ID

Antibiotic timing and risk of SSI

This large retrospective VA cohort found timing of perioperative antibiotics did not have any effect on SSIs (eg within or not within 60 minutes of skin incision). Despite longstanding public reporting for CMS, antibiotic timing does not appear to affect SSI rates (abstract).

Beware carbapenem resistant enterobacteriaceae

The CDC released a report outlining the concern of the increasing risks of CRE- infections, which were reported to occur in 5% of hospitals in 2012. Most infections occurred in patients with high exposure to health care environments (CDC).

Updated guidelines from surviving sepsis campaign

The Surviving Sepsis Campaign guidelines have been updated. Some of the highlights include (abstract): Initial fluids with crystalloids at 30cc/kg, with goal in first 6 hours of CVP 8-12mmHg, MAP>65 mmHg, and urine output >0.5cc/kg/hr; Antibiotics within 1 hour No steroids unless refractory shock and no RBC transfusions unless Hb<7 Vasopressor of choice is norepinephrine with epinephrine added if needed, phenylephrine only with arrhythmias, if cardiac output is high with low BP, or as salvage therapy, and dobutamine for myocardial dysfunction or continued hypoperfusion.

Careful QTc monitoring with fluoroquinolone-azole combinations

This small retrospective single center cohort found that 22% of patients on combination fluoroquinolone-azole drugs had clinically significant prolongation of their QT interval. Careful monitoring should be done for patients on this combination of drugs (abstract).

Continued reductions in hospital acquired infections

A recent CDC report showed continued reductions in several hospital acquired infections, including a 41% reduction in central line associated bloodstream infections, a 17% reduction in surgical site infections, and a 7% reduction in catheter associated urinary tract infections, since 2008-9 (CDC site).
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