A new randomized trial showed no benefit from intravenous vitamin C in patients with sepsis, but delays in treatment baked into the trial design will keep hope alive for true believers in the novel therapy. Vitamin C, hydrocortisone, and thiamine have been promoted as a lifesaving adjunctive therapy for septic shock, based on anecdotal data [… read more]
Jon-Emile S. Kenny MD [@heart_lung] “Sich regen bringt Segen” -German proverb Background It is an overcast day in Bern, Switzerland. I have recently left Zermatt, having had the honour and pleasure of speaking at ‘The Big Sick’ conference. I spent the day roaming the narrowed passages of this old, beautiful city. In the midst of my [… read more]
New Guideline Emphasizes Treatment of Drug-Resistant Tuberculosis with All-Oral Regimens for MDR-TB Patients The American Thoracic Society, Centers for Disease Control and Prevention, European Respiratory Society and the Infectious Diseases Society of America have published an official clinical guideline on the treatment of drug-resistant tuberculosis (DR-TB) in the Nov. 15 American Journal of Respiratory and [… read more]
by Zeena Nackerdien PhD, CME Writer, MedPage Today Recent estimates point to a rise in NTM lung disease in the U.S., particularly among those older than 50 or those with chronic underlying lung diseases, such as non-cystic fibrosis bronchiectasis, cystic fibrosis, and emphysema. According to a 1997-2007 estimate of the Medicare population (≥65 years old), NTM lung [… read more]
More than 32 million people in the U.S. have reported penicillin allergies — about 10% of the population. But almost 95% of them are not penicillin-allergic, and are removing themselves from eligibility for ideal antibiotic treatments, according to a review in JAMA. “More than 1 in 10 people who seek medical care self-report a history [… read more]
Use of C-reactive protein (CRP) in decision-making may reduce antibiotic use in COPD exacerbations, but not as a replacement for clinical judgment, a study suggested. Chronic obstructive pulmonary disease (COPD) exacerbations are characterized by increased inflammation in the airways and the body generally. C-reactive protein (CRP) is a serum test for inflammation, and has been [… read more]
by Molly Walker, Associate Editor, MedPage Today If you want an accurate reading from sepsis patients’ blood cultures, don’t start antibiotics until you’ve drawn the blood samples, a new study suggested. Among patients with severe sepsis, blood cultures taken prior to antibiotic therapy were positive for one or more microbial pathogens in 31.4% of patients [… read more]
Vitamin C infusion has generated tremendous interest as an adjunctive treatment for patients with sepsis, since a widely publicized cohort study claimed vitamin C dramatically reduced sepsis-related mortality at a single institution. The publicity, the plausible pathophysiologic mechanism, and the lack of any therapy for sepsis have led many intensivists to prescribe the so-called Marik [… read more]
Jon-Emile S. Kenny MD [@heart_lung] with illustrations by Carla M. Canepa MD [@_carlemd_] “Better never means better for everyone… It always means worse, for some.” -Margaret Atwood Case A 73-year-old woman with a history of severe chronic bronchitis, ESRD receiving thrice-weekly hemodialysis and heart failure with a preserved ejection fraction is admitted from home with fevers, [… read more]
Jon-Emile S. Kenny MD [@heart_lung] “I’ve looked at clouds from both sides now …” -Joni Mitchell Background In a recent physiological study – brought to my attention by the erudite and kinetic [@iceman_ex] – the detailed physiological effects of intravenous fluids, norepinephrine and dobutamine were sequentially evaluated in patients with sepsis. Sepsis was defined as [… read more]
“Nihilist” is one of the harshest insults that can be lobbed at a physician. Even while one knows intellectually that every patient can’t be saved, it’s considered odious to openly acknowledge that actuarial reality. Accepting the truth that some patients will inevitably die despite our best efforts is seen by some as the threshold of [… read more]
Guidelines advise physicians give large boluses of intravenous crystalloid infusions (two to three liters, generally) to patients with septic shock. Vasopressors are typically begun only if patients’ blood pressure remains low after fluid administration. A vocal minority of researchers have advised against delaying vasopressors in septic shock, arguing that norepinephrine, not intravenous fluid, is the [… read more]
by Molly Walker, Staff Writer, MedPage Today Omadacycline, a novel antibiotic in the tetracycline class, was non-inferior to standard of care for both community-acquired bacterial pneumonia and acute bacterial skin and skin-structure infections, two randomized trials found. There was no significant difference in early clinical response among patients with community-acquired bacterial pneumonia randomized to omadacycline and those [… read more]
Stethoscopes have always been an obvious suspect in the transmission of infections to patients by health care professionals. They’re carried room to room, come in contact with each patient, and are almost never disinfected between patient contacts. Testing has shown just what one would expect: stethoscopes are often contaminated with bacteria. One of the latest [… read more]
by Salynn Boyles, Contributing Writer, MedPage Today Treatment with antibiotics during hospitalization for asthma exacerbation was associated with longer hospital stays and higher hospital costs in a retrospective cohort study of nearly 20,000 adult patients. Mihaela Stefan, MD, PhD, of the University of Massachusetts Medical School in Springfield, and colleagues, found that despite guidelines recommending against routine [… read more]
Jon-Emile S. Kenny MD [@heart_lung] “The truth is balance, but the opposite of truth, which is unbalance, may not be a lie.” -Susan Sontag Case A 49 year old man presents with two days of hemoptysis, right-sided pleuritic chest pain and a few hours of ‘confusion’ according to his teammate in a pick-up hockey league. One [… read more]
The U.S. Food and Drug Administration (FDA) approved baloxavir marboxil, an oral tablet to be marketed as Xofluza, for treatment of early acute uncomplicated influenza in adolescents and adults. FDA Commissioner Scott Gottlieb said in a news release, This is the first new antiviral flu treatment with a novel mechanism of action approved by the FDA [… read more]
After a review of reported adverse events, the U.S. FDA is warning physicians that fluoroquinolone antibiotics may increase the occurrence of aortic dissections, resulting in aortic rupture and death. FDA used unusually direct language in advising, “Fluoroquinolones should not be used in patients at increased risk unless there are no other treatment options available.” Patients [… read more]
A large proportion of patients who remain in ICUs for more than a few days develop hospital-acquired infections, including bloodstream infections. Indwelling urinary or venous catheters, gut translocation, aspiration and impaired host defenses can all be causative. Bloodstream infection incidence has been reduced over time, but remains persistently ineradicable. One enticing method of prevention has been [… read more]
By Nicholas Mark, MD During the 1940s, many Melanesian cultures were profoundly altered as the Second World War was waged in the Pacific around them. Western soldiers constructed airstrips out of the jungles and the natives witnessed vast wealth in the form of manufactured goods literally rain down from the skies on parachutes or carried [… read more]
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