Infectious Disease and Sepsis Archives - Page 5 of 8 - PulmCCM
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Infectious Disease and Sepsis Articles

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]

Sep 302011
 

Hao et al pooled data from 10 heterogeneous randomized trials (n=3,451) comparing probiotics (various preparations) vs. placebo, with the outcome of upper respiratory tract infections. Those using probiotics had a reduction in number of URTIs and antibiotic prescriptions by ~1/3 to ~1/2. There was significant heterogeneity among the trials, which included very few people over [... read more]

Sep 272011
 

Perhaps the most contentious debate in critical care is whether and when to transfuse blood to patients, especially those with acute lung injury and/or septic shock. FACTT showed less fluids (which could include blood) are better for ALI/ARDS, but transfusion wasn’t controlled and its contribution to the outcomes is unknown. Practicing physicians vary widely in [... read more]

Sep 242011
 

Two kids under 5, one in Indiana and the other in Pennsylvania, have contracted a new reassorted swine flu: H3N2. The Pennsylvania child had had direct contact with a pig at an agricultural fair; the Indiana kid had been cared for by someone who had come in contact with a pig recently. Both children recovered [... read more]

Sep 222011
 

Observational epidemiologic data on 132 California kids who caught pertussis (of 15,000 in a cohort), presented at the American Society for Microbiology meeting last week, suggested that protection from pertussis vaccination may wane as soon as 3 years after the last dose. Kids age 8-12 were most at risk (the last dose is given at [... read more]

Sep 122011
 

Several favorable randomized trials and a meta-analysis have suggested procalcitonin is a reliable and useful biomarker of infection, including in the ICU. In contrast, Jensen et al report use of a procalcitonin-driven algorithm to guide antimicrobial therapy in 9 ICUs in Denmark seemed to cause a bit of harm. They randomized 1,200 patients to either [... read more]

Aug 312011
 

Grijalva et al analyzed the Nationwide Inpatient Sample (data from U.S. hospitalizations) and found that the rate of hospitalization for parapneumonic empyema doubled from 3 per 100,000 in 1996, to 6 in 2008. The rate of empyemas due to Streptococcus pneumoniae was stable; the increases were in non-pneumococcal infections like Staphylococcus. Mortality was unchanged overall [... read more]

Aug 232011
 

Obesity was named as a risk factor for severe H1N1 influenza during the pandemic. What about for influenza in general? Kwong et al analyzed community survey data in Ontario over 12 influenza seasons, 1996-2008. Severe obesity (BMI >= 35) carried an odds ratio of 2.1 for respiratory hospitalization during flu season. In those with no [... read more]

Aug 212011
 

For 10 years, Zahar et al prospectively observed 3,588 patients developing severe sepsis & septic shock who ended up in French ICUs. Their sample captured a broad array of infections acquired in the community, the hospital ward, or the ICU (about 1/3 each). After multivariate assessment, they could not find an independent influence on mortality [... read more]

Aug 212011
 

Schuetz et al review the 16 randomized controlled trials (n=4,647) testing procalcitonin-guided vs. standard care on the outcomes of antibiotic use, mortality, and infection control. Most of these studies were done in Europe; 6 were in ICU patients. Using procalcitonin reduced antibiotic use in all settings (primary care, emergency department, ICU) with no detectable differences [... read more]

Aug 172011
 

Johnson et al reviewed charts in a retrospective case-control cohort study on 754 consecutive patients at Barnes-Jewish with severe sepsis or shock due to Gram-negative bacteremia. The exposure was receipt of antibiotics in the previous 90 days. 310 of the bacteremic patients had received antibiotics previously. Compared to unexposed controls, the previously antibiotic-exposed had a [... read more]

Aug 102011
 

In the “why didn’t I think of that?” department: Menzies et al performed pleural fluid sampling on 62 patients with clinical pleural infection, and sent samples to the lab in both standard tubes and in blood culture bottles inoculated at the bedside. 20 standard samples were culture-positive; adding the positive inoculated samples identified an additional [... read more]