Here are some interesting tidbits recently published from the largest prospective cohort of infective endocarditis ever collected (abstract). Causative organisms were Gram positive in 81-88% of cases (3-4% Gram negative, 1-2% fungi or yeast, and 8-13% other / culture negative). MSSA accounted for almost 1/3 of cases, and MRSA accounted for 36% of cases in those >65 years old, and 21% of cases in those 18-65 years old. Compared to patients 18-65 years old, those >65 years old were more likely to have a +blood culture (92% vs 86%) but less likely to have vegetations (84% vs 88%) peripheral embolic events (15% vs 26%) or stroke (15% vs 18%). However, they were twice a likely to die (25% vs 13%). Take home messages here are to remember atypical presentations (lack of blood culture or vegetations; hence the need for the modified Duke criteria for diagnosis (Duke criteria)), and the overwhelmingly high rates of MRSA and death in the elderly.
What comes to mind when you think of getting CME? I bet most of you would say sitting in an auditorium, whether that be during your local grand rounds or at our professional society meeting, like Hospital Medicine 16 in sunny San Diego this past March. Hanging out in the Twitterverse? Probably not so much… […]
As a nurse practitioner in hospital medicine I have multiple opportunities to interact with all sorts of physician hospitalist colleagues, hospital medicine group leaders, quality officers etc. Often their interactions with me take on a certain wary curiosity, like I am some exotic monkey or another creature that is unfamiliar to them. If I am […]
By reading the headlines recently, practitioners would not know if they saved or tanked the healthcare system. One day disaster looms, the next we have moderated growth and business can continue as usual (and by business, I mean doing the correct things correctly). A new study, along with some recent data, helps shed some light […]