Infectious Disease and Sepsis Archives - Page 4 of 8 - PulmCCM
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Infectious Disease and Sepsis Articles

Jun 302012
 
Ventilator bundles (VAP bundles) not evidence-based, shouldn't be standard care

(image: Wikipedia) Anyone who has ever rounded in an ICU with a nurse manager knows that challenging or questioning the utility of the ventilator associated pneumonia (VAP) bundle is a losing proposition — one likely to get you labeled as a wiseguy troublemaker. Thanks to ventilator bundles’ endorsement by the nonprofit Institute for Healthcare Improvement, [… read more]

Jun 272012
 
Pertussis underdiagnosed; adult booster-vaccine prevents "whoop" & infant deaths

This gentleman (not pictured in the photo) graciously allowed himself to be videotaped in the midst of a severe whooping cough episode caused by Bordetella pertussis; the video is posted on the New England Journal’s website. He had not been vaccinated: vaccination during childhood greatly reduces the risk of severe or life-threatening pertussis infection, and reduces [… read more]

May 252012
 
Fever reduction improves early mortality in septic shock? Take a closer look

by Scott Aberegg, MD, MPH It is rare occasion that one article allows me to review so many aspects of the epistemology of medical evidence, but alas Schortgen et al afforded me that opportunity in the May 15th issue of AJRCCM. The issues raised by this article are so numerous that I shall make subsections for each one. [… read more]

May 092012
 
Do you have cooties? MDR-bug transmission rates in ICUs (Crit Care Med)

(image: flickrCC) Foam in, foam out, gown on, gown off … ah, the tedium of practicing critical care medicine in the age of rampant, lethal, multi-drug resistant bacteria. As a reminder to keep your guard up and your gear on, here’s a yucky study from Daniel Morgan, Elizabeth Rogawski, and Anthony Harris of the University [… read more]

Apr 272012
 
Watch out for staph coinfections in severe influenza pneumonia (MMWR)

The CDC announced in its Morbidity and Mortality Weekly Report (MMWR) the sad story of three members of a close-knit Maryland family who all died within days of each other from pneumonia due to seasonal influenza A (H3N2) with methicillin-resistant Staph aureus (MRSA) co-infection. Three additional family members acquired the same influenza A strain (which was [… read more]

Apr 122012
 
Release the data on Relenza and Tamiflu, Cochrane implores Pharma (NYT)

Antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) made big bucks for Roche and GSK respectively during the H1N1 influenza pandemic: Roche reportedly sold  about $3 billion of Tamiflu in 2009. Although sales have dropped off precipitously, the drugs are still recommended by CDC for serious cases of seasonal influenza. But do Relenza and Tamiflu even [… read more]

Feb 212012
 
Amoxicillin speeds resolution of acute sinus infections, but imperceptibly? (RCT, JAMA)

Amoxicillin may hasten the recovery from acute sinusitis (sinus infections), with more patients feeling just a tiny bit better after a week of amoxicillin compared to placebo, according to a clinical trial published in the February 15 JAMA. After 10 days, those taking placebo felt as well as those taking antibiotics. You may have heard [… read more]

Feb 102012
 

The Cochrane Collaboration smells a rat around Pharma’s handling of its data on oseltamivir (Tamiflu) and zanamivir (Relenza). They’re taking the unusual step of publicly calling for Roche (Tamiflu) and GlaxoSmithKline (Relenza) to make available their data from the original clinical studies that led to approval of the two blockbuster drugs. They point out that [… read more]

Feb 052012
 
Systemic steroids for severe sepsis and septic shock (Review)

The benefits of corticosteroids as a treatment for severe sepsis and septic shock (if any) are unknown: Although adrenal suppression is common in sepsis, it is still unclear how to assess adrenal function, or whether it should be done at all. The sensitivity and specificity of the cosyntropin (ACTH) stimulation test are unknown, and its [… read more]

Jan 272012
 

C. difficile has always been a foul and disgusting adversary, but lately it’s becoming more formidable and deadly, according to Linda Bobo, Erik Dubberke and Marin Kollef. A few highlights of this excellent review: C.diff infections (CDI) have more than doubled since 2001, to > 340,000 discharges in 2008. Attributable mortality is 6-7%, but may [… read more]

Jan 212012
 

People who survive the initial hyperinflammatory “cytokine storm” of severe sepsis regain their blood pressure, but are at high risk for secondary infection and viral reactivation. Animal models strongly suggest sepsis-induced immune suppression occurring later in the course of sepsis is to blame, but that’s never been proven in humans. Jonathan Boomer, Kathleen To, Richard [… read more]

Jan 202012
 

Richard Light and friends established that parapneumonic effusions (PPE) associated with community-acquired pneumonia very rarely progress if the effusion is freely layering and less than 1 cm in height on a lateral decubitus chest film. But who orders those anymore? Chest CT use has risen 20-fold since Light’s seminal 1980 paper. Often the CT has [… read more]

Jan 112012
 
13 doses rifapentine + isoniazid as good as 9 months INH for latent TB (RCT, NEJM)

Nine months is a long time to take daily isoniazid — and an even longer time to go without beer. If you have latent tuberculosis infection (LTBI) diagnosed by a positive tuberculin skin test, and you make it through a year or 2 without developing active TB, your lifetime risk of reactivation TB (given a healthy [… read more]

Jan 072012
 
Neti pots kill 2 after transmitting brain-eating amoeba

In December 2011, The Louisiana Department of Health and Hospitals reported the first two cases of death-by-neti-pot. Both deaths were due to lethal encephalitis caused by Naegleria fowleri, a freshwater amoeba. The first victim, a 20-year old man, died in June; it was known that he had used a neti pot, but the connection was [… read more]

Jan 012012
 
Xigris X'd! PROWESS-SHOCK negative; activated protein C yanked from global market

A newer post is available reviewing the final published findings for PROWESS-SHOCK in NEJM. PROWESS-SHOCK results are in, and they sounded the death knell for drotecogin alfa (activated protein C / Xigris), Eli Lilly’s often-challenged blockbuster drug for septic shock. Investigators reported a 28-day all-cause mortality rate of 26.4% in patients treated with activated drotrecogin [… read more]

Jan 012012
 

Medical tradition and lore advised follow-up chest films for asymptomatic people 6 weeks after pneumonia to see if a lung cancer might be lurking there. IDSA guidelines from 2007 don’t address the question, and UK guidelines suggest a follow-up chest X-ray only in those with a smoking history or over age 50. Using databases, Tang [… read more]

Jan 012012
 

Faster recovery from severe sepsis (or other disorders causing patchy/global hypoperfusion) should be accompanied by a faster disappearance of lactate from the bloodstream. The rate of lactate clearance was reported by Nguyen et al in Crit Care Med 2004 (among others) to predict survival from septic shock, and a strategy substituting lactate clearance of 10% for [… read more]

Jan 012012
 

Each individual episode of critical illness produces a mushroom cloud of data, most of which dissipates without being recorded at all (think realtime infusion rates of vasopressors and continuous ECG monitoring). A few large databases capture outcomes data from multiple participating hospitals (like the National Inpatient Sample), and the new MIMIC-II integrated data system can [… read more]

Dec 262011
 

Walkey et al combined 8 randomized trials including 1,641 people with MRSA pneumonia, and found no significant differences between those treated with linezolid or vancomycin in survival, resolution of clinical pneumonia, eradication from sputum of MRSA, or adverse events. Authors dispute linezolid’s supposedly higher lung penetration, pointing out that that dogma evolved from studies of healthy people; [… read more]