Treatment of bacterial skin infections in ED observation units: factors influencing prescribing practice John P. Haran, Gregory Wu, Vanni Bucci, Andrew Fischer, Edward W. Boyer, Patricia L. Hibberd
DOI: http://dx.doi.org/10.1016/j.ajem.2015.08.035
The American Journal of Emergency Medicine , Vol. 33 , Issue 12 ,
Published online: August 21 2015
x The Infectious Disease Society of America (IDSA) publishes evidence-based guidelines for the treatment of skin and soft tissue infections. How closely physicians follow these guidelines is unknown, particularly in the emergency department observation unit (EDOU) where increasing numbers of patients are treatment for these infections. Our objectives were to describe (1) the antibiotic treatment patterns EDOU patients, (2) physicians' adherence to the IDSA guidelines, and (3) factors that influence physician's prescribing practices.
Acute frontal sinus barotrauma Eunice M. Singletary, John F. Reilly Jr
DOI: http://dx.doi.org/10.1016/0735-6757(90)90088-H
The American Journal of Emergency Medicine , Vol. 8 , Issue 4 ,
Published in issue: July 1990
x A 25-year-old man presented to the emergency department with an acute onset of frontal sinus pain during descent on a commercial airliner. There was no history of recent upper respiratory infection, sinus infection, or chronic allergic rhinitis. Sinus radiographs demonstrated a left frontal sinus submucosal hematoma. Symptoms improved within 24 hours with systemic and topical decongestants/vasoconstrictors and a nonsteroidal antiinflammatory agent. He was asymptomatic at 1 week postinjury.
Antibiotic prescribing for presumed nonbacterial acute respiratory tract infections Sherrie L. Aspinall, Chester B. Good, Joshua P. Metlay, Maria K. Mor, Michael J. Fine
DOI: http://dx.doi.org/10.1016/j.ajem.2008.04.015
The American Journal of Emergency Medicine , Vol. 27 , Issue 5 ,
Published in issue: June 2009
x The objective of the study was to identify patient and provider factors associated with prescribing antibiotics for outpatients with acute respiratory tract infections of likely nonbacterial etiology.
Epstein-barr virus infection complicated by acute rhabdomyolysis James L. McCabe, Serge Duckett, Paul Kaplan
DOI: http://dx.doi.org/10.1016/0735-6757(88)90244-6
The American Journal of Emergency Medicine , Vol. 6 , Issue 5 ,
Published in issue: September 1988
x A patient presented with infectious mononucleosis complicated by acute rhabdomyolysis following physical exertion. This infrequent complication should be identified and treated quickly to prevent serious sequelae of rhabdomyolysis, which may include renal fallure and disseminated intravascular coagulation.
Occult bloodstream infections in adults: a “benign” entity Marcela González-Del Vecchio, Eleonora Bunsow, Carlos Sánchez-Carrillo, Eugenia Garcia Leoni, Marta Rodríguez-Créixems, Emilio Bouza
DOI: http://dx.doi.org/10.1016/j.ajem.2014.05.007
The American Journal of Emergency Medicine , Vol. 32 , Issue 9 ,
Published online: May 12 2014
x Patients with septic episodes whose blood cultures turn positive after being sent home from emergency departments (EDs) are recognized as having occult bloodstream infections (BSI). The incidence, etiology, clinical circumstances, and outcome of occult BSI in children are well known, but, to our knowledge, data in adult patients are scarce. We analyzed the episodes of occult BSI in adult patients at our institution.
Underrecognition of cervical Neisseria gonorrhoeae and Chlamydia trachomatis infections in pregnant patients in the ED Roman Krivochenitser, Jeffrey S. Jones, David Whalen, Cynthia Gardiner
DOI: http://dx.doi.org/10.1016/j.ajem.2012.11.017
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 6 2013
x The purposes of this study were to (1) quantify the frequency of underrecognized Neisseria gonorrhoeae (GC ) and Chlamydia trachomatis (CT ) infections in pregnant women tested in the emergency department (ED), (2) describe the characteristics of those not treated during the initial visit, and (3) determine how many pregnant women with acute cervicitis were lost to follow-up.
Management of febrile children with urinary tract infections Douglas S Nelson, Mindy B Gurr, Jeff E Schunk
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90165-6
The American Journal of Emergency Medicine , Vol. 16 , Issue 7 ,
Published in issue: November 1998
x This study of the management of children with fever and urinary tract infection (UTI) was conducted to identify factors associated with initial admission, outpatient treatment, and outpatient treatment failure. A retrospective chart review identified children 3 months to 16 years of age with an emergency department (ED) diagnosis of cystitis, pyelonephritis, or UTI, a positive urine culture, and an ED temperature of >38°C. Sixty-nine patients (90% female) were studied; 19% were admitted initially.
