Infectious Disease and Sepsis Archives - Page 5 of 9 - PulmCCM

Infectious Disease and Sepsis Articles

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]

Dec 182011

For one year, Dallas et al prospectively followed 2,060 intubated MICU/SICU patients at Barnes-Jewish, and concluded that 83 (4%) developed VAP and 28 (1.4%) got VAT, which was defined as fever and 100,000 CFUs in tracheal secretions, without an infiltrate. By their reckoning, a third of VATs progressed to VAPs. Pathogens (mainly MDR bacteria) overlapped. [… read more]

Dec 182011

In a well-intentioned performance improvement initiative, Daniel Kett and the IMPACT-HAP team prospectively observed 303 patients at risk for MDR pneumonia at four academic hospitals. Surprisingly, more of those who got appropriate antibiotics died (34%) than those treated off-ATS/IDSA guidelines (20%), with Kaplan-Meier-modeled 28-day survival of 65% vs. 79%, p=0.0044. The authors were concerned enough [… read more]

Dec 102011

Severe sepsis has had a 35-45% mortality rate in clinical trials. Gagan Kumar et al use national observational data to suggest that while population rates of severe sepsis are increasing, survival has likely improved, with mortality falling from 39% to 27%, 2000-2007. However, most of the new survivors are not going home, but rather to [… read more]

Nov 112011

Obesity may impose extra burdens on critical care staff (think turning, transport, intubation and central line placement), but reviews suggest people with “ordinary” obesity (BMI 30-39) with have the same mortality from critical illness as overweight or healthy-weight people. In fact, obese people may have a survival advantage, despite possible longer durations of mechanical ventilation and ICU stays. But what about extreme obesity (BMI > [… read more]

Nov 092011

Duke’s Momen Wahidi and other luminaries bring you a consensus statement on use of peri-procedure medications during bronchoscopy. I’m assuming you’ve done a few already, so here are some highlights (with slight liberties in paraphrasing): Use topical anesthesia as well as moderate sedation in all patients, unless there are contraindications or you practice at a secret CIA prison. [… read more]

Nov 012011

October’s Seminars in Respiratory & Critical Care Medicine brings you 110 pages and 11 articles on organ failure in the intensive care unit, with articles including: Organ failure scoring and predictive models Cardiac alterations due to organ failure The microcirculation as a therapeutic target in shock Immuologic derangements in organ failure Acute lung failure Cardiogenic [… read more]

Nov 012011

The 2009 randomized CESAR trial in Lancet concluded that in severe ARDS in the U.K., referral to an ECMO center saved lives. However, patients in the control (non-ECMO) group didn’t consistently get low-tidal ventilation, and many patients randomized to ECMO never received it, creating skepticism of the findings. A case series from Australia/New Zealand (ANZ ECMO) in JAMA showed a 70% survival [… read more]

Nov 012011

No one knows when to start antiretroviral drugs in people with HIV and tuberculosis. Delaying ARVs is often done, for fear of drug toxicity and interactions, as well as immune reconstitution syndrome (dangerous worsening of the inflammatory response to TB as the immune system recovers). Of course, that means the HIV gets to continue its [… read more]

Oct 062011

Goncalves-Pereira and Povoa meta-reviewed 57 reviews of pharmacokinetics of common beta-lactam antibiotics (piperacillin, meropenem, cefepime, ceftazidime, etc.) on patients in ICUs. The results were troubling or at least confusing: studies reported wide variability in pharmacokinetics of beta-lactam antibiotics in critically ill patients, with volume of distribution and drug clearance varying more than 2-fold for the [… read more]

Oct 042011

On the off chance you someday need to diagnose tuberculosis from intrathoracic lymphadenopathy (I suppose in the rare patient with smear-negative sputum, which is more common in HIV co-infection), endobronchial ultrasound can help you out, say Navani et al. They report on 156 consecutive patients (over 2 years at 4 centers) found to have tuberculous [… read more]