor hospital infrastructure. Delayed diagnosis: Early symptoms can be nonspecific, and diagnostic tests are limited compared to more common types of invasive fungal infections. The aim of Rare Opportunities is to work alongside patients, healthcare professionals, and advocacy leaders to amplify the unmet needs that matter most. Explore how we’re forging meaningful partnerships and helping drive progress across rare disease communities at RareOpportunities.com. References in comments below.

New Publication Alert! 🚨 We are delighted to announce that our recent study has been published in a Q1 journal: 📄 “Calcium Sulfate as a Local Antibiotic Delivery Vehicle in Chronic Osteomyelitis Following Internal Fixation: A Prospective Case Series” (Reviews on Recent Clinical Trials, 2025). 🔎 Why this matters: Chronic osteomyelitis after internal fixation remains one of the most persistent and challenging orthopedic infections. Traditional treatment often struggles to fully eradicate infection while restoring bone function. Our study explored the use of antibiotic-loaded calcium sulfate (CS) as a local delivery system to enhance outcomes. 👨⚕️ Study highlights: 15 patients with chronic osteomyelitis following internal fixation MRSA was the most common isolate (66.7%) After 1-year follow-up: ✅ 100% infection eradication ✅ Significant functional recovery (scores improved from 26.8 → 64.2, p < 0.001) 💡 Take-home message: Antibiotic-impregnated calcium sulfate, when combined with proper surgical debridement and systemic antibiotics, shows excellent potential for infection control and functional improvement in difficult bone infections. 📖 Read the full article here:doi: 10.2174/0115748871425903250909144103. Epub ahead of print. [insert DOI/link] Happy reading! ✨

A Urinary Tract Infection (UTI) is an infection of any part of the urinary system, most often caused by bacteria (commonly Escherichia coli). It can affect the lower tract (urethra, bladder) or upper tract (ureters, kidneys). Types 1. Lower UTI • Cystitis → infection of the bladder • Urethritis → infection of the urethra 2. Upper UTI • Pyelonephritis → infection of the kidneys (more severe) Risk Factors • Female sex (shorter urethra) • Sexual activity • Pregnancy • Urinary catheterization • Urinary obstruction (stones, enlarged prostate) • Diabetes mellitus • Poor hydration or hygiene Clinical Features Lower UTI (Cystitis): • Dysuria (burning pain on urination) • Frequency and urgency • Suprapubic pain • Hematuria (sometimes) • Cloudy or foul-smelling urine Upper UTI (Pyelonephritis): • Fever, chills • Flank or costovertebral angle (CVA) tenderness • Nausea, vomiting • Malaise • Lower UTI symptoms may also be present Investigations • Urinalysis (dipstick): • Leukocyte esterase (+) → WBCs present • Nitrites (+) → gram-negative bacteria (e.g., E. coli) • Blood (+) sometimes • Urine microscopy: WBCs, bacteria, RBCs • Urine culture: gold standard for diagnosis (≥10⁵ CFU/mL) • Blood tests if systemic infection suspected (CBC, blood cultures) Management • Uncomplicated UTI (non-pregnant women): • Oral antibiotics (e.g., nitrofurantoin, trimethoprim-sulfamethoxazole, fosfomycin, amoxiclav) • Adequate hydration • Analgesics (phenazopyridine, NSAIDs for pain relief) • Complicated UTI / Pyelonephritis: • Longer antibiotic course (oral or IV depending on severity) • Hospitalization if severe (sepsis, vomiting, pregnancy, comorbidities) • Recurrent UTI: • Prophylactic low-dose antibiotics in select cases • Lifestyle changes (hydration, post-coital voiding, hygiene) Complications • Pyelonephritis • Perinephric abscess • Urosepsis • Chronic kidney damage (in severe/recurrent cases) ✅ Key Point: UTIs are common, especially in women, usually caused by E. coli. Lower UTIs cause dysuria and frequency, while upper UTIs cause fever and flank pain. Diagnosis is confirmed with urinalysis and culture, and treatment is with antibiotics.

🎙 New OTA Podcast: Bone Infection Management Tools You Should Know* BONESUPPORT™ is proud to bring together experts in traumatology to discuss innovative tools and strategies for managing open fractures and fracture-related infections. Featured faculty: Dr. Scott Sandilands, DO – HCA Florida Kendall Hospital, Miami, FL Dr. Peter Everson, MD – University of Missouri Kansas City, Kansas City, MO Dr. Augustine Saiz, MD – UC Davis Health System, Sacramento, CA This episode sponsored by BONESUPPORT, makers of CERAMENT® G with Gentamicin, the first and only FDA-authorized, antibiotic-eluting bone void filler, highlights the 2-CAN delivery device for intramedullary nailing, combining bone remodeling with targeted local antibiotic delivery. Tune in now to gain insights from these experts and stay up to date on the latest in bone infection management. Listen here: https://bit.ly/467wK2F Join BONESUPPORT at OTA 2025 – Phoenix Continue the conversation live with some of these same experts. Join us for a symposium; Driving down deep infection rates: How CERAMENT® G with Gentamicin promotes AND protects bone healing in Exhibit Hall Theater C | Friday, October 17th. Visit Booth #201 to meet the BONESUPPORT team, explore real-world case studies, and see how the 2-CAN delivery device is helping surgeons protect bone remodeling while reducing infection rates. *This is an orthopedic expert discussion on the use of BONESUPPORT’s product CERAMENT® G. Some uses discussed may not be approved or cleared by FDA. Experts are independent, and content is not influenced by BONESUPPORT. For complete product information, see package insert. 

