In the Literature

The Hospitalist. 2008 July;2008(07):

July 1, 2008|The Hospitalist

Michael Kedansky, MD,robert Belsher, MD,victor Weaver, MD;Michael Goldman, MD;Lisa Gushwa, MD,

Literature at a Glance

A guide to this month’s studies.

Survival of in-hospital cardiac arrest decreases during nights and weekends.
C-reactive protein levels predict severity and complications in community-acquired pneumonia.
Adherence to current guidelines improves outcome in treatment of prosthetic joint infection.
Sodium phosphate bowel prep use is associated with a decline in GFR.
Minimally interrupted cardiac resuscitation improves survival.
Lower aPTT increases risk for future VTE.
Warfarin combined with antiplatelet therapy increases hemorrhage rate.
Creatinine rise during MI hospitalization is associated with long-term risk of death and ESRD.
Communication improves patient adherence to beta-blockers after MI.

CLINICAL SHORTS

DELAYS IN PRESENTATION OF PATIENTS WITH DECOMPENSATED CHF

Retrospective chart review demonstrated that several factors, including male sex, multiple presenting symptoms, lack of history of CHF and late night presentation were associated with a delay in seeking medical care.

Citation: Goldberg RJ, Goldberg JH, Pruell S, et al. Delays in seeking medical care in hospitalized patients with decompensated heart failure. Am J Med. 2008;121:212-218.

MRSA COLONIZATION INCREASES RISK OF INVASIVE INFECTION

Meta-analysis showed that methicillin-resistant Staph aureus (MRSA) colonized individuals were 4 times more likely than methicillin-sensitive Staph aureus (MSSA) colonized individuals to develop invasive infections.

Citation: Safdar N, Bradley EA. The risk of infection after nasal colonization with staphylococcus aureus. Am J Med. 2008;121:310-315.

HOSPITALS WITH CLINICAL TRIALS PROVIDE BETTER CARE

Retrospective review of CRUSADE enrolled hospitals demonstrated that hospitals that participated in clinical trials for acute coronary syndrome had lower mortality rates, better outcomes, and improved quality of care.

Citation: Majumdar SR, Roe MT, Peterson ED, et al. Better outcomes for patients treated at hospitals that participate in clinical trials. Arch Intern Med. 2008;168(6):657-662.

PNEUMOCOCCAL BACTEREMIA DOES NOT INFLUENCE CLINICAL OUTCOMES

In this retrospective review of the Community-Acquired Pneumonia Organization (CAPO) database of hospitalized patients, pneumococcal bacteremia by itself was not an independent risk factor for adverse outcomes.

Citation: Bordon J, Peyrani P, Brock GN, et al. The presence of pneumococcal bacteremia does not influence clinical outcomes in patients with community-acquired pneumonia: results from the community-acquired pneumonia organization (CAPO) international cohort study. Chest 2008;133:618-624.

MANDATORY ID CONSULTATION IMPROVES CARE OF STAPH AUREUS BACTEREMIA

Retrospective chart review demonstrated a mandatory policy of ID consult in patients hospitalized with Staph aureus bacteremia led to improved adherence to standards of care and treatment guidelines without increasing patient length of stay.

Citation: Jenkins TC, Price CS, Sabel AL, Mehler PS, Burman WJ. Impact of routine infectious diseases service consultation on the evaluation, management, and outcomes of staphylococcus aureus bacteremia. Clin Infect Dis. 2008;46:1000-1008.

AGGRESSIVE RISK FACTOR MANAGEMENT DOES NOT IMPROVE CARDIOVASCULAR OUTCOMES

This prospective randomized trial of 499 Native Americans with type 2 diabetes followed over four years showed that maintaining LDL-C at 69-75 as opposed to 104-106 and systolic blood pressure at 115-118 as opposed to 128-130 did not reduce cardiovascular disease events.

Citation: Howard BV, Roman MJ, Devereux RB, et al. Effect of lower targets for blood pressure and LDL cholesterol on atherosclerosis in diabetes. JAMA. 2008;299(14):1678-1689.

MRSA SCREENING DOES NOT REDUCE RISK OF HOSPITAL-ACQUIRED INFECTIONS

In this prospective interventional cohort study of 21,754 surgical patients, universal rapid MRSA admission screening with subsequent appropriate contact isolation of MRSA carriers did not reduce the rate of nosocomial MRSA infection.

Citation: Harbarth S, Fankhauser C, Schrenzel J, et al. Universal screening for methicillin-resistant staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. JAMA. 2008;299(10):1149-1157.

EARLY OUTPATIENT FOLLOW-UP AFTER ACUTE MI IMPROVES MEDICATION ADHERENCE

This prospective cohort study of 1,516 patients with acute MI found that a follow up appointment within 30 days of discharge was associated with higher rates of continued beta-blocker and statin use.

Citation: Daugherty SL, Ho PM, Spertus JA, et al. Association of early follow-up after acute myocardial infarction with higher rates of medication use. Arch Intern Med. 2008;168(5):485-491.

SIMVASTATIN PLUS EZETIMIBE MAY NOT CONFER ADDITIONAL CLINICAL BENEFIT

In this randomized, double-blind study of patients with familial hypercholesterolemia, adding ezetimibe 10 mg to simvastatin 80mg significantly lowered LDL cholesterol but did not lead to a significant difference in carotid artery intima-media thickness.

Citation: Kastelein JJP, Akdim F, Stroes ESG, et al. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med. 2008;358:1431-1443.