Infectious Disease and Sepsis

Feb 172019
 
FDA approves new anti-influenza drug Xofluza; worked better than oseltamivir

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]

Feb 172019
 
FDA warns of aortic dissection with fluoroquinolones

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]

Feb 082019
 
Decontaminating patients did not reduce bloodstream infections

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]

Jan 232019
 
Is Critical Care Medicine becoming a Cargo Cult of Vitamin C?

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]

Jan 092019
 
Hospitals should not implement one-hour sepsis bundles, say SCCM and ACEP

In an unusual turn, the Society for Critical Care Medicine (SCCM) is advising against implementation of the one-hour sepsis bundle originally advocated in Spring 2018 by committee members of its Surviving Sepsis Campaign. SCCM and American College of Emergency Physicians (ACEP) issued a joint statement in which they acknowledged “concerns expressed about the recently released Surviving [… read more]

Jan 012019
 
Best of 2018 on PulmCCM

Best of 2018:       Prone positioning for severe ARDS advised by major societies    2018 Update to Surviving Sepsis Guidelines: Cue Backlash   Management of Ground Glass and Subsolid Pulmonary Nodules: Review   Vasopressors and Inotropes for Shock Syndromes: Review     Prophylactic Precedex prevented delirium in ICU patients   Corticosteroids do help [… read more]

Dec 072018
 
More labeled warnings on fluoroquinolones ordered by FDA

Fluoroquinolone warning labels keep getting longer. In 2018 the U.S. FDA ordered stronger cautions about mental health side effects, and severe hypoglycemia causing coma and death. Mental health disturbances now attributed to fluoroquinolones include: Attention disturbances Disorientation Agitation Nervousness Short-term memory loss Delirium The risk of hypoglycemic coma now gets a specific mention on the [… read more]

Dec 072018
 
Why are obese people more likely to survive infections and sepsis?

Obese people are significantly more likely to survive severe illness due to infections, as compared to people with normal weights, according to analyses of three large data sets presented at a European conference. Among more than 1.5 million hospitalizations for pneumonia in the U.S. between 2013-2014, obese patients (BMI > 30) were 29% more likely [… read more]

Nov 262018
 
Hydrocortisone, Ascorbic Acid and Thiamine (HAT) Therapy in Sepsis: A Question & Answer with Dr. Paul Marik

Jon-Emile S. Kenny MD [@heart_lung] with illustrations by Carla M Canepa MD [@_carlemd_] “I’ve never known any trouble than an hour’s reading didn’t assuage.” -Schopenhauer The last few decades have infamously boasted numerous failed therapies for sepsis and septic shock.  Because sepsis represents an explosive and chaotic cacophony of pro and anti-inflammatory mediators – treatments which [… read more]

Nov 042018
 
Don't use procalcitonin to withhold antibiotics in severe COPD exacerbations

Procalcitonin (PCT) is an FDA-approved test for use in guiding clinical decisions on starting, continuing, or stopping antibiotics in patients with lower respiratory tract infections, such as community-acquired pneumonia. Procalcitonin is also approved for use in determining whether to stop antibiotics. Most of the small studies testing procalcitonin-driven algorithms have shown the method to be generally safe [… read more]

Oct 142018
 
Procalcitonin strategy in the ED did not reduce antibiotic use (ProACT)

Procalcitonin-driven algorithms did not lead to lower antibiotic use for suspected pneumonias in the emergency department, in a large randomized trial. The multicenter ProACT trial enrolled 1,656 patients presenting with symptoms of pneumonia at multiple emergency departments. Patients were randomized to receive care guided by procalcitonin results (with thresholds to guide initiation or withholding of antibiotics), [… read more]

Sep 282018
 
2018 IDSA Guidelines for Clostridium Difficile Infection: fecal transplant gets its moment in the sun

Jon-Emile S. Kenny MD [@heart_lung] with illustrations by Carla M Canepa MD [@_carlemd_] “My reputation’s never been worse, so …” -Taylor Swift Case A 54 year old woman with lupus nephritis – treated with mycophenolate mofetil and prednisone – is admitted with pancytopenia and worsening confusion.  She was recently discharged after receiving levofloxacin and clindamycin [… read more]

Aug 192018
 
Seven days of antibiotics were as good as 14 for gram-negative bacteremia

Two-week antibiotic courses have been considered standard care for most patients with bacteremia who do not have sepsis or an untreated primary source (e.g. endocarditis). No good evidence ever supported the practice, which was supported mainly by retrospective data in patients with sepsis. A new study suggests that treating gram-negative bacteremia for seven days is [… read more]

Aug 162018
 
Extended antibiotic infusions could save lives: Here's how to do it

By Thomas C. Neal, PharmD According to a meta-analysis of randomized trials, prolonged infusions of antipseudomonal beta-lactam antibiotics could save lives. However, obstacles to implementing pharmacodynamically optimized administration practices have slowed the adoption of this practice in most ICUs:1 The requirement for IV pumps, preferably smart IV pumps, is potentially problematic in resource-limited settings or on wards [… read more]

Jul 232018
 
Sodium Bicarbonate Administration in Severe Metabolic Acidemia: the BICAR-ICU Trial

Jon-Emile S. Kenny MD [@heart_lung] “What is REAL?” -Velveteen Rabbit A 42 year old woman with poorly-controlled type II diabetes is admitted with a severe soft tissue infection of her left lower extremity.  She is hypotensive with altered sensorium and she is noted to have a rapidly progressing border of deep, crimson erythema and edema [… read more]

Jul 152018
 
Should antibiotics for sepsis be given in the ambulance?

Observational studies of patients in sepsis strongly suggest that outcomes are improved by giving antibiotics as soon as possible after recognition of sepsis. The Surviving Sepsis Campaign recently decided everyone with suspected sepsis should receive antibiotics within one hour of emergency department arrival. So why not give antibiotics before the patient even arrives to the [… read more]

Jul 082018
 
Ceftazidime and avibactam (Avycaz) approved for hospital-acquired pneumonias

The FDA approved a new indication for the antibiotic combination ceftazidime and avibactam (marketed as Avycaz), for treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in adults. The drug was approved originally in 2015 for complicated intra-abdominal infections (in combination with metronidazole) and got another indication in 2017 for complicated urinary tract infections and pyelonephritis. The [… read more]

Jun 142018
 
Vitamin C cocktail for sepsis: randomized trials to test efficacy

Since Marik et al announced exceptional survival rates among patients with septic shock given a cocktail of vitamin C, thiamine, and hydrocortisone, physicians taking care of septic patients have expressed both enthusiasm and skepticism about the cocktail’s reported lifesaving effects. Soon, more rigorous testing from randomized, double-blind placebo-controlled trials should provide harder data about the [… read more]

Jun 072018
 
Prolonged infusions of beta-lactam antibiotics save lives in sepsis: meta-analysis

Infusing antipseudomonal beta-lactam antibiotics over longer periods could save lives in sepsis over intermittent bolus dosing, according to a systematic review and meta-analysis of randomized trials. Vardakas et al aggregated data from studies of patients with sepsis receiving infusions of carbapenems, cephalosporins, and penicillins with antipseudomonal activity. Studies included compared prolonged infusion (over at least three [… read more]

Jun 032018
 
Sepsis blood test with high accuracy may be coming to your hospital

In February 2017, the FDA approved Immunexpress’s SeptiCyte, a molecular test with an indication for diagnosing sepsis on the first day of ICU treatment. The test isn’t widely available, but that may change soon: the manufacturer announced a partnership with Biocartis, whose rapid-PCR testing platform could bring SeptiCyte into use in ICUs throughout the developed [… read more]