2012 March 24

Point-of-care Urine Albumin:Creatinine Ratio Is Associated With Outcome in Emergency Department Patients With Sepsis: A Pilot Study.

Mar 242012

Point-of-care Urine Albumin:Creatinine Ratio Is Associated With Outcome in Emergency Department Patients With Sepsis: A Pilot Study.

Acad Emerg Med. 2012 Mar;19(3):259-64

Authors: Drumheller BC, McGrath M, Matsuura AC, Gaieski DF

Abstract
ACADEMIC EMERGENCY MEDICINE 2012; 19:259-264 © 2012 by the Society for Academic Emergency Medicine ABSTRACT: Objectives:? Sepsis is characterized by an initial systemic proinflammatory response leading to endothelial damage and increased capillary permeability. The authors conducted a pilot study to determine if microalbuminuria, measured by the urine albumin:creatinine ratio (ACR), was associated with outcome in emergency department (ED) sepsis patients. Methods:? This was an observational cohort study of a convenience sample of adult patients presenting to two EDs over 10?months with sepsis (two or more systemic inflammatory response syndrome [SIRS] criteria and suspected infection). Those who received a urinalysis were prospectively enrolled. Patients with anuria, grossly contaminated specimens, or concurrent noninfectious diagnoses were excluded. Urine ACR was measured on a point-of-care (POC) device. The primary study outcome was ED disposition (three groups): treated and discharged, admitted to the floor, or admitted to the intensive care unit (ICU). Kruskal-Wallis testing was used to compare ACR based on disposition. Variables associated with ACR were identified by Spearman rank correlation or Mann-Whitney rank-sum testing. A post hoc subgroup analysis of patients with and without a genitourinary (GU) source of infection was also performed. Results:? A total of 121 patients were screened, and 29 (24%) were excluded; 92 patients met criteria (mean?±?SD age, 51.2?±?17.0?years; 51 [55%] had severe sepsis, three [3%] had septic shock). There were three in-hospital deaths. Median ACR for patients treated and discharged (n?=?22), admitted to floor (n?=?50), and admitted to ICU (n?=?20) was 2.54 (interquartile range [IQR]?=?0.89 to 6.16) versus 2.8 (IQR?=?1.69 to 8.8) versus 12.15 (IQR?=?4.76 to 20.95), respectively (p?=?0.0049). Age, serum creatinine, and GU source of infection were associated with ACR. ACR was significantly associated with disposition among patients without a GU source of infection (p?=?0.003), but not among patients with a GU source (p?=?0.3744). Conclusions:? In this pilot study, microalbuminuria measured by POC ACR was associated with disposition in ED patients with sepsis or severe sepsis. Larger studies using more robust outcomes comparing ACR with validated sepsis biomarkers are needed to elaborate on these results.

PMID: 22435857 [PubMed - in process]

Link to Article at PubMed

Outcomes of Early, Late, and No Admission to the Intensive Care Unit for Patients Hospitalized with Community-acquired Pneumonia.

Acad Emerg Med Start a Discussion »

Mar 242012

Outcomes of Early, Late, and No Admission to the Intensive Care Unit for Patients Hospitalized with Community-acquired Pneumonia.

Acad Emerg Med. 2012 Mar;19(3):294-303

Authors: Renaud B, Brun-Buisson C, Santin A, Coma E, Noyez C, Fine MJ, Yealy DM, Labarère J

Abstract
ACADEMIC EMERGENCY MEDICINE 2012; 19:294-303 © 2012 by the Society for Academic Emergency Medicine ABSTRACT: Objectives:? The objective was to compare outcomes associated with early, late, and no admission to the intensive care unit (ICU) for patients hospitalized with community-acquired pneumonia (CAP). Methods:? This was a post hoc analysis of the original data from the Emergency Department Community-Acquired Pneumonia (EDCAP) and Pneumocom-1 prospective multicenter cohort studies of adult patients hospitalized with CAP. Propensity score-adjusted analysis was used to compare 28-day mortality and hospital length of stay (LOS) for 199, 144, and 2,215 patients with early (i.e., ICU admission on the day of emergency department [ED] presentation), late, and no ICU admission. Results:? Unadjusted 28-day mortality rates were 13.1, 19.4, and 5.7% for early, late, and no ICU admissions, respectively (p?<?0.001). After adjusting for quintile of propensity score, the odds of 28-day mortality were higher for late ICU admissions relative to early ICU admissions (odds ratio [OR]?=?2.63; 95% confidence interval [CI]?=?1.42 to 4.90), and no ICU admissions (OR?=?3.40; 95% CI?=?2.11 to 5.48), but did not differ between early and no ICU admissions (OR?=?1.29; 95% CI?=?0.79 to 2.09). The median hospital LOS was 10?days for early (interquartile range [IQR]?=?7 to 18), 15?days for late (IQR 9 to 23), and 6?days (IQR 4 to 9) for no ICU admissions (p?<?0.001). Conclusions:? This study suggests that late but not early admission to the ICU is associated with higher 28-day mortality for patients hospitalized with CAP. Patients admitted to the ICU have longer hospital LOS in comparison to those managed on the wards, particularly if they are admitted late to the ICU. ACADEMIC EMERGENCY MEDICINE 2012; 19:#-# © 2012 by the Society for Academic Emergency Medicine.

