BACKGROUND Overuse of antibiotics to treat urinary tract infections (UTIs) is common in hospitalized patients and may begin in the emergency department (ED). METHODS For a 4‐week period we reviewed medical records of all patients admitted to the hospital who initiated treatment for a UTI in the ED. RESULTS According to study criteria, initiation of antibiotics was inappropriate for 55 of 94 patients (59% [95% confidence interval {CI}, 48%‐69%]), and continuation after admission was inappropriate for 54 of 80 patients (68% [95% CI, 57%‐78%]). CONCLUSION Failure to reevaluate the need for antibiotics initiated in the ED to treat UTIs may lead to overuse of antibiotics in hospitalized patients. Journal of Hospital Medicine 2016;11:181–184. © 2015 Society of Hospital Medicine

Purpose Most cases of cellulitis are traditionally attributed to β-hemolytic streptococci and Staphylococcus species, although in most cases, no organism is identified. Development of PCR using the conserved bacterial 16s-rRNA DNA permits identification of bacteria independent of conventional culture approaches and prior use of antibiotics. Methods We used PCR-based techniques to identify cellulitis etiology using aspirate samples from affected skin. Saline was infiltrated and aspirated at the site of greatest erythema or at the cellulitic border. Samples were tested for 16s-rRNA DNA and organism-specific probes used to identify bacteria commonly seen in skin infections. Results Aspirates from 32 patients were studied and16s-rRNA DNA was detected in 9/32 of the cases (28.1%). Bacterial species were identified by PCR methods in 6/9 (66.6%). S. aureus was identified in 4/6 samples, and 2/6 were methicillin-resistant S. aureus (MRSA). Of patients with positive aspirate bacterial cultures (3/9, 33.3%), S. aureus was present on culture in 2/3 (66.6%) positive samples, and coagulase-negative Staphylococcus (CoNS) was present on culture in 2/3 (66.6%) positive samples. Only in one of the three positive bacterial cultures did the PCR method detect the same organism as was detected by culture. Among patients with positive provider-collected clinical cultures, MRSA was the predominant organism (11/18, 61.1%) and when present, it was found as the sole organism. Where S. aureus or Streptococcus species were detected by molecular methods, clinical cultures yielded a positive result as well. Conclusions PCR-based techniques do not appear to be more sensitive than aspirate cultures for detection of pathogens in cellulitis.

Since the advent of anti-retroviral therapy, patients with HIV are living longer, and in the year 2015, over half of those infected with the virus will be older than age 50. Moreover, as the general aging population continues to grow, more elderly individuals will become newly infected with HIV. Older patients with HIV contribute to high numbers of initial and rehospitalizations, have longer lengths of hospital day stays, and are at increased risk of death compared to younger patients with HIV and those without HIV. Age-related comorbidities can be exaggerated in HIV-positive patients on and off therapy. Furthermore, signs and symptoms of HIV and AIDS may mimic features seen in the normal aging process of older adults. Internists caring for patients in inpatient settings will be expected to care for and diagnose increasing numbers of older patients with HIV. This will be critical for improving quality of patient care, reducing morbidity and mortality, and managing newly diagnosed patients earlier in the disease course while reducing spread of the virus. Internists should be central leaders in the development of targeted and non-targeted HIV screening efforts in inpatient general medicine wards.

When admission order completeness and quality for medical students who trained at hospitals using CPOE were compared to those who trained using handwritten orders, no important differences were found.