Background: Third International Consensus Definitions for Sepsis and Septic Shock (SEP-3) defines Sepsis as life-threatening organ dysfunction due to a dysregulated host response to infection. In United States about 1.5 million Americans are diagnosed with Sepsis each year and about 250,000 of them die each year. It is also the costliest single diagnosis to treat [...]

Background: Rifaximin 550 mg tablets is a nonsystemic antibiotic indicated for reducing the risk of overt hepatic encephalopathy (OHE) recurrence in adults and may be used alone or in combination with the cathartic lactulose. This analysis evaluated the safety profile of rifaximin alone vs rifaximin + lactulose (combination) in patients with cirrhosis. Methods: In a [...]

Background: Clostridioides difficile infection (CDI) can be prevented through infection prevention practices and antibiotic stewardship. We found in a 2013 national survey (571 hospitals, 71% response rate) that while infection prevention practices for CDI were common in U.S. hospitals, only 52% had an antibiotic stewardship program (ASP). On 1 January 2017, The Joint Commission required [...]

Background: In 2011, the Infectious Diseases Society of America (IDSA) published new guidelines on the management of community acquired pneumonia (CAP) in children and recommended use of narrow spectrum antibiotics such as ampicillin or amoxicillin over broader spectrum antibiotics such as ceftriaxone. Many studies have shown that these guidelines have been adopted with varying success [...]

Background: Growing antimicrobial resistance, C. difficile infection and cost have triggered a greater reliance on antimicrobial stewardship. Most stewardship models rely upon a central team, often led by ID specialists, to oversee prescribing in an institution. However, there are limitations to this paradigm. Purpose: We believe opportunities exist for hospitalists to drive stewardship by integrating [...]

Background: Most patients hospitalized with community-acquired pneumonia (CAP) can be safely treated with 5-days of antibiotic therapy. However, many are not. We aimed to determine whether a hospitalist-focused collaborative could reduce excessive antibiotic use in patients hospitalized with CAP through a combination of collaboration with antibiotic stewardship, data feedback, pay-for-performance, and sharing best practices. Methods: [...]

Case Presentation: A 55 year old male with a known history of sarcoidosis, hypertension, and penicillin allergy (anaphylaxis) presented with complaints of right swollen testicle associated with pain and dysuria for 2 weeks. Few days prior to the admission, the patient went to an urgent care facility and was treated with Ceftriaxone and Azithromycin. The [...]

Case Presentation: A 54-year old female was hospitalized for 3-week history of abdominal pain, chills, nausea and diarrhea. Her past medical history was significant for multiple self-reported antibiotic allergies, Roux-en-Y gastric bypass complicated by gastrojejunostomy leak, and prior perisplenic abscess requiring percutaneous drainage. On admission, blood pressure was 137/79, heart rate of 80, respirations 20, [...]

Case Presentation: A 66-year-old woman presented as a hospital transfer for further evaluation of 1 week of abdominal pain and jaundice and several months of a worsening dry cough and dyspnea. These were respectively attributed to acute cholecystitis status post unsuccessful ERCP and pulmonary edema. She had no fever, orthopnea, or edema. Her past medical [...]

Case Presentation: We present the case of a 70-year-old man who developed MSSA bacteremia after removal of a spinal stimulator. The bacteremia cleared with cefazolin treatment, but he developed an MSSA psoas abscess. He underwent abscess source reduction and was started on oxacillin, based on culture sensitivities. Unfortunately, he developed encephalopathy and was restarted on [...]