- Although hospital-acquired pneumonia (HAP) is the second most common HAI in hospitalized patients, the diagnosis is far from straightforward in many cases. More than 80% of HAP is ventilator-associated pneumonia (VAP), defined as pneumonia diagnosed within 24 hours of any duration of mechanical ventilation. Unfortunately, there is no diagnostic gold standard, and other common conditions, such as acute respiratory distress syndrome (ARDS), chest trauma, and even volume overload, share the key features of VAP.
- Sterile technique is always required for catheter insertion. However, current data support a surgical approach to preparation of the insertion site, with the operator wearing a gown, gloves, a mask, and a hat for the procedure, for all central line.
- The gold standard for detecting CDAD is to send a stool sample for cytotoxin determination, a procedure that has a sensitivity of 70 to 100%. This labor- intensive cell culture assay has been largely replaced in laboratories for enzyme immunoassays for toxins A and B with same-day results, but at a cost of decreased sensitivity (39 to 73%). At the time of this publication, polymerase chain reaction testing for the presence of toxin B is emerging as a rapid, more sensitive and specific test that will likely become the new standard for clinical screening.
Latest Updates
- Although hospital-acquired pneumonia (HAP) is the second most common HAI in hospitalized patients, the diagnosis is far from straightforward in many cases. More than 80% of HAP is ventilator-associated pneumonia (VAP), defined as pneumonia diagnosed within 24 hours of any duration of mechanical ventilation. Unfortunately, there is no diagnostic gold standard, and other common conditions, such as acute respiratory distress syndrome (ARDS), chest trauma, and even volume overload, share the key features of VAP.
- Sterile technique is always required for catheter insertion. However, current data support a surgical approach to preparation of the insertion site, with the operator wearing a gown, gloves, a mask, and a hat for the procedure, for all central line.
- The gold standard for detecting CDAD is to send a stool sample for cytotoxin determination, a procedure that has a sensitivity of 70 to 100%. This labor- intensive cell culture assay has been largely replaced in laboratories for enzyme immunoassays for toxins A and B with same-day results, but at a cost of decreased sensitivity (39 to 73%). At the time of this publication, polymerase chain reaction testing for the presence of toxin B is emerging as a rapid, more sensitive and specific test that will likely become the new standard for clinical screening.
Surgical Treatment of the Infected Aortic Graft
- Discussion of the management of aortic endograft infections, which are increasing in incidence and prevalence and represent a particularly technically challenging subset of aortic graft infections (AGIs)
- Discussion of the management of aortoenteric fistula, with special attention paid to the disastrous effects of gastrointestinal complications
- Updated review of the various methods of arterial reconstruction for AGI, with updated summary of outcomes
- The pneumococcal conjugate and influenza vaccines have been found to decrease the incidence of acute otitis media
- Oral antibiotics are associated with a higher rate of OME resolution; however, there is insufficient evidence regarding hearing and speech outcomes.
- Adenoidectomy should be considered with tympanostomy tube placement in children 4 years of age or older
Antibiotic Therapy and Common Otolaryngologic Infections
- Medical treatment of peritonsillar abscesses has been shown to be a safe and oft preferred alternative to surgical drainage.
- 2015 Adult Sinusitis CPG recommends 10 days of observation before antibiotics for uncomplicated sinusitis.
- Viral upper respiratory tract infections represent the leading diagnosis for inappropriate antibiotic prescription in the United States.
- Genomic medicine will lead to exciting new treatments for genetic causes of hearing loss.
- Cochlear implantation has been studied showing improved speech recognition and improved outcomes
- Cytomegalovirus -associated hearing loss treatment is controversial. Treatment with antivirals has risks and benefits and is currently in a multicenter clinical trial.
- High resolution manometry: A technology that facilitates topographic evaluation of esophageal motility.
- Wireless pH monitoring: A technique for pH monitoring that does not require an in-dwelling catheter, thought it requires endoscopic placement and does not provide impedance information
- Eosinophilic Esophagitis: A diagnosis of increasing frequency that causes dysphagia in pediatric and adult populations
- Transnasal esophagoscopy: A methodology for esophagoscopy that facilitates evaluation of the pharynx, larynx and pharyngoesophageal segment in contrast to traditional transoral esophagoscopy. Additionally, this can be done in office without sedation.
- Robot assisted hair transplantation: Robotic follicular unit extraction is a technique that is gaining popularity to more quickly and accurately harvest follicular units for transplantation.
- Novel drug treatments for hair loss: There are multiple novel drug treatments being developed and studied that have the potential to revolutionize hair loss treatment.
- Adjuvant therapies: Adjuvant treatments such as platelet-rich plasma, lasers, and stem cells have shown some benefit for hair loss.
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