SOS AMS Podcast

Applied Cases: Bacteremia 2

This episode of the SOS AMS podcast is a continuation of the Bacteremia part 1 podcast. In this episode, our hosts apply the systematic approach to bacteremia discussed in the previous podcast to 3 patient cases. Relevant references can always be accessed at the provided hyperlink.
 
The learning objectives for the podcast are:
Case 1: Viridans group Strep “bacteremia” 1 of 2 sets in a patient admitted with AECOPD
Case 2: E. coli bacteremia secondary to pyelonephritis
Case 3: Staph aureus bacteremia, unclear source
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Bacteremia

In this episode of the SOS AMS podcast, Julia and Nicki take a closer look at the management of bacteremia. They discuss interpretation of blood culture results, including distinguishing between contaminant and true pathogen, the clinical utility of time to positivity, and the identification of high risk bacteremias. They discuss a systematic approach to managing patients with bacteremia, and evaluation for sources of infection. They then make specific mention of Staphylococcus aureus bacteremia and the four-pronged bundle of care for Staphylococcus aureus bacteremia as well as discussing the rationale for that bundle. Relevant references can be accessed at the provided hyperlink
 
The learning objectives for this podcast are:
Review interpretation of blood culture results with respect to community vs hospital onset, time to positivity, discerning true pathogen from contaminant, and identifying highest risk pathogens. 
Explain why identifying the source of bacteremia is critical to the management plan.
Review appropriate bundle of care for Staphylococcus aureus bacteremia. 
Apply this knowledge to 3 patient cases (in Part 2 of this podcast: Applied Cases in Bacteremia)
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Sepsis NYD

This episode of the SOS AMS podcast focuses on the ID/AMS side of sepsis and septic shock. Our hosts distinguish sepsis and septic shock from infection with systemic features, and bacteremia, both of which are commonly incorrectly referred to as sepsis in practice. They discuss an approach to identifying the source of sepsis in a patient with sepsis NYD, with emphasis on localizing symptoms, investigations, and what to do in the absence of localizing symptoms. They discuss the challenge in finding a balance between good stewardship and the use of aggressive antimicrobial therapy given the high mortality associated with sepsis. They then end the podcast by applying principles discussed to a case of nosocomial sepsis NYD. Relevant references can be accessed at the provided hyperlink. 
 
The learning objectives for the podcast are: 
Distinguish between sepsis, septic shock, infection with systemic features, and bacteremia.
Describe the work-up of a patient with sepsis unclear source. 
Discuss considerations for appropriate empiric therapy for a patient with sepsis NYD. 
Apply this  knowledge to a patient case
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Intraabdominal Infections (IAI)

This episode of the SOS AMS podcast focuses on the pathophysiology, diagnosis, and management of various community-onset intraabdominal infections. Infections discussed include cholecystitis, cholangitis, diverticulitis, acute appendicitis, pancreatitis, and liver abscess. Our hosts end the podcast by applying principles discussed to a patient case, going from differential diagnosis to management. Check out the clinical decision-making matrix for a summary of our top 3 differential diagnoses, as well as the relevant references at the provided hyperlinks.
The learning objectives for this podcast are as follows:
Contrast the pathophysiology of cholecystitis, cholangitis, diverticulitis, acute appendicitis, pancreatitis, and liver abscess. 
List the usual pathogens implicated in community-onset intraabdominal infection.
Discuss selection of empiric therapy for community-onset intraabdominal infections.
Recognize the importance of source control in management of intraabdominal infections.
Apply knowledge of the above to a patient presenting with suspected intraabdominal infection. 
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Urinary Tract Infections (UTI)

This episode of the SOS AMS podcast focuses on the diagnosis, microbiology, and management of urinary tract infections, including cystitis, pyelonephritis, and catheter-associated UTIs. Our hosts also discuss the pressures in practice that lead to over-diagnosis of UTIs, a significant contributor to antibiotic resistance. They then end the podcast by applying the principles discussed to two patient cases, addressing common practice issues that arise when dealing with patients with suspected urinary tract infection.  Relevant references can be accessed at the provided hyperlink, and we would encourage taking a read through the excellent 3 page article written by Dr. Tom Finucane of Johns Hopkins.
 
