2012 February 23

Prognostic Significance of Elevated Baseline Troponin in Patients With Acute Coronary Syndromes and Chronic Kidney Disease Treated With Different Antithrombotic Regimens: A Substudy From the ACUITY Trial.

Circ Cardiovasc Interv Start a Discussion »

Feb 232012

Prognostic Significance of Elevated Baseline Troponin in Patients With Acute Coronary Syndromes and Chronic Kidney Disease Treated With Different Antithrombotic Regimens: A Substudy From the ACUITY Trial.

Circ Cardiovasc Interv. 2012 Feb 21;

Authors: Acharji S, Baber U, Mehran R, Fahy M, Kirtane AJ, Lansky AJ, Stone GW

Abstract
BACKGROUND: Elevation of baseline cardiac troponin in patients presenting with acute coronary syndromes (ACS) confers an adverse prognosis. The prognostic value of troponin elevation in patients with chronic kidney disease (CKD) and ACS is less certain. METHODS AND RESULTS: In the ACUITY (Acute Catheterization and Urgent Intervention Triage strategy) trial, 13 819 patients with moderate and high-risk ACS were assigned randomly to receive heparin plus a glycoprotein IIb/IIIa inhibitor (GPI), bivalirudin plus a GPI, or bivalirudin monotherapy. Among 2179 patients with CKD (creatinine clearance <60 mL/min), baseline troponin elevation was present in 1291 patients (59.2%). Major bleeding and major adverse cardiac events (MACE), including death, myocardial infarction (MI), or unplanned revascularization, were examined according to baseline troponin status and randomization arm. Patients with CKD in whom the baseline troponin level was elevated had significantly higher rates of death, MI, and MACE at 30 days and 1 year compared with CKD patients without elevated baseline troponin. By multivariable analysis, baseline troponin elevation in patients with CKD was an independent predictor of composite death or MI at 30 days (hazard ratio [95% CI]=2.05 [1.48, 2.83], P<0.0001) and 1 year (1.72 [1.36, 2.17], P<0.0001). In CKD patients with baseline troponin elevation, bivalirudin monotherapy compared with heparin plus a GPI significantly reduced the 30-day rates of major bleeding with nonsignificantly different rates of MACE at 30 days and 1 year. CONCLUSIONS: In patients with ACS and CKD, baseline troponin elevation is associated with significantly worse short- and long-term clinical outcomes. Bivalirudin monotherapy safely reduces major bleeding in ACS patients with CKD and baseline troponin elevation.

PMID: 22354934 [PubMed - as supplied by publisher]

Link to Article at PubMed

Geographic Disparities in the Incidence and Outcomes of Hospitalized Myocardial Infarction: Does a Rising Tide Lift All Boats?

Circ Cardiovasc Qual Outcomes Start a Discussion »

Feb 232012

Geographic Disparities in the Incidence and Outcomes of Hospitalized Myocardial Infarction: Does a Rising Tide Lift All Boats?

Circ Cardiovasc Qual Outcomes. 2012 Feb 21;

Authors: Yeh RW, Normand SL, Wang Y, Barr CD, Dominici F

Abstract
BACKGROUND: <0.001 for trend for each) between 2000-2008, adjusted rates of decline varied by region (annual declines ranging from 2.9-6.1%). Widening geographic disparities, as measured by percent change of between-state variance from 2000-2008, were observed for MI incidence (37.6% increase, P=0.03) and percutaneous coronary intervention rates (31.4% increase, P=0.06). Significant declines in risk-adjusted 30-day mortality were observed in all regions, with the fastest declines observed in states with higher baseline mortality rates.ConclusionsIn a large contemporary analysis of geographic trends in MI epidemiology, the incidence of MI and associated mortality declined significantly in all US Census Divisions between 2000-2008. Although geographic disparities in MI incidence may have increased, regional differences in MI-associated mortality have narrowed.

PMID: 22354937 [PubMed - as supplied by publisher]

Link to Article at PubMed

Medication errors in university-affiliated teaching hospitals as compared to non-university-affiliated teaching hospitals in Jordan.

nurs forum Start a Discussion »

Feb 232012

Medication errors in university-affiliated teaching hospitals as compared to non-university-affiliated teaching hospitals in Jordan.

Nurs Forum. 2011 Oct-Dec;46(4):206-17

Authors: Mrayyan MT, Al-Atiyyat N

Abstract
BACKGROUND: "Medication errors" is a serious underreported practice issue. This is the first study in Jordan and other countries that compare medication errors between university-affiliated teaching hospitals (UATHs) and non-university-affiliated teaching hospitals (NUATHs).
DESIGN AND SAMPLE: Survey method was used to collect data of the current study. A convenience sample of 171 nurses was recruited from two UATHs and a sample of 98 nurses from two NUATHs.
RESULTS: There were significant differences between the two types of hospitals in terms of causes, percentage, and reporting of medication errors. More medication errors are committed in NUATHs, thus immediate interventions are needed. Nurses in NUATHs should be encouraged to report medication errors; those nurses were more subjected to disciplinary actions or at the risk of losing their jobs.
CONCLUSIONS: Medication errors are escalating, and is a matter that requires immediate interventions in all types of hospitals, especially in NUATHs. More reporting methods should be established in NUATHs.

