Hospital Medicine Alert – April 1, 2015
April 1, 2015
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Do Corticosteroids Play a Role in the Treatment of Community-acquired Pneumonia?
Despite antibiotic therapy and hospital-based care, severe community-acquired pneumonia still carries a high risk for morbidity and mortality.
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Intravenous Fluids in Patients With Acute Heart Failure
Volume overload is a hallmark of acute heart failure (AHF). In hospitalized patients, intravenous loop diuretics are the most commonly used treatment for decongestion and symptom relief. Intravenous (IV) fluids are routinely administered to hospitalized patients, although their use in patients with AHF seems counterintuitive. No previous study has evaluated the frequency and effects of IV fluid administration among patients hospitalized for AHF.
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Surgical Management of Infective Endocarditis
Although guidelines outline specific indications for surgery in infective endocarditis (IE), applying these recommendations in the clinical area is challenging. In order to understand these challenges, the International Collaboration on Endocarditis (ICE) conducted a prospective study to evaluate the factors that influence the decision with regard to surgical intervention in IE.
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Bridging During Anticoagulation Interruptions Is Associated with Worse Outcomes
Despite the routine nature of discontinuing atrial fibrillation (AF) patients’ long-term oral anticoagulation (OAC) for procedures and “bridging” them with another agent, there is remarkably little data on the safety and benefit of this practice. Guidelines detailing when and how to initiate bridging therapy have been published, but data supporting why we should bridge at all are limited.1 To help fill this void, Steinberg and colleagues used a national, community-based registry of outpatients with AF (ORBIT-AF) to examine current practices around periprocedural OAC management and associated outcomes. Outcomes evaluated included rates of major bleeding, as well as myocardial infarction, stroke or systemic embolism, cause-specific hospitalization, and death within 30 days.
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Influenza, 2014-2015 — Something Old, Something New
As of early January, influenza activity had reached epidemic proportions in large parts of the United States, with many of those being affected despite prior vaccination.1 The occurrence of infection in vaccinated individuals is not unexpected since influenza vaccine efficacy is usually only approximately 60%. There is, however, an additional problem during this influenza season because of an unanticipated mismatch between the components of the 2014-2015 vaccine, which are identical to the 2013-2014 vaccine composition, and the dominating circulating virus type. Thus, current trivalent influenza vaccines contain hemagglutinin (HA) derived from an A/California/7/2009 (H1N1)-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like (Yamagata lineage) virus. Quadrivalent influenza vaccines contain these antigens as well as a B/Brisbane/60/2008-like (Victoria lineage) virus.