PMID: 22435862 [PubMed - as supplied by publisher]

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Prevalence of Methicillin-Resistant Staphylococcus aureus as an Etiology of Community-Acquired Pneumonia.

Clin Infect Dis Start a Discussion »

Mar 242012

Prevalence of Methicillin-Resistant Staphylococcus aureus as an Etiology of Community-Acquired Pneumonia.

Clin Infect Dis. 2012 Apr;54(8):1126-1133

Authors: Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, Albrecht V, Limbago B, Talan DA,

Abstract
(See the Editorial Commentary by Mandell and Wunderink, on pages 1134-6.) Background.?Methicillin-resistant Staphylococcus aureus (MRSA) is a common cause of skin infections. Recent case series describe severe community-acquired pneumonia (CAP) caused by MRSA, but the prevalence and risk factors are unknown. Methods.?We prospectively enrolled adults hospitalized with CAP from 12 university-affiliated emergency departments during the winter-spring of 2006 and 2007. Clinical information and culture results were collected, and factors associated with MRSA were assessed. Results.?Of 627 patients, 595 (95%) had respiratory (50%) and/or blood cultures (92%) performed. A pathogen was identified in 102 (17%); MRSA was identified in 14 (2.4%; range by site, 0%-5%) patients and in 5% of patients admitted to the intensive care unit. Two (14%) MRSA pneumonia patients died. All 9 MRSA isolates tested were pulsed-field type USA300. Features significantly associated with isolation of MRSA (as compared with any other or no pathogen) included patient history of MRSA; nursing home admission in the previous year; close contact in the previous month with someone with a skin infection; multiple infiltrates or cavities on chest radiograph; and comatose state, intubation, receipt of pressors, or death in the emergency department. Conclusions.?Methicillin-resistant Staphylococcus aureus remains an uncommon cause of CAP. Detection of MRSA was associated with more severe clinical presentation.

PMID: 22438343 [PubMed - as supplied by publisher]

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Influenza-Associated Pneumonia Among Hospitalized Patients With 2009 Pandemic Influenza A (H1N1) Virus–United States, 2009.

Clin Infect Dis Start a Discussion »

Mar 242012

Influenza-Associated Pneumonia Among Hospitalized Patients With 2009 Pandemic Influenza A (H1N1) Virus--United States, 2009.

Clin Infect Dis. 2012 Mar 20;

Authors: Jain S, Benoit SR, Skarbinski J, Bramley AM, Finelli L,

Abstract
Background.?Pneumonia was a common complication among hospitalized patients with 2009 pandemic influenza A H1N1 [pH1N1] in the United States in 2009.Methods.?Through 2 national case series conducted during spring and fall of 2009, medical records were reviewed. A pneumonia case was defined as a hospitalized person with laboratory-confirmed pH1N1 virus and a chest radiographic report consistent with pneumonia based on agreement among 3 physicians.Results.?Of 451 patients with chest radiographs performed, 195 (43%) had pneumonia (spring, 106 of 237 [45%]; fall, 89 of 214 [42%]). Compared with 256 patients without pneumonia, these 195 patients with pneumonia were more likely to be admitted to the intensive care unit (52% vs 16%), have acute respiratory distress syndrome (ARDS; 26% vs 2%), have sepsis (18% vs 3%), and die (17% vs 2%; P < .0001). One hundred eighteen (61%) of the patients with pneumonia had ?1 underlying condition. Bacterial infections were reported in 13 patients with pneumonia and 2 patients without pneumonia. Patients with pneumonia, when compared with patients without pneumonia, were equally likely to receive influenza antiviral agents (78% vs 79%) but less likely to receive antiviral agents within ?2 days of illness onset (28% vs 50%; P < .0001).Conclusions.?Hospitalized patients with pH1N1 and pneumonia were at risk for severe outcomes including ARDS, sepsis, and death; antiviral treatment was often delayed. In the absence of accurate pneumonia diagnostics, patients hospitalized with suspected influenza and lung infiltrates on chest radiography should receive early and aggressive treatment with antibiotics and influenza antiviral agents.

PMID: 22437239 [PubMed - as supplied by publisher]

Link to Article at PubMed

Methicillin-Resistant Staphylococcus aureus and Community-Acquired Pneumonia: An Evolving Relationship.

Clin Infect Dis Start a Discussion »

Mar 242012

Methicillin-Resistant Staphylococcus aureus and Community-Acquired Pneumonia: An Evolving Relationship.

Clin Infect Dis. 2012 Apr;54(8):1134-6

Authors: Mandell LA, Wunderink R

PMID: 22438344 [PubMed - in process]

Link to Article at PubMed

March 2012
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