Subject(s)
Kidney Failure, Chronic/therapy , Peritoneal Dialysis/adverse effects , Peritonitis/etiology , Pseudomonas Infections/etiology , Pseudomonas pseudoalcaligenes , Adult , Anti-Bacterial Agents/therapeutic use , Female , Humans , Meropenem , Peritonitis/diagnosis , Peritonitis/therapy , Pseudomonas Infections/diagnosis , Pseudomonas Infections/therapy , Thienamycins/therapeutic useABSTRACT
The aim of this study was to determine the extent and associated costs of repeat Clostridium difficile stool polymerase chain reaction (PCR) assays in patients with initially negative PCRs. C. difficile stool PCRs were done on adult hospitalized patients with diarrhea. The number/time course of repeat PCRs on initially negative PCR patients was determined. Of 5,027 C. difficile stool PCRs, 814 (16.2 %) were positive and 4,213 (83.8 %) were negative. Ninety-seven of the initially PCR-negative patients had >2 repeat tests 1-59 days after the initial negative stool PCR. Repeat negative PCR testing rarely resulted in a subsequent positive result (0.05 %). The unnecessary costs of 97 repeat PCRs was $32,658.00. Many of these patients were originally given empiric oral anti-C. difficile therapy, in spite of repeatedly negative PCRs.
Subject(s)
Bacteriological Techniques/methods , Clostridioides difficile/isolation & purification , Clostridium Infections/diagnosis , Cross Infection/diagnosis , Diarrhea/diagnosis , Polymerase Chain Reaction/methods , Adult , Bacteriological Techniques/economics , Clostridioides difficile/genetics , Clostridium Infections/microbiology , Cross Infection/etiology , Diarrhea/etiology , Feces/microbiology , Humans , Polymerase Chain Reaction/economicsABSTRACT
Fever of unknown origin (FUO) may be due to infection, malignancy, collagen vascular/inflammatory disorders, or other causes. Cytomegalovirus (CMV) infection is a rare cause of FUO in immunocompetent adults. We present a case of FUO due to CMV in an immunocompetent adult with polyclonal gammopathy on serum protein electrophoresis (SPEP).
Subject(s)
Blood Protein Disorders/complications , Cytomegalovirus Infections/virology , Cytomegalovirus/immunology , Fever of Unknown Origin/virology , Antiviral Agents/therapeutic use , Blood Protein Disorders/blood , Blood Protein Disorders/diagnosis , Blood Protein Electrophoresis , Cytomegalovirus Infections/blood , Cytomegalovirus Infections/diagnosis , Diagnosis, Differential , Fever of Unknown Origin/blood , Fever of Unknown Origin/diagnosis , Ganciclovir/analogs & derivatives , Ganciclovir/therapeutic use , Humans , Male , Middle Aged , Treatment Outcome , ValganciclovirABSTRACT
OBJECTIVE: We compare the reliability and define the role of plain film radiography and CT in the assessment of various severities of small-bowel obstruction. MATERIALS AND METHODS: A blinded retrospective analysis was done on 78 patients who underwent plain abdominal radiography, CT, and enteroclysis to assess for suspected small-bowel obstruction. The findings at enteroclysis and the clinical outcomes were used as standards of reference. RESULTS: The sensitivity of plain film radiography for revealing small-bowel obstruction was 69% (44/64), and its specificity was 57% (8/14). Overall accuracy of plain film radiography was 67% (52/78). The sensitivity and specificity of CT were 64% (41/64) and 79% (11/ 14), respectively. Overall accuracy of CT was 67% (52/78). When obstructions were classified as low- and high-grade partial obstruction, plain film radiography and CT had sensitivities of 86% (24/28) and 82% (23/28), respectively, for high-grade obstruction and 56% (20/36) and 50% (18/36), respectively, for low-grade obstruction. CT revealed the cause of the small-bowel obstruction in 95% (39/41) of those patients in who CT correctly showed the obstruction. CONCLUSION: Plain film radiography and CT had similar overall accuracies in showing small-bowel obstruction of various severities. Plain film radiography should remain the initial method of imaging patients with suspected small-bowel obstruction. The ability of CT to show the cause of small-bowel obstruction makes CT an important additional diagnostic tool when specific management issues must be addressed.
