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ASYMPTOMATIC BACTERIURIA

Population

  • Nonpregnant women.

Recommendations

IDSA 2019

  • Do not treat asymptomatic bacteriuria with antibiotics.

  • Only screen pregnant women and patients undergoing urologic procedures.

Source

COMMON COLD

Population

  • Healthy adults (those without chronic lung disease or immunocompromising conditions).

Recommendation

Annals of Internal Medicine 2016

  • Do not prescribe antibiotics for the common cold.

Source

Comment

  1. Harm from antibiotics outweighs benefits, as all causes of common cold are viral.

DIABETIC FOOT INFECTIONS, INPATIENT MANAGEMENT

Population

  • Hospitalized adults older than 18 y with diabetic foot problems.

Recommendations

IDF 2017

  • Assess arterial perfusion and need for revascularization.

  • Debride callus and necrotic tissue to fully visualize wound, measure depth and extent.

  • Obtain cultures: tissue or bone specimen preferred; deep swab only after debriding wound.

  • Obtain x-ray of all new diabetic foot infections. Obtain MRI if osteomyelitis suspected and plain film is not diagnostic.

  • Request surgical consult for deep abscesses, compartment syndrome, and necrotizing soft tissue infection.

  • Treat clinically infected wounds with antibiotics:

    • 1–2 wk for mild-to-moderate infections.

    • 3 wk for more serious skin and soft tissue infections.

    • 6 wk for osteomyelitis.

Source

Comment

  1. A deep space infection may have deceptively few superficial signs.

NICE 2016

  • Every hospital should have a multidisciplinary foot care team to assess and treat any diabetic patient with foot problems.

  • Every patient with a diabetic foot problem should undergo an assessment for:

    • Need for debridement, pressure off-loading.

    • Vascular inflow.

    • Infection of the foot.

    • Glycemic control.

    • Neuropathy.

  • If diabetic foot infection is suspected, obtain culture (soft tissue or bone sample preferred, or deep swab after debriding wound).

  • If osteomyelitis is suspected, obtain an x-ray; if x-ray is normal, obtain an MRI.

  • Provide off-loading for diabetic foot ulcers.

  • For mild diabetic foot infections, treat with empiric antibiotics that provide good coverage of gram-positive organisms.

  • For moderate-to-severe diabetic foot infections, treat with empiric antibiotics that provide coverage of gram-positive, gram-negative, and anaerobic bacteria.

Source

Comments

  1. The diabetic foot care team should include:

    1. Diabetologist.

    2. Surgeon with expertise managing DM foot problems.

    3. DM nurse specialist.

    4. Podiatrist.

    5. Tissue viability nurse.

    6. Biomechanic and orthotic specialist.

  2. Unless part of a clinical trial, do not treat diabetic foot ulcers with:

    1. Electrical stimulation therapy, autologous platelet-rich plasma gel, regenerative wound matrices, dalteparin,

    2. Growth factors,

    3. Hyperbaric oxygen therapy.

HUMAN IMMUNODEFICIENCY VIRUS (HIV)

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