Hospital Medicine Alert – August 1, 2013

August 1, 2013

• Overnight Vital Signs — Are They Always Beneficial?

  Low MEWS score may be beneficial in identifying a subset of hospitalized patients unlikely to benefit from nocturnal vital sign monitoring.

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• Macrolide Antibiotics May Increase the Risk of Statin Toxicity

  The toxicity of statins was increased in older adults who were coprescribed the CYP3A4 inhibitors clarithromycin or erythromycin.

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• Chest Pain and Dyspnea? Taking Steroids? Think PE.

  Corticosteroid use is associated with an increased risk of symptomatic pulmonary embolism. The greatest risk is in the first 30 days of use and increases with increasing steroid dose.

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• Early use of Daptomycin Compared to Vancomycin for MRSA Bacteremia

  In a matched, retrospective cohort study, early use of daptomycin compared to vancomycin in MRSA bacteremia with vancomycin MICs > 1 µg/mL resulted in improved clinical outcomes, including less clinical failure at 30 days, lower mortality and less persistent bacteremia.

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• Preventing ICU Infections: An Effective Application of An Old Public Health Strategy

  Despite better compliance with hand hygiene and screening, use of isolation, and other techniques, ICUs remain notorious breeding grounds for hospital-acquired infections. A universal decolonization strategy reduces the total number of ICU bloodborne infections.

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