Apr 172011
 

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]

Apr 162011
 

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]

Apr 152011
 

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]

Apr 142011
 

In a retrospective review of 418 tunneled pleural catheters placed over 2 years, 91% of patients did not require any other drainage procedure. Spontaneous pleurodesis occurred in one-quarter, in whom the catheter was taken out at a median 44 days. More patients with catheters placed in the operating room achieved pleurodesis (36%). Complication rate overall [… read more]

Apr 122011
 

Survival varies widely among people with N1 non-small cell lung cancer. Examining SEER data on 1,682 patients age > 65, who had a median 8 lymph nodes resected between 1992 and 2005, Wisnivesky et al observe that the ratio of positive-to-negative sampled lymph nodes independently predicted survival. Having more than 50% positive LNs foretold a median survival [… read more]

Apr 112011
 

Establishing mediastinal spread of non-small cell lung cancer (N2-3 disease) precludes surgery and worsens prognosis; whether PET-CT imaging can improve overall accuracy or safely prevent mediastinoscopies is still unknown. Fischer et al re-heat the data from their 2009 NEJM randomized trial in Denmark, with EUS-FNA and mediastinoscopy on 189 NSCLC patients, in which they concluded that the [… read more]

Apr 102011
 

Ashraf et al selected people with lung nodules from the Danish Lung Cancer Screening Trial, referring them for PET. Having a suspicious PET scan, or a volume-doubling time (VDT) of < 1 year, each separately had a sensitivity of 71% and a specificity of 91% for lung cancer. Combining PET data with VDT improved sensitivity [… read more]

Apr 092011
 

A retrospective look at 447 patients with stage I non-small cell lung cancer by Inoue et al suggests yes, but without affecting survival. When cancer recurred in those initially diagnosed by CT-guided needle biopsy, pleural dissemination was more likely (8 of 13 recurrences). However, 5-year disease free survival was 89% in the CT-biopsy group and [… read more]

Apr 072011
 

In 173 patients free of bronchiolitis obliterans syndrome at least 6 months post-transplant, having 10 or more colony-forming units of mesenchymal cells in bronchoalveolar lavage fluid carried a >5.0 hazard ratio for subsequently developing BOS. The relation persisted after multivariate analysis, report Badri et al. AJRCCM 2011;183:1062-1070.