In the Literature
In This Edition
- Treat with antibiotics for seven days or less in adults with community-acquired pneumonia.
- In patients with chronic kidney disease who present with non ST-segment elevation acute coronary syndromes, anticoagulation with fondaparinux (Arixtra) is safer than with enoxaparin (Lovenox).
- Multislice coronary angiography rules out suspected coronary artery disease.
- Hospitalists in teaching hospitals decrease length of stay in complex patients.
- Epoetin alfa (Procrit/Epogen) use in critically ill patients does not reduce red-cell transfusion but may reduce mortality in trauma.
- Newer antibiotics appear to be more effective for acute exacerbations of chronic bronchitis.
- Low-income patients and patients seen by specialists are less likely to use generic medications.
- Hospitalist-orthopedic comanagement of patients with hip fractures does not negatively affect long-term mortality.
- Probiotics reduce antibiotic and C. difficile-associated diarrhea.
- Healthcare-associated pneumonia closely resembles nosocomial pneumonia.
Citation: Pisani MA, Murphy TE, Van Ness PH, et al. Characteristics associated with delirium in older patients in a medical intensive care unit. Arch Intern Med. 2007; 167(15):1629-1634.
Idraparinux Inferior to Standard Therapy for VTE Treatment
Idraparinux, a subcutaneous long-acting inhibitor of factor Xa, was compared with standard therapy with heparin and adjusted-dose vitamin K antagonist for patients with acute deep venous thrombosis (DVT) or pulmonary embolism. Although Idraparinux was similar in efficacy for the treatment of DVT, it did not meet the non-inferiority requirement for the treatment of pulmonary embolism (OR, 2.14; 95% CI, 1.21 to 3.78).
Citation: The van Gogh Investigators. Idraparinux versus standard therapy for venous thromboembolic disease. N Engl J Med. 2007;357(11):1094-104.
Extended Prophylaxis of VTE with Idraparinux Effective but Associated with Major Bleeding
During a six-month extension of thrombo-prophylaxis, Idraparinux was more effective than placebo in preventing recurrent thromboembolism (1.0% versus 3.7%; p=0.002), but was associated with an increased risk of a major hemorrhage (3.1% versus 0.9%).
Citation: The van Gogh Investigators. Extended Prophylaxis of Venous Thromboembolism with Idraparinux. N Engl J Med. 2007;357(11):1105-1112.
Risk Factors for Persistent Staphylococcus aureus Bacteremia
This retrospective case-control study at a single academic medical center found the following risk factors for persistent (more than seven days) compared with nonpersistent (less than three days) S. Aureus bacteremia (pSAB): presence of Methicillin-resistant S. Aureus [MRSA], antecedent central venous catheter, chronic kidney disease, multiple sites of infection, and endocarditis.
Citation: Hawkins C, Huang J, Jin N, Noskin GA, Zembower TR, Bolon M. Persistent Staphylococcus aureus bacteremia. Arch Intern Med. 2007;167(17):1861-1867.
Hospital Workers Don’t Know Adequate Volume of Blood Required for Cultures
A survey of 360 employees at a tertiary care center revealed that 79% of healthcare providers do not know that that the current recommendation is to obtain at least 10 mL of blood per blood culture sample. Further, 44% thought the ideal measure was less than 5 mL.
Citation: Donnino MW, Goyal N, Terlecki TM, et al. Inadequate blood volume collected for culture: a survey of health care professionals. Mayo Clin Proc. 2007;82(9):1069-1072.
