ITL: Physician Reviews of HM-Relevant Research

The Hospitalist. 2013 March;2013(03):

March 1, 2013 | The Hospitalist

Charles A. Baillie, MD ; Eric N. Goren, MD ; Jerry Jacob, MD ; Neha Patel, MD ; Craig A. Umscheid, MD, MSCE ; Kai T. Xu, MD ; Section OF

Bottom line: Antimicrobial-coated catheters do not show a clinically significant benefit over standard PTFE catheters in preventing catheter-associated UTI.

Citation: Pickard R, Lam T, Maclennan G, et al. Antimicrobial catheters for reduction of symptomatic urinary tract infection in adults requiring short-term catheterisation in hospital: a multicentre randomized controlled trial. Lancet. 2012;380:1927-1935.

Outcomes Improve after In-Hospital Cardiac Arrest

Clinical question: Have outcomes after in-hospital cardiac arrest improved with recent advances in resuscitation care?

Background: Over the past decade, quality-improvement (QI) efforts in hospital resuscitation care have included use of mock cardiac arrests, defibrillation by nonmedical personnel, and participation in QI registries. It is unclear what effect these efforts have had on overall survival and neurologic recovery.

Study design: Retrospective cohort study.

Setting: Five hundred fifty-three hospitals in the U.S.

Synopsis: A total of 113,514 patients age >18 with a cardiac arrest occurring from Jan. 1, 2000, to Nov. 19, 2009, were identified. Analyses were separated by initial rhythm (PEA/asystole or ventricular fibrillation/tachycardia). Overall survival to discharge increased significantly to 22.3% in 2009 from 13.7% in 2000, with similar increases within each rhythm group. Rates of acute resuscitation survival (return of spontaneous circulation for at least 20 contiguous minutes after initial arrest) and post-resuscitation survival (survival to discharge among patients surviving acute resuscitation) also improved during the study period. Rates of clinically significant neurologic disability, as defined by cerebral performance scores >1, decreased over time for the overall cohort and the subset with ventricular fibrillation/tachycardia. The study was limited by including only hospitals motivated to participate in a QI registry.

Bottom line: From 2000 to 2009, survival after in-hospital cardiac arrest improved, and rates of clinically significant neurologic disability among survivors decreased.

Citation: Girotra S, Nallamothu B, Spertus J, et al. Trends in survival after in-hospital cardiac arrest. N Engl J Med. 2012;367:1912-1920.

Clinical Shorts

FDA WARNS OF DEATHS ASSOCIATED WITH HIGH-CAFFEINE PRODUCTS

The FDA is continuing to investigate reports of morbidity and mortality associated with high-energy drinks, including 5-Hour Energy, Monster Energy, Rockstar Energy, and Red Bull.

Citation: U.S. Food and Drug Administration. Energy “drinks” and supplements: investigations of adverse event reports. U.S. Food and Drug Administration website. Available at: https://www.fda.gov/Food/NewsEvents/ucm328536.htm. Accessed Dec. 28, 2012.

PPIS MAY INCREASE RISK OF COMMUNITY-ACQUIRED PNEUMONIA (CAP) DUE TO STREP PNEUMONIA

In this single-center study of 463 consecutive individuals suspected of having CAP, those on PPIs had 2.2 times the odds of being infected with Streptococcus pneumoniae.

Citation: De Jager CPC, Wever PC, Gemen EFA, et al. Proton pump inhibitor therapy predisposes to community-acquired Streptococcus pneumoniae pneumonia. Aliment Pharmacol Ther. 2012;36(10):941-949.

EGG-FREE SEASONAL FLU VACCINE NOW AVAILABLE

The FDA has approved Flucelvax, the first seasonal flu vaccine made in mammalian cell cultures rather than fertilized chicken eggs. The vaccine was approved by the European Union in 2007.

Citation: Chapelle R. FDA approves first seasonal influenza vaccine manufactured using cell culture technology. U.S. Food and Drug Administration website. Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm328982.htm. Accessed Dec. 28, 2012.

RIVAROXABAN NOW FDA-APPROVED FOR THE TREATMENT OF PE AND DVT

The FDA has expanded the approved use of rivaroxaban (Xarelto) to include the treatment of DVT and PE. It had previously been approved for the prevention of VTE after hip/knee surgery and stroke in nonvalvular atrial fibrillation.

Citation: Yao S. FDA expands use of Xarelto to treat, reduce recurrence of blood clots. U.S. Food and Drug Administration website. Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm326654.htm. Accessed Dec. 28, 2012.