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]
Walker et al give us a nice picture and high-yield tutorial on the reversed halo sign, in this case from cryptogenic organizing pneumonia: J Thorac Imaging 2011;26:w80. (FREE)
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]
Antimicrobial Stewardship for the Community Hospital: Practical Tools & Techniques for Implementation. Clin Infect Dis 2011;53(suppl 1).
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]
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]
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]
Influenza, RSV, human metapneumovirus, CMV, EBV, herpesviruses, rhinovirus, coronavirus, adenovirus … viruses are increasingly recognized as a cause of pneumonia in adults. Read all about it in this special issue & review. Semin Resp Crit Care Med 2011; 4.
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]
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]
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]
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]
Update on tuberculosis: TB in the early 21st century. Connell DW et al, Eur Resp Rev 2011;20:71-84. FREE FULL TEXT
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]