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181. Management of Pilonidal Disease

factor analysis to improve patient selec- tion. World J Surg. 2011;35:206–211. 43. Chaudhuri A, Bekdash BA, Taylor AL. Single-dose metroni- dazole vs 5-day multi-drug antibiotic regimen in excision of pilonidal sinuses with primary closure: a prospective, ran- domized, double-blinded pilot study. Int J Colorectal Dis. 2006;21:688–692. 44. Lundhus E, Gjøde P, Gottrup F, Holm CN, Terpling S. Bacteri- cidal antimicrobial cover in primary suture of perianal or pilo- nidal abscess: a prospective (...) , randomized, double-blind clinical trial. Acta Chir Scand. 1989;155:351–354. 45. Kronborg O, Christensen K, Zimmermann-Nielsen C. Chronic pilonidal disease: a randomized trial with a complete 3-year follow-up. Br J Surg. 1985;72:303–304. 46. Marks J, Harding KG, Hughes LE, Ribeiro CD. Pilonidal sinus ex- cision–healing by open granulation. Br J Surg. 1985;72:637–640. 47. Mavros MN, Mitsikostas PK, Alexiou VG, Peppas G, Falagas ME. Antimicrobials as an adjunct to pilonidal disease surgery: a systematic

2020 American Society of Colon and Rectal Surgeons

182. Diabetic Foot Infections

depth of infection. [I-C] If a patient does not have a current A1c result available, obtain upon hospital admission. Cultures. Obtain post-debridement soft tissue cultures rather than superficial swabs for evaluation of infected diabetic foot ulcers. [I-C] If wound swab is the only available method of obtaining a culture, perform it after debriding and cleaning the wound. [II-E] If osteomyelitis is suspected, obtain bone culture to guide antibiotic therapy rather than soft tissue culture (...) , or if additional imaging is needed to evaluate the extent of osteomyelitis, perform an MRI as the next imaging test. [I-C] Obtain a triple-phase bone scan in combination with a tagged WBC scan if MRI cannot be obtained but further evaluation of osteomyelitis is needed. [I-C] Treatment. Delay antibiotic initiation until after soft tissue cultures are obtained in patients with mild and moderate wound infections and without evidence of active cellulitis (Table 1). [II-E] Consult the appropriate surgical service

2020 University of Michigan Health System

183. Cirrhosis

patients with ascites, as SBP can be asymptomatic) - Do not delay for elevated INR or thrombocytopenia - Send for cell count/gram stain, culture, albumin, and total protein 1. Start antibiotics promptly (See Table, "Spontaneous Bacterial Peritonitis") 2. Give 1.5 g/kg 25% albumin on day 1 (Max 100 g) 3. Give additional 1 g/kg 25% albumin on day 3 (Max 100 g) 4. Hold diuretics and large volume paracentesis in patients with SBP or AKI 5. Prescribe antibiotics on discharge for secondary prophylaxis (see (...) Table, "Prophylaxis in Patients at High Risk for Spontaneous Bacterial Peritonitis") - Start antibiotics per ID guidelines (See Table, "Prophylaxis in Patients with Cirrhosis and GI Bleeds") - Start Octreotide infusion - Consult Hepatology for EGD (discuss the use of blood product such as PRBCs, platelets, FFP, etc. with Hepatology) - For all upper GI bleeds in cirrhotic patients, continue antibiotics for 5-7 days (see Table for oral options) 1. Continue octreotide drip for 72 hours (unless patient

2020 University of Michigan Health System

184. Management of Chronic Kidney Disease

Potassium-sparing diuretics (amiloride, eplenerone, spironolactone, triamterene) Sulfonamide antibiotics Acetazolamide Antacids Corticosteroids Fluconazole Insulin Loop diuretics Salicylates Stimulant laxatives (senna) Sodium polystyrene sulfonate Theophylline Thiazide diuretics 9 UMHS Chronic Kidney Disease Guideline, July 2019 Table 14. Key Elements of Patient Education for CKD Elements • Ensure patient awareness of CKD diagnosis • “Know your numbers”- make patients aware of their kidney function (...) ? Hydantoins ? Lovastatin ? Macrolide antibiotics ? Metoclopramide ? Nefazodone ? Nifedipine ? Orlistat ? Probucol ? Protease inhibitors ? Quinolones ? Rifamycins ? Serotonin reuptake inhibitors ? Sulfonamides ? Terbinafine ? Verapamil ? Grapefruit juice ? St. John’s wort ? Red wine ? Berberine ? Chaparral ? European Barberry ? Tree Turmeric ? Echinacea ? ? * ? indicates that the agent generally increases the effect of immunosuppression medications; ? indicates a decreased effect Table 20. Select Herbs

