Infectious Disease and Sepsis Archives - Page 7 of 9 - PulmCCM
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Infectious Disease and Sepsis Articles

Procalcitonin to guide (reduce) antibiotic use: meta-analysis, reviews

 Critical Care, Infectious Disease and Sepsis, Review Articles  Comments Off on Procalcitonin to guide (reduce) antibiotic use: meta-analysis, reviews
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]

Prior broad spectrum antibiotics associated with deadlier Gram-negative sepsis

 Critical Care, Infectious Disease and Sepsis  Comments Off on Prior broad spectrum antibiotics associated with deadlier Gram-negative sepsis
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]

UK investigators call entire concept of HCAP “controversial”

 Infectious Disease and Sepsis  Comments Off on UK investigators call entire concept of HCAP “controversial”
Jul 152011
 

In a prospective observational study of hospitalized patients with pneumonia, 20% met criteria for HCAP. Those with health care associated pneumonia were sicker of course, but it was impossible to tease out attributable mortality due to the multitude of interrelated confounders present. Antibiotic resistant organisms per se were not shown to cause death often enough [… read more]

No excess risk of severe pneumonia with inhaled steroids for COPD (case/cohort study)

 COPD, Infectious Disease and Sepsis  Comments Off on No excess risk of severe pneumonia with inhaled steroids for COPD (case/cohort study)
Jul 062011
 

Singanayagam et al prospectively observed 490 COPD patients admitted for community acquired pneumonia with COPD; 77% were using inhaled corticosteroids. As would be expected, ICS users had worse COPD (higher GOLD stage) than non-ICS-users. There were no differences between cohorts in pneumonia severity, mortality at 30 or 180 days, or requirement for mechanical ventilation or [… read more]

Longitudinal studies of HIV-associated lung infections and complications in the era of antiretroviral therapy. (Special Issue, Review)

 Infectious Disease and Sepsis, Review Articles  Comments Off on Longitudinal studies of HIV-associated lung infections and complications in the era of antiretroviral therapy. (Special Issue, Review)
Jun 172011
 

Bacterial pneumonia; tuberculosis; critical illness; pulmonary hypertension; smoking, and COPD in HIV-positive patients are discussed in >100 pages. Proc Am Thorac Soc 2011;8:215-332. Review.

When after TB exposure does an interferon-gamma release assay become positive?

 Infectious Disease and Sepsis  Comments Off on When after TB exposure does an interferon-gamma release assay become positive?
Jun 152011
 

No one knows, say Lee et al. They report on 27 Korean soldiers who were exposed to 5 barracks-mates with active TB; 26 eventually “converted” by tuberculin skin test/PPD or by interferon-gamma release assay. One-time TST/PPD identified 21, or 78%. IGRA every two weeks eventually diagnosed 26 (96%), but it took 14 weeks for 3 [… read more]

VAP prevention through GI/respiratory decontamination (meta-analysis)

 Critical Care, GI and Nutrition, Infectious Disease and Sepsis  Comments Off on VAP prevention through GI/respiratory decontamination (meta-analysis)
Jun 122011
 

Pileggi et al analyzed 28 studies and concluded that decontaminating the GI/respiratory tract with antiseptics reduced ventilator-associated pneumonia by 27%; decontamination with antibiotics reduced VAP by 36%. Antibiotic decontamination also reduced ICU infections in general, by 29%. Critical Care 2011;15:R155. FREE FULL TEXT Also see last month’s “Oral / gastric antibiotic decontamination reduced bacteremias in [… read more]

Jun 072011
 

Meijvis et al randomized 304 people hospitalized with CAP in the Netherlands to receive dexamethasone (5 mg) or placebo daily for 4 days on admission. Those getting steroids had a ~1 day shorter length of stay and no adverse effects, besides hyperglycemia. Patients were ill, with almost half having a pneumonia severity index/PORT class of [… read more]

Patients on continuous renal replacement may need higher beta-lactam doses

 Critical Care, Infectious Disease and Sepsis  Comments Off on Patients on continuous renal replacement may need higher beta-lactam doses
Jun 062011
 

Seyler et al prospectively observed 53 patients with sepsis and renal failure on CRRT. Measured at a single point in time after infusion, the concentrations of Zosyn, Ceftaz, and Cefepime at standard dosing regimens were all deemed suboptimal by the authors. Meropenem performed slightly better. Critical Care 2011;15:R137. FREE FULL TEXT

Procalcitonin and CRP as pneumonia biomarkers

 Critical Care, Infectious Disease and Sepsis  Comments Off on Procalcitonin and CRP as pneumonia biomarkers
Jun 042011
 

Bafadhel et al collected procalcitonin and CRP on 161 people admitted for COPD exacerbations, 96 for asthma exacerbations, and 62 for pneumonia (groups were discriminated by presence of consolidation on chest film), at 2 UK hospitals. The assays performed extremely well (area under the curve >0.93 for each) at differentiating pneumonia from non-infectious causes of [… read more]

Thiazolidinediones probably increase risk for pneumonia, minimally

 Infectious Disease and Sepsis, Review Articles  Comments Off on Thiazolidinediones probably increase risk for pneumonia, minimally
May 192011
 

Singh et al’s meta-analysis of 13 randomized trials of pioglitazone or rosiglitazone lasting for at least one year. There were 130 pneumonias among the 8,163 treated patients, and 100 among the 9,464 controls, for a relative risk of 1.40 for the thiazolidinedione group (CI 1.1-1.8, p=0.01). Pioglitazone showed more of a signal with a significant RR of [… read more]

Data sketchy on prolonged antibiotics for bronchiectasis

 Clinic and Consults, Infectious Disease and Sepsis, Review Articles  Comments Off on Data sketchy on prolonged antibiotics for bronchiectasis
May 172011
 

Evans et al attempted a meta-analysis of 9 randomized trials (7 in adults) testing prolonged (4 to 52 weeks) antibiotics in people with bronchiectasis. There was an improvement in “clinical response rate,” a poorly-defined endpoint, in 2 trials, but no difference in exacerbation rates or lung function. Emergence of resistant bacteria was not tested or [… read more]