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161. Small Intestinal Bacterial Overgrowth

) Methane-positive breath test to suggest intestinal methanogen overgrowth. ( c ) Normal breath test. ppm, parts per million. A recent North American Consensus article provides some guidelines for standardized methods of performing and interpreting breath test results ( ). Before breath testing, it is recommended that patients avoid use of antibiotics for 4 weeks and avoid promotility agents and laxatives for at least 1 week. The day before the breath test, fermentable foods (e.g., complex carbohydrates (...) is now based on meta-analysis, and other evidence such as 16S rRNA gene sequencing continues to support this concept ( ). Further evidence that IBS is associated with microbiome dysbiosis (or SIBO) is based on the successful use of antibiotics in the treatment of IBS. Although this will be discussed in more detail below, in 2015, the U.S. Food and Drug Administration (FDA) approved a nonabsorbed antibiotic, rifaximin, for the treatment of IBS with diarrhea based on the existing understanding that one

2020 American College of Gastroenterology

162. Recognition and Initial Management of Fulminant Myocarditis: A Scientific Statement From the American Heart Association Full Text available with Trip Pro

ability to augment stroke volume in the acutely affected nondilated heart. Consider hypersensitivity myocarditis, a subset of eosinophilic myocarditis, generally presenting as FM with peripheral eosinophilia (65% of patients), rash, or elevated LFTs. Patients often will have a fever and high risk (43%) of death, transplantation, or VAD placement at 120 d. An EMB is often necessary for definitive diagnosis. Common causative agents are antibiotics such as β-lactams and minocycline and certain central

2020 American Heart Association

164. Prevention of Early-Onset Group B Streptococcal Disease in Newborns

, an initial GBS culture should be obtained, and a latency antibiotic regimen that incorporates agents active against GBS should be started. If a woman with PPROM has or is suspected of having intraamniotic infection, administra- tion of broad-spectrum intrapartum antibiotics, includ- ing an agent that provides antimicrobial coverage against GBS, is recommended (75). In women with PPROM who report a penicillin allergy, conversion to an oral antibiotic regimen after completion of 48 hours of intravenous (...) (EOD)ismaternalcolonizationofthegenitourinaryandgastrointestinaltracts. Approximately 50% of women who are colonized with GBS will transmit the bacteria to their newborns. Vertical transmission usually occurs during labor or after rupture of membranes. In the absence of intrapartum antibiotic prophylaxis, 1–2% of those newborns will develop GBS EOD. Other risk factors include gestational age of less than 37 weeks, very low birth weight, prolonged rupture of membranes, intraamniotic infection, young

2020 American College of Obstetricians and Gynecologists

165. Neuroprotection from acute brain injury in preterm infants

Neuroprotection from acute brain injury in preterm infants Infants born at ≤32 +6 weeks gestation are at higher risk for intracranial ischemic and hemorrhagic injuries, which often occur in the first 72 hours postbirth. Antenatal strategies to reduce the incidence of acute brain injuries include administering maternal corticosteroids and prompt antibiotic treatment for chorioamnionitis. Perinatal strategies include delivery within a tertiary centre, delayed cord clamping, and preventing (...) hypothermia. Postnatal strategies include empiric treatment with antibiotics when chorioamnionitis is suspected, the cautious use of inotropes, the avoidance of blood PCO2 fluctuation, and neutral head positioning. Clinicians should be aware of the policies and procedures that, especially when combined, can provide neuroprotection for preterm infants. Keywords: Acute brain injury; Infant; Intraventricular hemorrhage; Neuroprotection; Neuroprotective strategies; Premature

2019 Canadian Paediatric Society

166. Recommendations for good practice in Ultrasound: Oocyte retrieval

literature search was conducted. Databases (PUBMED/Medline and the Cochrane Library) were searched from inception to 17 July 2018. Search terms focussed on ultrasound, oocyte retrieval, Doppler, sedation, anaesthesia, infection, antibiotics, hydrosalpinx and flushing, and included extended key words and MESH terms. References were divided according to topic, and full texts were assessed (see Supplementary Figure 1, available as Supplementary data at ESHRE online). Where possible, references of papers (...) sperm retrieval) can be considered. In any case, patients should be counselled on the possibility of such complications and informed consent should be obtained before starting the OPU procedure. Antibiotic prophylaxis Patients with history of endometriosis, pelvic inflammatory disease (PID), pelvic adhesions, dermoids, or previous pelvic surgery can be considered at high risk for pelvic infection. In these patients, administration of antibiotics is recommended shortly before or during OPU (according

2019 European Society of Human Reproduction and Embryology

167. C-Reactive Protein and Erythrocyte Sedimentation Rate Testing

; and an inflammatory or infectious disease is suspected; and a specific diagnosis is not made effectively by other means. CRP may be used to monitor the activity of: rheumatic conditions such as vasculitis (e.g., temporal (giant cell) arteritis and polymyalgia rheumatica ) and inflammatory arthritis (e.g., rheumatoid arthritis and SLE ); inflammatory bowel disease (e.g., ulcerative colitis and Crohn’s disease); or infections which require long term antibiotics and which are difficult to monitor clinically (e.g

