Background: There is no consensus on the management of asymptomatic inpatient hypertension. This is alarming as the prevalence of inpatient hypertension may be as high as 72%. Hypertension treatment guidelines focus on chronic hypertension in the outpatient setting and evidence for inpatient management is lacking. Aggressive treatment of asymptomatic inpatient hypertension with intravenous antihypertensives is [...]

Background: Inappropriate diagnosis of urinary tract infections (UTI) contributes to antibiotic overuse. We previously validated and refined a patient safety measure that defines inappropriate diagnosis of UTI (i.e., treatment of asymptomatic bacteriuria [ASB]) and was endorsed by the National Quality Forum. Use of this measure as a pay-for-performance metric in the Michigan Hospital Medicine Safety [...]

Background: Asymptomatic bacteriuria (ASB), or bacterial growth on urine culture without localizing urinary symptoms, is common in hospitalized patients.1,2 ASB is often misdiagnosed as urinary tract infection (UTI) and treated with antibiotics3 despite no improvement in mortality1 and multiple harms associated with antibiotic overuse.4,5 To reduce treatment of ASB, many hospitals set urinalysis parameters (e.g. [...]

Background: Urine culture testing should primarily be reserved for patients with clinical symptoms or other limited indications. Unfortunately, many admitted patients undergo unnecessary urine culture testing, leading to overdiagnosis and overtreatment of asymptomatic bacteriuria (ASB). Unnecessary antibiotic treatment for ASB does not improve outcomes and exposes patients to side effects. The negative implications may include [...]

Case Presentation: A 44-year man with history notable for illicit drug use (amphetamine, cocaine), poorly controlled HIV (CD4 count 387, HIV quantitative PCR with a viral load of 188,000) and anaphylaxis with penicillin use presented with a 1-day history of sore throat along with a 1-month history of a warm, diffuse, symmetric, non-pruritic, non-vesicular, maculopapular [...]

Case Presentation: A 63-year-old man with lung adenocarcinoma with multiple rib metastases and lytic spinal lesions was receiving palliative radiation treatment when computed tomography (CT) incidentally revealed a fluid collection along the anterior cecum with pneumatosis. Cultures taken during CT-guided abscess drainage were positive for piperacillin-tazobactam-sensitive enterococcus, and the patient was started on antibiotics. His [...]

Case Presentation: A 4-day old male was born full term at an outside hospital to a mother with a new vesicular labial lesion found during vaginal delivery. A viral culture of the lesion and maternal Herpes Simplex Virus (HSV) serology were obtained, but the patient did not undergo further work up or treatment in the [...]

Background: The ABIM Foundation’s Choosing Wisely Campaign and The Infectious Diseases Society of America recommend against screening and treating for suspected urinary tract infections (UTI) unless patients are symptomatic or meet specific clinical parameters (1). Inappropriate testing for UTIs with urinalysis and urine cultures is prevalent in healthcare and may lead to waste in resources, [...]