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Hospital Medicine Alert – August 1, 2006

August 1, 2006

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  • MRSA Hits the Streets

    Methicillin-resistant Staphylococcus aureus (MRSA) in the community was the cause of the majority of skin and soft tissue infections, and was predominantly of one strain different from MRSA of hospital origin.
  • CA-MRSA & CAP

    Seventeen cases of community acquired pneumonia due to Staphylococcus aureus are described. Most were methicillin resistant and caused severe disease with high mortality.
  • Use of Corticosteroids in Persistent ARDS

    A prospective randomized trial carried out over a 6-year period of time enrolled 180 patients with ARDS of at least 7 days duration, and randomized them to receive either methylprednisolone or placebo. There was no significant difference noted in mortality at 60 days, though there was some improvement in ventilator-free and shock-free days during the first 28 days in patients treated with steroids. Steroids were also associated with an increased risk of death if started more than 2 weeks after the onset of ARDS.
  • Does Early Enteral Feeding Improve Outcomes in Medical ICU Patients?

    In a retrospective analysis, medical ICU patients requiring mechanical ventilation for 2 days or more had lower ICU and hospital mortality (but more ventilator-associated pneumonia) if they were begun on enteral feeding during that time than if they were not.
  • Post-Chemotherapy Fatigue and the Role of Anti-Inflammatory Treatment

    Fatigue occurs commonly in patients with cancer, particularly when receiving chemotherapy or radiation. Furthermore, in long term survivors, persistent fatigue occurs in up to one third. Although anemia is one contributing factor, fatigue certainly occurs in its absence as well. Two recent reports are reviewed; one addressing the mechanisms and biochemical markers of persistent fatigue, and the other introducing a novel therapeutic approach directed at chemotherapy-associated fatigue. It is quite apparent that dysregulation of inflammatory mechanisms accounts for some component of fatigue and anti-inflammatory treatments may be of great value.
  • Cost-Effectiveness of BNP Measurement in Acute Dyspnea

    This study in patients presenting to the emergency department with acute dyspnea showed that rapid BNP testing is cost-effective during the initial hospital encounter as well as at 180 days.