Infectious Disease and Sepsis Archives - Page 3 of 9 - PulmCCM

Infectious Disease and Sepsis Articles

Sep 022013
Surviving Sepsis Guidelines: Early Goal Directed Therapy, Initial Fluid Resuscitation

Initial Volume Resuscitation and EGDT for Severe Sepsis/Septic Shock See all the Surviving Sepsis Guidelines An approach including early goal directed therapy with aggressive initial fluid resuscitation has been considered a cornerstone of initial therapy for severe sepsis and septic shock, since a single-center randomized trial showed such a strategy initiated in the emergency department [… read more]

Sep 022013
Surviving Sepsis Guidelines: Initial Antibiotic / Antimicrobial Therapy

Initial Antibiotic / Antimicrobial Therapy in Severe Sepsis/Septic Shock For Sepsis, Use the Right Antibiotics at the Right Time (= As Early As Possible) See all the Surviving Sepsis Guidelines  The short version: Give appropriate and effective antibiotics as early as possible for patients known or suspected to be in severe sepsis or septic shock. [… read more]

Jun 262013
FDA warns against use of Hetastarch in ICU

U.S. FDA Advises Against Hetastarch Use in ICU European Agency Recommends Ban It was probably only a matter of time. In the wake of large randomized trials suggesting hydroxyethyl starches (HES or hetastarch) cause kidney injury and death in critically ill patients from sepsis and other causes, and the European Medicines Agency formally suggesting this month [… read more]

Jun 162013
Decontaminate all incoming ICU patients to reduce infections, says RCT

“Decolonizing” New ICU Patients Reduces Bloodstream Infections: NEJM This article had an erratum posted in NEJM: read more here. In humankind’s battle against bacteria, the ICU is the front line. And with MRSA infection rates doubling in the past 5 years, and the more recent and scary spread of lethal pan-resistant Enterobacteriae, lately the bugs have [… read more]

Jun 162013

By Dr. Philippe Rola I was recently scanning the literature in preparation for our symposium, and came across what should have been a 2003 instead of a 2013 publication in the March issue of the CCM Journal, entitled “Point-of-Care Ultrasound to estimate Central Venous Pressure:  A Comparison of Three Techniques.” I have to admit this [… read more]

May 202013
Staph vaccine fails in cardiothoracic surgery patients

Staph Vaccine Fails in Cardiothoracic Surgery Patients Staphyloccocus aureus wound infections and bacteremia commonly complicate cardiothoracic surgery, even with meticulous attention to infection prevention. Staph mediastinitis, a deep infection of the surgical wound, is particularly feared and lethal. Vance Fowler et al randomized 8,031 people undergoing sternotomy to receive the V710 vaccine against S. aureus, [… read more]

May 122013
Killer carbapenem-resistant bacteria spreading through LTACs

Killer Carbapenem-Resistant Bacteria Spreading Across U.S. Gut-living bacteria like Klebsiella are gaining resistance to carbapenems at an alarming rate, and long-term acute care hospitals (LTACs) and nursing homes seem to be the incubators for these killer bugs spreading across the U.S. Carbapenems  like meropenem and doripenem have been the gold standard to treat infections from [… read more]

Apr 242013
Using procalcitonin to guide antibiotics for pneumonia

Use of Procalcitonin to Reduce Unnecessary Antibiotics by Blair Westerly, MD Acute respiratory tract infections have a wide range of disease severity and the use of antibiotics for self-limited infections contributes to antibiotic overuse and antimicrobial resistance, though we have all probably been guilty of it a time or two when we just weren’t sure [… read more]

Mar 242013
Passive leg raise offers promise in predicting fluid responsiveness

“Like this … kind of” Passive Leg Raise Improved Management of Patients in Shock* (*some assembly required) by Blair Westerly, MD Providing the right amount of fluid is vital in a critically ill patient, as both too little and too much can result in poor outcomes. Yet even with this understanding, the clinical assessment of [… read more]

Mar 102013
Hope floats: Fecal transplants cure >90% of recurrent C. difficile (RCT)

Fecal Transplants Cure C. difficile Infections, When Drugs Can’t Antibiotics are what cause Clostridium difficile infection to emerge in the first place, so it’s perhaps no surprise that the usual treatment — more antibiotics — often fails. From 15-25% of patients with C. difficile are not permanently cured by their initial treatment with metronidazole, and among those [… read more]