Helicobacter pylori infection 🔍 Testing options for H. pylori • Urea breath test: Very accurate. Used for diagnosis and follow-up after treatment (4–6 weeks later). → Stop PPI 2 weeks before the test and fast for 6 hours. • Stool antigen test: Very accurate and cheaper than breath test. → Stop PPI 2 weeks before. • Serum IgG test: Can’t tell if infection is old or new. → Not affected by PPI or antibiotics. • Endoscopic biopsy: Used when needed for rapid urease test or pathology (if no PPI in past 2 weeks, no antibiotics/bismuth in past 4 weeks). 💊 Common Proton Pump Inhibitors (PPIs) (Used in treatment; all are equally effective) • Omeprazole 20 mg twice daily • Lansoprazole 30 mg twice daily • Esomeprazole 20 mg twice daily • Pantoprazole 40 mg twice daily • Rabeprazole 20 mg twice daily ⚕️ Management • All regimens are taken orally. • Duration: 14 days. • Treatment choice: Should depend on antibiotic resistance results when available. 👉 First-line treatment options: 1. Bismuth quadruple therapy: • PPI + Bismuth + Metronidazole + Tetracycline 2. Non-bismuth quadruple therapy: • PPI + Amoxicillin + Metronidazole + Clarithromycin 3. Triple therapy (where resistance is low): • PPI + Amoxicillin + Clarithromycin 💡 Notes: • Always stop PPIs 2 weeks before testing for cure. • Do not replace antibiotics unless stated. • For treatment failure, alternative regimens may include levofloxacin or rifabutin-based therapy. 🧫 Antimicrobial Stewardship • Choose the treatment based on: • Local antibiotic resistance rates • Previous antibiotic use • Avoid using Clarithromycin-based triple therapy as the first choice if resistance is high. • Example sequential treatment: • PPI + Amoxicillin, then add Metronidazole + Clarithromycin later. ✅ Summary: • Test using urea breath or stool antigen test. • Treat for 14 days using PPI-based combination therapy. • Choose antibiotics based on resistance. • Re-test after 4–6 weeks to confirm eradication. #hpylori #hpyloriinfection #hpyloritreatment #PharmD

♦Intravenous furosemide in shock with volume overload Whether intravenous furosemide (a loop diuretic) can be used in a patient with shock + volume overload depends on the type of shock and the hemodynamic profile: 🔹 General principles Shock states are usually associated with low tissue perfusion and hypotension. Giving diuretics in shock may worsen hypotension and decrease organ perfusion unless the patient is carefully selected. In shock, the first priority is hemodynamic stabilization (fluids, vasopressors, inotropes depending on cause). 🔹 Scenarios 1. Cardiogenic shock with volume overload (e.g., acute decompensated HF, pulmonary edema) Furosemide can be used, but only after adequate perfusion pressure is restored with vasopressors/inotropes (e.g., norepinephrine, dobutamine). If systolic BP is very low (<90 mmHg), avoid furosemide initially as it can worsen hypotension. Once stabilized, loop diuretics help relieve pulmonary congestion and reduce preload. Ultrafiltration or renal replacement therapy may be considered if diuretics are ineffective. 2. Distributive or septic shock with fluid overload The priority is vasopressor support and infection source control. Furosemide may be used cautiously if patient is fluid-overloaded and perfusion pressure is supported by norepinephrine/vasopressin. 3. Hypovolemic shock Never give furosemide—it will worsen hypovolemia and shock. ★Practical approach Correct shock first (maintain MAP ≥ 65 mmHg with fluids/vasopressors). If patient remains congested (pulmonary edema, high CVP, poor oxygenation), then give IV furosemide carefully, often in small test doses, while monitoring: BP, urine output Renal function Electrolytes ★ Summary: IV furosemide can be given in shock with volume overload, but only after hemodynamic stabilization (adequate MAP with vasopressors/inotropes). In uncompensated or hypovolemic shock, it is contraindicated. : DR.YASSER ALWALI

The article addresses the escalating threat of antimicrobial resistance (AMR), emphasizing the role of pediatric hospitalists in antimicrobial stewardship to mitigate rising healthcare costs and mortality rates linked to inappropriate antibiotic use. Pediatric patients are particularly vulnerable to unnecessary antibiotic prescriptions, with studies indicating that 30%-50% of such prescriptions in hospitals might be inappropriate. One analysis from 32 US children's hospitals revealed that 1 in 3 hospitalized children receive antibiotics, and a significant number of these prescriptions are deemed suboptimal. The discussion highlighted the need for a multifaceted approach to antibiotic stewardship, focusing on critical factors such as the timing, appropriateness, and interpretation of testing. The importance of leveraging antibiograms—profiles of antimicrobial susceptibility testing—was stressed for optimizing treatment based on local data. The article outlined practical strategies for implementing stewardship programs, underscoring the necessity for pediatric-specific guidelines and the involvement of various healthcare team members, including pharmacists and infection prevention teams. To explore these insights further and discover practical approaches to enhancing antibiotic stewardship, please visit www.onehealthupdate.com. https://lnkd.in/gvhQrZcM