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BACTERIURIA, ASYMPTOMATIC
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–Do not treat asymptomatic bacteriuria with antibiotics.
–Only screen pregnant persons and patients undergoing urologic procedures.
–Treat asymptomatic bacteriuria in pregnant patients for 4–7 d.
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Practice Pearl
Delirium in older patients is often caused by urinary tract infections (UTIs). However, in the absence of overt urinary symptoms or signs of systemic infection, empiric treatment of bacteriuria does not improve patient-oriented outcomes. (JAMA Intern Med. 2019;179(11):1519–1527)
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COLITIS, CLOSTRIDIOIDES DIFFICILE
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–Develop antibiotic stewardship programs to minimize the frequency and duration of high-risk antibiotic therapy.
–Place patients with suspected C. difficile infection (CDI) preemptively on contact precautions pending the C. difficile test results.
–Maintain contact precautions for at least 48 h after diarrhea has resolved.
–Perform hand hygiene before and after contact of a patient with CDI and after removing gloves with either soap or water.
–Use gloves and gowns on entry to the room of a patient with known or suspected CDI and remove gowns and gloves before leaving the patient’s room.
–Prevent transmission by using single-use disposable equipment. Thoroughly clean and disinfect reusable medical equipment, preferentially with a sporicidal disinfectant. Dedicated nondisposable equipment should be kept in the patient’s room.
–Disinfect environmental surfaces using an Environmental Protective Agency (EPA)–registered disinfectant with C. difficile sporicidal label claim or minimum chlorine concentration of 5000 ppm.
–Although there is an epidemiological association between proton pump inhibitor (PPI) use and CDI, there is insufficient evidence for discontinuation of proton pump inhibitors as a measure for preventing CDI.
–Although there is moderate evidence that probiotics containing Lactobacillus rhamnosus GG and Saccharomyces boulardii decrease the incidence of antibiotic-associated diarrhea, there is insufficient data to recommend administration of probiotics for primary prevention of CDI. Still, short-term use of probiotics appears to be safe and effective when used along with antibiotics in patients who are not immunocompromised or severely ill.
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–Am J Gastroenterol. 2013;108(4):478.
–Clin Infect Dis. 2018;66(7):e1–e48.
–Cochrane Database Syst Rev. 2017;12:CD006095.
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►Annals of Internal Medicine 2016
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Practice Pearls
Harm from antibiotics outweighs benefits, as all causes of the common cold are viral.
Evidence-based therapies for cold symptoms include the following:
- Ipratropium (4 puffs QID) for cough.
- NSAIDs for headache, earache, ...