During the Nebraska Antimicrobial Stewardship Summit on June 1st, 2018, Dr. Christopher Crnich from the University of Wisconsin at Madison delivered an excellent review on the management of common infections in long-term care.  Dr. Crnich reviewed the management of Clostridium difficile infections (CDI), and what he called ‘pus infections’ which included urinary tract infections (UTI), respiratory tract infections, and skin and soft-tissue infections.  Below are some important points for each of the infections discussed.

Urinary Tract Infections

–  UTI is a clinical diagnosis, not a laboratory diagnosis
–  Urinalysis (UA) negative for bacteria or pyuria is helpful for ruling out UTI
–  Positive or abnormal UA does not always suggest an infection

 Respiratory Tract Infections

–  Many upper respiratory tract infections are viral in nature
–  Reserve antibiotics for severe symptoms or double-sickening in acute rhinosinusitis
–  It takes several weeks for symptoms to clear from acute bronchitis

Skin and Soft-Tissue Infections

–  Redness or a wound alone does not equal an infection
–  Wound care and addressing underlying cause are essential management strategies
–  Non-purulent cellulitis is typically caused by streptococci, not staphylococci

Clostridium difficile Infections

–  Do not test for CDI if there are no clear cut symptoms
–  Adequacy of environmental cleaning should be assessed
–  Antimicrobial stewardship program is an important intervention in controlling CDI

Many more important clinical pearls for these infections can be found throughout the presentation.  Although the presentation is geared toward long-term care setting, providers from other settings including ambulatory care can also benefit from this important review.

The video along with PDF of the slides are now available on the Nebraska Antimicrobial Stewardship Summit Presentation page (Hint: it’s toward the bottom of the page).  Alternatively, you can go to the Nebraska ASAP YouTube channel to watch the video.

We will be uploading additional videos from the Summit soon.  So stay tuned!

Written by Phil Chung, PharmD, MS, BCPS