2020 University of Michigan Health System

185. Prenatal Care

for high-risk women, including those with initial hemoglobin 100,000 CFU/mL, treatment at the time of diagnosis is recommended. Evidence is insufficient to recommend a test of cure after completion of antibiotic therapy, except in the case of GBS bacteriuria, for which a test of cure is recommended. Cervical cancer screening. Women who are current with routine screening for cervical cancer do not need to undergo additional testing. Rates of false positive cervical cytology increase in pregnancy

2020 University of Michigan Health System

186. Special Topics in Venous Thromboembolism

liver insufficiency with jaundice or those receiving antibiotics at risk for vitamin K deficiency. There are also evolving data on the use of direct acting oral anticoagulants in highly selected patients, but further studies of are needed. 81-83 Six months of anticoagulation therapy has a higher rate of recanalization, but no specific duration has been established. Chronic PVT in a cirrhotic patient (Figure 4). Systemic anticoagulation is not recommended for cirrhotic patients found to have

2020 University of Michigan Health System

187. Infection Control for Haemodialysis Units

with multi-resistant organisms (MROs) in dialysis units has been often high as a consequence of the high burden of comorbidities, high rates of hospitalisation and high rates of antibiotic exposure amongst its clients [11] ? MROs that are commonly found in dialysis populations are transmitted by direct and indirect contact [18] ? Cannulation, connection and disconnection of high flow and high-pressure dialysis circuits are a risk for accidental body fluid exposure [11] ? Colonisation or infection (...) with VRE colonisation at baseline testing, while admission to a renal unit and recent ticarcillin-clavulanate or carbapenem use was associated with new VRE acquisition. International studies have found similar risk factors for VRE colonisation including recent use of a broad spectrum antibiotic [102-104], recent hospitalisation [102] and duration of hospitalisation [103-107]. Additional risk factors for colonisation at admission that have described include non-ambulatory status [11], number

2019 KHA-CARI Guidelines

188. Hysterectomy for Benign Gynaecologic Indications

preferably be approached by either vaginal or laparoscopic routes (Strong, High). 2 Vaginal hysterectomy is still considered the preferred route of hysterectomy, but laparoscopic hysterectomy is an appropriate alternative minimally invasive approach (Strong, Moderate). 3 Correction of preoperative anemia (hemoglobin <120 g/L) is indicated to reduce morbidity and mortality in the perioperative period when elective surgery is planned (Strong, High). 4 Preoperative antibiotic prophylaxis and measures

2019 Society of Obstetricians and Gynaecologists of Canada

190. Management of Type 2 Diabetes Mellitus

intervention. Should a foot ulcer be found, infection and vascular status should be carefully evaluated and early treatment should be undertaken with aggressive wound care, orthotic prescriptions or casting to offload the ulcer, antibiotics, and revascularization when necessary. Studies have shown that patients with diabetic foot ulcers have the best outcomes if managed by a multidisciplinary team that specializes in diabetic foot care. Treatment of painful diabetic peripheral neuropathy (PDN). Optimizing

2020 University of Michigan Health System

191. CIRSE Standards of Practice on Diagnosis and Treatment of Pulmonary Arteriovenous Malformations Full Text available with Trip Pro

asymptomatic PAVMs, they should not be treated during pregnancy, mainly due to the potential risk of radiation exposure to the foetus. However, if any pregnant woman with HHT develops haemoptysis or sudden dyspnoea, urgent hospitalisation and further diagnosis is recommended; embolisation is then to be considered. For all pregnant women with HHT, antibiotic prophylaxis during delivery is recommended [ ]. Size of Feeding Arteries There is an arbitrary lower limit of 3 mm [ ] or 2–3 mm [ ] to treat PAVMs (...) . This is empirically defined and based on the fact that patients very seldom experience cerebral events below this size [ ]. Technical advances in microcatheter design and embolisation devices may decrease this cut-off size. Antibiotic prophylaxis is recommended if CE is positive, regardless of the size of the feeding artery on CT scan in patients undergoing surgical and dental interventional procedures [ ]. However, recently published long-term data from the Irish National HHT Centre on the natural progression