Purple urine bag syndrome Federico Vallejo-Manzur, Eduardo Mireles-Cabodevila, Joseph Varon
DOI: http://dx.doi.org/10.1016/j.ajem.2004.10.006
The American Journal of Emergency Medicine , Vol. 23 , Issue 4 ,
Published in issue: July 2005
x The purple urine bag syndrome (PUBS) is a rare condition associated with chronic urinary catheterization. It is characterized by the purple discoloration of the urine, collecting bag, and tubing. A number of factors are involved, but not always present, in its development including female sex, urinary tract infection, constipation, indicanuria, and alkaline urine. Despite multiple theories that involve the complex tryptophan metabolism to the tubing dye, the cause remains elusive. The syndrome resolves usually after treatment of urinary tract infection or changing of the collecting bag.
An unusual presentation of emphysematous cystitis John Weddle, Beth Brunton, David R Rittenhouse
DOI: http://dx.doi.org/10.1016/S0735-6757(98)90170-X
The American Journal of Emergency Medicine , Vol. 16 , Issue 7 ,
Published in issue: November 1998
x Emphysematous cystitis is a rare disorder most commonly seen in women and associated with urinary tract infections and poorly controlled diabetes mellitus. We report the case of a 76-year-old woman who presented with diarrhea and abdominal discomfort, and emphysematous cystitis was revealed on the abdominal X-ray series. This case is unique in that the patient had no evidence of urinary tract infection, diabetes, or recent instrumentation. As the patient was treated for emphysematous cystitis (bladder irrigation and intravenous antibiotics), the diarrhea rapidly resolved and the radiographic abnormalities of the emphysematous cystitis also resolved.
Vivax malaria Paul B. Baker, Steven C. Dronen
DOI: http://dx.doi.org/10.1016/0735-6757(86)90252-4
The American Journal of Emergency Medicine , Vol. 4 , Issue 1 ,
Published in issue: January 1986
x Malaria occurs in the United States infrequently and is found exclusively among immigrants and travelers returning from areas where the disease is endemic. Cases of acute relapses of Plasmodium vivax infection can present to the emergency department. Patients are often immigrants from developing countries who were sympton-free in this country for weeks or months preceding their illness. The clinical presentation and current treatment of malaria are reviewed. Malarial infection may become apparent months after leaving endemic areas despite adherence to prophylactic regimens.
Dermatologic problems encountered in the emergency department Peter C Ferrera, Marsha L Dupree, Vincent P Verdile
DOI: http://dx.doi.org/10.1016/S0735-6757(96)90108-4
The American Journal of Emergency Medicine , Vol. 14 , Issue 6 ,
Published in issue: October 1996
Diagnostic utility of the genital Gram stain in ED patients Peter Stefanski, John W. Hafner, Shanda L. Riley, Kharmene L.Y. Sunga, Timothy J. Schaefer
DOI: http://dx.doi.org/10.1016/j.ajem.2008.09.016
The American Journal of Emergency Medicine , Vol. 28 , Issue 1 ,
Published online: October 26 2009
x The study aimed to determine the diagnostic usefulness of the genital Gram stain in an emergency department (ED) population.
Exotic reptile bites John Kelsey, Marty Ehrlich, Sean O Henderson
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90204-7
The American Journal of Emergency Medicine , Vol. 15 , Issue 5 ,
Published in issue: September 1997
x Reptiles are a growing part of the exotic pet trade, and reptile bites have been considered innocuous in the emergency medicine literature. Two cases are reported of reptile bites, one from a green iguana and the other from a reticulated python. The treatment concerns associated with reptile bites are discussed.
CNS toxoplasmosis as the initial presentation of the acquired immunodeficiency syndrome Howard S. Snyder
DOI: http://dx.doi.org/10.1016/0735-6757(89)90280-5
The American Journal of Emergency Medicine , Vol. 7 , Issue 6 ,
Published in issue: November 1989
x Neurological manifestations are present in 30% to 60% of patients with acquired immunodeficiency syndrome (AIDS) and may be the initial presentation in 10% to 20% of cases. Central nervous system toxoplasmosis now represents the most common focal brain lesion in patients with AIDS and possibly the most common opportunistic infection. A case of fulminant central nervous system toxoplasmosis as the initial presentation of AIDS is presented. Emergency physicians will be confronted with neurological complications of AIDS with increasing frequency in the future and should maintain a high index of suspicion for human immunodeficiency virus infection in young patients with neurological dysfunction.