PMID: 22029764 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Epidemic methicillin-susceptible Staphylococcus aureus lineages are the main cause of infections at an Iranian university hospital.

J Clin Microbiol Start a Discussion »

Feb 232012

Epidemic methicillin-susceptible Staphylococcus aureus lineages are the main cause of infections at an Iranian university hospital.

J Clin Microbiol. 2011 Nov;49(11):3990-3

Authors: Havaei SA, Vidovic S, Tahmineh N, Mohammad K, Mohsen K, Starnino S, Dillon JA

Abstract
The majority of Staphylococcus aureus infections from Isfahan, Iran, were caused by epidemic methicillin-susceptible S. aureus (MSSA) lineages, sequence type 8 (ST8), ST22, ST30, and ST6. The predominant methicillin-resistant S. aureus strain was ST239. We observed a high prevalence of Panton-Valentine leukocidin-positive MSSA strains (19.7%), which is a matter of considerable concern, since these strains have the ability to cause severe infections.

PMID: 21940478 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Beta-D-glucan detection as a diagnostic test for invasive aspergillosis in immunocompromised critically ill patients with symptoms of respiratory infection: an autopsy-based study.

J Clin Microbiol Start a Discussion »

Feb 232012

Beta-D-glucan detection as a diagnostic test for invasive aspergillosis in immunocompromised critically ill patients with symptoms of respiratory infection: an autopsy-based study.

J Clin Microbiol. 2011 Nov;49(11):3783-7

Authors: De Vlieger G, Lagrou K, Maertens J, Verbeken E, Meersseman W, Van Wijngaerden E

Abstract
Beta-(1,3)-D-glucan (BG) detection is an emerging tool to diagnose invasive fungal infections (IFIs). Invasive aspergillosis (IA) is the second most common IFI in immunocompromised intensive care unit (ICU) patients. We retrospectively analyzed the serum BG concentration (Fungitell; Associates of Cape Cod) in immunocompromised ICU patients with proven IA and in immunocompromised ICU patients in whom autopsy failed to show IFI. The study was performed in a 17-bed medical ICU in a 1,900-bed referral hospital. Patients at risk for IA were eligible for inclusion when at least two additional clinical signs were present. Patients with other IFIs were excluded. Fourteen patients with IA and 33 patients who had no IFI were eligible for inclusion. Serum BG levels were significantly higher in patients with IA than patients without an IFI (P < 0.01). Using a cutoff of 140 pg/ml, the sensitivity and specificity were 85.7 and 69.7%, respectively; the positive and negative predictive values were 54.5 and 92.0%, respectively. The positive and negative likelihood ratios were 2.83 and 0.21, respectively. Although serum BG concentrations were higher in immunocompromised ICU patients with IA than in patients with the same risk factors who did not have IFI on autopsy, the moderate performance characteristics of this test limit its use as a diagnostic test for IA in this population.

PMID: 21880959 [PubMed - indexed for MEDLINE]

Link to Article at PubMed

Comparison of the clinical characteristics and outcomes associated with vancomycin-resistant Enterococcus faecalis and vancomycin-resistant E. faecium bacteremia.

Antimicrob Agents Chemother Start a Discussion »

Feb 232012

Comparison of the clinical characteristics and outcomes associated with vancomycin-resistant Enterococcus faecalis and vancomycin-resistant E. faecium bacteremia.

Antimicrob Agents Chemother. 2012 Feb 21;

Authors: Hayakawa K, Marchaim D, Martin ET, Tiwari N, Yousuf A, Sunkara B, Pulluru H, Kotra H, Hasan A, Bheemreddy S, Sheth P, Lee D, Kamatam S, Bathina P, Nanjireddy P, Chalana IK, Patel S, Kumar S, Vahia A, Ku K, Yee V, Swan J, Pogue JM, Lephart PR, Rybak MJ, Kaye KS

Abstract
Background: Published patient cohorts with bacteremia due to vancomycin-resistant Enterococcus (VRE) have predominantly consisted of E. faecium. Little is known about the epidemiology and outcomes associated with bacteremia due to VR E. faecalis.Methods: A retrospective study from 01/2008 to 10/2010 was conducted at Detroit Medical Center (DMC). Unique patients with blood cultures due to VRE were reviewed. Outcomes were analyzed using logistic regression.Results: During the study period, 105 cases of bacteremia due to VR E. faecalis and 197 cases of bacteremia due to VR E. faecium were identified. The mean age of the study cohort was 61.5 ±15 years, 162 (53.6%) were male. After controlling for a propensity score, bacteremia due to VR E. faecalis was associated with greater than two-fold lower in-hospital mortality, compared to bacteremia due to VR E. faecium. Interestingly, bacteremia due to VR E. faecalis was associated with longer length of hospital stay (LOS) after VRE isolation, although total LOS was similar for VR E. faecalis and VR E. faecium.Conclusions: Bacteremia due to VR E. faecalis was associated with a greater than two-fold lower risk for mortality compared to bacteremia due to VR E. faecium, possibly due to the availability of ? -lactam therapeutics for treatment of VR E. faecalis.

PMID: 22354290 [PubMed - as supplied by publisher]

Link to Article at PubMed

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