The risk of SBI in febrile infants with RSV infection seems to be very low, particularly in comparison with a control group of RSV-negative infants. These data suggest that full septic evaluations are not necessary in nontoxic-appearing infants with a positive RSV test. It seems to be prudent to examine the urine in these infants, as there is a clinically relevant rate of urinary tract infection.

Pertussis is a common cause of persistent cough in adults and should be considered in the differential diagnosis. Clinical symptoms, pertussis culture, direct fluorescent antibody testing, and lymphocytosis are of limited value in making the diagnosis.

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We have evaluated the effect of brief intervention by an alcohol health worker on alcohol consumption by 202 alcohol misusing patients. For 71 patients where questionnaires were successfully completed, 46 (65%) reported drinking less alcohol at 6 months as opposed to six (8.5%) who reported drinking more. The overall reduction was statistically significant (P < 0.001), with a mean reduction of 43%.

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OBJECTIVE:A large majority of urinary tract infections are caused by coliform organisms. Trimethoprim-sulfamethoxazole (TMP-SMX) resistance among uropathogens is increasing in many areas. The objective of this study was to determine risk factors for TMP-SMX-resistant coliforms in patients with urinary tract infections. DESIGN:Retrospective case-control study.SETTING: Emergency department of a tertiary care university hospital. PATIENTS:We studied 448 emergency department patients aged 14 years or older with a urinary tract infection caused by a coliform organism. Cases consisted of all patients with a culture-documented urinary tract infection caused by a TMP-SMX-resistant coliform, while control patients were those with a TMP-SMX-sensitive organism. MEASUREMENTS AND MAIN RESULTS: Highly resistant strains of pathogenic bacteria have evolved in recent years. This increase in resistance, usually seen among hospitalized patients, has been primarily due to evolutionary pressure from the use of antimicrobial agents. 1,2 However, increasing numbers of resistant bacteria are being found in outpatients. 3 The emergence of resistant strains of bacteria has been particularly challenging to physicians in outpatient settings as they usually rely upon empiric treatment of patients. In addition, physicians are frequently under pressure to limit the use of potent antimicrobial agents in order to decrease the cost of care and to avoid further resistance.The Enterobacteriaceae , a group of aerobic gramnegative bacilli that includes Escherichia coli , cause a large majority of urinary tract infections in outpatient and emergency department settings. 4,5 Antimicrobial resistance among these gram-negative coliforms has been increasing in recent years. At many centers, the majority of E. coli isolates are now resistant to ampicillin, and this antibiotic is no longer recommended for the routine treatment of urinary tract infections. 4 The prevalence of strains resistant to trimethoprim-sulfamethoxazole (TMP-SMX) has also been increasing in many communities. 4 This is of particular concern as TMP-SMX is currently considered the first-line therapy for uncomplicated urinary tract infections. 6 Few studies have examined risk factors for TMP-SMXresistant strains of coliforms in patients with a urinary tract infection. In particular, there have been no studies focusing on an outpatient population. The purpose of this study was to analyze risk factors for TMP-SMX-resistant coliforms in patients with urinary tract infections. METHODSWe conducted a retrospective case-control study of patients with culture-documented gram-negative coliform urinary tract infection. Case patients were those with urinary tract infections caused by coliforms that were resistant to TMP-SMX, while control patients were all those with TMP-SMX-susceptible strains. Patients were seen during a 3-year period from 1995 to 1997 and were treated in the emergency department of a large urban university hospital. Patients were identified via a computerized culture report log,...

Objective: To determine: 1) the number of patients arriving at the ED who had executed an advance directive (AD), 2) how many of the patients who had an A D brought the A D with them, and 3) whether those patients who did not have an A D had ever discussed ADS with their primary care providers (PCPs) or had ever heard of an AD. Methods:A cross-sectional, observational survey of a convenience sample of high-risk patients presenting to the E D of a university hospital was performed. Patients presenting to the E D for acute complaints who were elderly or had an underlying disease that suggested a risk of death in the near future were considered high risk. Results:Of the 238 patients surveyed, 90% had PCPs. However, only 22% had ADS. Of these, only 23% brought the A D to the ED. Of the patients who did not have ADS, 95% had never discussed ADS with their PCPs, and 42% did not know what an A D was. Blacks were less likely than whites to hate ADS (p < 0.0002) or to know about them (p < 0.004). Conclusion:The majority of high-risk patients presenting to this E D do not have ADS. Among those highrisk patients who did have ADS, fewer than 25% brought the ADS with them. The development of ADS for high-risk patients and the availability of ADS in the E D are woefully inadequate. Emergency ]physicians need to collaborate with PCPs to remedy these deficiencies.