Hospital Medicine Alert – March 1, 2007

March 1, 2007

• Diagnosing Adrenal Insufficiency in Sepsis

  Using the metyrapone test as a gold standard, the authors confirmed that a resting serum cortisol level < 10 micrograms/dL, or an increase of < 9 micrograms/dL after cosyntropin stimulation, accurately diagnoses adrenal insufficiency in ICU patients with severe sepsis or septic shock.

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• Catheter-Related Infections: Doing the Right Thing Pays Off

  In a study involving 108 ICUs in Michigan, an evidence-based intervention led to a 66% reduction in catheter-related bloodstream infections that was sustained over an 18-month period.

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• Antipsychotics in AD Patients: The CATIE-AD Study

  Because of adverse effects, special care should be used when prescribing the atypical antipsychotic drugs for patients with dementia.

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• Dr. Google, I Presume

  Searching Google yielded a correct diagnosis in greater than half of cases.

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• Antiretroviral for Acute HIV Infection

  A multicenter, observational study retrospectively compared 59 individuals with acute or early HIV infection who elected to receive antiretroviral (ARV) therapy for 12 weeks to 337 patients who declined treatment.

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• Posaconazole Salvage in Invasive Aspergillosis

  Salvage therapy of invasive aspergillosis with posaconazole was associated with a 42% response rate, compared to only 26% in an external control group.

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