The American journal of emergency medicine
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In this study, we aimed to explore the association between the choice of empirical antibiotic therapy and outcomes in ED patients with sepsis. ⋯ Empirical combination antibiotic therapy was not associated with reduced mortality in ED patients with sepsis. Compared with cephalosporins, penicillins and vancomycin, quinolone mono-antibiotic therapy was significantly associated with a decreased risk of in-hospital mortality, especially in patients with respiratory tract infections.
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Diagnosis of cryptococcal meningitis is typically aided through CSF analysis obtained via lumbar puncture (LP), revealing elevated WBCs, increased protein, decreased glucose, and increased opening pressure. While CSF culture confirms the diagnosis, it takes days, prompting reliance on these adjuncts. AIDS from Human Immunodeficiency Virus is less commonly diagnosed in the emergency setting due to advances in testing and treatment. ⋯ This case underscores that C. neoformans can present with normal CSF studies, delaying diagnosis and treatment, highlighted by the fact that this patient went undiagnosed in the preceding 3.5 weeks. CSF cryptococcal antigen and opening pressure are critical diagnostic tools, enabling timely antifungal therapy. Given the high mortality rate, early empirical treatment is essential, especially in high-risk patients, even when CSF findings seem normal.