Internal Medicine
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VRE and MRSA: Time to Assign Contact Precautions to the Dust Heap of History
In the context of other horizontally implemented, effective infection prevention measures, the use of contact precautions for most patients colonized or infected with MRSA or VRE fails to provide benefit.
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Rotavirus Vaccine and Intussusception
Using active surveillance, researchers enrolled 717 infants with intussusception from sub-Saharan Africa. The risk of intussusception was no higher in those who received the monovalent rotavirus vaccine than in non-immunized infants.
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Antibiotic Use in Infancy Associated With Allergic Disease During Childhood
In a large population-based study, antibiotic use during the first six months of life was associated with a two-fold increase in asthma and a 1.5-fold increase in allergic disease during early childhood.
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Sepsis-related Neurologic Dysfunction Strongly Associated With Long-term Mortality
In this multicenter, retrospective study, acute neurologic dysfunction was the organ dysfunction most strongly associated with short- and long-term mortality in patients surviving a sepsis hospitalization.
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Selection of Isotonic Crystalloid for Fluid Resuscitation: How Much Does It Matter?
Using balanced crystalloids rather than normal saline for intravenous fluid administration in critically ill adults leads to statistically significant lower rates of major adverse kidney events, including death from any cause, new renal replacement therapy, and persistent renal dysfunction, compared to normal saline in critically ill adults. Clinical judgment should be applied when selecting fluid.
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Re-evaluating Steroid Therapy in Septic Shock
Septic shock carries a significant risk of mortality despite increasing knowledge of its pathophysiology and clinical management. Studies dating back to the 1960s suggested steroid treatment may alter the course of septic shock and led to the concept of critical illness-related corticosteroid insufficiency. Two recent trials have provided more data regarding steroid therapy for septic shock. Comparing these seminal studies provides context for the decision about whether to treat septic shock with steroid therapy.
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Simple Prediction Tool Facilitates Diagnosis of Heart Failure With Preserved Ejection Fraction
In patients with unexplained dyspnea, a score based on six noninvasive criteria can predict the likelihood of heart failure with preserved ejection fraction.
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Mortality Risk Score for Degenerative Mitral Regurgitation
An international database of patients with significant degenerative mitral valve regurgitation was used to derive and test a score using clinical and echocardiographic data to estimate mortality with medical and surgical therapy. From seven weighted characteristics, investigators developed a 0-12 score that predicted medical and surgical long-term mortality with high discriminatory ability (C-statistic, 0.78 and 0.81, respectively). Investigators found the score added incremental information to surgical scores and believe that it will be useful for therapeutic decision-making.
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Long-term Risk of Transient Atrial Fibrillation After Coronary Artery Bypass Graft Surgery
Investigators compared post-coronary artery bypass graft (CABG) atrial fibrillation (AF) to non-surgical, non-valvular AF in a large cohort derived from the Danish health system database. Despite a lower rate of oral anticoagulant use compared to non-valvular AF patients and equivalent CHA2DS2-VASc scores, post-CABG AF demonstrated a lower risk of thromboembolism, death, and recurrent AF. These data do not support the concept that post-CABG AF is the same as traditional non-valvular AF regarding thromboembolic risk.
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Drug-eluting Stents Fare No Better Than Bare-metal Stents in Vein Graft Lesions
The two largest randomized trials to date have shown no advantage to drug-eluting stents compared to bare-metal stents in saphenous vein graft percutaneous interventions.