Assuntos
Carne Vermelha/parasitologia , Sus scrofa/parasitologia , Triquinelose/diagnóstico , Idoso , Animais , Dor no Peito/etiologia , Diagnóstico Diferencial , Erros de Diagnóstico , Diarreia/parasitologia , Dispneia/etiologia , Eletrocardiografia , Eosinofilia/etiologia , Febre/etiologia , Insuficiência Cardíaca/complicações , Humanos , Masculino , Triquinelose/complicaçõesRESUMO
Necrotizing fasciitis caused by Klebsiella pneumoniae has been described in Southeast Asia, but has only recently begun to emerge in North America. The hypermucoviscous strain of K. pneumoniae is a particularly virulent strain known to cause devastatingly invasive infections, including necrotizing fasciitis. Here we present the first known case of necrotizing fasciitis caused by hypermucoviscous K. pneumoniae in North America.
Assuntos
Fasciite Necrosante/diagnóstico , Infecções por Klebsiella/diagnóstico , Klebsiella pneumoniae/isolamento & purificação , Idoso , California , Fasciite Necrosante/microbiologia , Evolução Fatal , Feminino , Humanos , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/patogenicidade , Filipinas/etnologiaRESUMO
OBJECTIVES: The objective was to assess the efficiency and safety of an interactive computer kiosk module for the management of uncomplicated urinary tract infections (UTI) in emergency departments (EDs). METHODS: This was a prospective unblinded randomized trial. Women age 18 to 64 years seeking care for suspected UTI in three urban EDs were referred to a computer kiosk after triage. The kiosk evaluated women for uncomplicated UTI (based on patient report of at least one irritable voiding symptom within 7 days and absence of complicating features), and eligible patients were randomized to expedited management or usual ED care. Expedited management consisted of a brief clinician encounter to confirm computer kiosk responses and selection of one of four standard antibiotic regimens. Study outcomes included urine culture results, duration of ED visit, time to illness resolution, return visits, and satisfaction with care. RESULTS: Seventeen percent (n = 103) of 624 participants with suspected UTI fulfilled uncomplicated criteria and were randomized. Sixty-nine percent of these women had a positive urine culture. Compared with the control group, the computer-expedited management group had lower median visit duration (89 minutes, interquartile range [IQR] = 65 to 150 minutes vs. 146 minutes, IQR = 105 to 216 minutes) for a decrease of 57 minutes (95% confidence interval [CI] = 27 to 87, p = 0.004). They had similar time to illness resolution, number of return visits, and satisfaction with care. CONCLUSIONS: An interactive computer kiosk accurately, efficiently, and safely expedited the management of women with uncomplicated UTI in a busy, urban ED. Expanding the use of this technology to other conditions could help to improve ED patient flow.