2019 Clinical Practice Guidelines and Protocols in British Columbia

168. Pregnancy and Renal Disease

? KDIGO Guideline for the Care of Kidney Transplant Recipients, 2009. ? KDIGO Clinical Practice Guidelines for Nutrition in Chronic Renal Failure, 2008. ? NICE: Intrapartum Care for Women with Existing Medical Conditions or Obstetric Complications and their Babies [NG121], 2019. ? NICE: Urinary Tract Infection (Lower) Antimicrobial Prescribing [NG109], 2018 ? NICE: Urinary Tract Infection (Recurrent) Antimicrobial Prescribing [NG112], 2018. ? NICE: Antenatal Care for Uncomplicated Pregnancies [CG62

2019 Renal Association

169. ERCP-related adverse events

increase its severity are accepted indications for antibiotic prophylaxis, such as primary sclerosing cholangitis, hilar obstruction, and peroral cholangioscopy. Theaddition of antimicrobial agentsto ERCPcontrastmedia has been poorly evaluated and results are conflicting. A case– controlstudy(84patients,75%ofthemwithsclerosingcholan- gitis) reported fewer episodes of post-ERCP infection if genta- micin,vancomycin,plusfluconazolewereaddedtothecontrast medium [197]. On the other hand no difference (...) -guidewire ERCP endoscopic retrograde cholangiopancreato- graphy ESGE European Societyof Gastrointestinal Endoscopy INR International Normalized Ratio LRS lactated Ringer’ssolution NNT number needed totreat NS not significant NSAID nonsteroidal anti-inflammatory drug OR odds ratio PEC post-ERCP cholangitis PEP post-ERCP pancreatitis PSB post-sphincterotomy bleeding RCT randomized controlled trial RR relative risk SEMS self-expandable metal stent 4 ESGE recommends against the routine use of antibiotic

2020 European Society of Gastrointestinal Endoscopy

170. Guidelines for enhanced recovery after lung surgery: recommendations of the Enhanced Recovery After Surgery (ERAS) Society and the European Society of Thoracic Surgeons (ESTS) Full Text available with Trip Pro

phase Venous thromboembolism prophylaxis Patients undergoing major lung resection should be treated with pharmacological and mechanical VTE prophylaxis Moderate Strong Patients at high risk of VTE may be considered for extended prophylaxis with LMWH for up to 4 weeks Low Weak Antibiotic prophylaxis and skin preparation Routine intravenous antibiotics should be administered within 60 min of, but prior to, the skin incision High Strong Hair clipping is recommended if hair removal is required High (...) with pharmacological and mechanical VTE prophylaxis Moderate Strong Patients at high risk of VTE may be considered for extended prophylaxis with LMWH for up to 4 weeks Low Weak Antibiotic prophylaxis and skin preparation Routine intravenous antibiotics should be administered within 60 min of, but prior to, the skin incision High Strong Hair clipping is recommended if hair removal is required High Strong Chlorhexidine–alcohol is preferred to povidone-iodine solution for skin preparation High Strong Preventing

2020 ERAS Society

171. Society of Interventional Radiology Quality Improvement Standards on Percutaneous Ablation in Renal Cell Carcinoma Full Text available with Trip Pro

of the procedure, medical co-morbidities, and operator preference. Third, regarding imaging guidance, most ablative technologies can be performed using a variety of modalities including US, CT, MR imaging, PET, CT-fluoroscopy, or cone-beam CT. Decisions regarding imaging guidance should consider patient factors, availability, cost, radiation dose, and operator preference. Fourth, there is no consensus regarding the use of prophylactic antibiotics during IGTA for RCC ( x 67 Chehab, M.A., Thakor, A.S., Tulin (...) -Silver, S. et al. Adult and pediatric antibiotic prophylaxis during vascular and IR procedures: a Society of Interventional Radiology practice parameter update endorsed by the cardiovascular and Interventional Radiological Society of Europe and the Canadian Association for Interventional Radiology. J Vasc Interv Radiol . 2018 ; 29 : 1483–1501 | 67 ). Some patients, especially those with ureteral stents or non-native ureteral anatomy, may warrant prophylactic antibiotics as these patients

2020 Society of Interventional Radiology

172. Palliative Care for Adults

within 12 months • Frequent admissions (e.g., more than one admission for same condition within several months) • Admission prompted by difficult-to-control physical or psychological symptoms (e.g., moderate-to-severe symptom intensity for more than 24–48 hours) • Complex care requirements (e.g., functional dependency; complex home support for ventilator/antibiotics/feedings) • Decline in function, feeding intolerance, or unintended decline in weight (e.g., failure to thrive) Secondary Criteria b (...) just discussed with you?” “Can you explain to me why you feel that way?” Task specific. Deciding if the patient is decisional means weighing the degree to which the patient has decision-making capacity against the objective risks and benefits to the patient. Some decisions are more complex than others, requiring a higher level of decision-making capacity. Thus, a moderately demented patient may be able to make some decisions (e.g., antibiotics for pneumonia) but not others (e.g., chemo- therapy

