Potential metabolic consequences of statins in sepsis. Brealy DA et al. Crit Care Med 2011;39:1514-1520.
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.
In a 3-center observational study, Pareek et al report that 20% of new immigrants to the UK (224 of 1229) had latent tuberculosis infection as detected by interferon-gamma release assay. Standing screening policy may miss ~70% of these cases. Lancet Infect Dis 2011;11:435-444.
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]
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]
Of 421 patients admitted to ICUs after cardiac arrest, 281 (67%) developed 373 infections, mostly pneumonias, report Mongardon et al. Crit Care Med 2011;39:1359-1364.
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]
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
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]
Parasitic infections of the lung: a guide for the respiratory physician. Kunst H et al. Thorax 2011;66:528-536.
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]
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]
Antibiotic dosing in multiple organ dysfunction syndrome: Ulldemolins et al, CHEST 2011;139:1210-1220.
Invasive aspergillosis is often lethal in lung transplant patients, and early diagnosis and treatment improve survival. Luong M et al showed that testing bronchoalveolar lavage fluid with new rapid-result Aspergillus PCR and galactomannan tests bring both sensitivity and specificity into the 93-100% range. 150 BAL samples from lung transplant patients at Pitt were tested (there were only [… read more]
Diagnostic value of halo and reversed-halo signs in immune-compromised hosts. Georgiadou SP et al, Clin Infect Dis 2011;52:1144-1155. Review.
Waters et al tested 136 meat and poultry samples in U.S. grocery stores, and found 77% of the turkey, 42% of pork, 41% of chicken, and 37% of beef were contaminated with S. aureus. 96% of the isolates were resistant to at least one drug, and 52% of isolates were resistant to 3 antibiotic classes. In the Netherlands, [… read more]
Using PCR testing on BAL fluid, Denning et al (in Manchester UK) found Aspergillus DNA in 4 of 11 (36%) healthy volunteers; 21 of 22 patients with culture/microscopy-proven invasive aspergillosis; and 70-80% of patients with allergic bronchopulmonary aspergillosis or chronic pulmonary aspergillosis. Culture was positive in none of the ABPA patients, and only 17% of the CPA [… read more]
De Smet et al reheat the data from their 2009 NEJM study, in which they cluster-randomized and crossed-over 5,939 patients staying >48hrs in 13 Dutch ICUs to receive either 1) standard care; 2) selective oropharyngeal decontamination (topical amphotericin B, colistin, and tobramycin in the oropharynx), or 3) selective digestive tract decontamination (the same drugs in the mouth, stomach, [… read more]
Pseudomonas pneumonia part II, antibiotic therapy, resistance, pharmacodynamics, Sun H et al, CHEST 2011;139:1172-1185. Review.
Four-drug therapy (RIPE) requires high patient commitment and imposes logistical demands on health systems in developing countries. Lienhardt et al report that a fixed-drug combination (FDC) of rifampin, isoniazid, pyrazinamide, and ethambutol was noninferior in producing negative cultures at 18 months compared to taking the drugs separately (both arms ~94% cure rate) in Africa, Asia and Latin [… read more]