Summary: Patient centred participatory medicine Web 3.0 insights from a single patient PaJR (patient journey record) archived as part of a fever charting clinical complexity ProJR (project record) archive below replete with granular data. The learning points in this particular PaJR are:1) Diagnostic uncertainty around the causal correlation of bacteremia associated with pressure ulcers (BAPU) with nosocomial PUO.2) Therapeutic uncertainty and challenges to antibiotic stewardship. The structure of the IMRAD format below has been slightly tweaked below by including project learning point 1 in the introduction and project learning point 2 in the discussion!
Key words: BAPU, Faropenem, IMRAD tweaks
Glossary: http://
Introduction (Conversational Web 1.0)
Yesterday while discussing one of our AMC patient of nosocomial PUO we learned about BAPU and found this elegant study that "evaluated the clinical and microbiological characteristics of bacteremia associated with pressure ulcers (BAPU) and factors associated with mortality."
Their data was prospectively obtained in a single institution, over 32 years, applying strict diagnostic criteria. In the whole study period, 1.7 episodes of BAPU per 10,000 hospital discharges were observed."
Although the above study appears promising I wasn't sure how they derived causal correlation between the macro bed sore events and the bacteremia causing sepsis. Clearly they needed to add more contextual patient data for each of their microbiological isolates as to how they were instrumental in causing sepsis in the bed sore patients where they were originally isolated.
Methods (Conversational Web 2.0-Web 3.0):
The usual PaJR methodology to creating ProJRs as has been published before here:
I must admit that this particular BAPU and Faropenem PaJR archived here: https://
did expand my cognitive horizons and in the next text I hope to reflect on how today's afternoon learning session on the above patient is a positive +1 in our current LLM driven CBBLE at least to a few for whom all the above may not have been TLDR
Results:
(PaJR Web 2.0-3.0) Here's more details of our patient who's two blood cultures done here were negative and bed sore cultures weren't sent and the patient was sent home on oral Faropenem!
26-06-2025 15.10] PPM 1: Afternoon session:
Today's update of 65M with cerebellar infarction and PUO
Fever touched down baseline for the first time today
Hb is up and WBCs are also looking good
Getting ready to go home today.
[26-06-2025 15.24] PPM 1: Yesterday's bed sore image update for the same patient.
[26-06-2025 15.27] PPM 1: @PPM4 there's an increasing reliance on oral faropenem as if it's equivalent to parenteral carbapenem in terms of efficacy but we had earlier reviewed that it's needlessly over hyped and misutilized. Can the LLM share some perplexity style links toward RCT efficacy of oral faropenem?
Entire patient data and results archived in the link below:
Salient features especially images in the data re-pasted below:
Discussion:
In this context of the inclusion of oral faropenem as a take home, mentioned in the last day of his attached fever chart, highlights it's role in the current global over-testing and overtreatment pandemic as it appears to be prescribed like an antibiotic chocolate in many centers?
Here's some more interesting information for antibiotic stewards:
"Faropenem has seen a significant increase in use over the last two decades in China and India. Just between 2010 and 2014, faropenem consumption rates rose by more than 150% in India. Consumption was then higher than total carbapenem consumption. In contrast to most carbapenems in use, faropenem is available as an oral agent. It is obtainable in many parts of Asia, but in other parts of the world it has never reached the market, as it has not been approved by regulatory agencies. There are several concerns related to the use of faropenem that warrants attention, for example:
Oral availability of the drug makes it easier to obtain and use inappropriately
The lack of oversight of off-label use (such as use for clinical indications that differs from those it has been approved for)
The risk of development of cross-resistance to carbapenems."
Past Fever ProJRs:
Origins:
1) Resolving undifferentiated fever diagnostic uncertainty 2000-2002
2) Fever pattern recognition as a tool to optimise antibiotic stewardship in the community curtailing it's overuse in common viral fevers with diagnostic uncertainty
3) Follow up to the Bangalore study in a Bhopal PG thesis
4) Optimising clinical complexity in fever
Narketpally:
Regularly updated fever ProJR archives:
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