David H. Wesorick, MD; Vineet Chopra, MD, MSc
Disclosures: Dr. Chopra reports grants from the Agency for Healthcare Research and Quality. Dr. Wesorick has disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M16-1400.
The guideline recommends that any patient suspected of being at elevated risk for suicide be evaluated by a provider to assess this risk. However, there is no single, specific instrument or method that can sufficiently determine risk for suicide. Therefore, the guideline authors recommend using several means to evaluate risk (e.g., self-report measures, clinical interviews).
A suicide risk assessment should identify specific risk factors for suicide and determine if the patient has suicidal ideation with an intent to die by suicide. Any patient determined to be at increased risk for suicide should undergo a multifactorial psychiatric evaluation. Patients at high risk should be directly observed in a secure environment with no access to lethal means.
An editorialist notes that the evidence guiding the assessment and management of patients at risk for suicide is very limited. However, he points out that there are several examples, from other countries, in which high suicide rates have dramatically decreased over time. He suggests that those examples be studied as researchers search for ways to reduce the U.S. suicide rate.
The organism most commonly causes bloodstream infections and intra-abdominal infections, but has also been reported to cause endocarditis, surgical site infections, osteomyelitis, and endophthalmitis.
It is commonly resistant to antifungal medications. In the United States, 90% of isolates have been resistant to fluconazole, >40% to amphotericin B, and approximately 2% to echinocandins.
The organism colonizes the skin and nares and is commonly transmitted between patients in health care settings, causing significant outbreaks. In the United States, the primary risk factor for C auris infection seems to be hospitalization in a long-term, acute care setting.
Much is unknown about the organism, but the keys to preventing spread appears to be early identification, strict infection control measures (including hand hygiene and contact precautions for colonized or infected patients), and thorough disinfecting of the environment.
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Wesorick DH, Chopra V. Annals for Hospitalists - 17 September 2019. Ann Intern Med. 2019;171:HO1. doi: 10.7326/AWHO201909170
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Published: Ann Intern Med. 2019;171(6):HO1.
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