Background: Penicillin discovered in 1928 by Sir Alexander Fleming, beginning of the antibiotic revolution. Penicillin as helped increase average life Span in USA from 47 years to 78.8 years. Beta lactam account to about 40% of total antibiotic use every year. 10% of patients in U.S. report penicillin allergy, but 9 out of 10 patients […]

Background: Penicillin discovered in 1928 by Sir Alexander Fleming, beginning of the antibiotic revolution. Penicillin as helped increase average life Span in USA from 47 years to 78.8 years. Beta lactam account to about 40% of total antibiotic use every year. 10% of patients in U.S. report penicillin allergy, but 9 out of 10 patients […]

Background: Sepsis is one of the most common causes for adult emergency department admissions and carries high morbidity and mortality. Appropriate and timely administration of intravenous (IV) antibiotics is one of the cornerstones of initial management of sepsis. Indeed, mortality has been shown to increase by 7-14% for each hour of delay in antibiotic administration. […]

Background: Stress ulcer prophylaxis (SUP) is overused in the intensive care setting. Acid suppression therapy has been associated with multiple adverse effects including increased risk of nosocomial pneumonia and Clostridium difficile colitis. Reduction in the rate of inappropriate use of SUP will not only decrease the risk of medication side effects but also decreases unnecessary […]

Background: Nearly half of hospitalized patients with bacteriuria or treated for pneumonia receive unnecessary antibiotics (non-infectious/non-bacterial syndrome, e.g., asymptomatic bacteriuria), excess duration (antibiotics prescribed for longer than necessary), or avoidable fluoroquinolones (safer alternative available) at hospital discharge.1-3 However, it is unknown whether antibiotic overuse at discharge varies between hospitals or is associated with patient outcomes. […]

Background: Chronic obstructive pulmonary disease (COPD) is a major public health problem. The Global Burden of Disease Study has projected that COPD will become the third‐leading cause of death worldwide by 2020. In developed countries, COPD exacerbations account for the greatest burden in the health care system, costing the United States billions of dollars annually. […]

Background: Mentoring relationships among physicians in academic medicine have been implemented to facilitate scholarly productivity, faculty development, and retention. Mentorships have been shown to encourage productive activity (e.g., peer‐reviewed publications), drive career advancement (e.g., faculty promotion), and enhance attitudes toward work (e.g., reduced burnout). Yet few studies have examined mentorships' impact at critical points along […]

Background: Between 2007 and 2015, inpatient fluoroquinolone use declined in U.S. Veterans Affairs (VA) hospitals. Whether fluoroquinolone use at discharge has also declined, in particular since antibiotic stewardship programs became mandated at VA hospitals in 2014, is unknown. Methods: In this retrospective cohort study of hospitalizations with infection between January 1, 2014 and December 31, […]

Background: Clinicians often diagnose bacterial infections such as urinary tract infection (UTI) and pneumonia in patients who are asymptomatic or have non-bacterial causes of their symptoms. Misdiagnosis of infection leads to unnecessary antibiotic use and potentially delays correct diagnoses. Interventions to improve diagnosis often focus on infections separately. However, if misdiagnosis is linked at the […]

Background: Paracentesis and thoracentesis are among the most common procedures performed by hospitalists. Though many hospitalists feel comfortable with these procedures, there are several reasons to use ultrasound for these procedures: (1) the literature supports increased patient safety and operator success; (2) ultrasound has become increasingly accessible due to decreased cost, increased portability, and documented […]