Feb 192013
Time to retire routine replacement of peripheral IVs

Time to Retire Routine Replacement of Peripheral IVs Study question:  Do peripheral I.V.s need to be changed every 72-96 hours per the CDCs recommendations or can they be changed as clinically indicated? How many times as a resident did you receive a call at 4 a.m., often at the very moment you were about to [… read more]

Jan 312013
Etomidate associated with increased mortality in sepsis: meta-analysis

Etomidate: Unsafe for Intubation in Patients with Sepsis? by Blair Westerly, MD Etomidate is commonly used for rapid sequence intubation; however, even after one dose, it has been associated with adrenal axis suppression in critically ill patients. Though both adrenal insufficiency and increased mortality in sepsis have been associated with etomidate, the relationship of the [… read more]

Jan 042013
Azithromycin reduces exacerbations in non-CF bronchiectasis (RCT)

Azithromycin for non-CF Bronchiectasis Bronchiectasis — the permanently dilated, tortuous bronchi that can result after previous lung infections — is a frustrating problem for pulmonologists to treat, but not nearly as frustrating as it can be for patients to live with. People with bronchiectasis are plagued by chronic coughing, and many experience a steady decline [… read more]

Jan 042013
Femoral lines might not be so bad after all for infection risk

“We’ve got to get that femoral line out of there!” The attending’s face as he says it shadowed with a simmer of fear, a dash of anger. How could the moonlighter have been so incompetent or lazy as to choose the benighted femoral site for a central venous line when the internal jugular and subclavian [… read more]

Jan 032013
Can procalcitonin help guide therapy for suspected pneumonia & other infections? (Review)

Procalcitonin to Guide Treatment of Pneumonia (More PulmCCM Topic Reviews) With mounting evidence for its utility as a biomarker for pneumonia, procalcitonin is one of the hottest 2012 topics in pulmonary & critical care. Procalcitonin tends to rise quickly as bacterial infections (but not viral infections) develop, increase with the severity of infection, and decline [… read more]

Jan 012013
Should lactate clearance replace SvO2 in sepsis protocols?

It started with a friendly pro/con debate in the December 2011 Chest, about whether lactate clearance or mixed venous oxygen saturation is a better “goal” for early goal-directed therapy in severe sepsis and septic shock. It ended with Alan Jones reviving the rumors and innuendo that have swirled for years around Emanuel Rivers’s body of work. Continuous [… read more]

Jan 012013
Hydroxyethyl starch fries kidneys in another large trial (RCT)

Hydroxyethyl Starch (Voluven) Causes Kidney Failure In Large Trial Hydroxyethyl starch (HES) was already wearing a scarlet letter as an potentially dangerous volume resuscitation agent for patients in shock, after evidence emerged this year that hydroxyethyl starch kills people with severe sepsis. Now, another huge, convincing trial shows that hydroxyethyl starch (Voluven) damages kidneys and [… read more]

Dec 302012
Azithromycin associated with cardiovascular death

(image: People taking 5 days of azithromycin had a very small absolute increased risk of death, especially due to cardiovascular causes, compared to people taking amoxicillin, in a retrospective cohort review by Wayne Ray, Katherine Murray, and C. Michael Stein published in the May 17 New England Journal of Medicine. Erythromycin and clarithromycin (the other [… read more]

Dec 292012
Xigris' epitaph: "I Never Worked a Day in My Life" (PROWESS-SHOCK)

Recombinant human activated protein C or dotrecogin alfa — better known as Xigris, by Eli Lilly — seemed a godsend when it was first approved for treatment of severe sepsis in 2001. Xigris’ FDA approval (despite an evenly split 10-10 vote) was based solely on the Eli Lilly-funded PROWESS study, a phase 3 randomized trial [… read more]

Dec 272012
Surviving Sepsis Guidelines Updated: Preview from SCCM Meeting

More: Surviving Sepsis Guidelines Review / Update The Surviving Sepsis Campaign is a collaboration between the U.S. Society of Critical Care Medicine (SCCM), the European Society of Intensive Care Medicine, and the International Sepsis Forum, whose recommendations on the management of sepsis are considered widely. At the 2012 SCCM meeting, the Surviving Sepsis committee revealed [… read more]