Infection control for health care workers caring for critically injured patients: A national survey William A. Berk, Keir Todd
DOI: http://dx.doi.org/10.1016/0735-6757(94)90201-1
The American Journal of Emergency Medicine , Vol. 12 , Issue 1 ,
Published in issue: January 1994
x Prevention of transmission of bloodborne pathogens to health care workers (HCWs) involved in resuscitation of critically injured patients presents special challenges. As a step toward creation of a standard, a telephone survey of the infection control practices in this setting of the 100 busiest EDs in the United States (US) was performed. Departmental staff who were knowledgeable about ED infection prevention protocols were questioned about general policy, barrier protection measures, sharps management, and educational programs directed to HCWs.
Neonatal fever: Utility of the Rochester criteria in determining low risk for serious bacterial infections Peter C Ferrera, Joel M Bartfield, Howard S Snyder
DOI: http://dx.doi.org/10.1016/S0735-6757(97)90020-6
The American Journal of Emergency Medicine , Vol. 15 , Issue 3 ,
Published in issue: May 1997
x The purpose of this study was to test the utility of the Rochester criteria in determining which febrile neonates are at low risk for serious bacterial infections (SBI). This was a retrospective study over a 5-year period of 134 patients younger than 29 days old with fever without a source evaluated in the emergency department. Results of urinalysis, lumbar puncture, peripheral white blood cell count, and cultures of blood, urine, cerebrospinal fluid, and stool were recorded. Of the 134 neonates, 71 were high-risk, 48 low-risk, and 15 were not classifiable by the available data.
Prevalence and risk factors for multidrug resistant uropathogens in ED patients Seth W Wright, Keith D Wrenn, Marylou Haynes, David W Haas
DOI: http://dx.doi.org/10.1016/S0735-6757(00)90005-6
The American Journal of Emergency Medicine , Vol. 18 , Issue 2 ,
Published in issue: March 2000
x The purpose of this study was to describe resistance patterns of infecting organisms and determine risk factors for multidrug resistance in patients with urinary tract infections. Retrospective case series of 435 patients age ≥16 with urinary tract infection. Multidrug resistance was defined as resistance to ≥two classes of antibiotics. Demographic, historical, and microbiological data were collected. Univariate analysis and multivariate logistic regression were used to determine risk factors for multidrug resistance.
Severe sepsis and septic shock due to Plasmodium vivax infection Athanasios Chalkias, Sotirios Aridas, Drosos E. Karageorgopoulos, Georgios Stratiotis, Dimitra Mystrioti, Athanasios Mallios, Ioannis Nakos, Nikolaos Mpellos, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2012.12.011
The American Journal of Emergency Medicine , Vol. 31 , Issue 4 ,
Published online: February 4 2013
x Plasmodium vivax malaria is typically characterized by a mild and benign clinical course. Organ dysfunction is rarely seen, whereas acute lung injury has been found to occur after starting antimalarial treatment. We present an unusual case of severe sepsis and septic shock due to Plasmodium vivax monoinfection.
Emergency diagnosis of Fournier's gangrene with bedside ultrasound Daniel Morrison, Michael Blaivas, Matthew Lyon
DOI: http://dx.doi.org/10.1016/j.ajem.2004.12.010
The American Journal of Emergency Medicine , Vol. 23 , Issue 4 ,
Published in issue: July 2005
x Fournier gangrene is a life-threatening infection of the scrotal skin. Although originally thought to be an idiopathic process, Fournier gangrene has been shown to have a predilection for patients with diabetes as well as chronic alcohol abuse; however, it can also affect patients with nonobvious immune compromise. Because of potential complications, it is important to diagnose the disease process as early as possible. Ultrasound has been previously described to aid in the diagnosis of Fournier's gangrene.
Thrombocytosis accompanying urinary tract infection suggests obstruction or abscess Ofer N. Gofrit, Amos Shapiro, Deborah Rund, Antony G. Verstandig, Ezekiel H. Landau, Ran Katz, Ofer Z. Shenfeld, Yehoshuah Gdor, and others
DOI: http://dx.doi.org/10.1016/j.ajem.2005.05.007
The American Journal of Emergency Medicine , Vol. 24 , Issue 1 ,
Published in issue: January 2006
x Reactive thrombocytosis can be found in patients with different types of infections, including upper urinary tract infection (UTI). In this study, we determined whether thrombocytosis in patients with upper UTI is a random phenomenon or is related to complications associated with the UTI.
