Weekly Roundup 9-20-13

It was an antibiotics-filled week! First the CDC report on antibiotic resistance highlighted the threat of overuse of antibiotics in animals in increasing bacterial antibiotic resistance. The report itself is a fascinating read…caveat lector: the thought of vancomycin–resistant Staph aureus may cause nightmares. 

We had two outstanding talks from ID gurus Jen Fulcher for intern intake and Dr. Martha Lewis Blum at Westwood noon conference:

Intern Intake Handout - Antibiotics by Jen Fulcher
Look for Dr. Blum's talk on DOM TV coming soon!

From Patrick Ahearn (resident report): Patrick presented a case of a patient with known lupus who presented with acute worsening of chronic dyspnea found to have acute pulmonary embolism complicating likely chronic pulmonary hypertension of unclear etiology.

• Pulmonary Hypertension associated with SLE is rare (about 4% of lupus patients)
• Massive PE defined as drop in SBP < 90mmHg OR drop of 40 points below patient's baseline for 15 minutes
• Thrombolysis is recommended in Massive PE (grade 2C recommendation)
• There is a grade1C recommendation against systemic thrombolytics in most submassive PE
• Grade 2C recommendation for systemic thrombolysis in select patients at high risk for developing shock
• Risk factors for shock include, elevated troponin, elevated BNP, right heart strain, severe hypoxemia, PFO, free floating thrombus, large perfusion defect
• Chronic Thromboembolic Pulmonary Hypertension (CTEPH) is a rare complication of PE (1%)
• PA endarterectomy is recommended for operative candidates with CTEPH and generally has good results (84% 4 year survival, >90% conversion from NYHA III or IV -> I or II)

Slides from Patrick's presentation

From Janette Zara (resident report): Janette presented a case of a new diagnosis of infectious endocarditis presenting with a rash that was consistent with polyarteritis nodosa on biopsy (no prior known report in the literature! Look for the full report coming soon to a conference near you)

• Polyarteritis nodosa on pathology is classically seen as medium sized vasculitis without granulomas that spares the veins
• The standard time for blood culture is sufficient for fastidious organisms (5 days at UCLA).
• Indications for TEE (without prior TTE):

• See her presentation for more IE pearls!

And last but not least, a little gem from the past: from September 2011, Dr. Dan Uslan quoted in men's health about the rise of Superbugs.

Dr. Uslan, doing his best Nic Cage impression