2012 August 14

Clinical prediction rule for identifying patients with vancomycin-resistant enterococci (VRE) at the time of admission to the intensive care unit in a low VRE prevalence setting.

J Antimicrob Chemother Start a Discussion »

Aug 142012

Clinical prediction rule for identifying patients with vancomycin-resistant enterococci (VRE) at the time of admission to the intensive care unit in a low VRE prevalence setting.

J Antimicrob Chemother. 2012 Aug 10;

Authors: Yoon YK, Kim HJ, Lee WJ, Lee SE, Yang KS, Park DW, Sohn JW, Kim MJ

Abstract

OBJECTIVES: The purpose of this study was to develop and validate a clinical prediction rule to screen patients at risk of vancomycin-resistant enterococci (VRE) carriage at intensive care unit (ICU) admission in a hospital setting with low VRE prevalence. METHODS: This study was retrospectively conducted in the ICUs of a university-affiliated hospital in Korea, where active surveillance cultures for VRE had been run at ICU admission and weekly thereafter. In the derivation cohort from April 2008 to September 2010, risk factors for VRE carriage at ICU admission were determined and assigned weighted point values using a multivariate logistic regression model. In the validation cohort from October 2010 to March 2011, predictability of the prediction rule was evaluated. RESULTS: Of a total of 4445 cultures taken from patients at ICU admission, 153 (3.4%) patients carried VRE. In the derivation cohort, independent risk factors (assigned points) for VRE carriage at ICU admission were ICU readmission during hospitalization (1 point), chronic obstructive lung disease (2 points), recent antibiotic treatment (3 points) and recent vancomycin use (2 points). In the validation cohort, the sensitivity, specificity, and positive and negative predictive values of the prediction rule, on the basis of risk scores ?3 points, were 84.2%, 82.5%, 15.2% and 99.3%, respectively. CONCLUSIONS: This clinical prediction rule for identifying VRE carriage at the time of ICU admission is expected to markedly reduce the screening volume (by 80.1%) in our healthcare facility. For use in clinical practice, the rule needs to be prospectively validated in other settings.

PMID: 22888271 [PubMed - as supplied by publisher]

Link to Article at PubMed

Incidence of bacterial contamination in infusion set needles.

Am J Infect Control Start a Discussion »

Aug 142012

Incidence of bacterial contamination in infusion set needles.

Am J Infect Control. 2012 Aug 9;

Authors: Nakataki E, Oto J, Hata M, Tsunano Y, Okuda N, Imanaka H, Nishimura M

Abstract

We examined the incidence and types of bacterial contamination in 265 infusion set needles in adult critically ill patients. Bacterial contamination was detected in 15 samples (5.7%), and a total of 17 organisms were isolated. Ten were coagulase-negative staphylococci (CNS) and Staphylococcus aureus, and the remainder were ?-Streptococcus, Corynebacterium, and gram-negative rods. Although the contamination was not directly related to catheter-related bloodstream infections exchanging infusion bottles can cause intraluminal contamination and is a possible route of these infections.

PMID: 22884495 [PubMed - as supplied by publisher]

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Hepatic encephalopathy is associated with decreased cerebral oxygen metabolism and blood flow, not increased ammonia uptake.

Hepatology Start a Discussion »

Aug 142012

Hepatic encephalopathy is associated with decreased cerebral oxygen metabolism and blood flow, not increased ammonia uptake.

Hepatology. 2012 Aug 10;

Authors: Dam G, Keiding S, Munk OL, Ott P, Vilstrup H, Bak LK, Waagepetersen HS, Schousboe A, Sørensen M

Abstract

Studies have shown decreased cerebral oxygen metabolism (CMRO(2) ) and blood flow (CBF) in cirrhotic patients with hepatic encephalopathy (HE). It remains unclear, however, whether these disturbances are associated with HE or with cirrhosis itself and how they may relate to arterial blood ammonia concentration and cerebral metabolic rate of blood ammonia (CMRA). We addressed these questions in a paired study design by investigating cirrhotic patients during and after recovery from an acute episode of HE type C. CMRO(2) , CBF, and CMRA were measured by dynamic PET/CT. Ten cirrhotic patients were studied during an acute episode of HE; nine were reexamined after recovery. Nine cirrhotic patients with no history of HE served as controls. Mean CMRO(2) increased from 0.73 ?mol oxygen/mL brain tissue/min during HE to 0.91 ?mol oxygen/mL brain tissue/min after recovery (paired t-test; P < 0.05). Mean CBF increased from 0.28 mL blood/mL brain tissue/min during HE to 0.38 mL blood/mL brain tissue/min after recovery (P < 0.05). After recovery from HE, CMRO(2) and CBF were not significantly different from values in the control patients. Arterial blood ammonia concentration decreased 20% after recovery (P < 0.05) and CMRA was unchanged (P > 0.30); both values were higher than in the control patients (both P < 0.05). CONCLUSIONS: The low values of CMRO(2) and CBF observed during HE increased after recovery from HE and were thus associated with HE rather than the liver disease as such. The changes in CMRO(2) and CBF could not be linked to blood ammonia concentration or CMRA. (HEPATOLOGY 2012.).

