Huskins et al cluster-randomized 18 ICUs to an intervention of surveillance cultures with contact precautions for positive patients, or a control of no cultures and universal precautions (gloves). The intervention ICUs used contact precautions more frequently (51% vs. 38%), but had the same MRSA/VRE colonization/infection rates, the primary endpoint (40 vs 35%, p=0.35). Clinician compliance [… read more]
Overt vancomycin resistance in MRSA is still unusual, but ID docs are worried about the bug’s rising minimum inhibitory concentrations in some regions, with MICs > 1 mcg/mL associated with worse outcomes. Kullar et al retrospectively looked at Detroit’s Henry Ford Hospital’s 5-year micro data in 320 patients with MRSA bacteremia, reporting a 52% rate [… read more]
Latent tuberculosis infection in the U.S.: Horsburgh CR, NEJM 2011;364:1441-1448
Death, long hospital stays, and treatment failures are more likely when vancomycin is used for MRSA bacteremia with minimum inhibitory concentrations (MIC) > 1 mcg/mL. Lubin et al propose a clinical prediction rule to predict relative vancomycin resistance, based on a retrospective analysis of 272 patients with MRSA bacteremia at Tufts. Oversimplifying slightly: Having less [… read more]
Molecular diagnosis of respiratory tract infection in COPD exacerbations: Sethi S, Clin Infect Dis 2011;52 (supplement 4):S290-294.
Patel et al ran 9,999 computer simulations using various vancomycin doses and MICs. When the MIC was 2.0 or greater, 2 g IV q12 hours failed to achieve target drug levels 57% of the time, with 35% predicted nephrotoxicity. But…it’s also true that multiple vancomycin models have been published, which are each internally valid using their own [… read more]
Mucormycosis: clinical presentations and management: Sun H, Lancet Infect Dis 2011;11:301-311.
Probiotics and lung diseases: Forsythe P, CHEST 2011;139:901-908.
Pseudomonas pneumonia: Epidemiology, clinical diagnosis, source (Part 1) Fujitani S et al, CHEST 2011;139:909-919.
Viral community-acquired pneumonia: Ruuskanen O, Lancet 2011;377:1264-1275.
Serious Infections in Intensive Care Units: 100+ pages, 12 articles reflecting the state of the art on managing infections and antibotic usage in the ICU. Sem Resp Crit Care Med, April 2011. Review.
Workshop on molecular diagnostics for respiratory tract infections: Procalcitonin shows promise as a biomarker for differentiating bacterial from viral pneumonias, and to assess response to therapy. Rapid PCR for MRSA in sputum may become available after further development & testing. Molecular tests for S. pneumonia in respiratory secretions currently are uninterpretable in practice, due to [… read more]
Combating antimicrobial resistance; Policy recommendations to save lives: Clin Infect Dis 2011;52 (supplement 5). ** COMMENTARY by Brad Spellberg, MD **
Candida urinary tract infections: Clin Infect Dis 2011;52 (supplement 6).
Brassard et al analyzed a Canadian database cohort of >427,000 people and, finding 564 cases of tuberculosis, announced that users of inhaled corticosteroids had a rate ratio of ~1.26 to 1.97 over never-users, with current and high-dose ICS users on the higher end of that range. They also found that oral corticosteroids reduced the risk [… read more]
(1–>3) Beta-D-glucan, or BDG, is a component of the cell wall of most fungi (not Zygomycetes or Cryptococcus though). Karageorgopoulos et al pooled 16 studies, including 2,979 patients with definite or likely fungal infections, that reported the test characteristics of serum BDG. The pooled sensitivity of serum BDG for invasive fungal infection was 77% and [… read more]
Sadaka et al add their two cents and a cohort study to the Xigris efficacy/safety debate. In their retrospective, propensity-matched analysis of 563 patients sourced from the Project IMPACT database, the 108 who received activated protein C had 35% mortality, vs 54% for the 108 who did not (p=0.005). There were unusually low rates of [… read more]
After analyzing all AstraZeneca’s clinical trials data on budesonide for asthma (26 placebo-controlled, n~14,000; 60 non-placebo-controlled, n~33,000), O’Byrne et al found no increased risk of pneumonia with use of budesonide by asthmatics, who contracted 1-2 detected pneumonias per 100 patient-years of treatment. AJRCCM 2011;183:589-595.
Roquilly et ses amis francais randomized 150 critically ill victims of severe French trauma to hydrocortisone or placebo for 7 days. The treated group had an absolute 16-19% lower risk for hospital-acquired pneumonia, the primary endpoint (36% vs. 51-54% depending on which intention-to-treat analysis you prefer, p=0.007 to 0.01). (n=150). JAMA 2011;305:1201-1209.
Fernandez-Cerrano et al randomized 56 people with CAP in Spain (only 3 needed mechanical ventilation) to receive methylprednisolone bolus-and-taper or placebo, in addition to ceftriaxone and levofloxacin. The steroid-treated group had less hypoxemia (lower PaO2/FiO2). (n=56). Critical Care 2011;15:R96. FREE FULL TEXT MORE ON THIS: In AJRCCM 2005, Confalonieri found less septic shock and need [… read more]