2020 Institute for Clinical Systems Improvement

174. Laboratory diagnosis of G6PD deficiency Full Text available with Trip Pro

haemolysis in G6PD‐deficient subjects. Category of drug Predictable haemolysis Possible haemolysis Antimalarials Dapsone Chloroquine Primaquine Quinine Pamaquin * Not on UK market. Tafenoquine Methylene blue Analgesics/antipyretic Phenazopyridine Aspirin (high doses) † Acceptable up to a dose of at least 1 g daily in most G6PD‐deficient individuals. Paracetamol (Acetaminophen) Antibacterials Cotrimoxazole Sulfasalazine Sulfadiazine Quinolones ‡ Including ciprofloxacin, moxifloxacin, nalidixic acid

2020 British Committee for Standards in Haematology

175. Infection prevention and control

that when they prescribe antibiotics they do so in accordance with local antibiotic formularies which should take into account local patterns of resistance [17]. Whenever possible, anaesthetists should check that any appropriate microbiological samples have been taken before prescribing or giving antimicrobials. Clinical indication, dose and duration of course should be documented. This includes documentation using electronic prescribing systems that link indication with antimicrobial prescription (...) use of antimicrobials according to local protocols in order to preserve their future effectiveness. Recommendations 1. There should be a named Lead Consultant in each Department of Anaesthesia who is responsible for liaising with their Trust Infection Prevention and Control Team and Occupational Health Department to ensure relevant specialist standards are established and monitored in all areas of anaesthetic practice. 2. Precautions to prevent the transmission of infection between patient

2020 Association of Anaesthetists of GB and Ireland

176. 2019 EHRA International Consensus Document on How to Prevent, Diagnose, and Treat Cardiac Implantable Electronic Device Infections

. Device-related infection is, however, one of the most serious complications of cardiac implantable electronic device (CIED) therapy associated with significant morbidity, mortality, and financial health care burden. Although many preventive strategies such as administration of intravenous antibiotic therapy before implantation are well recognized, uncertainties still exist about other regimens. Questions still remain such as the use of CIED alternatives expected to be less prone to infections and how

2020 Heart Rhythm Society

178. AGA Clinical Practice Guidelines on the Management of Moderate to Severe Ulcerative Colitis

. In hospitalized adult patients with acute severe ulcerative colitis without infections, the AGA suggests against adjunctive antibiotics. Conditional Very low 10. In hospitalized adult patients with acute severe ulcerative colitis refractory to intravenous corticosteroids, the AGA suggests using infliximab or cyclosporine. Conditional Low 11. In hospitalized adult patients with acute severe ulcerative colitis being treated with infliximab, the AGA makes no recommendation on routine use of intensive vs

2020 American Gastroenterological Association Institute

179. American Gastroenterological Association Clinical Practice Update: Management of Pancreatic Necrosis Full Text available with Trip Pro

gastroenterologists, surgeons, interventional radiologists, and specialists in critical care medicine, infectious disease, and nutrition. In situations where clinical expertise may be limited, consideration should be given to transferring patients with significant pancreatic necrosis to an appropriate tertiary-care center. Best Practice Advice 2 Antimicrobial therapy is best indicated for culture-proven infection in pancreatic necrosis or when infection is strongly suspected (ie, gas in the collection, bacteremia (...) , sepsis, or clinical deterioration). Routine use of prophylactic antibiotics to prevent infection of sterile necrosis is not recommended. Best Practice Advice 3 When infected necrosis is suspected, broad-spectrum intravenous antibiotics with ability to penetrate pancreatic necrosis should be favored (eg, carbapenems, quinolones, and metronidazole). Routine use of antifungal agents is not recommended. Computed tomography–guided fine-needle aspiration for Gram stain and cultures is unnecessary

2020 American Gastroenterological Association Institute

180. Use of Bowel Preparation in Elective Colon and Rectal Surgery

. Lancet. 1973;2:735. 15. Clarke JS, Condon RE, Bartlett JG, Gorbach SL, Nich- ols RL, Ochi S. Preoperative oral antibiotics reduce septic complications of colon operations: results of pro- spective, randomized, double-blind clinical study. Ann Surg. 1977;186:251–259. 16. Matheson DM, Arabi Y, Baxter-Smith D, Alexander-Williams J, Keighley MR. Randomized multicentre trial of oral bowel prep- aration and antimicrobials for elective colorectal operations. Br J Surg. 1978;65:597–600. 17. Guglielmo BJ (...) and readmissions after colorectal surgery. J Am Coll Surg. 2013;216:756–762. 22. Oshima T, Takesue Y, Ikeuchi H, et al. Preoperative oral antibiotics and intravenous antimicrobial prophylaxis re- duce the incidence of surgical site infections in patients with ulcerative colitis undergoing IPAA. Dis Colon Rectum. 2013;56:1149–1155. 23. Scarborough JE, Mantyh CR, Sun Z, Migaly J. Combined me- chanical and oral antibiotic bowel preparation reduces inci- sional surgical site infection and anastomotic leak rates

2020 American Society of Colon and Rectal Surgeons


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