The Pulse - August 2025

Greetings Readers! In this monthly edition, we examine 3 practice changing studies.

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1. CAP-tivating Updates

   The American Thoracic Society has refreshed its playbook on community-acquired pneumonia (CAP), allowing for diagnostic chest POCUS instead of CXRs, and trimming antibiotic durations down to a tidy 3–4 days for stable patients. If your patient’s CAP comes with a positive viral panel, antibiotics get a nuanced treatment: none for healthy outpatients, but still on the menu for anyone sicker or carrying comorbidities. Steroids remain unrecommended in nonsevere cases but are now cautiously welcomed in severe pneumonia—unless influenza crashes the party. The bottom line: think shorter antibiotic courses, be selective with steroids, and don’t treat these guidelines like commandments—much of the evidence still has a soft underbelly. Jones BE et al. Am J Respir Crit Care Med 2025 Jul

   Study Type: co-sponsored guideline from ATS and IDSA

   Link: https://doi.org/10.1164/rccm.202507-1692ST

2. Complicated UTIs Don’t Wait 15 Years—But Apparently Guidelines Do

   After 15 years of silence, the IDSA is back with new marching orders for complicated UTIs, and they’re singing a familiar tune: start broad, think stewardship, and shorten the course. The guidelines now neatly separate “complicated” (anything febrile, bacteremic, or catheter-related) from “uncomplicated” (afebrile cystitis). Empiric therapy should be guided by severity, prior antibiotic exposure, and the local antibiogram—think cephalosporins, piperacillin–tazobactam, or carbapenems for the sickest, and oral fluoroquinolones or TMP-SMX for stable outpatients. A key update is the push to step down to oral agents quickly and keep total durations tight—just 5–7 days, even in bacteremic cases. In short, shorter is smarter, and stewardship is baked into every step. Trautner BW et al. 2025 Jul. 

   Study Type: IDSA Practice Guideline 

   Link: https://www.idsociety.org/practice-guideline/complicated-urinary-tract-infections

3. MIMIC-ing Trouble: Hypothermia Predicts Poor Sepsis Outcomes

   Turns out in sepsis, being “cool” is anything but. This large retrospective study showed that patients rolling into the ED hypothermic had the worst outcomes—higher mortality, more vasopressors, and more ICU admissions—compared to their febrile or normothermic counterparts. Fever, meanwhile, looked downright protective, with the lowest mortality and fastest ticket to cultures and antibiotics. Although temperature is no longer part of the sepsis definition (using Sepsis 3.0), this study reminds us that low temps should still raise red flags. Kijpaisalratana N et al. Am J Emerg Med 2025 Sep. 

   Study Type: retrospective cohort study analyzing data from the MIMIC-IV database, analyzing 5550 adults with sepsis diagnosed within 12 hours of ED triage at a Boston hospital. 

   Link: https://doi.org/10.1016/j.ajem.2025.07.001

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