Management of positive blood cultures at a city hospital in New York

We prospectively evaluated antimicrobial therapy in 205 episodes of positive blood cultures involving 85 patients admitted to the Medical Floors over a 6 month period. Of 205, 88 were contaminants and 117 episodes were true/probable bacteremias. Assessment of antimicrobial therapy for bacteremias revealed that 71/98 [72%] empirical antibiotics were appropriate; 80/108 [76%] antibiotics after gram stain were appropriate and 72/103 [70%] antibiotics after susceptibility results were appropriate Inappropriate antimicrobial therapy was most often due to incorrect dosing for renal function and severity of infection as well as with regard to combination used and susceptibility profile. Of 88 contaminants, 20 [23%] were treated after gram stain result and 10 [11.4%] were treated after identification of the organism. Vancomycin was used in 60 of 205 [29%] episodes and was inappropriate in 19 of 60 [32%]. This study underscores the need for continued education of physicians in the field of antimicrobial therapy

Sequential changes of traumatic vertebral compression fracture on MR imaging

The purpose of this study was to evaluate the sequential signal intensity changes in post-traumatic vertebral compression fractures of varying ages. Sixty-six patients with 115 post-traumatic vertebral compression fractures underwent MR imaging. The ages of fractures at the time of MR images ranged from 1 day to 6 years. Sequential follow-up MR imagings were obtained in 4 patients for 2 years after initial MR examination. The fracture sites in all 52 fractures with traumatic events less than 3 months prior were hypointense on T1-weighted images and hyperintense on T2-weighted images (type I). A type I fracture could be subdivided into 3 patterns depending on its morphologic appearance: diffuse (type Ia); patchy (type Ib); and bandlike (type Ic). In 12 fractures of 3 to 5 months after trauma, six showed focal hypointensity (type II) in all pulse sequences, and six showed isointensity (type IV). Four of 51 fractures with trauma over 5 months showed focal hyperintensity on T1-weighted images and isointensity on T2-weighted images (type III); and the remaining 47 fractures showed isointensity on all sequences (type IV). In conclusion, MR imaging is useful in predicting the age of known traumatic compression fractures, so familiarity with these sequential MR findings would be helpful in distinguishing benign from malignant fractures.