PMID: 22886493 [PubMed - as supplied by publisher]

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Preoperative "NPO" as an opportunity for diabetes screening.

J Hosp Med Start a Discussion »

Aug 142012

Preoperative "NPO" as an opportunity for diabetes screening.

J Hosp Med. 2012 Aug 7;

Authors: Sheehy AM, Benca J, Glinberg SL, Li Z, Nautiyal A, Anderson PA, Squire MW, Coursin DB

Abstract

BACKGROUND: Novel preventive care opportunities, such as in hospitalized patients, may merit further investigation in an Accountable Care Organization (ACO) model. As 40% of patients with diabetes are undiagnosed, diabetes screening is an urgent public health need. Screening fasting preoperative patients may present an effective means to identify patients who might otherwise remain undiagnosed. OBJECTIVE: To pilot an inpatient preventive care strategy for diabetes screening that would ascertain prevalence of unrecognized inpatient diabetes (DM) and impaired fasting glucose (IFG), determine reproducibility of preoperative fasting blood glucose (FBG), and establish feasibility of inpatient preventive screening. DESIGN: Prospective observational study. SETTING: Large Midwestern academic medical center. PATIENTS: Two hundred seventy-five elective orthopedic patients with a preoperative visit between December 1, 2007 and November 30, 2008. Most patients (96.6%) had seen their primary care provider (PCP) within 12 months, and 100% were insured. MEASUREMENTS: Medical history was recorded, and hemoglobin A(1C) (Hgb A(1C) ) and FBG were drawn immediately prior to surgery. Patients with preoperative FBG ?100 mg/dL had FBG drawn 6-8 weeks postoperatively. RESULTS: Twenty-four percent (67/275) of patients had previously unrecognized DM or IFG by virtue of 2 abnormal values. Sixty-four percent of patients with FBG ?100 mg/dL preoperatively remained elevated at ambulatory follow-up. No patients with new DM or IFG had point-of-care glucose checks ordered or had dysglycemia mentioned on discharge summary. CONCLUSIONS: Inpatient undiagnosed DM and IFG is common, even in insured, elective surgery patients with recent primary care visits. Preoperative FBG can be used to screen, but results need to be conveyed to PCPs. Journal of Hospital Medicine 2012; © 2012 Society of Hospital Medicine.

PMID: 22887757 [PubMed - as supplied by publisher]

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The accuracy of the INR and the ACCP recommendations on the use of vitamin K to reverse over anticoagulation.

J Thromb Haemost Start a Discussion »

Aug 142012

The accuracy of the INR and the ACCP recommendations on the use of vitamin K to reverse over anticoagulation.

J Thromb Haemost. 2012 Aug 10;

Authors: Tripodi A, Moia M

Abstract

We read with interest the 2012 evidence-based management of anticoagulant therapy on clinical practice guidelines of the American College of Chest Physicians (ACCP), published recently in Chest [1]. When discussing on how and when using vitamin K to reverse over anticoagulation, the guidelines recommended: (a) "for patients taking VKAs with an INR between 4.5 and 10 and with no evidence of bleeding, we suggest against the routine use of vitamin K (Grade 2B)". (b) "for patients taking VKAs with INR>10.0 and with no evidence of bleeding, we suggest that oral vitamin K be administered (Grade 2C)". © 2012 International Society on Thrombosis and Haemostasis.

PMID: 22882756 [PubMed - as supplied by publisher]

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The role of the kidney in heart failure.

Eur Heart J Start a Discussion »

Aug 142012

The role of the kidney in heart failure.

Eur Heart J. 2012 Aug 10;

Authors: Metra M, Cotter G, Gheorghiade M, Dei Cas L, Voors AA

Abstract

Renal dysfunction is common in patients with heart failure and is associated with high morbidity and mortality. Cardiac and renal dysfunction may worsen each other through multiple mechanisms such as fluid overload and increased venous pressure, hypo-perfusion, neurohormonal and inflammatory activation, and concomitant treatment. The interaction between cardiac and renal dysfunction may be critical for disease progression and prognosis. Renal dysfunction is conventionally defined by a reduced glomerular filtration rate, calculated from serum creatinine levels. This definition has limitations as serum creatinine is dependent on age, gender, muscle mass, volume status, and renal haemodynamics. Changes in serum creatinine related to treatment with diuretics or angiotensin-converting enzyme inhibitors are not necessarily associated with worse outcomes. New biomarkers might be of additional value to detect an early deterioration in renal function and to improve the prognostic assessment, but they need further validation. Thus, the evaluation of renal function in patients with heart failure is important as it may reflect their haemodynamic status and provide a better prognostic assessment. The prevention of renal dysfunction with new therapies might also improve outcomes although strong evidence is still lacking.

PMID: 22888113 [PubMed - as supplied by publisher]

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