Presented by Alfred Burger, MD, and Michael Roberts, MD, “Updates in Clinical Guidelines” provided a comprehensive review of clinical guideline updates spanning January 2024 through January 2026. The session highlighted developments with significant relevance and interest for hospital medicine, serving as an ideal accompaniment to the marquee “Updates in Hospital Medicine” session.
Dr. Burger began the session with a review of the Infectious Diseases Society of America’s practice guideline, “Complicated Urinary Tract Infections cUTI: Clinical Guidelines for Treatment and Management.” This update clarifies the definition of uncomplicated versus complicated urinary tract infection (UTI). Uncomplicated UTIs are infections limited to the bladder in afebrile women or men, while complicated UTIs involve infection beyond the bladder, including pyelonephritis, febrile or bacteremic UTIs, catheter-associated infections, and prostatitis.1
The guideline recommends a four-step management strategy: first, determine illness severity and assess for sepsis; second, evaluate patient-specific risk factors, such as known prior pathogens, renal function, and potential drug interactions; third, consult local antibiograms; and fourth, select an empiric antibiotic regimen. Preferred agents include third- and fourth-generation cephalosporins, piperacillin-tazobactam, carbapenems, and fluoroquinolones. A seven-day treatment course is recommended for non-fluoroquinolone agents, whereas a five-to-seven-day regimen is appropriate for fluoroquinolones. Patients demonstrating clinical improvement and oral tolerance should be transitioned to oral therapy when an effective antibiotic option is available.
Dr. Burger transitioned to a review of “Diagnosis and Management of Community-acquired Pneumonia: An Official American Thoracic Society Clinical Practice Guideline.” The guideline identifies lung ultrasound as an acceptable alternative to chest radiography for the diagnosis of pneumonia when performed by clinicians with appropriate expertise. For patients hospitalized with either non-severe or severe pneumonia who test positive for a viral pathogen, empiric antibiotic therapy remains recommended. The guideline suggests a three-to-five-day antibiotic course for non-severe pneumonia, while a duration of five or more days is advised for severe cases. Regarding adjunctive therapy, corticosteroids are not recommended for non-severe pneumonia but are indicated for severe pneumonia, with the exception of patients with influenza.2 Notably, this update sparked controversy, as the Infectious Diseases Society of America declined to endorse the guideline, citing concerns regarding antimicrobial stewardship and the broad recommendation for empiric antibiotics in the setting of positive respiratory viral testing.
Dr. Roberts then took the stage to review “Red Cell Transfusion in Acute Myocardial Infarction: Association for the Advancement of Blood and Biotherapies (AABB) International Clinical Practice Guidelines.” This update recommends red-cell transfusion for anemic patients presenting with acute myocardial infarction when hemoglobin levels fall below a threshold of 10 g/dL. The recommendation is primarily informed by the MINT and REALITY trials, which compared liberal (approximately 10 g/dL) versus restrictive (7 to 8 g/dL) transfusion thresholds. A meta-analysis performed by the AABB panel demonstrated an absolute risk reduction in 30-day mortality within the liberal transfusion group, equating to 1.2% fewer deaths at 30 days. The guideline emphasizes the necessity of evaluating the patient’s clinical status, particularly volume status, when making transfusion decisions.3
Dr. Roberts continued with transfusion updates with “Platelet Transfusion: 2025 AABB and ICTMG International Clinical Practice Guidelines.” The guideline from AABB and the International Collaboration for Transfusion Medicine provides a strong recommendation for platelet transfusion when counts fall below 10,000/µL in the setting of hypoproliferative thrombocytopenia resulting from chemotherapy or allogeneic stem cell transplantation. It also issues a strong recommendation to transfuse when platelets are below 20,000/µL before a lumbar puncture. Conditional recommendations were established for a transfusion threshold of 10,000/µL in cases of consumptive thrombocytopenia without major bleeding and before central venous catheter placement at a compressible site. Furthermore, the guideline suggests thresholds of 20,000/µL for low-risk interventional radiology procedures and 50,000/µL for high-risk procedures. For patients undergoing non-neuraxial surgery, platelet administration is recommended when the count is less than 50,000/µL.4
The final guideline update reviewed was “2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients with Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines.” Dr. Roberts focused on the guideline recommendations for antiplatelet management following acute coronary syndrome and percutaneous coronary intervention. The established default strategy is dual antiplatelet therapy (DAPT) for a minimum of 12 months after acute coronary syndrome, with ticagrelor or prasugrel identified as the preferred agents following percutaneous coronary intervention. For patients at elevated risk of bleeding, the guideline recommends a bleeding reduction strategy consisting of DAPT for one to three months followed by single antiplatelet therapy, with ticagrelor as the preferred agent. For those at the highest risk of bleeding, the guideline offers an alternative of one month of DAPT followed by single antiplatelet therapy with either aspirin or a P2Y12 inhibitor.5
To conclude the session, Dr. Roberts offered his predictions of what clinical guidelines will need to address within the next one to two years. The first topic is the optimal rate of correction for severe hyponatremia. Although recent studies suggest increased mortality with slow correction compared to rapid correction, experts maintain a cautious approach toward rapid correction in specific populations, such as those with malnutrition or liver disease. Given the clinical attention to this issue, Dr. Roberts predicts the emergence of updated guidelines.
The second area of focus involves reduced-dose anticoagulation for venous thromboembolism. Recent trials in cancer-associated venous thromboembolism have demonstrated that a half-dose anticoagulation regimen following an initial six-month treatment period is noninferior for thrombosis prevention and is associated with a reduction in bleeding complications. Perhaps you’ll catch these future updates in clinical guidelines at the next SHM Converge!
Key Takeaways
- The updated definition of a complicated UTI includes fever, chills, flank pain, and systemic distress indicative of infection beyond the bladder.
- In cases of acute myocardial infarction, consider transfusing anemic patients to achieve a hemoglobin level greater than 10 g/dL.
- For patients with thrombocytopenia requiring a lumbar puncture or a low-risk interventional radiology procedure, transfuse if the platelet count is less than 20,000/µL.
Dr. Caputo-Seidler
Dr. Caputo-Seidler is a hospitalist and assistant professor at the University of South Florida in Tampa, Fla.
References
- Infectious Diseases Society of America. Complicated urinary tract infections cUTI: clinical guidelines for treatment and management. IDSA website. https://www.idsociety.org/practice-guideline/complicated-urinary-tract-infections/. Published July 17, 2025. Accessed June 10, 2026.
- Jones B, et al. Diagnosis and management of community-acquired pneumonia: an official American Thoracic Society clinical practice guideline. Am J Respir Crit Care Med. 2026;212(1):24-44. doi:10.1164/rccm.202507-1692ST.
- Pagano MB, et al. Red cell transfusion in acute myocardial infarction: Association for the Advancement of Blood and Biotherapies (AABB) international clinical practice guidelines. Ann Intern Med. 2025; 178(10):1469-1477. doi:10.7326/ANNALS-25-00706.
- Platelet Transfusion: 2025 AABB and ICTMG international clinical practice guidelines. JAMA. 2025;334(7):606-617. doi:10.1001/jama.2025.7529.
- Rao SV, et al. 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients with Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2025;151(13):e771-e862. doi:10.1161/CIR.0000000000001309.