June 26, 2013

DynaMed EBM Journal Volume 8, Issue 26

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Physicians: .25 AMA PRA Category ICreditsTM

Family Physicians: .25 Prescribed credits

Nurse Practitioners: .25 Contact hours

Release Date: June 26, 2013

Expiration Date: June 26, 2014

Estimated Completion Time: 15 minutes

There is no fee for this activity.

To Receive Credit

In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.

Faculty Information

Alan Ehrlich, MD - Assistant Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Senior Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

James McLellan, PhD - Senior Medical Writer, DynaMed, Ipswich, Massachusetts, USA


Dr. Ehrlich, Dr. Fleming, Dr. McLellan, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.

No commercial support has been received for this activity.

Accreditation Statements

ACCME: This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Antidote Education Company and EBSCO Publishing. Antidote is accredited by the ACCME to provide continuing medical education for physicians. Antidote Education Company designates this enduring activity for a maximum of 0.25 AMA PRA Category 1 CreditsTM. Physicians should only claim credit commensurate with the extent of their participation in the activity.

AAFP: This enduring material activity, DynaMed EBM Focus Volume 8, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP certification begins March 6, 2013. Term of approval is for one year from this date with the option of yearly renewal. Each weekly updated is approved for 0.25 Prescribed credits. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.

Program ID: 1304158H


Last week 430 journal articles were evaluated via DynaMed's Systematic Literature Surveillance and summaries of 234 articles were added to DynaMed content.

Based on criteria for selecting "articles most likely to change clinical practice," one article of significant interest was selected by the DynaMed Editorial Team.

Universal MRSA Decolonization in Intensive Care Unit Reduces Overall Bloodstream Infections
Reference: N Engl J Med 2013 Jun 13;368(24):2255, (level 1 [likely reliable] evidence)

Infections from methicillin-resistant Staphylococcus aureus (MRSA) and other pathogens have become a major risk factor for preventable illness and death in health care settings, and patients admitted to intensive care units (ICUs) are at elevated risk. A common strategy for preventing MRSA infections involves screening of all patients upon ICU admission and isolation of patients testing positive for colonization. However, the optimal strategy for preventing healthcare-associated infections remains unclear. A recent cluster-randomized trial in 43 hospitals involving 74,256 adult patients admitted to 74 ICUs compared infections rates for 3 different MRSA prevention protocols.

Hospitals were randomized for 18 months to MRSA screening and isolation (control) vs. targeted decolonization vs. universal decolonization. In control hospitals, all patients were screened upon ICU admission, and contact precautions were put in place for all patients with any positive MRSA test, MRSA infection, or history of MRSA colonization. In hospitals with targeted decolonization, all ICU patients were screened and those testing positive had decolonization for 5 days with mupirocin 2% ointment intranasally twice daily and bathing with chlorhexidine 2%-impregnated cloths daily. In hospitals with universal decolonization, all ICU patients had decolonization without any MRSA screening. The targeted and universal decolonization groups had contact precautions similar to control group. Prior to the intervention period, baseline data were collected for all hospitals for 1 year.

The changes in outcome rates between the baseline and intervention periods were compared among the groups. The reduction in the overall rate of bloodstream infections from any pathogen was significantly greater with universal decolonization (-2.5 per 1,000 patient-days) than with either targeted decolonization (-1.1 per 1,000 patient-days) or control (-0.1 per 1,000 patient-days). The reduction was also significantly greater for targeted decolonization vs. control. However, there were no significant differences in the changes in MRSA-specific infection rates among the groups (-0.1 with universal decolonization vs. +0.1 with targeted decolonization vs. +0.1 with control per 1,000 patient days). Universal decolonization was associated with a significant reduction in MRSA-positive cultures (including both MRSA infection and colonization) compared to the control group (-1.3 vs. -0.2 per 1,000 patient-days, p = 0.003).

For more information, see the Methicillin-resistant Staphylococcus aureus (MRSA) infection topic in DynaMed.

Earn CME Credit for reading this e-Newsletter.
For more information on this educational activity, see the CME sidebar.

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Bartonellosis in immunocompromised patients


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