Der Internist
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A 33-year-old woman in a seriously ill state presented with hepatic abscesses. The proof of epitheloid-like reactions by biopsy and further serological analysis led to the final diagnosis of tularemia, which represents a rare disease in Germany. Thereafter targeted antibiotic therapy was successfully initiated. The contribution of simultaneously diagnosed celiac disease to the unusual manifestation of tularemia in the liver, remains uncertain.
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Case Reports
[Hematochezia and right-sided upper abdominal pain after puncture of a liver abscess in a 75-year-old male].
This article presents the case of a 75-year-old male patient, who underwent a percutaneous abscess puncture of a liver abscess. A few days after the puncture and drainage there was a sudden onset of right upper quadrant abdominal pain accompanied by hematochezia. ⋯ A false aneurysm of the cystic artery was identified only after a CT angiography of the abdomen. Due to spontaneous cessation of the bleeding a cholecystectomy was subsequently performed for definitive treatment of the false aneurysm.
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Antibiotic stewardship (ABS) is an important measure to counteract the spread of resistant pathogens and multidrug resistance. The most important ABS tools include the implementation of local guidelines, the development of a house-related list of anti-infective agents, regular ABS visits and practice-oriented internal training events. Effective strategies for therapy optimization include indication testing and therapy evaluation, dose optimization as well as determining an appropriate duration of therapy. ⋯ The incidence of Clostridioides difficile infections (CDI) can be more than halved by restricting the so-called "4C antibiotics". Point-of-care tests help to minimize the use of antibiotics in the outpatient setting. Vaccination reduces the need for antibiotic therapy.