2020 Cardiovascular and Interventional Radiological Society of Europe

192. Guidelines for Perioperative Care in Cardiac Surgery Enhanced Recovery After Surgery Society Recommendations

. Implement Sci . 2017;12(1):142. doi: Mutters NT, De Angelis G, Restuccia G, et al. Use of evidence-based recommendations in an antibiotic care bundle for the intensive care unit. Int J Antimicrob Agents . 2018;51(1):65-70. doi: Lazar HL, Salm TV, Engelman R, Orgill D, Gordon S. Prevention and management of sternal wound infections. J Thorac Cardiovasc Surg . 2016;152(4):962-972. doi: Bode LG, Kluytmans JA, Wertheim HF, et al. Preventing surgical-site infections in nasal carriers of Staphylococcus aureus (...) , Bernardi M, Alonzo N, Coyle K. Intranasal mupirocin reduces sternal wound infection after open heart surgery in diabetics and nondiabetics. Ann Thorac Surg . 2001;71(5):1572-1578. doi: Edwards FH, Engelman RM, Houck P, Shahian DM, Bridges CR; Society of Thoracic Surgeons. The Society of Thoracic Surgeons practice guideline series: antibiotic prophylaxis in cardiac surgery, part I: duration. Ann Thorac Surg . 2006;81(1):397-404. doi: Engelman R, Shahian D, Shemin R, et al; Workforce on Evidence-Based

2020 ERAS Society

193. Acute Kidney Injury (AKI)

adversely affect renal function (1D) ? therapeutic drug dosing must be adapted to altered kinetics in AKI. (1B) ? regular re-evaluation of drug dosing is undertaken as renal function changes and as renal support is initiated, altered or discontinued. (1D) ? individual acute hospital Trusts either sign-post to external guidance on drug use in AKI, for example, for the prescribing of antibiotics, analgesia, contrast media, and chemotherapy, or develop their own, in-house evidence-based recommendations (...) the risk of catheter-related infections. (1D) ? antimicrobial locking solutions should be used routinely to reduce the risk of catheter related bloodstream infections in adults. (1C) We suggest that: ? antimicrobial locking solutions should be used routinely to reduce the risk of catheter related bloodstream infections in children and young people. (2D) ? non-dominant arm upper limb vasculature should be preserved in patients with AKI on the background of CKD as a contingency for future permanent

2019 Renal Association

194. Care of Women Presenting with Suspected Preterm Prelabour Rupture of Membranes from 24+0 Weeks of Gestation Full Text available with Trip Pro

Should antibiotics be given? Recommendation Evidence Level Strength Rationale for the recommendation Erythromycin should be given for 10 days following the diagnosis of PPROM, or until the woman is in established labour (whichever is sooner) 1++ A A Cochrane review found benefits when antibiotics were administered: reduced chorioamnionitis, prolonged latency and improved neonatal outcomes Recommended by NG 25 A Cochrane review investigating the role of antibiotics for women with confirmed PPROM found (...) that the use of antibiotics is associated with a statistically significant reduction in chorioamnionitis (RR 0.66, 95% CI 0.46–0.96). There was a significant reduction in the numbers of babies born within 48 hours (RR 0.71, 95% CI 0.58–0.87) and 7 days (RR 0.79, 95% CI 0.71–0.89). Neonatal infection, use of surfactant, oxygen therapy and abnormal cerebral ultrasound prior to discharge from hospital was also reduced. There was no significant reduction in perinatal mortality or on the health of the children

2019 Royal College of Obstetricians and Gynaecologists

195. Brexit: RCN priorities overview

). The ECDC identifies and assesses risks posed to European citizens’ health from infectious diseases. Their work monitors potential outbreaks and recommends early warning response systems to protect our health. It is unclear currently what the on-going relationship with ECDC will be both in terms of submission and comparison of UK data on infections/antibiotic resistance and the management of outbreaks in Europe that could impact on the UK. The EU can legislate that member states take action on specific (...) -medics?CMP=Share_iOSApp_ Other. December 2017. The health and social care challenges that society is facing, such as antimicrobial resistance, infectious diseases and ageing populations, are global. They are not unique to the UK and know no borders. International collaboration and exchange increases the speed and likelihood of finding the solutions to these challenges, as well as adopting insight and innovation at faster rates. For example, through international collaborative research and academic

