ITL: Physician Reviews of HM-Relevant Research

The Hospitalist. 2012 August;2012(08):

August 28, 2012 | The Hospitalist

Setting: ED patients at a single tertiary-care center.

Synopsis: A retrospective analysis was performed on 3,563 patients who presented to the ED. Blood cultures obtained on patients with suspected infection revealed bacteremia in 289 patients (8.1%). Patients with bacteremia were reviewed for the presence of normal temperature (36.1° to 38° Celsius), normal WBC count (4,000 to 12,000 cells per µL), and presence of bandemia (>5% of WBC differential).

Among patients with bacteremia, 33% had a normal body temperature (67% sensitivity) and 52% had a normal WBC count (48% sensitivity). Of the 210 bacteremic patients who had a full differential performed, bandemia was present in 82% (sensitivity 82%). Bandemia was present in 80% of culture-positive patients with a normal temperature and 79% of culture-positive patients with a normal WBC count. Approximately 17% of patients with bacteremia had neither an abnormal temperature nor an abnormal WBC. This study was limited by the retrospective nature of analysis and the subjective designation of “suspected infection” by the original providers.

Bottom line: In patients presenting to the ED with suspected infection who are found to have culture-proven bacteremia, a significant percentage have normal temperature and WBC count, but the presence of bandemia could be more useful for identifying occult bacteremia.

Citation: Seigel TA, Cocchi MN, Salciccioli J, et al. Inadequacy of temperature and white blood cell count in predicting bacteremia in patients with suspected infection. J Emerg Med. 2012;42(3):254-259.

Clinical Shorts

LEAVING AGAINST MEDICAL ADVICE ASSOCIATED WITH HIGHER MORTALITY AND READMISSION

Observational study examining patients discharged from the hospital finds approximately double 30-day mortality and 30-day readmission, while only 0.75 days less LOS for patients who left against medical advice versus those discharged conventionally.

Citation: Southern WN, Nahvia S, Arnsten JH. Increased risk of mortality and readmission among patients discharged against medical advice. Am J Med. 2012;125(6):594-602.

ROBIOTICS REDUCE ANTIBIOTIC-ASSOCIATED DIARRHEA

Meta-analysis evaluating the efficacy of probiotics finds a relative risk reduction of approximately 40% and a number needed to treat of 13 for the prevention and treatment of antibiotic-associated diarrhea.

Citation: Hempel S, Newberry SJ, Maher AR, et al. Probiotics for the prevention and treatment of antibiotic-associated diarrhea. JAMA. 2012;307(18):1959-1969.

SECOND META-ANALYSIS FINDINGS CHALLENGE REPORTED ASSOCIATION OF SERIOUS ADVERSE CARDIOVASCULAR EVENTS WITH VARENICLINE USE FOR TOBACCO CESSATION

Meta-analysis examining serious cardiovascular adverse events occurring during varenicline treatment or within 30 days of discontinuation finds no clinical or statistically significant differences when compared with placebo.

Citation: Prochaska JJ, Hilton JF. Risk of cardiovascular serious adverse events associated with varenicline use for tobacco cessation: systematic review and meta-analysis. BMJ. 2012;344:e2856.

GLUCOCORTICOIDS ASSOCIATED WITH INCREASED RISK OF SUICIDAL BEHAVIOR AND NEUROPSYCHIATRIC DISORDERS

A large, retrospective cohort study comparing patients with similar underlying medical conditions found a sevenfold increased risk of suicidal behavior and approximately double the risk for severe neuropsychiatric disorders for patients prescribed glucocorticoids.

Citation: Fardet L, Petersen I, Nazareth I. Suicidal behavior and severe neuropsychiatric disorders following glucocorticoid therapy in primary care. Am J Psychiatry. 2012;169(5):491-497.