The learning objectives for this podcast are as follows:
Distinguish between asymptomatic bacteriuria (ASB), cystitis, pyelonephritis, and catheter associated UTI. 
Discuss important considerations for optimal timing and interpretation of urine cultures.
Rationalize which pathogens are usually implicated in UTIs.
Discuss usual treatment and treatment duration for UTIs
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Diabetic Foot Infections (DFI)

This episode of the SOS AMS podcast focuses on the diagnosis, microbiology, and management of diabetic foot infections, specifically in the setting of chronic ulcers. Julia and Nicki discuss important considerations for obtaining and interpreting cultures in this setting, as well as the role played by specific microbes like Pseudomonas, Enterococcus, and MRSA. They then apply the principles discussed to two patients presenting with differing severity of infection. Relevant references can always be accessed at the provided hyperlink.
 
The learning objectives for this podcast are as follows:
Describe the pathophysiologic processes that lead to diabetic foot ulcers.
Contrast microbial colonization from infection in the context of the usual microbial environment of diabetic foot ulcers. 
Identify proper technique for obtaining and interpreting cultures from chronic wounds.
Recognize the role of source control in patients with chronic wounds.
Devise a treatment plan for a patient with a diabetic foot infection.
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Skin and Soft Tissue Infections (SSTI)

In this episode of the SOS AMS podcast, our hosts discuss the diagnosis, microbiology, and management of cellulitis. They describe clinical features that could be suggestive of a necrotizing soft tissue infection, to highlight when we would want to obtain a stat surgical consultation. They end the podcast by applying principles discussed to a patient case, like always, going from differential diagnosis to management. Check out the clinical decision-making matrix for a summary of our top 3 differential diagnoses, as well as the relevant references in the provided hyperlinks.
 
The learning objectives for this podcast are as follows:
Describe the clinical presentation of cellulitis. 
Identify the usual pathogens implicated in cellulitis.
Describe “red flag” features concerning for necrotizing soft tissue infection. 
Rationalize empiric therapy selection for mild, moderate, and severe cellulitis.
Apply knowledge of SSTIs to manage a patient presenting with new cutaneous findings.
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Hospital Acquired Pneumonia (HAP)

This episode of the SOS AMS podcast focuses on the diagnosis and management of hospital-acquired pneumonia (HAP). Our hosts discuss the pathogenesis, microbiology, and treatment of HAP, with a brief discussion of when we would empirically cover MRSA as opposed to just MSSA. They then apply the principles discussed to a patient case, going from differential diagnosis to management. Check out the clinical decision-making matrix for a summary of our top 3 differential diagnoses, as well as the relevant references at the provided hyperlinks.
 
The learning objectives for this podcast are as follows:
Rationalize antimicrobial selection for HAP using knowledge of the commonly implicated pathogens.
Discern when MRSA coverage may be needed empirically. 
Recognize when oral stepdown may be appropriate. 
Apply knowledge of HAP to diagnose and manage a patient with new onset respiratory symptoms in hospital.
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Community Acquired Pneumonia (CAP)

During this episode of the SOS AMS podcast, Julia and Nicki dive into  the diagnosis and management of community-acquired pneumonia (CAP). They discuss the pathogenesis, microbiology, and treatment of CAP, with a brief discussion of the role of atypical pathogens. Our hosts then apply principles discussed to a patient case, going from differential diagnosis to management. Check out the clinical decision-making matrix for a summary of our top 3 differential diagnoses, as well as the relevant references at the hyperlinks provided.
 
The learning objectives for this podcast are as follows:
Identify the mechanism by which patients become infected with community acquired pneumonia (CAP)
Discuss selection of empiric therapy of CAP in the context of commonly implicated pathogens
Describe clinical features suggestive that empiric coverage of atypical pathogens would be necessary
Apply knowledge of CAP to a patient case
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Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD)

This episode of the SOS AMS podcast focuses on the diagnosis and management of AECOPD. Our hosts review how to identify which patients may benefit from antibiotics, and discuss appropriate antimicrobial agents for AECOPD. They finish the podcast by applying the principles discussed to a patient case, going from differential diagnosis to management. Check out the clinical decision-making matrix for a summary of our top 3 differential diagnoses, as well as the relevant references at the hyperlinks provided. 
 
The learning objectives for this podcast are as follows:
Describe the pathogenesis of AECOPD
Distinguish bacterial AECOPD from non-bacterial AECOPD and distinguish both of these from CAP.
Rationalize the antimicrobial therapy selection for treatment of bacterial AECOPD. 
Apply knowledge of AECOPD to diagnose and manage a patient with COPD who presents with new onset respiratory symptoms.
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