Perioperative Infections and Fever

Michael P. Carson, MD, and Edward Liu, MD, MPH

SUMMARY
Perioperative fever has multiple possible etiologies, including infections such as pneumonia, fungal infections, central-line associated infections, and urinary infections. By understanding the typical time frame and common risk factors for each etiology, hospitalists and other perioperative consultants can develop a differential diagnosis for perioperative fever. The following module will provide a general approach for determining the differential diagnosis in patients with a perioperative fever, as well as an outline of the diagnostic and treatment modalities. 
 
GOAL
To provide hospitalists and other perioperative consultants with a general approach to evaluating and treating patients with perioperative fever, especially those due to pulmonary, urinary, central venous catheter-related, and fungal infections. 
 
TARGET AUDIENCE
This activity is designed for hospitalists and other perioperative consultants. 
 
LEARNING OBJECTIVES
After completing the module, the participant should be able to:
 
  1. DEVELOP a differential diagnosis for patients with a perioperative fever based on the timing of the fever. 
  2. EVALUATE diagnostic and treatment strategies for postoperative pneumonia. 
  3. EVALUATE diagnostic and treatment strategies for postoperative urinary catheter-related infection. 
  4. EVALUATE diagnostic and treatment strategies for postoperative central venous catheter-related infection. 
  5. EVALUATE diagnostic and treatment strategies for postoperative fungal infection.
CME INFORMATION
Accreditation Statement:
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of University of Virginia School of Medicine, ASiM and Society of Hospital Medicine. The University of Virginia School of Medicine is accredited by the ACCME to provide continuing medical education for physicians.
 
Credit Designation Statement: 
The University of Virginia School of Medicine designates this enduring material, Journal-based CME activity, Test item writing activity for a maximum of 2.0 AMA PRA Category 1 Credits.TM   Physicians should claim only the credit commensurate with the extent of their participation in the activity.     
 
 
Release date: May 4, 2016                              Expiration date: May 4, 2019
 
Estimated time to complete activity: 2 hours
 
FACULTY & FACULTY DISCLOSURES
Full Disclosure Policy Affecting CME Activities:
The University of Virginia School of Medicine, as an ACCME accredited provider, endorses and strives to comply with the Accreditation Council for Continuing Medical Education (ACCME) Standards of Commercial Support, Commonwealth of Virginia statutes, University of Virginia policies and procedures, and associated federal and private regulations and guidelines on the need for disclosure and monitoring of proprietary and financial interests that may affect the scientific integrity and balance of content delivered in continuing medical education activities under our auspices.
 
The University of Virginia School of Medicine requires that all CME activities accredited through this institution be developed independently and be scientifically rigorous, balanced and objective in the presentation/discussion of its content, theories and practices.
 
All faculty presenters participating in an accredited CME activity are expected to disclose relevant financial relationships with commercial entities occurring within the past 12 months (such as grants or research support, employee, consultant, stock holder, member of speakers bureau, etc.). The University of Virginia School of Medicine will employ appropriate mechanisms to resolve potential conflicts of interest to maintain the standards of fair and balanced education to the participant. Questions about specific strategies can be directed to the Office of Continuing Medical Education, University of Virginia School of Medicine, Charlottesville, Virginia.
 
The faculty and staff of the University of Virginia Office of Continuing Medical Education have no financial affiliations to disclose.
 
The following relationships have been reported for faculty of this activity:
 
Leonard Feldman, MD, FACP, SFHM (Chair) 
Associate Professor of Medicine and Pediatrics
Johns Hopkins University School of Medicine
Med-Peds Urban Health Residency Program Director
Associate Program Director, Osler Medical Residency
Director, Comprehensive General Medicine Consult Service
Editor, Consultative and Perioperative Medicine Essentials for Hospitalists
Baltimore, Maryland
Dr Feldman reports having no significant financial or advisory relationships with corporate organizations related to this activity.
 
Michael P. Carson, MD
Clinical Associate Professor of Medicine
Clinical Associate Professor of Obstetrics/Gynecology
Rutgers—Robert Wood Johnson Medical School
New Brunswick, New Jersey
Director of Research/Outcomes
Jersey Shore University Medical Center 
Department of Medicine
Neptune, New Jersey
Dr Carson reports having no significant financial or advisory relationships with corporate organizations related to this activity.
 
Edward Liu, MD, MPH
Clinical Assistant Professor of Medicine
Rutgers-Robert Wood Johnson Medical School
Department of Medicine
New Brunswick, New Jersey
Jersey Shore University Medical Center
Neptune, New Jersey
Dr Liu reports receiving grants/research support from Gilead Sciences Inc, Merck & Co Inc, and Theravance; and serving on the advisory committee/board and holding stock in Gilead Sciences Inc.
 
Chris Arnold, MD (Peer Reviewer)
Assistant Professor 
Division of Infectious Diseases and International Health
University of Virginia Health System 
Charlottesville, Virginia
Dr Arnold reports receiving grants/research support for RSV treatment as part of a multicenter trial from Alios BioPharma Inc.
 
The staff at ASiM reports having no significant financial or advisory relationships with corporate organizations related to this activity. 
 
Disclosure of Discussion of Non-FDA–Approved Uses for Pharmaceutical Products and/or Medical Devices
The University of Virginia School of Medicine, as an ACCME provider, requires that all faculty presenters identify and disclose any off-label uses for pharmaceutical and medical device products. The University of Virginia School of Medicine recommends that each physician fully review all the available data on new products or procedures prior to clinical use.
 
All faculty have indicated that they have not referenced unlabeled or unapproved uses of drugs or devices.
 
DISCLAIMER
The opinions and recommendations expressed by faculty and other experts are based on current scientific evidence and standards of care and their professional expertise. This enduring material is produced for educational purposes only. The University of Virginia School of Medicine implements specific educational planning processes to ensure that content is patient-centric and independent. The University of Virginia School of Medicine recommends that each physician fully review all the available data on new products or procedures prior to clinical use. 
 
Click here to download the references for this educational activity.
 
INSTRUCTIONS
The following is an interactive educational module designed to help you gauge your basic knowledge of the topic and then direct you to areas you may need to focus on. It consists of 3 sections: a non-designated pre-test, a study program, and a CME post-test. All 3 sections must be completed to receive CME credit.
Course summary
Available credit: 
  • 2.00 AMA PRA Category 1 Credit™
  • 2.00 Participation (non-CME)
Course opens: 
05/04/2016
Course expires: 
05/04/2019
Non-member cost:
$0.00
Parent activity set: 
Rating: 
0

Available Credit

  • 2.00 AMA PRA Category 1 Credit™
  • 2.00 Participation (non-CME)

Accreditation Period

Course opens: 
05/04/2016
Course expires: 
05/04/2019

Price

Non-member cost:
$0.00
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