2019 Royal College of Nursing

196. COVID-19: Managing the COVID-19 pandemic in care homes

decisions about whether hospital transfer would be considered (for oxygen therapy, intravenous fluid and antibiotics) for COVID-related illness. Advance care plans should be shared with the primary care out-of-hours service. Primary care providers should consider how to respond in a timely fashion. Decisions about escalation of care to hospital Because most care home residents live with frailty and multiple medical conditions, there may be occasions where paramedics, general practitioners, or other

2020 British Geriatrics Society

197. Interim clinical guidance for patients suspected of/confirmed with COVID-19 in Belgium

end organ dysfunction (lung, heart, liver,…), diabetes, coronaropathy, chronic obstructive pulmonary disease, arterial hypertension Confirmed COVID-19 Severe disease = 1 of the following: ? Respiratory rate =30/min (adults); =40/min (children 50% of the lung field within 24-48 hours Optimal supportive care in hospital WARD (or ICU) Provide 02 Consider carefully antibiotics or antifungals according to local epidemiology Start hydroxychloroquine (Plaquenil®) IF NO CONTRA- INDICATION • 400 mg (...) quinolones and macrolides if possible, or monitor closely the QT if these antibiotics are needed Confirmed COVID-19 Critical disease = 1 of the following: ? Acute Respiratory Distress Syndrome ? Sepsis ? Altered consciousness ? Multi-organ failure Optimal supportive care in ICU Mechanical ventilation Specific prevention & treatment of ARDS Track secondary bacterial and opportunistic (Aspergillus) infections Prevention of sub-sequent lung fibrosis NB: ongoing studies with Remdesivir (compassionate use

2020 Sciensano

198. BSG expanded consensus advice for the management of Inflammatory Bowel Disease during the COVID-19 pandemic Full Text available with Trip Pro

, colestipol) Moderate-to-severely active disease*** not controlled by ‘moderate risk’ treatments Thiopurines (azathioprine, mercaptopurine, tioguanine) Anti-diarrhoeals (e.g. loperamide) Short gut syndrome requiring nutritional support Methotrexate Antibiotics for bacterial overgrowth or perianal disease Requirement for parenteral nutrition Calcineurin inhibitors (tacrolimus or ciclosporin) Janus kinase (JAK) inhibitors (tofacitinib) Immunosuppressive trial medication Mycophenolate mofetil Thalidomide

2020 British Society of Gastroenterology

199. North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition Position Paper on the Evaluation and Management for Patients With Very Early-onset Inflammatory Bowel Disease

disorders, respectively . Genetic Variants Influencing Bacterial Recognition and Clearance Chronic granulomatous disease (CGD) is a result of defective intestinal phagocytes, specifically the granulocytes, responsible for bacterial killing and clearance . The NADPH oxidase complex is responsible for killing of ingested microbes through its production of superoxide, the precursor to reactive oxygen species (ROS) that are critical for both immunoregulatory and antimicrobial function . Superoxide (O 2 (...) , and has potential benefits in other hyperinflammatory disease that lead to inflammasome activation with overproduction of IL-18, such as XIAP . Identification of the causative gene defect is also critical in avoiding therapy that is potentially harmful. For example, in CGD, HSCT is now considered curative, but more optimized use of steroids to treat inflammatory complications and the use of antibiotics to treat infections while awaiting transplant is common . Conversely, because of further

2020 North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition

200. Sexually transmitted infection

the limits of confidentiality: If their teen’s life were in jeopardy, you would talk with the teen about the best way for you to share that information with the parent, which you would then do. Treatment Goals Eradication of infection in patient and partner(s). Lifestyle modifications/non-pharmacologic options Patients who have tested positive for an STI should receive counseling to abstain from sex until they and their partner(s) have completed a course of antibiotic treatment. Pharmacologic options (...) or other considerations preclude treatment with this regimen, consultation with an infectious disease specialist is recommended. 1 Gonorrhea treatment using two antimicrobials with different mechanisms of action is recommended to potentially slow the emergence of resistance to cephalosporins. 2 MSM are at higher risk of infection with cefixime-resistant gonorrheal strains, so cefixime should be avoided in the MSM population. 3 Patients with pharyngeal gonorrhea who are treated with the second-line

2019 Kaiser Permanente Clinical Guidelines


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