Viral community-acquired pneumonia: Ruuskanen O, Lancet 2011;377:1264-1275.
Serious Infections in Intensive Care Units: 100+ pages, 12 articles reflecting the state of the art on managing infections and antibotic usage in the ICU. Sem Resp Crit Care Med, April 2011. Review.
Workshop on molecular diagnostics for respiratory tract infections: Procalcitonin shows promise as a biomarker for differentiating bacterial from viral pneumonias, and to assess response to therapy. Rapid PCR for MRSA in sputum may become available after further development & testing. Molecular tests for S. pneumonia in respiratory secretions currently are uninterpretable in practice, due to [... read more]
Combating antimicrobial resistance; Policy recommendations to save lives: Clin Infect Dis 2011;52 (supplement 5). ** COMMENTARY by Brad Spellberg, MD **
Candida urinary tract infections: Clin Infect Dis 2011;52 (supplement 6).
Brassard et al analyzed a Canadian database cohort of >427,000 people and, finding 564 cases of tuberculosis, announced that users of inhaled corticosteroids had a rate ratio of ~1.26 to 1.97 over never-users, with current and high-dose ICS users on the higher end of that range. Somehow, they also found that oral corticosteroids reduced the [... read more]
(1–>3) Beta-D-glucan, or BDG, is a component of the cell wall of most fungi (not Zygomycetes or Cryptococcus though). Karageorgopoulos et al pooled 16 studies, including 2,979 patients with definite or likely fungal infections, that reported the test characteristics of serum BDG. The pooled sensitivity of serum BDG for invasive fungal infection was 77% and [... read more]
Sadaka et al add their two cents and a cohort study to the Xigris efficacy/safety debate. In their retrospective, propensity-matched analysis of 563 patients sourced from the Project IMPACT database, the 108 who received activated protein C had 35% mortality, vs 54% for the 108 who did not (p=0.005). There were unusually low rates of [... read more]
After analyzing all AstraZeneca’s clinical trials data on budesonide for asthma (26 placebo-controlled, n~14,000; 60 non-placebo-controlled, n~33,000), O’Byrne et al found no increased risk of pneumonia with use of budesonide by asthmatics, who contracted 1-2 detected pneumonias per 100 patient-years of treatment. AJRCCM 2011;183:589-595.
Roquilly et ses amis francais randomized 150 critically ill victims of severe French trauma to hydrocortisone or placebo for 7 days. The treated group had an absolute 16-19% lower risk for hospital-acquired pneumonia, the primary endpoint (36% vs. 51-54% depending on which intention-to-treat analysis you prefer, p=0.007 to 0.01). (n=150). JAMA 2011;305:1201-1209.
Fernandez-Cerrano et al randomized 56 people with CAP in Spain (only 3 needed mechanical ventilation) to receive methylprednisolone bolus-and-taper or placebo, in addition to ceftriaxone and levofloxacin. The steroid-treated group had less hypoxemia (lower PaO2/FiO2). (n=56). Critical Care 2011;15:R96. FREE FULL TEXT MORE ON THIS: In AJRCCM 2005, Confalonieri found less septic shock and need [... read more]
New treatments against gram-negative organisms. Bassetti M, Critical Care 2011;15:215. New antibiotics review.
In a very small trial (n=24), inhaled RNA (ALN-RSV01) appeared to improve outcomes in lung transplant patients with RSV respiratory infections, by interfering with viral replication. Symptoms were reduced, and at 90 days, incidence of bronchiolitis obliterans syndrome was 6% vs 50% in the control group. AJRCCM 2011;183:531-538.
12 months of nebulized gentamicin (80 mg bid) markedly reduced symptoms, exacerbations, and bacterial density in people with bronchiectasis from causes other than cystic fibrosis. None of these benefits were sustained after 3 months without therapy, though. (n=65). AJRCCM 2011;183:491-499.
Louie et al report results of a phase 3 industry-funded trial of fidaxomicin, a poorly absorbed oral macrolide that’s bacteriocidal vs C. difficile. The new drug was equivalent to oral vanco in curing C.diff infections (~90%), and superior at preventing recurrences (~14% vs 24%). It did not prevent recurrences of the more lethal and increasingly [... read more]