Ann Arbor Guide to Triaging Adults with Suspected Urinary Tract Infection for In-Person and Telehealth Settings
A multidisciplinary expert panel used the RAND/UCLA Appropriateness Method to develop clinical algorithms guiding for adults with suspected urinary tract infection (UTI) presenting by phone, telehealth, or in‑person. The resulting triage recommendations stratify patients based on symptom severity and risk factors, aiming to standardize testing and treatment and reduce unnecessary antibiotic use. These criteria address both uncomplicated cystitis and more concerning presentations (e.g., pyelonephritis or complicated symptoms) across care settings. Clinical implications: Implementing these algorithms may improve antibiotic stewardship by reducing inappropriate prescriptions and guiding clinicians toward appropriate in‑person evaluation or testing before treatment, especially in telehealth contexts where over‑prescribing is common. Full Access: JAMA
Public Health Alerts: Paenibacillus dendritiformis as a cause of destructive meningitis in infants
Two US infants, both born prematurely, developed severe neurologic disease and destructive meningitis associated with Paenibacillus dendritiformis infection; initial cultures were misidentified as P. thiaminolyticus, but whole‑genome sequencing confirmed P. dendritiformis. The cases featured progressive hydrocephalus, brain abscesses, and long‑term developmental impairments despite broad antibiotic therapy. Clinical implications: Clinicians should be aware of this emerging environmental pathogen in young infants, as standard empiric antibiotics may be inadequate and early neurosurgical involvement for abscess drainage and hydrocephalus management may be critical. Full Access: CIDRAP
Health E-Stat 110: Change in the Maternal Syphilis Rate: United States, 2022–2024
From 2022 to 2024, the maternal syphilis rate in the United States increased by about 28%, rising from 280.4 to 357.9 cases per 100,000 live births. The rise occurred across most racial and Hispanic origin groups, with particularly high rates among American Indian/Alaska Native and Hispanic mothers. All maternal age groups saw increases, though younger mothers had the highest absolute rates. The findings reflect an ongoing syphilis epidemic and highlight significant racial/ethnic disparities in maternal infection. Clinical implications: This trend underscores the need for enhanced prenatal screening and timely treatment to prevent congenital syphilis and associated adverse outcomes like stillbirth, preterm birth, and neonatal morbidity. Full Access: CDC
Prediction of Bacteremia and Bacterial Meningitis Among Febrile Infants Aged 28 Days or Younger
In a large pooled analysis of prospective cohort studies involving febrile infants aged 28 days or younger, researchers evaluated an updated PECARN clinical prediction rule using urinalysis, procalcitonin, and absolute neutrophil count to identify low‑risk infants for bacteremia and bacterial meningitis. The rule demonstrated high sensitivity (94.2%) and excellent negative predictive value (99.4%), with no cases of bacterial meningitis misclassified as low risk, though specificity was modest (~41.6%). Clinical implications: This evidence supports using the prediction rule to risk‑stratify well‑appearing febrile neonates and potentially avoid routine lumbar punctures in infants who meet low‑risk criteria, enhancing shared decision‑making and reducing invasive testing. Clinicians should still be cautious, particularly in younger neonates and ensure close follow‑up. Full Access: JAMA